allergic diseases epidemiology, cost of diseases and quality of life

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Allergic diseases: epidemiology, cost of diseases and quality of life.

Prof DR Dr Ariyanto Harsono SpA(K)

Prof DR Dr Ariyanto Harsono SpA(K) 2

Introduction

• Epidemiological studies indicate a world-wide and significant increase in atopic diseases over the past decades, which has adopted alarming dimensions within the industrialized world. However, allergic asthma and pollinosis, in particular, are on the increase in Third world countries, in parallel to the industrialization and westernization of their life-style. Since both antigen exposure and the presence of additional realization factors are required for the manifestation of atopic diseases, this increase in prevalence is not surprising.


In addition to increased indoor and outdoor pollution, changes in the way of living--causing increased allergen exposure--certainly play an important role as cofactor in the increased incidence of allergies. Accurate diagnostic procedures permit a better understanding of the realization factors for allergic diseases in epidemiological studies and identification of the causative agent in the individual so that effective therapeutic and prophylactic steps can be taken.

Introduction…….


GENETIC FACTOR

•ALLERGEN•INFECTION• POLUTANT

ENVIRONMENT FACTOR

ALLERGIC DISEASESGern JE, Lemanske Jr RF. Immunol Allergy North Amer 1999; 19:233-52


Introduction…….

• Epidemiological information from Switzerland and Japan shows that the prevalence of atopy is increasing in children. In both these studies the increase in the prevalence of atopy was due to an increase in sensitisation to a variety of allergens and not dominated by an increase in sensitisation to one particular allergen. In Britain no evidence exists that exposure to allergen has increased—in fact grass pollen levels have steadily decreased over the past 20 years and pet ownership has probably not changed.


Epidemiology


Annual changes in prevalence of asthma in ISAAC phase I and phase III in Europe


Annual changes in prevalence of allergic rhinoconjunctivitis in ISAAC phase I and phase III in

Europe


Food Allergy Affect 200-250 million

globally CDC: 1998-2000 to 2007-

2009, food allergy increased from 3.5% to 4.6% cases

Food hypersensitivity is the most cases found in the early years of life, affecting about 6% of <3 years of age and decreasing over the first decade

15

Asthma Morbidity@Mortality

Braman SS: Chest 2006;130;4S-12S



Prevalence of food allergyFood Self report Skin prick test/IgE

specific/food challenge

Milk 3.5% (95%CI,2.9%-4.1%)

0.6% to 0.9%

Egg 1.3% (95% CI, 1.0%-1.6%)

0.3% to 0.9%

Peanuts 0.75% (95%CI, 0.6%-0.9%)

0.75%

Fish 0.6% (95% CI, 0.5% 0.7%)

0.2%

Shellfish 1.1% (95% CI, 1.0%-1.2%)

0.6%

Chafen JJS, et al. JAMA. 2010;303(18):1848-56.


Atopic dermatitis

• Atopic dermatitis affects 5-20% of children at ages 6-7 months and 13-14 years

• AD increased lifetime prevalence in Africa, Eastern Asia, Western and Nothern part of Europe

• Female : Male = 1.3 : 1

Williams H, et al. J Allergy Clin Immunol, January 1999Deckers IAG, et al. Investigating International Time Trends in the Incidence and Prevalence of Atopic

Eczema 1990–2010: A Systematic Review of Epidemiological Studies

http://www.jacionline.org/issues?issue_key=S0091-6749(05)X7101-9


Urticaria & Angioedema

Angioedema:• Angioedema frequently associated with

urticaria but 10% occurs alone• Prevalence angioedema in chillhood was 2-

5%

Urticaria :• Prevalence of urticaria in the first 3 years of

life was 3.2% & 1% at 5 years of age

Cantani A. Pediatric Allergy, Asthma & Immunology. Springerlink. Berlin.2008. 380


Prevalence of allergy in children (cross sectional)

Asthma Allergic Rhinitis Atopic Dermatitis Munasir Z, et al

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Asthma Fatality Rate

Chest 2006;130;4S-12S


Burden of Allergic Diseases

• The World Allergy Organization presented data this week on the marked global increase of allergic diseases, highlighting that allergies are becoming more severe and complex and that the heaviest burden is on children and young adults. Allergy interacts with many other environmental factors such as pollutants, infections, lifestyle, and diet that increase the impact on chronic disease.


• WAO addressed the need for increased disease awareness, improved patient care, better healthcare delivery and a focus on preventative strategies during international press conference.


…burden of allergic disease

Economic burden:• Drug prescription• Consultation to

physician• Hospital admission• Indirect costs


…burden of allergic disease

Parental reports of the most bothersome nasal allergy symptoms.


Component of financial burden of allergic diseases

DIRECT COST INDIRECT COST

Physician office visitsLaboratory testsMedicationImmunotherapyTreatment of co-morbidities

AbsenteeismDecreased productivity at work/schoolSleeping disorders

Impaired quality of life for patients and parents/family

Pawankar R, et al. WAO White Book on Allergy 2011


Approximately 30 to 40 percent of the world’s population suffers from allergic diseases, and the prevalence is escalating to epidemic proportions. According to the World Health Organization (WHO):

o An estimated 300 million individuals have asthma worldwide, a figure that could increase to 400 million by 2025 if trends continue.

o Allergic rhinitis, which is a risk factor for asthma, affects 400 million people annually, and

o Food allergies affect about 200 to 250 million. o An estimated 250,000 avoidable deaths from asthma

occur each year. Chest 2006;130;4S-12S


Asthma is a significant expense for society and healthcare systems

As prevalence increases, so do costs. The total costs of asthma in the US are estimated to have increased

between the mid 1980s and the mid 1990s from approximately US$4.5 billion to over US$10 billion.

Weiss and colleagues estimated the total asthma costs for Australia, the UK and the US (adjusted to 1991 US dollars for comparison purposes) at US$457 million, US$1.79 billion and US$6.40 billion, respectively.

Updating these figures to 2003 dollars using the Consumer Price Index (CPI) yields approximately US$617 million, US$2.42 billion and US$8.64 billion, respectively.

Total cost of asthma in the US in 1998 was estimated at US$12.67 billion (based on 1994 actual costs adjusted to 1998 dollars using the CPI); the adjusted cost (using the CPI) projected to 2003 would be US$13.34 billion.


Globally, the economic costs associated with asthma exceed those of tuberculosis and HIV/AIDS combined.

Developed economies can expect to spend 1 to 2% of their health-care budget on asthma.

Investigations have shown22 that the financial burden on patients with asthma in different Western countries ranges from $300 to $1,300 per patient per year.

In the United States, the total direct medical and indirect economic costs (ie, loss of school or work days, lost productivity, premature retirement) of asthma were approximately $12 billion in 1994, representing an increase of 50% from just 10 years before, mainly because of an increase in indirect economic costs.

The indirect costs represent not just costs relating to the patient but, if the patient is a child, also to their family; in England, 69% of parents or partners of parents of asthmatic children reported having to take time off work because of their child’s asthma, and 13% had lost their jobs.


Barriers to Reducing the Burden of Asthma

Poverty; inadequate resources Low public health priority Poor health-care infrastructure Difficulties in implementing guidelines developed in wealthier

countries Limited availability of and access to medication Lack of patient education Environmental factors Tobacco Pollution Occupational exposure Poor patient compliance Chest 2006;130;4S-12S


As the prevalence of allergic disease rises in countries around the world regardless of their economic status, so do the socioeconomic costs both direct: interference with breathing during day or night,emergency department visits, hospitalizationsand indirect reduced quality of life, reduced work productivity and absenteeism.


WAO recommends

(1) increased, availability and accessibility to allergy diagnosis and therapies

(2) increased resources dedicated to advanced research toward preventive strategies to increase tolerance to allergens and slow disease progression and

(3) global partnerships of multi-disciplinary teams, involving clinicians, academia, patient representatives, and industry.

The common goal is to reduce the burden of allergic diseases and develop cost-effective, innovative preventive strategies and a more integrated, holistic approach to treatment. These efforts can thereby prevent premature and unwanted deaths and improve quality of life.


Health-Related Quality of Life An important predictor of low Health Related Quality of Life (HRQL) was

allergic disease (i.e. asthma, eczema, rhino conjunctivitis) in addition to food hypersensitivity.

The higher the number of allergic diseases, the lower the physical HRQL for the child, the lower the parental HRQL and the more disruption in family activities.

Male gender predicted lower physical HRQL than female gender. If the child had sibling(s) with food hypersensitivity this predicted lower psychosocial HRQL for the child and lower parental HRQL.

Food-induced gastro-intestinal symptoms predicted lower parental HRQL food-induced breathing difficulties predicted higher psychosocial HRQL

for the child and enhanced HRQL with regards to the family's ability to get along.


• The variance in the child's physical HRQL was to a considerable extent explained by the presence of allergic disease. However, food hypersensitivity by itself was associated with deterioration of child's psychosocial HRQL, regardless of additional allergic disease. The results suggest that it is rather the risk of food reactions and measures to avoid them that are associated with lower HRQL than the clinical reactivity induced by food intake. Therefore, food hypersensitivity must be considered to have a strong psychosocial impact.


Asthma is a chronic disorder that can significantlyimpact the quality of life of the affected patients and

their families. Uncontrolled or poorly controlledasthma can:

• disturb sleep;• increase fatigue and decrease energy;• produce difficulty concentrating;• restrict physical activity and exercise;• cause absences from work and/or school; and• reduce participation in normal daily activities


A total of 232 patients with allergic rhinitis, 40 with asthma, and 44 with both diseases were enrolled. The mean (SD) age was 32

(13) years and 65% were females.

HRQL was significantly lower in patients with asthma, with or without rhinitis, than in those with allergic rhinitis alone.

• Female sex, • Older age, • Increased BMI and • Less educational status were found to be the major determinants of impaired

quality of life in patients with allergic rhinitis or asthma.

Internat. Arch. Allergy Immunol. (2003);130: pp. 2–9.

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Figure. Mean (SD) physical component summary (PCS) and mentalcomponent summary (MCS) health related quality of life scores in the

3 study groups.

J Investig Allergol Clin Immunol 2008; Vol. 18(3): 168-173

Rinitis Alergika

asma

Asma+rinitis

PCS MCS


quality of life was significantly impaired in patients with asthma with or without rhinitis than in those with allergic rhinitis only. However the results of our study suggest that the impairment in HRQOL seen in asthmatic patients may be similar to or not greater than that experienced by the patients with “one airway disease.” The major determinants of impaired HRQOL are

female sex, higher BMI, and older age as a reflection of the duration of the disease. Further investigation with larger populations is needed in order to

determine the extent to which asthma and rhinitis comorbidities are associated in HRQOL.

J Investig Allergol Clin Immunol 2008; Vol. 18(3): 168-173


Conclusions

• Prevalence of allergic diseases are increasing

• Burden of the diseases includes symptom burden, impaired quality of life and productivity, co-morbidities, complications, and disease management (economic burden)

• Allergy prevention is highly needed


Thank You

allergic diseases epidemiology, cost of diseases and quality of life

Education

increase inprevalence

increase insensitisation

annual changes

prevalence of asthma

oneparticular allergen

epidemiological information

isaac phase

allergic asthma