Haahtela T, von Hertzen L, Mäkelä M, Hannuksela M
Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland.
Allergy. 2008 Jun;63(6):634-45. doi: 10.1111/j.1398-9995.2008.01712.x.
The prevalence of allergic diseases has grown in Finland, similarly to many other western countries. Although the origin of allergy remains unresolved, increasing body of evidence indicates that the modern man living in urban built environment is deprived from environmental protective factors (e.g. soil microorganisms) that are fundamental for normal tolerance development. The current dogma of allergen avoidance has not proved effective in halting the 'epidemic', and it is the Finnish consensus that restoring and strengthening tolerance should more be in focus.
The national 10-year programme is aimed to reduce burden of allergies. The main goals are to (i) prevent the development of allergic symptoms; (ii) increase tolerance against allergens; (iii) improve the diagnostics; (iv) decrease work-related allergies; (v) allocate resources to manage and prevent exacerbations of severe allergies and (vi) decrease costs caused by allergic diseases.
For each goal, specific tasks, tools and evaluation methods are defined. Nationwide implementation acts through the network of local co-ordinators (primary care physicians, nurses, pharmacists). In addition, three nongovernmental organizations (NGOs) take care of the programme implementation. The 21 central hospital districts carry out a three step educational process: (i) healthcare personnel; (ii) representatives and educators of NGOs and (iii) patients and the general population. For outcome evaluation, repeated surveys are performed and healthcare registers employed at the beginning, at 5 years, and at the end of the programme. The process will be evaluated by an independent external body.
The Finnish initiative is a comprehensive plan to reduce burden of allergies. The aim is to increase immunological tolerance and change attitudes to support health instead of medicalizing common and mild allergy symptoms. It is time to act, when allergic individuals are becoming a majority of western populations and their numbers are in rapid increase worldwide. The Programme is associated with the Global Alliance of Chronic Respiratory Diseases (GARD), WHO.
与许多其他西方国家一样，芬兰过敏性疾病的患病率呈上升趋势。尽管过敏的起源尚未明确，但越来越多的证据表明，生活在城市建筑环境中的现代人缺乏对正常耐受性发展至关重要的环境保护因素（如土壤微生物）。目前避免接触过敏原的教条并未被证明能有效遏制这一“流行趋势”，芬兰的共识是应更加注重恢复和增强耐受性。
这项为期10年的国家计划旨在减轻过敏负担。主要目标包括：（i）预防过敏症状的出现；（ii）增强对过敏原的耐受性；（iii）改善诊断；（iv）减少与工作相关的过敏；（v）分配资源以管理和预防严重过敏的加重；（vi）降低过敏性疾病造成的成本。
针对每个目标，明确了具体任务、工具和评估方法。在全国范围内通过当地协调员网络（初级保健医生、护士、药剂师）实施。此外，三个非政府组织负责该计划的实施。21个中央医院区开展三个阶段的教育过程：（i）医护人员；（ii）非政府组织的代表和教育工作者；（iii）患者和普通民众。为了进行结果评估，在计划开始时、5年时和结束时进行重复调查并使用医疗登记数据。该过程将由一个独立的外部机构进行评估。
芬兰的这一举措是一项减轻过敏负担的全面计划。其目的是增强免疫耐受性，并改变态度以支持健康，而非将常见和轻微的过敏症状医学化。当过敏个体在西方人群中占多数且全球数量迅速增加时，是时候采取行动了。该计划与世界卫生组织的慢性呼吸疾病全球联盟（GARD）相关联。
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