Allergies, the “endless season” is coming. Today it is possible to intervene with targeted therapies

Every year the sneezing season starts a little earlier: climate change is bringing forward and even lengthening the difficult months for allergy sufferers. With the constantly rising temperatures the flowers bloom earlier, the greenhouse effect increases the production of pollen and so over the last thirty years it has been estimated that the allergy season yes it is extended on average by about twenty days. Twenty more days of runny nose and sneezing for
a continuously growing group of people: in Europe the prevalence of
allergic rhinitis it is around 23 percent, in Italy the estimates are between
16 and 25 percent but as he explains Giorgio Walter Canonica of society
Italian Institute of Allergology, Asthma and Clinical Immunology (SIAAIC) «according to the
projections, between 35 and 40 percent of the Italian population will suffer from
allergic rhinitis by 2030».

The appeal of scientists

Also for this reason a group of scientists at the beginning of April
from all over the world signed an appeal, published in Frontiers in Science, for the mitigation of the impact of climate change on diseases with an immune component: «Global warming is changing the exposome, i.e. the set of environmental factors to which we are exposed. The greatest incidence of extreme climate events puts the immune system is under stresspollution and the increase in pollen increase the probability that the defensive barrier of the skin and mucous membranes will be altered, the loss of biodiversity and the reduced exposure to germs due to the current lifestyle are altering the balance of the immune system: the result is a greater risk of allergies, autoimmune diseases, tumors», write the experts.

Mitigate pollution

The way out, in the face of a climate gone mad and human health at risk, should be a “global effort tothe pollution mitigation and adaptation to the new conditions of the planet”, as the representatives of the main world allergy scientific societies write in the recent document. It is certainly not a trivial task and as Canonica explained during a meeting dedicated to respiratory allergies of Assosalute, the National Association of self-medication drugs part of Federchimica, «We must face spring with fingers crossed: if the trend continues, also thanks to the levels of air pollution, it will be a season with a big impact on those who are allergic.”

A perennial season

A season that for many is becoming perennial or almost: with thelengthening of the pollination months due to the average higher temperatures, those who are allergic to parietary for example today he deals with the symptoms from February to November. The increase in pollen due to climate change, however, is only part of the problem, because many factors contribute to the greater discomfort of allergy sufferers and the increase in the number of patients, as Canonica specifies: «Allergies are not inherited, we inherit a predisposition to develop them. The problem is that the world we live in seems designed to make us allergic: today we know that the first step towards an allergy isalteration of barriers which protect us from contact with the outside, in fact the skin and the epithelium (lining tissue, ed) of the gastrointestinal tract. Pollutants of all kinds to which we are exposed, from atmospheric smog to microplastics, they also damage epithelia and mucous membranes and favor the entry of allergens into the body, facilitating the development of allergic sensitization. Among other things, the more pollution increases, the more damage to the mucous membranes becomes important, which further contributes to enhancing the abnormal immune response that leads to allergy symptoms.

The role of food

«It's not enough: even an incorrect diet (for example the “Western” diet, which is increasingly widespread and deviates from the Mediterranean diet by making extensive use of processed industrial foods, ed), altering the composition of the intestinal bacterial flora modifies the mucous membranes of the digestive tract, also in this case favoring the passage of allergens and the appearance of one abnormal immunological response. It can even happen to older people: an onset of allergic rhinitis can occur even at the age of 70 and it is good to be aware of this so as not to underestimate the symptoms and arrive at a correct diagnosis. The environment around us has changed a lot and now any time is a good time to become allergic”, continues Canonica. «Since the end of the pandemic there has been an explosion of respiratory allergies, especially among young people and children but also in adults: for a long time the mask had a protective effect from the inhalation of pollen, allergens, viruses and pollutants.”

A Trojan horse

As if that wasn't enough, it seems that pollen can trigger symptoms even in those who are not allergic, by attaching themselves to pollution particles: this was demonstrated some time ago by research from the Max Planck Institute in Mainz, Germany, observing that pollen can act as a vehicle for ozone, nitrogen dioxide and particulate matter which are thus transported and released deep into the airways. «The pollen from polluted areas are covered in harmful substances that alter their allergenic content and can strengthen their effect, causing allergic reactions more easily in anyone», comments Mario Di Gioacchino, Siaaic president. «Nitrogen oxides and ozone, in high concentrations, alter the protein components of pollen grains to the point of triggering rhinitis and coughs even in those who are not allergic: some pollens, for example those of grasses, trigger thehyperactivation of cellular receptors which trigger the immune system's reaction, regardless of whether you are allergic.” In short, the panorama is gloomy, considering that not much can be done to prevent allergies other than trying to have a healthy lifestyle, spending as much time as possible where the air is clean and perhaps taking out the mask again when we are forced to stay for a long time where the pollution is almost “tangible”.

The bulletins

Who already is allergic person can take specific precautions, for example by consulting the updated pollen bulletins: the service is offered by many Regions, otherwise you can consult the website www.pollinieallergia.net of the atmospheric monitoring network of the Association of Italian Territorial and Hospital Allergists and Immunologists. Also pay attention to the weather, because when they are there thunderstorms or downpours with lightning pollens can break down and enter deeper into the airwaysgiving more intense symptoms.

Molecular analyses

The first rule, however, is to treat yourself well after receiving a correct diagnosis. «Many still underestimate the symptoms and the importance of a thorough evaluation, which it is no longer the one with simple allergy tests on the skin», underlines Canonica. «Today, with a blood sample and extended molecular tests, just under 300 antigens can be analyzed and discovered cross allergies (when the allergy to a pollen is associated for example with a food allergy because pollen and food share similar molecules, ed), thus giving more precise indications to protect oneself from the appearance of symptoms, but above all having the possibility of drawing aspecific immunotherapy for the antigen that causes discomfort more than all the others.

How immunotherapy works

Today immunotherapy for pollen allergies (which consists in slowly “re-accustoming” the immune system to tolerating them by exposing itself to gradually increasing doses, ed) it's simple, it's done for sublingual route and has affordable costs, which in some Regions are fully or partially reimbursed; above all, can change the course of the disease because it has long-term effects, allowing you to maintain tolerance even up to five or eight years after discontinuing the treatment. This radically changes patients' quality of life and decreases the use of other drugs. Specific immunotherapy would be indicated for all pollen allergy sufferers in the absence of severe asthma, which must first be kept under control with biological drugs in order to then be able to start immunotherapy; however, it is estimated that around one allergy sufferer in ten follows it, especially because many do not know it or think that it is still a matter of getting an injection a week.” The majority therefore manage the allergy with antihistaminessometimes with nasal decongestants which, however, as Canonica underlines, «in the long run can cause problems. Allergies have an inflammatory basisfor this reason the most valid therapy, especially in moderate and severe cases of allergic rhinitis, is combination of steroids and inhaled antihistamines, also effective on conjunctivitis. Self-medication drugs can be helpful, but their use must always be managed with the help of the doctor”, concludes the expert.