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Allergic diseases epidemiology, cost of diseases and quality of life


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Presented at the Allergy Prevention Round Table Discussion, Surabaya 15 June 2013.

Presented at the Allergy Prevention Round Table Discussion, Surabaya 15 June 2013.

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  • 1. Allergic diseases: epidemiology,cost of diseases and quality of life.Prof DR Dr Ariyanto Harsono SpA(K) 1
  • 2. Introduction• Epidemiological studies indicate a world-wideand significant increase in atopic diseases overthe past decades, which has adopted alarmingdimensions within the industrialized world.However, allergic asthma and pollinosis, inparticular, are on the increase in Third worldcountries, in parallel to the industrialization andwesternization of their life-style. Since bothantigen exposure and the presence of additionalrealization factors are required for themanifestation of atopic diseases, this increase inprevalence is not surprising.2Prof DR Dr Ariyanto Harsono SpA(K)
  • 3. In addition to increased indoor and outdoor pollution,changes in the way of living--causing increased allergenexposure--certainly play an important role as cofactorin the increased incidence of allergies. Accuratediagnostic procedures permit a better understanding ofthe realization factors for allergic diseases inepidemiological studies and identification of thecausative agent in the individual so that effectivetherapeutic and prophylactic steps can be taken.Introduction…….3Prof DR Dr Ariyanto Harsono SpA(K)
  • 4. GENETICFACTOR•ALLERGEN•INFECTION• POLUTANTENVIRONMENTFACTORALLERGIC DISEASESGern JE, Lemanske Jr RF. Immunol Allergy North Amer 1999; 19:233-524Prof DR Dr Ariyanto Harsono SpA(K)
  • 5. Introduction…….• Epidemiological information from Switzerland andJapan shows that the prevalence of atopy is increasingin children. In both these studies the increase in theprevalence of atopy was due to an increase insensitisation to a variety of allergens and notdominated by an increase in sensitisation to oneparticular allergen. In Britain no evidence exists thatexposure to allergen has increased—in fact grasspollen levels have steadily decreased over the past 20years and pet ownership has probably not changed.5Prof DR Dr Ariyanto Harsono SpA(K)
  • 6. Epidemiology6Prof DR Dr Ariyanto Harsono SpA(K)
  • 7. 7Prof DR Dr Ariyanto Harsono SpA(K)
  • 8. 8
  • 9. 9Prof DR Dr Ariyanto Harsono SpA(K)
  • 10. 10Prof DR Dr Ariyanto Harsono SpA(K)
  • 11. 11Prof DR Dr Ariyanto Harsono SpA(K)
  • 12. Prof DR Dr Ariyanto Harsono SpA(K) 12Annual changes in prevalence of asthma in ISAACphase I and phase III in Europe
  • 13. Prof DR Dr Ariyanto Harsono SpA(K) 13Annual changes in prevalence of allergicrhinoconjunctivitis in ISAAC phase I and phase III inEurope
  • 14. Food AllergyProf DR Dr Ariyanto Harsono SpA(K) 14 Affect 200-250 millionglobally CDC: 1998-2000 to 2007-2009, food allergy increasedfrom 3.5% to 4.6% cases Food hypersensitivity is themost cases found in the earlyyears of life, affecting about6% of <3 years of age anddecreasing over the firstdecade
  • 15. Asthma Morbidity@MortalityBraman SS: Chest 2006;130;4S-12S15Prof DR Dr Ariyanto Harsono SpA(K)
  • 16. Prevalence of food allergyFood Self report Skin prick test/IgEspecific/food challengeMilk 3.5%(95%CI,2.9%-4.1%)0.6% to 0.9%Egg 1.3%(95% CI, 1.0%-1.6%)0.3% to 0.9%Peanuts 0.75%(95%CI, 0.6%-0.9%)0.75%Fish 0.6%(95% CI, 0.5% 0.7%)0.2%Shellfish 1.1%(95% CI, 1.0%-1.2%)0.6%Chafen JJS, et al. JAMA. 2010;303(18):1848-56.16Prof DR Dr Ariyanto Harsono SpA(K)
  • 17. Atopic dermatitis• Atopic dermatitis affects 5-20% of children atages 6-7 months and 13-14 years• AD increased lifetime prevalence in Africa,Eastern Asia, Western and Nothern part ofEurope• Female : Male = 1.3 : 1Williams H, et al. J Allergy Clin Immunol, January 1999Deckers IAG, et al. Investigating International Time Trends in the Incidence and Prevalence of AtopicEczema 1990–2010: A Systematic Review of Epidemiological Studies17Prof DR Dr Ariyanto Harsono SpA(K)
  • 18. Urticaria & AngioedemaAngioedema:• Angioedema frequently associated withurticaria but 10% occurs alone• Prevalence angioedema in chillhood was 2-5%Urticaria :• Prevalence of urticaria in the first 3 years oflife was 3.2% & 1% at 5 years of ageCantani A. Pediatric Allergy, Asthma & Immunology. Springerlink. Berlin.2008. 38018Prof DR Dr Ariyanto Harsono SpA(K)
  • 19. Prevalence of allergy in children (cross sectional)6.9%9.0%4.9%8.9%14.2%3.9%13.9%12.3%24.6%0%5%10%15%20%25%Jakarta Pusat (1990) ISAAC Jakarta Timur(2001)EAAEL Jakarta (2006)Asma Rinitis alergi Dermatitis atopiAsthma Allergic Rhinitis AtopicDermatitisMunasir Z, et al19Prof DR Dr Ariyanto Harsono SpA(K)
  • 20. Asthma Fatality RateChest 2006;130;4S-12S20Prof DR Dr Ariyanto Harsono SpA(K)
  • 21. Burden of Allergic Diseases• The World Allergy Organization presenteddata this week on the marked global increaseof allergic diseases, highlighting that allergiesare becoming more severe and complex andthat the heaviest burden is on children andyoung adults. Allergy interacts with manyother environmental factors such aspollutants, infections, lifestyle, and diet thatincrease the impact on chronic disease.21Prof DR Dr Ariyanto Harsono SpA(K)
  • 22. • WAO addressed the need for increaseddisease awareness, improved patient care,better healthcare delivery and a focus onpreventative strategies during internationalpress conference.22Prof DR Dr Ariyanto Harsono SpA(K)
  • 23. …burden of allergic diseaseEconomic burden:• Drug prescription• Consultation tophysician• Hospital admission• Indirect costs23Prof DR Dr Ariyanto Harsono SpA(K)
  • 24. …burden of allergic diseaseParental reports of the most bothersome nasalallergy symptoms.24Prof DR Dr Ariyanto Harsono SpA(K)
  • 25. Component of financial burden of allergic diseasesDIRECT COST INDIRECT COSTPhysician office visitsLaboratory testsMedicationImmunotherapyTreatment of co-morbiditiesAbsenteeismDecreased productivity atwork/schoolSleeping disordersImpaired quality of life for patients and parents/familyPawankar R, et al. WAO White Book on Allergy 201125Prof DR Dr Ariyanto Harsono SpA(K)
  • 26. Approximately 30 to 40 percent of the world’spopulation suffers from allergic diseases, and theprevalence is escalating to epidemic proportions.According to the World Health Organization (WHO):o An estimated 300 million individuals have asthmaworldwide, a figure that could increase to 400 millionby 2025 if trends continue.o Allergic rhinitis, which is a risk factor for asthma,affects 400 million people annually, ando Food allergies affect about 200 to 250 million.o An estimated 250,000 avoidable deaths from asthmaoccur each year. Chest 2006;130;4S-12S26Prof DR Dr Ariyanto Harsono SpA(K)
  • 27. Asthma is a significant expense for society andhealthcare systemsAs prevalence increases, so do costs. The total costs of asthma in the US are estimated to have increasedbetween the mid 1980s and the mid 1990s from approximatelyUS$4.5 billion to over US$10 billion. Weiss and colleagues estimated the total asthma costs for Australia,the UK and the US (adjusted to 1991 US dollars for comparisonpurposes) at US$457 million, US$1.79 billion and US$6.40 billion,respectively. Updating these figures to 2003 dollars using the Consumer PriceIndex (CPI) yields approximately US$617 million, US$2.42 billion andUS$8.64 billion, respectively. Total cost of asthma in the US in 1998 was estimated at US$12.67billion (based on 1994 actual costs adjusted to 1998 dollars usingthe CPI); the adjusted cost (using the CPI) projected to 2003 wouldbe US$13.34 billion. 27Prof DR Dr Ariyanto Harsono SpA(K)
  • 28. Globally, the economic costs associated with asthmaexceed those of tuberculosis and HIV/AIDS combined.Developed economies can expect to spend 1 to 2% of their health-carebudget on asthma. Investigations have shown22 that the financial burden on patientswith asthma in different Western countries ranges from $300 to$1,300 per patient per year. In the United States, the total direct medical and indirect economiccosts (ie, loss of school or work days, lost productivity, prematureretirement) of asthma were approximately $12 billion in 1994,representing an increase of 50% from just 10 years before, mainlybecause of an increase in indirect economic costs. The indirect costs represent not just costs relating to the patientbut, if the patient is a child, also to their family; in England, 69% ofparents or partners of parents of asthmatic children reportedhaving to take time off work because of their child’s asthma, and13% had lost their jobs.28Prof DR Dr Ariyanto Harsono SpA(K)
  • 29. Barriers to Reducing the Burden ofAsthma Poverty; inadequate resources Low public health priority Poor health-care infrastructure Difficulties in implementing guidelines developed inwealthier countries Limited availability of and access to medication Lack of patient education Environmental factors Tobacco Pollution Occupational exposure Poor patient complianceChest 2006;130;4S-12S29Prof DR Dr Ariyanto Harsono SpA(K)
  • 30. As the prevalence of allergic disease rises in countriesaround the world regardless of their economic status, sodo the socioeconomic costs both direct:interference with breathing during day or night,emergency department visits,hospitalizationsand indirectreduced quality of life,reduced work productivity andabsenteeism.30Prof DR Dr Ariyanto Harsono SpA(K)
  • 31. WAO recommends (1) increased, availability and accessibility to allergydiagnosis and therapies (2) increased resources dedicated to advanced researchtoward preventive strategies to increase tolerance toallergens and slow disease progression and (3) global partnerships of multi-disciplinary teams, involvingclinicians, academia, patient representatives, and industry.The common goal is to reduce the burden of allergic diseasesand develop cost-effective, innovative preventive strategiesand a more integrated, holistic approach to treatment.These efforts can thereby prevent premature andunwanted deaths and improve quality of life.31Prof DR Dr Ariyanto Harsono SpA(K)
  • 32. Health-Related Quality of Life An important predictor of low Health Related Quality of Life (HRQL)was allergic disease (i.e. asthma, eczema, rhino conjunctivitis) inaddition to food hypersensitivity. The higher the number of allergic diseases, the lower the physicalHRQL for the child, the lower the parental HRQL and the moredisruption in family activities. Male gender predicted lower physical HRQL than female gender. Ifthe child had sibling(s) with food hypersensitivity this predictedlower psychosocial HRQL for the child and lower parental HRQL. Food-induced gastro-intestinal symptoms predicted lower parentalHRQL food-induced breathing difficulties predicted higher psychosocialHRQL for the child and enhanced HRQL with regards to the familysability to get along.32Prof DR Dr Ariyanto Harsono SpA(K)
  • 33. • The variance in the childs physical HRQL was to aconsiderable extent explained by the presence ofallergic disease. However, food hypersensitivityby itself was associated with deterioration ofchilds psychosocial HRQL, regardless ofadditional allergic disease. The results suggestthat it is rather the risk of food reactions andmeasures to avoid them that are associated withlower HRQL than the clinical reactivity induced byfood intake. Therefore, food hypersensitivitymust be considered to have a strong psychosocialimpact.33Prof DR Dr Ariyanto Harsono SpA(K)
  • 34. Asthma is a chronic disorder that can significantlyimpact the quality of life of the affected patients andtheir families. Uncontrolled or poorly controlledasthma can:• disturb sleep;• increase fatigue and decrease energy;• produce difficulty concentrating;• restrict physical activity and exercise;• cause absences from work and/or school; and• reduce participation in normal daily activities34Prof DR Dr Ariyanto Harsono SpA(K)
  • 35. A total of 232 patients with allergic rhinitis, 40 with asthma, and44 with both diseases were enrolled. The mean (SD) age was 32(13) years and 65% were females.HRQL was significantly lower in patients withasthma, with or without rhinitis, than in thosewith allergic rhinitis alone.• Female sex,• Older age,• Increased BMI and• Less educational statuswere found to be the major determinants ofimpaired quality of life in patients with allergicrhinitis or asthma.Internat. Arch. Allergy Immunol. (2003);130: pp. 2–9.35Prof DR Dr Ariyanto Harsono SpA(K)
  • 36. 36
  • 37. Figure. Mean (SD) physical component summary (PCS) and mentalcomponent summary (MCS) health related quality of life scores in the3 study groups.J Investig Allergol Clin Immunol 2008; Vol. 18(3): 168-173Rinitis AlergikaasmaAsma+rinitisPCS MCS37
  • 38. quality of life was significantly impaired in patients withasthma with or without rhinitis than in those with allergicrhinitis only. However the results of our study suggest thatthe impairment in HRQOL seen in asthmatic patients maybe similar to or not greater than that experienced by thepatients with “one airway disease.” The majordeterminants of impaired HRQOL are female sex, higher BMI, and older age as a reflection of the duration of the disease.Further investigation with larger populations is needed inorder to determine the extent to which asthma and rhinitiscomorbidities are associated in HRQOL.J Investig Allergol Clin Immunol 2008; Vol. 18(3): 168-17338Prof DR Dr Ariyanto Harsono SpA(K)
  • 39. Conclusions• Prevalence of allergic diseases areincreasing• Burden of the diseases includes symptomburden, impaired quality of life andproductivity, co-morbidities, complications,and disease management (economicburden)• Allergy prevention is highly needed39Prof DR Dr Ariyanto Harsono SpA(K)
  • 40. Thank You40Prof DR Dr Ariyanto Harsono SpA(K)