Allergy in Latin America: Great Need, Even Greater Opportunity

Latin America is not a single epidemiological entity. Spanning tropical, temperate and high‐altitude environments, and home to more than 650 million people of admixed Amerindian, European and African ancestry, it is a land of immense contrasts. The region reports some of the highest and some of the lowest prevalences of allergic disease in the world. Allergic disorders have risen alongside urbanisation, yet the burden is strikingly uneven between and within countries, and its drivers often differ from those described in high‐income settings. Two themes run through this overview. First, allergy, together with infectious diseases, is probably the most geographically bound of all medical specialties, since many of its conditions depend directly on local allergens, diet and climate. Thus, locally generated evidence is indispensable, in Latin America as elsewhere. Second, despite an enormous patient population and uniquely informative natural conditions, the allergy research that Latin America itself generates remains scarce and publications have plateaued since the COVID‐19 pandemic. Here we summarise the situation, disease by disease, and argue that it's time to up the ante.

1. Asthma

Asthma is the most studied allergic disease in the region and captures its paradoxes. ISAAC and the Global Asthma Network have documented high symptom prevalence in many Latin American cities, reaching roughly 20%–27% in adolescents in some Brazilian centres, frequently coexisting with poverty, crowding and a high infectious burden, which contradicts the simplest formulations of the hygiene hypothesis [1, 2]. Much of this asthma is non‐atopic, and intense early‐life exposure to infections and unhygienic environments appears to attenuate atopy through enhanced immune regulation, as shown by the SCAALA programme in Brazil and Ecuador [2]. Conversely, about 80% of patients in a Mexican severe‐asthma registry had allergic asthma [3]. Symptom prevalence ranges more than fourfold between centres, from about 6%–7% in some Mexican cities to over 27% in Salvador, Brazil, underscoring that a single regional average can be misleading [1]. Morbidity and mortality remain disproportionately high, control is poor, and access to inhaled corticosteroids is inconsistent. Why this high‐burden, low‐atopy phenotype predominates, and what this teaches us about the very origins of asthma, is a question of global relevance that Latin American research is well placed to answer.

2. Allergic Rhinitis and Conjunctivitis

Allergic rhinitis and rhinoconjunctivitis are highly prevalent but, again, heterogeneous. In ISAAC Phase Three, current rhinoconjunctivitis affected, on average, 12.7% of children aged 6–7 years and 18.5% of adolescents aged 13–14 years, varying widely between centres (up to 21% and 45%, respectively) and higher in Spanish‐speaking centres [4]. House dust mites dominate as aeroallergens across most tropical and coastal regions, with perennial sensitisation and high exposure, whereas pollens and fungi gain importance in temperate and southern‐cone settings. Notably, the storage mite Blomia tropicalis is a leading sensitiser in the tropics yet is largely absent from temperate‐zone diagnostic panels, and molecular cross‐reactivity between mite tropomyosins and Ascaris antigens complicates the interpretation of allergy tests in helminth‐exposed populations, a distinctly regional problem that imported diagnostics ignore. This diversity should drive locally relevant diagnostic panels and immunotherapy formulations rather than imported ones. Chronic rhinosinusitis, by contrast, remains under‐characterised, with few population‐based or endotyping studies from the region, a conspicuous data gap.

3. Atopic Dermatitis and Chronic Urticaria

Atopic dermatitis is just as heterogeneous: in ISAAC, childhood prevalence ranged from over 20% in cities such as Quito (Ecuador) and Barranquilla (Colombia) down to about 4% in Monterrey (Mexico) [1]. Adult atopic dermatitis is almost unstudied, severity and phenotype data are sparse, and access to dupilumab and JAK inhibitors is highly unequal. The interplay between ancestry, filaggrin variants, climate and the skin microbiome in admixed populations is largely unexplored, and data collection across the region remains fragmented [5]. The first Latin American study of common filaggrin loss‐of‐function variants found them in Chileans at frequencies similar to those reported in Europeans, with a non‐significant trend toward association with atopic dermatitis [6]. Chronic spontaneous urticaria, by contrast, is a frequent reason for specialist consultation; regional real‐life studies show good responses to omalizumab but also limited and unequal access, while basic epidemiological data are scarce [7]. Here too, clinical volume far exceeds published evidence.

4. Food Allergy and Anaphylaxis

Food allergy is probably the least well documented. Self‐reported reactions are common, reaching 12%–24% of children in some Brazilian surveys, but physician‐ or challenge‐confirmed prevalence is far lower, often around 1%, and oral food challenge facilities, the diagnostic standard, remain scarce, leading to both over‐ and under‐diagnosis and unnecessary avoidance. Questionnaire‐based epidemiological studies in several Latin American countries demonstrate that triggers vary across the region: cow's milk and egg in early childhood, with tree nuts, peanuts and shellfish prominent in school‐age surveys. Notably, region‐specific triggers such as maize in Mexico or avocado in Chile have been described [8], and many confirmed cases are non‐IgE‐mediated. Standardised, challenge‐confirmed studies are needed to define the true regional burden and the relevant triggers.

5. Access to Diagnosis and Treatment

Across diseases, a common thread is unequal access. Standardised allergen extracts, validated diagnostics and biologics are available in major tertiary centres but scarce elsewhere; few countries adapt international guidelines to local context [9], and research funding is limited. Allergen immunotherapy reaches well under 1% of eligible patients in many countries, and biologics remain out of reach for most because of cost. Regional studies also reveal wide divergence in diagnostic and therapeutic practice. Furthermore, regional registries remain nascent, with the LASID inborn‐errors‐of‐immunity registry among few notable exceptions. The standard of care thus varies widely, even within a single country.

6. The Research Gap

These gaps reflect a deeper problem: the region publishes remarkably little allergy research of its own. A PubMed search restricted to Latin American author affiliations, with allergy‐related terms in the title, retrieves fewer than 500 articles per year, a figure that rose until about 2020 and has plateaued since (Figure 1). The true picture is more sobering still. About half of those records concern asthma, which largely overlaps with respiratory medicine, leaving only around 200 papers per year specifically on allergy, atopy, rhinitis, atopic dermatitis or anaphylaxis region‐wide. A substantial share of this work is led by international groups, consortia or societies, for example, the World Allergy Organization or the European Academy of Allergy and Clinical Immunology, with a Latin American co‐author, rather than being conceived and driven from within the region. High‐quality, regionally originated science does exist: Brazilian groups have led recognised cohort and immunological research on asthma and the helminth–allergy link; Colombian investigators are at the forefront of tropical molecular allergology, including mite allergen characterisation and mite–Ascaris cross‐reactivity; Mexican teams have advanced allergic rhinitis and severe asthma epidemiology and allergen immunotherapy; and Chilean groups have advanced skin‐barrier genetics and birth‐cohort studies. These are strengths to build on; the task is to grow them into a sustained, region‐wide body of work. The current output is glaringly disproportionate to a disease burden affecting tens or possibly hundreds of millions of people. It is also unsurprising: most Latin American countries invest < 1% of GDP in research and development. Heavy clinical workloads, scarce protected research time, inadequate funding and infrastructure, language barriers, publishing costs and editorial bias against developing‐world allergy research often push talented investigators abroad or out of science altogether.

FIGURE 1.

Annual allergy‐related publications from Latin American institutions, 2010–2025 in PubMed, separating titles that mention asthma from those mentioning allergy, atopy, atopic, rhinitis or anaphylaxis. Search date: June 2026; counts are unique indexed records. Output rose until about 2020 and has plateaued since, remaining below ~500 articles per year, of which only around 200 are not asthma‐related. Search string: (Argentina[ad] OR Bolivia[ad] OR Brasil[ad] OR Brazil[ad] OR Chile[ad] OR Colombia[ad] OR “Costa Rica”[ad] OR Cuba[ad] OR “Dominican Republic”[ad] OR Ecuador[ad] OR “El Salvador”[ad] OR Guatemala[ad] OR Honduras[ad] OR Mexico[ad] OR Nicaragua[ad] OR Panama[ad] OR Paraguay[ad] OR Peru[ad] OR “Puerto Rico”[ad] OR Uruguay[ad] OR Venezuela[ad] OR “Latin America”[ad] OR “South America”[ad] OR “Central America”[ad]) AND (allerg*[title] OR atopy OR atopic OR rhinitis OR anaphyla* OR asthma*) (the asthma layer restricted to asthma*). The title‐restricted affiliation ([ad]) search is deliberately conservative and undercounts regional output, missing abstract‐ or MeSH‐only records and regional journals (e.g., SciELO/LILACS) not indexed in PubMed.

7. It's Time to Up the Ante

Latin America has the three ingredients productive research requires: an immense and diverse patient population; uniquely informative natural conditions (genetic admixture, ethnic and environmental diversity, distinctive allergens and exposure gradients); and a growing base of capable clinicians and scientists. What is missing is scale and sustained investment. The opportunities span the full translational spectrum (Table 1). At the basic level, the coexistence of high allergen exposure, parasitism and diverse microbial environments is a natural laboratory for dissecting immune regulation, the epithelial barrier and the origins of the non‐atopic phenotype, while genetic admixture offers unusual power to map ancestry‐specific determinants of disease and treatment response. Translational priorities include characterising region‐specific allergens, developing molecular diagnostics tuned to local sensitisation and pharmacogenomics in admixed populations. Clinically, the region needs harmonised registries and birth cohorts, challenge‐confirmed food allergy studies and pragmatic trials of immunotherapy and biologics in local populations. Realising this will require deliberately training not only allergy specialists but clinician‐scientists dedicated to allergy and immunology, supported by mentorship, shared infrastructure, regional collaboration and durable funding. Strong collaborations and regional scientific societies such as the Latin American Society of Allergy, Asthma and Immunology (SLAAI) provide a natural backbone for the multicentre cohorts, registries and biobanks that no single centre can build alone.

TABLE 1.

Basic, translational, clinical and capacity‐building research opportunities in allergy in Latin America.

Domain	Priorities and opportunities
Basic	Mechanisms of immune regulation under high parasitic and microbial exposure; origins of the predominant non‐atopic asthma phenotype; epithelial‐barrier biology in tropical environments; influence of Amerindian, European and African ancestry on allergic susceptibility.
Translational	Characterisation of region‐specific allergens (mites, fungi, regional pollens and foods); component‐resolved and molecular diagnostics tuned to local sensitisation; biomarker discovery and pharmacogenomics of asthma controllers and biologics in admixed populations; knowledge translation, implementation science and health‐technology assessment.
Clinical	Harmonised regional registries and birth cohorts; oral‐food‐challenge–confirmed prevalence and anaphylaxis studies; pragmatic trials of allergen immunotherapy and biologics in local populations; implementation research to reduce inequities in diagnosis and access.
Capacity	Training not only allergy specialists but dedicated clinician‐scientists and researchers; mentorship, shared biobanks and data platforms; sustained regional and national research funding and collaboration; guideline‐methodology and GRADE training.

Latin America's allergic disease burden is large, rising and profoundly heterogeneous. Rather than a limitation, this diversity is an opportunity: the questions the region raises about gene–environment interactions in allergy are among the most important in the field. Answering them will require the region to generate its own evidence rather than import it, and to value the scientists who produce it as much as the clinicians who apply it. With coordinated effort, Latin America can convert its singular epidemiology into discoveries that reshape how allergy is understood and treated, and the benefits will reach patients far beyond its borders.

Author Contributions

A.B. conceived the article and wrote the original draft. D.L.‐L., D.S. and J.J.Y.‐N. critically reviewed and edited the manuscript. All authors read and approved the final version.

Conflicts of Interest

Dr. Arturo Borzutzky: research grants from Agencia Nacional de Investigación y Desarrollo (Chile) for work outside this manuscript; personal fees for editorial work from Springer Nature. Dr. Désirée Larenas‐Linnemann: personal fees from ALK, Armstrong, AstraZeneca national and global, Chiesi, GSK national and global, Megalabs Ecuador, Naos, Novartis, Pfizer, Sanofi, Siegfried, Syneos Health, grants from Abbvie, Lilly, Sanofi, AstraZeneca, Pfizer, Novartis, GSK, Chiesi, Biopharma, outside the submitted work; and Editor in chief of Immune System (Karger); Member of international committee ACAAI; Subgroup chair of allergen immunotherapy Practice parameter update JTF AAAAI/ACAAI 2026; Member of allergen immunotherapy committee AAAAI; Chair of allergen immunotherapy committee CMICA; Member of prevention task force EAACI. Dr. Dirceu Solé: personal fees from AstraZeneca; Scientific Director of the Brazilian Society of Paediatrics; Director of Research and Publications, Brazilian Association of Allergy and Immunology. Dr. Juan Yepes‐Nuñez declares no conflicts of interest.