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Keywords: asthma; atopic dermatitis; autoimmunity; epidemiology; ethnicity; rheumatoid; rhinitis; SLE; vitiligo EN asthma atopic dermatitis autoimmunity epidemiology ethnicity rheumatoid rhinitis SLE vitiligo 144 147 4 01/05/21 20210101 NES 210101 To the Editor, The burden of allergic diseases (ADs) such as asthma and rhinitis and autoimmune disorders (AIDs) such as rheumatoid arthritis (RA) is relatively low/moderate in low- and low-middle-income countries,1,2 and there is some evidence regarding higher incidence rates of these conditions amongst immigrant population settled in high-income countries.3,4 The burden of ADs is particularly high in high-income countries such as the UK, Republic of Ireland and New Zealand.1 Studies in immigrants have been limited by several factors including relatively small sample size, shorter duration and methodological issues such as selection bias, survey- or questionnaire-based data, focus on a single or limited number of ADs or AIDs, and some not accounting for important disease confounders such as smoking history. Specifically, the risk of AE, ARC, SLE, ATD and vitiligo is uniformly higher amongst British ethnic minority groups in comparison with the White population. Asthma, atopic dermatitis, autoimmunity, epidemiology, ethnicity, rheumatoid, rhinitis, SLE, vitiligo. [Extracted from the article]

Introduction: India is low‐middle‐income country (LMIC) with a population of 1.3bn, comprising about 20% of the global population. While the high‐income Western countries faced an "allergy epidemic" during the last three decades, there has been a gradual rise in prevalence of allergic diseases in India. Methods: Narrative review. Results and Discussion: Allergic diseases occur as a consequence of a complex interplay between genetic and environmental factors. There are multiple contrasting determinants that are important to consider in India including 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 (large proportion vegetarian), and high incidence rates of TB, HIV, malaria, filariasis, parasitic infestations, and others, that not only shape the immune system early in life, but also impact on biomarkers relevant to allergic diseases. India has a relatively weak and heterogeneous healthcare framework, and allergology has not yet been recognized as an independent specialty. There are very few post‐graduate training programs, and allergic diseases are managed by primary care physicians, organ‐based specialists, and general pediatricians. Adrenaline auto‐injectors are not available, there is patient unaffordability for inhalers, nasal sprays, and biologics, and this is compounded by poor compliance leading to 40%‐50% of asthmatic children having uncontrolled disease and high rates of oral corticosteroid use. Standardized allergen extracts are not available for skin tests and desensitization. This article provides a critical analysis of pediatric allergic diseases in India. [ABSTRACT FROM AUTHOR]