If it seems as though everyone around you has been sneezing, coughing and wheezing more often this summer, you’re not imagining things. Allergies are both becoming more common and getting worse. In some ways, this is not news. Respiratory allergy, asthma, eczema and food allergy rates have all been ticking upward for at least the past 50 years. Currently, approximately 30-40% of the global population has at least one allergic condition.
Industrialisation, urbanisation, changing diets, overuse of antibiotics and the climate crisis – with its warming temperatures, increased flooding and wildfires – are all exacerbating the difficulties our immune systems face as they are exposed to more and more things. So recently, if you’ve felt like your body is becoming more and more irritated by the world around it, you’re probably correct. In essence, our immune cells are being overwhelmed by modern life – more pollen in the air from both native and invasive plants; all the chemicals that we use in products, from detergents to shampoos; particulate matter from the fuels we burn. Even our companion animals – all the dogs, cats and birds that live inside our homes – are developing allergies. All of our immune systems are struggling to keep up with the changes we’ve been making over the past 200 years.
A key problem when it comes to treating our allergies more effectively – or preventing them from developing in the first place – is our lack of understanding of exactly how our immune systems learn to tolerate all the things we come into contact with.
We simply do not understand why one immune cell within our body will make the decision to respond negatively to a pollen grain – activating a full-on allergic reaction – while another immune cell in the same body does nothing. In theory, all of our immune cells should act exactly alike; they have the same genetics, environment and exposures. But we know that they don’t – and we’re absolutely in the dark as to why.
There are two reasons for this ignorance, in an era of fantastic scientific progress. First, the immune system itself is incredibly complicated and, until fairly recently, we simply didn’t have the technology to observe it in action. But the second, and perhaps more crucial, reason is this: until very recently, allergy was a backwater specialisation in medicine, largely ignored and drastically underfunded. At conferences in the 1980s, there were hardly any presentations on food allergy at all, despite rising numbers of patients throughout the US and Europe. There were only around 40 researchers even working on the topic.
Fortunately, over the past few decades, we’ve been slowly learning more about the biological mechanisms that drive our allergies. And we’ve been able to start using that knowledge to prevent allergies from developing in the first place – or at least to help us live with them when we can’t avoid them. We know that living close to major roads and bus depots as children can lead to a much higher risk of developing respiratory allergies and asthma. We also understand that early childhood exposure to certain microorganisms – like the “good” bacteria found in farmhouse dust – can have a protective effect. The “hygiene hypothesis” – or the idea that a little dirt can be good for us – is at least partially true; the problem is that we still don’t know which microbes are helping us or how. More research into the basic mechanisms behind allergy has also led to us dispelling unhelpful myths about allergies – sorry, probiotics aren’t helpful, and neither is eating local honey.
Perhaps the best example of how investing in research can lead to better outcomes is in the realm of food allergy. In response to the rising rates of paediatric food allergy in the late 1980s and early 90s, paediatricians counselled parents of young children to avoid giving them allergenic foods – such as peanuts or soy – before the age of three. It turned out, based on newer scientific studies, that was exactly the wrong advice. We now know that it’s a great idea to introduce infants to trace amounts of allergens as early as possible. Some children will still show signs of an allergy, but since the new guidelines came into effect in 2016, we’ve seen a dramatic decrease in food allergy to nuts.
But it wasn’t just food allergy research that was underfunded, leaving us more vulnerable to the wrong advice. In fact, allergy research in general in the last century received far less funding and attention than other medical conditions that seemed more serious and deadly – like cancer or diabetes. Medical schools barely touched upon allergies at all, spending on average just two weeks on the subject. This lack of focus on allergies is largely still the case, despite the fact that the recent significant rise in food allergy rates has galvanised a lot of private research funding on the topic. The problem with private money is that it’s often funnelled into the search for specific treatments instead of trying to understand basic immune functions or research that ultimately might lead to a “cure” or a more permanent solution.
As someone who has spent over five years investigating the history, science and economics of allergies and talking to researchers in the field, I can tell you that we absolutely need governments, advocacy groups and other NGOs to fund more basic science on the immune system and the various allergy pathways that are triggered in allergic disease. Considering that 4 billion people worldwide – 50% of us – are expected to have an allergic condition in the next decade, it should be an urgent priority.
The good news is that funding more basic research on allergy will probably uncover scientific knowledge that might help us prevent or treat a whole host of other immune-related disorders, like autoimmune diseases such as lupus or Crohn’s disease, and help us harness the power of our immune cells to ward off cancers as well as invading viruses and harmful bacteria.
There’s no downside to pouring more money into understanding all the aspects of our immune cells and how they “think”. That basic science is likely to help us all live longer, healthier, happier lives in our fast-changing environment. But in the meantime, if your allergies are getting worse or you’re struggling to find effective treatments, know that you’re not alone and that allergy researchers are dedicated to finding ways to help you. They just need a lot more of our support to find the keys to a possible cure – which is likely to be understanding our immune cells enough to be able to retrain them, or prevent them from making the wrong decisions about a grass pollen or milk protein in the first place. And wouldn’t that be nice?
Theresa MacPhail is a medical anthropologist and author of Allergic: How Our Immune System Reacts to a Changing World
