Clinical and Immunological Effects of a Forest Trip in Children with Asthma and Atopic Dermatitis


Asthma and atopic dermatitis are common allergic diseases, and their prevalence has increased in urban children. Recently, it is becoming understood that forest environment has favorable health effects in patients with chronic diseases. To investigate favorable clinical and immunologic effects of forest, we examined changes in clinical symptoms, indirect airway inflammatory marker, and serum chemokines before and after a short-term forest trip. The forest trips were performed with 21 children with asthma and 27 children with atopic dermatitis. All participating children were living in air polluted urban inner-city. We measured spirometry and fractional exhaled nitric oxide (FeNO) in children with asthma and measured scoring atopic dermatitis (SCORAD) index and Thymus and Activation-Regulated Chemokine (TARC)/CCL17 and Macrophage-Derived Chemokine (MDC)/CCL22 levels in children with atopic dermatitis before and after the forest trip. Indoor air pollutants such as indoor mold, particulate matter 10 (PM10) and total volatile organic compounds (TVOCs) of each child's home and the accommodations within forest were measured. A significant increase in forced vital capacity (FVC) and a significant decrease in FeNO were observed after the forest trip in children with asthma. SCORAD indices and MDC/CCL22 levels were significantly decreased after the forest trip in children with atopic dermatitis. Airborne mold and PM10 levels in indoor were significantly lower in the forest accommodations than those of children's homes; however, TVOC levels were not different between the two measured sites. Short-term exposure to forest environment may have clinical and immunological effects in children with allergic diseases who were living in the urban community.

1. Donohue KM, Al-alem U, Perzanowski MS, Chew GL, Johnson A, Divjan A, et al. Anti-cockroach and anti- mouse IgE are associated with early wheeze and atopy in an inner-city birth cohort. J Allergy Clin Immunol 2008;122(5):914-20.
2. Butz AM, Kub J, Bellin MH, Frick KD. Challenges in Providing Preventive Care To Inner-City Children with Asthma. Nurs Clin North Am 2013; 48(2):241-57.
3. Mao GX, Lan XG, Cao YB, Chen ZM, He ZH, Lv YD, et al. Effects of short-term forest bathing on human health in a broad-leaved evergreen forest in Zhejiang Province, China. Biomed Environ Sci 2012; 25(3):317-24.
4. Surette S, Vanderjagt L, Vohra S. Surveys of complementary and alternative medicine usage: a scoping study of the paediatric literature. Complement Ther Med 2013; 21:S48-S53.
}5. Li Q, Kawada T. Effect of forest environments on human natural killer (NK) activity. Int J Immunopathol Pharmacol 2011; 24(1 Suppl):39S-44S.
6. Li Q, Morimoto K, Kobayashi M, Inagaki H, Katsumata M, Hirata Y, et al. Visiting a forest, but not a city, increases human natural killer activity and expression of anti-cancer proteins. Int J Immunopathol Pharmacol 2008; 21(1):117-27.
7. Li Q. Effect of forest bathing trips on human immune function. Environ Health Prev Med 2010; 15(1):9-17.
8. Perzanowski MS, Divjan A, Mellins RB, Canfield SM, Rosa MJ, Chew GL, et al. Exhaled NO among inner-city children in New York City. J Asthma 2010; 47(9):1015-21.
9. Paro‐ Heitor MLZ, Bussamra MHC, Saraiva‐ Romanholo BM, Martins MA, Okay TS,Rodrigues JC. Exhaled nitric oxide for monitoring childhood asthma inflammation compared to sputum analysis, serum interleukins and pulmonary function.Pediatr Pulmonol 2008; 43(2):134-41.
10. Fujisawa T, Nagao M, Hiraguchi Y, Katsumata H, Nishimori H, Iguchi K, et al. Serum measurement of thymus and activation-regulated chemokine/CCL17 in children with atopic dermatitis: elevated normal levels in infancy and age-specific analysis in atopic dermatitis. Pediatr Allergy Immunol 2009; 20(7):633-41.
11. Furusyo N, Takeoka H, Toyoda K, Murata M, Maeda S, Ohnishi H, et al. Thymus and activation regulated chemokines in children with atopic dermatitis: Kyushu University Ishigaki Atopic Dermatitis Study (KIDS). Eur J Dermatol 2007; 17(5):397-404.
12. Furukawa H, Takahashi M, Nakamura K, Kaneko F.Effect of an antiallergic drug (Olopatadine hydrochloride) on TARC/CCL17 and MDC/CCL22 production by PBMCs from patients with atopic dermatitis. J Dermatol Sci 2004; 36(3):165-72.
13. Kakinuma T, Nakamura K, Wakugawa M, Mitsui H,Tada Y, Saeki H, et al. Serum macrophage‐ derived chemokine (MDC) levels are closely related with thedisease activity of atopic dermatitis. Clin Exp Immunol 2002; 127(2):270-3.
14. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J 2005; 26(2):319-38.
15. Silkoff PE. ATS/ERS Recommendations for Standardized Procedures for the Online and Offline Measurement of Exhaled Lower Respiratory Nitric Oxide and NasalNitric Oxide, 2005; American Thoracic Society; European Respiratory Society. ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide, 2005. Am J Respir Crit Care Med 2005;171(8):912-30.
16. Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology 1993; 186(1):23-31.
17. Renzetti G, Silvestre G, D'Amario C, Bottini E, Gloria- Bottini F, Bottini N, et al. Less air pollution leads to rapid reduction of airway inflammation and improved airway function in asthmatic children. Pediatrics 2009;123(3):1051-8.
18. Delfino RJ, Staimer N, Gillen D, Tjoa T, Sioutas C, Fung K, et al. Personal and ambient air pollution is associated with increased exhaled nitric oxide in children with asthma. Environ Health Perspect 2006; 114(11):1736-43.
19. Nielsen G, Larsen S, Olsen O, Løvik M, Poulsen LK, Glue C, et al. Do indoor chemicals promote development of airway allergy? Indoor air 2007; 17(3):236-55.
20. Cornell AG, Chillrud SN, Mellins RB, Acosta LM, Miller RL, Quinn JW, et al. Domestic airborne black carbon and exhaled nitric oxide in children in NYC. J Expo Sci Environ Epidemiol 2012; 22(3):258-66.
21. Shimada Y, Takehara K, Sato S. Both Th2 and Th1 chemokines (TARC/CCL17, MDC/CCL22, and Mig/CXCL9) are elevated in sera from patients with atopic dermatitis. J Dermatol Sci 2004; 34(3):201-8.

IssueVol 14, No 1 (2015) QRcode
Asthma Atopic dermatitis CCL22 Forest Nitric oxide Particulate matter CCL17 Urban

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How to Cite
Seo SC, Park SJ, Park C-W, Yoon WS, Choung JT, Yoo Y. Clinical and Immunological Effects of a Forest Trip in Children with Asthma and Atopic Dermatitis. Iran J Allergy Asthma Immunol. 14(1):28-36.