The British hay fever epidemic: Not to be sniffed at!
| Published: 14th April 2007 17:00 |
The British hay fever epidemic: Not to be sniffed at!
Andrew Williams is a Clinical Nurse Specialist for allergy at the Homerton University Hospital in Hackney, London, UK. He regularly holds immunotherapy clinics, drug and food allergy challenges, joint paediatric clinics and anti IgE treatment clinics.
What is the extent of the hay fever problem in Britain?
Britain has one of the highest prevalence's of hay fever in the world, with about 15 million sufferers. Some people can control their hay fever with medications, such as nasal corticosteroids and antihistamines, but there are a huge number of hay fever suffers who cannot.
Also, many of these symptomatic treatments can cause irritating side effects, such as stinging from nasal sprays and drowsiness from antihistamines (even second generation antihistamines for some). Therefore, many patients just stop taking these treatments resulting in a poor quality of life. This being a source of frustration for many healthcare professionals, as hay fever is a condition that can be effectively treated and cured with the treatment options available today.
Do you think that the problem is getting worse and, if so, why?
Yes, I believe that over the last 20 years, the number of people suffering from hay fever has increased. Unfortunately, in the UK at least, the systems are not in place to provide adequate treatment, care and support for them all. Now, people are also getting hay fever for the first time at an older age, including in their 30s, 40s and even 50s.
The increasing incidence of hay fever is concomitant with the increasing levels of grass pollen over the last few decades. The pollen season is also getting longer, with wetter, warmer, earlier springs, possibly attributable to changes in our weather patterns.
From your experience, how does hay fever affect a sufferer's ability to go about daily life?
Hay fever symptoms include coughing, headache, stuffy and runny nose, wheezing and sore throat. These symptoms will often lead to the patient having a reduced quality of life, causing other symptoms not often associated with hay fever such as tiredness and anxiety. For patients suffering from hay fever it is like having a severe cold for three continuous months over the summer - a time that is meant to be the best time of year for most people. These symptoms can cause absolute misery for many people. A number of my patients are school or university students and, although they work hard, they are always very anxious that their hay fever might affect their performance during exams, which usually take place in the hay fever season.
Immunotherapy offers hope for many such patients by combating the underlying cause of their hay fever. The efficacy statistics are good, but no-one can deny the experiences of real patients, such as mine. If they did not believe that this treatment would have an overall beneficial impact on their daily life, busy people would not go back for regular injections, taking time off work, missing important meetings, sometimes traveling long distances. The availability of the tablet-based immunotherapy called Grazax will be a dream come true for them - highly effective and extremely convenient, as, for the first time, it offers patients immunotherapy at home.
'One of my patients is a dentist and one day at work, his nasal secretions dripped onto his patient's lapel! It was at that point that he realised he had to get his problem fixed - there was no way he could not go to work, but his hay fever was seriously affecting his ability to do it properly.'
Do you feel that this impact on quality of life is underestimated by the general public and physicians?
My patients often complain that their friends and work colleagues are unsympathetic and don't appreciate how unwell they are feeling. After they come to us, they are so relieved and grateful when we listen to them and let them know that we understand what they are going through as hay fever sufferers.
A lot of my patients have suffered with hay fever for years, and every time they go back to the General Practitioner (GP) to let them know that their antihistamine medication isn't doing anything to relieve their symptoms, they are just prescribed yet another symptomatic medicine, which does not work for them.
In the UK, GPs are discouraged from making "too many" referrals, and so it takes a long time for patients to reach us at the specialist clinic. More often than not, it is the patient who has heard about us in the media and who "insists" on a referral from their GP.
As I have already mentioned, the availability of tablet-based immunotherapy products is a huge ‘breakthrough' in the management of hay fever enabling many more hay fever sufferers to benefit from immunotherapy in the comfort of their own home, as opposed to receiving subcutaneous immunotherapy injections under specialist supervision. Such products will offer many more patients an improved quality of life.
Do governments give hay fever sufficient prioritisation as a health issue?
No; this is definitely still an issue. In the UK, the Health Select Committee recently recommended that allergy provision be overhauled. The government has launched an investigation into the matter, but has not, as yet, provided any solutions. GPs have very little training in allergy management and best practice, and, in the UK, there are an incredibly small number of allergy specialists.
The problem is that decision makers, like many other people, underestimate allergies; as they are not deadly diseases, they are given a low priority. However, what they fail to realise is that mild allergies often progress to more serious illnesses. Many babies have eczema that might then develop into food allergy and allergic rhinitis as they get older, and, in a proportion of people, allergic rhinitis subsequently leads to asthma. If the allergy is treated at an early age, then this could prevent the onset of asthma, prevent years of reduced quality of life, and ultimately save the health authorities a lot of money!
In your view, what can/needs to be done to halt the European hay fever epidemic?
Education is so important. There needs to be a greater awareness of the incredibly high prevalence of hay fever and its detrimental impact on quality of life. Doctors, decision makers and the general public should be educated on the link between hay fever and asthma, in order to make more people stand up and take notice of how important it is to control hay fever at an early stage.
Training programmes should be set up across Britain, with groups of allergy specialist doctors or nurses training the GPs in the respective counties. This could take the form of a" roadshow" with specialist visits to various GP clinics. Recently, we have helped to set up an Allergy Network, which provides support for GPs in my area and into Essex. Doctors also need to be trained on the recent advances in immunotherapy, including the new tablet.
Find your local specialist allergy clinic on http://www.bsaci.org/
A GP referral is required to such clinics.
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