Priya had managed her hay fever for twelve years. She knew her triggers, kept antihistamines in her bag, and saw her doctor every season. Last monsoon, a cloudy afternoon sent her to the emergency room, wheezing, unable to speak in full sentences. She had never had asthma in her life.
Priya is a fictional composite created for illustrative purposes. The clinical scenario reflects real documented cases.
Her treatment had not failed. The problem had changed.
MedBound Times connected with two specialists, a pulmonologist and a dermatologist, who explain why this happens and what people should know in 2026.
Pollen seasons now start 20 days earlier, last 10 days longer, and carry 21% more pollen than in 1990. A March 2026 Climate Central analysis found 87% of U.S. cities have seen the growing season extend by 21 days since 1970. The pattern is tracking across South Asia. Climate change is projected to make Congress grass suitable for spreading across 65% of India, and it is already one of the ten most common allergens in the Indian environment.
India does not yet have a national pollen monitoring network, which limits real-time tracking of exposure trends across regions.
Increasing levels of CO₂ cause an increase in both pollen quantity and allergenicity per grain. Each grain now packs a heavier punch to your immune system than it did two decades ago. Your immune system can also be quietly building a reaction to an allergen for years before symptoms appear. The allergy did not start suddenly. The threshold was crossed.
Identifying triggers often requires clinical history and sometimes allergy testingDr. Aishwarya C, MD Pulmonology, Consultant Pulmonologist at Vagus Hospital, Bengaluru
Diesel exhaust particles coat pollen grains and create entirely new irritant proteins, which are not present in the clean, laboratory-grade samples used in standard allergy tests. Two patients with identical test results in Delhi and rural Himachal Pradesh may have fundamentally different symptom burdens.
Also read: Polluting household fuels are linked to higher eczema and asthma risk in young children
Beyond seasonal exposure, acute environmental events can dramatically amplify risk.
In November 2016, one storm sent approximately 10,000 people to emergency departments in Melbourne in a single night. Ten died. Most had only mild, previously undiagnosed hay fever. Thunderstorm updrafts carry pollen grains to altitude, where moisture causes each grain to burst open like a water balloon, releasing thousands of invisible fragments too small for your nose to catch, reaching the lower airways directly. A 2025 review in Exploration of Asthma & Allergy classifies thunderstorm asthma as a rising public health emergency across South and Southeast Asia.
If you have hay fever, treat storm warnings during pollen season as a health alert. Ask your doctor about keeping a reliever inhaler accessible before storm season begins.
The gut is now understood as the second brain, and its connection to allergic disease is well established. 70-80% of our immune cells live in the gut. When gut health is disrupted, the immune system loses its balance, and allergic conditions become harder to control.
In India, this is compounded by a misdiagnosis cycle. Allergic rhinitis (immune system overreaction to airborne allergens like dust, pollen, etc., causing runny nose, sneezing, itching) is routinely treated as bacterial sinusitis (inflammation of the sinuses - paired cavities in the face). A 2025 Dove Press study spanning 19 states and 40,001 patients found 53.7% of those with nasal symptoms had allergic rhinitis. Most had received repeated antibiotics. Those antibiotics do nothing for rhinitis and may disrupt the gut microbiome (microbes that live in your intestines), further worsening the sensitivity to triggers they fail to treat.
Clearing a sinus infection with antibiotics is treating the surface, not the source. The inflammation returns because the trigger was never identified.Dr. Aishwarya C, MD Pulmonology, Consultant Pulmonologist at Vagus Hospital, Bengaluru
Beyond seasonal exposure, acute environmental events can dramatically amplify risk.
Work: You show up to work. You answer emails. But if your rhinitis is poorly controlled, research shows you are functioning at under 40% of your normal capacity, present in body, largely absent in mind.
Sleep & Mental Health: At night, allergic inflammation keeps you from reaching deep sleep. You wake repeatedly without knowing why. Over weeks and months, this compounds into something that looks a lot like chronic fatigue or anxiety and is sometimes treated as such.
Children: For children, the cost is sharper. A child who has scratched through the night, with a blocked nose, and swollen eyes, is not ready to sit in a classroom the next morning. Untreated eczema and rhinitis do not stay on the skin and in the nose. They follow children into their concentration, their behaviour, and their grades.
Symptoms on more than 3 days a week or lasting beyond 4 weeks in a season
Symptoms affecting your sleep, concentration, or work performance
Recurring ‘sinus infections’ or antibiotic courses that provide no lasting relief
Your child has moderate to severe eczema, or onset in infancy
Wheezing or chest tightness during pollen season, even once
Symptoms worsening year on year despite using the same medication
You live in a high air-pollution area and your test results do not match your symptoms
Ask your doctor for a skin-prick test or specific IgE blood test. A confirmed diagnosis opens access to allergen immunotherapy (boosts or restores the body's immune system) - the only treatment that can modify the underlying immune response.
Also read: New IIT Bombay research explains how air pollution may alter lung mucus and increase asthma risk
Not inevitably but the risk is real and the connection begins at birth. Many non-infectious skin disorders have a genetic predisposition. A disrupted skin barrier in infancy allows allergen sensitisation before any respiratory symptoms appear. Based on multiple longitudinal studies, approximately half of children with moderate to severe eczema develop asthma. Two-thirds develop allergic rhinitis. Between 65% and 80% of Indian asthma patients have concurrent rhinitis.
Eczema/atopic dermatitis (a skin condition causing extreme itching, red, dry rashes), allergic rhinitis, and asthma share the same overactive immune response. Treating them in isolation, by separate specialists who never coordinate, routinely produces incomplete control of all three. Early, aggressive eczema treatment may interrupt the progression. Waiting until the child’s breathing is affected is waiting too long.
Parents need to understand from the start that eczema is not cosmetic. It is a marker of immune predisposition (increased risk of developing a disease due to inherited genetic variations). The skin barrier is the beginning of this story.Dr. A.P. Balaji, MD DVL; Consultant Dermatologist, Bhairavi Skin Clinic
India has no national pollen monitoring network. Allergy specialist training is concentrated in metros. Epinephrine autoinjectors (pre-filled devices to deliver epinephrine in emergency situations) are largely unavailable outside major cities. A report in The Lancet Global Health estimates 37.9 million Indians have asthma, with over 50% having severe, uncontrolled disease. The Global Asthma Network Phase I India study found allergic rhinitis in 23.5% of adolescents.
A patient without a confirmed allergy diagnosis cannot be referred for immunotherapy, cannot be counselled on allergen avoidance, and cannot be monitored for atopic march progression. Medication controls the inflammation. Only allergen immunotherapy has been shown to modify the underlying immune response that causes it, and that is the conversation most patients are never offered.
Dr. Aishwarya C, Pulmonologist and Dr. A.P Balaji, Dermatologist practise yoga and pranayama daily. Both of them advise, “Always learn pranayama from a qualified yoga teacher who knows your medical history, not from a social media video. Incorrectly performed pranayama can trigger bronchospasm (a sudden tightening of the airways).”
A 2025 analysis, pooling multiple clinical trials, found that asthma patients who practised pranayama regularly showed measurable improvement in how much air their lungs could move with the strongest results from people who practised daily, under supervision, for at least eight weeks.
A 2025 analysis of 89 clinical trials found significant reductions in the key inflammatory markers driving allergic disease, including stress hormones and immune signaling proteins.
Shambhavi Mahamudra - breath, bandha, and focused attention. Strongly beneficial for stress regulation and respiratory health. Must be learned under supervision(Dr. Balaji)
Bhastrika Kriya - vigorous breathing that improves lung capacity. Especially recommended for asthma and chronic sinus issues. Must be learned under supervision. (Dr. Balaji)
Jala Neti - nasal saline irrigation. Directly reduces mucosal inflammation and is one of the most effective adjuncts for chronic rhinitis. Must be learned under supervision (Dr. Balaji)
Pranayama daily practice - Fractional exhaled Nitric Oxide (FeNO measures airway inflammation) levels may drop, rescue inhaler use may reduce, symptom control between medication doses may improve. Must be learned under supervision (Pulmonologist)
Patients who take up supervised practices (along with medications) from a yoga teacher who is properly trained, consistently report better symptom control. Some have even completely come off medications.Dr. A.P. Balaji, MD DVL; Consultant Dermatologist, Bhairavi Skin Clinic
"A relief inhaler alone is no longer considered adequate", says Dr. Aishwarya C, MD Pulmonology, Consultant Pulmonologist, Vagus Hospital, Bengaluru.
Every asthma patient typically requires an anti-inflammatory inhaler, not just a relief inhaler. The 2026 Global Initiative for Asthma update is clear: Access to anti-inflammatory inhalers for everyone with asthma is an urgent need.
Monoclonal antibodies are available in India, but expensive. For patients with uncontrolled asthma or severe eczema, Omalizumab (targeting IgE, the antibody central to allergic disease) Mepolizumab, Benralizumab and Dupilumab (targeting the immune pathway driving both conditions) are now standard considerations in Indian specialty clinics. Access and affordability remain limited to those who can afford specialist care in metro hospitals.
Allergen immunotherapy remains the only treatment that can modify the underlying immune response. Unlike antihistamines and inhalers, which suppress symptoms, immunotherapy trains the immune system to tolerate the allergen at the source. It is significantly underused in India and largely inaccessible outside metro centers.
For most Indian patients, the most impactful step is not a new drug. It is a confirmed diagnosis. Without it, immunotherapy cannot be offered, allergen avoidance cannot be counselled, and the natural, sequential development of allergic diseases cannot be monitored. That one appointment changes everything that follows.
In 2026, the most important allergy intervention is not a new drug, but a correct diagnosis.
For informational purposes only. Not medical advice. Consult a qualified allergist, pulmonologist, or dermatologist. Yoga and pranayama are adjuncts to prescribed treatment, not replacements, and must be introduced under qualified medical and yoga supervision.
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