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Children of immigrants from India were more likely to develop atopic diseases if born in the United States or Canada than those who emigrated with their parents, according to new research published in The Journal of Allergy and Clinical Immunology: Global.

Additionally, parents overall had lower rates of conditions like asthma and food allergies than their children born in North America. This is a trend that pediatricians and allergists who emigrated from India have noted anecdotally.

Ruchi Gupta, MD, MPH, a pediatrician and director of the Center for Food Allergy and Asthma Research at Northwestern University Feinberg School of Medicine in Chicago and senior author of the study, said she was inspired to conduct the research because of her own experience.

“Both our kids are highly atopic, and we are not,” Gupta said. Gupta and her husband emigrated from India to the United States, and neither of them have conditions like allergic rhinitis.

Gupta and her colleagues surveyed physicians from India to track shifts in the development of atopic diseases after immigrating.

The 148 physicians surveyed reported developing allergic rhinitis and food allergies more often after migration (21.6%) than before migration (12.8%; P = .048).

Nearly 34% of children included in the study had migrated with their parents, and the remaining were born in North America (n = 183). Children born in North America vs India had higher rates of asthma (18.6% vs 8.6%), allergic rhinitis (36.1% vs 19.4%), and food allergies (17.5% vs 5.4%), the researchers found.

The survey is part of a larger effort to understand generational shifts in atopic disease. Gupta hypothesized changes may be linked to the microbiome or specific environmental exposures.

Clinicians might advise parents to introduce a wide variety of foods during infancy, such as peanuts that were once thought best avoided to prevent allergy, Gupta said. Parents might also moisturize a child’s skin to lower the risk of developing eczema. The American Academy of Dermatology endorses this strategy, although other research suggests applying moisturizers does not prevent the condition.

The focus in the new study was children of immigrants, but the nonprofit Food Allergy Research and Education (FARE) noted that 1 in 13 US children have food allergy, while the US Centers for Disease Control and Prevention reported more than 10% of children in this country have eczema, a potential precursor to allergic rhinitis and food allergies.

Screen All Kids for Atopy

Mahboobeh Mahdavinia, MD, PhD, head of allergy and immunology at The University of Texas Health Science Center at Houston, said many parents who have immigrated tell her no one in the family had allergies in their home countries but all their kids do since moving to the United States. Studies have documented what Mahdavinia has observed.

“Second-generation immigrants have very high rates of atopy, and that’s across all atopic diseases,” said Mahdavinia, who was not involved the latest research.

Pediatricians and primary care clinicians should screen all children for signs of atopy, rather than assuming some children have more protection against allergies based on their parent’s background. Clinicians might also want to inquire about dry skin or concerning eating habits that can inform a screening for atopy, she said.

“We know that the babies get dry sky here more, and dry skin is the mother of eczema,” Mahdavinia said.

Gupta reported receiving funds from FARE. Mahdavinia reported having no relevant financial disclosures.

Marcus A. Banks, MA, is a journalist based near New York City who covers health news with a focus on new cancer research. His work appears in Medscape Medical News, Cancer Today, The Scientist, Gastroenterology & Endoscopy News, Slate, and Spectrum.