WORLD ALLERGY ORGANIZATION WAWAOO WhiteWhite BookBook onon AllergyAllergy WAO White Book on Allergy World Allergy Organization (WAO) White Book on Allergy Copyright 2011 World Allergy Organization WAO White Book on Allergy Editors Prof. Ruby Pawankar, MD, PhD Prof. Giorgio Walter Canonica, MD WAO President Elect (2010-2011) WAO Past President (2010-2011) Allergy and Rhinology Allergy & Respiratory Diseases Nippon Medical School Department of Internal Medicine 1-1-5 Sendagi, Bunkyo-ku University of Genoa Tokyo 113-8603 Padiglione Maragliano, Largo Rosanna Benzi 10 JAPAN 1-16132 Genoa ITALY Prof. Stephen T. Holgate, BSc, MD, DSc, FMed Sci Prof. Richard F. Lockey, MD Member, WAO Board of Directors (2010-2011) WAO President (2010-2011) Medical Research Council Clinical Professor of Division of Allergy & Immunology Immunopharmacology Joy McCann Culverhouse Chair in Allergy & Immunology Infection, Inflammation and Immunity University of South Florida College of Medicine School of Medicine James Haley Veterans Administration Medical Center (111D) University of Southampton 13000 Bruce B. Downs Boulevard Level F, South Block Tampa, Florida 33612 Southampton General Hospital USA Tremona Road Southampton SO16 6YD United Kingdom Acknowledgement On behalf of the World Allergy Organization (WAO), the editors and authors of the WAO White Book on Allergy express their gratitude to the charity, Asthma, Allergy, Inflammation Research (AAIR) and Asian Allergy Asthma Foundation (AAAF) for their support in the production of this publication. The Editors of the White book extend their gratitude to His Excellency Dr. APJ Abdul Kalam, Former President of India and Madame Ilora Finlay Baronness of the House of Lords for their Forewords to the White Book and to the International Primary Care Respiratory Group (IPCRG) and European Federation of Allergy and Airways Diseases Patients ‘Associations (EFA) for their supporting statements. The editors also wish to thank the many experts around the world who have contributed to the completion of this book. Both the editors and authors also thank WAO staff members, Charu Malik and Karen Henley, for their editorial assistance, and Sofia Dorsano, for her technical assistance, in preparing the White Book. ISBN-10 0615461824 ISBN-13 9780615461823 Copyright 2011 World Allergy Organization (WAO). All rights reserved. No part of this publication may be reproduced in any form without the written consent of the World Allergy Organization. This book is not for sale. World Allergy Organization 555 East Wells Street Suite 1100 Milwaukee, Wisconsin 53202 United States of America Phone: +1 414 276 1791 Fax: +1 414 276 3349 Email: [email protected] Website : www.worldallergy.org Printed in the United Kingdom, 2011 World Allergy Organization (WAO) White Book on Allergy Editors Ruby Pawankar Giorgio Walter Canonica Stephen T. Holgate Richard F. Lockey Copyright 2011 World Allergy Organization WAO White Book on Allergy 1 Foreword by His Excellency Dr. APJ Abdul Kalam, Former President of India Allergic diseases are increasing worldwide with unprecedented The White Book on Allergy is an important initiative by the complexity and severity. Children bear the greatest burden of World Allergy Organization calling on international and national allergic deseases. The most common allergic conditions in health care policy makers to address early identification of children are food allergies, eczema, and asthma. The precise symptoms, early diagnosis and appropriate strategies to causes of this increase in allergic diseases are not fully understood manage and control allergies to avoid worsening of severe but as the numbers of afflicted people increase, so does the allergic disease to people at risk and to improve practice in research and development, and progress is being made. this clinical field of medicine for the benefit of those suffering from the consequences of allergies. I congratulate the World Allergy should be recognized as a public health problem and Allergy Organization for initiating this timely and much needed efforts should be made towards its prevention and optimal document and wish them all success in its impact and treatment. To achieve this, public awareness should be implementation. increased and efforts should be made towards proper education and training for more integrated and holistic approach to the diagnosis and management of allergic diseases. HE. Dr. APJ Abdul Kalam Former, President of India New Delhi, India Copyright 2011 World Allergy Organization WAO White Book on Allergy 3 Foreword by Baroness Finlay, House of Lords, United Kingdom I am delighted to have an opportunity of adding my strongest to provide education and training courses for allergy patients; support to the principles laid out in this World Allergy Organization their families; school staff and employers; in how to prevent and White Book on Allergy. Indeed, many of the recommendations treat allergic conditions. align with those of a recent report on Allergy Services that I was 2) Because of the lack of knowledge of health professionals asked to chair in 2006 for the UK House of Lords Committee in the diagnosis and treatment of allergic diseases, we on Science Technology (http://www.publications.parliament. recommended that those responsible for medical training uk/pa/ld200607/ldselect/ldsctech/166/166i.pdf). The scope strengthen the input of clinical allergy to the undergraduate of the Report encompassed an assessment of recent trends and postgraduate training of internists and primary care of allergy prevalence, the social and economic burdens that physicians as well of those of nurses. allergic disorders cause, current allergy treatments and research strategies, and policies which impact upon allergy 3) Although high quality research into cellular and molecular patients such as housing standards, food labelling and the mechanisms of allergy is advancing, the factors contributing work and school environments. As with the White Book, our to allergy development and the “allergy epidemic,” are poorly report came at a time when the prevalence of allergic disorders understood. It is imperative that further research should in this country has been claimed to have reached epidemic focus on the environmental factors, such as early allergen proportions. Although it is unlikely that a cure for all forms of exposure, which may contribute to the inception, prevention allergy will be found in the near future, we have made a number or exacerbation of allergic disorders. We were concerned of recommendations which we believe will contribute to the that the knowledge gained from cellular and molecular prevention, treatment and management of allergic disorders. research in allergy was not being translated into clinical Our main conclusions and recommendations were: practice and was identified as an area of unmet need that required greater priority. 1) There is a need for Allergy centres where specialist, high quality diagnostic and treatment services that are accessible Immunotherapy is a valuable resource in the prophylactic to the public. Once a diagnosis is obtained and a treatment treatment of patients with life-threatening allergies, or whose plan developed at the allergy centre, the patient’s disease allergic disease does not respond to other medication. can often be managed back in primary or general secondary Although initially expensive, immunotherapy can prevent care. However, patients with severe or complex allergic a symptomatic allergic response for many years, and may conditions may need long-term follow-up from specialists in prevent the development of additional allergic conditions, so the allergy centre. its wider use could potentially result in significant long-term savings for health services. Full cost-benefit analyses of the Allergen immunotherapy by injection should always be carried potential health, social and economic value of immunotherapy out by specialists within the allergy centre because of the risk treatment needs to be conducted so the case for its use and of anaphylaxis. Collaboration between clinicians in primary, funding can be strengthened. secondary and tertiary care is key to improving the diagnosis and management of people with allergic conditions. Once 4) We recognised the appreciable impact that allergic rhinitis established, the allergy centre in each geographical region has on student performance in schools and examinations. should encourage and co-ordinate the training of local GPs Indeed, we wished to encourage health professionals to and other healthcare workers in allergy. In a “hub and spokes” interface more closely with schools to ensure children with model, the allergy centre, or “hub,” would act as a central allergic disease receive optimal care. We support the use point of expertise with outreach clinical services, education of individual care plans for children with medical needs. and training provided to doctors and nurses in primary and However, we were concerned that many teachers and secondary care, the “spokes.” In this way, knowledge regarding support staff within schools are not appropriately educated in the diagnosis and management of allergic conditions would be how to deal with allergic emergencies and should take urgent disseminated throughout the region. remedial action to improve this training where required. We were especially concerned about the lack of clear guidance The allergy centre should also act as a lead in providing public regarding the use of autoinjectors of adrenaline on