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Something in the air

In the UK, the incidence of hayfever and allergy is on the rise, with more people suffering from increasingly severe symptoms and for longer periods of time. But why is this happening and what can pharmacy do to help?

At present, the UK has one of the highest rates of hayfever in the world, with about 25 per cent of the population – 16 million people – suffering from the rapid onset of irritating and uncomfortable symptoms, including itchy, watering eyes, runny noses, sneezing and headaches.

A recent survey of 2,000 UK adults on behalf of Opticrom found that the spring and summer months are becoming more uncomfortable for hayfever sufferers. Almost a third (32 per cent) reported that their symptoms have become more severe over the past few years and, as a result, more than one in 10 (12 per cent) have stopped going out altogether during peak pollen times.

According to another survey by Allergy UK, hayfever symptoms also have a negative impact in the workplace. Nearly one in five respondents said it affects their ability to carry out their job properly and 14 per cent of workers even admit to having taken a sick day due to the severity of their symptoms.

But why has the growth in the number of hayfever sufferers and the reported severity of the condition been so marked in recent years?

The climate change effect

Some experts are linking this rise to the effects of climate change and air pollution, with figures from Opticrom predicting that the number of hayfever sufferers in the UK is set to more than double to 31.8 million by 2030.

One theory for this is because climate change is raising the environmental temperature, it will probably lead to an increase in pollen-bearing plants. This will in turn generate more pollen in the atmosphere, starting earlier in the season and lasting longer.

In her 2014 report sponsored by Opticrom, Dr Jean Emberlin, director of Pollen UK Information Ltd, stated that as a result of pollution and climate change, up to 45 per cent of people in big cities such as London are expected to suffer from hayfever in the next two decades.

Dr Emberlin says that reasons for this may include increased awareness among hayfever sufferers and healthcare professionals “leading to improved identification and recording of cases”, but that “furthermore, we are experiencing longer and more severe pollen seasons as a result of climate change. Grass and weed pollen seasons are tending to get longer and more intense, and tree pollen seasons are tending to start earlier. Also some plants with allergenic pollen are extending their ranges so that there are more types of allergens in the air.”

Summer air pollution episodes are becoming more frequent due to increased incidence of hot, dry weather and Dr Emberlin suggests “some air pollutants increase the allergenicity of pollen and make hayfever symptoms worse.”

Birch pollen affects about 25 per cent of hayfever sufferers

Other factors at play

All of this spells bad news for sufferers of hayfever, but there are other possible reasons for this increase in cases, with a more human-centred origin.

Many people suggest that our modern-day obsession with cleanliness and germs is counter-productive. The ‘hygiene hypothesis’ proposed in 1989 by Professor David Strachan implies modern hygiene standards reduce our exposure and subsequent protection against ‘bad germs’, but Gary Choo, Numark’s head of information services, says the rise in hayfever cannot easily be attributed to any single factor.

“Whilst this may seem an attractive theory,” he says, “the rise in allergies may be caused by a number of factors. For example, overuse of antibiotics tends to upset the balance between ‘good’ and ‘bad’ bacteria – these ‘good’ bacteria are needed to promote health and strengthen the immune response of the body. In addition, modern day lifestyles, increased alcohol consumption, changes and restrictions in diet, especially in young children (such as avoiding peanuts and cows’ milk), and reduction in breastfeeding may all lead to decreasing levels of immunity to the allergens responsible for hayfever.”

Airborne allergies expert Max Wiseberg suggests the quality of our food may also be a problem. “The modern western diet contains fewer whole foods and antioxidant rich fruits and vegetables than it used to,” he says. “These nutritious foods are important for supporting the immune system and, in addition to this, the average diet also contains far more processed foods, which may also be detrimental to health, including the immune system.”

On the other hand, it could just be that we are experiencing better diagnosis rates for hayfever. “More people are seeking a proper diagnosis for their health problems than ever before, including hayfever,” says Max, “which is coupled with a better overall clinical understanding of allergies, both in pharmacy and clinics. There has also been a fantastic drive by leading allergy charity Allergy UK to fund more specialist allergy nurses in hospitals.”

All of these theories are plausible, but Dr Stephen Till, consultant allergist at Kings College London and Guy’s Hospital and spokesperson for the British Society for Allergy & Clinical Immunology (BSACI), is also cautious about pinning the rise in hayfever cases onto any particular cause. He says: “The honest truth is there is a lot of comment around this and people are doing research – although more in relation to asthma than hayfever – but there is no definitive proof that links pollution with hayfever, as far as I’m aware, and it’s difficult to prove these things. So what else could it be?

“Certainly, allergies and hayfever seem to be increasing, and more people seem to be allergic to tree pollen than in the past, but we don’t really know the reason for that. In general, there is quite good evidence that exposure to certain microbes protects against allergies – for example, children growing up on farms are less likely to have asthma and allergies – so things that reduce or change the microbes we are exposed to can have a negative impact on immunity,” he continues.

“Interestingly, we do see patients who develop hayfever later in life – in their mid-40s even – and I really don’t know why this is the case, but if climate change is a factor then that could be one way you’d expect it to show – for example, if the pollen season is lasting longer.”

The majority of hayfever sufferers seek relief from their symptoms in pharmacies

Getting ahead of the game

With so many unknowns, Dr Till suggests that early prevention of hayfever symptoms can be more beneficial than trying to deal with them once they occur.

“The first thing that pharmacy staff can advise sufferers do to prevent and treat their symptoms is to be aware of when they occur, which can help determine whether the major cause is tree or grass pollen,” Dr Till says. “Sufferers allergic to tree pollen start to report symptoms in March, which then peak in mid-April, and grass affects people in the latter part of June and early July.”

“Think of it this way: Easter or Wimbledon – tree or grass. Once they’ve worked out when their symptoms usually begin, the next thing to do is to encourage your customers to take treatments that prevent hayfever well in advance of this [see panel below]. I get my patients to start at the beginning of March and continue treatment every day for the rest of the season, even if they remain symptom-free.”

Dr Emberlin says birch is the main allergenic tree pollen in the UK and Ireland, affecting about 25 per cent of hayfever sufferers, and predicts that “the birch season is likely to be more severe this year than last. Once the season has started, high or very high birch pollen counts will occur on warm, dry days with some wind.” She says those living in urban areas will suffer most, “with the birch pollen being more allergenic here than that from rural areas. Air pollution can also alter the allergens on the birch pollen, making it more potent, as well as increasing hayfever symptoms by causing irritation to the nose and throat.”

Dr Till points out that about half of the people who are allergic to birch pollen – called pollen fruit syndrome – “can also be allergic to other pollen fruits such as apples, plums, peaches and nectarines, and sometimes hazelnuts and almonds. This can result in oral allergy syndrome, causing redness, swelling and itching of the lips and inside their mouths when they eat these foods, but cooking the fruit helps avoid this.”

It is tips like these, as well as expert knowledge of the treatments available, that make pharmacy staff well equipped to help customers suffering with mild to moderate hayfever symptoms. Historically, the hayfever season is from April to July, but as it seems to have started earlier in recent years, it’s worth promoting the category as early as possible and helping customers to start defending themselves against the uncomfortable – and potentially debilitating – symptoms before they have a chance to take hold.

Useful resources

 

OTC treatments and advice

According to Allergy UK, the majority of hayfever sufferers seek relief from their symptoms in pharmacies, with pharmacies seeing an average of 22 patients a week during a typical hayfever season, compared with GPs, who see an average of 15 or 16 patients.

Despite a reported lack of symptom relief and dissatisfaction with treatment, 85 per cent of sufferers admit that they haven’t changed their approach to treatment for three years or more. Research demonstrates that sufferers have resorted to other ways of relieving or managing their symptoms, often taking unconventional measures, including using cold and flu remedies (25 per cent), putting Vaseline in and around their nostrils (23 per cent), trying not to breathe in through the nose (15 per cent) and using a salt water nasal wash or spray (10 per cent).

The charity says that, on average, hayfever sufferers spend £13.42 on hayfever treatments whenever they visit the pharmacy. Almost half of people surveyed (43 per cent) said they visit a pharmacy more than three times a year, meaning they could be spending at least £40 a year on seeking treatments to relieve their hayfever symptoms. The research also found that 49 per cent of 25 to 34-year-olds admit that they go to the pharmacist more than four times a year, therefore spending a minimum of £53 a year on seeking symptom relief.

How can you help?

The first step in dealing with any allergy is to try to remove the allergen from the sufferer’s everyday environment. However, when it comes to pollen this is not always that simple, so conventional hayfever treatments can be of more use:

  • Antihistamines in the form of tablets, syrups or eye drops can help reduce a runny and itchy nose and/or eyes
  • Sodium cromoglicate is mainly available as eye drops, but also comes in nasal spray form. As it is not an antihistamine, it is useful to add to a treatment regimen if antihistamines aren’t working on their own. Sodium cromoglicate eye drops reduce red, runny and itchy eyes
  • Oral or nasal decongestants can help unblock congested nasal passages, but shouldn’t be used for more than a week as using them for too long can make congestion worse (known as rebound congestion)
  • Corticosteroid nasal sprays and drops have an anti-inflammatory effect and can relieve and prevent symptoms. They’re most effective if started two weeks before symptoms begin and then used regularly.

A good eye care routine is also recommended for hayfever sufferers, including removing eye make-up at night to give the skin time to breathe, and using hypoallergenic cosmetics and toiletries that limit exposure to other potential allergens. Some customers who wear contact lenses may find that their eyes are too itchy or irritated to cope with lenses during the hayfever season, so they may prefer to switch back to wearing glasses for that period.

Although hayfever is a seasonal allergy, sufferers may also find they have trouble with pet allergies, skin allergies, nettle rash or hives, so it’s worth stocking antihistamines and other allergy control products all year round.




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