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WORLD ALLERGY ORGANIZATIONWAOWhite Book on AllergyWAO White Book on Allergy
World Allergy Organization (WAO)White Book on AllergyCopyright 2011 World Allergy Organization
WAO White Book on AllergyEditorsProf. Ruby Pawankar, MD, PhDWAO President Elect (2010-2011)Allergy and RhinologyNippon Medical School1-1-5 Sendagi, Bunkyo-kuTokyo 113-8603JAPANProf. S tephen T. Holgate, BSc, MD,DSc, FMed SciMember, WAO Board of Directors (2010-2011)Medical Research Council Clinical Professor ofImmunopharmacologyInfection, Inflammation and ImmunitySchool of MedicineUniversity of SouthamptonLevel F, South BlockSouthampton General HospitalTremona RoadSouthampton SO16 6YDUnited KingdomProf. Giorgio Walter Canonica, MDWAO Past President (2010-2011)Allergy & Respiratory DiseasesDepartment of Internal MedicineUniversity of GenoaPadiglione Maragliano, Largo Rosanna Benzi 101-16132 GenoaITALYProf. Richard F. Lockey, MDWAO President (2010-2011)Division of Allergy & ImmunologyJoy McCann Culverhouse Chair in Allergy & ImmunologyUniversity of South Florida College of MedicineJames Haley Veterans Administration Medical Center (111D)13000 Bruce B. Downs BoulevardTampa, Florida 33612USAAcknowledgementOn behalf of the World Allergy Organization (WAO), the editors and authors of the WAO White Book on Allergy express theirgratitude to the charity, Asthma, Allergy, Inflammation Research (AAIR) and Asian Allergy Asthma Foundation (AAAF) for theirsupport in the production of this publication.The Editors of the White book extend their gratitude to His Excellency Dr. APJ Abdul Kalam, Former President of India and MadameIlora Finlay Baronness of the House of Lords for their Forewords to the White Book and to the International Primary Care RespiratoryGroup (IPCRG) and European Federation of Allergy and Airways Diseases Patients ‘Associations (EFA) for their supporting statements.The editors also wish to thank the many experts around the world who have contributed to the completion of this book. Boththe editors and authors also thank WAO staff members, Charu Malik and Karen Henley, for their editorial assistance, and SofiaDorsano, for her technical assistance, in preparing the White Book.ISBN-10 0615461824ISBN-13 9780615461823Copyright 2011 World Allergy Organization (WAO). All rights reserved.No part of this publication may be reproduced in any form without the written consent of the World Allergy Organization.This book is not for sale.World Allergy Organization555 East Wells StreetSuite 1100Milwaukee, Wisconsin 53202United States of AmericaPhone: 1 414 276 1791Fax: 1 414 276 3349Email: info@worldallergy.orgWebsite : www.worldallergy.orgPrinted in the United Kingdom, 2011
World Allergy Organization (WAO)White Book on AllergyEditorsRuby PawankarGiorgio Walter CanonicaStephen T. HolgateRichard F. LockeyCopyright 2011 World Allergy Organization
WAO White Book on AllergyForeword by His ExcellencyDr. APJ Abdul Kalam,Former President of IndiaAllergic diseases are increasing worldwide with unprecedentedThe White Book on Allergy is an important initiative by thecomplexity and severity. Children bear the greatest burden ofWorld Allergy Organization calling on international and nationalallergic deseases. The most common allergic conditions in childrenhealth care policy makers to address early identification ofare food allergies, eczema, and asthma. The precise causes of thissymptoms, early diagnosis and appropriate strategies toincrease in allergic diseases are not fully understood but as themanage and control allergies to avoid worsening of severenumbers of afflicted people increase, so does the research andallergic disease to people at risk and to improve practice indevelopment, and progress is being made.this clinical field of medicine for the benefit of those sufferingAllergy should be recognized as a public health problem andefforts should be made towards its prevention and optimaltreatment. To achieve this, public awareness should be increasedand efforts should be made towards proper education andfrom the consequences of allergies. I congratulate the WorldAllergy Organization for initiating this timely and much neededdocument and wish them all success in its impact andimplementation.training for more integrated and holistic approach to thediagnosis and management of allergic diseases.HE. Dr. APJ Abdul KalamFormer, President of IndiaNew Delhi, IndiaCopyright 2011 World Allergy Organization1
WAO White Book on AllergyForeword by Baroness Finlay,House of Lords, United KingdomI am delighted to have an opportunity of adding my strongestto provide education and training courses for allergy patients;support to the principles laid out in this World Allergy Organizationtheir families; school staff and employers; in how to prevent andWhite Book on Allergy. Indeed, many of the recommendationstreat allergic conditions.align with those of a recent report on Allergy Services that I wasasked to chair in 2006 for the UK House of Lords Committeeon Science Technology /ldselect/ldsctech/166/166i.pdf). The scopeof the Report encompassed an assessment of recent trendsof allergy prevalence, the social and economic burdens thatallergic disorders cause, current allergy treatments and research2) Because of the lack of knowledge of health professionals in thediagnosis and treatment of allergic diseases, we recommendedthat those responsible for medical training strengthen theinput of clinical allergy to the undergraduate and postgraduatetraining of internists and primary care physicians as well ofthose of nurses.strategies, and policies which impact upon allergy patients such3) Although high quality research into cellular and molecularas housing standards, food labelling and the work and schoolmechanisms of allergy is advancing, the factors contributingenvironments. As with the White Book, our report came at a timeto allergy development and the “allergy epidemic,” are poorlywhen the prevalence of allergic disorders in this country hasunderstood. It is imperative that further research shouldbeen claimed to have reached epidemic proportions. Althoughfocus on the environmental factors, such as early allergenit is unlikely that a cure for all forms of allergy will be found inexposure, which may contribute to the inception, preventionthe near future, we have made a number of recommendationsor exacerbation of allergic disorders. We were concerned thatwhich we believe will contribute to the prevention, treatmentthe knowledge gained from cellular and molecular researchand management of allergic disorders. Our main conclusions andin allergy was not being translated into clinical practice andrecommendations were:was identified as an area of unmet need that required greater1) There is a need for Allergy centres where specialist, highpriority.quality diagnostic and treatment services that are accessibleImmunotherapy is a valuable resource in the prophylacticto the public. Once a diagnosis is obtained and a treatmenttreatment of patients with life-threatening allergies, orplan developed at the allergy centre, the patient’s disease canwhose allergic disease does not respond to other medication.often be managed back in primary or general secondary care.Although initially expensive, immunotherapy can prevent aHowever, patients with severe or complex allergic conditionssymptomatic allergic response for many years, and may preventmay need long-term follow-up from specialists in the allergythe development of additional allergic conditions, so its widercentre.use could potentially result in significant long-term savings forAllergen immunotherapy by injection should always be carriedout by specialists within the allergy centre because of the riskof anaphylaxis. Collaboration between clinicians in primary,secondary and tertiary care is key to improving the diagnosishealth services. Full cost-benefit analyses of the potential health,social and economic value of immunotherapy treatment needsto be conducted so the case for its use and funding can bestrengthened.and management of people with allergic conditions. Once4) We recognised the appreciable impact that allergic rhinitis hasestablished, the allergy centre in each geographical regionon student performance in schools and examinations. Indeed,should encourage and co-ordinate the training of local GPswe wished to encourage health professionals to interfaceand other healthcare workers in allergy. In a “hub and spokes”more closely with schools to ensure children with allergicmodel, the allergy centre, or “hub,” would act as a central point ofdisease receive optimal care. We support the use of individualexpertise with outreach clinical services, education and trainingcare plans for children with medical needs. However, weprovided to doctors and nurses in primary and secondary care,were concerned that many teachers and support staff withinthe “spokes.” In this way, knowledge regarding the diagnosisschools are not appropriately educated in how to deal withand management of allergic conditions would be disseminatedallergic emergencies and should take urgent remedial actionthroughout the region.to improve this training where required. We were especiallyThe allergy centre should also act as a lead in providing publicinformation and advice. Specialists at the centre should work incollaboration with allergy charities, schools and local businessesconcerned about the lack of clear guidance regarding the useof autoinjectors of adrenaline on children with anaphylacticshock in the school environment.Copyright 2011 World Allergy Organization3
4Pawankar, Canonica, Holgate and Lockey5) We considered that controlled trials should be conductedadvice of appropriately trained healthcare personnel, and thatinvolving multiple interventions to examine the effect ofthe IgG food antibody test is being used to diagnose foodventilation, humidity and mite-reduction strategies on allergyintolerance in the absence of stringent scientific evidence. Wedevelopment and control. As climate change and air pollutionrecommend that further research into the relevance of IgGmay significantly impact upon the development of allergicantibodies in food intolerance together with and the necessarydisease, we supported greater effort to take account of thecontrolled clinical trials should be conducted.interlinkages between air quality, climate change and humanhealth.Although my task was to direct our activity to issues relevantto allergy as occurs in the United Kingdom, nevertheless, it is6) Vague defensive warnings on food product labels forremarkable how closely our recommendations from the Houseconsumers with food allergy can lead to dangerous confusionof Lords Report that I chaired resonate with those of the Allergyand an unnecessary restriction of choice. We recommendWhite Book. Following the presentation of our Report to the UKthat the responsible government agencies should ensure theGovernment, I was asked to establish an Implementation Groupneeds of food-allergic consumers are clearly recognised duringby the Royal Colleges of Physicians and Pathologists (http://any review of food labelling legislation. Many teenagers andbookshop.rcplondon.ac.uk/details.aspx?e 317). I would likeyoung adults with food allergies sometimes take dangerouslyto suggest that following the launch of the Allergy White Bookhigh risks when buying food. We considered that the relevantby the WAO, implementation groups are established in eachgovernment agencies, charities and other stakeholders shouldcountry and by the WAO as a whole to monitor uptake of theexplore novel ways to educate young people about allergy andrecommendations and their impact, to improve practice for thethe prevention of anaphylaxis.benefit of patients with allergy.As sensitivities to various allergens vary widely, the setting ofI wish to use this opportunity to congratulate the WAO forstandardised threshold levels for package labelling is potentiallyinitiating this timely Report, all those who have contributed to itsdangerous for consumers with allergies. Instead, we consideredcontent and especially those in different countries whose allergythat food labels should clearly specify the amount of each allergen,societies have contributed their own experiences. I wish youand if it is contained within the products, we wish to discourageevery success in its impact and uptake.vague defensive warnings. The phrases “hypoallergenic” andBaroness Ilora FinlayHouse of LordsWestminsterLondon, UK“dermatologically tested” are almost meaningless, as they onlydemonstrate a low potential for the products to be a topicalirritant. Such products should warn those with a tendency toallergy that they may still get a marked reaction to such products.8) In various parts of the world, traditional and complementarymedical interventions for treating allergic disease are availableand frequently accessed by the public, but the evidence basefor this is poor. We recommend that robust research into the useof complementary diagnostic tests and treatments for allergyshould examine the holistic needs of the patient, assessing notonly the clinical improvement of allergy symptoms, but alsoanalysing the impact of these methods upon patient wellbeing. Such trials should have clear hypotheses, validatedoutcome measures, and risk-benefit and cost-effectivenesscomparisons made with conventional treatments.9) We were also concerned that the results of allergy self-testingkits available to the public are being interpreted without theCopyright 2011 World Allergy Organization
WAO White Book on AllergySupporting Statement by theInternational Primary CareRespiratory GroupAuthorsDermot Ryan: General Practitioner, Woodbrook MedicalCenter, Loughborough, LE11 1NH, UK.Osman Yusuf: Director (Research) IPCRG; Chief Consultant,The Allergy & Asthma Institute, Pakistan.Marianne Stubbe Ostergaard: Associate Professor of.General Practice, University of Copenhagen, Blegdamsvej 3;DK-2200 N, Copenhagen, DenmarkMiguel Román-Rodríguez: President IPCRG: Son PisaPrimary Care Centre. IB-Salut Family Medicine Training Unit,Mallorca, Baleares, SpainAbout the InternationalPrimary Care RespiratoryGroup (www.theipcrg.org)The IPCRG provides a forum for its constituent national groupsencompassing different health systems models and socioeconomic status ranging from those that have a completehealth care system to those where the state plays little partin the provision of health care. It represents internationalprimary care perspectives in respiratory medicine trying to raisestandards of care in individual countries and globally, throughcollaborative research, innovation and dissemination of bestpractice and education. It co-publishes with the UK PrimaryCare Respiratory Society (PCRS) the Primary Care RespiratoryJournal http://www.thepcrj.org/, a free online, Medline listedjournal.The primary care perspectiveon respiratory allergiesIntroductionAlthough there are differences among countries, theincidence and prevalence of asthma and rhinitis isincreasing worldwide. These differences in some countriescould be due to underreporting or a lack of awarenessof these diseases in deference to more important socioeconomic medical problems. However, in general,patients with asthma are inadequately managed andasthma and rhinitis are both under-recognized1 for theirimpact on the health and decreased quality of life of thoseafflicted. In addition, studies to assess prevalence andcare delivery show that there is a large variation amongcountries in the delivery of care to those suffering fromasthma and allergy2. What is common among severalcountries, however, is that the majority of patients whoseek medical advice for allergy and asthma are seeninitially in primary care3 because there are inadequatenumbers of trained allergists to meet the needs of somany patients4.The most common reasons for presentation to primary careare respiratory symptoms, encompassing both acute infectionsand long-term conditions such as asthma, rhinitis, and chronicobstructive pulmonary disease (COPD). Asthma and asthmaattacks are often triggered by allergies. It is, therefore, importantthat primary care physicians also assess the allergic triggers ofThe IPCRG is an associate member of WAO with whichthese diseases. However, proper diagnosis and treatment fororganization it has many areas of overlap given the allergicallergy and asthma are limited by the inadequate state of allergyetiology of many common respiratory disorders.knowledge within primary care. (The WAO estimate of allergyprevalence of the whole population by country ranges between10 - 40%).III Allergy training at the undergraduate level is almostnon-existent in several countries, paired with little exposure topost-graduate allergy training except for physicians pursuing acareer in allergy. It is not surprising that allergists obtain superioroutcomes with asthma sufferers compared to the primary carephysicians who see the majority of the patients.Copyright 2011 World Allergy Organization5
6Pawankar, Canonica, Holgate and LockeyUnmet Needs 2. GPs with a special interest: A further possibility is toManagement of Allergy: The limited data availablecreate a cohort of General Practitioners with a specialsuggest that a structured approach to care delivery hasinterest in allergy with the joint task of developing anda positive impact on outcomes, and at reduced costs. Aproviding a clinical service in primary care at the samesystematic approach to disease management has beentime as raising skills within their community9. To date thereundertaken in Finland in the area of asthma which hasis only one recorded incidence of this innovative proposaldelivered decreased morbidity, mortality and, of particularhaving reached fruition, but it was a success.10interest to governments worldwide, decreased costs,3. Guidelines in Allergy: Regularly produced and updatedboth direct and indirect. This program is being furtherinternational and national allergic respiratory diseasesdeveloped to reduce the impact of allergic disease.5 Theguidelines will help to promote high quality care in primaryUnited Kingdom Royal College of Physicians publishedcare, Primary Care physicians need to be appropriatelya document, “Allergy the Unmet Need” in 20036 whichrepresented on these guideline committees to ensure thatprovides descriptions of prevalence of allergic diseasethey are grounded in what is realistic and achievable.as well as current service delivery and training needspertaining to allergy care. This study may be used as aReferences1. Bauchau V, Durham SR. Prevalence and rate of diagnosis of allergicrhinitis in Europe. Eur Respir J. 2004 Nov;24(5):758-64.2. abe KF, Adachi M, Lai CK, Soriano JB, Vermeire PA, Weiss KB, WeissRST Worldwide severity and control of asthma in children and adults:the global asthma insights and reality surveys. J Allergy Clin Immunol.2004 Jul;114(1):40-73.Ryan D, van Weel C, Bousquet J, Toskala E, Ahlstedt S, Palkonen S,van den Nieuwenhof L, Zuberbier T, Wickman M, Fokkens W. Primarycare: the cornerstone of diagnosis of allergic rhinitis. Allergy. 2008Aug;63(8):981-9.4. nrico Compalati, Martin Penagos, Henley Karen, G. Walter Canonica.EPrevalence Survey by the World Allergy Organization. Allergy ClinImmunol Int: J World Allergy Org, vol. 19, no. 3, pp. 82-905.Haahtela T, von Hertzen L, Mäkelä M, Hannuksela M; AllergyProgramme Working Group. Finnish Allergy Programme 2008-2018-time to act and change the course. Allergy. 2008 Jun;63(6):634-45.document detailing the needs for developed and LMIC.76.‘Allergy: The Unmet Need’ – a blueprint for better patient care’ RoyalCollege of Physicians 2003.Awareness of allergic problems: Governments globally7. innock H, Thomas M, Tsiligianni I et al. The International Primary CarePResearch Group Research Needs Statement 2010. PCRJ June 2010,19, Supple 1, pp 1-20)8.Potter PC, Warner JO, Pawankar RS, Kaliner MA, Del GiaccoA, Rosenwasser L, for the WAO Specialty and Training Council.Recommendations for Competency in Allergy Training forUndergraduates Qualifying as Medical Practitioners: A WorldAllergy Organization Position Paper. World Allergy Organization J.2009;2(8):150-189).9.Ryan D, Levy M, Morris A, Sheikh A, Walker S. Management of allergicproblems in primary care: time for a rethink? Prim Care Respir J. 2005Aug;14(4):195-203. Epub 2005 Jul 11)model of assessment by countries wishing to adopt astructured approach to care delivery or similar solutionsfor optimal patient care. These solutions, of course, needto be country-specific and will depend on national healthcare delivery systems. Research in Allergy: Extensive research is needed at thePrimary Care level for the diagnosis, prevention, treatmentand management of all types of respiratory and relatedallergies in both developed and developing / low andmiddle income countries (LMIC). The International PrimaryCare Respiratory Group (www.theipcrg.org) focuses onsuch research needs, and has produced a comprehensive need to be made aware of the morbidity currently causedby respiratory and allergic disorders and associated costs.Some of these costs may as yet be poorly quantified,particularly the costs of presenteeism (when someoneis present at work but with reduced productivity due toa disease or the treatment for that disease), as well asabsenteeism. With the proper awareness of the scopeof the problem, governments need to ensure that thetraining, skills and infrastructure exist with which todevelop and provide effective and efficient care delivery.10. Levy ML, Walker S, Woods A, Sheikh A. Service evaluation of a UKprimary care-based allergy clinic: quality improvement report. PrimCare Resp J. 2009;18:313–319.1. Training in Allergy: The WAO has led the way indescribing the minimum allergy curriculum requirements atthe undergraduate level8. Introducing a structured allergycurriculum into undergraduate training may, of course,take several years to make a significant impact. However,given that allergy is so prevalent, allergy training in someform, even modular, should be considered an essentialpart of general professional training for all physicians.Copyright 2011 World Allergy Organization
WAO White Book on AllergySupporting Statement by EFAfor WAO White Book on AllergyEFA identifies low public awareness of allergies as serious chronicdiseases as major issue. Therefore EFA developed a four-yearawareness program calling on the media to report the alarmingfacts of allergies with the aim to raise awareness of respiratory,skin and food allergies as well as anaphylaxis as serious chronicdiseases. EFA is also calling on international and national healthcare policy makers to address early identification of symptoms,early diagnosis and appropriate strategies to manage and controlThe European Federation of Allergy and Airways DiseasesPatients’ Associations (EFA) congratulates the World AllergyOrganization (WAO) for leading the effort in developingthis first global WHITE BOOK on Allergy, since it brings thediscussion about allergy back in Europe to the public mindand highlights the negative impact on the quality of lifeof people with allergies and the huge burden on nationaleconomic systems!allergies to avoid exacerbations of severe allergies to people atrisk, primary care physicians, paediatricians, and pharmacists.With these activities EFA wants to support the outstanding workof WAO and wishes the WAO WHITE BOOK as much resonance aspossible as it will be important to achieve our aims as well.While allergy does not enjoy the same level of public andgovernmental attention as other chronic diseases like canceror cardiovascular diseases, it is certainly the most pervasivedisorder globally. Allergic conditions pose a major public healthMarianella Salapatas,EFA Presidentproblem, as it is documented in this WAO WHITE BOOK andpublications of other leading bodies. They respect no nationalfrontiers. One major risk is that allergic diseases often are notperceived as serious chronic diseases and therefore are notdiagnosed early enough and not treated consequently. Dueto this underestimation the global community often ignoresallergy and does not act appropriately, even if the increase inAntje-H. Fink-Wagner,EFA Project & Fundraising Officerglobal prevalence is such that between 20-30% of the world spopulation suffers from some form of allergic disease.In Europe, one in four children is allergic and it is documentedthat 87 million people suffer from allergies. 40% of patients withallergic rhinitis have asthma and up to 80-90% of asthmatics havealso allergic rhinitis. This one airway concept needs to be betterunderstood by the lay public since allergic rhinitis and asthmagreatly impact the daily life of patients and their families, as wellas their performance at school, work or social activities.Taking into consideration the rising prevalence of allergies,EFA decided in 2009 to go global. EFA built the Global Allergyand Asthma Patient Platform (GAAPP). During the WorldAllergy Congress 2009 ( the official congress of WAO) GAAPPannounced the “Declaration of Buenos Aires” on the rights andresponsibilities of people with allergies, signed and supported bypatient organisations and patient supporters around the world.Copyright 2011 World Allergy Organization7
WAO White Book on AllergyTable of ContentsIntroduction and Executive Summary11Establishing the need to treat Allergic Diseases as a Global Public Health issueRuby Pawankar, Giorgio Walter Canonica, Stephen T. Holgate, Richard F. LockeyWAO Declaration of Recommendations21How to Address Allergic Diseases as a Global Public Health IssueRuby Pawankar, Giorgio Walter Canonica, Stephen T. Holgate, Richard F. LockeyChapter 1. The Practice of Allergology23Authors: Michael A Kaliner, Sergio Del GiaccoChapter 2. The Burden of Allergic Diseases272.127Rhinitis, Conjunctivitis, and RhinosinusitisRuby Pawankar, Mario Sanchez-Borges, Sergio Bonini, Michael A. Kaliner2.234Asthma Stephen T. Holgate, Giorgio Walter Canonica, Carlos E. Baena-Cagnani,Thomas Casale, Myron Zitt, Harold Nelson, Pakit Vichyanond2.3Atopic Eczema and Contact Dermatitis39Thomas Bieber, Donald Leung, Juan-Carlos Ivancevich, Yehia El Gamal2.443AnaphylaxisRichard F Lockey, Stephen Kemp, F.Estelle R Simons, Philip Lieberman, Aziz Sheikh2.547Food AllergyAlessandro Fiocchi, Hugh A. Sampson, Sami L. Bahna, Gideon Lack2.653Urticaria and AngioedemaTorsten Zuberbier, Carsten Bindslev Jensen, Allen P. Kaplan2.757Allergy to Drugs and BiologicsMarek L. Kowalski, Pascal Demoly, Werner Pichler, Mario Sanchez- Borges2.862Insect allergyMarek Jutel, Takeshi Fukuda, Anthony Frew, Patrizia Bonadonna, Richard F Lockey2.965Occupational AllergyOlivier Vandenplas, Margitta Worm, Paul Cullinan, Hae-Sim Park, Roy Gerth van Wijk702.10 Sports and AllergiesSergio Bonini, Kai-Håkon Carlsen, Sergio Del Giacco, William W StormsChapter 3. Risk Factors for Allergic Disease753.175Genetic aspectsJohn Holloway, Ian Yang, Lanny J. Rosenwasser, Stephen T. Holgate3.279AllergensThomas A. E. Platts-Mills, Bee Wah Lee, Karla Arruda, Fook Tim Chew3.3Environmental risk factors: indoor and outdoor pollution84Sara Maio, Sonia Cerrai, Marzia Simoni, Giuseppe Sarno, Sandra Baldacci, Giovanni Viegi3.4Socio-economic factors and environmental injustice91Rosalind J Wright, Michelle J Sternthal3.595Climate Change and MigrationGennaro D’Amato, Menachem RottemCopyright 2011 World Allergy Organization9
10Pawankar, Canonica, Holgate and LockeyChapter 4. Evidence Based Approachesto Diagnosis and Management4.1Diagnosis and identification of causative allergens101101Mario Sanchez Borges, Juan-Carlos Ivancevich, Noel Rodriguez Perez, Ignacio Ansotegui4.2106PharmacologicalCarlos E Baena-Cagnani, Héctor Badellino4.3110ImmunotherapyGiovanni Passalacqua, Dennis K. Ledford, Linda Cox, Paul Potter, Giorgio Walter Canonica4.4116BiologicalsVesselin Dimov, Jeffrey R Stokes, Thomas B Casale, Stephen T. Holgate4.5123Patient EducationJohn O.Warner, Erkka Valovirta4.6127Allergen AvoidanceAdnan Custovic, Roy Gerth Van WijkChapter 5. Prevention of Allergic Diseases133Tari Haahtela, Leena Von Hertzen, Adnan CustovicChapter 6. Health Care, Health Economicsand Medical Education in Allergy6.1139139Health Care, Health EconomicsJay Portnoy, Martyn Partridge6.2142Medical Education in AllergyPaul Potter, John O Warner, Ruby Pawankar, Jill A.Warner, Paul Van Cauwenberge, Michael A. Kaliner6.3Cost Effectiveness of consulting an allergist147Jose Gereda, Paul Potter, Sergio Del Giacco, Michael A KalinerMember Society Survey Report153Author Affiliations209Copyright 2011 World Allergy Organization
WAO White Book on Allergy11Allergic Diseases as a GlobalPublic Health IssueR. Pawankar, GW Canonica, ST.Holgate, RF Lockeytheir ailments. In some countries, patients are repeatedly toldthat priorities for diagnosis and treatment of allergic diseaseare determined at the local governmental level, i.e., by “PrimaryCare Trusts”. However, if representatives at this local level do notunderstand the prevalence and significance of allergic diseasesand their complications, what hope is there for them to chooseIntroductionINTRODUCTION ANDEXECUTIVESUMMARYIntroduction and Executive SummaryThe prevalence of allergic diseases worldwide is risingdramatically in both developed and developing countries.These diseases include asthma; rhinitis; anaphylaxis;drug, food, and insect allergy; eczema; and urticaria (hives)and angioedema. This increase is especially problematicin children, who are bearing the greatest burden of therising trend which has occurred over the last two decades.In spite of this increase, even in the developedworld, services for patients with allergic diseases arefragmented and far from ideal. Very few countries havecomprehensive services in this field of medicine.important for a well-trained physician to identify the allergensThere ar
Division of Allergy & Immunology Joy McCann Culverhouse Chair in Allergy & Immunology University of South Florida College of Medicine James Haley Veterans Administration Medical Center (111D
