Allergic diseases such as asthma, atopic dermatitis and food allergies are a burgeoning health challenge in the Asia-Pacific region. Compounding this, the region has become increasingly susceptible to the impacts of climate change. The region has weathered extreme precipitation, intense heat waves, and dust storms over the recent decades. While the effects of environmental and genetic factors on allergic diseases are well understood, prevailing gaps in understanding the complex interactions between climate change and these factors remain. We aim to provide insights into the various pathways by which climate change influences allergic diseases in the Asia-Pacific population. We outline practical steps that allergists can take to reduce the carbon footprint of their practice on both a systemic and patient-specific level. We recommend that allergists optimise disease control to reduce the resources required for each patient's care, which contributes to reducing greenhouse gas emissions. We encourage the responsible prescription of metered dose inhalers by promoting the switch to dry powder inhalers for certain patients, at each clinician's discretion. We also recommend the utilisation of virtual consultations to reduce patient travel while ensuring that evidence-based guidelines for rational allergy management are closely adhered to. Finally, eliminating unnecessary testing and medications will also reduce greenhouse gas emissions in many areas of medical care.

Background: Infants with atopic dermatitis (AD) are reported to be at higher risk of early childhood caries (ECC) at 3-years, but the clinical validity of the reported link remains unknown. We investigated if clinical severity of AD in young children is associated with increased ECC risk at 3-years. Methods: In Growing Up in Singapore Towards healthy Outcomes (GUSTO) mother-offspring cohort, AD was diagnosed by trained physicians using Hanifin and Rajka criteria at 18-month and 3-year clinic visits (n=837). Of the children diagnosed with AD, disease severity was assessed using SCORAD (SCORing Atopic Dermatitis) index and categorized into moderate-to-severe AD (SCORAD≥25), and mild AD (SCORAD<25), with children without AD (non-AD) as a reference group. Oral examinations for ECC detection was performed by calibrated dentists in 656 children at age 3-years. Negative binomial regression was used to calculate the adjusted incidence risk ratio (aIRR; adjusted for socio-demographic factors and prenatal tobacco smoke exposure). Results: Atopic dermatitis was diagnosed in 7.3% (61/837) children; amongst which 23% had moderate-to-severe AD and 77% had mild AD. ECC was observed in 85.7%, 36.8% and 42.8% of the children in moderate-to-severe, mild and non-AD groups, respectively. Children with moderate-to-severe AD were at higher risk of ECC (aIRR 2.30 [95% confidence interval (CI) 1.04-5.06]; p=0.03) at 3 years compared to non-AD, while no association was seen between mild AD and ECC. Conclusions: Children with moderate-to-severe atopic dermatitis were at higher risk of ECC compared to those without AD and may benefit from early dental referral.