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Here, we qualitatively and quantitatively synthesize the evidence of outdoor pollen exposure on various lung function and airway inflammation markers in community\u2010based studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Four online databases were searched: Medline, Web of Science, CINAHL and Google Scholar. The search strategy included terms relating to both exposure and outcomes. Inclusion criteria were human\u2010based studies published in English that were representative of the community. Additionally, we only considered cross\u2010sectional or short\u2010term longitudinal studies which investigated pollen exposure by levels or season. Study quality assessment was performed using the Newcastle\u2010Ottawa scale. Meta\u2010analysis was conducted using random\u2010effects models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 27 of 6551 studies identified from the search. Qualitative synthesis indicated associations between pollen exposure and predominantly type\u20102 inflammation in both the upper and lower airways, but little evidence for lung function changes. People with ever asthma and\/or seasonal allergic rhinitis (SAR) were at higher risk of such airway inflammation. Meta\u2010analysis confirmed a positive relationship between pollen season, eosinophilia and eosinophil cationic protein (ECP) in people with ever SAR but the results between studies were highly variable. Heterogeneity was reduced after further subgrouping by age, and the forest plots indicated that eosinophilic airway inflammation to outdoor pollen exposure increased with age.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Among people with ever asthma and ever SAR, exposure to increased ambient pollen triggers type\u20102 upper and lower airway inflammation rather than a non\u2010specific or innate inflammation. These findings can lead to the formulation of specific pollen immunotherapy for susceptible individuals. Future research should be directed towards investigating lagged associations and effect modifications using larger and more generalized populations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Systematic review registration<\/jats:title><jats:p>CRD42020146981 (PROSPERO).<\/jats:p><\/jats:sec>","DOI":"10.1111\/cea.13842","type":"journal-article","created":{"date-parts":[[2021,2,7]],"date-time":"2021-02-07T23:31:22Z","timestamp":1612740682000},"page":"636-653","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Outdoor pollen\u2010related changes in lung function and markers of airway inflammation: A systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7079-3670","authenticated-orcid":false,"given":"Nur Sabrina","family":"Idrose","sequence":"first","affiliation":[{"name":"Allergy and Lung Health Unit Melbourne School of Population and Global Health The University of Melbourne Carlton VIC Australia"},{"name":"Centre for Food and Allergy Research (CFAR) Murdoch Children's Research Institute Parkville VIC Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. 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