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Home / New Zealand

Peter Calder: Poor old allergy sufferers made to splutter on

NZ Herald
15 Jul, 2014 05:00 PM4 mins to read

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As much as 30 per cent of the population suffers allergic rhinitis.

As much as 30 per cent of the population suffers allergic rhinitis.

A friend of mine is having a hell of a job buying drugs. No, not those sorts of drugs. A woman in her 60s, she's partial to a drug described on its Wikipedia page as "one of the naturally occurring alkaloids of ephedra, a sympathomimetic ... that facilitates vasoconstriction and the shrinkage of congested mucosa in upper respiratory areas".

It is known as pseudoephedrine hydrochloride (she gets it in tablet form as a medication called Sudomyl) and it works like a charm when she gets an attack of what she calls hay fever but doctors call allergic rhinitis - sneezing attacks that can leave her weeping from a mixture of nasal congestion and despair.

But it's a class B2 controlled drug.

Prescriptions must be written (in triplicate, so the Health Ministry gets notified) and it is dispensed in minuscule quantities each time.

Ask anyone who suffers from allergic rhinitis: when it hits, you have to hit back, hard and fast. Inevitably, when she needs some, she hasn't got any.

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Doctors are not in the habit of prescribing for people who are not sick but swear they will be sooner rather than later.

Preparations containing pseudoephedrine hydrochloride used to be available over the counter, but when the National-led Government came to office in 2008 it moved quickly against them, because the substance can be used in the manufacture of methamphetamine, or P.

John Key wanted the medicines regulator Medsafe to consider a complete ban, a move the late anti-P crusader Paul Holmes described as "a message of intent" at best.

The $1.5 billion industry "has not come about because of the sale of a few cold and flu tablets over the counter of the chemist shops", Holmes wrote at the time. Instead, it became a prescription-only medicine.

As I listened to my friend's latest tale of woe, I decided the good people at the lobby group Allergy New Zealand might want to help me kick up a fuss, but inquiries there alerted me to a much wider problem.

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They directed me to clinical immunologist Dr Andrew Baker, who explained that allergy sufferers of all sorts were grievously underserved by our health system.

We have one allergy specialist immunologist for every 400,000 people (the ratio for dermatologists is 1:68,000; for psychiatrists 1:6500) and Baker says that is a much worse ratio than in other countries. There is no adult allergy service to speak of in the South Island.

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"Many patients end up turning up to alternative practitioners and many, if not most of their [treatments] are just fictitious," he says.

The Pharmacology and Therapeutics Advisory Committee, Pharmac's primary clinical advisory committee, has representatives of all sorts of specialties, but no allergy specialist. "Who is there to advocate for our patients?"

Baker says allergies have become increasingly common here in the past 30 years or so. Our rates of dust mites - the villain of the piece in most cases of allergic rhinitis - is up to 40 times that of many European countries and rates of asthma and hay fever are among the highest in the world.

There are many theories about why that is. The so-called "hygiene hypothesis" says that our immune systems aren't as robust as they used to be because our houses are too clean.

"People on farms, particularly where there are animals in the house, have fewer allergies than people living in towns. The more bacteria in a child's mattress, the less likely that child is to get an allergy."

The increase, Baker says, has "caught us on the hop" and allergies are "falling through the cracks because no one is taking ownership".

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As much as 30 per cent of the population gets allergic rhinitis, ranging from mild to utterly debilitating, and it's probably under-reported because of our stoic tendency to battle on.

"But a mild problem every day for 30 years is actually a really big problem."

Finding several hundred allergy specialists is a tall order, however.

It is certainly less likely to work as fast or as well as relaxing restrictions on medicines containing pseudoephedrine hydrochloride.

A police spokesman told me they didn't want to see a change, although interestingly the figures he supplied showed that precursor seizures went up 68 per cent and P busts by almost 150 per cent after the restrictions came in. Tormenting sneezing sexagenarians doesn't seem to be having much of an effect.

Everything I know about P manufacture I learned from Breaking Bad, whose cooks - such as Walter White - got their ingredients by the truckload, rather than sending grandmothers to the pharmacy.

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