An interview with Anthony S. Fauci
Are seasonal allergies on the rise? If so, why? There has been an increase in seasonal allergies, but this trend may be leveling off . The reasons for the increase are unclear, but one explanation may be common lifestyle changes that include less physical exercise and more exposure to air pollutants and less contact with microorganisms and childhood infections as a result of the broad public health Advances of the past century. With regard to the latter, the "hygiene hypothesis" suggests that microorganisms alter the way our immune systems react to allergens, so our chances of developing allergies increase in the absence of exposure to infectious agents.
What research has been done recently in the area of seasonal allergies? Specifically, have there been any significant findings or breakthroughs in allergy shots, e.g. are there new medications that "last longer" between shots? Recent findings include the discovery that allergen therapy delivered under the tongue, called sublingual immunotherapy, is effective in treating seasonal allergies, and substantially safer than the standard two- to three-year course of allergy shots, called subcutaneous immunotherapy. Another recent finding is that children who do not have asthma, but have seasonal allergies and receive subcutaneous immunotherapy, are far less likely to develop asthma over the ensuing years .
I read that an immunotherapy for airborneallergy vaccine is nearing FDA approval, perhaps in time for the 2006 allergy season. If so, what is the name of this product, what allergies will it protect against and when can people expect to have access to it? Recently, the NIAID-sponsored Immune Tolerance Network partnered with Dynavax on the clinical trial of a product called Tolamba. This trial showed that Tolamba was highly effective in reducing ragweed symptoms, and symptom relief persisted for a year after the treatment was completed. If future clinical trials are equally successful, this could lead to Food and Drug Administration approval of the Dynavax product in two to three years, with major benefits to ragweed allergy patients by shortening the duration of treatment compared to standard allergen immunotherapy. The feasibility of developing comparable approaches against other seasonal allergies is still uncertain.
Have there been changes in the effectiveness of over-the-counter or prescription medications? Over-the-counter and prescription medications are generally very effective for the treatment of seasonal allergies, even for patients with severe symptoms. In particular, "newer" antihistamines effectively reduce nasal allergy symptoms but have minimal sedative properties.
Finally, can people hope for a cure? Or will relief only come through proper prevention and careful treatment of symptoms? Most patients can now obtain excellent symptom relief from allergic rhinitis, including complicating conditions, such as sinusitis and asthma. But further improvements will be possible with the development of new therapeutic approaches and a better understanding of the immune mechanisms that are responsible for allergic diseases. Since continued allergen exposure is necessary to induce symptoms, allergen avoidance is an attractive approach, and the NIAID-sponsored Inner City Asthma Study of children demonstrated that environmental interventions reduced wheezing in proportion to the reduction in allergens.
For more information on allergies and other infectious diseases, visit the National Institute of Allergy and Infectious Diseases at www.niaid.nih.gov.