GRF 2nd One Health Summit 2013: Presentation by Cezmi A. Akdis, Swiss Institute of Allergy and Asthma Research(SIAF)

1. Allergy Asthma and
One Health
„Thesize of theproblem“
Cezmi A. Akdis
Swiss Institute of Allergy and Asthma Research
(SIAF)

2. Allergies and Asthma
1’500’000’000 patients
300’000’000 asthma
250’000 deaths from asthma per year
10 % of all patients have severe disease
15 times more likely to use emergency services
Utilize 60% of the health costs

3. TheAllergy-Epidemic
40
Prevalence
allergen-specific IgE
30
rhinitis
atopic dermatitis
20
asthma
10
0
1900
1940
1960
1980
2000

4. Proportional Increase in Incidence (%)
EpidemicIncrease in
Immune Regulation
RelatedDiseases
Type 1
Diabetes
400
Asthma
Rhinitis
IBD (Crohn)
300
Anaphylaxis
in preschool
children
Lupus
Multiple
Sclerosis
200
100
1920
1960
1980
2000

5. JEAN-FRANÇOIS BACH
New England Journal of Medicine September 2002

7. Increased prevalence of chronic noncommunicable disorders
including allergy and asthma with westernized life style.
The reduced exposure to diverse microbioma and physical inactivity may
impair immune regulatory mechanisms and immune tolerance to environment.

8. leaky barrier
breaking of tolerance
infections and microbiome
exposome
life style
genes
mechanisms
of being
clinically
healthy
despite
allergen
sensitization
Healthy
Allergic
molecular
events in
the facit
circle of
chronicity
and severity
diet
infections microbiome
induction of tolerance
strengthening of barriers
control of exposome
education
T. Bieber, R. Lauener, P-S Grendelmeier, C-T Hoffmann, C.A. Akdis

9. Risk factors for asthma exacerbations

11. Whatwouldbethe optimal strategy to prevent

13. Barriers Related to Research Grants-I
• Lack of political awareness and low understanding
and priority setting for allergyepidemics
• Curative approaches and research for prevention
have not been efficientlysupportedso far
• Small quantities of grants have been given to
hypothesis-based research, although the real need is
large scale, non hypothesis based, in dept research,
which is now possible with the novel developments in
next generation DNA and RNA sequencing, exposome
analysis, and epigenetic analysis

14. Barriers Related to Research Grants-II
• Human research is receiving relatively less
funding in many grant giving bodies compared
to animal models
• Many major grant giving bodies had to
decrease their budgets during the last
yearsbecauseofgeneralfinancialproblems
• Negative results that are not published are
being repeated

15. Global Vision and Roadmap I
•Allergy and Asthma epidemic affects more than 1.5 billion patients
with a global rise in prevalence, as the most common chronic childhood
disease and highest health-care costs
•Effective policies and strategy development are needed to fill this gap
at the global, regional and national level
•Efforts to overcome unmet needs should focus on 4 main directions
Research and development
Better patient care at the global level
Increased public awareness
Allergies and Asthma in political agenda

16. Global Vision and Roadmap II
•A “Global Allergy and Asthma Fight Strategy” should be developed
•All stakeholders, such as specialists, primary care physicians, nurses,
dieticians, psychologists, pharmacists, patient organizations, educators,
industry, and policy makers should be involved
•A multidisciplinary and scientific approach should be used
•“One Health”concept that suggests systemic interconnections between
human, environment, animal health and food and water safetyshould be
integrated
•Next generation guidelines should be developed
•A World Allergy and Asthma integrated surveillance network should be
established
•Existing know-how from successful approaches in the past should be
utilized and implemented

17. WIRM VIII
19-22 March 2014

18. 18

19. The One Health Science
Environment
Immune
Regulation
Infections

20. environmental risk factors for asthma

21. Global Unmet Needs in Allergies and Asthma
•Pathomechanisms of allergic diseases are still not fully known
•There is a global burden of access to drugs and good patient care in
underdeveloped regions
•There is no established way of prevention of allergies
•There is no established way of curative treatment
•Biomarkers to subgroup patients, predict outcomes and follow
therapy response are needed
•Vaccine development against viruses that trigger exacerbations
should be supported
•Patient-tailored treatment should be strongly implemented
•Next generation global guidelines that consider individual needs,
regional differences and disease subgroups are needed
•A worldwide registry and regional biobanks for allergy and asthma
are needed

22. Development of Allergic Diseases in Children