Decreasing the burden Decreasing the burden of allergyof allergy

Brigita Sitkauskiene, MD, PhDBrigita Sitkauskiene, MD, PhDEAACI Member-at-LargeEAACI Member-at-LargeAssociate Professor and HeadAssociate Professor and HeadDivision for Allergology and Clinical ImmunologyDivision for Allergology and Clinical ImmunologyKaunas University of Medicine, LithuaniaKaunas University of Medicine, Lithuania

Brussels 17-11-2008Brussels 17-11-2008

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What lessons were learnt?What lessons were learnt?

What is the iWhat is the importancemportance of the researchof the research??

What can we do for the health of population- What can we do for the health of population-

decreasing the burden of allergy- at regional decreasing the burden of allergy- at regional

and national levels?and national levels?

Allergic disease is the 5th leading chronic disease Allergic disease is the 5th leading chronic disease among all agesamong all ages

3rd common chronic disease among children 3rd common chronic disease among children under 18 years oldunder 18 years old; up to one child in three is ; up to one child in three is affectedaffected

Trends indicate that by Trends indicate that by 2015, half of all Europeans 2015, half of all Europeans may be suffering from an allergymay be suffering from an allergy

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

Allergy is a systemic disAllergy is a systemic disorderorder

NosePharynx

Stomach

OesophagusLungs

““Global diseases” – due to the large spectrum of Global diseases” – due to the large spectrum of symptoms affecting the whole bodysymptoms affecting the whole body

SkinFood allergyFood allergy

Allergic rhinitisAllergic rhinitisAsthmaAsthma

EczemaEczemaUrticariaUrticariaAllergic dermatitisAllergic dermatitis

Bone marrowBone marrow BALBALffEosinophilsEosinophils

BrdU+

CD34+

Sitkauskiene B et al. Am J Respir Cell Mol Biol 2003

Allergic diseasesAllergic diseases

Seriously compromise the quality of life:Seriously compromise the quality of life:

over 70% of allergic patients say they feel limited over 70% of allergic patients say they feel limited in their daily activitiesin their daily activities

Some allergies may be fatal Some allergies may be fatal

Allergic diseasesAllergic diseases

Impose significant burdens on societiesImpose significant burdens on societies

Are becoming more important from a financial Are becoming more important from a financial and healthcare perspectiveand healthcare perspective

Research needs on allergy and asthmaResearch needs on allergy and asthma

To identify the causes of the increasing To identify the causes of the increasing prevalence, which might lead to preventionprevalence, which might lead to prevention

- risk factors, epidemiology-- risk factors, epidemiology-

To define the exact mechanisms causing allergic To define the exact mechanisms causing allergic symptoms, which could lead to better treatmentssymptoms, which could lead to better treatments

- disease mechanisms, management-- disease mechanisms, management-

Lithuania had a 10-20-fold reduced risk of asthma and Lithuania had a 10-20-fold reduced risk of asthma and hay fever in the comparative analysis, using UK as a hay fever in the comparative analysis, using UK as a reference (SPACE data)reference (SPACE data)

Arshad SH et al. J Investig Allergol Clin Immunol 2001

SPACESPACEStudy on Prevention of Allergy in Children in EuropeStudy on Prevention of Allergy in Children in Europe

SPACESPACEStudy on Prevention of Allergy in Children in EuropeStudy on Prevention of Allergy in Children in Europe

Arshad SH, Bojarskas J et al. Clin Exp Allergy 2002Halmerbauer G et al. Pediatr Allergy Immunol 2003

UKUK GreeceGreece LithuaniaLithuania

Children seen at 1 year: n

Sensitized to dust mite: %

15.8

Controlgroup

Controlgroup

Controlgroup

Prophylact.group

Prophylact.group

Prophylact.group

15

20.0

16

6.25

43 50

0 0

38 51

3.9

Development of sensitization to house dust mite Development of sensitization to house dust mite

During the recruitment phase, sensitization to HDM was relatively low in Lithuanian children (3.3%)

Changes in the prevalence of allergic diseases Changes in the prevalence of allergic diseases combinations in combinations in 6-7 yrs old children6-7 yrs old children

Kudzyte et al. Pediatric Pulmonology and Allergology 2004

A+ADAR+AD0

0.5

%1994-95 y

2001-02 y

A+AR+AD A+AR

* * *

*p<0.05

ISAAC (International Study of Asthma and Allergy in Childhood)ISAAC (International Study of Asthma and Allergy in Childhood)

Changes in the prevalence of allergic diseases Changes in the prevalence of allergic diseases combinations in combinations in 13-14 yrs old children13-14 yrs old children

Kudzyte et al. Pediatric Pulmonology and Allergology 2004

A+ADAR+AD0

0.5

%1994-95 y

2001-02 y

A+AR+AD A+AR

*

*

*p<0.05

1.0

ISAAC (International Study of Asthma and Allergy in Childhood)ISAAC (International Study of Asthma and Allergy in Childhood)

Prevalence of allergic diseasesPrevalence of allergic diseases

In LithuaniaIn Lithuania In other European In other European countriescountries

Allergic rhinitis 3-8% 15-20%Allergic rhinitis 3-8% 15-20%

Asthma 4-6% 5-15%Asthma 4-6% 5-15%

Atopic dermatitis 4-8% 17-21%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 Allergy has become increasingly common in developed societies

Diseases (ICD-10Diseases (ICD-10 code code) 2004 2005 2006 2007) 2004 2005 2006 2007

Children (0-17 yrs)Children (0-17 yrs)

Allergic rhinitis (J30.1-J30.4) 12.9 13.9 15.3 17.7Allergic rhinitis (J30.1-J30.4) 12.9 13.9 15.3 17.7

Asthma (J45-J46) 16.6 17.6 20.1 23.1Asthma (J45-J46) 16.6 17.6 20.1 23.1

Dermatitis (L20-L30) 64.0 63.7 64.2 60.2Dermatitis (L20-L30) 64.0 63.7 64.2 60.2

Adults (>18 yrs)Adults (>18 yrs)

Asthma (45-J46) 7.8 8.5 8.9 9.5Asthma (45-J46) 7.8 8.5 8.9 9.5

Dermatitis (L20-L30) 24.9 24.9 31.5 24.7Dermatitis (L20-L30) 24.9 24.9 31.5 24.7

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 During the last decade, the prevalence of allergic diseases in Lithuania has notably increasedin Lithuania has notably increased

Genetic predispositionGenetic predisposition

Environment changes Environment changes

Decreased exposure to infectious micro-Decreased exposure to infectious micro-organisms and/or changed commensal flora – organisms and/or changed commensal flora – the hygiene hypothesis the hygiene hypothesis

Evolution of the “western lifestyle”Evolution of the “western lifestyle”

What are the causes?What are the causes?

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

2

0

6

4

%

Griska E. Thesis 2008Beasley R et al. Lancet 2008

Asthma Atopic dermatitis

Allergic rhinitis

3.1

1.7

4.4

2.1

2.8

2.0

Have used paracetamol

Haven’t used paracetamol

**p<0.001

***

*p<0.05,

Exposure to paracetamol might be a risk factor for the development of asthma in childhood

Allergic diseases and usage of antibiotics Allergic diseases and usage of antibiotics in the first year of lifein the first year of life

2

0

6

4

%

Griska E. Thesis 2008

Asthma Atopic dermatitis

Allergic rhinitis

3.8

1.4

5.2

2.2

3.0

1.9

Have used antibiotics

Haven’t used antibiotics

**p<0.001

****

Antibiotic use early in life may increase the risk of asthma

0

2

4

6

8

10

12

14

Smokers

Non-smokers

**

** p=0.0001

**

induced sputum cell countsinduced sputum cell counts

Allergic asthma: influence of smokingAllergic asthma: influence of smoking

Total cell counts Neutrophils Lymphocytes Eosinophils Macrophages

Ragaisiene S et al. EAACI 2006

(x10(x1066/ml)/ml)

University of Aberdeen, UKUniversity of Antwerp, BelgiumHCPB of Barcelona, SpainUniversity of Basle, SwitzerlandUniversity of Bergen, NorwayUniversity of Bern, SwitzerlandUniversity of Bochum, GermanyUniversity of Bucarest, RomaniaUniversity of Budapest, HungaryUniversity of Copenhagen, DenmarkUniversity of Dublin, IrelandUniversity of Geneva, SwitzerlandUniversity of Groningen, The NetherlandsUniversity of Leiden, The NetherlandsUniversity Hospital of Iceland, IcelandUniversity of Louvain, UCL, BelgiumUniversity of Lübeck, Borstel, GermanyUniversity of Marburg, GermanyGSF Munich, GermanyUniversity of Nottingham, UKUniversity of Pavia, ItalyUniversity of Ferrrare/Modena, ItalyCharles University of Prague, Czech RepublicRome Health Authority, ItalyUniversity of Rotterdam, The NetherlandsUniversity of Salzburg, AustriaUniversity of Sofia, BulgariaUniversity of Tartu, EstoniaUniversity of Ulm, GermanyUniversity of Uppsala, SwedenUniversity of Verona, ItalyUniversity of Vilnius, LithuaniaKaunas University of Medicine, Lithuania

GA2LEN Collaborating CentresGA2LEN Collaborating Centres

Global Allergy and Asthma European NetworkGlobal Allergy and Asthma European Network

Aim- to strengthen the impact of Europe’s researchAim- to strengthen the impact of Europe’s research

• by integrating research teams from across Europeby 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 industrymarkets and industry

EUROPREVALLEUROPREVALL

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 2007Dubakiene R. Data on file

Important questions in allergyImportant questions in allergy

Food safety(allergenicity of food:composite and geneticallymodified foods)

Biological factors(safety of vaccination)

Chemical factors(products highly aggressivefor the skin, self-imposed medication )

The main topics of concernThe main topics of concern

Healthy environmentHealthy environment

Important questions in allergyImportant questions in allergy

Decreasing the burden of allergy IDecreasing the burden of allergy I

To identify the main risk factors and To identify the main risk factors and

to investigate the role of possible modifiable to investigate the role of possible modifiable environmental factors that may ultimately lead environmental factors that may ultimately lead

to a reduction in the personal burden of these to a reduction in the personal burden of these diseasesdiseases

Early intervention may modulate the natural Early intervention may modulate the natural course of atopic disease course of atopic disease

Decreasing the burden of allergy IIDecreasing the burden of allergy II

To share important research findings with To share important research findings with professionals, the public, policy markets and professionals, the public, policy markets and industryindustry

Adaptation, translation and dissemination on a Adaptation, translation and dissemination on a regular basis evidence-based prevention regular basis evidence-based prevention guidelinesguidelines

Decreasing the burden of allergy IIIDecreasing the burden of allergy III

The enhanced partnership of European systems The enhanced partnership of European systems working in the area of allergy and asthmaworking in the area of allergy and asthma

Harmonization throughout Europe in term of Harmonization throughout Europe in term of Allergology training, Allergology practice and Allergology training, Allergology practice and Allergy managementAllergy management

Thank you for your attention!Thank you for your attention!