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Asthma is a leading chronic disease in children. And since it’s an allergic disease, it’s also common in children with food allergies. Both conditions are part of a progression of allergic diseases called the “allergic march.”

There are several factors involved in the development of asthma. Genetics, exposure to tobacco smoke, and illnesses can play a role. But community factors may influence who develops asthma and how they are able to manage it.

On May 5, 2021 – World Asthma Day – the Asthma and Allergy Foundation of America (AAFA) released the 2021 Asthma Capitals Report™. This report analyzes data from the 100 largest cities in the U.S. to identify the most challenging places to live with asthma. This year, Allentown, Pennsylvania, takes the top spot.

AAFA ranked each city based on these asthma outcomes:

  • Asthma prevalence (or occurrence)
  • Asthma-related emergency room visits
  • Asthma-related deaths

The top 10 most challenging cities overall to live in with asthma in 2021 are:

  1. Allentown, Pennsylvania
  2. Baltimore, Maryland
  3. Richmond, Virginia
  4. Milwaukee, Wisconsin
  5. New Haven, Connecticut
  6. Cleveland, Ohio
  7. Philadelphia, Pennsylvania
  8. Dayton, Ohio
  9. Oklahoma City, Oklahoma
  10. Tucson, Arizona

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The report also highlights risk factors that can influence asthma outcomes. Risk factors include poverty, lack of health insurance, air quality, pollen counts, medicine use, smoking policies, and access to asthma specialists.

In 2020, three major crises shed light on the burden of asthma in the United States:

  • The COVID-19 pandemic
  • Extreme weather patterns, wildfires, and other natural disasters
  • Systemic racism and racial injustices

The report outlines steps law makers, local and federal officials, health care providers, and people with asthma and their caregivers can take to help improve asthma outcomes in their communities.

To see the full report, visit

Kids With Food Allergies is the food allergy division of AAFA.

The 2021 Asthma Capitals™ report is an independent research project of the Asthma and Allergy Foundation of America in part by support from the Pharmaceutical Care Management Association (PCMA) Foundation.

Does your child have asthma? Join our community to chat with others managing asthma, food allergies, and other related conditions. And follow our blog for more news and tips on managing your child's asthma symptoms.


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