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      The importance of allergic disease in public health: an iCAALL statement

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          Abstract

          Introduction Allergic diseases constitute a significant cause of morbidity worldwide and a considerable burden on the health and medical systems of both developed and emerging economies. Allergies and related diseases including asthma, rhinosinusitis, atopic dermatitis and life threatening food, drug, and stinging insect allergies affect at least 30% of the population and nearly 80% of families. According to recent studies, their prevalence is increasing globally [1–4]. Medical services providing expert allergy care are lacking in many countries; therefore, the major organizations devoted to the field of allergy (American Academy of Allergy, Asthma and Immunology, AAAAI; American College of Allergy, Asthma, and Immunology, ACAAI; European Academy of Allergy, Asthma and Clinical Immunology, EAACI; and the World Allergy Organization, WAO), strongly feel that education of health professionals and the public on the importance and impact of allergic diseases as a public health concern should be encouraged. The International Collaboration in Allergy, Asthma, and Immunology (iCAALL), a partnership constituted by AAAAI, ACAAI, EAACI, and WAO, have recommended publishing an advocacy statement with the purpose of calling to the attention of the medical community, health authorities and the public in general, the major impact and relevance of the allergy specialists as key groups of professionals specifically trained for the adequate diagnosis, treatment, and prevention of allergic diseases. Allergic diseases are often underdiagnosed and undertreated Allergy is a rather “new” medical specialty, having only emerged with increased awareness of immunologic responses and the increasing importance of non-communicable diseases. However, in spite of being a major global public health issue, the public and the health establishment have generally not recognized the importance of allergic diseases. Since the prevalence of allergic diseases has been steadily increasing, it is time to place the field of allergy in a more prominent place within global medical organizations. This absence of proper recognition frequently results in a lack of, or incorrect, diagnosis resulting in sub-optimal disease management, negative effects on quality of life, increased morbidity and mortality, and considerable additional direct and indirect costs. Moreover, the complexity and involvement of multiple organs and systems of allergic diseases confounds management in fragmented care based on our current health care delivery systems dependent on traditional organ-based specialists. Unmet needs in allergic care In most populations around the world there is a lack of adequate education on the definition, etiology, pathogenesis, proper therapies, and prevention of allergic diseases. Awareness of the morbidity and potential mortality associated with allergic diseases, the chronic nature of those conditions, and the importance of consulting a physician knowledgeable in allergic diseases, asthma and clinical immunology are often lacking. This translates into patients with allergic diseases not being managed by physicians with the necessary training and skills in the appropriate use of efficacious medications required for optimal management. There is an increasing need to expand the number of allergy/clinical immunology specialists as well as local and regional diagnostic and treatment centers in order to facilitate timely referrals for patients with complex allergic diseases. A goal should be established to guarantee the universal accessibility to affordable and cost-effective therapies as well as novel medications used in the management of allergic diseases. Presently, there are millions of people worldwide who do not have access to care by specialists in allergy [1]. Moreover, epinephrine auto-injectors, some drugs for severe asthma, allergen-specific immunotherapy, and some drugs for adverse reactions to biologicals and chemotherapeutic agents in desensitization centers are not available in many parts of the world. Public health officers should provide for optimal allergy/clinical immunology services, including access to specialists and diagnostic and treatment centers. Allergists should be able to prescribe the most cost-effective medications to manage the specific clinical findings of each allergic patient. Consultations with allergists to assure correct diagnosis and treatment are indispensable to improve long-term patient outcomes and their quality of life and reduce the unnecessary additional direct and indirect costs passed on to the patient, payer and society. In the last decade there have been important advances in the field of allergy, especially in the understanding of the mechanisms leading to disease, improved diagnostic methods based in molecular allergy, and novel medications for immune modulation and immunotherapy based in more effective and safe vaccines and biologicals [5–9]. What can be done to improve the current situation? Advocacy from these professional organizations on the role of allergy in public health has been identified as the most important objective of iCAALL. Increasing awareness on the relevance of allergic diseases as a major public health problem could lead to a better recognition by governments and health authorities. Programs to increase awareness of allergic diseases should focus on the causes, prevention, control, and economic impact. The main goal would be better care of allergic diseases around the world with the aim to effectively engage regional, country, and local authorities. An important step forward supported by the major allergy organizations resides in current efforts to obtain World Health Organization (WHO) recognition of allergy through the new nomenclature of allergic diseases included in the ICD-11 classification of diseases [10, 11]. Because allergic diseases are systemic multi-organ diseases, allergists are in the best position to diagnose and manage the allergic patient, in contrast to the classic organ-based approach of most other medical specialties. Allergic disease management by allergists based on the new technological advancements could be more efficacious and cost-effective when compared to the care provided by generalists or other specialists. In addition, allergists have significant experience in the implementation of preventive measures which have been shown to diminish or eliminate allergic symptoms, including environmental control measures and allergen-specific immunotherapy, which could reduce the costs of disease management. Focus on the patient Educational efforts focused on allergic diseases should be specifically directed to patients and their families as the final targets of these awareness programs. In order to obtain better results regarding disease prevention and control, it will be strictly necessary to reach the community at various levels, including regional, local, and state agencies as well as schools and patient organizations with straight forward and understandable messaging. At the same time, approaching governments, politicians and public health officers should be part of the strategy in order to promote the allocation of sufficient resources for the diagnosis, control, treatment and prevention of allergic diseases. Notes This is a Joint Statement by the organizations of the International Collaboration on Allergy Asthma and Immunology (iCAALL): American Academy of Allergy Asthma and Immunology (AAAAI), represented by Robert Wood, Thomas Casale, Thomas Fleisher, David Peden); American College of Allergy Asthma and Immunology (ACAAI), represented by Bryan Martin, James L Sublett, Stephen A Tilles; European Academy of Allergy Asthma and Clinical Immunology (EAACI), represented by Antonella Muraro, Ioana Agache, Peter Hellings, Nikos Papadopolous; World Allergy Organization (WAO), represented by Mario Sánchez-Borges, Ignacio J Ansotegui, Lanny Rosenwasser. Published on behalf of AAAAI, ACAAI, EAACI, and WAO.

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          International consensus on allergy immunotherapy.

          Allergen immunotherapy (AIT) has been used to treat allergic disease since the early 1900s. Despite numerous clinical trials and meta-analyses proving AIT efficacious, it remains underused and is estimated to be used in less than 10% of patients with allergic rhinitis or asthma worldwide. In addition, there are large differences between regions, which are not only due to socioeconomic status. There is practically no controversy about the use of AIT in the treatment of allergic rhinitis and allergic asthma, but for atopic dermatitis or food allergy, the indications for AIT are not well defined. The elaboration of a wider consensus is of utmost importance because AIT is the only treatment that can change the course of allergic disease by preventing the development of asthma and new allergen sensitizations and by inducing allergen-specific immune tolerance. Safer and more effective AIT strategies are being continuously developed both through elaboration of new allergen preparations and adjuvants and alternate routes of administration. A number of guidelines, consensus documents, or both are available on both the international and national levels. The international community of allergy specialists recognizes the need to develop a comprehensive consensus report to harmonize, disseminate, and implement the best AIT practice. Consequently, the International Collaboration in Asthma, Allergy and Immunology, formed by the European Academy of Allergy and Clinical Immunology; the American Academy of Allergy, Asthma & Immunology; the American College of Allergy, Asthma & Immunology; and the World Allergy Organization, has decided to issue an international consensus on AIT.
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            Update on allergy immunotherapy: American Academy of Allergy, Asthma & Immunology/European Academy of Allergy and Clinical Immunology/PRACTALL consensus report.

            Allergy immunotherapy (AIT) is an effective treatment for allergic asthma and rhinitis, as well as venom-induced anaphylaxis. In addition to reducing symptoms, AIT can change the course of allergic disease and induce allergen-specific immune tolerance. In current clinical practice immunotherapy is delivered either subcutaneously or sublingually; some allergens, such as grass pollen, can be delivered through either route, whereas others, such as venoms, are only delivered subcutaneously. Both subcutaneous and sublingual immunotherapy appear to have a duration of efficacy of up to 12 years, and both can prevent the development of asthma and new allergen sensitivities. In spite of the advances with AIT, safer and more effective AIT strategies are needed, especially for patients with asthma, atopic dermatitis, or food allergy. Novel approaches to improve AIT include use of adjuvants or recombinant allergens and alternate routes of administration. As part of the PRACTALL initiatives, the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma & Immunology nominated an expert team to develop a comprehensive consensus report on the mechanisms of AIT and its use in clinical practice, as well as unmet needs and ongoing developments in AIT. This resulting report is endorsed by both academies. Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.
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              A WAO - ARIA - GA²LEN consensus document on molecular-based allergy diagnostics

              Molecular-based allergy (MA) diagnostics is an approach used to map the allergen sensitization of a patient at a molecular level, using purified natural or recombinant allergenic molecules (allergen components) instead of allergen extracts. Since its introduction, MA diagnostics has increasingly entered routine care, with currently more than 130 allergenic molecules commercially available for in vitro specific IgE (sIgE) testing. MA diagnostics allows for an increased accuracy in allergy diagnosis and prognosis and plays an important role in three key aspects of allergy diagnosis: (1) resolving genuine versus cross-reactive sensitization in poly-sensitized patients, thereby improving the understanding of triggering allergens; (2) assessing, in selected cases, the risk of severe, systemic versus mild, local reactions in food allergy, thereby reducing unnecessary anxiety for the patient and the need for food challenge testing; and (3) identifying patients and triggering allergens for specific immunotherapy (SIT). Singleplex and multiplex measurement platforms are available for MA diagnostics. The Immuno-Solid phase Allergen Chip (ISAC) is the most comprehensive platform currently available, which involves a biochip technology to measure sIgE antibodies against more than one hundred allergenic molecules in a single assay. As the field of MA diagnostics advances, future work needs to focus on large-scale, population-based studies involving practical applications, elucidation and expansion of additional allergenic molecules, and support for appropriate test interpretation. With the rapidly expanding evidence-base for MA diagnosis, there is a need for allergists to keep abreast of the latest information. The aim of this consensus document is to provide a practical guide for the indications, determination, and interpretation of MA diagnostics for clinicians trained in allergology.
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                Author and article information

                Contributors
                +58 212 261 5284 , sanchezbmario@gmail.com
                bryan.martin@osumc.edu
                muraro@centroallergiealimentari.eu
                rwood@jhmi.edu
                ibrumaru@unitbv.ro
                ignacioansotegui@gmail.com
                tbcasale@health.usf.edu
                tfleishe@mail.nih.gov
                peter.hellings@med.kuleuven.ac.be
                ngp@allergy.gr
                david_peden@med.unc.edu
                jsublett@familyallergy.com
                stilles@nwasthma.com
                lrosenwasser334@gmail.com
                Journal
                World Allergy Organ J
                World Allergy Organ J
                The World Allergy Organization Journal
                BioMed Central (London )
                1939-4551
                27 April 2018
                27 April 2018
                2018
                : 11
                : 1
                : 8
                Affiliations
                [1 ]ISNI 0000 0001 2231 8907, GRID grid.418386.0, Allergy and Clinical Immunology Department, , Centro Medico Docente La Trinidad, Allergy Service, Clinica El Avila, ; 6a. Transversal Urb. Altamira, Piso 8, Consultorio 803, Caracas, 1060 Venezuela
                [2 ]ISNI 0000 0001 2285 7943, GRID grid.261331.4, Ohio State University, ; Powell, OH USA
                [3 ]ISNI 0000 0004 1760 2630, GRID grid.411474.3, Padua University Hospital, ; Padua, Italy
                [4 ]ISNI 0000 0001 2171 9311, GRID grid.21107.35, Johns Hopkins University, ; Baltimore, MD USA
                [5 ]Spitalul Judetena Brasov, Brasov, Romania
                [6 ]Hospital Quirónsalud Bizkaia, Bilbao, Spain
                [7 ]ISNI 0000 0001 2353 285X, GRID grid.170693.a, University of South Florida Morsani College of Medicine, ; Tampa, FL USA
                [8 ]ISNI 0000 0001 2297 5165, GRID grid.94365.3d, National Institutes of Health, ; Bethesda, MD USA
                [9 ]ISNI 0000 0001 0668 7884, GRID grid.5596.f, KU Leuven, ; Leuven, Belgium
                [10 ]ISNI 0000 0001 2155 0800, GRID grid.5216.0, University of Athens, ; Athens, Greece
                [11 ]ISNI 0000 0001 1034 1720, GRID grid.410711.2, University of North Carolina, ; Chapel Hill, NC USA
                [12 ]GRID grid.477249.b, Family Allergy and Asthma, ; Louisville, KY USA
                [13 ]Northwest Asthma and Allergy Center, Redmond, WA USA
                [14 ]ISNI 0000 0001 2162 3504, GRID grid.134936.a, University of Missouri School of Medicine, ; Kansas City, MO USA
                Article
                187
                10.1186/s40413-018-0187-2
                5921992
                29743965
                726117f9-dfa5-4973-b983-1737cacb2872
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 23 April 2018
                : 23 April 2018
                Categories
                Consensus Document
                Custom metadata
                © The Author(s) 2018

                Immunology
                Immunology

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