Allergies like rhinitis appear to be on the increase. The reason why is not clear, and people with allergic rhinitis are not well managed or treated. It may be time for specialized health workers or pharmacists to step into the breach.

 Summary

Allergic rhinitis accounts for around 11 billion dollars in the USA and allergies like this seem to be on the increase. Experts in the UK are saying that sufferers are now well served, because there are so few allergy specialists around. But maybe specialist health workers and pharmacists could step forward to meet the need.

Introduction

Experts in The Lancet have just highlighted the problem of allergic rhinitis, sometimes also known as hay fever. Sufferers in the United States spend a whopping 11 billion dollars on doctor visits and prescriptions to help relieve itchy, watery eyes, stuffy noses, coughing and headaches. This data comes from 2005 and represents a doubling of costs over 2000.

Is hay fever on the increase?

The huge spend on allergic rhinitis does represent a genuine increase in the prevalence of the condition - which is often more prominent at this time of the year and may be triggered by many substances, from pollen to household chemicals. In the UK, Government statistics say that allergy symptoms have indeed increased over the last few decades. In England, 3.3 million people have a recorded diagnosis of allergic rhinitis. This is roughly the same proportion of the population as in the USA. The condition is also common in other Western European countries.

The hygiene hypothesis

There is no agreement on why allergic rhinitis is on the increase. One strong suggestion is the so-called hygiene hypothesis put forward in the 1980s. This says that kids who are exposed to poor hygiene and many infections in early childhood have a more robust immune system that is not readily sensitized to allergens. Modern lifestyles come with higher hygiene standards and the immune system may be accordingly more sensitive. Another idea is that environmental pollution may be the cause of increasing allergic rhinitis. Indeed, there are many more chemicals around in everyday life than there were a few decades ago.

The burden of allergic rhinitis

Whatever the underlying causes of allergic rhinitis, there's no doubt it can be miserable and debilitating condition. People may be so affected by symptoms that they need to take time off school or work. And sufferers get little help. There are only six specialist allergy centers in the UK, at present, so the chances of getting to see an expert are slim. And general practitioners do not get much training in allergy.

The way forward

The Lancet experts suggests that the community pharmacy may be the place where allergy sufferers can get the help they need, In the UK, pharmacists learn a lot about allergies in their training - since many patients will be relying on over-the-counter remedies. Earlier this year, pharmacists with an interest in allergy screening were invited for extra training by the UK National Pharmacy Association. This suggests there could be group of professionals only too keen to help people suffering with watering eyes and runny noses at this time of the year.

Source

Allergic rhinitis: common, costly, and neglected  , The Lancet, June 21 2008, vol. 371, pp. 2057--