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Do children outgrow allergy or asthma?
Transcript of Do children outgrow allergy or asthma?
Can we ever agree on
Understanding (& accepting)
the ability to blah blab blah.
Avoiding the trap of
the ability to blah blab blah.
Why are definitions important?
Asthma definition in children (ICON)
A hypersensitivity reaction initiated by immunological mechanisms
WHAT about ALLERGY !?
when there's no pressure.
which can hijack your mind, leaving
no room for creative genius
pressure and judgement create
That pressure to be creative comes from different sources.
It's the pressure we put on
that's so critical, because it's so
and so destructive.
The design of
We have to admit that our interventions in terms of natural history
are at their infancy
Some guided people.
Some guided families.
Others lived in the walls
and belonged to the house itself.
Some children will outgrow their asthma or allergy
Some other will not
by proactively managing risk
by making the environment right
by better understanding the mechanisms
by using and improving the specific treatments
What is your
Do children outgrow asthma or allergy?
University of Manchester, UK
University of Athens, Greece
The natural history of allergy and can we do anything about it ?
Because they can radically change the way we see things
“Asthma is a chronic inflammatory disorder associated with variable airflow obstruction and bronchial hyperresponsiveness.
It presents with recurrent episodes of wheeze, cough, shortness of breath, chest tightness.”
Allergy 67 (2012) 976-97
Taussig JACI 2003; 11:661
Morgan AJRCCM 2005; 172:1253
Illi Lancet 2006;368:763−70
Phelan JACI 2002; 109:189-94
The Tuscon Study
The MAS Study
The Melbourne study
Johansson et al. Allergy 2001
which makes one wonder...
Why do we almost always talk about IgE-mediated forms only?
The Melbourne Study
Or is it changes over time we observe...?
Remissions & Relapses
Within "allergy" there are many syndromes with unique characteristics in terms of trigger, mechanism and natural history
IgE-mediated and non-IgE mediated Cow's Milk Allergy
Saarinen; JACI 2005
Prospective study of 6209 newborns
On average 8.5 years after the first incident
Stavroulakis et al 2014 unpublished
n=75 children, followed up for 2-15 years
Sears M et al; NEJM 2003
Between (groups of) Individuals
The "phenotype" idea is a key concept in allergy, highlighting the need for a stratified approach
e.g. it has been suggested that CMA has become more protracted
...and the transformation of one disease to another...
Those who have knowledge don't predict
Those who predict don't have knowledge
The best way to predict the future is to create it
* Statistical prediction refers to populations
Development (and resolution) of asthma is a dynamic process
Holt & Sly; Nature Med 2012
Repeated events (infections) not allowing hyperresponsiveness to resolve
Xepapadaki et al JACI 2005
An 'accident' that may prevent allergy
Pelosi et al Allergy 2005
Salmonellosis reduces the risk of allergy and asthma development
80 children who have being hospitalized for gastroenteritis
Skripak JACI 2007
* No difference between atopic and non-atopic
can be defined as the intentional interaction with uncertainty
Our potential to predict the future is limited by our capacity to change it
We may still be missing a key to disease understanding
Consider 'protective' environments
Anti-inflammatory treatment doesn't work
Immunotherapy works (but needs improvement)
It is something we
This depends considerably on...
or we may be trying to discover more, without fully exploiting what we know
Avoid smoke - Breathe normally !
Xepapadaki et al; PAI 2009
McCreanor et al; NEJM 2007
Promote a healthy diet
Numerous associations with omega-3 fatty acids, fruit and vegetables, vitamin D
Little effect from specific interventions
Moreira A et al Allergy 2013
Moreno-Macias & Romieu JACI 2014
Effects of a Mediterranean diet
Garcia Marcos et al PAI 2013
Weight gain increases symptoms
Weight loss decreases symptoms, lung function, exacerbations
Allergen Immunotherapy (AIT) as a
Oral immunotherapy for food allergy
Nurmatov U et al. Br J Nutr 2013; 15: 1-11
Anagnostou et al Lancet 2014
Burks et al NEJM 2012
Konstantinou et al JACI 2008
Keet et al JACI 2012