Global atlas oF allERGYP u b l i s h e d b y t h e E u r o p e a n A c a d e m y o f A l l e r g y a n d C l i n i c a l I m m u n o l o g y

w w w . e a a c i . o r g

Allergy - Mechanisms

Epidemiology and risk factors

Allergy diagnosis

Major Allergic Diseases

Other hypersensitivity diseases

Special considerations

Management of allergic diseases

Towards a comprehensive global strategy for the

management of allergic diseases

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Global atlas oF allERGY

Published by the European Academy of Allergy and Clinical Immunology

2014

Cezmi A. AkdisIoana Agache

Editors

Editorial Board

Pascal DemolyPeter Hellings

Antonella MuraroNikolaos G.Papadopoulos

Ronald van Ree

Global atlas of allERGY

II

BOARD OF OFFICERS

Nikos Papadopoulos, President

Antonella Muraro, Secretary General

Peter Hellings, Treasurer

Ioana Agache, Vice-President Communication and Membership

Pascal Demoly, Vice-President Education and Specialty

Ronald Van Ree, Vice-President Congresses

Cezmi A. Akdis, Past President

SECTION CHAIRPERSONS

Leif Bjermer, Asthma

Carsten Bindslev-Jensen, Dermatology

Cemal Cingi, ENT

Carsten Schmidt-Weber, Immunology

Susanne Lau, Pediatrics

Alexandra Santos, Junior Members and Affiliates

INTEREST GROUP REPRESENTATIVES

Moises Calderon

Karin Hoffmann-Sommergruber

MEMBERS AT LARGE

Lars K. Poulsen

Tomas Chivato

Thomas Werfel

Beatrice M. Bilo

Graham Roberts

Musa Khaitov

CHAIR EAACI PATIENT ORGANIZATION COMMITTEE

Frans Timmermans

ADJUNCT MEMBERS

Fulvio Braido, CME Committee Chairperson

Jan de Monchy, Specialty Committee Chairperson

Jacques Gayraud, Ethics Committee Secretary

Peter Schmid-Grendelmeier, Exam Committee Chairperson

Marek Jutel, SPC Co-ordinator

Angel Mazon, Web Editor

Olympia Tsilochristou, Web Editor

Michael Walker, Executive Director

EAACI Executive Committee

EAACI ExECUTIVE COMMITTEE

Global atlas of allERGY

III

Azza Abdel-Gadir, PhDDivision of Immunology, Boston

Childrens Hospital. Department of Pediatrics, Harvard Medical School.

Ioana Agache, MDDept, of Allergy and Clinical

Immunology, Transylvania University of Brasov, Faculty of Medicine

Cezmi A. Akdis, MDSwiss Institute of Allergy and Asthma

Research (SIAF), University of Zurich, Davos, Switzerland

Christine Khne Center for Allergy Research and Education (CK-CARE), Davos, Switzerland

Medical Faculty, University of Zurich

Mbeccel Akdis, MD, PhDSwiss Institute of Allergy and Asthma

Research (SIAF), University of Zurich, Davos, Switzerland

Walter J. Ammann, PhD Global Risk Forum (GRF) Davos,

Switzerland

Abena S. Amoah, MDDepartment of Parasitology, Leiden

University Medical Center, Leiden, The Netherlands

Department of Parasitology, Noguchi Memorial Institute for Medical Research, Accra, Ghana

Evangelos Andreakos, PhDBiomedical Research Foundation,

Academy of Athens, Greece

Isabella Annesi-Maesano, MDFrench Institute of Health and

Medical Research, Epidemiology of Allergic and Respiratory Diseases (EPAR), France

Claus Bachert, MDUpper Airways Research Laboratory,

University of Ghent, Ghent, Belgium;

Division of ENT Diseases, CLINTEC, Karolinska Institutet Stockholm, Sweden

Barbara Ballmer-Weber, MDDepartment of Dermatology,

University Hospital Zrich, Switzerland University Hospital

Zrich, Switzerland

Mark Ballow, MDDivision of Allergy and Immunology,

University of South FloridaMorsani School of Medicine, All

Childrens Hospital, St Petersburg USA

Nuray Bayar Muluk, MDDept Otorhinolaryngology,-Krkkale

University, Turkey

Thomas Bieber, MD, PhD, MDRADepartment of Dermatology and

Allergy, University Medical Center, Friedrich-Wilhelms University of Bonn, Germany

M. Beatrice Bil, MDAllergy Unit - Department of Internal

Medicine University Hospital Ospedali Riuniti di Ancona - Italy

Carsten Bindslev-Jensen, MDOdense Research Center for

Anaphylaxis, Odense DenmarkOdense University Hospital, Odense

Denmark

Leif Bjemer, MDLund University, Department

of Respiratory Medicine and Allergology, Sweden

Barbara Bohle, PhDDepartment of Pathophysiology

and Allergy Research and Christian Doppler Laboratory for Immunomodulation, Division of Cellular Allergology, Medical University of Vienna, Vienna, Austria

Matteo Bonini, MDDepartment of Public Health and

Infectious Diseases Sapienza University of Rome, Italy

Sergio Bonini, MDDepartment of Internal Medicine,

Second University of Naples, Italy

Jean Bousquet, MDUniversity of Montpellier,FranceWHO Global Alliance Against

Chronic Respiratory Diseases (GARD)

Director of the WHO Collaborating Centre for Asthma and Rhinitis in

Montpellier, France

Onur Boyman, MDDepartment of Clinical Immunology,

University Hospital Zurich, Zurich, Switzerland.

Gert Jan Braunstahl, MDSt. Franciscus Gasthuis Rotterdam,

The Netherlands

Heimo Breiteneder, PhDDepartment of Pathophysiology

and Allergy Research, Medical University of Vienna, Austria

Knut Brockow, MD Department of Dermatology

and AllergologyBiederstein, TechnischeUniversittMnchen, Germany.

A. Wesley Burks, MDDepartment of Pediatrics, University

of North Carolina at Chapel Hill, Chapel Hill ,USA

Robert K. Bush, MDUniversity of Wisconsin-Madison,

U.S.A

Jeroen Buters, PhDCenter for Allergy & Environment

(ZAUM), Technische Universitt Mnchen and Helmholtzzentrum Mnchen, Germany

EAACI Interest Group Aerobiology and Air Pollution

Moiss A. Caldern, MDSection of Allergy and Clinical

Immunology, Imperial College London, NHLI, Royal Brompton Hospital, London, UK.

Victria Cardona, MD, PhDAllergy Section, Department of

Internal Medicine. Hospital U n i v e r s i t a r i V a l l d H e b r o n , Barcelona, Spain

Kai-Hkon Carlsen, MD(Paediatric respiratory medicine and

allergology), University of Oslo, Institute for Clinical Medicine and Oslo University Hospital, Department of Paediatrics, Oslo, Norway

Jean-Christoph Caubet, MDDepartment of Child and Adolescent,

Contributors

CONTRIBUTORS

Global atlas of allERGY

IV

University Hospitals of Geneva and Medical School of the University of Geneva, Geneva, Switzerland

Yih-Chih Chan, MDKings College London, London,

United Kingdom

Talal Chatila, MDDivision of Immunology, Boston

Childrens Hospital/ Department of Pediatrics, Harvard Medical School.

R. Sharon Chinthrajah, MDDivision of Immunology and Allergy,

Department of Pediatrics, Stanford University, Stanford, USA

Toms Chivato Prez, MDUniversity CEU San Pablo, Madrid,

Spain

Cemal Cingi, MDDept Otorhinolaryngology, Eskisehir

Osmangazi University, Turkey

Linda Cox, MDAllergy and Asthma Center, Fort

Lauderdale, Florida, USA

Reto Crameri, PhDSwiss Institute of Allergy and Asthma

Research (SIAF), University of Zrich, Davos, Switzerland

Adnan Custovic, MD, PhDUniversity of Manchester, UK

Janet Davies, PhDLung and Allergy Research

Centre, School of Medicine, The University of Queensland, Translational Research Institute, Woolloongabba, Queensland, Australia

Jan G. R. de Monchy, MDUniversity of Groningen, University

Medical Center Groningen, The Netherlands

Pascal Demoly, MDUniversity Hospital of Montpellier,

France

Gnnur Deniz, PhDIstanbul University, Experimental

Asthma Research Institute, Istanbul, Turkey

Anthony E.J. Dubois, MDDept. of Pediatric Allergy, University

of Groningen, The Netherlands

Stephen R. Durham, MDAllergy and Clinical Immunology,

National Heart and Lung Institute,

Imperial College London, United Kingdom.

EAACI Patient Organisation Committee,

Philippe Eigenmann, MDUniversity Hospitals of Geneva,

Geneva, Switzerland

Veit Erpenbeck, PhDNovartis Institutes for Biomedical

Research, Basel, Switzerland

Claude Favrot, Dr .Vet. Dermatology Service, Clinic for

Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland

Fatima Ferreira, PhDDepartment of Molecular Biology,

Christian Doppler Laboratory for Allergy Diagnosis and Therapy, Saltzburg, Austria

Michael B. Foggs, MDPresident American College of

Allergy, Asthma & ImmunologyDept of Allergy and Immunology,

Advocate Health Care, Chicago, United States

Remo Frei, PhDSwiss Institute of Allergy and Asthma

Research (SIAF), University of Zurich, Davos, Switzerland

Christine Khne-Center for Allergy Research and Education, Davos

Anthony J. Frew, MDDepartment of Respiratory Medicine,

Royal Sussex County Hospital, Brighton, UK

Gabriele Gadermaier, MDDepartment of Molecular Biology,

Christian Doppler Laboratory for Allergy Diagnosis and Therapy, University of Salzburg, Austria

Stephen J. Galli, MDStanford Center for Genomics and

Personalized MedicineProfessor Stanford University, USA,

Chair, Department of Pathology

James Gardner, RN DipDepartment of Child Health, Royal

Free Hospital, London, UK

Jacques Gayraud, MDPolyclinique de lOrmeau, Tarbes,

France

Julia Katharina Genser, MDAllergy Unit, Dept of Dermatology,

University Hospital of Zrich, Switzerland

Philippe Gevaert, MD, PhD Dept Otorhinolaryngology, Ghent

University Hospital

Stefanie Gilles, PhDInstitute for environmental medicine,

UNIKA-T, TechnischeUniversitt Munich, Germany

Christine Khne Center for Allergy Research and Education (CK-Care), Davos, Switzerland

Hannah Gould, PhDDivision of Cell and Molecular

Biophysics and Division of Allergy, Asthma and Lung Biology, Allergy and Asthma Group in the Division of Cell and Molecular Biophysics Kings College London, London, United Kingdom

Clive E. Grattan, MDNorfolk and Norwich University

Hospital, UK

Hans Grnlund, PhDKarolinska Institutet, Therapeutic

Immune Design Unit, Department of Clinical Neuroscience, Center for Molecular Medicine

Karolinska University Hospital

Tari Haahtela, MDSkin and Allergy Hospital, Helsinki

University Hospital, Finland

Viktor Hafner, PhDLandesgeschftsstelle Wien, ster-

reichische Apothekerkammer, Austria

Susanne Halken, MD, DMSciHans Christian Andersen Childrens

Hospital, Odense University Hospital, Denmark

Firdaus Hamid, MDDepartment of Parasitology, Leiden

University Medical Center, Leiden, The Netherlands

Department of Microbiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia

Catherine M. Hawrylowicz, PhD MRC and Asthma UK Centre for

Allergic Mechanisms in Asthma,Division of Asthma, Allergy and Lung

Biology, Guys Hospital, Kings College London, London, United Kingdom

Enrico Heffler, MD, PhDDepartment of Medical Sciences,

Allergy and Clinical Immunology, University of Torino, Italy

Contributors

Global atlas of allERGY

V

Peter W. Hellings, MDDepartment of Otorhinolaryngology,

Head and Neck Surgery, University Hospitals Leuven, Belgium

Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands

Christoph Heusser, PhDNovartis Institutes for Biomedical

Research, Basel, Switzerland

Hans Jrgen Hoffmann, PhDDepartment of Respiratory Medicine

and Allergology, Aarhus University Hospital

Department of Clinical Medicine, Aarhus University, Denmark

Karin Hoffmann-Sommergruber, MD, PhD

Dept. of Pathophysiology and Allergy Research, Medical University of Vienna,Vienna, Austria

Stephen T Holgate, MD, DSc, FMedSci

Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton,UK.

Patrick G. Holt, MD, PhDDivision of Cell Biology, Telethon

Institute for Child Health Research, The University of Western Australia and Queensland Childrens Medical Research Institute, The University of Queensland, Australia

Friedrich Horak, PhD Research Consult GmbH, Dpt.

Vienna Challenge Chamber (VCC), Vienna, Austria

Arne Hst, MDHead of Hans Christian Andersen

Childrens Hospital, Odense University Hospital Denmark

Natalia I. Ilyna, MDNRC Institute of Immunology FMBA

Russia

Kenji Izuhara, MD, PhDSaga Medical School, Saga, Japan

Jan Ltval, MDKrefting Research Center, University

of Gothenburg, Gteborg, Sweden

S.G.O. Johansson, MD, PhDDepartment of Medicine, Allergy

and Clinical Immunology Unit, Karolinska Institute, Stockholm, Sweden

Marek Jutel, MDDepartment of Clinical Immunology,

Wroclaw Medical UniversityALL-MED Medical Research Institute,

Wroclaw , Poland

mer Kalayci, MDPediatric Allergy and Asthma Unit,

Hacettepe University School of Medicine, Ankara, Turkey

Hajime Karasuyama, MD, PhDDepartment of Immune Regulation,

Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan

Constance H. Katelaris, MB BS PhD FRACP

Immunology & Allergy, University of Western Sydney and Campbelltown Hospital, Sydney, Australia.

Musa R. Khaitov, MDNRC Institute of Immunology FMBA

Russia

Rakhim M. Khaitov, MDNRC Institute of Immunology FMBA

Russia

Jrg Kleine-Tebbe, MDAllergy & Asthma Center Westend,

Outpatient Clinic Hanf, Ackermann & Kleine-Tebbe, Berlin, Germany

Edward F. Knol, PhDDept. Immunology and Dermatology/

Allergology; University Medical Center Utrecht, Utrecht, The Netherlands

Marek L. Kowalski, MDMedical University of Lodz, Poland

Thomas M. Kndig, MDDepartment of Dermatology,

University Hospital Zurich, Zurich, Switzerland

Gideon Lack, MDMRC Asthma UK Centre in Allergic

Mechanisms of Asthma, Kings College London, Guys and St Thomas NHS Foundation Trust, Childrens Allergies Department, St Thomas Hospital, London, UK

Bart N. Lambrecht, MD, PhDVIB Inflammation Research Center,

Gent University, Belgium

Mark Larch, PhDDivision of Allergy & Clinical

Immunology, Department of

Medicine, McMaster University, Hamilton, ON, Canada

Dsire Larenas Linnemann, MDHospital Mdica Sur, Mexico city,

Mexico

Susanne Lau , MDCharit Medical University Berlin,

Germany

Roger Lauener, MDChildrens Hospital of Eastern

Switzerland, St. Gallen, Switzerland

Christine Khne-Center for Allergy Research and Education, Davos

Dennis K. Ledford, MDMorsani College of Medicine,

University of South Florida andJames A. Haley V.A. Hospital, Tampa,

Florida, USA

Robert F. Lemanske Jr., MDUniversity of Wisconsin, Madison,

Wisconsin

Donald Y. M. Leung, MD, PhDDepartment of Pediatrics, National

Jewish Health, Denver, USA

James T. Li, MD PhDMayo Clinic, Rochester, Minnesota,

USA

Maximin Liebl, PhDPharmaceutical Group of the

European Union, Bolzano, Bozen, Italy

Richard F. Lockey, MDJoy McCann Culverhouse Airway

Disease Research Center, Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine;

James A. Haley Veterans Hospital, Tampa, FL, USA

Karin C. Ldrup Carlsen, MDHead of Research, University of Oslo,

Institute for Clinical Medicine and Oslo University Hospital, Department of Paediatrics, Oslo, Norway

Lyudmila V. Luss, MDNRC Institute of Immunology FMBA

Russia

Adriano Mari, MDAssociated Centers for Molecular

Allergology, Rome, Italy

Gianni Marone, MD, PhDDepartment of Translational Medical

Contributors

Global atlas of allERGY

VI

Sciences and Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, School of Medicine, Naples, Italy

Paolo Maria Matricardi, MDDept. of Paediatric Pneumology and

Immunology, Charit Medical University, Berlin, Germany

Marcus Maurer, MDDepartment of Dermatology

and Allergy, Charit Universittsmedizin Berlin

Angel Mazon, MDChildrens Hospital La Fe, Valencia,

Spain

Shanthi Mendis, MD, PhDWHODepartment of Management of

Noncommunicable Diseases, World Health Organisation, Geneva, Switzerland

Dean D. Metcalfe, MDNational Institute of Allergy and

Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States

Antonella Muraro, MD, PhDFood Allergy Referral Centre Veneto

Region Department of Women and Child Health , Padua General University Hospital

Dept of Pediatric Allergology, University of Padua, Italy

Erika von Mutius, MDDr. von Hauner Childrens Hospital,

Ludwig-Maximilians-University Munich, Germany

Kari C Nadeau, MD, PhDDivision of Immunology and Allergy,

Department of Pediatrics, Stanford University, Stanford, USA

Jennifer A. Namazy, MDScripps Clinic, San Diego, California,

USA

Andrew Nickels, MDDept. of Allergy and Immunology

Fellow, Mayo Clinic, Rochester, Minnesota

Verena Niederberger, PhDDepartment of Otorhinolaryngology,

Medical University of Vienna, Austria

Anna Nowak-Wgrzyn, MDAssociate Professor Pediatrics,

Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Division of Allergy and Immunology, Kravis Childrens Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA

Liam OMahony, PhDSwiss Institute of Allergy and Asthma

Research (SIAF), University of Zurich, Davos, Switzerland

Christine Khne-Center for Allergy Research and Education, Davos

Markus Ollert, MDTechnische Universitt Mnchen

(TUM), Munich, Germany

Nikolaos G. Papadopoulos, MDDept of Allergy & Pediatric Allergy,

University of Manchester, UK, University of Athens, Greece, EAACI President

Ruby Pawankar, MD, PhDPast President, World Allergy

OrganizationDept. of Pediatrics, Nippon Medical

School,Tokyo, Japan.

Oliver Pfaar, MDCenter for Rhinology and Allergology

Wiesbaden, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Mannheim, Mannheim, Germany

Werner J Pichler, MDClinic for Rheumatology and

Clinical Immunology/Allergology, University Hospital of Bern, Bern, Switzerland

Thomas A.E Platts-Mills, MD, PhD, FRS

Asthma and Allergic Disease Center, University of Virginia, Charlottesville, USA

Lars K. Poulsen, PhDNational University Hospital, Allergy

Clinic, Copenhagen, Denmark

Susan L. Prescott, MDSchool of Paediatrics and Child

Health (SPACH), University of Western Australia, Australia

Santiago Quirce, MD, PhDDepartment of Allergy, Hospital La

Paz Institute for Health Research (IdiPAZ), Madrid, Spain.

Harald Renz, MDPhilipps- University of Marburg,

Institute of Laboratory Medicine

Johannes Ring, MD, PhDDepartment Dermatology and

Allergology Biederstein, Technische Universitt Mnchen

Christine Khne-Center for Allergy Research and Education (CK-CARE) Davos

Graham Roberts, MDDavid Hide Asthma and Allergy

Research Centre, St Marys Hospital, Newport, Isle of Wight

NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust

Faculty of Medicine, Human Development and Health and Clinical Experimental Sciences Academic Units, University of Southampton, Southampton, UK

Caroline Roduit, MDZurich University Childrens Hospital,

Zurich, SwitzerlandChildrens Hospital of Eastern

Switzerland, St. Gallen, Switzerland

Lanny J. Rosenwasser, MDPresident, World Allergy

OrganizationAllergy-Immunology Division,

Childrens Mercy Hospital, Kansas City

University of Missouri-Kansas City School of Medicine

Frederick J. Rubner, MDUniversity of Wisconsin, Madison,

Wisconsin

Franziska Ruff, MDDepartment of Dermatology and

Allergology, Ludwig-Maximilian University, Munich, Germany

Dermot Ryan, Dr.GP Woodbrook Medical Centre,

Loughborough Honorary Clinical Research Fellow Allergy and Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Medical School

Hirohisa Saito, MD, PhDNational Research Institute for Child

Health & Development, Tokyo, Japan

Boleslaw Samolinski, MDDepartment of Prevention of

Environmental Hazards and Allergology, Medical University of

Contributors

Global atlas of allERGY

VII

Warsaw, Warsaw, Poland

Marek Sanak, MDDepartment of Medicine, Jagiellonian

University Medical College, Krakw, Poland

Alexandra Santos, MDKings College, Paediatric Allergy,

London, UK

Georg Schppi, MD aha! Swiss Allergy CentreChristine Khne Center for Allergy

Research and Education (CK-CARE), Davos, Switzerland

Michael Schatz, MD, MS Department of Allergy, Kaiser

Permanente Medical Center, San Diego, California, USA

Peter Schmid-Grendelmeier, MDHead of the Allergy Unit, University

Hospital Zurich, Dept of Dermatology, Zrich, Switzerland

Carsten B. Schmidt-Weber, PhDCenter for Allergy & Environment

(ZAUM), Technische Universitt Mnchen and Helmholtzzentrum Mnchen

Gabriela Senti, MDClinical Trials Center, University

Hospital Zurich, Zurich, Switzerland

Saira Z Sheikh, MDDivision of Rheumatology, Allergy

& Immunology, Department of Medicine and Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill ,USA

Scott H. Sicherer, MDThe Elliot and Roslyn Jaffe Food

Allergy Institute, Kravis Childrens Hospital, Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA

Hans-Uwe Simon,Institute of Pharmacology, University

of Bern, Switzerland

F. Estelle R. Simons, MDDepartment of Pediatrics &

Child Health, Department of Immunology , Faculty of Medicine University of Manitoba, Canada

Isabel Skypala, PhDRoyal Brompton&Harefield NHS

Foundation Trust, Sydney Street,

London, UK

Helen Smith, MDBrighton & Sussex Medical School,

UK

Hermelijn H. Smits, PhDDepartment of Parasitology, Leiden

University Medical Center, Leiden, The Netherlands

Franois Spertini, MDDivision of Immunology and Allergy,

Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

Otto Spranger, MDsterreichische Lungenunion, Wien,

Austria

Cristiana Stellato, MDDepartment of Medicine and Surgery,

University of Salerno, Italy, Division of Allergy and Clinical Immunology, Johns Hopkins University, Baltimore,

Alex Straumann, MDChairman Swiss EoE Research

NetworkDepartment of Gastroenterology,

University Hospital Basel, Basel, Switzerland

Stanley J. Szefler, MDPediatric Asthma Research Program,

Section of Pediatric Pulmonary Medicine, Breathing Institute, Department of Pediatrics, Childrens Hospital Colorado;

University of Colorado Denver School of Medicine, Aurora, Colorado

Morvarid Tavassoli, MDDivision of Immunology and Allergy,

Department of Pediatrics, Stanford University, Stanford, USA

Michael N. Teng, MDJoy McCann Culverhouse Airway

Disease Research Center, Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine

Ingrid Terreehorst, MDDepartment of ENT & Pediatrics,

Academic Medical Center, Amsterdam, The Netherlands

Wayne R. Thomas, PhDCentre for Child Health Research,

University of Western Australia, Perth, Australia

Telethon Institute for Child Health

Research, Western Australia

Claudia Traidl-Hoffmann, MDInstitute of environmental medicine

UNIKA-T, Technische Universitt, Munich, Germany

Christine Khne Center for Allergy Research and Education (CK-Care), Davos, Switzerland

Massimo Triggiani, MDDivision of Allergy and Clinical

Immunology, University of Salerno, Italy

Rudolf Valenta, PhDDepartment of Pathophysiology

and Allergy Research, Medical University of Vienna, Austria

Willem van de Veen, PhDSwiss Institute of Allergy and Asthma

Research (SIAF), University of Zurich,Davos, Switzerland

Ronald van Ree, PhDProfessor, Department of

Experimental Immunology, Academic Medical Center, Amsterdam, The Netherlands, Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands

Roy Gert van Wijk, MDDept of Internal Medicine, Erasmus

Medical Center Rotterdam, Netherlands

Gilda Varricchi, MDDepartment of Translational Medical

Sciences and Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, School of Medicine, Naples, Italy

J. Christian Virchow, MDUniversittsmedizin Rostock,

GermanyDepartment of Pneumology/

Intensive Care Medicine, Clinic 1, Center of Internal Medicine

Berber Vlieg-Boerstra, PhD RDDepartment of Pediatric Respiratory

Medicine and Allergy, Emma Childrens Hospital, Academic Medical Center, University of Amsterdam, The Netherlands

Kimberly Vu, MDDivision of Immunology and Allergy,

Department of Pediatrics, Stanford University, Stanford, USA

Contributors

Global atlas of allERGY

VIII

Ulrich Wahn, MDDepartment of Pediatric Pneumology

and Immunology, Charit, Berlin, Germany

Michael Wallner, MDUniversity of Salzburg, Department

of Molecular Biology, Christian Doppler Laboratory for Allergy Diagnosis and Therapy, Saltzburg, Austria

Canonica G. Walter, MDDept of Allergy & Respiratory

Diseases Clinic, University of Genova, Genova- Italy

Richard Weber, MDDepartment of Medicine, National

Jewish Medical & Research Center, Denver, US

Stephan Weidinger, MDDepartment of Dermatology and

Allergy, University Hospital Schleswig-Holstein, Kiel, Germany

Thomas Werfel, MD Division of Immunodermatology and

Allergy Research, Department of Dermatology, Hannover Medical School, Hannover, Germany

Marsha Wills-Karp, PhDDepartment of Environmental

Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltomore, USA

Margitta Worm, MDCharit-Universittsmedizin, Klinik

fr Dermatologie, Venerologie und Allergologie, Berlin, Germany

Maria Yazdanbakhsh, PhDDepartment of Parasitology, Leiden

University Medical Center, Leiden, The Netherlands

M Osman Yusuf, MDThe Allergy & Asthma Institute,

Pakistan.

The International Primary Care Respiratory Group

Quaid e Azam University, Islamabad, Pakistan.

Torsten Zuberbier, MDDept. of Dermatology and Allergy,

Charit, Berlin

Global Allergy and Asthma European Network (GA2LEN)

Contributors

Global atlas of allERGY

Ix

SECTION A ALLERGY - MECHANISMS

CONTENTS

Contents

2 What is allergyJohannes Ring

4 The discovery of IgES.G.O. Johansson

6 Allergens structure and functionRonald van Ree

9 Mechanisms of allergenicity of allergensHeimo Breiteneder

11 Allergens and cross-reactivityBarbara Bohle

13 House dust mite allergensWayne R. Thomas

15 Pet allergensHans Grnlund

18 Tree pollen allergensFatima Ferreira, Gabriele Gadermaier, Michael Wall-ner

22 Grass pollen allergensJrg Kleine-Tebbe, Janet Davies

27 Weed pollen allergensRichard W. Weber

29 Food allergensBarbara Ballmer-Weber

32 Venom allergensFranziska Ruff

34 Emerging allergensKarin Hoffmann-Sommergruber

36 Pollen allergens and geographical factorsJeroen Buters

39 The underlying mechanisms in allergy Cezmi A. Akdis

43 Innate immune response in allergyMichael N. Teng, Richard F. Lockey

45 Dendritic cellsBart N. Lambrecht

48 Natural killer cells and natural killer-T cellsGnnur Deniz

50 Innate lymphoid cellsHirohisa Saito

53 Mast cellsStephen J. Galli

56 BasophilsHajime Karasuyama

58 EosinophilsHans-Uwe Simon

60 T cellsCarsten B. Schmidt-Weber

62 B cells Azza Abdel-Gadir, Talal Chatila

64 Immunoglobulin E and other antibodies in allergy Hannah Gould, Yih-Chih Chan

67 Role of superantigens in allergic diseases Donald Y. M. Leung

69 Cytokines in allergyLars K. Poulsen

71 Cell migration and chemokinesCristiana Stellato, Gilda Varricchi, Gianni Marone

76 Complement-mediated regulation of the allergic responseMarsha Wills-Karp

79 Lipid mediators of hypersensitivity and inflammationMarek Sanak

81 Lipid mediators in resolution of allergic inflammationEvangelos Andreakos

84 Allergy and the epithelial barriersStephen T. Holgate

88 Epithelial proteases and allergic diseasesmer Kalayci

90 Mechanisms of immune regulation in allergyWillem van de Veen, Mbeccel Akdis

92 Neuro-immune regulation of allergic inflammationHarald Renz

95 United airways and immune regulationClaus Bachert

98 Genetics of allergyStephan Weidinger

101 Epigenetics of AllergyR. Sharon Chinthrajah, Kimberly Vu, Morvarid Tavas-soli, Kari C Nadeau,

104 Endotypes of allergic diseases Ioana Agache, Cezmi A. Akdis

108 Animal models of allergic diseaseRemo Frei, Liam OMahony

Global atlas of allERGY

x

SECTION B EPIDEMIOLOGY AND RISK FACTORS

Contents

112 The allergy epidemicPaolo Maria Matricardi

115 Natural history of allergySusanne Lau

119 Birth cohortsAdnan Custovic

121 Environmental risk factors for allergy: outdoor/indoor pollution and climate changeStefanie Gilles, Claudia Traidl-Hoffmann

124 Measuring exposure to environmental airborne allergensIsabella Annesi-Maesano

127 Environmental risk factors for allergy: food Scott H. Sicherer

130 Environmental risk factors for allergy: home environmentThomas A.E. Platts-Mills

133 Environmental risk factors for allergy: working environmentRoy Gert van Wijk

135 Risk factors for childhood asthma: viral infection and allergic sensitizationFrederick J. Rubner, Robert F. Lemanske Jr.

138 Environmental risk factors for allergy: helminth infections Abena S. Amoah, Firdaus Hamid, Hermelijn H. Smits, Maria Yazdanbakhsh

141 Perinatal immune development and its role in atopy developmentPatrick G. Holt

143 Perinatal risk and protective factors for allergic diseasesArne Hst

146 The role of microbiomeErika von Mutius

SECTION C ALLERGY DIAGNOSIS

150 In vivo allergy diagnosis - skin testsJulia Katharina Genser, Peter Schmid-Grendelmeier

153 In vivo allergy diagnosis- nasal and bronchial provocation testsGert Jan Braunstahl

156 In-vivo allergy diagnosis- food provocation tests Philippe Eigenmann

158 In vivo diagnosis of NSAID hypersensitivityMarek L. Kowalski

161 In vivo allergy diagnosis - drug provocation testKnut Brockow

163 The allergen challenge chamber Friedrich Horak

166 In vitro allergy diagnosis Allergen- specific IgE Reto Crameri

168 In vitro allergy diagnosis molecules and component-resolved diagnosis Markus Ollert, Adriano Mari

171 In vitro allergy diagnosis - cellular allergy testingHans Jrgen Hoffmann

173 Biomarkers for allergy diagnosis and treatmentKenji Izuhara

SECTION D MAJOR ALLERGIC DISEASES

178 Allergic rhinitisPeter W. Hellings

180 Chronic rhinosinusitis and nasal polyposisCemal Cingi, Philippe Gevaert , Nuray Bayar Muluk

184 Ocular allergy Constance H. Katelaris

186 Pediatric AsthmaStanley J. Szefler

188 Adult asthmaLeif Bjermer

191 AnaphylaxisF. Estelle R. Simons

197 Drug allergyPascal Demoly

199 Food allergySusanne Halken, Antonella Muraro

203 Atopic dermatitisThomas Bieber

206 UrticariaCarsten Bindslev-Jensen

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SECTION E OTHER HYPERSENSITIVITY DISEASES

226 Eosinophilic esophagitisAlex Straumann

228 Food protein-induced enterocolitis syndrome Anna Nowak-Wgrzyn

232 Reactions to food and drug additivesMargitta Worm

234 Adverse reactions to vaccines for infectious diseasesJean-Christoph Caubet , Ingrid Terreehorst

236 Allergic bronchopulmonary aspergillosis J. Christian Virchow

239 Hypersensivity pneumonitisIoana Agache

242 MastocytosisDean D. Metcalfe

245 Hypersensitivity vasculitisMarcus Maurer, Torsten Zuberbier

248 Primary immunodeficiency diseasesMark Ballow

251 Allergic disease in the elderlyRobert K. Bush

253 Allergic diseases in pregnancyJennifer A. Namazy, Michael Schatz

256 Allergic diseases and sportsMatteo Bonini, Sergio Bonini

259 Allergic diseases in adolescents Graham Roberts

261 Adherence to the management plan Andrew Nickels, James T. Li

264 Allergic diseases and quality of lifeAnthony E.J. Dubois

266 Allergic diseases in animalsClaude Favrot

SECTION F SPECIAL CONSIDERATIONS

209 EAACI - GA2LEN - EDF - WAO Guideline on UrticariaTorsten Zuberbier, Marcus Maurer

212 AngioedemaMassimo Triggiani

215 Allergic contact dermatitisThomas Werfel

217 Latex allergyClive E. Grattan

219 Insect sting allergyM. Beatrice Bil

221 Occupational allergySantiago Quirce

SECTION G MANAGEMENT OF ALLERGIC DISEASES

270 Overview: avoidance, treatment, induction of toleranceAnthony J. Frew

273 Avoidance measures in the management of allergic diseases focus on environmentUlrich Wahn

276 Avoidance measures - focus on dietAlexandra F. Santos, Gideon Lack

278 Perinatal risk factors and strategies for allergy preventionSusan L. Prescott

281 Pharmacological treatment of allergic disease Dennis K. Ledford

285 Anti IgE treatment for allergic diseaseChristoph Heusser, Veit Erpenbeck

287 Biological agents for the treatment of allergic disordersOnur Boyman, Franois Spertini

290 Biosimilars and allergy treatment G. Walter Canonica

292 Targeting basophils and mast cells for novel treatment approachesEdward F. Knol

295 Tolerance induction: principle and modalitiesCatherine M. Hawrylowicz

297 Allergen immunotherapy- overviewLinda Cox

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336 Contribution of allergy to the burden of non-communicable diseasesShanthi Mendis

338 Allergic diseases on the political agendaNikolaos G. Papadopoulos

340 Policies and strategies to facilitate access to diagnosis and treatment for allergic diseasesMichael B. Foggs

342 Policies and strategies to reduce risk factors for allergic diseasesRuby Pawankar

344 The role of primary care in the management of allergic diseasesDermot Ryan, M. Osman Yusuf

346 The role of allied health in the management of allergic diseasesBerber Vlieg-Boerstra, James Gardner,Isabel Skypala

348 The role of patient organisations in the management of allergic diseasesEAACI Patient Organisation Committee

352 The role of pharmacists in managing allergic diseasesMaximin Liebl, Viktor Hafner, Otto Sprange

354 The role of schools in managing allergic diseases Angel Mazon

357 Comprehensive allergy management plan. Towards a patient-centered attitude Georg Schppi

359 Social mobilization for management of allergic diseases

Toms Chivato Prez

362 Best buys for allergy prevention and controlTari Haahtela

365 Dealing with the implementation gap for allergy prevention and controlVictria Cardona

367 Generating resources for allergy prevention and controlKai-Hkon Carlsen, Karin C. Ldrup Carlsen

369 Strengthening the speciality of Allergology and Clinical ImmunologyJan G. R. de Monchy, Jaques Gayraud

371 EAACI-UEMS Exam in Allergology/Clinical ImmunologyWerner J. Pichler , Peter Schmid-Grendelmeier

374 Managing allergic diseases in developing countries Musa R. Khaitov, Lyudmila V. Luss, Natalia I. Ilyna, Rakhim M. Khaitov

377 The One Health concept and allergic diseasesWalter J. Ammann

379 Allergy and active and healthy ageingJean Bousquet, Boleslaw Samolinski

381 Allergy in internet Enrico Heffler

383 iCAALL: International Collaboration in Asthma, Allergy and ImmunologyJan Ltval, Denis Ledford, Cezmi A. Akdis, iCAALL Chairs

385 Vision and roadmap to fight with allergies Cezmi A. Akdis

SECTION H TOWARDS A COMPREHENSIVE GLOBAL STRATEGY FOR THE MANAGEMENT OF ALLERGIC DISEASES

300 Mechanisms of allergen immunotherapyMarek Jutel

303 Subcutaneous allergen immunotherapyDsire Larenas Linnemann

306 Sublingual allergen immunotherapyMoiss A. Caldern

309 Oral allergen Immunotherapy for foodsSaira Z Sheikh, A. Wesley Burks

311 Recombinant allergens for allergen immunotherapyRudolf Valenta, Verena Niederberger

313 Peptide immunotherapy for allergic diseaseMark Larch

316 New routes for allergen immunotherapy

Thomas M. Kndig, Gabriela Senti

319 Measuring clinical outcomes in allergen immunotherapyStephen R. Durham, Oliver Pfaar

323 Implementing a healthy life style Caroline Roduit, Roger Lauener

326 Psychological support in the management of allergic patientsHelen Smith

329 Pharmacogenetics and pharmacogenomics of allergic diseasesLanny J. Rosenwasser

331 Pharmacoeconomics of allergic diseasesLinda Cox

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PREFACE

Allergic diseases are affecting the lives of more than one billion people worldwide. With an epidemic rise during the last 60 years, their prevalence is expected to reach up to 4 billion in 2050s. Because of immense numbers of affected individuals, the general public confronts huge direct and indirect costs with major effects on macroeconomics due to health-care, loss of productivity and absenteeism of patients. Unfortunately, high number of unmet needs due to missing scientific knowledge in disease mechanisms, prevention, patient care, and social determinants remain to be resolved.

To tackle this huge global health problem, we as the EAACI decided to develop the Global Atlas of Al-lergy as a follow up of our Global Atlas of Asthma which was launched last year. With this Atlas, we aimed to gather evidence to call attention to the burden of allergic diseases; to warrant their recog-nition as a main concern in national health strategies; to reveal their priority for research; to describe environmental factors; to evaluate the best ways to prevent and control allergies; to provide guidance on how to overcome barriers; to alert the political bodies to ensure global management approaches.

The EAACI Global Atlas of Allergy contains 139 chapters written by 183 authors with 274 illustra-tions and 100 tables. It is developed as a desktop reference for multisectoral usage covering all as-pects of allergic diseases from allergens, epidemiology, risk factors and molecular and cellular mecha-nisms to their management, major current problems in allergies and associated diseases, prevention and control of allergic diseases. In addition, the Atlas will offer an educational tool and a desktop reference for medical students, allied health workers, primary care physicians, medical industry, pol-icy makers, patient organizations and specialists dealing with allergies and co-morbid diseases. We would like to thank all of the authors for their contributions.

Cezmi A. AkdisIoana Agache

Editors

TitleEAACI Executive CommitteeContributorsContentsPreface