Integrated care pathways for improved safety in patients with allergies: From strategies to policy needs

The prevalence of allergic diseases is rising to epidemic proportions worldwide, particularly in low and middle income countries. Prof Ruby Pawankar, President, Asia Pacific Association of Allergy Asthma and Clinical Immunology Dept of Paediatrics, Nippon Medical School, Tokyo, Japan, gives an insight

The prevalence of allergic diseases is rising to epidemic proportions worldwide, particularly in low and middle income countries. Moreover, the complexity and severity of allergic diseases, continue to increase especially in children and young adults, who are bearing the greatest burden of these trends.

Allergic diseases include life-threatening anaphylaxis, food allergies, certain forms of asthma, angioedema, drug allergies, latex allergies, urticaria, eczema, and insect allergies. Globally, 300 million people suffer from asthma and about 200 to 250 million people suffer from food allergies. One tenth of the population suffers from drug allergies and 400 million from rhinitis. Moreover, allergic diseases commonly occur together in the same individual, and are often associated with other comorbidities like diabetes, obesity and other non-communicable diseases.

Patient safety is the absence of preventable harm and the reduction of unnecessary harm to a patient in the process of healthcare. However, much of the focus of patient safety has been on medical errors or device related errors.

Patients with allergies are at risk of being subject to several challenges including adverse drug reactions like with medications, during surgical procedures and even dietary errors in those who suffer from food allergies. The selection of appropriate medications and the appropriate diet is dependent upon the availability and review of critical patient information.

In the light of this ever-increasing threat of allergic diseases it is crucial not only to create greater public awareness of allergies, but also to develop a systematic approach of identifying, recording and implementing creative strategies to ensure the safety of patients with allergies in the hospital environment as well as in the community settings such as in schools, restaurants or shopping malls (in case of food allergies). Strategies and policies are crucially needed including strict food labeling laws and easy access to life saving medications to prevent premature and unwanted deaths and improving the quality of life of patients with allergies.

As a multisystem disease, patients with allergic diseases need an integrated care pathway approach as an effective model for patient care and safety. Allied health professionals like nurses, dietitians, pharmacists need to work along with the specialists and general practitioners to form multi-professional teams with disease-specific knowledge and skill sets required to ensure the safety of patients with allergic diseases.

Finally the active participation of the patient in the development of treatment guidelines, in the assessment of their disease via Patient Reported Outcomes (PROs) and the use of technology like mobile health are key ways in empowering and engaging the patient for better compliance.