Implementation of guidelines, allergy programs, and the October issue.

As the prevalence of allergic diseases such as asthma, allergic rhinitis, and atopic dermatitis increased worldwide, the role of not only allergy specialists but also general practitioners has become more important. During past years, international guidelines and consensus statement on allergic diseases have been developed. However, there is still huge gap between recommendations from guidelines and real practice. This issue of Asia Pacific Allergy features important issue on the management of allergic rhinitis in general practitioners by Wang [1]. The author describes that allergic rhinitis is one of the top-ten reasons for a visit to the primary care clinics and that allergic rhinitis was estimated to be 10-40% of the total patient visits in about 50% of the primary care clinics. Thus implementation of guidelines in general practitioners is essential for the standard management. For the successful implementation of guidelines, internal barriers such as doctor's prescription habits and preference and external barriers such as health insurance policy should be analyzed [2]. We have to find a way to overcome these barriers.

In the same issue, Haahtela et al. [3] described the Finnish Allergy Program 2008-2018 and the scientific rationale and practical implementation. The 10-year implementation program is aimed to reduce burden of allergies both at the individual and societal levels. As an outcome, not only the awareness of healthcare professionals and allergic patients improved, but also emergency visits and hospital days caused by asthma are in steady decline (54% during the last 10 years). The authors suggest that networking of allergy experts with primary care doctors and nurses as well with pharmacists is the key for effective implementation. In Asia Pacific region, many countries such as Australia and Korea also run government-supported Allergy Programs [4]. It will be worthy to compare Allergy Programs from each country and to organize international network for Allergy Programs.

Readers of this journal will also find a review article on eosinophilic esophagitis whose prevalence is increasing in both adult and children. Ridolo et al. [5] address the possible role of food and inhalant allergens in eosinophilic esophagitis.

Radiocontrast media is a major cause of drug induced hypersensitivity reactions whose incidence is 3.8 to 12.7% (severe reactions: 0.1-0.4%) for hyperosmolar ionic contrast and 0.7 to 3.1% (severe reactions: 0.02-0.04%) for low-osmolar ionic contrast [6]. Ho et al. [7] reported the immediate hypersensitivity reactions to IV non-ionic iodinated contrast in computed tomography from Australia in this issue including a seasonal variation in the incidence.

Readers will find original articles on differences in airway inflammation according to atopic status in patients with chronic rhinitis [8], the effect of interferon-alpha on airway eosinophila and hyperresponsiveness in a guinea pig asthma model [9], and contribution of serum IL-4 and IgE to the early prediction of horse serum allergies in guinea pigs [10]. Readers may have an idea how to tell the patients of atopic dermatitis about the effect of bathing during summer season [11].

This issue contains an interesting case report of biphasic anaphylaxis to gemifloxacin [12]. The prevalence of biphasic anaphylaxis is about 2.2-23% [13-15]. Intramuscular injection of epinephrine is the treatment of choice for anaphylaxis. Even anaphylaxis resolved immediately after epinephrine administration, it is recommended to observe patients for several hours for possible biphasic anaphylaxis. For example, patients with moderate respiratory or cardiovascular compromise should be monitored for at least 4 hours, and if indicated, for 8-10 hours or longer, and patients with severe or protracted anaphylaxis might require monitoring and interventions for days [15].