Skip to main content

Increasing Prevalence of Allergic Disease and Its Impact on Current Practice


Purpose of Review

To summarize the most up-to-date literature on allergic diseases with an emphasis on understanding the increase in prevalence of allergic diseases.

Recent Findings

As atopy continues to rise, there is increasing evidence that genetic factors in addition to environmental factors contribute to the development of allergic disease. There is research to support that worsening air pollution and climate change as well as lifestyle changes such as an increase in saturated fats and sugars in the diet, antibiotic use, changes in the gut microbiome, and a shift towards a more sterile, more urbanized environment could all increase the likelihood of developing allergic diseases.


While the options available for management of allergic diseases are increasing and improving, the prevalence of allergic disease continues to rise. Further investigation of how we can influence the changes in our environment leading to increases in atopy as well as the genetics involved is crucial in order to prevent the development of allergic diseases.

This is a preview of subscription content, access via your institution.

Fig. 1


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Yang L, Fu J, Zhou Y. Research progress in atopic march. Front Immunol. 2020;11:1907.

    CAS  Article  Google Scholar 

  2. • Kuruvilla ME, Lee F, Lee GB. Understanding asthma phenotypes, endotypes, and mechanisms of disease. Clin Rev Allergy Immunol. 2019;56(2):219–233. Contemporary review of asthma endotypes and associated mechanisms of disease.

  3. GBD 2015 Chronic Respiratory Disease Collaborators. Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Respir Med. 2017;5(9):691–706.

  4. Eder W, Ege MJ, von Mutius E. The asthma epidemic. N Engl J Med. 2006;355(21):2226–35.

    CAS  Article  Google Scholar 

  5. Croisant S. Epidemiology of asthma: prevalence and burden of disease. Adv Exp Med Biol. 2014;795:17–29.

    Article  Google Scholar 

  6. Guilbert T, et al. Racial disparities in asthma-related health outcomes in children with severe/difficult-to-treat asthma. J Allergy Clin Immunol Pract. 2019;7(2):568–77.

    Article  Google Scholar 

  7. • Kuruvilla ME, et al. Epidemiology and risk factors for asthma. Respir Med. 2019;149:16–22. Despite decreases in overall mortality, disproportionate burdens of disease are experienced by children and ethnic minorities.

  8. Mushtaq A. Asthma in the USA: the good, the bad, and the disparity. Lancet Respir Med. 2018;6(5):335–6.

    Article  Google Scholar 

  9. Strachan D, et al. Worldwide variations in prevalence of symptoms of allergic rhinoconjunctivitis in children: the International Study of Asthma and Allergies in Childhood (ISAAC). Pediatr Allergy Immunol. 1997;8(4):161–76.

    CAS  Article  Google Scholar 

  10. Ait-Khaled N, et al. Global map of the prevalence of symptoms of rhinoconjunctivitis in children: the International Study of Asthma and Allergies in Childhood (ISAAC) phase three. Allergy. 2009;64(1):123–48.

    CAS  Article  Google Scholar 

  11. Ono SJ, Abelson MB. Allergic conjunctivitis: update on pathophysiology and prospects for future treatment. J Allergy Clin Immunol. 2005;115(1):118–22.

    CAS  Article  Google Scholar 

  12. Sanchez-Hernandez MC, et al. Severity and duration of allergic conjunctivitis: are they associated with severity and duration of allergic rhinitis and asthma? Eur Ann Allergy Clin Immunol. 2021.

  13. Singh K, Axelrod S, Bielory L. The epidemiology of ocular and nasal allergy in the United States, 1988–1994. J Allergy Clin Immunol. 2010;126(4):778–783 e6.

  14. Galli SJ, Tsai M, Piliponsky AM. The development of allergic inflammation. Nature. 2008;454(7203):445–54.

    CAS  Article  Google Scholar 

  15. Vandenplas O, et al. Impact of rhinitis on work productivity: a systematic review. J Allergy Clin Immunol Pract. 2018;6(4):1274–1286 e9.

  16. Devillier P, et al. In allergic rhinitis, work, classroom and activity impairments are weakly related to other outcome measures. Clin Exp Allergy. 2016;46(11):1456–64.

    CAS  Article  Google Scholar 

  17. Colas C, et al. Estimate of the total costs of allergic rhinitis in specialized care based on real-world data: the FERIN study. Allergy. 2017;72(6):959–66.

    CAS  Article  Google Scholar 

  18. Bousquet J, et al. Allergic rhinitis Nat Rev Dis Primers. 2020;6(1):95.

    Article  Google Scholar 

  19. Bousquet PJ, et al. Geographical distribution of atopic rhinitis in the European Community Respiratory Health Survey I. Allergy. 2008;63(10):1301–9.

    Article  Google Scholar 

  20. Dykewicz MS, et al. Rhinitis 2020: a practice parameter update. J Allergy Clin Immunol. 2020;146(4):721–67.

    CAS  Article  Google Scholar 

  21. Burke H, et al. Prenatal and passive smoke exposure and incidence of asthma and wheeze: systematic review and meta-analysis. Pediatrics. 2012;129(4):735–44.

    Article  Google Scholar 

  22. Lim H, et al. Short-term effect of fine particulate matter on children’s hospital admissions and emergency department visits for asthma: a systematic review and meta-analysis. J Prev Med Public Health. 2016;49(4):205–19.

    Article  Google Scholar 

  23. Bowatte G, et al. The influence of childhood traffic-related air pollution exposure on asthma, allergy and sensitization: a systematic review and a meta-analysis of birth cohort studies. Allergy. 2015;70(3):245–56.

    CAS  Article  Google Scholar 

  24. Orellano P, et al. Effect of outdoor air pollution on asthma exacerbations in children and adults: systematic review and multilevel meta-analysis. PLoS ONE. 2017;12(3): e0174050.

    Article  Google Scholar 

  25. D’Amato G, et al. Effects on asthma and respiratory allergy of climate change and air pollution. Multidiscip Respir Med. 2015;10:39.

    Article  Google Scholar 

  26. Manangan A, et al. Long-term pollen trends and associations between pollen phenology and seasonal climate in Atlanta, Georgia (1992–2018). Ann Allergy Asthma Immunol. 2021;127(4):471–480 e4.

  27. Huang YJ, et al. The microbiome in allergic disease: current understanding and future opportunities-2017 PRACTALL document of the American Academy of Allergy, Asthma & Immunology and the European Academy of Allergy and Clinical Immunology. J Allergy Clin Immunol. 2017;139(4):1099–110.

    Article  Google Scholar 

  28. Brick T, et al. Omega-3 fatty acids contribute to the asthma-protective effect of unprocessed cow’s milk. J Allergy Clin Immunol. 2016;137(6):1699–1706 e13.

  29. Castro-Rodriguez JA, et al. Risk and protective factors for childhood asthma: what is the evidence? J Allergy Clin Immunol Pract. 2016;4(6):1111–22.

    Article  Google Scholar 

  30. Radzikowska U, et al. The influence of dietary fatty acids on immune responses. Nutrients. 2019;11(12).

  31. Mahdavinia M, et al. Effects of diet on the childhood gut microbiome and its implications for atopic dermatitis. J Allergy Clin Immunol. 2019;143(4):1636–1637 e5.

  32. Ni J, et al. Early antibiotic exposure and development of asthma and allergic rhinitis in childhood. BMC Pediatr. 2019;19(1):225.

    Article  Google Scholar 

  33. Aversa Z, et al. Association of infant antibiotic exposure with childhood health outcomes. Mayo Clin Proc. 2021;96(1):66–77.

    Article  Google Scholar 

  34. Arrieta MC, et al. Early infancy microbial and metabolic alterations affect risk of childhood asthma. Sci Transl Med. 2015;7(307):307ra152.

  35. Lin TH, et al. The interactive roles of lipopolysaccharides and dsRNA/viruses on respiratory epithelial cells and dendritic cells in allergic respiratory disorders: the hygiene hypothesis. Int J Mol Sci. 2017;18(10).

  36. Lin TH, et al. Lipopolysaccharide attenuates induction of proallergic cytokines, thymic stromal lymphopoietin, and interleukin 33 in respiratory epithelial cells stimulated with PolyI: C and human parechovirus. Front Immunol. 2016;7:440.

    PubMed  PubMed Central  Google Scholar 

  37. Mahdavinia M, et al. House dust microbiota and atopic dermatitis; effect of urbanization. Pediatr Allergy Immunol. 2021;32(5):1006–12.

    Article  Google Scholar 

  38. Birzele LT, et al. Environmental and mucosal microbiota and their role in childhood asthma. Allergy. 2017;72(1):109–19.

    CAS  Article  Google Scholar 

  39. Portelli MA, Hodge E, Sayers I. Genetic risk factors for the development of allergic disease identified by genome-wide association. Clin Exp Allergy. 2015;45(1):21–31.

    CAS  Article  Google Scholar 

  40. Paller AS, et al. The atopic march and atopic multimorbidity: many trajectories, many pathways. J Allergy Clin Immunol. 2019;143(1):46–55.

    Article  Google Scholar 

  41. Ferreira MA, et al. Shared genetic origin of asthma, hay fever and eczema elucidates allergic disease biology. Nat Genet. 2017;49(12):1752–7.

    CAS  Article  Google Scholar 

  42. Waage J, et al. Genome-wide association and HLA fine-mapping studies identify risk loci and genetic pathways underlying allergic rhinitis. Nat Genet. 2018;50(8):1072–80.

    CAS  Article  Google Scholar 

  43. Hall R, Hall IP, Sayers I. Genetic risk factors for the development of pulmonary disease identified by genome-wide association. Respirology. 2019;24(3):204–14.

    Article  Google Scholar 

  44. Orlandi RR, et al. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol. 2021;11(3):213–739.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Joshua M. Levy.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical collection on Otolaryngic Allergy

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Edwards-Salmon, S.E., Padmanabhan, S.L., Kuruvilla, M. et al. Increasing Prevalence of Allergic Disease and Its Impact on Current Practice. Curr Otorhinolaryngol Rep (2022).

Download citation

  • Accepted:

  • Published:

  • DOI:


  • Atopy
  • Prevalence
  • Allergic rhinitis
  • Asthma
  • Allergic conjunctivitis