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Are we becoming allergic to the 21st century?

November 05, 2018

With rates of allergies on the rise, how can we reconcile our increasingly urban lifestyles with our healthcare needs?

We are increasingly becoming more urban. In 1950, 751 million people around the world lived in urban areas, today the number is 4.2 billion. By 2050, 68% of us will live in towns and cities. This explosion of people living in densely populated, industrial areas has coincided with a huge rise in the incidence rates of allergies, particularly airborne ones.

The World Health Organization currently counts 235 million asthmatics worldwide1. So have we created an environment we can’t cope with? Have we become allergic to the 21st century? And if so, how do we address this?

Infographic showing increasing rates of urban living from 751m in 1950 to a projected 6.7bn in 2050

Our urban lifestyles help drive allergy rates

According to the World Allergy Organization (WAO), allergies have been rising in prevalence for the last 50 years2, and show no sign of slowing down. Sensitization rates to one or more common allergens among school children are approaching 50%3. And by 2025, it’s anticipated that more than half of the population of the EU4 will have some form of allergy.

The conditions of modern, urban, industrialized life are driving these trends5. Pollutants in the air can cause allergic reactions – and the more particles, the more pressure on allergy suffers. There are as many as 200 different types of airborne allergens plus other irritants, such as petrol and ozone, all of which can cause or increase the impact of allergic reactions.

For example, one study6 found that children living within 50 meters of busy roads were more likely to develop atopic conditions like allergy and asthma than those who were not. Ground ozone, formed when diesel emissions mix with substances known as volatile organic compounds (VOCs) can create a smog that worsens the symptoms of asthmatics.

But if we are in fact becoming allergic to the world we’ve built – what can we do about it?

Infographic showing rates of allergies globally

Breathe easy: What can we do to reduce respiratory allergies?

While attempts to address urban pollution are underway, the number of people suffering from respiratory allergies is expected to rise in the foreseeable future. The good news is there are things we can do to both lessen the symptoms and reduce the incidence.

  • Supporting the sufferer: Those with allergies can improve their daily lives through both medication and lifestyle changes. Modern antihistamines can help relieve the symptoms of allergies without making the sufferer drowsy, while new smartphone apps can help them monitor air quality and pollution levels and modify their day-to-day life to reduce their exposure. Air purifiers can also be used to reduce your exposure to pollutants inside buildings.
  • A holistic, harmonized public health effort: Addressing large-scale health problems requires a coordinated approach between governments, NGOs, healthcare professionals and the public at large. The Finnish Allergy Programme (2008-2018), for example, took a holistic approach to allergy prevention. It focused on increasing tolerance to allergens in the population, improving allergy diagnostics, reducing work-related allergies and minimizing the health care costs caused by allergies. It has been a huge success, in its first five years asthma emergency visits and days in hospital were halved, while occupational allergies fell by 40%.
  • Harness cutting-edge medicine: The most radical approach to addressing respiratory allergies is to tackle them at a microscopic level. Two areas where scientists hope to develop potential transformative treatments are through gene editing and using beneficial gut bacteria. Gene editing techniques such as CRISPR/Cas9, may enable scientists to go into the gene and switch off the mechanisms that control allergic response. While this has been achieved for certain allergies in mice7, it remains is a long way off for humans and is more likely be used for asthma. At the same time, scientists in Canada are studying how particular intestinal bacteria can influence our immune responses and therefore affect our susceptibility to asthma and allergies. They believe that the right microbe-based diagnostics and therapeutics might help prevent the development of asthma and allergies.

It sometimes feels that allergies are a price we have to pay for our modern urban lifestyles. But they don’t have to be. Changing how we diagnose, manage and treat them means we don’t have to accept that we will be allergic to the 21st century.

Footnotes

  1. Asthma fact sheet, World Health Organization, http://www.who.int/en/news-room/fact-sheets/detail/asthma
  2. Pawankar, R. et al. Whote Book on Allergy: Update 2013, World Allergy Organization, http://www.worldallergy.org/UserFiles/file/WhiteBook2-2013-v8.pdf
  3. Pawankar, R. et al. Whote Book on Allergy: Update 2013, World Allergy Organization, http://www.worldallergy.org/UserFiles/file/WhiteBook2-2013-v8.pdf
  4. Muraro, A. et al. Tackling the allergy crisis in Europe, The European Academy of Allergy and Clinical Immunology (EAACI), http://www.eaaci.org/documents/EAACI_Advocacy_Manifesto.pdf
  5. Morgan, B. et al. Asthma and allergic disorders in Uganda: A population-based study across urban and rural settings, https://www.jaci-inpractice.org/article/S2213-2198(17)30953-4/abstract
  6. Shima, M. et al. Effects of air pollution on the prevalence and incidence of asthma in children, https://www.ncbi.nlm.nih.gov/pubmed/12696649
  7. Al-Kouba, J. et al. Allergen-encoding bone marrow transfer inactivities allergic T cell responses, alleviating airway inflammagtion, https://insight.jci.org/articles/view/85742
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