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.