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Allergies and asthma

Reframing the conversation from disease burden to prevention and health promotion

Allergies and asthmaThis year, the European Academy of Allergy and Clinical Immunology (EAACI) celebrates its 60th anniversary at the forefront of allergy science and patient care. As the primary source of expertise in Europe for all aspects of allergic diseases and asthma, EAACI calls on all healthcare professionals, National Allergy Societies, patients, EU and policymakers to support its initiative to reframe the conversation from disease burden to prevention and health promotion.

Allergies and asthma constitute a public health concern of pandemic proportions that requires immediate and concerted action. While at the beginning of the twentieth century allergy was seen as a rare disease, in the last few decades we have witnessed a dramatic increase in this disease burden. Today, 100 million Europeans suffer from allergic rhinitis, 70 million Europeans from asthma and 17 million Europeans live with a food allergy. By 2025, more than 50% of all Europeans will suffer from at least one type of allergy. Allergies and asthma often occur together: 90% of asthmatic children and 50% of asthmatic adults are allergic, and half of the patients with allergies and asthma are under-diagnosed or poorly managed due to a lack of awareness and a shortage of medical specialists.

Allergies and asthma are preventable and controllable
Allergic diseases and asthma have a dramatic economic and societal impact: every year, asthma and allergic rhinitis alone are estimated to result in more than 100 million lost workdays and missed school days in Europe. This figure is augmented by an increase in presenteeism, in which people still go to work but are unable to perform to their fullest capacity. Up to 20% of patients with allergies live with a severe debilitating form of their condition, and struggle daily with the fear of a possible asthma attack, anaphylactic shock or even death from an allergic reaction. On top of that, the prevalence of allergic diseases and asthma is growing rapidly in parallel to risk factors that include urbanisation, industrialisation, pollution, climate change and lifestyle changes - factors that are not expected to decrease in the near future. Therefore, asthma and allergic diseases are a public health concern of pandemic proportions that requires an immediate and coordinated response. EAACI's aim is to make all stakeholders understand that the best and most cost-efficient way to tackle the epidemics and decrease the disease burden is prevention and control. If patients in Europe were treated appropriately with available cost-effective treatments, savings of €142bn each year could be made. Recent scientific breakthroughs support the value of prevention for allergic disease and asthma. 

How allergies and asthma can be prevented
A real-world setting trial (Schmitt et al, 2015) and one randomised open-label trial (Jacobsen et al, 2007) showed that allergen immunotherapy (AIT) prevents asthma in patients with allergic rhinitis. AIT with birch or grass pollen had a long-lasting preventive effect on asthma, up to seven years after the treatment was stopped. The effect is stronger if AIT is administered for more than three years.

Next to AIT, food consumption also shows a preventable effect on asthma. A mediterranean diet and food enriched with vitamins C, E and D, fruits and fish consumed from pregnancy onwards are known to prevent asthma and wheezing (Garcia-Larsen et al, 2015). The results are based on a systematic review of studies investigating the relation between dietary intake and asthma, wheezing or lung function. Interestingly, the positive effect is passed down to the offspring when the dietary pattern is followed during pregnancy. A cohort study by Lumia et al, 2015 investigated the risk of developing atopic and non-atopic asthma in early life and demonstrated that a higher consumption of breast milk and oats prevents non-atopic asthma, whereas consumption of cow's milk products reduces the risk of atopic asthma, including in children with a cow's milk allergy. Early consumption of fish decreases both types of asthma.

20% struggle daily with the fear of a possible asthma attack, anaphylactic shock or even death

Moreover, changes in lifestyle show a positive effect on the prevention of asthma. Platts-Mills et al,  2015 analysed the allergy epidemics from 1870-2010 and found that sequential changes in lifestyle have led to increases in different forms of allergic diseases. Hygiene, indoor lifestyle, diet and reduced physical activity seem to play a role in the acquisition of allergies. Children watching content on a screen might experience prolonged periods of shallow breathing that are shown to increase nonspecific bronchial hyper-reactivity (BHR). The increase in sensitisation to indoor allergens and the loss of lung-specific protective effect of regular deep inspiration seem to be the best explanation for the increase in the incidence of asthma. Thus, outside activity and less time in front of a TV, monitor or hand-held device should be considered to positively influence the risk of asthma.

Allergy sufferers [need] to receive an accurate diagnosis and appropriate treatment early

Early prevention is recommended 
Allergic diseases (eg food allergies, rhinitis, asthma, atopic dermatitis) usually start in childhood but can develop at any age. The safest way to manage allergy symptoms is to tackle them before they set in. The review by SH Arshad published in 2005 recommends breastfeeding for four to six months after birth because of its anti-allergic effect. In cases in which breastfeeding is not possible and for high-risk infants, von Berg et al, 2008 confirmed in a randomized double-blind cohort trial the long-term preventive-effect of the hypo-allergenic milk formula on cow's milk allergy and atopic dermatitis (AD). Several studies (Prescott SL & Björkstén B, 2007, Osborn DA & Sinn JK, 2013, Simpson et al, 2015 to name a few) also show a positive effect on AD by the intake of probiotics from pregnancy onwards. A mixture of probiotics is more effective than one single probiotic as shown in a meta-analysis by Zuccotti et al, 2015. This evidence-based data demonstrates the need to manage allergies and asthma prenatally, as early treatment already prevents the occurrence of allergic diseases.

Your support is needed
The optimal way for allergy sufferers to experience relief is to receive an accurate diagnosis and appropriate treatment early. Public awareness campaigns, street marketing events, EU and national political lobbying, annual congresses and focus meetings or educational tools are just some of the activities EAACI undertakes in order to educate society at large about asthma and allergies. However, in order to reframe the conversation from disease burden to prevention and health promotion, healthcare professionals, National Allergy Societies, patients, EU and national policymakers all need to engage and act in a coordinated way to improve prevention and allergy and asthma care. They should support the allocation of resources and the development of allergy speciality care in all EU countries. 

You can support EAACI by sharing science-based evidence and encouraging your peers to spread the word that allergies and asthma can be prevented and controlled.

For more information and resources we invite you to visit the campaign webpage at www.eaaci.org/outreach/eaaci-2016-campaign.html

Article by
Ioana Agache

is EAACI vice-president of communication and membership, and associate professor at Transylvania University Brasov, Romania

10th August 2016

Article by
Ioana Agache

is EAACI vice-president of communication and membership, and associate professor at Transylvania University Brasov, Romania

10th August 2016

From: Healthcare

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