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Increasing prevalence of asthma and allergic rhinitis and the role of environmental factors

Thomas A E Platts-Mills, MD, PhD
Scott P Commins, MD, PhD
Section Editor
Bruce S Bochner, MD
Deputy Editor
Elizabeth TePas, MD, MS


Allergic rhinitis and asthma are both common chronic diseases that affect the quality of life of patients and have a significant economic impact. The prevalence of allergic rhinitis increased in Westernized countries from the 1870s through the 1950s. The rate of asthma subsequently increased in these countries beginning in the 1960s. Asthma and allergic rhinitis prevalence began increasing in many developing countries in the late 1980s to early 1990s.

Changes in genetic factors are unlikely to be the underlying cause of the rise in allergic diseases, since the increases in allergic rhinitis and asthma occurred relatively rapidly. Instead, multiple environmental factors may have played a role. These include improvements in hygiene, eradication of most parasitic worm infections, changes in home heating and ventilation, and a decline in physical activity and alterations in diet due to lifestyle changes. Although we lack a complete understanding of the possible role of epigenetic changes in the rise of allergic diseases, there is increasing literature on potential mechanisms by which environmental exposures associated with specific epigenetic changes could lead to allergic phenotypes [1].

This topic discusses the increase in rates of allergic rhinitis and asthma and the environmental changes that may have led to their alterations in prevalence. Risk factors for the development of asthma, including atopy and allergen sensitization, and the relationship between allergic rhinitis and asthma are discussed separately. (See "Risk factors for asthma" and "Relationships between rhinosinusitis and asthma".)

The rising prevalence of food allergy and the factors that may play a role in this increase are also reviewed in detail separately. (See "Food allergy in children: Prevalence, natural history, and monitoring for resolution", section on 'Prevalence of childhood food allergy' and "Pathogenesis of food allergy", section on 'Prevalence'.)


Seasonal allergic rhinitis was first described in the United States in 1872 (autumnal catarrh or ragweed hay fever) [2] and in England in 1873 (catarrhus aestivus) [3]. The disease was well recognized in England and Germany by 1900 and in the United States by 1920. The island of Heligoland in the North Sea was established as a summer refuge for hay fever patients by 1910, and, during the early part of the 20th century, it became common for sufferers in New England to retreat to resorts in the mountains to escape the pollen. The first paper on immunotherapy against pollen "toxin" was published in 1911 [4]. At that time, hay fever was considered to be a disease of the affluent and was rarely reported among working-class people, especially farmers.


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