therapy are not well-defined. WAO White Book on Allergy 1 9 Copyright 2011 World Allergy Organization Allergy Education for Patients and Families • The provision of appropriate training and education for patients and families is fundamental to the management of allergic disease. • The evidence base for the efficacy of education and training is relatively weak but it is effective in asthma and, to a lesser extent, eczema and anaphylaxis. • Different age and ethnicity populations require different educational approaches. • Modern information technology is valuable, especially to educate younger subjects. • Education and training programs should contain a written self management action plan. Allergen Avoidance • Effective allergen avoidance leads to an improvement of symptoms in allergic patients. • Several studies of comprehensive environmental interventions in asthmatic children report benefits. • There is little evidence to support the use of a simple single intervention, e.g., only covering bedding, to control dust mite allergen levels. • Similarly, in mite allergic patients with rhinitis, single mite avoidance measures are not beneficial. • The following is a guide for a pragmatic approach to allergen avoidance: – Use a comprehensive environmental intervention to achieve the greatest possible reduction in allergen exposure; – Tailor the intervention to the patient’s allergen sensitization and exposure status; – If unable to assess the level of allergen exposure, use the level of allergen-specific IgE antibodies or the size of skin test wheal as an indicator; – Start the intervention as early as possible in the natural course of the disease; – Primary prevention strategies aimed at eliminating or reducing exposure to potentially sensitizing agents should be developed and evaluated. 4. PREVENTION OF ALLERGIC DISEASES • The rise in prevalence of allergic diseases has continued in the industrialized world for more than 50 years. • Sensitization rates to one or more common allergens among school children are currently approaching 40%-50%. • Strategies used to tackle these problems are thus far ineffective. • Primary prevention is difficult because the reasons for increased sensitization rates are unknown. Also, the mechanisms involved in the progression of sensitization in increasing numbers of individuals resulting in allergic diseases are incompletely understood. Asthma and allergies may have their origin early in life, even in-utero. • Reliable early markers of IgE-mediated diseases are unavailable. • Novel research indicates that tolerance is the key to prevention. More research about the mechanisms involved in the development of tolerance should be encouraged. Inadequate or lack of tolerance in allergic individuals appears to link with immune regulatory network deficiencies. • National asthma and allergy plans (e.g. The Finnish Asthma Programme 1994-2004) have concluded that the burden of these community health problems can be reduced. The change for the better is achieved as governments, communities, physicians and other health care professionals, and patient organizations commit to an educational plan to implement best practices for prevention and treatment of allergic diseases. INTRODUCTION AND EXECUTIVE SUMMARY CHAPTER 3 CHAPTER 1 CHAPTER 4 CHAPTER 6 CHAPTER 2 CHAPTER 5 MEMBER SOCIETY SURVEY REPORT 2 0 Pawankar, Canonica, Holgate and Lockey Copyright 2011 World Allergy Organization 5. HEALTH ECONOMICS, MEDICAL EDUCATION AND COST-EFFECTIVE HEALTH CARE IN ALLERGY Health Care Delivery and Health Economics in Allergy • Asthma and allergic diseases are significant causes of morbidity on a global scale. • Asthma disproportionately affects minorities and people from lower socio-economic groups. • The total global cost of care for people with asthma and allergic disorders is disproportionately high despite the relatively low cost per person mainly due to the high prevalence of these disorders. • The most effective management for these disorders is to teach patients self-management skills. • Education should focus on training physicians to promote and foster self-management skills in their patients. Medical Education in Allergy The intended outcomes