Food allergies, gluten and lactose intolerance, allergic reactions to dogs and cats – these kinds of problems seem to be increasing in recent years. Do we really have an allergy rash today? And if so, what does it result from and how can we reverse this negative trend? For MedTvoiLokony, Prof. Rafał Pawliczak, allergist, immunologist and specialist in internal diseases.
I have come across the statement more and more recently that we have an allergy epidemic. That there are more allergy sufferers now than ever before. Are these numbers actually significantly higher from an allergist’s point of view?
First, we have to deal with the nomenclature. We have an epidemic of allergies, not allergies. Allergy is a physiological, natural mechanism. For example, the body fights parasites through allergic mechanisms. So allergy occurs in every person, always. An allergic disease, on the other hand, is something completely different. This term covers, for example, allergic rhinitis or conjunctivitis. And here the incidence, first of all, of allergic rhinitis, but also of bronchial asthma, actually increases.
- Make an appointment with a dermatologist today! Get free advice
Interestingly, there is also a greater number of anaphylaxis, i.e. those life-threatening sudden allergic reactions. We associate anaphylaxis with allergy to the venom of hymenoptera insects. We all know that such a reaction can occur and are trying to protect against it. On the other hand, the number of multi-component, idiopathic anaphylaxis, i.e. those in which a sudden life-threatening condition occurs in a completely healthy person, is also growing.
In addition, the frequency of food allergies is also increasing. Until now, we believed that there were relatively few such cases. Between half a per mille and a per mil of population. Now, however, this number is growing, especially among adults.
We have approximately 2 million patients with bronchial asthma, approximately a quarter of the population with allergic rhinitis, and a correspondingly lower percentage of the population with food allergy or allergy to Hymenoptera venom.
What is the cause of these increasing numbers? What factors contribute to such a dynamic increase in the percentage of allergic diseases in society?
Such factors are genetics and the interaction of genes with the environment. We do not have much influence on the former, so let’s focus on the environment. Today we spend more and more time indoors, we have more and more effective and more often used, often without justification, antibiotics. There is also an unprecedented range of cleaning products, from wet baby wipes to advanced steam cleaners and vacuum cleaners. Problems in this context are also smaller and smaller families and declining fertility.
How is declining fertility associated with the occurrence of allergic diseases?
Very often, the city family has only one child, who was also born by caesarean section. And such a birth roughly triples the risk of an allergic disease in a baby. Moreover, each subsequent child in the family is less likely to be born with an allergy sufferer.
Every pregnancy is a transplant, therefore, in order to maintain it, the child is covered by the mother with an immunological umbrella consisting in the activation of Th2 lymphocytes. In the natural world, when a baby is born by force of nature, it has an early bacterial colonization when it passes through the birth canal. Therefore, bacterial endotoxin changes the advantage of Th2 lymphocytes over Th1 lymphocytes, compensates for this immune imbalance and blocks the way to the development of allergic diseases.
However, if a child is born by cesarean section, this phenomenon does not exist. If the child additionally lives in a sterile world, free from playing in the sandbox, contact with peers, no pets, no cows, hens, goats, then he has a low exposure to bacterial endotoxin, which means that this pregnancy and post-pregnancy Th2 umbrella is preserved, i.e. and allergic disease.
How does the pollution of the environment in which we live affect allergic diseases?
Air pollution, i.e. smog, all particles of suspended dust, sulfur dioxide and nitric oxide damage young developing respiratory tract. It should also be added to that smoking by parents, guardians or people from the environment. Cigarette smoke damages the airways that continue to develop for some time after the baby is born, and therefore the risk of asthma increases.
We must emphasize that smoking – including secondhand smoke – kills. The cigarette is a very fatal addiction that leads to damage to the respiratory system, it is also conducive to diseases such as chronic obstructive pulmonary disease (COPD), but also dramatically increases the risk of developing atherosclerosis. We must be aware that atherosclerotic plaque does not develop in a year or two, but in a dozen or even several dozen. Exposure to the free radicals that are released when you smoke cigarettes dramatically affects your respiratory system and blood vessels.
So we have this simple recommendation: categorically not to smoke. Only how many patients actually follow it?
Almost every smoker wants to quit at some point. Ultimately, it is 1 – 2 percent. people who smoke classic cigarettes. Any doctor who a smoking patient comes to should ask him if he wants to quit. And I’m talking about an ophthalmologist, dermatologist, internist, GP, gynecologist. About each. Of course, we do not do this, but if the patient reports such a need, we should allow him to do so.
If you fail to quit smoking with nicotine substitutes, some of which are drugs, some of which are medical products, and some are dietary supplements, the next step in the therapeutic ladder is prescription drugs to help you quit. If this still fails, we are left with alternative forms of supplementation desired by the nicotine smoker, which contain tobacco. So in Poland, we only really have the so-called tobacco heaters.
Are these warmers also as damaging to the smoker’s lungs as cigarettes? And are they also dealing with passive smoking, which can damage the respiratory tract?
They heat the tobacco to a temperature three times lower than in the case of classic cigarettes, which burn tobacco at a temperature of up to 3 degrees. Due to the lack of combustion, tobacco heating systems release many times less free radicals and three to four times less aldehydes, which are also harmful. Two years ago, the US Food and Drug Administration approved one of them as a device that reduces exposure to harmful chemicals compared to a cigarette.
Unfortunately, in Polish conditions, there are not many mechanisms, e.g. tax mechanisms, persuading smoking patients to use tobacco heating systems in a situation where the therapy fails in their case. We could make wiser use of the health-promoting functions of taxes, such as excise duties, to encourage smokers to quit smoking altogether, or at least temporarily replace cigarettes with a tested nicotine product that emits much less harmful substances, until complete abstinence is achieved.
At the same time, we must make it clear that nicotine products are especially dangerous for some people. In particular, they should not be used by young people or pregnant women. These tobacco heating systems are designed for smokers who want to break away from classic cigarettes and exposure to cigarette smoke. And it actually works, because within a few or several months of use, a significant proportion of patients, even up to 50%, quit the addiction. We don’t have good studies yet showing how long this effect lasts, or if it’s permanent, but it seems likely.
So are tobacco heaters safe? In the case of e-cigarettes, the negative effects did not become apparent until some time later
We don’t know everything about tobacco heating systems yet. However, what we already know from industry-independent research is that we can consider them less hazardous to the health of the smoker and bystanders than cigarettes. As a rule, exposure to all these harmful substances found in classic cigarettes (93 harmful and 79 considered carcinogenic) still occurs in most, but not all, cases, but is much lower. We have a much lower temperature there, which means that less free radicals and these substances are released. The U.S. Food and Drug Administration continues to oversee tobacco heaters to determine their long-term health effects. For 2 years, this office has maintained its position that encouraging a smoker to replace a cigarette with such a heater is an appropriate and sensible action from the point of view of public health.
And when it comes to passive smoking, tobacco heaters are, to a lesser or even very small extent, harmful to the environment. We would need very close contact with the person who uses them to be able to talk about exposure to secondhand smoke. And it will still be an exposure that is probably much less risky than with cigarette smoke.
Passive smoking of classic cigarettes increases the risk of developing asthma in children. Are active tobacco smokers also more likely to suffer from allergic diseases?
Passive smoking, i.e. exposure to cigarette smoke by a non-smoker, causes damage to the developing bronchi and respiratory tract in children – so it is an independent environmental factor in the development of asthma. There are no good studies that show that passive smoking increases the risk of developing allergic diseases, but we can say that any damage to the respiratory tract, also in adults and also from passive smoking, facilitates the penetration of allergens. Therefore, in some form it carries the risk of developing the disease. However, first and foremost, it is important to remember that smoking, apart from cancer, is the cause of atherosclerosis and COPD.
An allergist is interested in smoking cigarettes, insofar as our Proxal study shows that a significant proportion of asthmatics (over 35%) actively smoke cigarettes. This is quite a shocking situation. In actively smoking asthmatics, as well as those exposed to secondhand smoke, to gain control of the disease, we must use up to twice the dose of inhaled steroids to gain control of the disease. So we can say that the cost of treatment both for the patient and for the budget in the case of an asthmatic who smokes is twice as high, and of course the excise tax associated with cigarettes does not reimburse it. This tax could definitely be even higher than it is today. Suffice it to say that today we have the second lowest excise duty on cigarettes in the European Union. It speaks for itself. And finally, one last thing: we are increasingly dealing with patients who suffer from asthma, but after many years of passive exposure to cigarette smoke, they begin to resemble COPD patients. We have been saying for several years that these patients suffer from the comorbid syndrome of asthma and COPD.