Tuesday 20 August 2019

Immunotherapy could be a game changer in hay fever treatment but why is uptake slow in Ireland?

Almost one of five Irish people suffer from hay fever and it can be debilitating at this time of year. And a treatment called sublingual immunotherapy (SLIT) which could offer a cure currently has a slow uptake, writes Kathy Donaghy

Crona Tansey is asthmatic and also suffers from hay fever. Photo: Arthur Carron
Crona Tansey is asthmatic and also suffers from hay fever. Photo: Arthur Carron
Crona Tansey, pictured at her home in Dundalk. Photo: Arthur Carron

Itchy eyes, runny nose, sinus pain and congestion, coughing and wheezing and generally feeling uncomfortable and miserable - this is what hay fever sufferers have to endure at this time of year.

And while some may dismiss the condition as a mild downside to the summer, for those among the 20pc of the population who suffer from hay fever, the reality is it's debilitating and can affect your psychological wellbeing.

However, advancements in medicine could mean that allergic rhinitis, to give hay fever its proper name, could be cured in some patients. One of the country's leading respiratory doctors says immunotherapy could be a game changer in the treatment of hay fever, and yet only a small percentage of sufferers here have undergone the treatment.

Professor Stephen Lane, a Consultant Respiratory Physician at Tallaght University Hospital in Dublin, who treats patients with sublingual immunotherapy (SLIT), says the treatment can often cure the condition in many patients. However, the slow uptake of the treatment by medics here means that many people continue to grapple with managing their symptoms on a daily basis.

Prof Lane says the treatment, which is administered via a tablet is a new kind of allergen immunotherapy (AIT). It works by dissolving a large amount of the allergen in tablet form under the tongue on a daily basis.

The latest studies show that if you take the SLIT every day for three years, hay fever can often be cured. It may even prevent the development of asthma in patients with hay fever, particularly children from the age of five.

Prof Lane explains that we are coming to immunotherapy treatment from a very low base. The practice of AIT by 'allergy shots/injections' was severely curtailed in Ireland and the UK from 1986 when a number of deaths were reported with its use in general practice in the UK, particularly in those patients who had unstable underlying asthma.

However, the situation has changed over the past 10 years, with strong evidence that AIT can effectively treat allergic rhinitis, make it go away for good, and perhaps prevent the development of asthma in allergic children if used early enough.

Prof Lane says patients are advised to take SLIT before the hay fever season begins. They would continue taking the medication for three years, although the benefits in terms of a reduction of symptoms would occur much earlier than that.

"The numbers of people getting this treatment have been increasing steadily since 2011. It's currently about 500-600 people a year - it's not thousands of people. It could and should be a GP delivered service in my view. Unfortunately, with the cessation of AIT in primary care in 1986, AIT left the medical curriculum and is only returning recently with the advent of safe and effective SLIT vaccines. It's a very safe treatment, but there's some natural anxiety on the part of GPs to deliver it in light of lack of formal training in medical school and the historical record of allergy shots.

"I would be a strong advocate for this treatment for interested GPs," says Prof Lane.

While he says hay fever is often trivialised, its effects are anything but. "Hay fever sufferers are scared of the summer. The eye symptoms alone can drive people crazy and it can really get people down. The symptoms are far greater than a blocked nose," he says.

In his Dublin practice, allergist Dr Paul Carson points to the fact that allergies are on the increase globally, with air pollution linked to an increased prevalence of allergies. Of the 20pc of the population who suffer with hay fever, Dr Carson says about one-fifth get it aggressively.

He explains that when you're allergic to grass pollen, the nose lining begins to swell and you get an obstruction of the nose or a runny nose. The sufferer may start to sneeze as the membranes of the nose fill with fluid. If the hay fever goes on unchecked, the sufferer may not even be tasting their food properly. As well as all this, the lungs are affected and the eyes itch.

"People don't go to the doctor until they need to. I tell patients to come early next year, but they forget about the hay fever when it's gone. It's hard to think about pollen when there's snow," he says.

Dr Carson says he is administering SLIT to more patients now and if taken for three consecutive years, it can potentially cure people of the condition.

According to the Asthma Society of Ireland, up to 80pc of people with asthma also have hay fever and must be prepared for the season to cope with the effects of hay fever. It says preparation is key when it comes to tackling the symptoms. The society has a pollen tracker, which updates daily, showing the pollen levels across the four provinces of the country, and provides helpful tips to assist people in managing their symptoms better.

The society's CEO Sarah O'Connor knows from personal experience the debilitating effects of the condition, which she's put up with since childhood. Her hay fever diminished in her 20s but returned with a vengeance in her early 30s.

"I was shattered from it; physically exhausted. One GP thought I was getting repeat ear infections and treated them with antibotics, but there was no alleviation of symptoms. After about 18 months of this, I had an appointment with another GP in the same practice and he went back to basics and looked at the whole picture."

"He put my mild asthma and my allergies together and figured out the relationship between the two. He changed my asthma medication and gave me a new nasal spray for my allergic rhinitis. After 18 months of fatigue, headaches, and embarrassingly snotty sneezing, things looked up for me," says Sarah.

"People don't talk about hay fever or allergies much - other people dismiss it as whinging - but I had felt simply awful for months and getting the right treatment was revolutionary for me. Alongside managing the allergies, the new medication has meant that I haven't had a chest infection in over three years - a feat I had never even managed for six months prior to this."

Sarah is evangelical about suffererers talking about their symptoms with GPs, bringing the whole picture to them so they can recognise where to take treatment.

"I'm also really keen to help all patients, but especially those with asthma, to understand the link between the nose and the lungs - 80pc of people with asthma also have hay fever, but lots ignore it, are too used to its negative symptoms, and don't understand the way that it can cause their asthma to escalate," says Sarah, adding: "There are small tweaks that people can do, along with getting the right medical treatment, that can give them back their summer. As someone who revels in this season, having previously avoided it, I'd love to see hay fever management be taken more seriously all round."

 

The realities of life with hay fever

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Crona Tansey, pictured at her home in Dundalk. Photo: Arthur Carron
 

CRÓNA Tansey (27) from Dundalk loves to see the first signs of spring. It's her favourite time of year, but she knows it will be quickly followed by the summer and the onset of hay fever and its symptoms that spell misery.

The primary school teacher's first memory of hay fever was when she was seven or eight. She was playing outside in the fields around the family home and her mother noticed that a jelly-like substance had built up in her eyes. The next morning, she couldn't open her eyes.

As she grew older, Cróna couldn't understand why she couldn't go outside in the good weather. It was only when she started to prepare better for the onset of the hay fever season that she could enjoy the summers once again.

"I have my own little tricks that I use, like putting Vaseline under the nose as a block to the pollen. I do other things, like not drying my clothes outside that help me with my symptoms," says Cróna, who also has asthma.

She uses an air purifier in her room at night to get rid of any dust, and never sleeps with the window open. "When I get up in the morning, I check the pollen count on the Asthma Society's pollen tracker. I know how much I need to prepare. Pollen is also a trigger for asthma and it will affect my throat and leave me feeling wheezy."

"As soon as spring is sprung and the grass is cut, I can feel it coming on me. I love the spring, but it's a double edged sword as I know I'll soon have symptoms".

She describes hay fever as leaving her feeling unsettled. "Because hay fever is so common, people think it's fine, but it can be dangerous when it's combined with asthma.

"It's important to be careful to stay on top of your symptoms," she says.

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