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Decreasing the burden of allergy Brigita Sitkauskiene, MD, PhD EAACI Member-at-Large Associate Professor and Head Division for Allergology and Clinical.

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Presentation on theme: "Decreasing the burden of allergy Brigita Sitkauskiene, MD, PhD EAACI Member-at-Large Associate Professor and Head Division for Allergology and Clinical."— Presentation transcript:

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

3 lAllergic disease is the 5th leading chronic disease among all ages l3rd common chronic disease among children under 18 years old; up to one child in three is affected lTrends indicate that by 2015, half of all Europeans may be suffering from an allergy

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

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

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

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

8 Allergic diseases lImpose significant burdens on societies lAre becoming more important from a financial and healthcare perspective

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

10 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 SPACE Study on Prevention of Allergy in Children in Europe

11 Arshad SH, Bojarskas J et al. Clin Exp Allergy 2002 Halmerbauer G et al. Pediatr Allergy Immunol 2003 UK GreeceLithuania Children seen at 1 year: n Sensitized to dust mite: % 15.8 Control group Control group Control group Prophylact. group Prophylact. group Prophylact. group Development of sensitization to house dust mite During the recruitment phase, sensitization to HDM was relatively low in Lithuanian children (3.3%)

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

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

14 Prevalence of allergic diseases In Lithuania In other European countries Allergic rhinitis 3-8% 15-20% Asthma 4-6% 5-15% Atopic dermatitis 4-8% 17-21% (17%) (17%) Dubakiene R 2007 European Academy of Allergology and Clinical Immunology (EAACI) 2007 Allergy has become increasingly common in developed societies

15 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) Lithuanian Ministry of Health/ Lithuanian Health Information Centre of Diseases 2008 *number of persons with certain disease per 1000 pop. * During the last decade, the prevalence of allergic diseases in Lithuania has notably increased

16 lGenetic predisposition lEnvironment changes lDecreased exposure to infectious micro- organisms and/or changed commensal flora – the hygiene hypothesis lEvolution of the western lifestyle What are the causes?

17 Allergic diseases and use of paracetamol for fever in the first year of life % Griska E. Thesis 2008 Beasley R et al. Lancet 2008 AsthmaAtopic dermatitis Allergic rhinitis Have used paracetamol Havent used paracetamol **p<0.001 * ** *p<0.05, Exposure to paracetamol might be a risk factor for the development of asthma in childhood

18 Allergic diseases and usage of antibiotics in the first year of life % Griska E. Thesis 2008 AsthmaAtopic dermatitis Allergic rhinitis Have used antibiotics Havent used antibiotics **p<0.001 ** Antibiotic use early in life may increase the risk of asthma

19 Smokers Non-smokers ** ** p= ** induced sputum cell counts Allergic asthma: influence of smoking Total cell counts Neutrophils Lymphocytes Eosinophils Macrophages Ragaisiene S et al. EAACI 2006 (x10 6 /ml)

20 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 GA2LEN Collaborating Centres

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

22 EUROPREVALL lThe goal of the study - to determine the incidence of food allergies during the first 2½ yrs of life lStudy represents the different cultural and climatic regions of Europe lThe 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 Important questions in allergy 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 ) The main topics of concern

24 Healthy environment Important questions in allergy

25 Decreasing the burden of allergy I lTo identify the main risk factors and to investigate the role of possible modifiable environmental factors that may ultimately lead to investigate the role of possible modifiable environmental factors that may ultimately lead to a reduction in the personal burden of these diseases 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 lTo share important research findings with professionals, the public, policy markets and industry lAdaptation, translation and dissemination on a regular basis evidence-based prevention guidelines

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

28 Thank you for your attention!


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