Round about 20 million Germans are said to be affected – trend upwards – among other things as a result of global warming and environmental pollution. “We observe coherences between climate change, pollen count and appearance of allergies” says for example Professor Karl-Christian Bergmann, chairman of the Stiftung Deutscher Polleninformationsdienst (foundation German pollen information service).
Everyone suffering from hay fever knows the general standard recommendations:
• Keep the windows in your bedroom closed
• Do not undress in your bedroom to avoid pollen spreading from your cloths
• Wash hair before going to sleep
• Mouth-nose mask
• Nose shower
• Avoid stress and alcohol
A known standard is the symptomatic therapy with nasal sprays containing cortisone and with modern antihistamines. A “jump” in development into asthma requires anti-inflammatory medications. Leukotriene antagonists are in the discussion for a while but a meta-analysis in 2006 caused the authors to come to the following conclusion: With hay fever a mono-therapy with leukotriene antagonists is just as effective as treatment with oral antihistamines but not as good as intranasal steroids. According to the authors of a new HTA report a final evaluation of mono-therapy with leukotriene antagonists and in combination with antihistamines is not possible yet.
Positive experience with needle, globules and EPD
Some physicians report about positive results with acupuncture. But scientific data here does not appear to be conclusive as Professor Edzard Ernst and his team of researchers at the Exeter University explain. Also homeopathy shows some good results. “Homeopathic remedies, mainly globules, are a good method to fight hay fever“, says for example Mirko Berger, GP in Hamburg/Germany. The specialist for naturopathy Dr. Michael Hess in Munich states that about EPD (enzyme-potentiated desensitization). This method is offered in England for some twenty years, for the past 10 years also increasingly in the US. EPD is an immunotherapy where an extreme highly diluted allergen mixture (0.0000001 to 0.0000000000001 g) in combination with a body-own enzyme named beta-Glucuronidase is being applied. According to Hess, the mechanism of action of EPD is not fully cleared. With high probability, EPD induces the production of activates T-suppressor cells. According to the North American EPD-study 60 to 80 percent of the patients (depending on allergy/intolerance) reported an improvement of their symptoms of more than 50 percent all the way to being completely free of any medical condition. An additional 15 percent reached an improvement of condition of 25 to 50 percent.
Up and away to the farm?
Many scientists look at alternative methods with a certain scepticism. For example Dr. Gundi Willer at the ‘Hochgebirgsklinik’ in Davos says: “There is no scientific proof for diagnostic significance for any of the alternative medical methods (e. g. bio-resonance, cytotoxological food testing, electro-acupuncture, hair analysis) or a significant therapeutic effect (e. g. bio-resonance, acupuncture, homeopathy, auto-hemotherapy).” There is more consensus regarding an exposure to pathogens during early childhood prior to a development of for example hay fever. The exposure itself is considered the decisive factor, but not the location (rural environment, farm). As authors of a recent study in The Netherlands report, the nutrition in early childhood years appears to have a rather small preventive advantage.
A causal approach: Specific immunotherapy
Specific immunotherapy (SIT) is considered undisputedly therapeutically ensured and it is also the only available causal therapy. Professor Hans Merk, president of the Ärzteverband Deutscher Allergologen (ÄDA, Association of German Physicians): “We know that the therapeutic effect of classic subcutaneous immunotherapy lasts beyond the period of treatment and decreases the risk for asthma”. A SIT is worth a while also for patients older than 50. “SIT can help with allergic rhinitis against seasonal pollen to lower symptoms and use of drugs.” The authors of the HTA report (Health Technology Assessment), looking at selected SIT variations, published by DIMDI come up with the same results. Nonetheless the authors observed an enormous demand for research for all those different forms of treatment and for cost effectiveness.
HTA-report: Faulty data about SLIT
The authors analysed mainly data about subcutaneous and sublingual therapy. They consider the effectiveness of SIT proven for grass pollen. Also for other seasonal allergens like tree pollen both forms of therapy can help. Given the faulty data situation though, the authors are hesitant mainly about the sublingual variation and state that the effectiveness of SIT and all forms of therapy and allergens are hard to assess by the current literature. The most relevant demand for research the authors see in regard to non-grass pollen associated SIT. In addition it should be checked whether this therapy helps preventing asthma. And also missing is any according evidence concerning cost effectiveness of SIT. Professor Ludger Klimek states there are plenty of approaches being tested to further develop SIT after all in order to lower side effect rates and increase compliance. The development of depigmented and polymerized allergoids has contributed to increase the safety of subcutaneous immunotherapy (SCIT) explains the expert at the Zentrum für Rhinologie und Allergologie (center for rhinology and allergology) in Wiesbaden. Thus a faster increase of dosage and a pre-seasonal short-term SCIT would be possible – which would improve the willingness of patients to get a SIT.
Enormous costs, enormous demand for research
Additional research is necessary since just the costs for treatment are enormous, emphasizes GA2LEN, a European network of allergy experts, research centers and patients’ associations. It its position paper published in 2009, GA2LEN (Global Allergy and Asthma European Network) writes: “Direct costs for the healthcare system depend on the stage of the disease, the treatment of an allergic rhinitis for example costs an average of less than 30 to 50 Cents per day. On the other hand, the daily treatment of severe allergic asthma bronchial costs mot than 30 Euro a day… But still allergic rhinitis is not considered a severe disease in many EU countries… Less than half of the patients with an allergic rhinitis are diagnosed correctly and treated – with considerable indirect costs: Compared to a regular cold, an untreated allergic rhinitis causes a negative impact on the mental performance and learning ability by up to 30 percent… According to the latest estimates, the European industry loses about 100 billion Euro every year due to lost working time. On an average, daily treatment costs of 50 Cent might help to save daily costs of more than 50 Euro caused by lost working time. Facing such figures we should not be talking about a trifle here.