The intersection of climate change, allergic disease and social vulnerability: conceptual framework and strategies for risk mitigation

Climate change is reshaping the aeroallergen landscape, with rising temperatures, elevated CO2, shifting precipitation, and land-use change extending pollen seasons, increasing pollen loads and allergenicity, and expanding the geographic range of allergenic plants. These changes are accompanied by escalating air pollution from fossil fuel combustion and wildfires that act as an adjuvant with co-exposure with allergen exacerbate allergic airway disease. Vulnerable populations—particularly those in socioeconomically disadvantaged and marginalized communities in the US—experience disproportionate exposure to pollutants and allergens due to structural inequities that result in some populations being exposed to more environmental hazards than other groups. Climate-amplified aeroallergen exposure and air pollution are associated with higher sensitization, symptom burden, exacerbations, and healthcare use. Structural inequities magnify exposures to allergens and air pollution, while also influencing the social environment through concentration of poverty and diminished access to resources. This review synthesizes evidence linking climate change-related effects on aeroallergens and air pollution with allergic disease risk and the modification of this relationship by social vulnerability, with a focus on Europe and North America. We also highlight established and emerging strategies to mitigate the effects of climate change on allergic disease prevalence and morbidity, including anticipatory guidance, digital forecasting, community adaptation measures, and local, regional, and national policies that promote responsible land use, healthy housing, and equity-focused public health initiatives.