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We read with interest the above article published by Yao and Sbihi in the Canadian Journal of Public Health. The authors reported the prevalence of non-food (mainly respiratory) allergies in Canada to be lower among immigrants and rightly attributed this to environmental causes. However, as they discussed in their article, the extent and direction of this association remains controversial. When investigating allergies among Canadian immigrants, a distinction should be made between European immigrants and African and Asian immigrants. The rates of allergies among people living in Europe and North America are higher than among those living in Asia and Africa, which has previously been attributed to genetics and the environment. As well, many Canadian immigrants originate from Europe: based on the 2006 Census, the place of birth for most immigrants to Canada was the United Kingdom, followed by China and India. Many others originated from Italy, USA, Germany and Poland. In addition, a distinction should be made between diagnosed and perceived allergies. Immigrants may perceive diseases differently due to a lack of knowledge about or access to health care. This may be especially true for allergies, as they manifest in a wide range of symptoms. Lower rates of allergy among immigrants may be attributed to under-reporting of perceived allergies and/or underdiagnosis. We recently performed a cross-sectional study (UBC – H16-00826) to determine the prevalence of allergies among a sample of British Columbia (BC) residents (n = 7995). We compared the prevalence of perceived allergies (self-reported) and diagnosed allergies (self-reported to have been diagnosed by a physician) between Caucasians (North Americans of European descent) and nonCaucasians, as well as immigrants and non-immigrants. We found that the proportion (95% CI) of perceived non-food allergies (respiratory allergies categorized as hay fever/seasonal allergies/dust allergies and animal fur/dander allergies) was significantly higher among Caucasians (4.3%, 95% CI: 3.7–5.0) (n = 3697) compared to non-Caucasians (2.1%, 95% CI: 1.7–2.6) (n = 4298). A similar, but stronger pattern was found for diagnosed non-food allergies among Caucasians (1.8%, 95% CI: 1.4–2.3) and non-Caucasians (0.3%, 95% CI: 0.2–0.5). The odds ratios of diagnosed if perceived for non-food allergies were 41.5% (34, 49) for Caucasians and 14.4% (8.6, 23) for non-Caucasians (see Figure 1). A separate analysis for immigrants irrespective of whether or not they were Caucasian led to a similar pattern (data not reported). While we agree with Yao and Sbihi’s findings that the rate of diagnosed allergies among immigrants of Asian and African origin is lower than that among non-immigrants, we would like to add that this may depend on whether we are investigating perceived or diagnosed allergies. The large difference we found for perceived allergies in our study could be the result of non-Caucasians not seeking care from a physician because they perceive allergies as mild. This is also consistent with the concept that an immigrant’s perception of allergy approaches that of a non-immigrant the longer he/she resides in Canada. In addition, immigrants of European descent (Caucasian in our analysis) should be evaluated separately from other immigrants.

Prevalence of non-food allergies among British Columbia residents from different countries of origin