The Decibel - You’re not wrong, allergies are getting worse

Episode Date: May 25, 2023

Seasonal allergies are getting worse all across North America, in large part due to changes in pollen driven by climate change. But fear not, there is hope.Dr. Anne Ellis is a professor and division chair in the department of medicine at Queen’s University. She’s on the show today to discuss the effect worsening allergies can have on us and what we can do to live with them.Don't forget to fill out our survey!Questions? Comments? Ideas? E-mail us at [e-mail]

Okay. Chris. Chris, Chris, Chris, Chris. I need to get sneezes for the decibel. So I'm going to try and make you sneeze using this. Can you describe what I'm holding right now? It's some rolled up paper towel or maybe toilet paper. Okay. It comes to a point at the end, which I presume will be for the sneezing. With allergy season upon us, we sent our intern, Andrew Hines, on a mission to collect sneezes. Is it okay if I put this up your nose and wiggle it around and try to get a sneeze out of you? That's fine. You can put that up my nose. And maybe I'll look at the sun.

I find that always helps. Oh, really? Not directly in the sun, though. No, of course. Safety first. We're trying to be safe here. We're responsible journalists. Okay, ready?

Yep. It's going up the nose. Come on. Yes! Yes! We got it! Oh my god. Okay, and now we can talk about allergies.

That's the perfect intro. We did it. It turns out, it's hard to get someone to sneeze on demand. But a lot of us are sneezing more and more these days because this year, allergy season seems to be really bad. So today we're talking to Dr. Anne Ellis. She's a professor and division chair in the Department of Medicine at Queen's University, where she studies how to help people with their allergies. She'll tell us if allergy season is actually getting worse and what we can do about it. I'm Maina Karaman-Wilms, and this is The Decibel from The Globe and Mail. Dr. Ellis, thank you so much for joining me today.

It's a pleasure to be here. I'm excited to talk to you because I have to say my allergies have been very bad this spring. I keep hearing from other people about how bad their allergies are as well. I mean, do you just hear complaints from people all the time right now? Well, it's definitely a busy time of year. We're in the thick of birch pollen season, which is really the first significant allergen to hit the air, if you will, particularly in Ontario. Again, nationally, pollen season started back in February in BC. But for Ontario, we've had such a slow, cold spring. It was really took a while for everything to take off. And then of course, when you have sudden warming, that sends a real signal to the trees that, oh, time to get caught up. We didn't start pollinating yet. So you end up being hit pretty hard when you have a sudden

warm up like that. Okay. I think maybe we should start with a little biology lesson here. So can you actually just walk us through here? How exactly do allergies work? Like what's the process from pollen to sneeze? Right. So it starts off by becoming sensitized to the various things that people can become allergic to. So through living through several seasons, if you are what we call an atopic individual, or in other words, someone who's prone to developing allergies, eventually you can become sensitized to things like tree pollen, grass pollen, ragweed pollen. And then when that allergen hits your nose, it triggers what we call mast cells or your allergy cells to degranulate and release a

whole bunch of mediators. And so it activates things like nerves in your nose, making you sneeze, causes edema, causing swelling or nasal congestion. So it's all the downstream effects of the mediators that the mast cell releases once you start to encounter a new allergen. So this sounds like an immune response, basically, like the body thinks the pollen is something bad it doesn't like. Yeah, you can think of it that way. It's just that certain arm of your immune system that deals with allergies as opposed to the arm of your immune system that helps you fight off infections. But definitely, you can think of it as an immune response that's inappropriate, right?

So we often call it hypersensitivity. So again, it's an innocuous protein for most people. But for people who have allergies, unfortunately, it does trigger these types of allergic reactions. So again, we don't understand why some people get allergies and other people don't. Other than we know that they're increasing. We know that up to 40% of the Canadian population will experience at least one allergic condition at some point in their lives. And there's a partially a genetic basis to it, but that's not the whole explanation. But again, once you've declared yourself as a quote-unquote an allergic individual, then you're prone to potentially developing things like seasonal allergies. And do you need to breathe in the pollen to get the reaction?

Or if you get it on your skin, does that have the same kind of effect? It's much more common if you actually inhale the allergen to get into issues. Occasionallyally people will have contact reactions, but for this time of year and the things that are in the air, it's much more likely to be something that you inhale and it causes issues such as allergic rhinitis or hay fever, or sometimes people have asthmatic flares as well from inhaling the pollen. And how much pollen is actually needed to induce this kind of reaction? It doesn't take much. We define the start of any pollen season as the first of three days in a row

where the pollen counts are higher than 10 grains per cubic meter. But again, when we've had some really impressive seasons in the last few years, sometimes people are recording counts of 300 to 1,000 grains per cubic meter, which is why they can be tough on people with allergies. All right. So now that we know how allergies work, it certainly feels like they're getting worse. Dr. Ellis, is there evidence to show that that's actually the case? So what's happening is because we're having a delayed start to the spring season, tree pollen is just getting up and running.

And usually there used to be a break in between tree pollen season and grass pollen season, which is the next one that will come. Now there's more of an overlap. So if people are allergic to both trees and grass, they're having a much harder time of it. But also in the last two years, we've had sort of record pollen count. So that definitely makes the season worse for people who suffer from allergies. And so you mentioned something too about the length of time that pollen is released. Can you tell me a little bit more about that? Yeah. So it depends on which pollen we're talking about. Tree pollen season is usually around two to four weeks. Grass pollen season, again, about four to six weeks. The longest, and again, it only affects the eastern provinces, is ragweed. It starts around August 15th and sticks around until

the first good frost in the fall. So that's the longest season. Now, fortunately for people who live west of Manitoba, there's no ragweed out there yet. So it's really mostly Ontario, Quebec, and the Atlantic provinces that suffer from ragweed allergy. Huh, I didn't know that. Interesting. Okay, so it sounds like really we're talking about temperature changes as a big factor here. So I've got to ask, is this an impact of climate change and the differences that we're seeing now? We are seeing a change in our weather patterns. And it's that changing of the like the differences in our season is almost certainly driving some of this changes we're seeing to pollen seasons. Okay. Okay. So climate change is kind of lengthening the time or changing the time

that pollen is around each year. Is that the only thing that's changing? Is there anything else that's contributing to why allergies are so bad? So there's a couple of things. So particularly when we're talking about trees. So urban planning, they love to plant male plants because the females make fruit and they're hard to clean up after. And the males plants are the ones that release the pollen. So obviously the female plants are the ones that receive it and they're pollinated and they make their fruit, right? Wow.

I never would have thought of that. Male versus female trees. Wow. Yeah. So that's contributing to higher pollen counts as well. The other thing that we're noticing is that we do know that there's probably higher concentrations of CO2 in the air now compared to 10 years ago. And higher CO2 levels have been shown to increase the allergenicity of the plants. So that's contributing a little bit as well. What exactly does that mean that you said a word there, the allergen, I don't even know if I can say it. Allergenicity. So how potent it is, if you want to think of it that way, like how much more likely it is to cause an allergic reaction.

And why is increased CO2, why does that lead to it being more potent? It's something we've noticed from studies of what you do in greenhouses, is that if you raise ragweed plants, for example, in a greenhouse with a higher CO2 concentration than the greenhouse next door, it's been noted they have more allergen in their pollen than the ones that have less CO2. And do we know why? Or is this just kind of a correlation that has been noticed, but we don't really know the reason behind it? Well, as you know, plants absorb CO2 as a way to then exchange it for oxygen. That's how they do

their photosynthesis stuff. And so we think that's probably what enhances the growth of the plants. Okay. And when we're talking about CO2, I mean, I'm thinking too about the wildfires that we're seeing rage out west right now too. So I would imagine that's putting more CO2, I mean, I'm thinking too about the wildfires that we're seeing rage out west right now too. So I would imagine that's putting more CO2 into the environment that we're breathing in as well. Absolutely, yeah. So you're getting a double hit that way as well because all the stuff from the wildfires is causing direct respiratory irritation. It's almost like air pollution, really. So you get sort of a double hit in that way as well.

So you're going to be more irritable from breathing in these known irritants. But then also, eventually over time, it'll lead to stronger pollen, if you will. We'll be back after this message. All right, so we know how allergies work. We know they're getting worse. Dr. Ellis, are there any long-term health effects from prolonged seasonal allergies? Like, do you have to worry about anything if you get this year after year? So fortunately, allergic rhinitis or hay fever is not something that leads to mortality, but it sure does lead to a lot of what we call morbidity. So it has a huge impact on

patients' quality of life, their ability to do well at work, to learn well at school. It affects their sleep because if you're congested, you can't breathe through your nose. It's similar to having a cold for a lot longer than just the time of a normal upper respiratory tract infection. So it can have lots of consequences to a patient's day-to-day life, even though it's not something you're going to quote-unquote die from. That's kind of the individual health concerns, I guess, slightly bigger picture then. Does that affect anything like in terms of our healthcare system? Does it have any effects on that? Well, it certainly comes with a big economic burden, right? So the cost to the patient to purchase medications, whether it be over the

counter or prescriptions, if they don't have a drug plan that covers that cost, time away from work, that can cause issues, especially if you seek medical care, and then you have to take time away from work to see your primary care provider and then ultimately see an allergist to get on some definitive treatments. So it does come with a definite economic cost as well. Okay. I mean, this all doesn't sound great. But of course, there are over-the-counter medications that people can take to reduce symptoms, reactant, cloridin, aureus, those kind of things. But is it okay to take those things every day for several weeks? I guess I wonder if there's any health concerns with doing that.

No, fortunately, our non-sitting antihistamines, such as the ones you rhymed off, are very safe to take long term. Patients sometimes have to take antihistamines in high doses for years and years on end, not necessarily for this particular indication. But it is safe and there's no longterm health consequences to taking antihistamines on a regular basis if needed. Okay, so that's manageable. A lot of us can manage those with the over-the-counter medications, but I wonder, what if you have really severe allergies? What are some of the medical options available beyond just the over-the-counter medication? So, your primary care provider can prescribe, there's a myriad of nasal corticosteroids, which help to reduce the swelling of the nasal tissues and help with all of the other symptoms that we've talked about as well. But if you do see

an allergist, the allergist can get you on an immunotherapy regimen, which actually works to change the underlying immune system so that you don't react to the things you're allergic to anymore, but you can tolerate them. So that can be life-changing for people who have suffered and they want to step in with something more definitive, such as immunotherapy. So how does that work? How does somebody change their immune system like that? So there's two ways in which we can use immunotherapy currently. The traditional way, which has been around for over 100 years, are the so-called allergy shots. And basically, that's a series of weekly injections that

gradually gives you more and more and more of the things you're allergic to through the injection, so that by the time you get to what's called a maintenance dose, you're now being able to tolerate exposure to a very high level of that allergen, so that when you breathe it in, it doesn't do anything, or it does much less than it used to. The problem with traditional immunotherapy is it is an injection. So some people are not so keen on that. It's weekly injections for the first six months, followed by monthly injections thereafter for a total of five years. So it's a big time commitment. These injections do have to be given in a doctor's office because of the risk of having an allergic reaction to it.

I mean, injecting people with things they're allergic to. So that is one of the potential consequences. So the development of the new sublingual tablets has really revolutionized what we can do for patients. They are a fixed dose, but they've been shown to be effective in reducing symptoms and reducing need for other medications during the season. And basically the first dose is given in the doctor's office, but then the patient takes it themselves at home for the four months leading up to the season and throughout the season. You can either then stop and wait and restart again the same time the following year, or some people choose just to keep taking it all year round so they don't have to worry about starting and stopping, et cetera. And that's just a tablet that they can

take at home basically on their own. Yeah, just dissolves under your tongue. And we also have a house dust mite tablet. So that would be one that you would take all year round because house dust mite is a perennial allergen that never goes away. Those are the little microscopic insects that live in your mattress and pillow. Oh, lovely. Yes. Yeah. Okay. How expensive are these options? Because I would imagine this might not be accessible to a lot of people because these can be pretty extensive, it sounds like. Yeah.

So the injections are actually fairly cost effective when you consider what you might be paying. If you're paying a dollar a pill for reactant for example every pricing is a little bit different depending on where you are so I'll just quote you what we have in Ontario so it's $300 for the first six months and then that same amount for every year's renewal is about the average cost I would say if you have a drug plan it's covered by drug plans the tablets are definitely more expensive they run about three dollars and50 per pill. So especially if you're looking at the dust mite tablet, where you're gonna be taking it every day all year

round for three to five years, that can add up if you don't have some sort of coverage. And when we're talking about the more basic options, like the over the counter medication, is that something people can get covered by their drug plan as well? So we do have two prescription antihistamines now available in Canada that are covered by their drug plan as well? So we do have two prescription antihistamines now available in Canada that are covered by plans. And the advantage of one of them, which is called rupanidine, actually blocks another thing that mast cells release, not just histamine. So you've got dual action, so it's highly effective. The other one, some patients like it, it's called bilastine. It doesn't cross the blood-brain barrier, so it's very unlikely to cause sedation.

So for people who drive for a living, for example, or are really worried about becoming sedated, or they're just quote-unquote sensitive to medications, that's a good option for them as well. But again, a lot of the over-the-counter antihistamines are also safe and effective. I just make sure that everybody realizes you want to get the ones that say non-drowsy. So no more Benadryl or diphenhydramine. The Canadian Society for Allergy and Clinical Immunology has come out strongly with a position statement that those older agents should be avoided.

They have multiple side effects, not only sedation, but also cognitive impairment, learning impairment in children, psychomoral performance impairment. So people don't drive as well if they've taken sedating antihistamine. So again, it's one of these medications that we recognize. It's been around forever, but really it's just clever marketing. And really we want to make sure that people are taking the safer non-sedating antihistamines where possible. Before I let you go, Dr. Ellis, there's a lot of fear around allergy season getting longer and longer, especially when we're talking about kind of

the connection here to climate change, things getting warmer for a longer period of time. What is the future of allergy season in Canada look like, do you think? I think the good news is, is that I don't think it's going to change too, too much from what we see now. We've already seen a number of changes in terms of the certain tree pollen season being worse than it used to. I think it's just important for Canadians to realize that, yes, no one dies of allergic rhinitis, but it does cause a lot of misery. Don't be afraid to ask your doctor or your primary care provider to send you to an allergist so you can find an allergist and find relief. Yeah. And I guess in certain parts of the country, we're always going to have that cold period over winter. So you have that little reprieve,

even if the rest of the spring and fall is difficult. Yeah, exactly. That's one of the upsides of cold weather. Dr. Ellis, thank you so much for taking the time to speak with me today. It's a pleasure. Thank you for having me. That's it for today. I'm Mainika Raman-Wilms. Our interns are Wafa El-Rayis and Tracy Thomas. Our producers are Madeline White, Cheryl Sutherland, and Rachel Levy-McLaughlin. David Crosby edits the show. Adrian Cheung is our senior producer,

and Angela Pachenza is our executive editor. Thanks so much for listening, and I'll talk to you tomorrow.