26 Countries Thanks to all the UEMS delegates involved OUR WAY OF WORKING 26 Countries Thanks to all the UEMS delegates involved JACQUES GAYRAUD MD, DIONYSIS GIANNAKOPOULOS MD June 2014

DENMARK GERMANY SWEDEN FINLAND ESTONIA UK IRELAND LITHUANIA POLAND NETHERLANDS CZECH REP. BELGIUM AUSTRIA FRANCE HUNGARY SLOVENIA SLOVAKIA ROMANIA PORTUGAL BULGARIA ESPANA GREECE CYPRUS TURKEY SWITZERLAND ITALY

ALLERGOLOGY AS A SPECIALITY ITALY PORTUGAL SPAIN GREECE CROATIA SWITZERLAND ROMANIA UK SWEDEN SLOVAKIA CZECH REP. LITHUANIA LUXEMBURG CYPRUS NETHERLANDS YES:14 SUBSPECIALITY:6 FINLAND FRANCE GERMANY TURKEY POLAND ESTONIA HUNGARY DENMARK SLOVENIA AUSTRIA* BELGIUM IRELAND NO:5

ALLERGOLOGY DIVISIONS/ DPTs IN MEDICAL SCHOOLS YES FINLAND CROATIA ITALY CZECH REP. LITHUUANIA SPAIN PORTUGAL NETHERLANDS FRANCE GERMANY DENMARK AUSTRIA SWITZERLAND TURKEY SWEDEN BELGIUM ROMANIA UK SLOVAKIA NO GREECE HUNGARY SLOVENIA CYPRUS ESTONIA In the vast majority of european countries there are all divisions

4 34 55 In mother spe. 2 5 4 (Univ) +3 7-10 4+2 14+11 16 38-40 7 2+3 COUNTRIES Number of years for training in Allergology Allergology training centres Allergology trainees/year ESPANA 4 34 55 SLOVENIA In mother spe. 2 PORTUGAL 5 4 (Univ) +3 7-10 NETHERLANDS 4+2 LITHUANIA CZECH REP. 14+11 16 ITALY 38-40 HUNGARY 7 GREECE 2+3 3 7 FRANCE 17 25 GERMANY 18 months 50-100 IRELAND SLOVAKIA

2+5 0-10 - 5 (ENT, Dermat, Pulmo., Ped) 3+3 27 20-30 2-4 ? COUNTRIES Number of years for training in Allergology Allergology training centres Allergology trainees/year FINLAND 2+5 0-10 DENMARK - CYPRUS AUSTRIA 5 (ENT, Dermat, Pulmo., Ped) SWITZERLAND 3+3 27 20-30 BELGIUM 2-4 ? SWEDEN internal med+2 8 5 TURKEY 3+5 15 10 ESTONIA 4 years C.IMN 2 3 CLIN IMN ROMANIA 4 20-25 UK 6-13 POLAND 3 BULGARIA

SPECIALTY OR SUBSPECIALTY OF PAEDIATRIC ALLERGY AUSTRIA NO SPAIN LITHUANIA SLOVAKIA POLAND ? GREECE BULGARIA YES UK ROMANIA GERMANY FRANCE YES (competence)

COMPLEMENTARY ALLERGY TRAINING FOR GPS, OTHER SPECIALISTS OR PARA MEDICAL PROFESSIONALS AUSTRIA NO SPAIN YES, N.A. LITHUANIA YES SLOVAKIA POLAND GREECE BULGARIA UK ROMANIA GERMANY FRANCE Is there?

UNIVERSITY/PREGRADUATE LEVEL HOURS DEVOTED TO ALLERGY AUSTRIA 6 SPAIN 0-30 LITHUANIA 30 SLOVAKIA 14 POLAND GREECE BULGARIA 18 UK - ROMANIA GERMANY 6-12( no formal obligation) FRANCE 6+2 Recent data from 7 countries :from 0-30 hours

DISEASES FOR ALLERGISTS In 22 european countries Asthma Rhinitis, conjunctivitis Food allergy Drug allergy Venom allergy Anaphylactic shock Immunotherapy Urticaria, angioedema Eczema In the vast majority Skin allergy Contact dermatitis Occupational asthma Primary Immuno deficiencies In a few countries AIDS Transplantation

Prices of Allergy in Europe (2014) Country 1st Cs Follow Cs SP CE T. SP native T. IDR test Patch test ESS - Other notes 1 Austria 50 15 20 25 20 - 20   2 Belgium 40.05 23.78 19.88 158-198 (hosp) 79 - 79 Derm+ 3 Croatia 12,61 5,44 5,45 10,89 4 Czech Rep. 24.4 12.4 0.9€/Ag 1.1€/Ag 0.8€/Ag 5 France 23 – 56 23 – 28.8 28.8 36.05 36.05-43.15 29.3 – 43.15 6 Germany 16.28-20.83 - 45.33 16.28 (1?) 62.65 7 Greece 50 – 80 30 – 50 65.45 120 – 180 150 8 Hungary 33 – 83 (SPT) 24 – 60 (SPT) 1.6€/Ag 100 – 66 9 Italy 26.7 15.9 23.2 32.5 10 Netherlands 285 265.39-312.55 304.12-438 Hosp.+ spe (360€) 11 Portugal 7.75 12 Slovenia 27 9 - 9 13 Spain 18 14 Sweden T/nurse Switzerland 14.71/13.95 41.07 (10) + 5.33 (/+10) 26.69 54.42 (10) 42.35 + 49.79 Mean Price 26.6 € 19 € 21.8 € 34 € 34.5 €

IMMUNOTHERAPY IMMUNOTHERAPY SIT SCIT SLIT TABLETS AUSTRIA Yes COUNTRY SIT SCIT SLIT TABLETS AUSTRIA Yes CZECH REP FINLAND FRANCE GREECE POLAND ROMANIA SLOVENIA SPAIN yes SWEDEN SWITZERLAND TURKEY UK Yes? PORTUGAL IMN is practiced in all 3 ways, SCIT, SLIT, TAB in all european countries

COUNTRY SPECIALISTS PRESCRIBING LEGAL BUILD-UP PHASE MANTEINANCE AUSTRIA All, ped, ENT, Pulm, Derm Any CZECH REP Allergists Allergists, hosp or private FINLAND Ped all, ped, ENT, pulm specialist Hosp or private Hosp, private, primary care FRANCE All, few Pulm, ENT, ped, intern, GP Hosp, private, GREECE All, few ENT, Pulm POLAND Allergists, pulm IT units ROMANIA Allergists, hosp SLOVENIA All, few Pulm and ped SPAIN Allergists, few ENT, pulm Allergists, primary care SWEDEN SWITZERLAND Any, but recomended All any TURKEY PORTUGAL Allergists, pulm,ped UK allergists, hosp But it is surprising that although they do not have the same allergy training as us, in many european countries, doctors of other specialties can also prescribe our therapies

ANAPHYLAXIS GUIDELINES IN EUROPE YES NO Hungary France UK Germany Slovenia Finland Czech republic Sweden Spain Switzerland Netherlands Greece Romania Denmark Portugal Italy As for anaphylactic guidelines, European countries are shared, half of them have, half not. In mine, we are now working on that.

CME Mandatory: YES:14, NO:9 Benefits to practitioners: YES:8, NO:13 1. FRANCE 10. CZECH REP. 2. HUNGARY 11. SWITZERLAND 3. ITALY 12. TURKEY 4. AUSTRIA 13. BELGIUM 5. SPAIN 14. ROMANIA 6. NETHERLANDS 15. GREECE 7. SLOVENIA 16. UK 8. LITHUANIA 17. CYPRUS 9. GERMANY 18. IRELAND NO 1. DENMARK 2. PORTUGAL 3. FINLAND 4. SWEDEN 5. ESTONIA 6. IRELAND Whereas they are mandatory in 14 countries, but beneficial only in 8 Mandatory: YES:14, NO:9 Benefits to practitioners: YES:8, NO:13

ALLERGOLOGY PRACT. STATUS ALLERGOLOGISTS/POPULATION(P) ITALY: ?/P=1/? CZECH REP. : 520/P=1/20192 LITHUANIA : 28+11/P=1/92337 NETHERLANDS : 8+20/P=1/573850 PORTUGAL: 205/P=1/50000 SPAIN : 800/P=1/50097 FIN LAND: 107/P=1/48445 DENMARK : 3+30/P=1/162693 GREECE: 103/P=1/106796 SWEDEN: 100/P=1/100000 ROMANIA: 103+80/P=1/121955 FRANCE: 600+1273/P=1/34743 HUNGARY : 200/P=1/50000 GERMANY :  5000/P=1/16450 SLOVENIA: 92/P=1/21739 CYPRUS: 2/P=1/383657 AUSTRIA:400/P=1/20000 SWITZERLAND:?+148 / P=1/? BELGIUM: 10+460/P=1/21861 TURKEY:90/P=1/800000 ESTONIA:31/P=1/43290 UK: 27+86/P=1/529009 POLAND:850/P=1/45442 IRELAND:2/P=1/1941580 What’s the ratio of allergists per population? Are we sufficient in terms of population? I can not tell for other countries, but Best ratio seems to be in germany and the worse in ireland

DISTRIBUTION OF ALLERGOLOGISTS ACCORDING TO THEIR STATUS (:PUBLIC/PRIVATE/BOTH) COUNTRY ALLERGISTS ALL + SPE HOSP.ALL PRIVATE BOTH Austria 15 400 Czech Rep. 590 140 450 Estonia 2 Finland 90 30 60 France 505 1273 112 (GP) Greece 115 17 98 Lithuania 34 33 1 Netherlands 8 20 22 6 Portugal 150 Spain 700 550 200 Sweden 70 100 + 110 Switzerland 162 12 More specifically the distribution of…. Can be seen in this slide

STRUCTURES/INSTITUTIONS FOR OUR REPRESENTATION PATIENTS’ ASSOCIATIONS SCIENTIFIC SOCIETY YES :23 NO:IRELAND YES(19) NO (5) PATIENTS’ ASSOCIATIONS

THANKS TO ALL UEMS DELEGATES