White Book on Allergy: Update 2013 - World Allergy Organization

248 Pages·2013·3.96 MB·English

WORLD ALLERGY ORGANIZATION
WWAAOO
WWhhiittee BBooookk oonn AAlllleerrggyy
2013
Update
WAO White Book on Allergy

World Allergy Organization (WAO)
White Book on Allergy: Update 2013
Copyright 2013 World Allergy Organization
WAO White Book on Allergy:
Update 2013
Editors
Prof. Ruby Pawankar, MD, PhD Prof. Giorgio Walter Canonica, MD
WAO President WAO, Historian
Professor of Allergy Allergy & Respiratory Diseases
Department of Pediatrics Department of Internal Medicine
Nippon Medical School University of Genoa
1-1-5, Sendagi IRCCS AOU S.Martino, Largo Rosanna Benzi
Bunkyo-ku, 101-16132 Genoa
Tokyo 113-8603 ITALY
JAPAN
[email protected]
Prof. Richard F. Lockey, MD
WAO Past President
Prof. S tephen T. Holgate, BSc, MD, Division of Allergy & Immunology
DSc, FMed Sci Joy McCann Culverhouse Chair in Allergy & Immunology
WAO Treasurer University of South Florida College of Medicine
Medical Research Council Clinical Professor of James Haley Veterans Administration Medical Center (111D)
Immunopharmacology 13000 Bruce B. Downs Boulevard
Infection, Inflammation and Immunity Tampa, Florida 33612
School of Medicine USA
University of Southampton
Level F, South Block
Prof. Michael S. Blaiss, MD
Southampton General Hospital
Tremona Road WAO Board Member
Southampton SO16 6YD Clinical Professor of Pediatrics and Medicine
United Kingdom University of Tennessee Health Science Center
7205 Wolf River Blvd
Germantown, Tennessee 38138
USA
ISBN-10: 061592915X (print)
ISBN-13: 978-0-615-92915-6 (print)
ISBN-10: 0615929168 (digital)
ISBN-13: 978-0-615-92916-3 (digital)
Copyright 2013 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
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Website : www.worldallergy.org
World Allergy Organization (WAO)
White Book on Allergy: Update 2013
Editors
Ruby Pawankar
Giorgio Walter Canonica
Stephen T. Holgate
Richard F. Lockey
Michael S. Blaiss
Copyright 2013 World Allergy Organization

WAO White Book on Allergy: Update 2013 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 2013 World Allergy Organization

WAO White Book on Allergy: Update 2013 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 children
information and advice. Specialists at the centre should work in
with anaphylactic shock in the school environment.
collaboration with allergy charities, schools and local businesses
Copyright 2013 World Allergy Organization
4 Pawankar, Canonica, Holgate, Lockey and Blaiss
5) We considered that controlled trials should be conducted 9) We were also concerned that the results of allergy self-testing
involving multiple interventions to examine the effect of kits available to the public are being interpreted without the
ventilation, humidity and mite-reduction strategies on advice of appropriately trained healthcare personnel, and that
allergy development and control. As climate change and air the IgG food antibody test is being used to diagnose food
pollution may significantly impact upon the development of intolerance in the absence of stringent scientific evidence.
allergic disease, we supported greater effort to take account We recommend that further research into the relevance of
of the interlinkages between air quality, climate change and IgG antibodies in food intolerance together with and the
human health. necessary controlled clinical trials should be conducted.
6) Vague defensive warnings on food product labels for Although my task was to direct our activity to issues relevant
consumers with food allergy can lead to dangerous confusion to allergy as occurs in the United Kingdom, nevertheless, it is
and an unnecessary restriction of choice. We recommend remarkable how closely our recommendations from the House
that the responsible government agencies should ensure of Lords Report that I chaired resonate with those of the Allergy
the needs of food-allergic consumers are clearly recognised White Book. Following the presentation of our Report to the UK
during any review of food labelling legislation. Many teenagers Government, I was asked to establish an Implementation Group
and young adults with food allergies sometimes take by the Royal Colleges of Physicians and Pathologists (http://
dangerously high risks when buying food. We considered bookshop.rcplondon.ac.uk/details.aspx?e=317). I would like
that the relevant government agencies, charities and other to suggest that following the launch of the Allergy White Book
stakeholders should explore novel ways to educate young by the WAO, implementation groups are established in each
people about allergy and the prevention of anaphylaxis. country and by the WAO as a whole to monitor uptake of the
recommendations and their impact, to improve practice for the
As sensitivities to various allergens vary widely, the setting
benefit of patients with allergy.
of standardised threshold levels for package labelling is
potentially dangerous for consumers with allergies. Instead, we I wish to use this opportunity to congratulate the WAO for
considered that food labels should clearly specify the amount initiating this timely Report, all those who have contributed to
of each allergen, and if it is contained within the products, we its content and especially those in different countries whose
wish to discourage vague defensive warnings. The phrases allergy societies have contributed their own experiences. I wish
“hypoallergenic” and “dermatologically tested” are almost you every success in its impact and uptake.
meaningless, as they only demonstrate a low potential for the
Baroness Ilora Finlay
products to be a topical irritant. Such products should warn House of Lords
those with a tendency to allergy that they may still get a marked Westminster
London, UK
reaction to such products.
8) In various parts of the world, traditional and complementary
medical interventions for treating allergic disease are
available and frequently accessed by the public, but the
evidence base for this is poor. We recommend that robust
research into the use of complementary diagnostic tests and
treatments for allergy should examine the holistic needs of
the patient, assessing not only the clinical improvement of
allergy symptoms, but also analysing the impact of these
methods upon patient well-being. Such trials should have
clear hypotheses, validated outcome measures, and risk-
benefit and cost-effectiveness comparisons made with
conventional treatments.
Copyright 2013 World Allergy Organization