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 17-11-2008

? ? ? ? ? ? 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? ? ? ? ? ? ?

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

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

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

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

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

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

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-

SPACE Study on Prevention of Allergy in Children in Europe Lithuania had a 10-20-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 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

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) 1994-95 y % 2001-02 y 0.5 * AR+AD A+AR+AD A+AD A+AR *p<0.05 Kudzyte et al. Pediatric Pulmonology and Allergology 2004

ISAAC (International Study of Asthma and Allergy in Childhood) Changes in the prevalence of allergic diseases combinations in 13-14 yrs old children ISAAC (International Study of Asthma and Allergy in Childhood) 1994-95 y % * 2001-02 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

Allergy has become increasingly common in developed societies 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%) Allergy has become increasingly common in developed societies Dubakiene R 2007 European Academy of Allergology and Clinical Immunology (EAACI) 2007

*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) 2004 2005 2006 2007 Children (0-17 yrs) Allergic rhinitis (J30.1-J30.4) 12.9 13.9 15.3 17.7 Asthma (J45-J46) 16.6 17.6 20.1 23.1 Dermatitis (L20-L30) 64.0 63.7 64.2 60.2 Adults (>18 yrs) Asthma (45-J46) 7.8 8.5 8.9 9.5 Dermatitis (L20-L30) 24.9 24.9 31.5 24.7 * *number of persons with certain disease per 1000 pop. Lithuanian Ministry of Health/ Lithuanian Health Information Centre of Diseases 2008

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”

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

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

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

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

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

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

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 )

Important questions in allergy Healthy environment

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

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

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

Thank you for your attention!