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Combating Allergy and Asthma in Europe: Issues and Perspectives. Erika von Mutius MD MSc Professor of Pediatrics University Children‘s Hospital Munich, Germany WROCŁAW Atopic sensitisation in Sobotka and surrounding villages. UK-type prevalence 40 Sobotka villages 30 % 20 10 lowest prevalence in Europe 0 5-10 11-20 21-30 31-40 41-50 51-60 61+ age Sozanska et al, Allergy 2007 Lifetime residence and atopy. 35 Never village 30 Moved between town and village Always village 25 20 15 10 5 0 5-20 yrs 21-40 yrs 41-60 yrs Sozanska et al, Allergy 2007 Prevalence of atopy in Karelian children. % 45 Finnish 40 35 Russian 30 25 20 z 15 10 5 0 Asthma Hay fever Skin test positive von Hertzen et al, JACI 2006 Microbial exposures in Finnish and Russian Karelian homes. Pakarinen et al, Environ Microbiology 2008 Allergy protection from exposures to stables, farm milk and barns (ALEX Study). OR 1 No exposure One exposure At least 2 exposures All 3 exposures 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0 Asthma Wheeze Hay fever Hay fever diagnosis symptoms Atopy mattress dust DNA extraction amplification of the bacterial 16S rRNA gene gel-electrophoresis under non-denaturing conditions scanning gel and transformation into density values ds DNA exonuclease digestion denaturation of DNA ss DNA statistical analysis for significant associations with health outcomes or farm-related exposures Study the Microbiome in Environmental Samples by Pyrosequencing. • The ‚New Age of Molecular Diagnostics for Microbial Agents‘ (R. Whitley in NEJM March 2008). • The most comprehensive method to detect bacteria, viruses, fungi of all known and unknown species. • Will identify the most solid, so far unexplored, candidates. Margulies et al, Nature 2005; Whitley NEJM 2008, Palacios et al, NEJM 2008. GABRIEL Advanced Surveys Population Children 6-12 years Alpine regions and Poland Parental questionnaire Phenotypes Lung function Genetics Blood sampling: Allergy test, DNA/RNA Exposure Nasal and throat swabs Indoor and outdoor dust Milk samples GABRIEL Advanced Survey Design • Stage I: Recruitment in alpine areas – Recruitment questionnaire to large populations (N=135,359). Participation rate: 80.7%. • Randomisation: Random sample of full consent group • Stage II: Main study – Comprehensive questionnaire, blood samples (IgE, genetics), dust samples, nasal swabs (n=9,668) • Randomisation: Random sample in area with strongest effects (Germany) • Stage III: In depth environmental exposure – Collection of multiple dust samples, milk samples, throat swabs and measurement of lung function (n=895) GABRIEL exposure assessment. • Because of restricted funding only possible in 225 subjects (26.2% of subjects in Stage III) – Bacterial exposure by 16 sRNA – Viable bacteria – Endotoxin – Muramic acid – CpG DNA – Fungal exposure by 16 sRNA Vision for FP7: • Comprehensive characterisation of allergy protective environments (Alpine Areas, Eastern Europe, China). • Test identified allergy protective microbes / compounds in experimental studies. • Develop novel prevention strategies