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This study examines associations between pollen exposure and allergic rhinitis symptoms in German adolescents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In the 15\u2010year follow\u2010up of the GINIplus and LISA birth cohorts at the Munich study area, monthly occurrence of nasal symptoms was assessed in 1594 participants. Pollen concentrations of birch, grass, ragweed, and mugwort between January 2010 and March 2014 were considered. Monthly individual pollen exposures (grains\/m\n                      <jats:sup>3<\/jats:sup>\n                      ) were assigned as the sum of all pollen types to which participants were sensitized. Associations between pollen exposure and monthly nasal symptoms were analyzed using adjusted generalized additive mixed\u2010effect models.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A non\u2010linear association between individual pollen exposure and nasal symptoms was observed, with symptom probability increasing significantly at low pollen concentrations and plateauing around 24 grains\/m\n                      <jats:sup>3<\/jats:sup>\n                      (birch) and 14 grains\/m\n                      <jats:sup>3<\/jats:sup>\n                      (grass). The non\u2010linear association was evident during birch pollen seasons as well as early and late grass pollen seasons. Symptom probability increased more strongly in participants sensitized to birch and grass compared to those sensitized to grass only during grass seasons.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Even at low pollen concentrations, there is an increase in symptom probability of seasonal allergic rhinitis that remains elevated at high pollen concentrations in sensitized participants. Enhanced probability rates also remain in late seasons after the pollen peak. These findings show that allergic rhinitis patients cannot rely on high\u2010pollen warnings but require accurate measurements to avoid exposure and allergic symptoms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pai.70429","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T04:47:09Z","timestamp":1784177229000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Symptom probability increases at low pollen exposure in adolescents with allergic rhinitis findings from the GINIplus and LISA birth cohorts"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5290-5360","authenticated-orcid":false,"given":"Jonas","family":"Schmid","sequence":"first","affiliation":[{"name":"Institute of Epidemiology Helmholtz Center Munich, German Research Center for Environmental Health  Neuherberg Germany"},{"name":"Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine LMU  Munich Germany"},{"name":"Pettenkofer School of Public Health  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Grill","sequence":"additional","affiliation":[{"name":"Institute of Epidemiology Helmholtz Center Munich, German Research Center for Environmental Health  Neuherberg Germany"},{"name":"Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine LMU  Munich Germany"},{"name":"Pettenkofer School of Public Health  Munich Germany"},{"name":"German Center for Child and Adolescent Health (DZKJ)  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Flexeder","sequence":"additional","affiliation":[{"name":"Institute of Epidemiology Helmholtz Center Munich, German Research Center for Environmental Health  Neuherberg Germany"},{"name":"Institute and Clinic for Occupational, Social and Environmental Medicine LMU University Hospital  Munich Germany"},{"name":"German Center for Lung Research (DZL)  Giessen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Thiering","sequence":"additional","affiliation":[{"name":"Institute of Epidemiology Helmholtz Center Munich, German Research Center for Environmental Health  Neuherberg Germany"},{"name":"Division of Metabolic and Nutritional Medicine, Department of Pediatrics, Dr. von Hauner Children's Hospital LMU University Hospital  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeroen","family":"Buters","sequence":"additional","affiliation":[{"name":"Center of Allergy &amp; Environment (ZAUM), Member of the German Center for Lung Research (DZL) Technical University and Helmholtz Center Munich  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inga","family":"We\u00dfels","sequence":"additional","affiliation":[{"name":"Center of Allergy &amp; Environment (ZAUM) Technical University and Helmholtz Center Munich  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten","family":"Schmidt\u2010Weber","sequence":"additional","affiliation":[{"name":"Center of Allergy &amp; Environment (ZAUM) Technical University and Helmholtz Center Munich  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5345-2049","authenticated-orcid":false,"given":"Marie","family":"Standl","sequence":"additional","affiliation":[{"name":"Institute of Epidemiology Helmholtz Center Munich, German Research Center for Environmental Health  Neuherberg Germany"},{"name":"German Center for Child and Adolescent Health (DZKJ)  Munich Germany"},{"name":"German Center for Lung Research (DZL)  Giessen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viktoria","family":"Ocvirk","sequence":"additional","affiliation":[{"name":"Institute of Epidemiology Helmholtz Center Munich, German Research Center for Environmental Health  Neuherberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2022.874114"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1398-9995.2007.01620.x"},{"key":"e_1_2_11_4_1","unstructured":"Koch\u2010Institut R.Allergic diseases in children and adolescents in Germany. 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