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Allergic Rhinitis & House Dust Mite at Urban District of Seoul, Korea, in 1990s.

Key-Hun Kim, M.D., MS.D., Ph.D. & Janet K. Oh, M.D.
Department of Oto-Rhino-Laryngology,
Dr. Kim Ear, Nose & Throat Clinic, Seoul, Korea
H.D.M.: House Dust Mite +- D.P.: Dermatophagoides Pteronyssinus
+- D.F.: Dermatophagoides Farinae

Allergic Rhinitis is one of the typical form of inhalant allergy and IgE mediated atopic disease. During the past 6 years from 1987 to 1993, the author had studied the allergic survey of 1400 odd who were suspected of allergic rhinitis clinically.
Among the studied group, 35% of the patients showed allergic rhinitis and then 90% of these patients had the allergic rhinitis due to House Dust Mite (H.D.M.).
The author proposed and pointed out that such a high percentage, almost 90% of allergic rhinitis due to H.D.M., could be a big problem related to the environmental pollution at the urban district, Seoul, Korea in 1990s.
The offending allergen as a H.D.M. was limited to about 10% during the period of 1970 in all over the country but it is rapidly changed to the pattern which shows marked increasing of the rate from the 14% in 1975 to the more than 90% at urban district in 1991.
The author emphasized that the pollution could be a main causative factors, which is evidenced by the increasing rates of allergic rhinitis patients due to H.D.M. in urban district. Why does author present this simple title here? But, then, is it a complicated one?
We have to know the predisposing factors and causative risk factors of H.D.M. prevalence since so highly prevalent offending allergen of H.D.M. (90%) is well-known as a reactive allergen to the allergic rhinitis.

The author has reviewed all the epidemiologic reports of the allergic rhinitis in Korea and the incidence of allergic rhinitis was compared to its offending allergen mainly due to H.D.M. during the past and present period in the urban and rural districts.
And he had applied the predisposing factors of highly prevalent allergic rhinitis due to H.D.M. at urban districts to correlate it with the pollution, environmental factors, i.e.,
mainly the living pollutants of Seoul in 1990s.
Seoul City
(urban district)
Year Author Allergen Percent
1975 K.M. House Dust 14.0%
1980 K.R. H. D. M. 57.0%
1982 K.S. H. D. M. 50.1%
1985 K.K. H. D. M. 65.3%
1989 K.H. H. D. M. 87.0%
1991 K.H. H. D. M. 90.0%
Honam Province
(rural district)
1979 P.M. House Dust 9.3%

There is no doubt that both asthma and hay fever prevalences have steadily increased within the last 50 years. The increasing figures are roughly twice as high as 20 years ago. Jeong 1) reported twice increase in incidence of the O.P.D. allergic patients during the past 6 years.
Risk factors for developing allergic diseases are many. The predisposition is probably the most prevailing risk factors; family history, geographic, meteologic, period of birth, sex, race, diet, the presence of other allergic diseases, tobacco smoking, pollutions and allergens in environment, all these factors alone or in combination almost double the risk. We must by all means try to decrease the growing pollution, because this is one of the factors which are known to increase both the allergic and the non-allergic hyperreactivity
in the bronchi and the nose.3)
According to the report of Muranaka et al 1), the prevalence rate of allergic rhinitis was so low that the disease was extremely rare prior to 1950s and no case report was known until 1964. They proposed that exposure to pollen and its consequence to the disease, allergic rhinitis, could be related to diesel exhaust particles.
The review of air pollution in Korea shows SO2 concentration of 0.372 PPM which is far higher, almost 2-3 times, than the normal upper limit of 0.15 PPM in Korea. It is also higher than the alert value of 0.3 PPM in U.S.A.. NO2 distributed in the air of Seoul is as high as 0.278-0.35 PPM while its normal upper limit should not be over the level of 0.15 PPM. Further, people in Korea are widely exposed to CO, produced from using domestic on-dol heating system. Its upper limit according the review from the dept. of Environment is less than 20 PPM for 8hours of exposure. Air pollution is particularly a problem in the city of Seoul because of its geographic and topographic features. Seoul is located in the mid portion of Korea. It is bordered on the north and east by mountains, downtown looking like a valley or basin form and its west by industrial area and the Yellow sea. Consequently, the area is ideal for trapping air pollutants generated by the industrial complex located on the west of Seoul.

1. House Dust Mite, D. Farinae or D. Pteronyssinus is the most prevalent reactive allergen to allergic rhinitis in the patient of Seoul, Korea.
2. The offending allergen as a H.D.M. was limited to about 10% of 1970s in all over the country but it is rapidly changed to the patterns indicating a marked increase of the rate from 14% in 1975 to the more than 90% at urban district in 1990.
3. The environmental pollution in Seoul area is one serious problem in that the levels of polluted air is as high as twice and three times more than that of the normal standard upper level of air pollution.
    pollution : SO2 : 0.372 ppm -- double or triple of the normal level
                   NO2 : 0.35 ppm -- ‥ ‥
                    CO : 800-1200 ppm -- 40%HbO2
4. Special factors such as meteology and topography may also be involved. It is one of the causative factors of high humidity which is quite correlated to reproduction of the mites in dust. Not only the climate condition of high humidity but also the living facilities provide the patterns of humidity as people use high humidifiers at room.
5. Particularly important factors of modern living facilities are its compact and tight room conditions with blanket use, heavy carpet, curtain, and bed mattress etc.
6. Author proposes that we need to have standard reports of the incidence rates of H.D.M., an offending allergen as an aeroallergen to allergic rhinitis between city area (urban district) and country area (rural district) throughout the world wide.

① Jeong, J H., Kwang, S K., Song, I M., Lee, S H.
    A clinical study for offending allergens of allergic rhinitis in Pusan area. J. of the Korean
    Otolaryngological Society 30: 5, 711-720, 1987.
② Muranaka, M., Suzuki, S., Koijumi, K., Takafuji, S., M iyamoto, T., Ikemori, R., Tokiwa, H.     Adjuvant activity of diesel-exhaust particulates for the production of IgE antibody in mice.     J. Allergy Clin. Immunology 77: 616-23, 1986.
③ Weeke, ER. Epidemiology of allergic diseases in children.
    Rhinology, Suppl. 13: 5-12, 1922.