Plenary Session III: European Priorities for Health Regarding Chronic and Respiratory Diseases

Chaired by Cezmi A. Akdis

Cezmi Akdis
described the European Academy of Allergy Clinical Immunology (EAACI), an umbrella organisation. All sections of it are relevant to One Health in terms of human, environmental and animal health. Dr Akdis noted the importance of investing in the next generation. There is an allergy and pollution interest group, and others on food quality and safety, and on skin care. In a year we each ingest ten billion particles and 2,000 species of bacteria. Our immune systems engage in highly interactive networking, which makes decisions on the basis of inputs from all our organs. Allergies are a global problem with a strong human and economic impact, yet we do not know the risk factors and we lack adequate prevent strategies. Allergies are also increasingly prevalent, but many of their aspects remain unknown. We do know that rates of allergies are much higher in children than in adults. Research and networking are needed, as is an all-embracing concept that involves all parties.

Monica Przygucka Gawlik observed that European Union health policies are fragmentary. The EU trans-border healthcare directive is the only integrative policy. Healthcare has many national and regional variations in policies, organisation, economics and technologies. Concerted action is needed across Europe to promote healthy lifestyles. National action is needed everywhere in childhood asthma. Common action is needed at the EU level on the control of respiratory diseases.. Network activities will prepare a background for political decision making at the EC level.

Charlotte Braun-Fahrländer noted that childhood asthma is a leading paediatric chronic disease in industrialised countries. There is no real effective primary prevention. Pollution factors and loss of protective mechanisms constitute the "hygiene hypothesis" about change in exposure and loss of immunity. Children who live on traditional farms have lower levels of allergies than those who live in the same villages but not on farms. As long ago as 1873 it was noted that a high exposure to pollen was associated with a low rate of hay fever. Xenogenic pressure and microbial exposure at an early stage in life (pregnancy or infancy) can stimulate immunity and lead to low rates of respiratory disease. However, the exposure situation may be very different in less wealthy countries.

Nikos Papadopoulos
discussed the high burden of chronic respiratory diseases. Allergies start very early in life (asthma at less than one year). Serious respiratory disease can persist over 35 years or more, as was found in the Melbourne study which followed patients from 5 to 42 years of age. Asthma almost always starts with an infection. After that it has a persistence rate of 42 per cent. However, asthma is still an atopic allergic disease. Whether asthma will persist as an allergy is usually determined at 6-7 years of age. The PreDicta hypothesis argues that more than one infection must occur in sequence, along with allergy and atopy, to cause persistence of asthma. Early pharmacological infection and early treatment help improve outcomes. When treatment with steroids ends, there will probably be a relapse, and hence steroids will not prevent the disease. Whether a rhinovirus vaccine is possible is still under evaluation. Allergen avoidance does not work well practically. There is a European Declaration of Immunotherapy: allergen-specific immunotherapy is promising.