WAO White Book on Allergy - World Allergy Organization

1 World Allergy Organization . WAO. White book on Allergy 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. S. tephen 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).

2 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.

3 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: Website : Printed in the United Kingdom, 2011. World Allergy Organization (WAO).

4 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 children health care policy makers to address early identification of are food allergies, eczema, and asthma. The precise causes of this symptoms, early diagnosis and appropriate strategies to increase in allergic diseases are not fully understood but as the manage and control allergies to avoid worsening of severe numbers of afflicted people increase, so does the research and allergic disease to people at risk and to improve practice in development, and progress is being made.

5 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 increased implementation. 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.

6 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 in the asked to chair in 2006 for the UK House of Lords Committee diagnosis and treatment of allergic diseases, we recommended on Science Technology ( that those responsible for medical training strengthen the uk/pa/ld200607/ldselect/ldsctech/166 ). The scope input of clinical Allergy to the undergraduate and postgraduate of the Report encompassed an assessment of recent trends training of internists and primary care physicians as well of of Allergy prevalence, the social and economic burdens that those of nurses.

7 Allergic disorders cause, current Allergy treatments and research strategies, and policies which impact upon Allergy patients such 3) Although high quality research into cellular and molecular as housing standards, food labelling and the work and school mechanisms of Allergy is advancing, the factors contributing environments. As with the White book , our report came at a time to Allergy development and the Allergy epidemic, are poorly when the prevalence of allergic disorders in this country has understood. It is imperative that further research should been claimed to have reached epidemic proportions. Although focus on the environmental factors, such as early allergen it is unlikely that a cure for all forms of Allergy will be found in exposure, which may contribute to the inception, prevention the near future, we have made a number of recommendations or exacerbation of allergic disorders.

8 We were concerned that which we believe will contribute to the prevention, treatment the knowledge gained from cellular and molecular research and management of allergic disorders. Our main conclusions and in Allergy was not being translated into clinical practice and recommendations were: 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 plan developed at the Allergy centre, the patient's disease can whose allergic disease does not respond to other medication. often be managed back in primary or general secondary care.

9 Although initially expensive, immunotherapy can prevent a However, patients with severe or complex allergic conditions symptomatic allergic response for many years, and may prevent may need long-term follow-up from specialists in the Allergy the development of additional allergic conditions, so its wider centre. use could potentially result in significant long-term savings for health services. Full cost-benefit analyses of the potential health, Allergen immunotherapy by injection should always be carried social and economic value of immunotherapy treatment needs out by specialists within the Allergy centre because of the risk to be conducted so the case for its use and funding can be of anaphylaxis. Collaboration between clinicians in primary, strengthened. secondary and tertiary care is key to improving the diagnosis and management of people with allergic conditions.

10 Once 4) We recognised the appreciable impact that allergic rhinitis has established, the Allergy centre in each geographical region on student performance in schools and examinations. Indeed, should encourage and co-ordinate the training of local GPs we wished to encourage health professionals to interface and other healthcare workers in Allergy . In a hub and spokes more closely with schools to ensure children with allergic model, the Allergy centre, or hub, would act as a central point of disease receive optimal care. We support the use of individual expertise with outreach clinical services, education and training care plans for children with medical needs. However, we provided to doctors and nurses in primary and secondary care, were concerned that many teachers and support staff within the spokes. In this way, knowledge regarding the diagnosis schools are not appropriately educated in how to deal with and management of allergic conditions would be disseminated allergic emergencies and should take urgent remedial action throughout the region.