title: A systematic review on the development of asthma and allergic diseases in relation to international immigration: the leading role of the environment confirmed.
abstract: BACKGROUND
  The prevalence of asthma and allergic diseases is rising worldwide. Evidence on potential causal pathways of asthma and allergies is growing, but findings have been contradictory, particularly on the interplay between allergic diseases and understudied social determinants of health like migration status. This review aimed at providing evidence for the association between migration status and asthma and allergies, and to explore the mechanisms between migration status and the development of asthma and allergies.
  
  
  RESULTS
  Systematic review on asthma and allergies and immigration status in accordance with the guidelines set by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The pooled odds ratio (OR) of the prevalence of asthma in immigrants compared to the host population was 0.60 (95% CI 0.45-0.84), and the pooled OR for allergies was 1.01 (95% CI 0.62-1.69). The pooled OR for the prevalence of asthma in first generation versus second generation immigrants was 0.37 (95% CI 0.25-0.58). Comparisons between populations in their countries of origin and those that emigrated vary depending on their level of development; more developed countries show higher rates of asthma and allergies.
  
  
  CONCLUSIONS
  Our findings suggest a strong influence of the environment on the development of asthma and allergic diseases throughout the life course. The prevalence of asthma is generally higher in second generation than first generation immigrants. With length of residence in the host country the prevalence of asthma and allergic diseases increases steadily. These findings are consistent across study populations, host countries, and children as well as adults. Differences have been found to be significant when tested in a linear model, as well as when comparing between early and later age of migration, and between shorter and longer time of residence.
authors.affiliation: Universidad del Desarrollo- Clínica Alemana, CAS-UDD, Lo Barnechea Santiago, Chile; Bradford Institute for Health Research, BIHR, Bradford Royal Infirmary, Bradford, United Kingdom; Department of Health Sciences University of York, Heslington, York, United Kingdom.
authors.forename: Báltica
authors.initials: B
authors.lastname: Cabieses
authors.affiliation: Bradford Institute for Health Research, BIHR, Bradford Royal Infirmary, Bradford, United Kingdom; Department of Health Sciences University of York, Heslington, York, United Kingdom.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Uphoff
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; IMIM (Hospital del Mar Research Institute), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Universitat Pompeu Fabra, Departament de Ciències Experimentals i de la Salut, Barcelona, Spain.
authors.forename: Mariona
authors.initials: M
authors.lastname: Pinart
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; IMIM (Hospital del Mar Research Institute), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Universitat Pompeu Fabra, Departament de Ciències Experimentals i de la Salut, Barcelona, Spain.
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Antó
authors.affiliation: Bradford Institute for Health Research, BIHR, Bradford Royal Infirmary, Bradford, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Wright
mesh_terms: D000328:Adult; D001249:Asthma / Q000453:epidemiology*; D002648:Child; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D004777:Environment; D006801:Humans; D010375:Pedigree; D015995:Prevalence