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World Allergy Organization Guidelines for Prevention of Allergy and Allergic Asthma
Editors
S.G.O. Johansson
Tari Haahtela
WAO Project Co-ordinator
Karen Henley DaviesPrevention of Allergy and Allergic Asthma. World Allergy Organisation Project Report and Guidelines. Eds. SGO Johansson and T Haahtela. Chemical Immunology and Allergy. Editors J Ring et al. Vol. 84, Karger, Basel, 2005.
Prevention, Definitions Primary Prevention: prevention of immunological
sensitization (i.e. development of IgE antibodies)
Secondary Prevention: preventing development of an allergic disease following sensitization
Tertiary Prevention: treatment of allergic diseases and asthma
Measures should benefit all, not harm anyone, not involve unreasonable costs
PAAA ContributorsCarlos Baena Cagnani, Argentina
Patrick Holt, Australia
Charles Naspitz, Brazil
Nan-Shan Zhong, China
Arne Høst, Denmark
Johannes Ring, Germany
Torsten Schäfer, Germany
Ulrich Wahn, Germany
Michal Hemmo-Lotem, Israel
Benjamin Volovitz, Israel
Attilio Boner, Italy
G. Walter Canonica, Italy
Yoji Iikura, Japan
Joseph Odhiambo, Kenya
Innes Asher, New ZealandTadd Clayton, New ZealandMarek L. Kowalski, PolandAlexander Chuchalin, RussiaJoaquin Sastre, SpainMatthias Haus, South AfricaPakit Vichyanond, ThailandElif Dagli, TurkeyAdnan Custovic, UKStephen T. Holgate, UKJohn W. Holloway, UKKatherine Venables, UKJohn Warner, UKAllen Kaplan, USARichard Lockey, USAKewin Weiss, USA
GeneticsCurrent knowledge
The atopic constitution is a major risk factor for the development of IgE-sensitization
Individuals with a family history of atopy have an increased risk of developing allergic diseases
Target organ sensitivity is a familial trait
Environmental Influences on Asthma and Allergy - Current knowledge
Cigarette smoking in pregnancy increases the risk of wheezing in infancy
Environmental Tobacco Smoke aggravates asthma
Allergen avoidance is partially successful (high risk infants)
Some early respiratory infections, e.g. pertussis and RSV, may enhance IgE-sensitization
Relative lack of early microbial exposure may enhance the
development of allergic diseases
Early Immunological InfluencesCurrent knowledge
Allergen specific T-helper cell programming is initiated early in life
and is driven by ubiquitos dietary and inhalant allergens
Early exposure to high levels of dietary allergens results in high zone
tolerance
Exposure to low levels of inhalant allergens triggers low zone
tolerance with weak Th1-like immunity or Th2 polarised response
Predictive and Early DiagnosisCurrent knowledge
Double heredity means a four-fold risk to develop allergies
Single heredity means a two-fold risk
Early signs of atopic eczema, and presence of IgE antibodies to inhalant allergens, are important risk factors for later respiratory allergy
High IgE level in cord blood is specific for subsequent allergic disease but has a low sensitivity
Preventive MeasuresGuidelines
Primary prevention Avoid smoking and Environmental Tobacco Smoke, particularly during
pregnancy and early childhood (B). Remove tobacco smoke from work places (B)
Avoid damp housing conditions (C) and reduce indoor air pollutants (C) Breast-feed exclusively until 4-6 months (B*). No special diet for
lactating mothers (A) Reduce exposure to inhalant allergens in young children at high risk Eliminate sensitizing and highly irritating agents in occupational
environments (C). Implement measures to prevent employee exposure * WHO: exclusive breast-feeding for 6 months in general
Preventive MeasuresGuidelines
Secondary prevention
Treat atopic eczema topically, and possibly with systemic pharmacotherapy to prevent respiratory allergy (D)
Treat upper airways disease (rhinoconjunctivitis, sinusitis) to reduce risk of asthma (D)
In young children sensitized to mites, pets or cockroaches, exposure should be reduced to prevent onset of allergic disease (B)
Remove employees from occupational exposure if they have symptoms caused by occupational allergic sensitization (C)
Preventive MeasuresGuidelines
Tertiary prevention Infants with cow’s milk allergy avoid cow’s milk proteins; if a supplement is
needed, use hypoallergenic formula, if available/affordable, to improve symptom control (B)
Patients with asthma, rhinoconjunctivitis or eczema, who are allergic to indoor allergens, should eliminate or reduce the exposure to improve symptom control and prevent exacerbations (A-B)
Aim pharmacotherapy primarily towards the underlying inflammatory process (A)
Avoid strictly ASA and other non-steroidal anti-inflammatory drugs (NSAID) in patients who are sensitive to them (C)
Preventive MeasuresFurther actions for occupational allergies
Risks of occupational allergy should be monitored and epidemiological information collected by a globally agreed questionnaire
High risk allergy environments should be identified. In atopic employees who work in these environments, detection of sensitization by Skin Prick/Puncture Tests or IgE antibody measurements could prevent development of clinical allergy
General principles of prevention of occupational allergies should be published by national regulatory and advisory authorities
Allergy and Asthma EducationGuidelines
Patient education regarding precipitants of allergic
symptoms, asthma and anaphylaxis is essential.
Guided self-management is the key to optimizing
disease control (A)
School policies on asthma and anaphylaxis
management are essential (D)
Allergy and Asthma EducationFurther actions required
Initiation of an International Coalition for Allergy and Asthma
Prevention. The aims are:
To collect effective programs in a database for all countries
To establish an annual convention on allergy and asthma
prevention, education and applied research
To establish an International Allergy and Asthma Prevention &
Education Promotion Fund
The Costs of Allergy and AsthmaGuideline
Cost of treating allergies and asthma are increasing, switching
from hospital costs to medication costs in developed countries
When considering any intervention, take into account not only
the evidence showing beneficial effect but also the costs
Use the most cost-effective product or measure
Patient Information (Appendix 1)Allergens House dust mite allergen reduction (major
strategies, additional strategies)
Pollen avoidance
Pet allergen avoidance
Cockroach allergen avoidance
Mould allergen avoidance (indoors, outdoors)
Severe reactions, allergic anaphylaxis (schools, work places)
Educational Programs (Appendix 2)
Allergic asthma and rhinitis
Atopic eczema/dermatitis
Severe Reactions, allergic anaphylaxis (schools, work places)
Preventive MeasuresGuidelines
Education
Patient education regarding precipitants of asthma, allergic
symptoms, and especially anaphylaxis is essential. Guided self-
management to prevent, assess and treat symptoms is the key to
optimizing disease control (A)
School policies on asthma and anaphylaxis management are useful
(D)
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