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In Allergy, ‘A new day has begun’

2008; Wiley; Volume: 63; Issue: 6 Linguagem: Inglês

10.1111/j.1398-9995.2008.01730.x

1398-9995

Jean Bousquet, Thomas Bieber, W. J. Fokkens, Marek L. Kowalski, Marc Humbert, B. Niggemann, Hans‐Uwe Simon, A. A. Cruz, Tari Haahtela,

Food Allergy and Anaphylaxis Research

‘A new day has begun’ is the last verse of the Cats song ‘Memory’. Cats is an award-winning musical composed by Andrew Lloyd Webber and based on Old Possum’s Book of Practical Cats and other poems by T. S. Eliot. The show has been performed around the world in numerous productions and has been translated into more than 20 languages. Cats became the longest-running musical in Broadway history with 6138 performances. In the Cats musical, the audience finds itself in a huge junkyard. Onstage, a special breed of cats, known as Jellicle cats, are making their way to the junkyard. The ultimate goal is that one of the cats will be chosen to be reborn in heaven. Magical Mr Mistoffelees can perform many feats of magic that no other cat can, and the magical cat succeeds in bringing Grizabella back who appears for the final time. She addresses the cats and explains how she wants to be reborn for a second chance to live differently – to live the happy memories she has. The appeal succeeds and she is chosen to be the one. ‘A new day has begun’. The prevalence of allergic disease has grown in all countries of the world resulting in a global health problem. Although the origin of allergy remains unresolved, increasing evidence indicates that modern man living in an urban-built environment is deprived of environmental protective factors that are fundamental for normal tolerance development (1). Many recent papers of the Journal have dealt with this issue (2–6). The increase in allergic disease is not restricted to developed countries (7–9) although in countries with endemic parasitosis, mechanisms associated with the increased allergy prevalence may differ (10). The cost of inaction is unacceptable and national plans need to be commenced to reduce the increased prevalence and severity of allergic disease. The aim of the Finnish national 10-year program is to reduce the burden of allergies. It is presented in this issue of the Journal (11). The main goals are: (i) to prevent the development of allergic symptoms; (ii) to increase tolerance against allergens; (iii) to improve the diagnostics; (iv) to decrease work-related allergies; (v) to allocate resources to manage and prevent exacerbations of severe allergies; and (vi) to decrease costs pertaining to allergic diseases. The aim is to increase immunologic tolerance and to change attitudes to support health, instead of medicalizing common and mild allergy symptoms. This program uses the very innovative methods of the extremely effective 10-year asthma plan which states that ‘a community problem needs community solutions’ (12) and which leads to ‘major change for the better’. After 10 years (1994–2004), the results are impressive (13). The incidence of asthma is still increasing, but the burden of asthma has decreased considerably. The number of hospital days has fallen by 54%. The number of patients of working age who receive a disability pension from the Social Insurance Institution has decreased by around 80%. The increase in the cost of asthma (compensation for disability, drugs, hospital care and outpatient doctor visits) has ended: in 1993, the costs were 218 million € and in 2003, they had fallen to 213.5 million €. Costs per patient per year have decreased by 36% (from 1 611€ to 1 031€). This plan has convincingly shown that it is possible to reduce the morbidity of asthma as well as its impact on individuals and society. Other national or regional asthma plans have been shown to reduce asthma morbidity and costs, even in developing countries or deprived areas (14–17), but the Finnish asthma plan was the first and has changed the paradigm of asthma. All stakeholders in Finland are part of this program, from the Ministry of Health to insurance institutions, the Lung Health association, medical and other healthcare worker societies and, very importantly, patients. This is the key factor for a successful outcome of the program. The Finnish National Allergy 10-year program takes advantage of the network that was created during the Asthma Program (12). Methods are defined for each goal, for specific tasks, tools and evaluation procedures (11). Nationwide implementation acts through the network of local coordinators (primary care physicians, nurses and pharmacists). It is clear that all healthcare professionals should be involved in a coordinated scheme for the optimal success of a health plan (18). The program is very ambitious but achievable. The prevalence of allergic diseases needs to be reduced by 20%, occupational allergic diseases by 50% and predefined costs by 20%. These goals are similar to those of the World Health Organization concerning chronic diseases (19). Interestingly, the Finnish program is part of the global fight against chronic respiratory diseases, the Global Alliance against Chronic Respiratory Diseases, of the World Health Organization (GARD) (20, 21). GARD will promote this program around the world, as once translated and adapted, it can be used in many countries. We all think that the new Finnish Allergy Program will be at least as successful as the Cats musical and will be an award-winning program with many translations for the utmost benefit of our patients. We wish the program great success and we do think that ‘In Allergy, a new day has begun’.