Air Pollution and Atopic Dermatitis in Children

Importance Atopic dermatitis is a common inflammatory skin condition that is heavily influenced by environmental factors, and while ambient air pollution has been linked to atopic dermatitis outcomes in adults, its effects in children remain more uncertain. Objective To synthesize the evidence examining the associations between ambient air pollutants and atopic dermatitis prevalence in children. Data Sources MEDLINE, Embase, and Cochrane databases were searched from inception to February 10, 2026. Study Selection Observational studies of children under 18 years of age that examined the association between at least 1 atopic dermatitis outcome of interest and a pollutant exposure were included. Data Extraction and Synthesis The PRISMA 2020 reporting guidelines were used; methodological quality was assessed using the Joanna Briggs Institute checklist, and risk of bias was evaluated using the risk of bias in nonrandomized studies of exposure effects (ROBINS-E) tool. Data were synthesized using random-effects models, and certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Main Outcomes and Measures The primary outcomes were health care utilization and prevalence, incidence, or severity of atopic dermatitis in relation to predefined ambient air pollutant exposures, including nitrogen dioxide (NO 2 ), sulfur dioxide (SO 2 ), particulate matter with a diameter of 10 µm or less (PM 10 ), particulate matter with a diameter of 2.5 µm or less (PM 2.5 ), ozone (O 3 ), carbon monoxide (CO), and traffic-related pollution. Results Of 2528 citations, 52 observational studies met the inclusion criteria and were included. It was found that every 10-µg/m 3 increase in NO 2 (odds ratio [OR], 3.46; 95% CI, 1.06-11.31; moderate certainty) and SO 2 (OR, 3.96; 95% CI, 1.00-15.65; moderate certainty) was probably associated with increased atopic dermatitis outpatient visits. It was also found that every 10-µg/m 3 increase in PM 2.5 (OR, 1.04; 95% CI, 1.00-1.08; moderate certainty) and PM 10 (OR, 1.19; 95% CI, 1.06-1.35; moderate certainty) was probably associated with higher atopic dermatitis prevalence. Findings were mixed or did not support associations between air pollutions exposure and incidence or severity of atopic dermatitis. Conclusions and Relevance This systematic review and meta-analysis found that increased levels of certain ambient air pollutants were probably associated with some increased population burden of atopic dermatitis in children.