March 15, 2023

The frequency and severity of allergies has been steadily increasing in recent years, although their impact often remains underestimated: in France, almost one person in two considers that an allergy is not a disease. However, these can heavily impact the quality of life and in some cases be life-threatening. They thus represent a real challenge, and need to be better understood, anticipated and taken care of. A major challenge, which requires rethinking the health system in order to allow more appropriate care for patients, both preventive and curative.

More and more food allergies

Milk, eggs, gluten, fish, soy, nuts… Perhaps you monitor the presence of these allergens in your food when you go shopping, or when you choose a dish from the restaurant menu. Perhaps also that the foodstuffs to which you are allergic are not among the 14 products usually mentioned. However, in recent years, food allergies have tended to increase and diversify: goat’s milk, buckwheat, sesame, peas, lentils or even kiwis are more and more frequent allergens while they are common in our diet. In 20 years, the number of anaphylactic shocks (potentially fatal generalized reactions of the body to an allergen) has quadrupled. These are all reasons why healthcare professionals are asking for these new allergens to be indicated on the packaging of products that contain them, in addition to the 14 others that are already mandatory. These emergences require an adaptation which notably involves the reassessment of current standards.

There are several causes for these emerging allergies, although the mechanisms behind them still represent a vast field of study among researchers. Ultra-processed foods, insufficiently varied diet, passive smoking or Western lifestyle can play a role in the development of allergies. Indeed, living in ever cleaner environments means that children are less confronted with bacteria and viruses that might strengthen their immune system and their intestinal microbiota.

Rising allergies and a deteriorating environment

The quality of the external and internal environment have a great influence on allergies. Indoors, exposure to mould, chemical pollutants such as those present in certain paints, or dust mites, contribute to the development of asthma and aggravate its symptoms. Indoor air is 5 to 10 times more polluted than outdoor air, even though we spend more than 80% of our time there. There are several tips for taking care of your space, such as airing your home daily.

Carbon dioxide (CO2) emissions also play a role in the development of allergies, including asthma. A study published in 2022 showed that car traffic was responsible for 2 million cases of asthma each year in children, due to CO2 and nitrogen dioxide (NO2) in particular emitted by diesel vehicles. Low Emission Zones (ZFE) are part of the solutions implemented in some cities in France to limit these emissions and reduce the number of deaths and illnesses linked to air pollution.

Due to ever higher temperatures and CO2 emissions which are struggling to drop, opportunistic trees and plants producing allergenic pollen can develop more easily. In the years to come, the pollen season will undoubtedly become longer and more intense. According to a study published in 2022 in Nature Communicationsby the end of the century, the amount of pollen produced might increase by 40%.

Take care of half the population

To date, allergic diagnosis is still a long and difficult process. Therapeutic wandering means that it takes an average of 7 years for a patient to consult an allergist, during which time the diseases have time to develop and worsen.

“It took me 10 years for my severe asthma to be identified and well managed, testified Dorian Cherioux, vice-president of the patient college of the Asthma & Allergies association, during the symposium “Tomorrow, all allergic? Acting to prevent” organized on March 9, 2023 at the Ministry of Health. Today I accept my chronic illness; I just regret that my general practitioner did not detect it earlier because he did not know regarding desensitization treatments; for my part, I probably wanted to minimize the disease in the beginning.”

On the management side, while the number of allergic patients continues to increase and should concern half of the population within thirty years, the number of allergist physicians continues to decline. To date, less than 30 allergists per year are trained in France, for 80 retirements. Although efforts have been made in recent years to make these sectors attractive, we are still far from being able to meet the challenge posed by allergies. Not only is there one practitioner in France for regarding 66,000 people, but these are also unevenly distributed around the territory and some departments do not have a practitioner in this specialty. Today, it takes an average of a year to get an appointment with an allergist.

Many avenues are currently being studied to overcome these problems: to make allergology courses more attractive, to offer more appropriate training or even to encourage teleconsultations in order to improve patient care. “It is urgent to set up training, new dedicated structures, but also to deploy actions to prevent and fight once morest allergens and sources of allergies. Actions that will also be committed to offering the same prevention, diagnosis and treatment pathways throughout France”, explained Professor Frédéric de Blay, pulmonologist and head of the thoracic pathologies center at the CHU De Strasbourg, in a press release.

Sometimes costly treatments

But the obstacle course does not end there: finding a treatment adapted to your situation is not always easy, and drug costs vary. While antihistamines or corticosteroids are reimbursed by health insurance, this is not the case for treatments for the most serious forms of allergy: Allergens Prepared Specially for a Single Individual (APSI) which were reimbursed at 65 % are only 30% since 2018 and injectable allergens have been fully reimbursed. At the time, this had aroused many reactions from doctors and patient associations, who denounced a loss of opportunity for many patients as well as unequal access to care. For sublingual tablets, the reimbursement is made up to 15%. The Haute Autorité de Santé should reassess this decision in 2023.