The worst time of year for 48-year-old He Yanbin is from late June to September, when he suffers from severe pollen‐induced allergic rhinitis, or hay fever. He was diagnosed in 1996 in his hometown of Yulin in North China’s Shaanxi Province.
He told NewsChina that after the doctor told him he had hay fever, which included symptoms like itchy eyes, a runny nose, sneezing and coughing, he was given an injection, and immediately felt better. “Thinking back, I think the doctor must have used steroids, since drug prescriptions were not strictly regulated then,” He said.
Yulin is in the very northern part of Shaanxi Province, right at the part where the Loess Plateau meets the vast desert in the Inner Mongolia Autonomous Region. It has been at the forefront of China’s fight against desertification for decades. Before the People’s Republic of China was founded in 1949, sand and dust storms resulted in the encroachment of the desert from Inner Mongolia into Yulin, engulfing six towns and over 400 villages. The city was forced to relocate three times, records show. But by 1996, due to reforestation programs, tree coverage had expanded from 0.9 percent to 42.7 percent within five decades.
Protected by the shelter forests, Yulin started to boom and gradually developed into a city of over three million residents. However, until recent years, no one expected such a surge in the number of people suffering from hay fever and asthma, attributed to pollen emanating from the Artemisia genus, commonly known as mugwort, which was widely adopted in forestation programs in the 1960s.
According to the book Yulin Sand Control, the city started afforestation by aerial seeding with mugwort, the most popular species. Mugwort plants, effective in stabilizing desert landscapes, have been grown across China’s large expanses of steppe ever since.
Each year, from July until September, over tens of thousands of people in Northern Shaanxi suffer from pollen-induced allergies, and even millions in neighboring regions like Inner Mongolia, Ningxia Hui Autonomous Region and Hebei Province. This June, He Yanbin shut himself inside his home, with tightly shut doors and windows, and a central air conditioning and purification system. He said that after he fixed the temperature to 26 Celsius and humidity at 70 percent, his constant sneezing and runny nose finally stopped. He said that since he was diagnosed with hay fever, he had noticed more people were also suffering. He learned that hay fever is a chronic disease which requires long-term medication and cannot be completely cured. He found that some sufferers went to Peking Union Medical College Hospital (PUMCH) to try a skin prick test to determine what they were allergic to. PUMCH launched its allergy department in 1956, the first of its kind in China. Founder of the department and expert in allergens Professor Ye Shitai from PUMCH had conducted research on airborne allergens across dozens of cities in China during the 1970s and 80s. Ye found that the numbers of allergy sufferers or the severity of their symptoms were related to the local pollen counts of the Artemisia annua, or sweet wormwood, a type of mugwort which is widespread in North China. Using a nasal challenge test, a standard procedure to diagnose allergic rhinitis, using wormwood extract, Ye’s study verified that Artemisia annua is a major outdoor allergen source in North China. The results were published in a 1991 paper titled “Research on Airborne Pollens in China.”
There have been other studies since Ye’s. According to an article titled “Artemisia Allergy Research in China” published in science journal BioMed Research International in 2015, two national allergenic pollen surveys were conducted in China. The article stated that “Artemisia pollen is a major important outdoor allergen in China. It has been verified as an allergen by nasal challenge and bronchial provocation tests, and these allergens have been shown to occur not only in its pollen but also in its leaves and stems.” Wormwood pollen can trigger not only allergic rhinitis but also asthma, or both together. The article continued that almost half of the patients with autumnal pollen allergic rhinitis had developed seasonal allergic asthma within nine years.
He Yanbin had a skin prick test in 2006 which indicated his allergen was mugwort. Chen Xiushan, director of the allergy department in Yulin No.2 Hospital told NewsChina: “In recent decades, the number of people suffering from hay fever and allergic asthma has significantly increased.” The situation in Shaanxi and neighboring provinces caught the attention of Wang Lianglu, deputy director of the allergy department of PUMCH. Wang’s team conducted research and analysis of 260 hay fever patients from Shenmu Hospital in Yulin from 2003 through 2006. The results showed that more than 97 percent had hay fever, and more than 25 percent had asthma, and again Artemisia was the major source of allergens in summer and autumn.
Wang Minghao from Shenmu, a district of Yulin, started suffering from hay fever in 2005 when he was 20. His symptoms have worsened in recent years. Wang told NewsChina that he suddenly could not breathe when he was asleep during a summer night in 2012. His family noticed and sent him to hospital immediately. After emergency treatment, he survived and realized he had developed allergic asthma. Since then, he has to carry salbutamol, a drug used for the relief of bronchospasms during the allergy season.
“For patients who suffer severe hay fever or asthma, we suggest they move to places in southern regions, if possible, better to the south of the Yangtze River,” a doctor from Yulin No.2 Hospital told the reporter.
Wang Minghao’s son also started developing similar allergic symptoms to Wang in August 2015. The little boy woke up with a blocked nose and said: “Daddy, I can’t breathe!” Wang booked flights ticket that night for Xi’an, the capital city of Shaanxi Province around 600 kilometers south of Yulin. The child felt much better while in Xi’an, and since then, Wang sends his son there for two months during the autumn. He only returns to Yulin in October when the allergy season is over. But Wang knows that this is not a long-term solution. “Now he’s in kindergarten, I don’t know what we’ll do once he starts primary school,” Wang said.
“The only solution is to either leave our home, or shut ourselves completely indoors, so that we can ensure isolation from allergens,” He said, who developed asthma after 11 years of hay fever. Like a migrating bird, from 2004 he started spending two to three months in Southern China. After installing his air purification system, he decided to stay at home all the time rather than move to other places. He estimated that only 1 percent of the patients who suffer from chronic allergies in Yulin can afford to leave during peak allergy season. Most have no choice but to stay and fight. “Those suffering from seasonal allergies are getting younger and younger,” said one doctor from Yulin, who requested anonymity. A decade ago, the youngest patients were around five to six years old, but now, the youngest he sees are one year old. Yin Jia from the department of allergy at PUMCH said that the one-year-old might have been born right before a pollen allergy season, and starts to show symptoms the next.
According to scientific studies, Mugwort plants produce small pollen grains that can be transported for hundreds or even thousands of kilometers through the air. Species of Artemisia are widely grown in the Inner Mongolia grasslands in Northern China.
Online calls and petitions to authorities to contain the spread of the Artemisia species started in September 2010. An open letter titled “Petition for Yulin Government to Disclose the Truth behind the Surging Number of Allergic Rhinitis Patients in Yulin” was published. Following that, sufferers from Yulin published another open letter on People.com.cn in 2014 challenging the government’s slow response. One sufferer spoke to local newspaper the Yulin Daily: “We have hay fever, but we do not want to live our lives with masks on, and we hope the government will investigate the issue.” The Yulin Bureau of Health issued a response, saying that “Artemisia might be an allergen which causes arousing allergic rhinitis, but it is not the only factor that causes the disease.” The bureau also stated that “aerial seeding of Artemisia to combat desertification are all local species, and there are no exotic species as people have rumored.” He Yanbin started a WeChat group for hay fever sufferers in Yulin. He and a few other patients went to an area where mugwort was planted in August 2015 to live broadcast their reaction to the pollen of the plant, which attracted a lot of attention from hay fever sufferers. In 2016, He Yanbin was elected to the Chinese People’s Political Consultative Committee in Yulin. He delivered a proposal calling for the local government to pay attention to the increasing number of hay fever sufferers, but he got no response. He repeated the same proposal in 2017, and people in neighboring provinces including Inner Mongolia and Ningxia also started to organize and present petitions to local governments. One petition letter online was viewed hundreds of thousands of times.
Soon after, an emergency meeting was held by the government inviting doctor Yin Jia from PUMCH, along with a few doctors from other hospitals and experts from the Chinese Center for Disease Control and Prevention. Yin proposed that field research was needed in Yulin. In August 2018, 19 doctors from the Department of Allergy, PUMCH went to Yulin No.2 Hospital to offer voluntary medical consultations to local patients. Over 1,000 people attended.
After four consecutive years of proposals, He Yanbin finally received positive feedback from the local government in 2019. In March 2019, the Yulin government listed the prevention and treatment of allergic rhinitis as one of the 10 priority tasks for improving local livelihoods. The government also distributed a special fund to fulfill the local epidemiological survey of the disease, set up a special research project and installed facilities to monitor the pollen count and broadcast the levels.
No one knows when the final research results will be attained. Yulin resident Lin Peng, who has suffered from hay fever for 20 years, told NewsChina that the final goal of his 10 years of petitioning on the issue is to have the government “completely uproot all Artemisia species.” But this is not practical and far from realistic.
An NGO based in Xi’an applied to the State Forestry and Grassland Administration in July 2018, asking to provide information disclosure on any correlation between allergies and Artemisia planting. It also applied to the National Health Commission to disclose the figures from 2003 to 2017 related to the number of allergic rhinitis and asthma patients, medical measures and treatment effects in Northern China. The National Health Commission responded within one month that such statistics are not available.
Few Resources The Inner Mongolia grasslands of Northern China are home to a high diversity of grass pollen species. However, an article titled “Prevalence of pollen‐induced allergic rhinitis with high pollen exposure in grasslands of northern China,” published in the Allergy: European Journal of Allergy and Clinical Immunology in 2018, indicated that there are no epidemiological studies looking at the prevalence of pollen‐induced allergic rhinitis and its relationship to environmental factors such as climatic variables, airborne pollen allergen intensity, and period of exposure for local residents living in this region.
“There are tens of millions of allergy patients across China, but in contrast, there are only around 200 doctors specializing in allergies, and only around 20 specialized allergy departments in China,” said Wang Lianglu during the 13th International PUMCH Allergy Forum held this August, who added that achieving regulated treatment for allergic diseases will take a long time. According to Yin Jia, over 30 doctors from Yulin will train in allergy treatment at PUMCH.
The forest coverage rate in Yulin is up to 33 percent now, and there are no more sand storms in the region. Until 2014, when aerial seeding measures stopped, the reserved total area for Artemisia was over 333,500 hectares. In 1959, the desert control program was set up in Yulin. “Back then, there were no experts in health and medication in the expert team, and the purpose of desert control was mainly for the development of agriculture economy. So no one was thinking of causing potential pollen allergy issues at that time, which was a limitation of that specific time in history,” Shi Changchun, deputy director of Shaanxi Provincial Desert Control, told NewsChina.
In Shi’s opinion, the situation worsened due to a ban on grazing in Yulin since 2002. Properly managed grazing can contain the growth of Artemisia. According to Shi, by 2014, the encroaching desert in the Yulin area was successfully controlled, but this is not the final step for the desert control program.
“From an encroaching desert to the terrain of shrubs, the desert is contained effectively, but the shrubs still need to be replaced with trees, for example using the Mongolian scotch pine,” Shi said, adding that the final goal is to revive the grasslands with trees.
Yin Jia wrote in a report on the research of desert control plants in Yulin published in 2018 that as Yulin turns from a former desert city into a forest city, the lifestyles of residents have changed from a traditional farming culture to a modern industrial civilization, which might be the core reason behind the surging number of allergy sufferers. Allergies, as an epidemic of the 21st century, affect 30 to 40 percent of the global population.
“We are now experiencing what has already been experienced by developed Western countries – a similar visible increase in different kinds of allergic diseases,” Yin said.
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