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While the high\u2010income Western countries faced an \u201callergy epidemic\u201d during the last three decades, there has been a gradual rise in prevalence of allergic diseases in India.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Narrative review.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results and Discussion<\/jats:title><jats:p>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 PM<jats:sub>2.5<\/jats:sub> due to burning of fossil fuels and biomass fuels, diverse aero\u2010biology, 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.<\/jats:p><jats:p>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\u2010graduate training programs, and allergic diseases are managed by primary care physicians, organ\u2010based specialists, and general pediatricians. Adrenaline auto\u2010injectors are not available, there is patient unaffordability for inhalers, nasal sprays, and biologics, and this is compounded by poor compliance leading to 40%\u201050% of asthmatic children having uncontrolled disease and high rates of oral corticosteroid use. Standardized allergen extracts are not available for skin tests and desensitization.<\/jats:p><jats:p>This article provides a critical analysis of pediatric allergic diseases in India.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pai.13306","type":"journal-article","created":{"date-parts":[[2020,6,10]],"date-time":"2020-06-10T21:10:24Z","timestamp":1591823424000},"page":"735-744","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Pediatric allergic diseases in the Indian subcontinent\u2014<i>Epidemiology, risk factors and current challenges<\/i>"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2109-5777","authenticated-orcid":false,"given":"Mamidipudi Thirumala","family":"Krishna","sequence":"first","affiliation":[{"name":"Allergy and Immunology Department University Hospitals Birmingham NHS Foundation Trust and Institute of Immunology &amp; Immunotherapy University of Birmingham 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