Allergy Asthma and One Health „The size of the problem“


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GRF 2nd One Health Summit 2013: Presentation by Cezmi A. Akdis, Swiss Institute of Allergy and Asthma Research (SIAF)

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Allergy Asthma and One Health „The size of the problem“

  1. 1. Allergy Asthma and One Health „Thesize of theproblem“ Cezmi A. Akdis Swiss Institute of Allergy and Asthma Research (SIAF)
  2. 2. Allergies and Asthma 1’500’000’000 patients 300’000’000 asthma 250’000 deaths from asthma per year 10 % of all patients have severe disease 15 times more likely to use emergency services Utilize 60% of the health costs
  3. 3. TheAllergy-Epidemic 40 Prevalence allergen-specific IgE 30 rhinitis atopic dermatitis 20 asthma 10 0 1900 1940 1960 1980 2000
  4. 4. Proportional Increase in Incidence (%) EpidemicIncrease in Immune Regulation RelatedDiseases Type 1 Diabetes 400 Asthma Rhinitis IBD (Crohn) 300 Anaphylaxis in preschool children Lupus Multiple Sclerosis 200 100 1920 1960 1980 2000
  5. 5. JEAN-FRANÇOIS BACH New England Journal of Medicine September 2002
  6. 6. Increased prevalence of chronic noncommunicable disorders including allergy and asthma with westernized life style. The reduced exposure to diverse microbioma and physical inactivity may impair immune regulatory mechanisms and immune tolerance to environment.
  7. 7. leaky barrier breaking of tolerance infections and microbiome exposome life style genes mechanisms of being clinically healthy despite allergen sensitization Healthy Allergic molecular events in the facit circle of chronicity and severity diet infections microbiome induction of tolerance strengthening of barriers control of exposome education T. Bieber, R. Lauener, P-S Grendelmeier, C-T Hoffmann, C.A. Akdis
  8. 8. Risk factors for asthma exacerbations
  9. 9. Whatwouldbethe optimal strategy to prevent
  10. 10. Barriers Related to Research Grants-I • Lack of political awareness and low understanding and priority setting for allergyepidemics • Curative approaches and research for prevention have not been efficientlysupportedso far • Small quantities of grants have been given to hypothesis-based research, although the real need is large scale, non hypothesis based, in dept research, which is now possible with the novel developments in next generation DNA and RNA sequencing, exposome analysis, and epigenetic analysis
  11. 11. Barriers Related to Research Grants-II • Human research is receiving relatively less funding in many grant giving bodies compared to animal models • Many major grant giving bodies had to decrease their budgets during the last yearsbecauseofgeneralfinancialproblems • Negative results that are not published are being repeated
  12. 12. Global Vision and Roadmap I •Allergy and Asthma epidemic affects more than 1.5 billion patients with a global rise in prevalence, as the most common chronic childhood disease and highest health-care costs •Effective policies and strategy development are needed to fill this gap at the global, regional and national level •Efforts to overcome unmet needs should focus on 4 main directions Research and development Better patient care at the global level Increased public awareness Allergies and Asthma in political agenda
  13. 13. Global Vision and Roadmap II •A “Global Allergy and Asthma Fight Strategy” should be developed •All stakeholders, such as specialists, primary care physicians, nurses, dieticians, psychologists, pharmacists, patient organizations, educators, industry, and policy makers should be involved •A multidisciplinary and scientific approach should be used •“One Health”concept that suggests systemic interconnections between human, environment, animal health and food and water safetyshould be integrated •Next generation guidelines should be developed •A World Allergy and Asthma integrated surveillance network should be established •Existing know-how from successful approaches in the past should be utilized and implemented
  14. 14. WIRM VIII 19-22 March 2014
  15. 15. 18
  16. 16. The One Health Science Environment Immune Regulation Infections
  17. 17. environmental risk factors for asthma
  18. 18. Global Unmet Needs in Allergies and Asthma •Pathomechanisms of allergic diseases are still not fully known •There is a global burden of access to drugs and good patient care in underdeveloped regions •There is no established way of prevention of allergies •There is no established way of curative treatment •Biomarkers to subgroup patients, predict outcomes and follow therapy response are needed •Vaccine development against viruses that trigger exacerbations should be supported •Patient-tailored treatment should be strongly implemented •Next generation global guidelines that consider individual needs, regional differences and disease subgroups are needed •A worldwide registry and regional biobanks for allergy and asthma are needed
  19. 19. Development of Allergic Diseases in Children