1. Decreasing the burden of allergy
Brigita Sitkauskiene, MD, PhD
EAACI Member-at-Large
Associate Professor and Head
Division for Allergology and Clinical Immunology
Kaunas University of Medicine, Lithuania
Brussels

2. ? ? ? ? ? ? What lessons were learnt?
What is the importance of the research?
What can we do for the health of population- decreasing the burden of allergy- at regional and national levels? ? ? ? ? ? ?

3. Allergic disease is the 5th leading chronic disease among all ages
3rd common chronic disease among children under 18 years old; up to one child in three is affected
Trends indicate that by 2015, half of all Europeans may be suffering from an allergy

4. Allergies affect people from the early stages of their life and continue until their late adult ages

5. Allergy is a systemic disorder
Nose
Allergic rhinitis
Asthma
Pharynx
Lungs
Oesophagus
Stomach
Food allergy
Skin
Eczema
Urticaria
Allergic dermatitis
“Global diseases” – due to the large spectrum of symptoms affecting the whole body

6. Eosinophils BrdU+ CD34+ Bone marrow BALf
Sitkauskiene B et al. Am J Respir Cell Mol Biol 2003

7. Allergic diseases Seriously compromise the quality of life:
over 70% of allergic patients say they feel limited in their daily activities
Some allergies may be fatal

8. Allergic diseases Impose significant burdens on societies
Are becoming more important from a financial and healthcare perspective

9. Research needs on allergy and asthma
To identify the causes of the increasing prevalence, which might lead to prevention
- risk factors, epidemiology-
To define the exact mechanisms causing allergic symptoms, which could lead to better treatments
- disease mechanisms, management-

10. SPACE Study on Prevention of Allergy in Children in Europe
Lithuania had a fold reduced risk of asthma and hay fever in the comparative analysis, using UK as a reference (SPACE data)
Arshad SH et al. J Investig Allergol Clin Immunol 2001

11. SPACE Study on Prevention of Allergy in Children in Europe
Development of sensitization to house dust mite UK
Greece
Lithuania
Children seen at 1 year: n
Sensitized to dust mite: %
Control
group
Prophylact.
group
Control
group
Prophylact.
group
Control
group
Prophylact.
group 15 16 43 50 38 51
20.0
6.25
15.8
3.9
During the recruitment phase, sensitization to HDM was relatively low in Lithuanian children (3.3%)
Arshad SH, Bojarskas J et al. Clin Exp Allergy 2002
Halmerbauer G et al. Pediatr Allergy Immunol 2003

12. ISAAC (International Study of Asthma and Allergy in Childhood)
Changes in the prevalence of allergic diseases combinations in 6-7 yrs old children
ISAAC (International Study of Asthma and Allergy in Childhood) y % y
0.5 *
AR+AD
A+AR+AD
A+AD
A+AR
*p<0.05
Kudzyte et al. Pediatric Pulmonology and Allergology 2004

13. ISAAC (International Study of Asthma and Allergy in Childhood)
Changes in the prevalence of allergic diseases combinations in yrs old children
ISAAC (International Study of Asthma and Allergy in Childhood) y % * y
1.0
0.5
AR+AD
A+AR+AD
A+AD
A+AR
*p<0.05
Kudzyte et al. Pediatric Pulmonology and Allergology 2004

14. Allergy has become increasingly common in developed societies
Prevalence of allergic diseases
In Lithuania
In other European
countries
Allergic rhinitis % %
Asthma % %
Atopic dermatitis % %
(17%)
Allergy has become increasingly common in developed societies
Dubakiene R 2007
European Academy of Allergology and Clinical Immunology (EAACI) 2007

15. *number of persons with certain disease per 1000 pop.
During the last decade, the prevalence of allergic diseases
in Lithuania has notably increased
Diseases (ICD-10 code)
Children (0-17 yrs)
Allergic rhinitis (J30.1-J30.4)
Asthma (J45-J46)
Dermatitis (L20-L30)
Adults (>18 yrs)
Asthma (45-J46)
Dermatitis (L20-L30) *
*number of persons with certain disease per 1000 pop.
Lithuanian Ministry of Health/
Lithuanian Health Information Centre of Diseases 2008

16. What are the causes? Genetic predisposition Environment changes
Decreased exposure to infectious micro-organisms and/or changed commensal flora – the hygiene hypothesis
Evolution of the “western lifestyle”

17. Allergic diseases and use of paracetamol for fever in the first year of life% 6
Have used paracetamol
Haven’t used paracetamol
4.4
*p<0.05,
**p<0.001 4
3.1 **
2.8 *
2.1
2.0 2
1.7
Asthma
Atopic dermatitis
Allergic rhinitis
Exposure to paracetamol might be a risk factor
for the development of asthma in childhood
Griska E. Thesis 2008
Beasley R et al. Lancet 2008

18. Allergic diseases and usage of antibiotics in the first year of life% 6
Have used antibiotics
5.2
Haven’t used antibiotics
**p<0.001 4
3.8
3.0 **
2.2 **
1.9 2
1.4
Asthma
Atopic dermatitis
Allergic rhinitis
Antibiotic use early in life may increase the risk of asthma
Griska E. Thesis 2008

19. induced sputum cell counts
Allergic asthma: influence of smoking
induced sputum cell counts 14
(x106/ml) 12
Smokers 10
Non-smokers
** p=0.0001 8 6 ** 4 ** 2
Total cell counts Neutrophils Lymphocytes Eosinophils Macrophages
Ragaisiene S et al. EAACI 2006

20. GA2LEN Collaborating Centres
University of Aberdeen, UK
University of Antwerp, Belgium
HCPB of Barcelona, Spain
University of Basle, Switzerland
University of Bergen, Norway
University of Bern, Switzerland
University of Bochum, Germany
University of Bucarest, Romania
University of Budapest, Hungary
University of Copenhagen, Denmark
University of Dublin, Ireland
University of Geneva, Switzerland
University of Groningen, The Netherlands
University of Leiden, The Netherlands
University Hospital of Iceland, Iceland
University of Louvain, UCL, Belgium
University of Lübeck, Borstel, Germany
University of Marburg, Germany
GSF Munich, Germany
University of Nottingham, UK
University of Pavia, Italy
University of Ferrrare/Modena, Italy
Charles University of Prague, Czech Republic
Rome Health Authority, Italy
University of Rotterdam, The Netherlands
University of Salzburg, Austria
University of Sofia, Bulgaria
University of Tartu, Estonia
University of Ulm, Germany
University of Uppsala, Sweden
University of Verona, Italy
University of Vilnius, Lithuania
Kaunas University of Medicine, Lithuania

21. Global Allergy and Asthma European Network
Aim- to strengthen the impact of Europe’s research
by integrating research teams from across Europe
by communicating information beyond the research
community to healthcare professionals, patients, policy
markets and industry

22. EUROPREVALL
The goal of the study - to determine the incidence of food allergies during the first 2½ yrs of life
Study represents the different cultural and climatic regions of Europe
The incidence of food allergy in a cohort of 1558 Lithuanian children – 5 % (initial data),
whereas in developed European counties –
3 children from 10
M|ills ENC et al. Allergy 2007
Dubakiene R. Data on file

23. The main topics of concern
Important questions in allergy
The main topics of concern
Food safety
(allergenicity of food:
composite and genetically
modified foods)
Biological factors
(safety of vaccination)
Chemical factors
(products highly aggressive
for the skin, self-imposed
medication )

24. Important questions in allergy
Healthy environment

25. Decreasing the burden of allergy I
To identify the main risk factors and
to investigate the role of possible modifiable environmental factors that may ultimately lead
to a reduction in the personal burden of these diseases
Early intervention may modulate the natural course of atopic disease

26. Decreasing the burden of allergy II
To share important research findings with professionals, the public, policy markets and industry
Adaptation, translation and dissemination on a regular basis evidence-based prevention guidelines

27. Decreasing the burden of allergy III
The enhanced partnership of European systems working in the area of allergy and asthma
Harmonization throughout Europe in term of Allergology training, Allergology practice and Allergy management

28. Thank you for your attention!