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The high levels of pollen being experienced this season are due to a number of factors, researchers suggest.
“Firstly, higher than average temperatures last June, when the pollen is produced, allowed greater potential for high pollen levels,” explains Dr Beverley Adams-Groom, senior palynologist and pollen forecaster at Worcester University.
“Secondly, birch trees have a biennial pattern of pollen production, one mild year and one severe year – and this year was already expected to be a high year.
“Summers are often getting warmer, allowing increasing pollen production. We have already seen the hazel and alder tree pollen allergens, which flower in late winter, produce and emit particularly high amounts of pollen this year.”
Recent research led by the university found that climate change is affecting different types of pollen in different ways, with some starting earlier in the season and others becoming more severe.
Meanwhile, grass pollen – which affects 95 per cent of hay fever sufferers – shows a trend towards an earlier ‘first high day’ (i.e. when pollen levels reach the ‘high’ threshold).
Climate change link
Awareness is now growing rapidly over the link between climate change and the increase in allergies. This year’s World Allergy Week, held in June, focused on managing allergic diseases amidst environmental change.
Climate change is impacting on seasons, says Adams-Groom. “It is difficult to predict the long-term future as there are many factors at play. What we do know is that there are going to be more extreme weather events – that is documented and can impact on the seasons.”
An Environmental Sciences study, published in 2021, found that North American pollen seasons increased by an average of 20 days and became more intense (21 per cent rise in concentrations) from 1990 to 2018. Met Office data reveal there are similar findings in Europe, with knock-on consequences for greater respiratory allergies.
“As a result of climate change, we are noticing a change in our seasons. Milder winters mean the pollen seasons start earlier and last longer,” comments Margaret Kelman, acting head of clinical services, Allergy UK. “This alters the vegetation patterns and this speeds up the growing process, so plants produce pollen for longer periods, leading to longer and more intense pollen seasons.”
High allergy prevalence
It is not just respiratory allergies that are on the increase. Allergy UK statistics reveal that the UK has some of the highest prevalence rates of allergic conditions in the world, with over 20 per cent of the population affected by one or more allergic disorder. As many as 44 per cent of British adults now suffer from at least one allergy and the number of sufferers continues to grow.
“Allergies can place a huge burden on a person’s or family’s quality of life, affecting the ability to carry out everyday tasks, interrupting work or school, and having a significant financial impact,” says Kelman. “The most commonly reported impacts are disturbed sleep, reduced concentration, feeling fatigued and generally unwell, as well as the burden on mental health, including stress, anxiety and frustration.”
According to Allergy UK, almost a third of allergy sufferers have had to change their lifestyles to reduce their allergic reactions.
Anaphylaxis rising
Figures also show that hospital admissions from anaphylaxis appear to be rising – although fortunately death remains rare with approximately 20 each year in the UK, according to NICE.
Hospital admissions for anaphylactic shock in adults increased from 3,751 to 4,756 from 2019 to 2020, a jump of 27 per cent. In England alone, hospital admissions for food allergy reactions increased by 57.6 per cent between 2013 and 2019, according to NHS Digital data.
An allergic reaction is generally considered anaphylaxis when it involves difficulty breathing or affecting heart rhythm or blood pressure. The reaction usually develops in minutes and requires emergency treatment.
While common causes of anaphylaxis include certain foods, insect stings and latex, there isn’t always an obvious trigger.
Additional signs of anaphylaxis can include swelling of the throat and mouth, lightheadedness, confusion, blue skin or lips, vocal changes such as hoarse voice, difficulty swallowing or speaking, and collapsing or losing consciousness. Adrenaline should be immediately administered by intramuscular injection into the thigh, and this can be given through clothing.
MHRA guidance recommends that while waiting for an ambulance, the patient should lie flat with legs up to allow blood to flow (unless there is difficulty breathing and sitting up is easier). If needed, a second adrenaline injection can be given between 5-15 minutes after the first.
Anyone with an allergy should be pointed in the direction of resources on anaphylaxis, such as those available from Allergy UK, because, as NICE points out, “people who have had a mild or moderate allergic reaction are at risk of, and may subsequently present with, suspected anaphylaxis”.
Hay fever during pregnancy
Research involving 500 women who were currently pregnant, or who had given birth within the last five years, found that 25 per cent avoided eating nuts while pregnant in case they gave their unborn child an allergy, with gluten (20 per cent) and pollen (16 per cent) also topping the list of potential allergens avoided by mums-to-be.
A further 57 per cent were worried about passing on an existing sensitivity of their own.
Of previously pregnant women, 41 per cent suffered from hay fever yet less than a third (29 per cent) took any medication for it during the nine months because they didn’t realise they could. Just over one in five pregnant women (22 per cent) felt there is not enough information about allergens and unborn babies.
More than a quarter (27 per cent) said their hay fever got worse whilst they were carrying their child with 28 per cent saying it made them not enjoy their pregnancy. Twenty-three per cent said they spent less time outdoors in fear of symptoms flaring up and a further 18 per cent said they were less active.
Tips and advice on how to deal with hay fever during pregnancy can be found at fusion-allergy.com/drshireen.
Asthma and allergic rhinitis
Asthma remains by far the most common lung condition. In the UK, approximately 12 per cent of the population have been diagnosed with asthma and 5.4 million people are currently receiving asthma treatment, according to NICE.
Living in deprived areas can increase incidence quite significantly, according to the British Lung Foundation. This is believed to be due to higher levels of damp housing, fungal spores, pollution and exposure to tobacco smoke.
Allergens such as pollen, animal dander, dust mite faeces, cold air, respiratory tract infections, exercise and sulphite-containing foods (such as beer, wine and processed meals) can all trigger an exacerbation of asthma.
RPS guidance suggests that pharmacists can support asthma patients by advising on correct inhaler technique and identifying poor asthma control. Patients can also be counselled on their medicines and proper use. “If patients are requesting more than two blue inhalers a year, it is maybe worth suggesting that they have a follow-up with the asthma nurse or GP,” suggests Margaret Kelman.
Year-round support
In spring and summer various pollens may be largely to blame for allergic rhinitis, but there are still many asthma and rhinitis triggers during autumn and winter. Certain tree varieties, such as hazel and alder, may release pollen outside of the hay fever season. Cold, damp weather and airborne mould spores bring about their own misery for allergic rhinitis sufferers. Cold air can also trigger asthma attacks.
Just like asthma, rhinitis is a year-round condition for many patients. Some evidence suggests that indoor air pollutants can be up to five times more concentrated than outdoor air pollutants, which is alarming considering that people spend up to 90 per cent of their time indoors – particularly during colder weather. Coupled with this, global warming will also make things worse for asthma and rhinitis sufferers.
Sneezing, blocked or runny nose, and itchy and watery eyes are typical symptoms of allergic rhinitis, but headaches and sleep disturbances are also common. Antihistamines and intranasal corticosteroids remain the preferred treatment.
“The choice of antihistamine to treat hay fever/allergic rhinitis is a daily, non-sedating one,”
says Kelman.
“In terms of non-drug treatments, sterile saline nasal sprays and irrigation can help soothe inflammation in the nose and clear the nasal passages. Non-perfumed barrier balms or ointments can be applied to the rim of the nostril and help catch any allergens before they get into the nasal passages.”
A report in the Journal of Pharmaceutical Policy and Practice, published last November, specifies that pharmacists have a key role in providing allergic rhinitis management information beyond medication advice. This information includes, the report suggests, disease identification, allergen avoidance strategies, treatment risk-benefit, promoting patient self-management, patient support and follow-up care. In doing so, those pharmacists who have been trained in allergic rhinitis management improve patients’ symptom control and quality of life, the report says.
Advice on trigger avoidance that may be helpful for patients includes using exhaust fans when cooking, regularly opening windows, staying on top of damp and mould in the home and keeping pets out of the bedroom.
Eczema
As many as one in five children and one in 10 adults suffer from atopic eczema, according to the National Eczema Society. People with eczema are more likely to develop asthma. Eczema, asthma and allergies occurring together is often referred to as the ‘atopic triad’. All three conditions are caused by chronic inflammation and children with eczema are more likely to develop asthma than those without eczema.
One study (published in BMC Dermatology) found that babies diagnosed with eczema in the first two years of life were three times more likely to develop asthma and rhinitis within the next five years than those who didn’t have infant eczema.
Eczema is typically managed with non-perfumed emollients, topical steroids and antihistamines, but some people seek natural remedies like chamomile and aloe vera. As with other allergies, pharmacist support can help people manage and stay on top of their eczema.
Keeping a symptoms diary is often a good first start, to watch for any emerging patterns, but pharmacy teams can also counsel patients about using soap substitutes, avoiding stronger detergents, using gloves to protect hands, wearing natural fibres and keeping rooms cool if heat aggravates the condition.
Like eczema, urticaria – or hives – is an allergic reaction, but unlike eczema this condition may come and go. Both skin conditions cause rash-like symptoms but eczema presents most often as dry rough plaques on the skin, while hives is more likely to present as wheals or larger bumps. Treatment for urticaria is also skin soothers, antihistamines and corticosteroids.
Allergy testing in pharmacy
Allergy UK has seen an increasing demand for allergy testing,and it is a service pharmacies could consider introducing if they have seen a rise in sales of allergy treatments over the past few years.
“Allergy testing is often sought out by customers who have been suffering from repeated or continuous flare-ups from their allergy for quite some time and is affecting their day-to-day activities,” says Reshma Malde, superintendent pharmacist at John Bell & Croyden Pharmacy, which offers an allergy testing service.
Over recent years we have seen more patients with allergies coming to the pharmacy for advice and treatment, she says. “In many cases the patient/customer is unaware of the root cause of the allergy and just looking for symptomatic relief.
“Allergy testing has mainly been accessed through GP referrals to specialist allergy clinics but allergy tests are becoming more available and accessible in forms such as finger prick tests or phlebotomy blood draw tests.”
The John Bell & Croyden service uses a phlebotomy blood sample, with IgE antibodies laboratory tested for a response to one or more of 294 common allergens, ranging from fruit, vegetables, cereals, egg, milk, nuts, sea food and meat to spices, animals, insects, tree pollens, moulds and yeasts.
“Customers who have had allergy tests have often been surprised to find out about allergens that they are continually exposed to and unaware that these could be the factors causing them to suffer symptoms.”
Reshma Malde believes that as demands on NHS services continue to rise, allergy management is becoming a key area of opportunity for pharmacists.
“I believe we can further build on the allergy testing services by offering a much fuller and broader service through the introduction of independent pharmacist prescribers who choose to specialise in allergy,” she says.
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Let’s get clinical. Follow the links below to find out more about the latest clinical insight in community pharmacy.