| Summary: | Precise exposure assessment of air pollutants is crucial in epidemiologic studies to ensure valid estimates of health effects. We conducted a longitudinal study to evaluate the role of air quality monitoring (AQM) measurements and high-resolution modeling outcomes focusing on nitrogen dioxide (NO<sub>2</sub>) exposure and atopic dermatitis (AD). A total of 128 young children with AD in Seoul Metropolitan Area, Korea, were recruited as a panel. We estimated the participants’ exposure to NO<sub>2</sub> for four months, from 1 April through 31 July 2014 based on (1) monitored levels from 60 AQM stations located at varying distances from residential areas (AQM station-based NO<sub>2</sub>, AQM-NO<sub>2</sub>) and (2) estimates from a community multi-scale air quality (CMAQ) modeling system with a high-resolution (1 × 1 km) (CMAQ-NO<sub>2</sub>). We then compared the effect of AQM-NO<sub>2</sub> on AD symptoms with that of CMAQ-NO<sub>2</sub>. The average distance between the participants’ residences and the nearest AQM station was 2.03 ± 1.06 km, ranging from 0.28 km to 5.73 km. Based on AQM-NO<sub>2</sub>, the AD symptoms increased by 10.28% (95% confidence interval (CI): 3.24, 17.79) with an increase of 10 ppb of NO<sub>2</sub>. The effect estimates of CMAQ-NO<sub>2</sub> were similar to those of AQM-NO<sub>2</sub> when assessed in patients living within 3 km from the nearest AQM station. Even within 1 km, the CI estimate obtained from the CMAQ was much narrower than from AQM (44.18–49.54 vs. 7.02–64.75). However, the association of AQM-NO<sub>2</sub> with AD symptoms of patients living beyond 3 km was not positive, whereas that of CMAQ-NO<sub>2</sub> maintained positive. In conclusion, exposure to ambient NO<sub>2</sub> is significantly associated with aggravation of AD symptoms in young children. In addition, our study suggests that exposure assessment of NO<sub>2</sub> using measurement data obtained from monitoring stations far from residential locations can lead to misclassification bias.
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