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However, it remains unclear whether air pollution may also be a risk of ocular allergic diseases. Using a web-based, nation-wide, cross-sectional study design, we examined whether the level of ambient air pollution is significantly associated with the prevalence of ocular allergic diseases. A web-based questionnaire was posted to invite the participants who are members of the Japan Ophthalmologist Association and their family members. The answers from 3004 respondents were used to determine whether there were significant associations between the level of the pollutants and the prevalence of ocular allergic diseases. The study period was between March to May 2017. The data of the air pollutants during 2012 to 2016 were obtained from the National Institute for Environmental Studies. The prevalence of allergic diseases was calculated by post stratification and examined for significant associations with the level of pollutants using multiple logistic regression analyses. The prevalence of seasonal allergic conjunctivitis, perennial allergic conjunctivitis, atopic keratoconjunctivitis (AKC), and vernal keratoconjunctivitis (VKC) in Japan was 45.4%, 14.0%, 5.3%, and 1.2%, respectively. The high prevalence of the severe forms of allergic conjunctivitis, including AKC and VKC, were significantly associated with the levels of the air pollutants. The prevalence of AKC was significantly associated with the levels of NO<jats:sub>2<\/jats:sub> with an odds ratio (OR) of 1.23 (per quintile). The prevalence of VKC was significantly associated with the levels of NO<jats:sub>x<\/jats:sub> and PM<jats:sub>10<\/jats:sub> with ORs of 1.72 and 1.54 respectively. The significant associations between the prevalence of AKC and VKC and the levels of air pollutants indicate that clinicians need to be aware that air pollutants may pose serious risks of vision threatening severe ocular allergy.<\/jats:p>","DOI":"10.1038\/s41598-019-54841-4","type":"journal-article","created":{"date-parts":[[2019,12,3]],"date-time":"2019-12-03T11:04:18Z","timestamp":1575371058000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":80,"title":["Air pollution significantly associated with severe ocular allergic inflammatory diseases"],"prefix":"10.1038","volume":"9","author":[{"given":"Dai","family":"Miyazaki","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazumi","family":"Fukagawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsuki","family":"Fukushima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5926-5826","authenticated-orcid":false,"given":"Hiroshi","family":"Fujishima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eiichi","family":"Uchio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuyuki","family":"Ebihara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Shoji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Etsuko","family":"Takamura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenichi","family":"Namba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuichi","family":"Ohashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shigeki","family":"Okamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiyuki","family":"Satake","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3261-8828","authenticated-orcid":false,"given":"Hiroshi","family":"Ohtsu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yumiko","family":"Shimizu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshitsugu","family":"Inoue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,12,3]]},"reference":[{"key":"54841_CR1","doi-asserted-by":"publisher","first-page":"1581","DOI":"10.1016\/S0140-6736(14)60617-6","volume":"383","author":"M Guarnieri","year":"2014","unstructured":"Guarnieri, M. & Balmes, J. 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Kazumi Fukagawa reports lecture fee from Santen Pharmaceutical outside the submitted work. Atsuki Fukushima reports grants from Santen Pharmaceutical, Senju Pharmaceutical, Alcon Pharma (Novartis), Tanabe-Mitsubishi, Pfizer, and Ohtsuka, personal fees from Santen Pharmaceutical, Senju Pharmaceutical, Alcon Pharma (Novartis), Tanabe-Mitsubishi, Pfizer, Ohtsuka, Eisai, Abbvie, Ohtsuka, Kowa, Kyowa-Kirin, and Rohto, other from Santen Pharmaceutical outside the submitted work. Jun Shoji reports personal fees from Santen Pharmaceutical, Senju Pharmaceutical, and Alcon Pharma outside the submitted work. Kenichi Namba reports grants from Abbvie, Mitsubishi Tanabe, and Eisai, lecture fees from HOYA, Alcon, Pfizer, Novartis, Kowa, Senju Pharmaceutical, Mitsubishi Tanabe, Eisai, Abbvie, and Santen Pharmaceutical outside the submitted work. Hiroshi Ohtsu reports personal fees from Deloitte Tohmatsu Consulting LLC, personal fees and non-financial support from Public Health Research Foundation, outside the submitted work. Yoshitsugu Inoue reports grants and consultant fee from Senju Pharmaceutical, grants from Santen Pharmaceutical and Alcon outside the submitted work. Hiroshi Fujishima, Eiichi Uchio, Nobuyuki Ebihara, Etsuko Takamura, Yuichi Ohashi, Shigeki Okamoto, Yoshiyuki Satake, and Yumiko Shimizu have nothing to disclose.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"18205"}}