Jonas Binnmyr
Astma- och Allergiförbundet arbetar för att möjliggöra ett friskare och tryggare liv för alla med astma, allergi eller annan överkänslighet genom att sprida information, bedriva opinionsbildning och stödja forskning.
Lite fakta • Förbund, ca 20000 medlemmar • Forskningsfond, ca 10 miljoner årligen • Märkning • Unga Allergiker
Allergi och Astma i Sverige • Allergier vuxna: • Allergier Barn: • Astma: • Astma Barn: • Atopiskt Eksem: • Doftöverkänslighet:
Allergi och Astma i Sverige • Allergier vuxna: 45% anger allergi eller överkänslighet • Allergier Barn: 45 % av 16 åringarna är sensibiliserade • Astma: 7-8% • Astma Barn: 7-10% • Atopiskt Eksem: ca 10% • Doftöverkänslighet: 1-5% Källor:Miljöhälsorapporten 2017, BAMSE uppföljning 2017, Atopikerrapporten, https://www.ncbi.nlm.nih.gov/pubmed/23448366 (Doftöverkänslighet)
Vad hände? • Första statliga utredningen genomfördes 1988 • Röda Fjädern 1989 • Stora kohorter startades, ffa BAMSE • Orsaker diskuterades och behandlingarna utvecklades Det här fotot av Okänd författare licensieras enligt CC BY-SA
Finland då… • Samma sak där… till Sovjet upplöstes
Self-reported allergic symptoms and asthma were much more common in the city of Joensuu and its surroundings in Finnish Karelia than in Pitkaranta in Russian Karelia. In Finnish Karelia, over 20% of adults (25 – 54 years) reported having hay fever, almost 25% had allergic eye symptoms (conjunctivitis), and over 25% had atopic eczema. A little more than 5% reported physician-diagnosed asthma. In Russian Karelia, the respective prevalences were less than 5% for hay fever and allergic eye symptoms, slightly over 10% for atopic eczema and 2% for physician-diagnosed asthma
Vad beror detta på? • … it became apparent that on the Finnish side, healthy children had a more biodiverse living environment as well as greater diversity of certain bacterial classes on their skin than atopic children. • …These observations support the notion that the epidemic of allergy and asthma results from reduced exposure to natural environments with rich microbiota, changed diet and sedentary lifestyle. • …Genetic studies have confirmed strong influence of lifestyle and environment. • …With our results from the Karelia study, a 10 -year National Allergy Programme was started in 2008 to combat the epidemic in Finland.
• Finland (population 5,5 million), a 10-year national campaign to treat allergic diseases was initiated in 2008. It was carefully planned and based on consensus among experts because the long-term strategy of allergen avoidance had not reduced the burden or stopped the “epidemic”. New insights into immune development in modern, urban societies have challenged conventional thinking. A public health programme has now been implemented, and an avoidance strategy was replaced with a tolerance strategy. This course of action was supported by the Ministry of Social Affairs and Health and the National Institute for Health and Welfare.
Key messages The Finnish Allergy Programme 2008 – 2018 messages for both healthcare professionals and lay-public; allergy health is promoted • Endorse health, not allergy • Strengthen tolerance • Adopt a new attitude to allergy, and avoid allergens only if mandatory • Recognise and treat severe allergies early; prevent exacerbations • Improve air quality; stop smoking
Key messages The Finnish Allergy Programme 2008 – 2018 messages for both healthcare professionals and lay-public; allergy health is promoted • Endorse health, not allergy • Strengthen tolerance • Adopt a new attitude to allergy, and avoid allergens only if mandatory • Recognise and treat severe allergies early; prevent exacerbations • Improve air quality; stop smoking
Astma Vuxna
Astma Barn
Exacerbationer-Alla
Primary Prevention Practical advice for building and improving tolerance as well as preventing symptoms and exacerbations • Support breastfeeding, with solid foods from 4 – 6 months onwards • Do not avoid exposure to environmental allergens (foods, pets), if not proven necessary • Strengthen immunity by increasing contact with natural environments (e.g. by taking regular physical exercise and following a healthy diet such as a traditional Mediterranean or Baltic diet) • Antibiotics should only be used in cases of true need (the majority of microbes are useful and build a healthy immune function) Probiotic bacteria in fermented food or other preparations may balance the immune function • Do not smoke (parental smoking increases the risk of asthma in children)
Secondary and tertiary prevention Practical advice for building and improving tolerance as well as preventing symptoms and exacerbations • Regular physical exercise is anti-inflammatory • Healthy diets are anti-inflammatory (a traditional Mediterranean or Baltic diet may improve asthma control) • Probiotic bacteria in fermented food or other preparations may be anti-inflammatory • Respiratory/skin inflammation should be treated early and effectively; maintenance treatment titrated for long-term control • To stop symptom exacerbations proactively, instructions for guided self-management are provided for 10 allergic conditions (available in both paper and electronic formats) • Allergen-specific immunotherapy is recommended for more severe symptoms, e.g: allergens as such (for foods) sublingual tablets or drops (sublingual immunotherapy, or SLIT) (for pollens) subcutaneous injections (for pollens, pets, mites, insect stings) • Smoking should be strictly avoided (the effectiveness of asthma and allergy drugs is reduced in smokers)
Vad har vården gjort • Tydliga rekommendationer • Göra diagnostik vid allergimisstanke • Erbjuda immunterapi för de som är allvarligast sjuka (enligt fastställda rekommendationer) • Vid allergidiagnos, gör om diagnostiken • Tydliga rekommendationer till patienterna gällande förhållningssätt • Starta behandling mot eksem tidigt och utbilda patienterna i hur och med vad • Hindra folk att röka • Patienterna skall förstå sin behandlingsplan (Astma)
Föreläsningar och informationskampanjer • Förbundet • Professionen • Staten • Tydliga och mätbara målsättningar • Mät ifall budskapet nått fram
Outcome • 1) Prevent allergy Indicator: asthma, rhinitis and atopic eczema prevalence reduced by 20% Outcome: • 2) Improve tolerance Indicator: food allergy diets reduced by 50% Outcome: • 3) Improve allergy diagnostics Indicator: skin prick testing practised in certified testing centres Outcome: • 4) Reduce work-related allergies Indicator: occupational allergies reduced by 50% • 5) Focus on severe allergies and treat in time Indicator: effective allergy practice; asthma emergency visits reduced by 40% Outcome: • 6) allergy costs reduced by 20% Outcome:
Outcome • 1) Prevent allergy Indicator: asthma, rhinitis and atopic eczema prevalence reduced by 20% Outcome: no information yet • 2) Improve tolerance Indicator: food allergy diets reduced by 50% Outcome: allergy diets in day-care settings −40% • 3) Improve allergy diagnostics Indicator: skin prick testing practised in certified testing centres Outcome: 30 hospitals and other centres educated, audited and certified • 4) Reduce work-related allergies Indicator: occupational allergies reduced by 50% Outcome: occupational allergies reduced by 40% • 5) Focus on severe allergies and treat in time Indicator: effective allergy practice; asthma emergency visits reduced by 40% Outcome: e mergency visits −46%; asthma hospital days −67% • 6) Reduce allergy and asthma costs Indicator: allergy costs reduced by 20% Outcome: total costs in the 2000s −15%; in 2007–2013 −5%
Framtiden i Sverige Vad • Certifieringsmodell i primärvården för Astma-Allergi och KOL • Utbilda mer Allergologer, Lungläkare • Kunskapscentrum • Allergikonsulentverksamhet (Information till samhället)
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