Allergies : Epidemic in sight, Research needed

An epidemic extension

In the Black book of allergies (L’archipel, Paris), the allergologue Pierrick Hordé speaks of an epidemic in explosion. WHO anticipated that half of the Western population in 2050  will be victims of allergies of all kinds (respiratory, food, professional). There are today in Europe 150 million allergic people. Moreover, symptoms (rhinitis, conjunctivitis, exemas) are not necessarily taken into account and allergic rhinitis evolve almost half the times to asthma, still too often underdiagnosed. However, recalls Mr. Horde, in the 1970s,  there were little discussions  about allergies. It has become a phenomenon of civilization and such an explosion has to be explained by environmental factors and lifestyle changes.

 

The air pollution plays an important role, particularly in allergy to pollen where pollen and particulate form what Mr. Hordé called an "explosive cocktail". Fine particles increase the irritability of the mucous membranes; in addition they attach to pollen and make them explode, thus facilitating their deepest penetration in the bronchi and the leaching of allergens. Often overlooked, indoor pollution is five to seven times greater than outdoor pollution and represents a real scourge on public health; ANSES spoke of 2,000 deaths in France and WHO of 4.3 million annual deaths compared to 3.7 to air pollution. The pollutants involved are volatile organic compounds, particularly formaldehyde and other aldehydes, present in paints, adhesives, wood agglomerates, detergents etc, mites and very often, tobacco residues _ thus,  prohibition of smoking in car is a good decision. Dr. Hordé also called to be wary of products and supposed aor purification devices that often worsen the situation: candles, incense, oils, aerosols also often contain harmful volatile organic compounds and he denounced a lack of regulation and often misleading ones. The only and true measurement consists in the daily ventilation of dwellings. Cosmetics must also be monitored, (and bio cosmetic labels provide no guarantee as to allergies! – peanuts allergens are natural as well as poison ivy)). UHT sterilization methods, preferable, are now more often used. Schools are a point obviously important, critical and disturbing. Inserm has conducted a study on the quality of the air inside 108 primary schools in 6 cities: 30% of the children are exposed to levels of major air  pollutants  higher than values guides recommended by WHO and ANSES - and this exposure is associated with increased asthma and rhinitis among schoolchildren. Many improvements are possible on the living environment. Authorities still  need to take the measure of the severity of the allergic outbreak and this is an area a bit neglected, perhaps because involving very complicated research.

Immunologists and allergologues_ take allergy seriously

One point is quite symbolic: in France, the allergy is not a medical specialty recognized and taught as such, unlike in most European countries; on the contrary, Immunology (notice the difference allergologue/immunologist, the iste is immediately more serious than the logue) with well recognized scientific basis - and it must be said that, since Pasteur, the France has a beautiful and strong tradition in this area of Immunology. Immunology deals with very serious problems: vaccines, releases of transplantation, autoimmune diseases, rheumatoid arthritis. In all these areas, huge progress has been made - in the last, drugs more effective and better tolerated than antibodies, such as the filgotinib of Galapagos are developing. On the other hand, the allergy would deal with small harms , poorly defined, affecting very different organs, often in relationships with the environment, which simplifies nothing; It is exploded between pulmonologists, pediatricians, dermatologists, the oto-rhino-laryngologues...).

Except that allergies get worse in severity and number of persons concerned, to become the threatening epidemic I mentioned at the beginning of this blog. Immunology relies on a strong basic research, the allergy seems to be based on more or less assessed empirical practices. So, it is time that the allergology becomes a discipline recognized that can rely on a basic powerful search, to work better together immunologists and allergologists and give the means to seriously fight the extension of the announced allergy epidemic and of better care for the many allergic.

We do not well understand the links between Immunology and allergy. Apart from the environment, the development of hygiene which resulted in early childhood reduced contact with many allergens, at a point where the immune system educates seems to play an important role in the allergy epidemic. This was already suggested by studies showing that children raised in farms in contact with animals would then become less allergic. A recent study of 650 children followed from birth to five years (Du Toit and al.) New England Journal of Medicine, 372, 803, 2015) shows that even in the case of allergens very powerful as the peanut, early exposure between four and eleven months allows to significantly reduce the number of people suffering from allergies. even when infants seem to be sensitized to peanuts. There is therefore an age window during which diversify food and contacts allows natural desensitization.