Prof. Marek L. Kowalski , M.D., Ph.D.

Department of Immunology, Rheumatology and Allergy , Chair of Immunology,

Medical University of Łódź, Poland

AllergyAllergyAllergyAllergy andandandand asthmaasthmaasthmaasthma controlcontrolcontrolcontrol inininin PolandPolandPolandPoland

Prevalence

of asthma

ISAC 1999

. ISAAC

Prevalence of asthma in Poland

Prevalence %

5

10

15

20

( Małolepszy J. et al. Alergia Astma Immunol 2000,5 suppl 2)

Adults

Children 3-16y

Asthma

5.4

8.6

Seasonal

rhinitis

8.7 8.9

Perennial

rhinitis

2.13.0

Atopic

dermatitis

1.4

4.7

2.01.0

Contact

dermatitis

15.8

19.2

Any

disorder

Epidemiology of Asthma and Allergy in Poland

-Population study of 14 701 randomly selected subjects

-Questionnaire- based diagnosis verified by experts

Regional differences in the

prevalence of asthma in PolandPrevalence %

5

10

15

20

(Młolepszy J. et al. Alergia Astma Immunol 2000,5 suppl 2)

Białys

tok

8.4

6.9

2.84.9

15.8

Bydgo

szcz

7.0

10.5

11.8

9.5 10.1

Pozna

ńZabrze

KrakówŁód

ź

Wrocław

Rabka

Gdańs

kWars

zawa

ISAAC Phases One and

Three surveys

9.3- 35.16.2-

18.4 W

Europe

2.6-13.14.6-

11.1N/E

Europe

Phase 2Phase

1

Region

BronchialBronchialBronchialBronchial asthmaasthmaasthmaasthma

6 6 6 6 ----7 7 7 7 yearsyearsyearsyears

ageageageage groupgroupgroupgroup

13 13 13 13 ----14 14 14 14 yearsyearsyearsyears

ageageageage groupgroupgroupgroup

• Cross-sectionalquestionairesurvey (7 yearsapart)

193 404 childrenaged 6-7years from 37 countries

304 679 childrenaged 13-14 yearsfrom 56 countries

AsherAsherAsherAsher MI Lancet 2006,368,733MI Lancet 2006,368,733MI Lancet 2006,368,733MI Lancet 2006,368,733----743743743743

Trends in asthma prevalence in

Europe

AgeAgeAgeAge 6666----7year7year7year7year AgeAgeAgeAge 13131313----14year14year14year14year

0

1

2

3

4

5

6

7

Lis G, Breborowicz et al.

Pneumonol Alergol Pol. 2003;71(7-8):336-43

Kraków Poznań Kraków Poznań

2001-2002

1994-1995

[%]

13-14 years old

Changes in the prevalence of bronchial

asthma in children in Poland

6-7 years

Kraków Poznań Kraków Poznań

2001-2002

1994-1995

[%]

Występowanie alergicznego nieżytu nosa i spojówek u dzieci w

wieku 6-7 lat i 13-14 lat w Krakowie i Poznaniu w latach 1994-95 i

2001-2002

0

5

10

15

20

25

30

35

Changes in the prevalence of allergic

rhinits/conjunctivitis in children in

Poland

Lis G, Breborowicz et al.

Pneumonol Alergol Pol. 2003;71(7-8):336-43

Kraków Poznań Kraków Poznań

13-14 years old6-7 years

PrevalencePrevalencePrevalencePrevalence ofofofof allergyallergyallergyallergy inininin ruralruralruralrural andandandandurbanurbanurbanurban childrenchildrenchildrenchildren

Urban area200 children

Rural area200 children

Questionaires + Clinical examination– physicianphysicianphysicianphysician mademademademade diagnosisdiagnosisdiagnosisdiagnosis ofofofof allergyallergyallergyallergy

• SPT (15 allergens)

• Serum total IgE and sIgE– Derp1 ,Derp1 ,Derp1 ,Derp1 ,tymothytymothytymothytymothy ((((UnicapUnicapUnicapUnicap))))

• Allergen concentration in house dust– Der p1, Fel d1, Der p1, Fel d1, Der p1, Fel d1, Der p1, Fel d1, CanCanCanCan d1 d1 d1 d1 Majkowska at al.

2006

0%

5%

10%

15%

20%

25%

30%

35%

40%wskaźnik struktury [%]

miasto 38,81% 11,94% 16,42% 2,49% 2,49% 0,50% 0,50%

wieś 10,84% 0,00% 1,97% 0,00% 0,49% 0,49% 0,00%

ANN

Alergiczne

zap.

Spojówek

AstmaAlergia

pokarmowaZAZS

Pokrzywka

alergiczna

Wyprysk

kontaktowy

Prevalence of allergic diseases in

rural and urban children

Urban

Rural

AR RC AsthmaAsthmaAsthmaAsthma FoodFoodFoodFood

AllergyAllergyAllergyAllergyEczemaEczemaEczemaEczema UrticariaUrticariaUrticariaUrticaria

ContctContctContctContct

dermatitisdermatitisdermatitisdermatitis

Majkowska at al. 2006

0%

5%

10%

15%

20%

25%

30%

35%

wskaźnik

wartości [%

]

der p der f kot pies

miasto

wieś

0%

5%

10%

15%

20%

25%

30%

35%

wskaźnik struktury [%]

brzoza trawy/zboża babka bylica Alternaria

miasto

wieś

s

Allergic sensitisation (SPTs)

in rural and urban children

Der p1 Der f1 Der p1 Der f1 Der p1 Der f1 Der p1 Der f1 CatCatCatCat DogDogDogDog BirchBirchBirchBirch GrassGrassGrassGrass MugMugMugMug Alt.Alt.Alt.Alt.

Majkowska at al. 2006

Prevalence of allergy among school children

( 13-16 years old) in Poland

Majkowska , Kowalski 2006

0

10

20

30

40

50

60

Symptoms Sensitization

Urban

Rural

Prevalence%

Majkowska at al. 2006

RuralRuralRuralRural vsvsvsvs urbanurbanurbanurban environmentenvironmentenvironmentenvironment andandandandprevalenceprevalenceprevalenceprevalence ofofofof asthmaasthmaasthmaasthma inininin PolandPolandPolandPoland

Urban 16. 7%Rural 2 %

Risk of development of asthma in

urban children

• Decreased risk– contact with live stock contact with live stock contact with live stock contact with live stock OR= 0,22OR= 0,22OR= 0,22OR= 0,22 (0,09(0,09(0,09(0,09----0,59), 0,59), 0,59), 0,59), p<0,001)].p<0,001)].p<0,001)].p<0,001)].– attendance to kindergarten attendance to kindergarten attendance to kindergarten attendance to kindergarten OR=0,05,OR=0,05,OR=0,05,OR=0,05, (0,004(0,004(0,004(0,004----0,48); 0,48); 0,48); 0,48); p=0,001],p=0,001],p=0,001],p=0,001],

• Increased risk – daily contact with dog/cat during first 3 years of life daily contact with dog/cat during first 3 years of life daily contact with dog/cat during first 3 years of life daily contact with dog/cat during first 3 years of life [OR= (1,46[OR= (1,46[OR= (1,46[OR= (1,46----8,79); p<0,005]8,79); p<0,005]8,79); p<0,005]8,79); p<0,005]– a history of frequent URT infections history of frequent URT infections history of frequent URT infections history of frequent URT infections OR=5,20 OR=5,20 OR=5,20 OR=5,20 (2,56(2,56(2,56(2,56----10,56); p<0,0001]10,56); p<0,0001]10,56); p<0,0001]10,56); p<0,0001]– childchildchildchild’’’’s birth from first or second pregnancy s birth from first or second pregnancy s birth from first or second pregnancy s birth from first or second pregnancy OR=3,6OR=3,6OR=3,6OR=3,61,461,461,461,46----8,79); p=0,005] 8,79); p=0,005] 8,79); p=0,005] 8,79); p=0,005] – delivery by Cesarean labor delivery by Cesarean labor delivery by Cesarean labor delivery by Cesarean labor OR=2,36OR=2,36OR=2,36OR=2,36(1,03(1,03(1,03(1,03----5,41); p=0,049]. 5,41); p=0,049]. 5,41); p=0,049]. 5,41); p=0,049].

PatientPatient

PhysicianPhysicianScientistScientist

SocietySociety

AsthmaAsthma

controlcontrol

AIRCEE Asthma

Inside and

Reality in

Central and

Eastern

Europe

1998: 2509 patients

1999:7 countries in

western Europe2 803patients

2000: 12 countries in Central and

Eastern Europe

1617 patients

Asthma symptoms reported during

previous 4 weeks

Raz w tyg.

8%

codziennie

20%

3 dni w tyg.

17%

większość dni

20%

2 razy w tyg.

7%

2 razy w m-cu

1%

Nie było

25%

Raz w m-cu

2%

Liczba ankietowanych N=300.

57%>2x/week

Kowalski i wsp. Alergia Astma Immunologia 2004

Nocturnal symptoms during

previous 4 weeks

Nie było

51%

2 x w m-cu

1%

Raz w m-cu

1%

3 -4 razy w m-cu

2%

2 noce w tyg.

7%

Większość

nocy

14%

3 noce w tyg.

10%

Co noc

11%

1 noc w tyg.

3%

Kowalski i wsp. Alergia Astma Immunologia 2004

45% - > 1x/week

Emergency visits (ER or ambulance) due to

asthma exacerbation during last year

36%41%

37%

0%

10%

20%

30%

40%

50%

60%

70%

Total (N=300) Adults(N=239) Children (N=61)

Kowalski i wsp. Alergia Astma Immunologia 2004

Hospital admission due to asthma

exacerbation during last year

18%

8%

16%

0%

10%

20%

30%

40%

50%

60%

Łącznie (N=300) Dorośli (N=239) Dzieci (N=61)

Kowalski i wsp. Alergia Astma Immunologia 2004

Total Adults Children

Patients with prescribed inhaled

glucocorticosteroids

Stosuje steroidy

wziewne

30%

Nigdy nie

przepisano

steroidów

wziewnych

57%

Obecnie nie

stosuje

13%

(N=300)

Never

57%

Prescribed

In past 16%

Curently

using

27%

Europe

41.1

Poland

Asthma Insights & Reality Central,

Eastern Europe

100

0

80

60

20

40

% patients on IGCS

27.0

Rabe, Eur Respir J, 2000

GSK,Data in file, AIRCEE

AAI 2004: AIRIAP

USA

35.4

16% 14% 15%

26%

17%

8%

20%

2% 4%

17%

56%

62%

44%

60%

70%

57%

50% 48%

39%

57% 59%

8%

27%

62%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Poland Hungary Czech

Republic

Slovenia Croatia Lithuania Slovakia Bulgaria Russia Romania Ukraine Latvia

Anti-inflammatories Quick relief medications

Reliever and anti inflammatory treatment

reported by patients in AIRCEE study

Summary of the situation

• Allergy and asthma have significant prevalence in Poland

• A significant regional differences in the prevalence of asthma and allergy are observed

• In majority of patients asthma is not well controlled

• Asthma is undertreated in most patients

Asthma 6.5 13.9 20.4

Allergic 1.3 1.7 3.0

rhinitis

Eczema 0.3 0.4 0.7

Contact 3.0 2.5 5.5

dermatitis

Total 29.4

Direct Non-direct Total

Costs of allergy and asthma

in Europe (bilions ECU)

Member countries succes ratio for

2/3 of 6 FP budget

0

5000

10000

15000

20000

25000

30000

DE IT UK FR ES NL GR BE SE PL AT FI PT DK HU CZ IE SI SK LT EE LV CY MT LU

Number of calls Number of projects=succes

Number of calls - New Members Number of projects=succes for New Members

Allergic diseases from FP6 to FP7

• « Allergy » covered in the Food section ofthe programme although food allergy represents only 8% of allergic diseases.

• EAACI and GA²LEN are raising awarenesson the need to have « allergic diseases » in the Health theme

– Meeting with the Rapporteur –prof. Jerzy BuzekFebruary 2006– Presentation to the members of EP in Brussels-March 2006

• Amendment 114Annex I, Chapter I "Cooperation", Theme 1 "Health", Subtitle "Activities", bullet 2, indents 3 and 4

• Amendment by Jerzy Buzek on behalf of the PPE-ED Group, Philippe Busquin on behalf of the PSE Group, Vittorio Prodi on behalf of the ALDE Group andUmberto Guidoni on behalf of the GUE/NGL Group

FP7 framework text : , “allergy” is proposed to be included under the Health theme, “Translating research for human health”, “Translational research in major diseases” as “respiratory diseases, including those induced by allergies“.

Allergic diseases from FP6 to FP7

Łódź

29th Congress of theEAACI

Warsaw ,June

2009