Japan’s pollen problem

And the businesses bringing relief

Text by Alena Eckelmann

Get your masks and protective glasses ready — hay fever season is about to hit again.

Spring is not a happy time of year for the over 30 million people in Japan who have been diagnosed as having cedar pollen allergies. Over the past 30 years, the number of Japanese who have fallen victim to the scourge of cedar pollen has been growing steadily. From 1998 to 2008 alone, the prevalence of those with the allergy rose from 16.2% to 26.5% of the population.

Hay fever is the popular name for seasonal allergic rhinitis (AR). It is an inflammation in the nose caused by triggers — allergens such as pollen — in the air that are inhaled. When the immune system recognises the presence of these allergens, there is a chain reaction in the body that leads to a range of unpleasant symptoms, similar to those of the common cold.

Although the main culprit is sugi, the Japanese cedar, there are 61 types of plants that can cause pollen allergies in Japan. The number of people with AR has been estimated to be as high as 39.4%, compared to about 20% in Europe.

AR can greatly impair a sufferer’s quality of life by, for example, causing a decrease in work productivity or learning ability. And, if not treated, AR can lead to worse health problems, such as asthma.

“Pollen by itself is not harmful; it is the human body’s immune system reacting abnormally to the pollen that causes the symptoms and disease,” says Ruby Pawankar. A professor in the department of pediatrics at Nippon Medical School, she is also past president of the World Allergy Organization (2012–2013) and president-elect of the Asian Pacific Association of Allergy, Asthma and Clinical Immunology.

The number of allergy sufferers is increasing globally. Factors such as a person’s immune system, their environment and genetics can all lead to the development of allergies. But there are a variety of other lifestyle factors that play a role in the increase of allergies, including living in an urban area; a high level of hygiene coupled with a lower-than-average number of infections; and such dietary factors as eating processed food and fast food.

Non-Japanese residents of Japan are also at risk of developing AR, even if they did not have a previous pollen allergy.

“Migration studies have shown that environmental factors in more developed and industrialised countries facilitate development of allergies in the migrant population,” says Pawankar. “AR is not only a national affliction of Japan. We have to realise that it has become a global public health concern that affects 10% to 50% of the world’s population. Prevalence is rising, and the costs incurred are substantial.”

Two-thirds of Japan’s land area — around 25 million hectares — is covered in forests. After WWII, some 40% of the forests were planted with fast-growing trees, such as cedar and cypress, in an effort to secure a stable wood supply for Japan’s construction industry. However, due to cheaper wood imports coming into the country in the 1970s and 1980s, Japan’s industrial forests were not cut down as planned. As of 2012,  seven million hectares of these trees were still standing.

Cedar and cypress trees generally mature 30 years after being planted, and this is also when they peak in their production of pollen. If not cut down, they will continue producing pollen year after year.

The Japan Forestry Agency is leading initiatives that aim to replace pollen-emitting trees with hybrids that release less pollen. There are also programmes to encourage the use of cedar and cypress wood in the construction of public buildings and in civil engineering projects.

Extremely popular in Japan are products that help people to protect themselves against pollen, including masks and special protective glasses. Also selling well are air purifiers and air ventilators with pollen filters, for use in the home and in cars.

Japan ranks second after the US as the largest market for allergy medicines, according to research firm EUROMONITOR. In 2016, sales reached ¥252 billion, a 2% increase over the previous year. The biggest-selling products are those combining remedies for coughs, cold and hay fever.

Taisho Pharmaceutical leads with a market share of 18%, followed by Daiichi Sankyo Healthcare with 10%, and Takeda Pharmaceutical with 7%. The largest foreign player, holding a share of 4%, is GlaxoSmithKline, with their global Contac brand. While sales of these combination products have stagnated over the past few years, growing sales of antihistamines, oral decongestants, nasal sprays and nasal decongestant plasters have been growing.

Osaka-based Bayer Yakuhin counts on the increasing demand for antihistamines and on the popularity of its brand Claritin, available in Japan as a prescription drug. In 2016, Bayer entered into a partnership agreement with Taisho Pharmaceutical to market an over-the-counter version of Claritin in Japan, which is expected to be introduced in time for the coming allergy season.

The World Health Organisation considers allergy immunotherapy to be the only approach that targets the cause of allergies and alters the natural course of the disease.

In January 2011, Torii Pharmaceutical entered into a partnership agreement with ALK-Abelló, a Denmark-based pharmaceutical company specialising in the development and production of allergy immunotherapy products. The partnership will market sublingual immunotherapy (SLIT) tablets in Japan. December 2015 saw the launch of MITICURE to counter against house dust mite allergy. Though still awaiting final approval, the SLIT-tablet against cedar pollen allergy is expected to be available to consumers here this year. The Japanese National Health Insurance has offered coverage for SLIT-tablets since 2014.

“Japan has one of the highest levels of diagnosed AR in the world, but allergy immunotherapy is not yet as widely used as in Europe,” says Pawankar. “Immunotherapy treatment is time-consuming, needs continued treatment for three years at a minimum; but the long-term effect has proven to be very effective.”

There is hope for allergy sufferers, and scope for pharma businesses to grow in Japan.  •