D2.399 - Antihistamine Residues in Wastewater may allow to estimate the burden by Airborne Pollen Concentrations
Background
Pollinosis, or hay fever, is the most prevalent allergic disorder.This study explores the potential of wastewater-based epidemiology (WBE) to investigate the relationship between airborne pollen concentrations and antihistamine residues in wastewater as an indicator of pollinosis symptom treatment at the population-scale.
Method
In Zurich (Switzerland), 279 wastewater samples were collected during the period 2021-2023. Each sample represents a 24-hour period with excreta from approximately 471,000 individuals. Eleven antihistamine markers were analyzed in the samples using liquid chromatography high-resolution mass spectrometry. The relationship between antihistamine loads in wastewater and concentrations of airborne pollen (47 taxa and miscellaneous pollen) was investigated by determining seasonal components of antihistamine loads and exploring pollen-specific contributions using Non-Negative Least Squares (NNLS) optimization.
Results
The loads of three second-generation antihistamines bilastine, cetirizine, and fexofenadine in wastewater showed strong day-to-day variation which correlate with airborne pollen patterns. For fexofenadine, which was investigated in detail, approximately 50% of the annual fexofenadine consumption was linked with acute pollen exposure, 20% to baseline consumption during the pollen season, and 30% was independent of unrelated to pollen. Birch, grasses, hazel, hornbeam, plane, and plantain explained most of the variance in consumption(R² = 0.82), with grass pollen alone explaining a quarter of the annual loads.
Increased fexofenadine loads during periods without elevated concentrations of common allergenic pollen suggests the presence of additional triggers for allergy symptoms, potentially yew pollen.
Conclusion
Our study demonstrates that WBE can effectively capture substantial day-to-day variation in antihistamine consumption related to pollen exposure symptoms. As such, WBE presents an additional objective, cost-effective, and questionnaire-independent method for investigating pollinosis symptom treatment at a population-scale.
