They appeared with the development of civilization and the creation of chemicals; doctors cannot recognize many of them – acquired allergies are a real challenge for medicine – says Prof. Ewa Czarnobilska, allergist from the University Hospital in Krakow.
According to research by the European Academy of Allergology and Clinical Immunology (EAACI), currently 30 percent. Europeans have symptoms of allergies. In 15 years, every second European will have them. 50 percent allergy is genetic. The other half are acquired and their number is constantly increasing.
PAP: Apparently, several dozen years ago, no one heard about allergies.
Prof. Ewa Czarnobilska: Allergies, or allergies, have always existed. In the past, these were mainly congenital allergies, i.e. atopic allergies, the development of which was influenced by genetic factors. These allergies are caused by natural environmental allergens, such as plant pollen, dust mites, cat, dog and other dander. Within these allergies, there are only three diseases: allergic rhinitis, atopic bronchial asthma and atopic dermatitis. We have known about congenital allergies for a long time and we can easily diagnose them using classic tests. These allergies tend to be aggressive in their course. Fortunately, we have drugs for them and we can use the causal treatment of specific immunotherapy, i.e. desensitization.
So why is allergies so loud lately? After all, there were no more natural allergens of the environment, such as dust mites or pollen. After all, we care more and more about cleanliness, there are more and more detergents. We don’t drink more milk and we don’t eat more other natural foods. However, there were more and more chemicals and they caused the appearance of acquired allergies, ie non-atopic, chemical allergies in recent years. It is the number of these allergies that is growing.
Acquired allergies are a disease of civilization and a real challenge for medicine, because we still have not recognized many allergens that cause them, so we often cannot treat them. Besides, who is to finance research proving that, for example, cosmetics are bad?
PAP: So the patients remain defenseless?
E. Cz .: Patients are defenseless, but so are doctors. Even the largest allergy societies in the world cannot raise funds to develop research on chemical allergies.
PAP: So how can you fight new allergies?
E. Cz .: So far we have patch tests that allow to detect acquired allergies caused by 30 artificial allergens. The patient wears special pads with samples of artificial substances on his back for two days. On this basis, we often diagnose an allergy to metals: nickel, chromium, cobalt; for fragrance mixtures, preservatives. After detecting an allergy, we can only recommend that you avoid contact with agents containing these metals. If the patient limits contact with allergens, the symptoms will disappear. The problem is that there are no medical tools available to detect which chemicals are sensitizing, because there are hundreds of them.
PAP: It seems that allergy is being underestimated.
E. Cz .: Patients know little about allergies in general, incl. because there are no funds for information campaigns. Allergies are often confused with infections caused by bacteria and viruses. People don’t understand exactly how allergens work. They don’t know that there are congenital and acquired or chemical allergies. For example, people who are allergic to birch often think that when they leave the city for a birch forest, their allergic symptoms will worsen. And that’s not true. Birch growing far from the city made the patient less sensitive. Why? Because birch pollen in the city is surrounded by crystals of various types of pollution. Such pollen settles on the nasal mucosa, damages it and causes irritation. Thus, natural allergens in the urban environment become more aggressive. This was confirmed a long time ago by research in Japan, conducted to detect allergies to cedar pollen. Cedar pollen allergy was more common in people living in the city, close to communication routes, than in people living in cedar forests.
PAP: So city dwellers are more likely to suffer from acquired allergies?
E. Cz .: The closer to communication junctions and busy streets, the greater the risk of allergies. This does not mean that we will avoid it in the countryside. After all, chemicals are commonly found in everyday life. We have them in the air, especially in smog, in the soil, and thus – in vegetables and fruits, in air-conditioned rooms, supermarkets, cars, in fragrance blends, e.g. in the form of air fresheners, in cosmetics. By using the same ointment for a long time, even a hypoallergenic ointment, we allergize our skin to its substances and in the future it results in allergies to creams or foods containing similar substances to the ointment used before.
PAP: So in order to have an acquired allergy, you have to “energize” yourself?
E. Cz .: Among others. We get allergic after prolonged contact with chemicals, especially in childhood. It is not only about rubbing creams, but also about eating food, inhaling polluted air.
PAP: When should we suspect acquired allergy?
E. Cz .: Sneezing, chronic cough, strange skin blemishes – these are common symptoms. Children are especially at risk. They have a weaker immune system, more sensitive mucosa and conjunctiva. In case of any suspicion, the primary care physician is obliged to refer to an allergist. If the classic test for congenital allergy is negative, patch tests for chemical hypersensitivity should be performed. Only they can show acquired allergy, but often they do not because we still do not know all the allergenic chemicals.
PAP: What does untreated allergy lead to?
E. Cz .: It reduces the quality of life. It causes, especially that related to the respiratory system, other disease complications, incl. bronchial asthma or sinusitis. Also, malocclusion may be the result of an untreated allergy, manifested by a chronic runny nose. A child with a stuffy nose breathes with his mouth, which leads to a malocclusion. This, in turn, requires many years of orthodontic treatment.
PAP: One of the most polluted cities in Europe and the most polluted city in Poland is Krakow. Should its inhabitants be particularly afraid of acquired allergies?
E. Cz .: Yes. In 2013, in Krakow, 61 percent. students aged 7-8 and 16-17 reported symptoms suggesting allergy, and 50% of them were not covered by specialist treatment. It is not known how it is in other cities because there is no monitoring there. However, I would like to point out that in smaller towns and villages the risk of allergies is also high if you use coal or plastic garbage in stoves. Nowy Sącz and Nowy Targ, just like Kraków, lie in basins where smog accumulates in winter.
PAP: People who walk around Krakow during the heating season, after returning home, find that they smell of smog. So they have a lot of chemicals on them. What do you advise them? You can’t lock yourself up at home.
E. Cz .: After returning, it is not enough just to wash your hands and face to remove dirt. Contaminants also settle in the mucous membranes. If we stay longer in a polluted environment, it is worth buying sea water or saline from a pharmacy and rinsing the mucous membranes of the nose and throat with them. Artificial tears can be instilled into the eyes. This is the most effective prophylaxis so that pollution does not cause coughing, nasal congestion or conjunctivitis in the morning.
PAP: Do we have enough good allergists in Poland?
E. Cz .: Contrary to what many people might think, the level of Polish allergology is high. There is no shortage of good specialists. We conduct high-quality research. Our acquired allergy tests test for hypersensitivity to 30 substances and other European tests to 28.
The problem of Polish allergists is the lack of time to talk or interview the patient. This is due to limited finances for the health service.
Interviewed by Beata Kołodziej (PAP)