• The global prevalence, morbidity, mortality and economic
burden of asthma have increased over the last 40 years.
• However, the growth and burden of the disease is not
uniform. Disparities in asthma morbidity and mortality, with
an inverse relationship to social and economic status, are
increasingly documented around the world.
• Asthma and other atopic disorders may be more
concentrated among those of lower socio-economic
status because they also bear a disproportionate burden
of exposure to suboptimal, unhealthy environmental
conditions (e.g. physical, social, and psychological
conditions).
• Future research needs to pay increased attention to
the social, political, and economic forces that result in
marginalization of certain populations in disadvantaged
areas of the world which may increase exposure to known
environmental risk factors contributing to the rising asthma
burden.
Climate Change, Migration and Allergy
• The Earth’s temperature is increasing as illustrated by
rising sea levels, glaciers melting, warming of the oceans
and diminished snow cover in the northern hemisphere.
• Climate change coupled with air pollutant exposures may
have potentially serious adverse consequences especially
for human health in urban and polluted regions.
• High summer temperatures have an impact on rates of
acute exacerbation and hospital admission for elderly
patients with breathing problems and may cause
unexpected death.
• Pollen allergy is frequently used to study the
interrelationship between air pollution and respiratory
allergy. Climatic factors (temperature, wind speed,
humidity, thunderstorms, etc.) can affect both biological
and chemical components of this interaction.
• Changes in the weather such as thunderstorms during
pollen seasons may induce hydration of pollen grains
and their fragmentation which generates atmospheric
biological aerosols carrying allergens. As a consequence
asthma outbreaks can be observed in pollinosis patients.
• Migration from one country to another involves exposure
to a new set of pollutants and allergens as well as
changes in housing conditions, diet and accessibility to
medical services which may affect migrants’ health.
• Atopy and asthma are more prevalent in developed and
industrialized countries compared with undeveloped and
less affluent countries.
• Migration studies provide information on the role of
environmental factors on the development of atopy
and asthma.
• Physicians should be aware that environmental and
climate changes may enhance the development of allergic
diseases and asthma.
• Physicians should be aware that migrants, especially from
developing to more developed countries, are at increased
risk to acquire allergic diseases and asthma and that the
effect is age and time-dependent. Early age and longer
time increase the likelihood of developing atopy and
asthma.
EVIDENCE BASED APPROACHES
TO DIAGNOSIS AND MANAGEMENT
Diagnosis and Identification
of Causative Allergens
• Confirmation of allergy and identification of causative
allergens are crucial to correctly manage allergic diseases.
• Precise diagnosis allows the implementation of therapies
oriented to the etiologic factors of allergic diseases, such
as environmental measures and immunotherapy.
• Diagnosis begins with a detailed medical history and
physical examination.
• The identification of a temporal association between
symptoms and allergen exposure constitutes the basis for
further testing.
• Clinical suspicion is confirmed by means of investigation of
IgE antibodies in vivo (skin tests) or in vitro.
• Skin tests should include relevant allergens and the use of
standardized allergen extracts.
• In vitro testing is especially useful when skin test results do
not correlate with the history or cannot be performed.
• In vitro tests can be applied to “probability of disease”
prediction in food allergy.
• There is a need for increased accessibility to allergy
diagnosis and therapies and improved diagnostic
methodologies that can substitute in vivo provocation
tests for drug and food allergy.
• The use of unproven tests increases the unnecessary
costs of allergy diagnosis
