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Lifting The Lid on the Allergy Epidemic
|Allergy and Allergy Like Health Conditions - Allergy Epidemic|
LIFTING THE LID ON THE ALLERGY EPIDEMIC
Dorothy M Bowes, October 2010
Allergy can be a chronic, debilitating disease that reduces quality of life, it can cause problems such as poor sleep, irritability and affect behaviour and learning. Some allergic conditions include food allergy, anaphylaxis, asthma, hay fever, rhinitis, sinusitis, eczema, allergic contact dermatitis, allergy to insect bites/stings, angioedema (localised swelling) and conjunctivitis (ASCIA, 2010). Allergy as a public health problem has increased dramatically in the population in recent years. The Australian Society of Clinical Immunology and Allergy( ASCIA), have described the rising incidence of allergy in Australia over the last twenty five years as epidemic, with Australia and New Zealand currently having the highest rate in the world.
Existing statistics for allergy are likely to be conservative as most statistics are gathered from hospital discharges or population surveys that depend on self reporting. Many allergy sufferers do not become inpatients in hospitals; instead, they may consult an allergist, immunologist or GP for treatment and would not be taken into account in hospital statistics. Gaps in statistics can also occur because while allergy can be a chronic health problem, not everybody acknowledges they have the problem, or seeks a medical diagnosis and help. Whether or not treatment is sought would depend on the severity of the allergy and its impact on quality of life. Individuals may know, or suspect they have allergy, but some continue to itch, wheeze, snuffle, cough, or blow copiously and put up with symptoms rather than treat the problem. Others deny suffering from allergy and while it is clear that they do, it is a case of either not wanting to acknowledge the problem, or not recognising the problem as an allergic condition e.g. they are adamant they do not have allergy but suffer from obvious eczema, asthma, sinusitis or some other allergic condition.
There are many manifestations of allergy and it is interesting that ‘Asthma, hay fever and "allergy" comprise three of the top six most common long-term self-reported illnesses in Australia’ and most allergy sufferers usually have more than one allergy problem (ASCIA, 2010).
THE BURDEN OF ALLERGIC DISEASE
Some prevalence data
According to ASCIA:
• ‘Of children aged 6-7 years, 1 in 6 have eczema, 1 in 10 have allergic rhinitis or asthma, and approximately 1 in 50 infants are estimated to have food allergy.’
• 4.1 million Australians (19.6%) have at least one allergy
• The highest prevalence is in the working population, with 78% of those with allergy aged 15-64 years
• The average allergic person has 1.74 allergies. i.e. most people suffer from more than one condition at the same time e.g. hay fever and asthma, or food allergy and eczema
• If current time trends continue, there will be a 70% increase in the number of Australians affected by allergy from 4.1 million now to 7.7 million by 2050, and an increased proportion affected from 19.6% to 26.1% .
• Not only does Australia have one of the highest incidences of allergic disorders in the developed world, but recent studies have demonstrated a doubling in some conditions such as allergic rhinitis (hay fever), eczema but more recently, potentially dangerous anaphylaxis (mainly due to food) as well. Asthma, hay fever, chronic sinusitis and "other allergy" comprise 4 of the top 10 most common long-term self-reported illnesses in youth aged 12-24 years in Australia (ASCIA, 2010).
What does allergy cost?
• The financial cost of allergies in 2007 was $7.8 billion, with lost productivity and health system expenditure the major contributing factors.
• The estimated cost to Australians who suffer from allergy due to reduced quality of life (the "burden of disease") is estimated at $21.5 billion, approximately double the estimated figures for arthritis ($11.7 billion) and hearing loss ($11.7 billion).
• In 2007 the calculated cost of allergies was $7.8 billion.
• This is due to lower productivity ("presenteeism" $4.2 billion), direct medical costs ($1.2 billion) lower employment rates ($1.1 billion), absenteeism and lost household productivity ($0.2 billion) and premature death ($83 million).
• Individuals with allergies and their families bear 49% of the financial costs of allergic disease.
• Patients with allergies spend over $120 million/year on across the counter allergy medications
• If the cost of wellbeing is included, then allergic patients bear 86% of the costs (Access Economics, 2007).
Allergy is a major public health problem
Clearly, allergy is a problem that affects a large percentage of the population, costs a lot in terms of health spending and lost productivity. As a public health problem, allergy does not receive the attention it needs from government and health authorities. Those responsible for planning and public health need to be making a greater effort to deal with allergy and remediate its causes - as a priority.
WHY IS ALLERGY INCREASING
Allergy can be caused by sensitisation or can be an inherited characteristic (atopy). Some known factors that can cause or contribute to allergy in the population are climate change, outdoor air pollution, indoor air pollution, food, food additives, risk factors such as smoking, exposure to allergens and chemical substances that are known sensitisers e.g. sulphur dioxide or can enhance IgE production. There is also evidence to suggest that some viral infections can ‘trigger exacerbations of asthma and may also contribute to allergic sensitization to aeroallergens and the development of asthma’ (Schwarze J and Gelfand G W, 2002).
Climate change is a considerable threat to human health. Should the current emissions and land use trends continue, future generations are expected to face more injury, disease and death related to natural disasters such as heat waves, floods, wide-spread malnutrition, climate-related infections e.g. from insect borne viruses, and ‘more allergic and air pollution-related death and disease’ (Shea KM et al, 2008). Some diseases associated with air pollution include cardiac disease, diabetes and cancer as well as increases in allergic diseases. Air pollution has also been linked to premature births and low birth weight babies. Children born prematurely are more sensitive to the respiratory effects of air pollution. (For those interested in research on these topics Environmental Health Perspectives provides open access to much information. Environmental Health Perspectives is the website of the peer reviewed journal of the US Institutes of Environmental Health Sciences and can be found at ehp03.niehs.nih.gov/).
Medical researcher Dr Paul Beggs of Macquarie University, winner of the Australian Museum’s 2009 People Choice Awards for his work exploring climate change asthma and allergy, has found that increases in levels of carbon dioxide (CO2) in the atmosphere, higher temperatures and changing rainfall patterns are directly influencing the incidence of allergens. He is exploring stress on plants from the impact of warming and CO2 and the role these play in increasing the allergenicity of food plants such as peanuts (Australian Museum, 2009). Dr Beggs’ work is expected to lead to wider investigation e.g. climate-based seasonal forecasting of allergen activity.
Ragweed is a major allergen that affects many people as it produces large amounts of pollen that are carried hundreds of miles on breezes. In the USA, Dr Clifford Bassett, allergist at Long Island College Hospital claims that ragweed is affecting more and more people and in the past three years he has seen around fifty percent more new allergy patients. The increases included adults and children.
Scientists believe that the increase in pollen allergy is caused by climate change because as the planet warms, weeds grow faster and they produce more pollen making allergies and asthma worse across the country. The American Academy of Allergy, Asthma and Immunology (AAAAI) in the September issue of the Journal of Allergy and Clinical Immunology have decisively linked climate change to longer pollen seasons, greater exposure and an increased burden of disease. The US Department of Agriculture research showed increased plant size, greater amounts of pollen and early research suggest that the pollen is more allergenic (Stone G, 2008)
The air we breathe has been linked to allergic disease for many years now with most studies concentrated on hay fever and asthma. There have been numerous studies that show living by freeways and heavily trafficked areas impacts on asthma, especially in infants. Hay fever, once rare in Japan is now common and affects those living in Japanese cities and near highways. As allergic disease has increased in the developed world and is less common in undeveloped countries, this indicates that modern urban life promotes allergy.
Pollutants such as ozone, sulphur dioxide, nitrogen dioxide and fine particles are responsible for much disease and have been shown to be hazardous to adults and children with asthma. There is thought to be a link between diesel exhaust particles and the world wide increase in respiratory allergies. Diesel particles have been shown to enhance the production of immunoglobulin E (IgE) in response to allergen exposures (Szeftel a, 2007).
Indoor air pollutants are also implicated in allergic disease. Cigarette smoke is an important indoor air pollutant that is associated with allergic sensitisation, asthma and other respiratory diseases. Cigarette smoke enhances the body’s ability to produce IgE which attaches to other allergens such as pollen and dust mite to produce allergic reactions. Parental smoking increases the risk of children developing respiratory diseases such as bronchitis, chronic cough and asthma. Smoking during pregnancy and breastfeeding results in a higher risk of children developing allergic eczema. The rate of asthma in infants of smoking mothers is double that of mothers who do not smoke (Szeftel A, 2007).
Some other indoor air pollutants that can cause or exacerbate allergic disease are:
• Volatile organic compounds (e.g. formaldehyde, benzene, xylene, fragrances) in the indoor environment from products such as adhesives, building products, furnishings, carpets, fragranced products, personal care products, disinfectants, cleaning products, laundry detergents. Fragrances are mixtures of chemicals, largely solvents, that add to overall VOCs in indoor air at levels that are sufficient to cause health impacts in humans e.g. nasal allergy, asthma, other respiratory disease. Many VOCs are sensitisers so can actually cause allergic disease as well as trigger reactions in sensitive individuals.
• Nitrogen dioxide (NO2) from domestic gas appliances adds to the overall level of NO2 that already exists in indoor air. Studies show that exposure to NO2 may promote sensitisation that results in allergic airway disease in response to allergens and can occur several days following exposure to NO2 (Bevelander M et al, 2007)
• Allergens such as mould, dust mites, toxic chemicals. Mould and dust mites are common allergens. It is anticipated that increased temperature, moisture and humidity will promote the growth of mould and as mould and house dust mites coexist there will be higher dust mite counts that can affect more individuals. Household dust is a source of many allergens and many chemical contaminants.
Infants are at increased risk of allergic diseases and accumulating a body load of chemicals because their systems are immature. They crawl on the ground, engage in hand-to-mouth behaviour, ingesting and inhaling allergens and toxic chemicals which can adversely affect the immature and developing immune, endocrine and other systems of the body. More recently the flame retardant PBDE has been found in infants in similar concentrations to those found in household dust (EWG, 2010). This can set the stage for chronic ill health all of life. As there are now in excess of 100,000 man made chemicals in our environment and this increases at the rate of several hundred per year, the risk of poisoning and pollution increases as the numbers rise. It would be naïve to think that man made chemicals are not polluting the earth and impacting on human health. There is a considerable body of data to show chemicals are poisoning humans with some accumulating in the human body.
While food is a daily necessity, it can cause distressing, sometimes dangerous reactions and chronic ill health. Allergic reactions to food can cause a rash around the mouth, redness and swelling of the face. More severe reactions can include hives, angioedema (localised swelling), breathing difficulties, vomiting and anaphylactic shock that can result in death. Food allergy can also appear as eczema and asthma where the relationship between food and the chronic disease is not always obvious. The main foods involved in food allergy are peanuts, tree nuts, egg, milk, seafood, sesame, wheat and soy (ASCIA, 2010).
Cross reactivity between pollens and food allergens is another factor influencing food allergy and as studies show that levels of pollen and allergen production in plants is intensifying, it is reasonable to assume that the allergenic component of plants may be in part responsible for some increases in food allergy. However, there are other components that can also contribute to allergic reactions, these include naturally occurring chemicals in food, food additives and contaminants such as pesticides, heavy metals and packaging materials e.g. BPA. Other factors for which the impacts on human health are unknown include gene technology and more recently nanomaterials.
Food intolerance/food chemical sensitivity
Chemicals occur everywhere in nature including in food with some food chemicals such as vitamins and minerals being important to nutrition and good health. Other naturally occurring food chemicals are phenolic compounds such as the aspirin like salicylates, vasoactive amines and MSG. These can work in various ways; they can affect many systems of the body and provoke urticaria, eczema, irritable bowel, migraine, lethargy, myalgia, rhinitis, mouth ulcers, asthma and impact on behaviour and learning (Loblay R H and Swain A R. 1986). Phenolic compounds in foods are responsible for flavour and aroma among other things and generally, the stronger the flavour and aroma, the higher the level of phenolics and the greater the likelihood of provoking a reaction in sensitive individuals. It is reasonable to assume that climate change is impacting on the intensity of these naturally occurring food chemicals as it has on allergens and their impact on the population may be greater reactivity and higher levels of allergic disease. More information on food chemicals and additives can be found at the RPAH Allergy Clinic www.sswahs.nsw.gov.au/rpa/allergy/ and FINA at www.fedupwithfoodadditives.info/
We cannot look at these naturally occurring food chemicals without considering man made additives that are similar in structure to naturally occurring chemicals, fulfil similar functions i.e. preserve, flavour and colour food and cause reactions, in the same way as their natural counterparts. Benzoate is a typical example. It may occur naturally in fruits and fruit juices and is also added as a preservative in processed fruit juices and many other foods. Many people already react to food additives and should the naturally occurring levels of phenolics increase we may be consuming more than the recommended daily allowance and increasing the risk of adverse reactions. Most foods on the supermarket shelves these days contain food additives and it is easy to exceed recommended daily allowances, so these must be included in factors that can increase allergic disease.
Another factor that must be taken into account is cross reactivity between naturally occurring chemicals in food and food additives. It is known for instance that salicylate is one of the most widely distributed and reactive of natural food chemicals that is associated with allergic disease. What is not widely considered is the cross reactivity between salicylates, benzoates and tartrazine other food additives and other allergens in food. Loblay and Swain estimated in 1986 that an average Australian diet contained up to 100g of natural salicylate per day, which is sufficient to cause symptoms in sensitive individuals. If we consider that food allergen levels are higher, salicylate levels are also higher due to climate change, plus man made added chemicals of similar structure in more foods, cross reactivity between them and other contaminants e.g. pesticides, then we can almost certainly be looking at resultant higher levels of allergy and perhaps high enough with other factors to be impacting on those with no existing allergy or inherited predisposition
Pesticides are widely used in modern society. We spray them in our homes, home gardens, on food crops, in the wider urban environment for weed control, mosquito and other pest reduction programs and they are present in our drinking water. They are everywhere. For more information on pesticides see ASEHAs leaflet produced by Dr Sharyn Martin, PhD ‘Pesticides they’re everywhere’ www.aseha.org.au
Some pesticides e.g. pyrethrum (natural or manmade) are sensitisers and are known to trigger allergic reactions such as asthma and skin reactions. Other pesticides that are known allergens are: allidochlor, anilazine, antu, barban, benomyl, captafol, captan, dazomet, dichloropropane, dichloropropene, lindane, maneb, nitrofen, propachlor, pyrethrum/pyrethroids, rotenone, thiram, zineb (MUSC, 2010). In many cases pesticides are irritants although some penetrate the skin, can cause sensitisation and allergic reactions. In the indoor environment, pesticides can add to the overall levels of VOCs that can impact on occupants and cause or contribute to allergic disease.
There are many substances in water that can cause or contribute to allergy. One of the most irritant of additives to water is chlorine which is a known respiratory irritant and in the long term can cause skin sensitisation (ICSC 0482) . Chorine can also cause eye irritation, dry skin, coughing, sneezing, stuffy or itchy nose which may be symptoms of an intolerance to chlorine rather than a true allergy. Chlorine can also react with other chemicals in water to cause reactivity and increase the risk of allergy. However, more recently in Brisbane we had fluoride added to our water supply and fluoride allergy has been reported. Many have had to purchase bottled water to avoid unwanted allergy but this does not help with skin reactions that occur when bathing or showering.
Some other chemicals in our drinking water include aluminium and lime which are added as flocculants to clear the water following the addition of fluoride which sends the water cloudy; pesticides and other farm chemicals e.g. phosphates, nitrates; pharmaceuticals; chemicals from personal care products such as perfume, deodorants, cosmetics, hair products etc; cleaning chemicals e.g. disinfectants, detergents, laundry products, deodorisers; industrial chemicals such as benzene,Teflon, brominated flame retardants, plasticisers e.g.. xylene, toluene, BPA, phthalate and many others; waste products from recycled water that are not removed by filtration e.g. bacterium and nanomaterials. While these are anticipated by public health authorities to be at levels that are not harmful to humans, they do not take into account the long term, low level exposure of what is a potentially dangerous MIXTURE of chemicals. Not only are these in our drinking water but many are in our air and food as well.
One does not have to be a genius to see that increasing levels of allergens together with man made pollutants and irritants is having a major impact on our lives and allergic disease. We just need someone to put it all together and do the necessary studies to provide irrefutable proof. Until this happens people will continue to suffer from increased allergy and other diseases such as chemical poisonings associated with man made pollutants and climate change. We may even see a decline in humans as per wildlife and other species.
ASCIA. 2010. Is it Allergy. www.allergy.org.au
Access Economics. 2007. Report to ASCIA: Economic Impact of Allergies. www.allergy.org.au
Australian Museum. 2009. People’s Choice Awards. Dr Paul Begg. Global allergic reaction. www.eureka.australianmuseum.new.au
Bevelander M et al. 2007. Nitrogen dioxide promotes allergic sensitisation to inhaled antigen. Journal of Immunology 179:3680-3688 www.jimmunol.org/cgi/content/full/179/6/3680
Environmental Working Group. 2010. In the Dust. www.ewg.org
ICSC 0482. International chemical safety card 0482, 1999. International Program on Chemical Safety. http://www.inchem.org/pages/icsc.html
Lobaly R H and Swain A R. 1986. Food intolerance. Recent Advances in Clinical Nutrition 2:169-177
MUSC, 2010. Allergy and pesticides: Ten questions and answers. Medical University of South Carolina. Agromedicine program. http://www.musc.edu/oem/pestallr.html
Shea KM, Truckner RT, Weber RW, Peden DB. 2008. Climate change and allergic disease. J.Allergy Clin.Immunol 122(3):4434-53, 2008
Stone, G. 2008. Research links allergies to climate change. ABC News September 8 http://a.abcnews.com/Health/Allergy/Story?id=5752549&page=1
Schwarze J and Gelfand G W. 2002. Respiratory viral infections as promoters of allergic sensitisation and asthma in animal models. European Respiratory Journal 19(2):341-349 http://erj.ersjournals.com/content/19/2/341.full
Szeftet, A. 2007. Air pollution and allergies: A connection? MedicineNet.com. 3rd May 2007. http://www.medicinenet.com/script/main/art.asp?articlekey=17112
Last Updated (Wednesday, 12 October 2011 03:16)