When Dr Ranbir Kaulsay graduated from the Royal College of Surgeons in Ireland (RCSI) as a trainee trauma neurosurgeon 32 years ago, he expected to have a long and varied career ahead of him in his chosen field.
But after doing a three-year stint as a Formula One track doctor, an event in his family changed the course of his career entirely.
In 2001, his twin daughters Julia and Kelly were born and Julia was found to have severe eczema and other allergies. Looking for treatment for her, he discovered there was a serious lack of allergy specialists in Ireland. Eventually, after many visits to dermatologists and paediatricians, Kaulsay found that Julia’s eczema was exacerbated by cow’s milk and an egg protein allergy, and her skin improved once these two common food groups were eliminated from her diet.
The experience of getting help for his daughter made him realise how hard life could be for those suffering from allergies, and a new career was born.
“All allergies are on the increase whether they’re related to food or the environment. When people hear this, they of course ask the natural question – why is this happening? That’s the million dollar question and it’s very difficult to answer,” he said. “There are a few theories as to why we seem to be becoming more allergic but the main one is that our society is becoming too clean and as a result we’re not priming our immune systems and giving them the opportunity to fight that we should.”
Known as the hygiene hypothesis, this theory is widely accepted in the medical community as being a key contributor to a problem that is exploding in the western world. In the past, allergies were rare and notable, but changes to our diet, the amount of travel we do, climate change and an overreliance on household disinfectants are all partly to blame, as is the over prescription of antibiotics.
“These all contribute to a situation in which our bodies don’t get used to fighting off the bugs that they should do. Instead, our immune systems start to attack things that it should naturally be able to accept such as certain foods and environmental allergens,” said Kaulsay.
If you’re a hay fever sufferer and it seemed as if this summer was unusually bad for sneezing and spluttering, then you might be interested to learn that you weren’t imagining it. According to Kaulsay, this summer was up to 10 times worse than previous years for sufferers.
“Hay fever, or to give its full name allergic rhinitis, is one allergy that has particularly exploded in recent years, and in my opinion [the] summer [of] 2019 was the worst that we’ve seen in the last 10 years,” he said.
The specific reasons for this are multi-factorial but take in global warming, milder winters, plants producing more pollen for longer and a change in the kinds of crops being grown in Ireland.
"Pollens can change depending on the species of flora. For example, we're growing a lot of rapeseed in certain parts of the country and that makes those places very difficult for those with hay fever. Ragweed, which is a huge problem in North America and in continental Europe, has found its way to here and because of that we're seeing a spike in new allergies related to it," he said.
When it comes to food allergies, these too are on the increase, including potentially life-threatening ones. “Previously these were unheard of but they’re becoming a big problem in schools in particular. I’ve been here for 32 years and the Irish diet has become very different in that time. We’re exposing children to a lot more foodstuffs that they previously wouldn’t have encountered, things like sesame seeds, hummus and tahini, lots of nuts and lots of exotic food.”
The good news for people suffering from the most common allergies is that the range of treatments on offer for them is growing and for some lucky people, an end to allergies in general could be in sight thanks to a new class of immunotherapy drugs.
“A lot of treatments historically involved suppressing the symptoms of the allergic reaction but now we have new treatments known as desensitisation or immunotherapy. The principle has been explored for about 20 years but it’s only really recently that drugs based on these techniques have become commercially available in tablet form,” said Kaulsay.
Already two tablets for dealing with pollen allergies are available called Grazax and Oralair but later this year Kaulsay hopes that new drugs, Acarizax and Actair, targeted at those who suffer from dust mite allergies will be available to Irish patients.
“I have been practising immunotherapy for many years now, but these new convenient tablets are a game changer. Not many people know about them but for example, the house dust mite is responsible for most cases of asthma, sinus and skin problems in Ireland and this new treatment is revolutionising our therapy for sufferers,” he said.
“Even better, these new drugs are available on the drug payment scheme and on the medical card. The grass pollen ones have been widely used since 2008 but these new ones will be on the medical schemes by the end of this year. That’s big news if you’re a sufferer.”
One person who will be extremely happy to hear this is Niamh Maher, a 45-year-old TV producer who has suffered from severe hay fever for more than 35 years. In her career, she's worked on shows such as Masterchef, Dragon's Den, Say Yes to the Dress and more.
"I first started getting hay fever at 10 years of age, when we all used to play in the field beside our house in Ballinteer. I can vividly remember being frequently rushed to the doctor with it, but there wasn't much they could offer back then other than washing your eyes out with Optrex," she said.
As she got older, she started using over-the- counter antihistamine tablets but found, like most people, the side effects of drowsiness meant that she had to choose between not being able to concentrate at work or suffering with swollen eyes, sneezing and an unbearable itch in her sinuses.
“Every summer, it kicks in around the June bank holiday. I’ve tried everything – getting the injection, taking antihistamines etc – but this year was really bad and all the over-the-counter remedies didn’t really work. I also ended up with a cough related to it that wouldn’t shift.”