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'It will help to list allergy as a superspeciality'


About 20 to 30 per cent of people in India, especially children, suffer from allergic diseases. And it is predicted that about 50 per cent of all children in India will have some sort of allergy by 2050. Dr Ruby Pawankar, a professor of paediatrics and allergy at the Nippon Medical School in Tokyo, has taken on the task of improving allergy-care globally. This year she was appointed the president of the World Allergy Organisation - the first woman president in its 61-year-old history. In an interview with TOI-Crest, Pawankar talks about how allergy patients in India often go untreated or under-diagnosed due to lack of clinical specialty and the need to develop allergies as a medical superspeciality

How common have allergies become?

Allergies affect up to 30-40 per cent of the population worldwide, and the severity and complexity of allergic diseases, including asthma, continue to increase. This escalation in the prevalence of allergies is especially seen in children and young adults. Globally, 300 million people suffer from asthma, and approximately 200 to 250 million people suffer from food allergies. One tenth of the population suffers from drug allergies and 400 million from rhinitis. This dramatic increase is observed as societies become more affluent and urbanised, outdoor and indoor pollution increase, and lifestyle and dietary habits change. In Asia, the prevalence of allergic diseases varies widely but was found to have increased from 0. 8 to 29. 1 per cent for asthma and from 5 per cent to 45 per cent for allergic rhinitis. Time trends in the prevalence of asthma symptoms also showed different regional patterns. For example, while there's been a decrease in wheezing in children aged 13 to 14 years in Western Europe, it has increased in the same age group in the Asia-Pacific region.

What are Indians most allergic to?

In Asia, it is the house dust mite. In Europe and northern America, often, pollens. In Japan, Japanese cedar pollen is a major cause in addition to dust mite. Also different pollens from trees, grass and weeds. Food allergies in very small children in early life are usually due to cow's milk and egg. Other foods that can cause food allergies are shell fish like shrimps, prawns, lobsters and crabs, nuts, lentils, chickpeas, wheat etc.

Are scientists close to a cure for allergies?

Currently, there is no complete cure for allergy. What makes it more complicated is that there are different phenotypes that may respond differently to different treatments. But there are very good treatments available for asthma and rhinitis that can control these diseases. One of the disease modifying treatments that can potentially be very beneficial is immunotherapy which is also one of the topics which will be discussed in the upcoming WAO International Scientific Conference in Hyderabad in December.

Does India have enough doctors to treat allergies?

Despite the high prevalence of allergic diseases in the population, expert or specialist allergy treatment is very difficult to access in many countries, and there is a lack of appropriate training not only at the undergraduate level but also at the postgraduate level. In India, most of the time patients with allergic diseases are seen by organbased specialists such as respiratory physicians, ear, nose and throat specialists, ophthalmologists, dermatologists depending on the organ affected. But since one individual can have multiple allergies, it becomes tedious for the patient to consult the various specialists in the absence of one allergy expert. For example, allergic rhinitis, skin allergies, and asthma are three problems which may commonly manifest together, yet affect three different organ systems. Having the speciality of allergy, like other super specialities, can help address this issue and result in a more integrated, holistic approach to treatment.

What should the Indian government do to help the situation?

Training at undergraduate level will help medical professionals to understand and better treat allergic diseases at the primary care level. At super specialty level, there is a need to have allergy as a super specialty. We are already in dialogue with the health ministry in India and other countries that lack the specialty to institute that kind of training both at undergraduate level and as a separate field of specialty at the post graduate level. Besides, the World Allergy Organisation is also partnering with member organisations to help initiate various training schools to increase capacity building and to create better and awareness.

What are the misconceptions people have about allergies?

In many parts of the world, there is a lack of adequate education about, and awareness of, the morbidity and mortality associated with allergic diseases;allergic diseases are often trivialised and the chronic nature of these diseases is not well understood. Moreover, the importance of consulting a specialist early enough and early diagnosis and the need to continue adequate and appropriate treatment that can control the disease is not well understood.

Why is it necessary to recognise allergic diseases as a global public
health concern?

A steady increase in the prevalence of allergic diseases globally has occurred. A high proportion of this increase is occurring in young subjects (asthma in infancy often goes unrecognised and thus untreated ). Therefore, as this young population reaches adulthood, the burden of allergic diseases is expected to increase even more. Complex allergies involving polysensitisation and multiple organ involvement are increasing, with a high morbidity placing a higher demand on health care delivery services. The Global Initiative on Asthma estimates that approximately 2, 50, 000 persons die of asthma annually.

It is forecast that allergic problems will increase further as air pollution and the ambient temperature increase. These environmental changes will affect pollen counts, the presence or absence of stinging insects, and the presence or absence of moulds associated with allergic diseases. In many countries, attempts to tackle these problems on a national basis are widely variable and fragmented, resulting in decreased quality of life, increased morbidity and mortality, and considerable cost to patients with allergic diseases.

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