Finnish Allergy Programme 2008-2018--time to act and change the course.
BACKGROUND
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.


OBJECTIVE
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.


METHODS
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.


CONCLUSIONS
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.
Haahtela
T
T
Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland.
von Hertzen
L
L
Mäkelä
M
M
Hannuksela
M
M
D018876:Environmental Illness / Q000175:diagnosis / Q000517:prevention & control; D005387:Finland; D005512:Food Hypersensitivity / Q000175:diagnosis / Q000517:prevention & control; D006282:Health Personnel / Q000193:education; D006293:Health Promotion / Q000191:economics / Q000639:trends; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis / Q000276:immunology / Q000503:physiopathology* / Q000517:prevention & control*; D007108:Immune Tolerance; D009313:National Health Programs; D012307:Risk Factors