White Book on Allergy

Atopic Eczema

•  An increase in the worldwide prevalence of atopic eczema has been observed. 

• Atopic eczema is the most common chronic inflammatory skin disease with a varied clinical spectrum. 

• Atopic eczema is often the first manifestation of the atopic patient and early intervention may offer an opportunity to impede or stop the atopic march. 

• Atopic eczema represents an important public health issue due to its impact on quality of life and its socio-economic burden.

Anaphylaxis 

• Epinephrine, at appropriate doses, is the drug of choice to treat anaphylaxis. 

• There is lack of consensus about the definition of anaphylaxis and this lack of consensus in definition contributes to the variability in its identification, treatment and the use of epinephrine. 

• The variability and severity of anaphylaxis is somewhat dependent on the route by which the allergen or inciting agent is delivered, i.e. parenteral versus oral administration; the former is commonly associated with more severe reactions. 

• There is a variety of other terms which describe anaphylaxis which cause confusion, especially with its definition and treatment. These include: generalized systemic reaction; systemic allergic reaction; constitutional reaction; and serious hypersensitivity reaction. 

• Anaphylaxis includes both allergic and non-allergic etiologies.

• The term “anaphylactoid” is outdated

Food Allergy 

• Globally, 220 – 250 million people may suffer from food allergy. 

• Food allergy significantly affects the quality of life of sufferers (mainly children). 

• Stakeholders must be prepared to meet the needs of patients by enhancing the diagnostic process, the traceability of responsible foods, and the availability of substitute foods, assisting hospitalized patients, and preventing mortality. 

• Large areas in the world lack legislation on food labelling.

• As diagnostic and therapeutic decision strategies are not clear-cut, evidence-based guidelines are necessary for clinicians, patients, governments and industry to deal with the challenge of food allergy. Such guidelines, eg, the WAO recommendation on the Diagnosis and Rationale Against Cow’s Milk Allergy (DRACMA) are available and are ready to be implemented. 

• Epidemiologic studies are necessary, in particular, in less developed areas of the world. 

• Oral desensitization represents a promising approach to reduce the burden of disease caused by food allergy.

Urticaria and Angioedema 

• Urticaria is a heterogeneous group of disease sub-types characterised by wheals (fleeting elevations of the skin lasting approximately 24 hours) and/or angioedema (deeper swellings of skin and mucus membranes). 

• Three major categories exist: a) spontaneous occurrence of wheals, associated with acute and chronic urticaria; b) wheals and angioedema elicited by particular stimuli, and in particular physical urticarias: and c) other urticarial disorders such as exercise-induced urticaria. 

• Urticaria occurs frequently with a lifetime prevalence above 20%.

• Except for acute urticaria, diagnostic and therapeutic procedures can be complex and referral to a specialist is often required.

• Untreated, chronic urticaria has a severe impact on quality of life and impairs productivity by up to 30%.

• The socio-economic impact of urticaria is great, since it is a disease which primarily occurs in people of working age. 

• Moderate to severe urticaria requires specialist treatment. In many health care systems worldwide, access to specialty care is insufficient.