Why are there more and more allergies? What types of allergies have increased the most?
There are multiple factors involved in allergic diseases as a whole. There is the genetic predisposition of each person, the exposure to infections, the variety of bacterial flora, the exposure to pollutants such as gases from vehicles, and specifically the climate where the person lives and the place of residence, whether in the countryside or in the city. In addition, it must be taken into account that allergic diseases are chronic processes and patients need to consult frequently during the whole process of their allergic disease.
In Europe, allergic diseases affect 25-30% of the population. Patients with higher social status have more symptoms of atopic dermatitis, rhinitis and asthma due to less exposure to microbes. In recent years, allergic pathologies have also increased in the middle class and in the most disadvantaged population presenting severe asthma, helped by factors such as tobacco and humidity, which favor indoor allergens such as mites, fungi, animals, contamination by fuels, viral infections, etc.
Allergic rhinitis is the most prevalent pathology in the adult population. And atopic dermatitis affects mostly children. The higher incidence of allergy in the population is due to the reduction of the diversity of the microbial flora of the intestine, due to the reduction of environmental exposure to bacteria and fungi in childhood, as well as the low dietary diversity in early childhood, not favoring the proper development of the immune system.
We are facing a second allergic wave that is developing allergies to certain foods (peach, kiwi, shellfish, nuts, etc.) in developed countries.
Will the weather in recent months, with abundant rainfall, make the effects of allergies stronger?
Precipitation before spring favors a greater growth of vegetation during spring and therefore an increase in pollination. In contrast, rain during the spring cleans the pollen from the pollen environment and reduces pollen allergy symptoms. For adequate pollination, mild average temperatures are needed, especially for olive, grass and weed pollens such as salsola, parietaria and artemisia. Cypress pollen is winter pollen and needs cold temperatures.
Can the use of masks reduce the effects of spring allergies?
This year, with the use of the masks, a huge reduction in respiratory infections of the common flu has been observed, and also in bacterial infections in patients with bronchitis. In addition, during the previous year’s confinement, patients reduced their exposure to pollens, and the intensity of allergic symptoms was lower.
The pollen grain can have a size between 20 to 40 microns. Therefore, to prevent the passage of pollen into the airway we must have masks with smaller pores. Surgical masks are not useful. We must use masks FFP2 at least, or masks with filters for pollens and mites such as 3M. Both are sold in pharmacies.
What other measures of prevention against COVID favor this fact?
The use of eye protection goggles in COVID also reduces exposure to pollen at the ocular level. Confinement and currently less exposure to open air has favored that patients are not exposed to external allergens such as pollens and fungi.
Hand hygiene has prevented other respiratory tract infections that can develop asthma in allergy sufferers, or sinusitis in patients with rhinitis and even infectious conjunctivitis from scratching their eyes. And we have also reduced the number of maneuvers to bring allergens, such as animal dander and other mite particles, to the face with the hands.
Some people are allergic to the masks themselves. Why is that?
More than allergy, what we have observed on occasions is an increase in facial dermatitis, due to the accumulation of nasal secretions in patients with rhinitis and greater humidity and less skin perspiration, favoring dermatitis in predisposed patients.
What symptoms warn of a reaction to masks?
In addition to the limitation to free breathing in all patients, patients with dermatitis present facial redness in the area where the mask is applied, and itching in the same area of the face. After removing the mask, it is important to perform a good skin hygiene and apply a facial moisturizing cream.
The use of the mask is a small inconvenience that provides a benefit to society by avoiding a generalized spread of COVID-19.
Do patients still confuse allergy symptoms with COVID-19 symptoms?
Allergy patients with more than one year of evolution know how to properly differentiate between allergy symptoms and COVID-19. Allergic symptoms are seasonal according to pollen or dust mites as examples, and are usually associated more with itching and sneezing. And when they present asthma, cough is more associated with efforts and with “wheezing” or whistling and asthma is not accompanied by fever or muscular pain.
It is true, however, that patients come to your office referring to a distancing from other people when they have sneezing spells due to allergies or coughing attacks.
Have you seen a reduction in the number of visits to your practice for fear of COVID contagion?
During the weeks after Christmas, with the third wave, in public hospitals face-to-face care was suspended, except for urgent and serious situations, and in private hospitals there was an increase in non-face-to-face consultations by telephone. However, in private hospitals, patients requiring face-to-face complementary tests were attended, although many patients cancelled or did not attend appointments for fear of contagion.
What advice would you give a patient to try to reduce the effects of allergies?
Depending on their allergic cause, they should take appropriate avoidance measures.
The pollens that we can observe in each month depend on the type of pollen and the atmospheric conditions. It is necessary to protect yourself with masks or avoid going outdoors during windy days and early in the day and in the evening when the highest levels of pollen are found in the air.
In the winter months, cupressaceae (cypress, juniper) pollens predominate. This year, cupressaceae pollen levels were lower than in the previous year. On the other hand, high levels of pollen from shady banana trees found in some streets of large cities have been collected, as well as high levels of parietaria pollen in orchard areas.
The rains before spring favor a more intense pollination. However, rain during the spring cleans the pollen from the environment. We could obtain high levels of grass and olive tree pollens in the next two months; in June and late summer, important levels of salsola pollen can be reached.
Mites increase inside damp houses and houses close to the sea, in basements and cellars, and also during rainy days and with the change of weather and cloudy days. For these patients, it is advisable to vacuum mattresses and sofas, and to reduce environmental humidity.
The animals that produce the most allergies are cats and horses. It is preferable, if allergic, to have them outdoors. Even so, horses can produce allergy up to distances of one km if there is wind that carries the allergen in the direction where the patient is. And the animals that are indoors and produce allergy should be taught to have their place and not to invade the rooms or other places where people sit and stay.
If despite all these measures the symptoms persist, the administration of specific immunotherapy for the allergens responsible for the patient’s symptoms should be considered.