Atopy and allergy prevention

Transcription

1 Atopy and allergy prevention Dr Tiina Laatikainen National Institute for Health and Welfare Department of Chronic Disease Prevention Esityksen nimi / Tekijä 1

2 Global Asthma Burden. Asthma deaths per 100,000 asthmatics in the 5- to 34-year age group In Europe: 32 million have asthma annually 10 million hospital days deaths ( globally) Allergy 2004;59: Finland

3 Finnish Asthma Programme TRADITIONAL Money Personnel Facilities Time NEW Innovation and new knowledge Attitude and motivation Unused know-how Resources not organised for common goals Interest group participation

4 Zero tolerance to asthma deaths mortality has almost disappeared in Finland (population 5,2 million) Number of cases all men women In asthma deaths < 75 years, 6 deaths < 65 years

5 Collapse of hospital days and mortality : - 25%

6 Value of the index Finnish Asthma Programme New patients, disability pensions and rehabilitation Number of asthmatics still slightly growing Absolute decrease in disability 76% Share of asthmatics Disability pensions 20 0 Patients attending rehabilitation courses : -30% Haahtela T, et al. Thorax

7 From New Understanding to National Programme Professor Tari Haahtela Clinics and Epidemiology M. Ahlström P. Jousilahti T. Kosunen T. Laatikainen P. Pekkarinen T. Petäys E. Vartiainen Animal Models, Microbiology H. Alenius M. Andersson M. Leino J. Pakarinen M. Salkinoja-Salonen O. Saris K. Sirola Prevention, Probiotics R. Korpela M. Kuitunen K. Kukkonen E. Savilahti Genetics T. Laitinen P. LeSoeuf J. Kere GABRIEL-Project National Programme Secretaries L. von Hertzen, M. Hannuksela, M. Mäkelä, E. Tommila, E. Valovirta Allergen structure S. Mäkinen-Kiljunen J. Rouvinen K. Takkinen H. Söderlund M-L. Laukkanen International collaboration: GARD (J. Bousquet, A. Cruz), GA2LEN (T. Zuberbier), GABRIEL (E. von Mutius, W. Cookson), DIABIMMUNE (M. Knip)

8 Asthma and allergy study in North Karelia, Finland and the Republic of Karelia, Russia Sub-study in FINRISK 1997 and 2007 Data collection in North Karelia and Pitkäranta in 1998 and 2007 Adults between years of age Asthma and allergy questionnaire Skin prick test in 1998 Total and specific IgE concentrations in serum

9 Study areas N North Pohjois-Karjala Karelia KARJALAN Russian TASAVALTA Karelia Pitkäranta SUOMI Finland 100 km

10 Allergic diseases and asthma among year old in North Karelia and Russian Karelia % Russia 1998 Finland Hay fever Allergic eye symptoms Atopic eczema Asthma p< 0,

11 Positive skin prick test among year old in North Karelia and Russian Karelia % Russia 1998 Finland 1998 p< 0, Birch Timothy grass Mugwort Cat Cow Mold AA Derm. Pter. Any positive

12 Atopy in children and their mothers in Finland and Russia (Prevalence of positive prick test in 2003) Children Mothers Russia (%) Finland (%) Russia (%) Finland (%) Birch Timothy grass Mugwort Cat Dog Horse 0, Cow House dust mite Fish 0,2 0,3 2 3 Oat Wheat Milk 0,2 0,3 2 3 At least one positive von Herzen L et al. JACI

13 The Hygiene Hypothesis The Hygiene Hypothesis: Are Cleanier Lifestyles Causing More Allergies For Kids? ScienceDaily (Sep. 5, 2007) A little dirt never hurt. But in today s super-clean world, vaccinations, anti-bacterial soaps, and airtight doors and windows are keeping dirt and diseasecausing germs at bay. It s called the hygiene hypothesis, says Marc McMorris, M.D., a pediatric allergist at the University of Michigan Health System. We ve developed a cleanlier lifestyle, and our bodies no longer need to fight germs as much as they did in the past. As a result, the immune system has shifted away from fighting infection to developing more allergic tendencies

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15 % sensitized Present exposure to cat allergens and sensitization to cat (Custovic A. JACI 2001) Bell-shaped sensitization curve: Heavy exposure induces tolerance, because of strong Treg function! < >151

16 Prevalence of itchy rash (in the past 12 mo) in Russian and Finnish mothers in relation to genotypes of CD14 (C-260T) Prevalence % P linear =0.29 P linear =0.010 Finnish mothers Russian mothers CC CT TT Zhang G et al. Allergy 2009; Epub

17 Asthma Programme Focus: (1) inflammation, (2) early intervention, (3) guided selfmanagement, and (4) networking Haahtela T, et al. Thorax 2006 National Allergy Programme time to act and change the course Finn Med J 2008,Suppl 14:1-22; Allergy 2008;63: ; Allergy 2008;63: , Editorial; Allergy 2009;64: In association with the WHO GARD Programme = Global Alliance against Respiratory Diseases Focus: (1) children, young people, (2) from treatment to prevention, (3) tolerance, (4) diagnostic quality, and (5) early intervention to control severe allergies Ministry of Health; National Public Health Institute; NGOs: Allergy & Asthma Federation, Finnish Lung Health Association, Finnish Pulmonary Association HELI

18 Key messages of the Allergy Programme Endorse health, not allergy Strenghten tolerance Adopt a new attitude to allergy. Avoid allergens only if mandatory Recognize and treat severe allergies early. Prevent exacerbations Improve indoor air quality. Stop smoking Haahtela T, von Hertzen L, Mäkelä M, Hannuksela M, The Allergy Programme Group. Finnish Allergy Programme time to act and change the course. Allergy 2008 Bousquet J, et al. In Allergy, A new day has begun. Allergy 2008, Editorial

19 Allergy Programme Goals Prevent allergies. Prevalences of asthma, allergic rhinitis and atopic dermatitis reduce by 20 %. Increase tolerance to allergens in the population. Avoidance diets to foods decrease by 50 %. Improve allergy diagnostics. All patients are tested in a quality certified allergy-testing centre. Reduce work related allergies. Their numbers reduce by 50 %. Use resources to treat severe allergies and reduce exacerbations. Good Allergy Care is employed in the whole country and asthma exacerbations are reduced by 40 %. Reduce costs caused by allergies. Costs reduce by 20 %. Haahtela T, von Hertzen L, Mäkelä M, Hannuksela M, The Allergy Programme Group. Finnish Allergy Programme time to act and change the course. Allergy 2008 Bousquet J, et al. In Allergy, A new day has begun. Allergy 2008, Editorial

20 Allergic diseases and asthma among year old in North Karelia and Russian Karelia % Russia 1998 Russia 2007 Finland 1998 Finland Hay fever Allergic eye symptoms Atopic eczema Asthma p< 0,

21 Percentage of high total IgE ( 110 IU/L) and specific IgE values ( 0,35 IU/L) among year old in North Karelia and Russian Karelia % Total IgE Birch Timothy Cat Clad herb Derm pter p< 0,01 for area difference and change in Finland Russia 1998 Russia 2007 Finland 1998 Finland

22 Percentage of specific IgE values ( 0,35 IU/L) among year old in North Karelia and Russian Karelia % ** Any positive Any positive - Two or more positive Russia 1998 Russia 2007 Finland 1998 Finland 2007 Any positive = all but Derm. Pter. p< 0,001 for change in Finland ** p<0,01 for change in Finland

23 Allergy gap between Finnish and Russian Karelia on increase Prevalence of positive IgE response in total IgE, Birch, Timothy grass and Cat according to birth cohort in Russian (RUS) and Finnish Karelia (FIN) Laatikainen et al. Allergy

24 Positive IgE except D pteronyssinus by agegroup and birth cohort % FIN FIN FIN RUS RUS RUS

25 One positive IgE response to D pteronyssinus by agegroup and birth cohort % FIN FIN FIN RUS RUS RUS

26 Allergy on increase in Finland The allergy epidemic continues in Finland In Russia, no signs of the epidemic are discernible, even though decrease in total IgE may indicate a change in environmental exposure that might increase allergy risk in future In Finland the increasing prevalence of atopy is mainly attributable to the birth cohort effect indicating that the younger generation is more atopic than the former

27 National allergy programme time to change the course