A new study published in Pediatric Allergy and Immunology presented a narrative review on pediatric allergic diseases in India, in the context of the gradual rise in prevalence of allergic diseases over the last three decades, in the subcontinent.

The authors discussed that manifestation of allergic conditions depend on both, genetic and environmental factors. India harbors many of these etiological factors, such as – high levels of air pollution, in particular PM2.5 due to burning of fossil fuels and biomass fuels; diverse aero-biology; tropical climate; cultural and social diversity; religious beliefs/myths; linguistic diversity; literacy level; breastfeeding and weaning; diet, primarily vegetarian; and high incidence rates of TB, HIV, malaria, filariasis, parasitic infestations, and other tropical diseases. These factors not only shape the immune system early in life, but also impact on biomarkers relevant to allergic diseases. 

In addition, allergology has not yet been recognized as an independent specialty in India. While very few post-graduate training programs cover allergic diseases. Hence, these conditions are managed by primary care physicians, organ-based specialists and general pediatricians. Furthermore, adrenaline auto-injectors are not available in the country. In addition, most patients cannot afford inhalers, nasal sprays and biologics, and this is compounded by poor compliance. Therefore, around 40-50% of asthmatic children suffer from uncontrolled disease and high rates of oral corticosteroid use. Furthermore, standardized allergen extracts are not available for skin tests and desensitization in India. 

Source: Pediatric Allergy and Immunology. 2020 Oct;31(7):735-744. doi: 10.1111/pai.13306.