An appraisal of allergic disorders in India and an urgent call for action

Abstract

India is the second most populous country in the world with a population of nearly 1.3 billion, comprising 20% of the global population. There are an estimated 37.5 million cases of asthma in India, and recent studies have reported a rise in prevalence of allergic rhinitis and asthma. Overall, 40–50% of paediatric asthma cases in India are uncontrolled or severe. Treatment of allergic rhinitis and asthma is sub-optimal in a significant proportion of cases due to multiple factors relating to unaffordability to buy medications, low national gross domestic product, religious beliefs, myths and stigma regarding chronic ailment, illiteracy, lack of allergy specialists, and lack of access to allergen-specific immunotherapy for allergic rhinitis and biologics for severe asthma. High quality allergen extracts for skin tests and adrenaline auto-injectors are currently not available in India. Higher postgraduate specialist training programmes in Allergy and Immunology are also not available. Another major challenge for the vast majority of the Indian population is an unacceptably high level of exposure to particulate matter (PM) 2.5 generated from traffic pollution and use of fossil fuel and biomass fuel and burning of incense sticks and mosquito coils. This review provides an overview of the burden of allergic disorders in India. It appraises current evidence and justifies an urgent need for a strategic multipronged approach to enhance quality of care for allergic disorders. This may include creating an infrastructure for education and training of healthcare professionals and patients and involving regulatory authorities for making essential treatments accessible at subsidised prices. It calls for research into better phenotypic characterisation of allergic disorders, as evidence generated from high income western countries are not directly applicable to India, due to important confounders such as ethnicity, air pollution, high rates of parasitic infestation, and other infections.

COVID-19 – A wakeup call for allergy practice transition

“…Approximately 15-30% of people, out of 1.33 billion total Indian population, are currently suffering from respiratory allergies. [1] The situation becomes grimmer with lower literacy, poor socioeconomic conditions, and unclean environment. [1] Uncontrolled allergies cause lifelong morbidities, reduce lung age, and adversely affect quality of life.…”

“…[1] The situation becomes grimmer with lower literacy, poor socioeconomic conditions, and unclean environment. [1] Uncontrolled allergies cause lifelong morbidities, reduce lung age, and adversely affect quality of life. [2] These alarming circumstances are contributed by lack of qualified allergists, provider-receiver communication gap, and inappropriate resource distribution.…”

“…[2] These alarming circumstances are contributed by lack of qualified allergists, provider-receiver communication gap, and inappropriate resource distribution. [1] COVID-19 has made matters worse by markedly limiting the clinic attendance and conduction of only select aerosol-generating procedures like spirometry. [3] With the pandemic at its current pace, it will be prudent to rapidly adapt allergy practices to benefit the masses.…”

A pan-European perspective on food allergy

“…Parasites thrive in the tropical climates of most underdeveloped countries. [175][176][177] Despite the fact that both allergies and parasitic infections are characterised by a strong TH2 immune response and elevated levels of IgE, studies have found that these diseases are inversely related to one another. 175,178,179 The immunological basis for this inverse association is unclear, but parasites are known to employ immunomodulatory mechanisms to prevent an inflammatory response and their subsequent elimination from the human body.…”

“…175,181,183 In reality, the observations in the INCO study that parasitic infections were detected in less than 20% of the population and that occurrence was similar in subjects with and without symptoms to foods, contradict this idea, and additional explanations for the high rates of FS in Asian countries are needed. 176 Perhaps, rather than parasitic infection preventing a food allergic reaction, tropomyosins or CCDs in parasites and mites lead to cross-reactive FS, 175,178 with cross-reactivity based on tropomyosins potentially explaining the high levels of clinically irrelevant shrimp sensitisation in India. 93 Clinical implications  Notwithstanding other valid reasons, fear to develop FA should not prevent parents from getting a dog, as dog ownership in infancy is associated with reduced prevalence of FA.…”