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Brief Report

Integrated Allergy and Asthma Prevention and Care: Report of the MeDALL/AIRWAYS ICPs Meeting at the Ministry of Health and Care Services, Oslo, Norway

Lødrup Carlsen K.C.a, b · Haahtela T.e · Carlsen K.-H.a, b · Smith A.c · Bjerke M.c · Wickman M.f, g · Keil T.h, i · Ballereau S.j · Bedbrook A.k, l · Bergström A.f · Nawjin M.C.o · Pinart M.h,p-r · Skrindo I.a, d · Xu C.J.o · De Carlo G.t · Anto J.M.p-s · Bousquet J.k-n

Author affiliations

aDepartment of Paediatrics, Oslo University Hospital, bInstitute of Clinical Medicine, Faculty of Medicine, University of Oslo, cThe Norwegian Directorate of Health, and dDepartment of Otorhinolaryngology, Akershus University Hospital, Oslo, Norway; eSkin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland; fInstitute of Environmental Medicine, Karolinska Institutet, and gSachs' Children's Hospital, Södersjukhuset, Stockholm, Sweden; hInstitute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, and iInstitute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany; jENS-CNRS USR3010, Campus Charles Mérieux, Université Claude Bernard, Lyon, kMACVIA-LR, and lUniversity Hospital, CHRU Montpellier, Montpellier, mINSERM, VIMA: Ageing and chronic diseases, epidemiological and public health approaches, and nUVSQ, UMR-S 1168 Université de Versailles St-Quentin-en-Yvelines, Paris, France; oDepartment of Pathology and Medical Biology, University of Groningen, GRIAC Research Institute, University Medical Center Groningen, Groningen, The Netherlands; pCentre for Research in Environmental Epidemiology (CREAL), qHospital del Mar Medical Research Institute (IMIM), rCIBER Epidemiología y Salud Pública (CIBERESP), and sUniversitat Pompeu Fabra (UPF), Barcelona, Spain; tEuropean Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium

Corresponding Author

Correspondence to: Prof. Karin C. Lødrup Carlsen

Women and Childrenʼs Division, Oslo University Hospital and

The Faculty of Medicine, University of Oslo

PO Box 4956 Nydalen, NO-0424 Oslo (Norway)

E-Mail k.c.l.carlsen@mail.uio.no

Related Articles for ""

Int Arch Allergy Immunol 2015;167:57-64

Abstract

Allergic diseases and asthma are increasing in prevalence globally. They can start early in life and many persist. It is important to prevent, detect and control these diseases early on and throughout life, so as to promote active and healthy ageing. The translational activities of MeDALL (Mechanisms of the Development of Allergy; EU FP7) are of great importance and include the deployment of successful allergy programmes. The Finnish Allergy Plan is a prototype for the prevention and control of severe allergic diseases. It has been considered for deployment to Norway by the Ministry of Health and Care Services in the frame of AIRWAYS ICPs (Integrated Care Pathways for Airway Diseases), a programme of Action Plan B3 of the EIP on AHA (European Innovation Partnership on Active and Healthy Ageing). Deployment of the Finnish and Norwegian Plans will make use of the scaling-up strategy of the EIP on AHA in regions in the European Union, and the WHO GARD (Global Alliance against Chronic Respiratory Diseases) globally. The regional deployment in Norway serves as a model of a national plan for the use of the EIP on AHA scaling-up strategy in other regions.

© 2015 S. Karger AG, Basel


Keywords

Allergy · Asthma · EIP on AHA · MeDALL · AIRWAYS ICPs · GARD ·


Introduction

Allergic diseases are increasing in prevalence and severity globally. They start early in life and many persist throughout the life cycle. They include rhinitis, asthma, atopic eczema and diseases associated with food allergy. Although control has been achieved with many patients, there are needs that have not yet been met including the prevention and the management of severe disease [1]. Moreover, allergic diseases should be diagnosed and managed early in childhood in order to promote active and healthy ageing [2]. The concept that health and disease can be influenced by factors that often start early in childhood and manifest at various periods throughout the life cycle has an important bearing on the management of allergic diseases.

Since 2008, ‘a new day has begun' [3] because an innovative Allergy Plan was endorsed by the Finnish Ministry of Social Welfare and Health following the successful Asthma Plan, designed to shift the paradigm of allergic diseases by focussing on the prevention and control of severe diseases [4]. This integrated programme has been operative in Finland and the first results, allowing a proof-of-concept, are encouraging enough to promote its deployment to other countries [5]. The MeDALL (Mechanisms of the Development of Allergy) Work Package 10 proposed the deployment of the Finnish Allergy Plan to other countries [6].

We report here on a meeting organized at the Ministry of Health and Care Services, Oslo, Norway, at which the following issues were discussed: (1) how the Finnish Allergy Plan can be deployed in Norway as part of the Norwegian Public Health Programme and (2) how this expertise can be used to scale up the programme with AIRWAYS ICPs (Integrated Care Pathways for Airway Diseases) [7 ]and the EIP on AHA (European Innovation Partnership on Active and Healthy Ageing) [8] in Europe, and the WHO GARD (Global Alliance against Chronic Respiratory Diseases) [9 ]globally. The meeting was co-organised by MeDALL and AIRWAYS ICPs.

MeDALL

MeDALL (EU FP7-CP-IP; project No. 261357; 2010-2015) was launched to generate novel knowledge on the mechanisms of the initiation of allergy in early childhood to young adulthood, in order to propose early prediction, diagnosis, prevention and targets for therapy [6,10]. The MeDALL design was based on a novel, step-wise, large-scale and integrative approach led by experts in the fields of allergy, epidemiology, allergen biochemistry, immunology, molecular biology, epigenetics and genomics, functional genomics, bioinformatics and computational and systems biology. It has combined the strengths of previous and ongoing projects in the European Union, and linked epidemiological and clinical research [11] with experimental and animal models. The MeDALL study population includes about 44,000 children from 14 birth cohorts spread across Europe, making this study unique, in terms of the geographical variability and a wealth of prospectively collected data on phenotypes, lifestyles and exposures in the first 2 decades of life. The MeDALL project was organized as 12 work packages developed by a consortium encompassing 23 public and private institutions and including 3 European small and medium enterprises.

The main achievements of MeDALL include (1) the description of the inter-relationships between asthma, rhinitis and eczema and comorbidity [12], with these phenotypes being defined according to MeDALL-agreed, expert-based definitions and (2) the classification of these entities into novel phenotypes by means of unsupervised cluster analysis. A major MeDALL effort has been a harmonized follow-up of all the participating birth cohorts [11,13], with this follow-up and historical databases being integrated in knowledge-based management. The latter also integrates the results of the experimental work packages which used samples from the birth cohorts. The characterization of IgE and IgG responses in children from birth to adolescence is being performed with the MeDALL chip which contains more than 170 allergens [14]. This analysis holds great promise for the identification of the components predictive of disease severity or prognosis [15]. To further understand the mechanisms explaining the distribution of allergic diseases from birth to adolescence, MeDALL is performing epigenetic, proteomic and transcriptomic studies on the birth cohort samples. Initial findings in the discovery-based phase are currently being replicated in a large number of samples. Analytical strategies to integrate the different omics studies are being explored. To complement mechanistic experimental studies on children, MeDALL has included in vitro studies and in vivo animal studies. Relevant ethical and societal issues on allergic diseases are being internationally debated within MeDALL. Ultimately aiming to improve the health of European citizens, MeDALL includes a translational work package to reinforce its impact.

Public Health Policy in Norway

The public health policy in Norway is determined by the Public Health Act and the Public Health Report which are updated every 2 years (e.g. 2013 and 2015) [16] and include several principles of public health:

• Health equities which arise for the societal conditions in which people are born, grow, live and age. Levelling up the gradient of health inequities throughout society by acting on social determinants of health is a core public objective in order to distribute fairly limited resources.

• Health in all policies: equitable health systems are important to public health, but health inequities arise from societal factors beyond health care. The impact on health should be considered when policies and actions are developed and implemented in all sectors.

• Joined-up governance and inter-sectoral actions are vital for the reduction of health inequities.

• Sustainable development meets the needs of the present without compromising the ability of future generations to meet their own needs. Public health work is based on a long-term perspective.

• Precautionary principles need to be enforced if an action or policy has a suspected risk of causing harm to the public or the environment. The absence of scientific consensus that the action is harmful cannot justify postponing action to prevent such harm.

• Participation: public health work should be transparent and inclusive of process with participation by multiple stakeholders. The promotion of civil society participation is a key factor for good public health policy development.

The Public Health Report has stratified the responsibilities to local (municipality), regional (county) and national levels. Municipalities and counties are key stakeholders, but the responsibility to support them on a national level is clear. The responsibility of public health work has been moved from the Health Services sector to the municipalities. A regulation passed in June 28, 2012, emphasized that municipalities are to have a continuous overview of the health status of their populations and the determinants of health. They are to define public health challenges and strategies as well as implementing measures to fulfil these.

Local health reports, available to the public and updated once every 4 years, are collected by the Public Health Institute. Annual systematic planning with the municipalities proposes concrete goals and adjusts plans according to local challenges and opportunity structures. Measures should address social determinants (including housing, education, employment and income), social and physical environmental issues and health-related behaviours.

An evaluation of stated goals, strategies and efforts should be conducted for each planning period as part of the internal quality assessment. An annual review of all public health efforts should be undertaken by the elected municipal council (fig. 1).

Fig. 1

Systematic public health work.

http://www.karger.com/WebMaterial/ShowPic/345350

The Public Health Report has developed a National Burden of Disease Evaluation based on data obtained across the country, in order to (1) facilitate a more systematic use of public health economies and (2) develop performance targets and indicators to be able to monitor the objectives of the public health policy and present a white paper to Parliament every year (fig. 2). The 2013 Public Health Report took developing environments and communities, environment and active and healthy ageing into consideration.

Fig. 2

White paper.

http://www.karger.com/WebMaterial/ShowPic/345349

Rationale and First Results of the Finnish Allergy Plan

The asthma death epidemic of the 1980s has abated and, in most, but not all, European countries, death rates due to asthma (1,164 deaths in 2012) are quite low (European short list: cause of death statistics; source: www.gbe-bund.de). A similar trend of a reduction in hospitalisations due to asthma can be observed. Certain national plans such as the Finnish Asthma Plan (1994-2004) [17] have been found to be cost-effective but are insufficiently deployed, even in Europe. Thus, there are still many patients suffering from severe disease. An efficient strategy for the large-scale prevention of allergy and asthma has not yet been demonstrated as being effective or feasible. However, there is sufficient evidence to support changes in habits that have the potential to be effective at a low cost and with a low risk of harm.

The ongoing Finnish Allergy Plan (2008-2018) was developed in order to reduce the severity of allergic diseases and as an attempt to prevent them. The plan was based on studies showing that environmental factors may promote or reduce the onset of allergy. The example of Karelia is worthy of note [18]. In the Russian Karelia, allergy has not increased in the past 50 years, but in Finland, it has boomed. Although the reasons for the differences are not fully understood, they may be related to biodiversity [19]. Along the same lines, it has been established that green areas around homes reduce allergic sensitization [20]. There is greater biodiversity in the Russian Karelia, both at the macro- and micro-level, than in the Finnish part. Microbiome studies suggest that IgE sensitization is associated with a decrease in microbial abundance and diversity [21]. These data propose that environmental biodiversity, human microbiota and allergy are inter-related [22]. Constant exposure to ‘non-danger' signals (commensals) leads to making the difference between good and bad (danger vs. non-danger, self and non-self), preventing inappropriate inflammatory responses. The causes of allergy appear to be complex, but the solutions may prove to be simpler (fig. 3) [21].

Fig. 3

Acquisition/maintenance of healthy indigenous microbiotas. Printed with permission [21].

http://www.karger.com/WebMaterial/ShowPic/345348

The Finnish Allergy Plan is based on 5 key messages: (1) endorse health not allergy, (2) strengthen tolerance, (3) adopt a new attitude towards allergy and only avoid allergens if mandatory, (4) recognize and treat severe allergies early and (5) improve air quality and stop smoking [23].

The Finnish Allergy Plan (2008-2018) includes simple prevention measures, and has been widely disseminated in Finland at all levels, including to the lay public. The first results show that the severity of asthma (according to data on emergency visits, hospitalisations and self-reported severity) has been reduced and that prevention measures are meeting many of the proposed targets [5].

Deployment of the Finnish Allergy Plan to Norway

Asthma and allergic diseases represent a national challenge in Norway. Goals have been set by a 2015-2024 national plan. The Finnish Allergy Plan serves as a background to this plan, which includes issues like tolerance, exposure, improved diagnosis and control and, importantly, prevention, as well as acknowledging the need for more research to be able to achieve these goals.

The Norwegian Asthma and Allergy Plan has several goals (table 1). These are to be attained through an integrated programme which will include all stakeholders (health care professionals, social workers, citizens, public health, local authorities, patients' organisations), who will function within networks coordinated by the Helsedirektoratet (Norwegian Directory of Health) on all levels of health care.

Table 1

Goals of the Norwegian Asthma and Allergy Plan

http://www.karger.com/WebMaterial/ShowPic/345355

Specific goals include the increased knowledge of allergic diseases (from research), the assessment of baseline data and improved diagnosis, treatment and prevention (table 2).

Table 2

Specific goals of the Norwegian Asthma and Allergy Plan

http://www.karger.com/WebMaterial/ShowPic/345354

The plan will be implemented through networks, including the regional competence centres in all 4 health regions of Norway (fig. 4).

Fig. 4

Regional competence network for the implementation of the Norwegian Allergy Plan. ENT = Ear, nose and throat.

http://www.karger.com/WebMaterial/ShowPic/345347

Correct and relevant information are to be disseminated to all stakeholders (table 3).

Table 3

Dissemination strategy of the Norwegian Asthma and Allergy Plan

http://www.karger.com/WebMaterial/ShowPic/345353

The plan will be implemented by means of the 4 main strategies outlined in table 4. In particular, it will focus on (1) improving competence throughout the health care system as well as that of patients and the public and (2) improving knowledge by strengthening research and extensive collaborative work throughout the country.

Table 4

Strategy of the Norwegian Asthma and Allergy Plan (2015-2024)

http://www.karger.com/WebMaterial/ShowPic/345352

Research will focus particularly on reducing the burden of disease and improving treatment and collaborative and multi-disciplinary care. These are to be achieved by: (1) prevention, (2) understanding gene-environment complexity, (3) basic mechanism research, (4) clinical research (diagnosis, treatment and health care/resources) and (5) the evaluation and implementation of research results.

Integration of the National Asthma and Allergy Plan into AIRWAYS ICPs

AIRWAYS ICPs is the model of chronic diseases of Area 5 of Action Plan B3 of the EIP on AHA (DG Sanco and DG Connect) [7] according to disease burden, mortality and comorbidities [24]. It was launched by the NHS in England (Newcastle, February 2014) and has been endorsed by the EIP on AHA Reference Site Network. The goals of AIRWAYS ICPs are to launch a collaboration to develop multi-sectoral care pathways for chronic respiratory diseases in European countries and regions (as part of the EIP on AHA), and to scale up globally with a WHO GARD demonstration research project [9]. AIRWAYS ICPs has strategic relevance for the European Union Health Strategy and the WHO Action Plan for Non-Communicable Diseases (2013-2020), adding value to existing public health knowledge (table 5).

Table 5

Goals of AIRWAYS ICPs

http://www.karger.com/WebMaterial/ShowPic/345351

The Finnish Allergy Plan focuses on all allergic conditions, including asthma, and is generic enough to be used as a model for all chronic respiratory diseases. Several AIRWAYS ICPs goals are in line with the Finnish/Norwegian Allergy Plans, including Actions 4, 5, 7, 8 and 10.

The Finnish and Norwegian Allergy Plans have been endorsed by AIRWAYS ICPs and will be promoted across all regions of Europe and beyond.

Recommendations from the Meeting

The meeting highlighted opportunities within and outside of Europe to deploy national plans for combatting allergic diseases and reducing the burden on the individual and societal levels. The Finnish Asthma Plan, Finnish Allergy Plan and Norwegian Asthma and Allergy Plan can serve as templates for other countries and be adjusted to local limitations and national health care systems.

Furthermore, thanks to the MeDALL project, it has become clear that there is a need to improve our understanding of the mechanisms as well as the optimal management of co-existing allergic diseases in a smaller, but important, proportion of patients with allergic disease. Several recent papers from Oslo and by the MeDALL consortium suggest the likelihood that children and adults with asthma, allergic rhinitis and atopic eczema may constitute particular phenotypes that require specific attention, in research as well as in care. The results of the MeDALL project will be further embedded in the national plans. More comprehensive management plans for these selected at-risk patients is called for.

The meeting in Oslo thus led to a new initiative within the MeDALL consortium to enhance our understanding of the developmental trajectories of these complex allergic phenotypes [12,15,25,26,27,28]. We will combine longitudinal data from birth to young adulthood, including lung function development and gene-environment interactions, particularly in subjects with ≥2 allergic diseases. The findings will be complemented by mechanistic studies. This initiative will hopefully bring us closer to understanding the mechanisms involved, and may lead to the identification of potential new targets for personalised treatment.

The link with AIRWAYS ICPs [7] is of importance, as chronic respiratory and allergic diseases must be taken into consideration throughout the lives of sufferers, in order to promote active and healthy ageing [29,30]. Deployment of the Finnish and Norwegian Plans in other regions of the European Union will be carried out in collaboration with the EIP on AHA and the Collaborative Reference Network using the scaling up strategy of the EIP on AHA [Bousquet, in prep.], and globally with WHO GARD. The plans will be presented during the AIRWAYS ICPs meeting scheduled to take place at the Ministry of Health in Portugal (July 1-2, 2015) and in collaboration with WHO GARD. One further impact will be the regional deployment in Norway, which can serve as a model of a national plan for the deployment of the EIP on AHA scaling-up strategy in other regions. For the Finnish and Norwegian Plans, follow-up and evaluation are already built in. No local or national plan should be started without an organized evaluation process. Both the process itself and the outcomes should be evaluated in order to learn for the future. It is already clear that a systematic approach to tackle the asthma and allergy burden works in different societies. The Finnish and Norwegian Plans can be adjusted and implemented locally in variable health care environments. Simple common goals and educational tools to do the job pave the way for improved public allergy health.


References

  1. Bousquet J, Anto JM, Demoly P, Schunemann HJ, Togias A, Akdis M, et al: Severe chronic allergic (and related) diseases: a uniform approach - a MeDALL-GA2LEN-ARIA position paper. Int Arch Allergy Immunol 2012;158:216-231.
  2. Bousquet J, Anto J, Berkouk K, Gergen P, Pinto-Antunes J, Camuzat T, et al: Developmental determinants in non-communicable chronic diseases and ageing. From research to novel policies and value creation. Thorax 2015, in press.
    External Resources
  3. Bousquet J, Bieber T, Fokkens W, Kowalski M, Humbert M, Niggemann B, et al: In allergy, ‘a new day has begun'. Allergy 2008;63:631-633.
  4. Haahtela T, von Hertzen L, Makela M, Hannuksela M: Finnish Allergy Programme 2008-2018 - time to act and change the course. Allergy 2008;63:634-645.
  5. Haahtela T, Valovirta E, Kauppi P, Tommila E, Saarinen K, von Hertzen L, et al: The Finnish Allergy Programme 2008-2018 - scientific rationale and practical implementation. Asia Pacific Allergy 2012;2:275-279.
  6. Bousquet J, Anto J, Auffray C, Akdis M, Cambon-Thomsen A, Keil T, et al: MeDALL (Mechanisms of the Development of ALLergy): an integrated approach from phenotypes to systems medicine. Allergy 2011;66:596-604.
  7. Bousquet J, Addis A, Adcock I, Agache I, Agusti A, Alonso A, et al: Integrated care pathways for airway diseases (AIRWAYS-ICPs). Eur Respir J 2014;44:304-323.
  8. Bousquet J, Michel J, Standberg T, Crooks G, Iakovidis I, Igelsia-Gomez M: The European Innovation Partnership on Active and Healthy Ageing: the European Geriatric Medicine introduces the EIP on AHA Column. Eur Geriatr Med 2014;5:361-362.
    External Resources
  9. Bousquet J, Dahl R, Khaltaev N: Global Alliance against Chronic Respiratory Diseases. Allergy 2007;62:216-223.
  10. Anto JM, Pinart M, Akdis M, Auffray C, Bachert C, Basagana X, et al: Understanding the complexity of IgE-related phenotypes from childhood to young adulthood: a Mechanisms of the Development of Allergy (MeDALL) seminar. J Allergy Clin Immunol 2012;129:943-954.e4.
  11. Bousquet J, Gern JE, Martinez FD, Anto JM, Johnson CC, Holt PG, et al: Birth cohorts in asthma and allergic diseases: report of a NIAID/NHLBI/MeDALL joint workshop. J Allergy Clin Immunol 2014;133:1535-1546.
  12. Pinart M, Benet M, Annesi-Maesano I, von Berg A, Berdel D, Carlsen KC, et al: Comorbidity of eczema, rhinitis, and asthma in IgE-sensitised and non-IgE-sensitised children in MeDALL: a population-based cohort study. Lancet Respir Med 2014;2:131-140.
  13. Hohmann C, Pinart M, Tischer C, Gehring U, Heinrich J, Kull I, et al: The development of the MeDALL core questionnaires for a harmonized follow-up assessment of eleven European birth cohorts on asthma and allergies. Int Arch Allergy Immunol 2014;163:215-124.
  14. Lupinek C, Wollmann E, Baar A, Banerjee S, Breiteneder H, Broecker BM, et al: Advances in allergen-microarray technology for diagnosis and monitoring of allergy: the MeDALL allergen-chip. Methods 2014;66:106-119.
  15. Westman M, Lupinek C, Bousquet J, Andersson N, Pahr S, Baar A, et al: Early childhood IgE reactivity to pathogenesis-related class 10 proteins predicts allergic rhinitis in adolescence. J Allergy Clin Immunol 2015;135:1199-1206.
  16. Norwegian Ministry of Health: Report to the Norwegian Parliament, No. 34 (2012-2013). Report on public health: good health - common responsibility. Melding til Stortinget Folkehelsemeldingen God helse - felles ansvar, 26.04.2013.
  17. Haahtela T, Tuomisto LE, Pietinalho A, Klaukka T, Erhola M, Kaila M, et al: A 10-year asthma programme in Finland: major change for the better. Thorax 2006;61:663-670.
  18. Haahtela T, Laatikainen T, Alenius H, Auvinen P, Fyhrquist N, Hanski I, et al: Hunt for the origin of allergy - comparing the Finnish and Russian Karelia. Clin Exp Allergy 2015;45:891-901.
  19. Hanski I, von Hertzen L, Fyhrquist N, Koskinen K, Torppa K, Laatikainen T, et al: Environmental biodiversity, human microbiota, and allergy are interrelated. Proc Natl Acad Sci USA 2012;109:8334-8339.
  20. Ruokolainen L, von Hertzen L, Fyhrquist N, Laatikainen T, Lehtomaki J, Auvinen P, et al: Green areas around homes reduce atopic sensitization in children. Allergy 2015;70:195-202.
  21. von Hertzen L, Beutler B, Bienenstock J, Blaser M, Cani PD, Eriksson J, et al: Helsinki alert of biodiversity and health. Ann Med 2015, Epub ahead of print.
  22. Fyhrquist N, Ruokolainen L, Suomalainen A, Lehtimaki S, Veckman V, Vendelin J, et al: Acinetobacter species in the skin microbiota protect against allergic sensitization and inflammation. J Allergy Clin Immunol 2014;134:1301-1309.e11.
  23. von Hertzen LC, Savolainen J, Hannuksela M, Klaukka T, Lauerma A, Makela MJ, et al: Scientific rationale for the Finnish Allergy Programme 2008-2018: emphasis on prevention and endorsing tolerance. Allergy 2009;64:678-701.
  24. Bousquet J, Khaltaev N: Global surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach. World Health Organization Global Alliance against Chronic Respiratory Diseases, 2007.
  25. Neuman A, Bergstrom A, Gustafsson P, Thunqvist P, Andersson N, Nordvall L, et al: Infant wheeze, comorbidities and school age asthma. Pediatr Allergy Immunol 2014;25:380-386.
  26. Hovland V, Riiser A, Mowinckel P, Carlsen KH, Carlsen KC: Asthma with allergic comorbidities in adolescence is associated with bronchial responsiveness and airways inflammation. Pediatr Allergy Immunol 2014;25:351-359.
  27. Lødrup Carlsen KC, Mowinckel P, Hovland V, Haland G, Riiser A, Carlsen KH: Lung function trajectories from birth through puberty reflect asthma phenotypes with allergic comorbidity. J Allergy Clin Immunol 2014;134:917-923.e7.
  28. Westman M, Stjarne P, Asarnoj A, Kull I, van Hage M, Wickman M, et al: Natural course and comorbidities of allergic and nonallergic rhinitis in children. J Allergy Clin Immunol 2012;129:403-408.
  29. Samolinski B, Fronczak A, Kuna P, Akdis CA, Anto JM, Bialoszewski AZ, et al: Prevention and control of childhood asthma and allergy in the EU from the public health point of view: Polish presidency of the European Union. Allergy 2012;67:726-731.
  30. Samolinski B, Fronczak A, Wlodarczyk A, Bousquet J: Council of the European Union conclusions on chronic respiratory diseases in children. Lancet 2012;379:e45-e46.

Author Contacts

Correspondence to: Prof. Karin C. Lødrup Carlsen

Women and Childrenʼs Division, Oslo University Hospital and

The Faculty of Medicine, University of Oslo

PO Box 4956 Nydalen, NO-0424 Oslo (Norway)

E-Mail k.c.l.carlsen@mail.uio.no


Article / Publication Details

First-Page Preview
Abstract of Brief Report

Received: January 29, 2015
Accepted: May 13, 2015
Published online: July 15, 2015
Issue release date: July 2015

Number of Print Pages: 8
Number of Figures: 4
Number of Tables: 5

ISSN: 1018-2438 (Print)
eISSN: 1423-0097 (Online)

For additional information: http://www.karger.com/IAA


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References

  1. Bousquet J, Anto JM, Demoly P, Schunemann HJ, Togias A, Akdis M, et al: Severe chronic allergic (and related) diseases: a uniform approach - a MeDALL-GA2LEN-ARIA position paper. Int Arch Allergy Immunol 2012;158:216-231.
  2. Bousquet J, Anto J, Berkouk K, Gergen P, Pinto-Antunes J, Camuzat T, et al: Developmental determinants in non-communicable chronic diseases and ageing. From research to novel policies and value creation. Thorax 2015, in press.
    External Resources
  3. Bousquet J, Bieber T, Fokkens W, Kowalski M, Humbert M, Niggemann B, et al: In allergy, ‘a new day has begun'. Allergy 2008;63:631-633.
  4. Haahtela T, von Hertzen L, Makela M, Hannuksela M: Finnish Allergy Programme 2008-2018 - time to act and change the course. Allergy 2008;63:634-645.
  5. Haahtela T, Valovirta E, Kauppi P, Tommila E, Saarinen K, von Hertzen L, et al: The Finnish Allergy Programme 2008-2018 - scientific rationale and practical implementation. Asia Pacific Allergy 2012;2:275-279.
  6. Bousquet J, Anto J, Auffray C, Akdis M, Cambon-Thomsen A, Keil T, et al: MeDALL (Mechanisms of the Development of ALLergy): an integrated approach from phenotypes to systems medicine. Allergy 2011;66:596-604.
  7. Bousquet J, Addis A, Adcock I, Agache I, Agusti A, Alonso A, et al: Integrated care pathways for airway diseases (AIRWAYS-ICPs). Eur Respir J 2014;44:304-323.
  8. Bousquet J, Michel J, Standberg T, Crooks G, Iakovidis I, Igelsia-Gomez M: The European Innovation Partnership on Active and Healthy Ageing: the European Geriatric Medicine introduces the EIP on AHA Column. Eur Geriatr Med 2014;5:361-362.
    External Resources
  9. Bousquet J, Dahl R, Khaltaev N: Global Alliance against Chronic Respiratory Diseases. Allergy 2007;62:216-223.
  10. Anto JM, Pinart M, Akdis M, Auffray C, Bachert C, Basagana X, et al: Understanding the complexity of IgE-related phenotypes from childhood to young adulthood: a Mechanisms of the Development of Allergy (MeDALL) seminar. J Allergy Clin Immunol 2012;129:943-954.e4.
  11. Bousquet J, Gern JE, Martinez FD, Anto JM, Johnson CC, Holt PG, et al: Birth cohorts in asthma and allergic diseases: report of a NIAID/NHLBI/MeDALL joint workshop. J Allergy Clin Immunol 2014;133:1535-1546.
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