Instant Genius - The science of hay fever, with Sam White

Episode Date: April 16, 2023

Hay fever is something huge parts of the population deal with every year, but what actually causes it, is it genetic and is it something that is faced all over the world? We spoke to Dr Sam White, a senior lecturer of immunology and genetics at Nottingham Trent University to find out more about this common issue. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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BBC Science Focus magazine. This is Instant Genius, a bite-sized masterclass in podcast form. I'm Alex Hughes, staff writer at BBC Science Focus magazine. This week, we're talking about hate fever. It comes around every year to destroy the joys of summer with watery eyes and sneezes galore. But what actually causes it? How can we treat it?

And which of the many tales that surround it are real? I'm joined by Dr. Sam White to discuss this topic. He's a senior lecturer of immunology and genetics at Nottingham Trent University. He dives into the many aspects of hay fever and explains how you can battle it this year. So a huge number of people suffer from it each year, but what actually is causing hay fever? Brilliant. So yes, like you say that, a phenomenal amount of people. So, I mean, the latest statistics we're looking at in about 42% of people suffering with hay fever.

And essentially what we find that hay fever is it's an over-exaggerated immune response to pollen that we are interacting with every day, which is why we find this sort of seasonal nature of it. Is this something that's genetic or is this just very much the complete luck of the draw if you suffer from it or not? Yes, so it's very much genetic as well as having some sort of major environmental factors. So we know for a fact that several different genes can be involved in hay fever. So particularly there's something called the HRA gene.

And that's really responsible for producing a range of proteins that we associate the sort of immune reactions to foreign substances. And we know that in particularly European descendants that are suffering with hay fever, we see large alterations in this HAL gene across the board. And why is it that certain people are, I guess, more susceptible to it than others? Absolutely. So definitely we've got this genetic factor. So we know that sort of heredability of hay fever is up to sort of 91%. So in sort of conjunction with that genetic factor, there's a huge amount of environmental factors that can also start to play a role in that. And for us, some of those environmental factors can look at things.

sort of that our early life at impact. So we know that things like even exposure to secondhand smoke in early life can impact how much of sufferers with hay fever will develop. We know that we can also see things like excessive pollution can impact our uptake of hay fever. And so we don't know if that could partially be due to things sort of as damage to our nasal or respiratory system making those allergens easier to pass into the body, or if that's more of their hypersensitivity of the immune system as well. Other major factors that can play a role

are things like if you suffer with another allergy. So sufferers of asthma, or if you have exma, your sort of immune system's already in this sort of override state or over responsive state. And so we know that those sort of individuals are also going to be more likely to suffer with hay fever. And you were mentioning a little bit there about the exosm and the asthma. Is there a reason that those three things tend to come together, you know, the atopic triad of exma, asthma, and hay fever? Absolutely. So we call it the atopic march and we actually see it sort of across the board in animals as well. So it's something we see very much in the horse as well, for example. And it could be for a few sort of variety of reasons.

So firstly, the sort of genetic alteration that could result in more of an overactive immune system are similar amongst sort of all allergies as a whole. But also because you are suffering with that one allergy, your immune system can quite often already be in a bit of a sort of sensitive state or overreactive state. and as such it's more likely to sort of become hypersensitized to these different sort of aspects or allergens it comes into contact with. And in a similar vein, a lot of people who have bad hay fever also seem to struggle a lot with pet hair or, you know, dust allergies. Is this sort of all in one together? Is it that these things are just aggravating one another? So a bit again of that sort of hypersensitivity, but we also can find sort of, sort of, of cross-reactivity.

There's sort of major components of these paligenic proteins, whether it's sort of potentially a dog epithelial protein or a grass protein. Sometimes there are cross-reactive components, which means if you are allergic to one, you're sort of more likely to have a response to another as well, and well about genomic or genetic impact. Very different topic, but last year, my hay fever felt absolutely horrible. a lot of people I know had very bad hay fever. Do you think there was, I guess, a link between the lockdown period ending

and then as all going back out into the world and just being hit with the most horrific feeling hay fever? Yes, definitely, it's very much due to exposure as well. So I think we were finding the year before when we were all very much inside, we actually had that sort of natural allergen avoidance. So we weren't really going outside so much and coming into so much contact with those sort of pollens there. The other sort of things to consider as well is actually we do find severity year on year or through the different seasons, obviously, can change drastically due to the sort of different exposer, we call it, so the things we're being exposed to. And what kind of things would that include year on year that are changing?

So particularly what we can find is actually the different. differences in pollen through year or year. And so some things we find, particularly weather condition. So things like temperature, humidity, and wind could all hugely affect the distribution of pollen. So if we have sort of a very rainy spring, it may sort of wash away the pollen,

while a sort of warm, dry summer may lead to sort of increased pollen production at the whole. So rain, for example, could make your hay fever slightly better. Wind could make it far worse. Yes, yes, well, yes. Quite. So the wind sort of distribution is very much sort of important as well. If you're sort of downwind from huge quantities of pollen that you are allergic to, that can be a huge issue yet. And on a similar vein, does air pollution aggravate here fever? Is that something that's very much

a separate issue? So air pollution as a whole, we sort of use different classification methods for air pollution. So if we were looking at sort of particulate matter under 2.5 micrometer, which is the of main focus of a particle that we're interested in, that has a huge impact on our sort of lung respiratory immune health as a whole. So if we're having lots of that sort of environmental debris that we're inhaling, we actually have a very sort of sensitive and inflammatory respiratory system. And as then, so many of our immune cells there and presence because we sort of been inhaling these particles, it means that that sort of upregulation, So finding those allergens and bring them in is a bit hypersensitized.

It's sort of increased. So it can have a huge impact there. And we're both talking about this based in the UK, but what's the spread of hay fever like around the world? Is this something that is more common in certain countries, or is this very much countries all around the world are all suffering like we are? So it's hugely dependent around the world. So obviously in some countries like Iceland, for example, you might find, that there's a lower pollen, sort of, in general. So I think these sort of statistics we generally work with is globally,

it's between 11 and 42% prevalent. So you can see that actually there's quite a lot, wide sort of variety there or prevalent that varies between the different countries that we see. And actually, if we look at the sort of pollens that each individual in different countries are allergic to, we see that it's completely different. So this is when we start to think about,

the exposome to what we're exposed to. And so we find that in certain regions like Mississippi, for example, you're more likely to be sensitized or allergic to things like tropical grass pollen. In Italy, they find there's a high incidence of allergies to olive pollen trees. So it has sort of a huge variability depending on what you're exposed to as well. And is that the same even in, I guess, smaller regions, obviously the United States is huge, but even if we focus down into the UK, could you suffer from a different level of hay fever compared to, say, Scotland and Cornwall? Yeah, most definitely.

And so some of that is to do with that sort of climatic impact as well. And I know so there's been a study, for example, in France, looking across all the different regions. And actually, the variability between the regions that are associated with things sort of coastal, the way you might have increased wind flow as well, compared to areas there might be drier. It's phenomenally different across the board. No one goes to Hank's for his spreadsheets. They go for a darn good pizza.

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Is there any link of hay fever with tribes or groups that are out in jungles and more separated from cities and towns? Absolutely. So, I mean, it was first actually sort of officially reported in 1819. So it's been around for a very long time. But, I mean, undoubtedly it's something that was spoken about long before that. So that's the first report for 1890. And so then obviously our knowledge has really come on as a whole.

It'd be sort of much easier to identify because quite often with allergies, it can be hard to find out what the association is, but due to its sort of seasonal nature, it's easier to identify than some other allergies. And so as a whole, you can sort of identify a little easier. Across regions, yes, it can vary hugely. So partly that's going to be due to things like that genetic factor again. And so we know that if we're looking at that slightly altered gene and that heredibility factor in some sort of subfet,

we know that with some sort of regions that is going to vary significantly between, for example, places in Brazil, that are more regional compared to somewhere like Europe. And when, say for someone this year that's really struggling their hay fever, they can't seem to kick it or they can't seem to deal with how they're feeling right now, what are some of the easy ways to manage hay fever or the ones that they can do at home? Yes, there's actually a huge variety of ways that you can start to think about how you could sort of cope with hay fever as a whole. And so probably the first thing to think about is sort of true diagnosis. And so obviously we were to have a diagnosis a bit earlier as well. We were thinking that actually those sort of clinical signs are probably some of the first things you're going to think about. We're going to know, even as ourselves as a patient, if we're outside in times where there's high pollen, we're going to suffer war, and we know we weren't removed from that environment.

But actually, what we're going to need to hone in on is, again, that immune response to be able to identify water allergic to first. And so to think about what we're allergic to, there's a few sort of simple ways that we might go about that. So the immune response we'll be having to the allergen is that our overreactive immune system will produce an antibody called IGE. And effectively, when that IGE bind with a certain type of pollen we're allergic to, it will produce histamine and other sort of pro-inflammatory protein that will call. the inflammation and the response we see, which is why classically we would take antihistamine. So what we can think about first is actually identifying what we are allergic to.

And so a couple of ways we might go about that are things like skin cricketts. So where we take different types of pollen, so different types of grasses and trees, and it might be pricked into the skin to see if we have that swelling response from histamine. Or another way that we can do it is actually, to run a laboratory test in which we will measure the quantity of our IgE antibody against a huge range of different types of pollen.

And we'll be able to see whether we've got sort of high level with the bi-gea against specific ones will help us profile what we're allergic to. So that's generally how we'd first go about trying to identify what we are allergic to. and then once we know that, we can start to think about how are we going to sort of implement treatment. And so one of the main things that we can start to think about is actually allergen avoidance. And so similar to it, if we were allergic to peanuts, we obviously would keep eating peanuts and use an epipan every time.

We would avoid them. And so we try to go through that very similar method with Hageriever where possible. So if we know what we're allergic to, for example, for sort of high levels of grass pollen, we can make sure that when we can sort of look at the allergen mapping, so we get our sort of high pollen counts, we know to avoid going outside if possible or working outside. We might start to think about how we can produce exposure inside as well. So we can do things like shut our windows or doors to try and prevent pollen coming inside.

And we could also think about things like the use of filters. So air filters or heather filters, which have to be quite popularised with COVID, are also very useful in helping to try to remove pollen out of our air sort of flow systems as well. There's, I think every year, a huge insurg of just misconceptions and I guess old wives tales around hay fever. And I guess all illnesses or problems that we face each year, what I saw with the big misconceptions. conceptions of hay fever that you tend to see? I think probably one of the sort of main misconceptions with hay fever that we see that if you might move to a different region

or sort of a warmer climate, for example, that you might suffer less. And so things like that are obviously very dependent on actually what you are allergic to. So if you, again, move to an area, it might be that you've not been exposed to intelligence before, and actually it could become worse. So thinking about actually sort of movement of areas and locations sometimes can be a bit of a misconception as well.

I think another one as well is things sort of like the use of masks. Sometimes they're excellent, but we need to again make sure they're of the correct filtration recommendations to be able to filter the pollen out of the air as well. And I think some other sort of misconceptions that we potentially have are the use of different sorts of nutraceuticals. So actually whether we're thinking about what we can feed ourselves to try and sort of prevent allergies or support our allergic responses as a whole, there's some very good science for some sort of diets or nutrients or probiotics, but not for others. So I think that can sometimes be a bit of a gray area. I don't know if this is one you've heard, but I've heard before that eating honey from your local area is supposedly going to help with your hay fever. Is there anything there or have I just been, have I been lied to on that one? No, that's actually a really interesting one.

So if we think about how it's as a whole, one of the sort of only sort of reliably qualitative treatments we could have is something called immunotherapy. And so the main concept of immunotherapy is we can take what you're allergic to, so the different types of pollen in this case, and actually by exposing you to them in higher and higher increments, we can reach a stage where you become desensitized. So if you are then exposed to that pollen, your immune response isn't going to overreact because you have other antibodies that will bind to it effectively. And what we see in this sort of pollen example here is almost like a natural immunotherapy type approach. Because those bees have been collecting pollen that are all around you. So all of those pollens you're usually exposed to. And that's why they recommend the local honey. And actually by taking that, you can start to almost have that immunotherapy response.

Obviously, it's not quite as effective as the sort of medical tailored response. But it does have some sort of grounds there, yes. I feel like I know the answer to this already, but is Hayfever realistically on its way out? Is it something that we could, in the future, see being just gone from civilization? Or is this something that is a lifelong issue that will just have to, I guess, learn to face or learn to deal with? Yes. I think essentially we can see that it is on the rise. I think particularly with there's been a lot of articles lately looking at things like, climate change and how that's actually

increasing pollen rates, which is associated with, again, higher levels of hay fever. And I think it's something that we probably will keep growing as you're seeing with all allergies across the board there. I think our real sort of way to move forward is actually to think about treatments.

And so we spoke a bit about immunotherapy there and we can actually see that immunotherapy is starting to become a very effective treatment in which that even after sort of a call-filled tablets under your tongue, exposing you to those pollen, you can become desensitized still for several years after treatment. So I think it's probably going to be moving to how can we actually very sensitively

detect these pollens so we can create tailored treatment and just more than accepting the fact that genetically and environmentally, they're probably continuing to rise. Thank you for listening to this episode of Instant Genius. That was Sam White. talking about hay fever. The Instant Genius podcast is brought to you by the team behind BBC Science Focus magazine, which you can find on sale now in supermarkets and newsagents, as well as on your preferred app store. Alternatively, you can come find us online at sciencefocus.com.

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