Global Integrative Studies, School of


Date of this Version


Document Type



Published in Journal of Allergy and Clinical Immunology 2023



Copyright © 2023 American Academy of Allergy, Asthma & Immunology. Used by permission.


Respiratory illnesses, such as asthma and allergy disorders, are disproportionately more common among minority racial/ethnic groups and those of low socioeconomic status. In the United States, asthma prevalence and severity are highest among Puerto Ricans (19.2%), American Indians/Alaska Natives (13%), and Black Americans (12.7%) and higher in families living below the poverty threshold than among those living above it (11% vs 8%–9%).1 Many studies of asthma/allergy inequalities assume that genetic differences underlie racial/ethnic differences in these disorders, pointing to genetic ancestry differences between races, but most genetic variants fail to explain racial/ethnic differences and are usually studied only in White populations.2 In reality, racial and ethnic groups—terms that are often used interchangeably and in overlapping ways—can exhibit varying levels of genetic ancestry, cultural traits, and environmental exposures that all may be entangled together. Thus, any genetic finding differing by race/ethnicity can be confounded by social and environmental factors that also track with different ancestries. However, epigenetic mechanisms (i.e., heritable and stable changes in gene expression) may prove important in explaining these inequalities, as they are influenced by a combination of environmental, social, and genetic factors.