Roberta Savli from EFA provides insight into allergic rhinitis
Rhinitis is a very common disorder, far more than just sneezing a couple of days in the year. Allergic rhinitis is a serious chronic respiratory disease that reduces patients’ quality of life and their productivity at work and at school. Despite patients are used to cope with disease, there are things allergic patients cannot adapt to, and need political attention.
Allergy is in the air, don’t you see?
Allergic rhinitis consists of an inflammation of the nasal mucosa provoking a runny nose, and often itching and ocular symptoms. It is a disease mostly caused by viral infections or as an allergic reaction to the allergens in the air. (1) This brings bad news in itself because we cannot stop breathing, or see what’s in the air, and the information available on the presence of airborne particles remains limited.
The current air quality monitoring legislation in Europe mainly covers air traffic pollutants and chemicals, responsible for more than 460,000 deaths in Europe every year. Indoor air pollution and biological particles, especially the allergenic aerobiological particles, are not under the radar. But if we know which allergens are in the air, we can improve diagnosis and treatment of patients with respiratory allergies.
Respiratory allergy patients, healthcare professionals and biologists have been asking the European authorities to look into the problem, develop guidelines, recommend biological pollutant levels and boost the set-up of a monitoring network in Europe. (2) Still, there is no general obligation to monitor and communicate about the pollen situation in Europe. Most of the 600 sampling sites for pollen monitoring in Europe rely on voluntary work, like the pollen information in Denmark, run by EFA Member Danish Asthma and Allergy Foundation.
It is not easy to explain every time what every situation, even the smallest, provokes to our health. Imagine a new built-up street decorated with allergenic trees, especially problematic if next to a school; or living in an area of open-sky industrial monoculture. Allergy concerns are intimately linked to the environment we live in, and therefore touch upon everything, even urban planning. Every time an allergenic tree is planted in urban settings it is a catastrophe for 1 in 7 Europeans living with allergic rhinitis. (3)
The thinking that puts health into all policies does not come naturally in policy-making. Take for example the legislation on the energy performance of buildings directive (EPBD), under revision in the European Union. Patients see it as an opportunity not only to develop greener buildings but also healthier environments. While some Members of the European Parliament have called for better indoor air quality and the creation of a certificate to inform citizens about the air quality in closed spaces, many have not seen the link between energy and health. (4) As patients, we call for long, not short-sighted, vision for health.
Research, docs and meds
Things have evolved though. It was only 50 years ago that scientists found allergic patients produce a specific antibody, immunoglobulin E (IgE), due to their sensitization to allergens, like those airborne; pollens, dust, moulds, animal dander. It was a major discovery that paved the way for new medicines and the treatments patients have today.
One of them is allergen-specific immunotherapy (AIT) for allergic rhinitis and some food allergies, which not only treats but helps to prevent and allows for a long period without medication. Regrettably, most countries consider this treatment as a last resort and therefore difficult to access, or not part of the treatment regime and not at all reimbursed, like in Belgium. Yet there is hope: 1 in 3 Members of the European Parliament have asked for more research into the causes of respiratory diseases and for reimbursed access to state-of-the-art therapy for patients. We also expect the new guidelines from the leading allergologists society, EAACI, will help to facilitate access to this secondary prevention option. (5)
Nevertheless, a cure for allergy remains a big question mark. There have been major European projects looking at the underlying mechanisms provoking allergy that have allowed the clustering of allergy phenotypes. This ground-breaking research will help improving diagnosis, especially when 45% of the patients are likely to be misdiagnosed in Europe.6 But more needs to be done.
Allergy and asthma challenge the sustainability of our healthcare systems. In Europe, allergic rhinitis may cost up to €100 billion annually directly.7 Still, allergology is not a consolidated medical speciality and for that reason, patients struggle to get the expertise and guidance they need, which delays diagnosis and optimal treatment.8
Fortunately, some countries like Finland have understood respiratory allergies as a public health problem affecting the population, and through a forward-thinking national allergy programme have invested in reducing the impact and prevent allergy with already a 5% decrease in direct asthma and allergy costs. This is all coupled with a targeted treatment investment and support for people with severe allergy. Their motto is to endorse health, not allergy!
Unless governments start considering the investment on finding the causes of allergy and mainstreaming good allergy care as a worthy-effort, severe allergy will not go away but instead affect up to half of the population. Anyone living with someone or having severe allergy knows life is scary, but health could be just around the corner with the right support.
- “About rhinitis”, EAACI: http://www.eaaci.org/patients/allergic-and-immunologic-diseases-and-causes/allergic-conditions/rhinitis/aboutrhinitis.html.
- “Biological Air Quality Monitoring Petition”, EFA-EAACI-EAS, December2013: http://www.efanet.org/images/2013/12/Joint_Biological_Air_Monitoring_Petition-14dec2013.pdf.
- “Tackling the Allergy Crisis in Europe – Concerted Policy ActionNeeded”, EAACI, June 2015: http://www.eaaci.org/documents/EAACI_Advocacy_Manifesto.pdf.
- “Indoor Air Quality vaguely covered in the revision of the EnergyPerformance of Buildingsdirective”, EFA, 9 November 2017: http://www.efanet.org/resources/library/3249-indoor-air-qualityvaguely-covered-in-the-revision-of-the-energy-performance-of-buildings-directive.
- “EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis”, EAACI, September 2017: https://www.ncbi.nlm.nih.gov/pubmed/28940458.
- EAACI op cit.
- GAL²EN, the Global Allergy and Asthma European Network.
- “Allergy Alert! Paper”, EFA-EAACI-IPCRG-ARIA-UEMS, June 2014: http://www.efanet.org/images/2015/01/EFA-Allergy-Alert-Paper-lay-FINAL.pdf.
Roberta Savli
Director of strategy and policy
EFA – European Federation of Allergy and
Airways Diseases Patients’ Associations
Tel: +32 (0)2 227 271
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