PowerPointPrsentation

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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
Immunology Kaunas University of Medicine,
Lithuania
Brussels 17-11-2008
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• 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?

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• 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

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

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Allergy is a systemic disorder
Allergic rhinitis Asthma
Nose
Pharynx
Lungs
Oesophagus
Stomach
Food allergy
Skin
Eczema Urticaria Allergic dermatitis
Global diseases due to the large spectrum of
symptoms affecting the whole body
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Eosinophils
BALf
Bone marrow
Sitkauskiene B et al. Am J Respir Cell Mol Biol
2003
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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

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Allergic diseases

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

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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-

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SPACEStudy 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
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SPACEStudy on Prevention of Allergy in Children
in Europe
Development of sensitization to house dust mite
Control group
Control group
Control group
Prophylact. group
Prophylact. group
Prophylact. group
51
50
38
43
16
15
3.9
15.8
0
6.25
0
20.0
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
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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
0
AAD
AARAD
AAR
ARAD
plt0.05
Kudzyte et al. Pediatric Pulmonology and
Allergology 2004
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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
0
AAD
AARAD
AAR
ARAD
plt0.05
Kudzyte et al. Pediatric Pulmonology and
Allergology 2004
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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
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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 (gt18 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
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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

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Allergic diseases and use of paracetamol for
fever in the first year of life

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Have used paracetamol
Havent used paracetamol
4.4
plt0.001
plt0.05,
4
3.1
2.8


2.1
2.0
2
1.7
0
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
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Allergic diseases and usage of antibiotics in
the first year of life

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Have used antibiotics
5.2
Havent used antibiotics
plt0.001
3.8
4
3.0

2.2

1.9
2
1.4
0
Asthma
Atopic dermatitis
Allergic rhinitis
Antibiotic use early in life may increase the
risk of asthma
Griska E. Thesis 2008
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Allergic asthma influence of smoking
induced sputum cell counts
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(x106/ml)
12
Smokers
Non-smokers
10
p0.0001
8
6

4

2
0
Total cell counts Neutrophils
Lymphocytes Eosinophils Macrophages
Ragaisiene S et al. EAACI 2006
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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
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Global Allergy and Asthma European Network

• Aim- to strengthen the impact of Europes
  research
• by integrating research teams from across Europe
• by communicating information beyond the research
  
• community to healthcare professionals,
  patients, policy
• markets and industry

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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

Mills ENC et al. Allergy 2007 Dubakiene R. Data
on file
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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 )
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Important questions in allergy
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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
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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

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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

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Thank you for your attention!