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Background The prevalence of allergic respiratory disease (ARD) is increasing worldwide during the last few decades, causing a great disease burden especially for children. Air pollution has been increasingly considered as a potential contributor to this trend, but its role in ARD induced by house dust mite (HDM-ARD) remains unclear, especially in time-series study. Methods A positive reporting of respiratory allergy to named allergens was included by serum specific IgE testing. A time series Quasi-Poisson regression with distributed lag non-linear model, combined with generalized linear model was used to examine the effects of air pollutants on ARD, HDM-ARD and ARD induced by non-house dust mite (NHDM-ARD). Results A total of 16,249 cases of ARD, including 8,719 HDM-ARD and 8,070 NHDM-ARD from 1 Jan 2013 to 31 Dec 2017 were involved in this study. Air pollutants were significantly associated with clinical visits for childhood ARD and HDM-ARD. Exposure to higher O 3  and interquartile range (IQR) increment in O 3  (40.6 µg/m 3 ) increased the risks of clinical visits for childhood HDM-ARD (RR lag0-5  for the 95th percentile of O 3 : 1.26, 95% confidence interval (CI): 1.03, 1.55; RR lag0-5  for IQR increment (40.6 µg/m 3 ): 1.09, 95% CI: 1.01, 1.17) and ARD (RR lag0-5  for the 95th percentile of O 3 : 1.19, 95% CI: 1.03, 1.38; RR lag0-5  for IQR increment (40.6 µg/m 3 ): 1.06, 95% CI: 1.01, 1.12). In addition, higher O 3  was associated with increased RR of boys with ARD (RR lag0-5  for the 95th percentile: 1.26, 95% CI: 1.05, 1.51; RR lag0-5  for IQR increment (40.6 µg/m 3 ): 1.09, 95% CI: 1.02, 1.16) and HDM-ARD (RR lag0-5  for the 95th percentile: 1.36, 95% CI: 1.06, 1.75; RR lag0-5  for IQR increment (40.6 µg/m 3 ): 1.11, 95% CI: 1.02, 1.22), but not in girls. Conclusions Exposure to O 3  appeared to be a trigger of clinical visits for childhood ARD, especially for HDM-ARD and boys. These findings provide novel evidence on the impact of air pollution on HDM-ARD, which may have significant implications for designing effective intervention programs to control and prevent childhood ARD, especially HDM-ARD, in China and other similar developing countries.

Assessing the impact of air pollutants on clinical visits for childhood allergic respiratory disease induced by house dust mite in Shanghai, China