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

Mamidipudi Thirumala Krishna; Padukudru Anand Mahesh; Pudupakkam Vedanthan; Saibal Moitra; Vinay Mehta; Devasahayam Jesudas Christopher

doi:10.1016/j.waojou.2020.100446

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

World Allergy Organ J. 2020 Aug 1;13(7):100446. doi: 10.1016/j.waojou.2020.100446. eCollection 2020 Jul.

Authors

Mamidipudi Thirumala Krishna¹, Padukudru Anand Mahesh², Pudupakkam Vedanthan³, Saibal Moitra⁴, Vinay Mehta⁵, Devasahayam Jesudas Christopher⁶

Affiliations

¹ Department of Allergy and Immunology, University Hospitals Birmingham NHS Foundation Trust and Institute of Immunology & Immunotherapy & Institute of Clinical Sciences, University of Birmingham, UK.
² Department and Respiratory Medicine, JSS Medical College, JSSAHER, Mysore, India.
³ Department of Medicine, Division of Allergy and Immunology, The University of Colorado, Aurora, CO, USA.
⁴ Department of Allergy and Immunology, Apollo Gleneagles Hospital, Kolkota, West Bengal, India.
⁵ Allergy, Asthma and Immunology Associates, Lincoln, NE, USA.
⁶ Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamilnadu and Indian Chest Society, India.

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.

Keywords: A&I, Allergy and Immunology; AB-NHPS, Ayushman Bharath National Health Protection Scheme; ABPA, Allergic Bronchopulmonary Aspergillosis; AD, Atopic Dermatitis; BTS, British Thoracic Society; CME, Continuing Medical Education; COPD, Chronic Obstructive Pulmonary Disease; DALY, Disability Associated Life Years; DBPCFC, Double Blind Placebo Controlled Food Challenge; ELISA, Enzyme Linked Immunosorbent Assay; ETS, Environmental Tobacco Smoke; GDP, Gross Domestic Product; GINA, Global Initiative for Asthma; ICAAI, Indian College of Allergy Asthma and Applied Immunology; IHDS, Indian Human Development Survey; INR, Indian Rupees; ISAAC, International Study of Asthma and Allergies in Childhood; NMBA, Neuromuscular blocking agents; PAFs, Population Attributable Factors; SAFS, Severe Asthma and Fungal Sensitisation; SCIT, Subcutaneous Injection Immunotherapy; SLIT, Sublingual Immunotherapy; SPT, Skin Prick Test; USA, United States of America; USD, United States Dollars; WHO, World Health Organization.

Publication types

Review