Allergiaohjelma – Mikä muuttui?

Esitys aiheesta: "Allergiaohjelma – Mikä muuttui?"— Esityksen transkriptio:

1 Allergiaohjelma – Mikä muuttui?

2 SLL 2015

3 Goals of the Finnish Allergy Programme
Goals defined in a multidisciplinary Allergy Programme Councelling Group acc. the goals of WHO concerning chronic diseases ► Prevent allergies – Support Allergy Health! Indicator: prevalence of asthma, allergic rhinitis and atopic dermatitis reduces by 20 % ► Increase tolerance to allergens in the population Indicator: avoidance diets to foods decrease by 50 % ► Improve allergy diagnostics Indicator: all patients are tested in a quality certified allergy-testing centre ► Reduce work related allergies Indicator: Their numbers reduce by 50 % ► Focus to severe allergies and reduce attacks Indicator: ”Good Allergy Care” employed in the country, asthma attacks reduced by 40 % ► Reduce costs caused by allergies Indicator: total costs of allergic diseases reduced by 20 % in 10 years Haahtela T, et al. Finnish Allergy Programme – time to act and change the course. Allergy 2008 von Hertzen L, et al. Scientific rationale of the Finnish Allergy Programme Allergy 2009 Bousquet J, et al. In Allergy, ”A new day has begun”. Allergy 2008, Editorial Haahtela T et al. The Finnish Allergy Programme works. Eur Respir J 2017

4 Goals of the Finnish Allergy Programme
Goals defined in a multidisciplinary Allergy Programme Councelling Group acc. the goals of WHO concerning chronic diseases ► Prevent allergies – Support Allergy Health! Indicator: prevalence of asthma, allergic rhinitis and atopic dermatitis reduces by 20 % ► Increase tolerance to allergens in the population Indicator: avoidance diets to foods decrease by 50 % ► Improve allergy diagnostics Indicator: all patients are tested in a quality certified allergy-testing centre ► Reduce work related allergies Indicator: Their numbers reduce by 50 % ► Focus to severe allergies and reduce attacks Indicator: ”Good Allergy Care” employed in the country, asthma attacks reduced by 40 % ► Reduce costs caused by allergies Indicator: total costs of allergic diseases reduced by 20 % in 10 years Haahtela T, et al. Finnish Allergy Programme – time to act and change the course. Allergy 2008 von Hertzen L, et al. Scientific rationale of the Finnish Allergy Programme Allergy 2009 Bousquet J, et al. In Allergy, ”A new day has begun”. Allergy 2008, Editorial Haahtela T et al. The Finnish Allergy Programme works. Eur Respir J 2017

5 Goals of the Finnish Allergy Programme
Goals defined in a multidisciplinary Allergy Programme Councelling Group acc. the goals of WHO concerning chronic diseases ► Prevent allergies – Support Allergy Health! Indicator: prevalence of asthma, allergic rhinitis and atopic dermatitis reduces by 20 % ► Increase tolerance to allergens in the population Indicator: avoidance diets to foods decrease by 50 % ► Improve allergy diagnostics Indicator: all patients are tested in a quality certified allergy-testing centre ► Reduce work related allergies Indicator: Their numbers reduce by 50 % ► Focus to severe allergies and reduce attacks Indicator: ”Good Allergy Care” employed in the country, asthma attacks reduced by 40 % ► Reduce costs caused by allergies Indicator: total costs of allergic diseases reduced by 20 % in 10 years Haahtela T, et al. Finnish Allergy Programme – time to act and change the course. Allergy 2008 von Hertzen L, et al. Scientific rationale of the Finnish Allergy Programme Allergy 2009 Bousquet J, et al. In Allergy, ”A new day has begun”. Allergy 2008, Editorial Haahtela T et al. The Finnish Allergy Programme works. Eur Respir J 2017

6 Goals of the Finnish Allergy Programme
Goals defined in a multidisciplinary Allergy Programme Councelling Group acc. the goals of WHO concerning chronic diseases ► Prevent allergies – Support Allergy Health! Indicator: prevalence of asthma, allergic rhinitis and atopic dermatitis reduces by 20 % ► Increase tolerance to allergens in the population Indicator: avoidance diets to foods decrease by 50 % ► Improve allergy diagnostics Indicator: all patients are tested in a quality certified allergy-testing centre ► Reduce work related allergies Indicator: Their numbers reduce by 50 % ► Focus to severe allergies and reduce attacks Indicator: ”Good Allergy Care” employed in the country, asthma attacks reduced by 40 % ► Reduce costs caused by allergies Indicator: total costs of allergic diseases reduced by 20 % in 10 years Haahtela T, et al. Finnish Allergy Programme – time to act and change the course. Allergy 2008 von Hertzen L, et al. Scientific rationale of the Finnish Allergy Programme Allergy 2009 Bousquet J, et al. In Allergy, ”A new day has begun”. Allergy 2008, Editorial Haahtela T et al. The Finnish Allergy Programme works. Eur Respir J 2017

7 Goals of the Finnish Allergy Programme
Goals defined in a multidisciplinary Allergy Programme Councelling Group acc. the goals of WHO concerning chronic diseases ► Prevent allergies – Support Allergy Health! Indicator: prevalence of asthma, allergic rhinitis and atopic dermatitis reduces by 20 % ► Increase tolerance to allergens in the population Indicator: avoidance diets to foods decrease by 50 % ► Improve allergy diagnostics Indicator: all patients are tested in a quality certified allergy-testing centre ► Reduce work related allergies Indicator: Their numbers reduce by 50 % ► Focus to severe allergies and reduce attacks Indicator: ”Good Allergy Care” employed in the country, asthma attacks reduced by 40 % ► Reduce costs caused by allergies Indicator: total costs of allergic diseases reduced by 20 % in 10 years Haahtela T, et al. Finnish Allergy Programme – time to act and change the course. Allergy 2008 von Hertzen L, et al. Scientific rationale of the Finnish Allergy Programme Allergy 2009 Bousquet J, et al. In Allergy, ”A new day has begun”. Allergy 2008, Editorial Haahtela T et al. The Finnish Allergy Programme works. Eur Respir J 2017

8 Goals of the Finnish Allergy Programme
Goals defined in a multidisciplinary Allergy Programme Councelling Group acc. the goals of WHO concerning chronic diseases ► Prevent allergies – Support Allergy Health! Indicator: prevalence of asthma, allergic rhinitis and atopic dermatitis reduces by 20 % ► Increase tolerance to allergens in the population Indicator: avoidance diets to foods decrease by 50 % ► Improve allergy diagnostics Indicator: all patients are tested in a quality certified allergy-testing centre ► Reduce work related allergies Indicator: Their numbers reduce by 50 % ► Focus to severe allergies and reduce attacks Indicator: ”Good Allergy Care” employed in the country, asthma attacks reduced by 40 % ► Reduce costs caused by allergies Indicator: total costs of allergic diseases reduced by 20 % in 10 years Haahtela T, et al. Finnish Allergy Programme – time to act and change the course. Allergy 2008 von Hertzen L, et al. Scientific rationale of the Finnish Allergy Programme Allergy 2009 Bousquet J, et al. In Allergy, ”A new day has begun”. Allergy 2008, Editorial Haahtela T et al. The Finnish Allergy Programme works. Eur Respir J 2017

9 Goals of the Finnish Allergy Programme
Goals defined in a multidisciplinary Allergy Programme Councelling Group acc. the goals of WHO concerning chronic diseases ► Prevent allergies – Support Allergy Health! Indicator: prevalence of asthma, allergic rhinitis and atopic dermatitis reduces by 20 % ► Increase tolerance to allergens in the population Indicator: avoidance diets to foods decrease by 50 % ► Improve allergy diagnostics Indicator: all patients are tested in a quality certified allergy-testing centre ► Reduce work related allergies Indicator: Their numbers reduce by 50 % ► Focus to severe allergies and reduce attacks Indicator: ”Good Allergy Care” employed in the country, asthma attacks reduced by 40 % ► Reduce costs caused by allergies Indicator: total costs of allergic diseases reduced by 20 % in 10 years Haahtela T, et al. Finnish Allergy Programme – time to act and change the course. Allergy 2008 von Hertzen L, et al. Scientific rationale of the Finnish Allergy Programme Allergy 2009 Bousquet J, et al. In Allergy, ”A new day has begun”. Allergy 2008, Editorial Haahtela T et al. The Finnish Allergy Programme works. Eur Respir J 2017

10 Kainuu 12/2008 12/2010

11 Kainuu 12/2008 12/2010

12 Kainuu 12/2008 12/2010

13 The Finnish Allergy Programme 2008-2018 in action
Education for opinion leaders, specialists, health care – and other professionals 340 educational sessions so far, more than participants; from PC appr 9000 Regional education with varying themes for primary care Multidisciplinary – doctors, nurses, pharmacists, dieticians, lab personnel, medical and nursing students… Free of charge At their own hospital / health center during working hours Practical topics tailored to meet the local needs An allergy specialist and a nurse by Filha always on the spot Educational sessions completed April Oct 2017

14 Käypä hoito -suositukset
Astman Käypä hoito –suositus Lasten ruoka-allergian Käypä hoito –suositus Atooppisen ihottuman Käypä hoito –suositus Siedätyshoito Käypä hoito –suositus Tupakasta vierotus Käypä hoito –suositus Liikunnan Käypä hoito –suositus Lasten lihavuus Käypä hoito –suositus Aikuisten lihavuus Käypä hoito –suositus Kosteus ja homevauriopotilas -suositus

15 Severe (uncontrolled) asthma in Finland
Allergy Barometer Study in Finnish Pharmacies 20 % Severe (uncontrolled) asthma in Finland 1990–2016 10 % 4 % 2,4 % Early 1990s 2001 2010 2016 Haahtela T, Laitinen LA, The Finnish Asthma Programme Group. Clin Exp Allergy 1996 Kauppi P, et al. Asia Pacific Allergy 2015 Kauppi P, Jantunen J, et al. 2017, preliminary data

16 Daily smokers in Finland 1997–2015 We still have a lot to do!
2015: Men: 19% Women: 15 % Asthma patients smoke as much as others

17 A) Reduction of asthma emergency visits
Haahtela T, and the Programme Group. Finnish nationwide allergy programme at mid-term – Change of direction producing results. The Finnish Medical Journal 2015 A) Reduction of asthma emergency visits – 46%, in children – 63% B) Increase in asthma patients on maintenance medication, and decrease in hospital days – 67%

18 Reducing Health Care Costs and Disability
- 15% Haahtela T, and the Allergy Programme Group. The Finnish Medical Journal 2015

19 Ammattitaudit: Hengitystieallergiat diagnoosin mukaan 2010–2014 Irmeli Lindström www.ttl.fi

20 Ammattitaudit: Ihotaudit diagnoosin mukaan 2010–2014 Irmeli Lindström www.ttl.fi

21

22 Varhainen ihoaltistuminen  allerginen herkistyminen Varhainen per os altistuminen  toleranssi MERKITYSTÄ AJOITUKSELLA ja IHO & ORAL TASAPAINOLLA JACI, Lack G 2012, Amer Acad All Asthma & Immunol 2014

23 Ehkäisy Yksinomaisella yli 4 kuukautta kestävällä rintaruokinnalla ei voida pienentää allergisten sairauksien riskiä. Sietokyky ruoka-aineille näyttää syntyvän parhaiten, kun kiinteiden ruokien antaminen aloitetaan 4–6 kuukauden iässä. Imetystä suositellaan jatkettavaksi lisäruoan ohella 1 vuoden ikään saakka. Kiinteiden ruokien aloittaminen yksilöllisen tarpeen mukaan 4–6 kuukauden iässä myös allergiaperheissä saattaa pienentää ruoka-allergian, allergisten sairauksien tai allergisen herkistymisen kehittymisen riskiä. Jos rintamaito ei riitä, käytetään yleensä tavallista lehmänmaitopohjaista korviketta. Jos rintamaito on riittämätön ravinnonlähde, käyttämällä osittain tai pitkälle pilkottuja korvikkeita ensimmäisten 4 kuukauden aikana on allergiariskiperheen lapsella voitu vähentää ekseemaa muttei ruoka-allergiaa.

24

25

26 Päiväkotien allergiaruokavalioiden kuormaa voidaan vähentää käytänteitä uusimalla, SLL 2016
Tarpeettomiksi tulleet ja perusteettomat allergiaruokavaliot kuormittavat perheitä ja päivähoitoa ja voivat haitata lapsen normaalia kasvua ja kehitystä LILLA-tutkimuksen tavoitteena oli päivähoidon allergiaruokavalioiden määrän vähentäminen käyttämällä uutta erityisruokavalion ilmoituslomaketta, joka ohjasi arvioimaan ruokavaliota allergiaohjelman perusteiden mukaisesti

27 After 2 years, the new special diet form was used by 64% of families with food-allergic children, and the prevalence of allergy diets in daycare centers decreased by 43% to 4.3% (IQ range 3.05–5.96). A significant decrease was found in the prevalence of all basic (milk, grains, egg) and most other allergy diets (P for trend < 0.01).

28 Ruokasiedätys Hypoteesi: antamalla potilaalle kasvavin annoksin ruoka-ainetta, jolle hän on herkistynyt, saadaan aikaan sietokyvyn vahvistuminen (desensitisaatio) ja osalle toleranssin kehittyminen ko. ruoka-aineelle Sietokyvyn vahvistuminen: annosmäärä, mikä aiheuttaa allergiset oireet, nousee vahinkoaltistuksen aiheuttaman reaktio todennäköisyys laskee sietokyvyn ylläpitäminen edellyttää päivittäistä käyttöä Toleranssin kehittyminen: Tutkimustulokset: ainakin osittainen toleranssi saadaan indusoitua 50-90%:lle potilaista (maito, muna, pähkinä)

29 Are we reaching the Goals?
► Prevent allergies Indicator: prevalence of asthma, allergic rhinitis and atopic dermatitis reduces by 20 % No data yet, but several follow-ups ongoing (military conscripts, FinEsS-study) ► Increase tolerance to allergens in the population Indicator: avoidance diets to foods decrease by 50 %. Allergy diets in schools -50%, in day-care centres -40%, some variation in the country ► Improve allergy diagnostics Indicator: all patients are tested in a quality certified allergy-testing centre. 30 hospital and other centres audited and certidied ► Reduce work related allergies Indicator: Their numbers reduce by 50 %. Occupational allergies reduced by 40%, asthma -24% ► Focus to severe allergies and reduce attacks Indicator: ”Good Allergy Care” employed in the country, asthma attacks reduced by 40 % Emergy visits -46%, asthma hospital days -67% ► Reduce costs caused by allergies Indicator: total costs of allergic diseases reduced by 20 % in 10 years. Total costs in the 2000s -15%; in %

30 21 Health Care Districts cowerned by County Councils
Turku Vaasa Joensuu Mikkeli Lahti Tampere Oulu Kokkola Kotka Porvoo Seinäjoki Maarianhamina Kuopio Pori 21 Health Care Districts cowerned by County Councils The goal is to have a Local Allergy Committee LAC in every district (at the moment n=14) by the end of the Programme in 2018 In the future LAC organizes allergy and asthma education for all stakeholders in the HC to support and increase Allergy Health!

31 ALUEELLINEN ALLERGIA TYÖRYHMÄ!
Allergia- ja astmakoulutuksen jatko Kainuun sosiaali- ja terveydenhuollon Kuntayhtymässä: ALUEELLINEN ALLERGIA TYÖRYHMÄ!

32