History of the World Allergy Organization: Innovation in Continuity 2008-2009

Abstract

History of the World Allergy Organization: In 1951, the leaders in allergy from all over the world came together to form the International Association of Allergology and Clinical Immunology (IAACI). For the next 60 years, the allergy world converged at the IAACI triennial meetings, which became biennial in 2003. The international meetings, originally named the International Congress of Allergology and Clinical Immunology (ICACI), are now the World Allergy Congress (WAC) hosted by the World Allergy Organization (WAO). Everyone who has aspired to have worldwide recognition has played a part in IAACI-WAO. The History of the World Allergy Organization traces the global arc of the allergy field over the past 60 years. The current officers of WAO elected to focus on this rich history, inviting prominent leaders who are interested in being part of this history project to write about their time with IAACI-WAO. This series will be presented in Cancún, México as part of the XXII World Allergy Congress (December 4-8, 2011). Leading up to the Congress in Cancún, the World Allergy Organization Journal is presenting segments of the History as part of the "Notes of Allergy Watchers Series." Please enjoy.

--Michael A. Kaliner, MD

Historian, and Past President (2006-2007)

World Allergy Organization

During my term as President of the World Allergy Organization (2008-2009), I was gratified to oversee an excellent World Allergy Congress held in Buenos Aires, Argentina (December 6-10, 2009) and the realization of several new initiatives of the organization that would help to enhance its standing and our specialty. The Officers and Board of Directors, the Council, Committee and Special Committee Chairs and members, the Editorial Boards of the WAO Web site and the World Allergy Organization Journal, and the staff all helped to achieve the presidential mandate. The WAO Member Societies worked enthusiastically with WAO to receive and promote our programs and collaborate on initiatives and publications.

In my 2008-2009 presidential mandate, I wanted to focus on the theme of "Innovation in Continuity," and to achieve this WAO embarked on 6 specific initiatives:

• 1. Strengthen the pillars of WAO: science, education, advocacy

• 2. Deepen WAO's relationship with other scientific societies worldwide

• 3. Exploit Internet technology and the WAO Web site http://www.worldallergy.org to reach every allergist in the world

• 4. 4. Empower the World Allergy Organization Journal http://www.waojournal.org

• 5. 5. Use WAO surveys as a leading initiative

• 6. 6. Make the XXI World Allergy Congress the most successful to date.

Initiative 1. Strengthen the Pillars of WAO: Science, Education, and Advocacy

Research opportunities, important publications, and educational programs were the major outcomes of WAO's priority to strengthen the foundation on which it was founded.

Science

Long-term and short-term research fellowships enabled 2 junior clinicians to travel to an international host center for a period of training in research. WAO/Nycomed Research Fellowships supported international research placements for 8 young clinicians to learn a new research or clinical technique.

A WAO study, "Epinephrine: the drug of choice for anaphylaxis" was published in Allergy in 2008 and reproduced as a supplement in the World Allergy Organization Journal, led by Estelle Simons and an ad hoc committee of the WAO Special Committee on Anaphylaxis [1]. She also worked with the Special Committee to prepare a WAO position paper, "World Allergy Organization Guidelines for the Assessment and Management of Anaphylaxis," which was copublished with the Journal of Allergy and Clinical Immunology in 2011 [2].

The evidence and GRADE-based paper authored by the WAO Food Allergy Special Committee was published in 2010, "World Allergy Organization (WAO) Diagnosis and Rationale Against Cow's Milk Allergy (DRACMA) Guidelines" and was ratified in 2011 as a WAO Position Paper [3]. Pediatric Allergy and Immunology copublished the DRACMA Guidelines as a supplement.

Another global initiative regarding the delivery of immunotherapy by the sublingual route, an exciting therapeutic strategy gradually being adopted by allergy communities throughout the world, resulted in the completion of a WAO Position Paper. Following a first meeting in Genoa in November 2008 to review the experience of American trials of Sublingual Immunotherapy (SLIT), WAO hosted a meeting in Paris in January 2009 to develop the first global consensus on SLIT and to prepare the paper, "Sub-Lingual Immunotherapy: World Allergy Organization Position Paper 2009," which was published in the World Allergy Organization Journal in 2009 [4] and copublished as a supplement in Allergy. All WAO Regional & Affiliate Member Societies sent representative delegates to this meeting, where they were joined by observers representing several national member societies and delegates representing organizations such as the National Institutes of Health, Global Allergy and Asthma European Network (GA²LEN), European Federation of Allergy and Airway Diseases Patients Association, International Primary Care Respiratory Group, and Allergic Rhinitis and Its Impact on Asthma, for a total of 65 societies endorsing the document. The Genoa meeting findings have been published as "Recommendations for Appropriate Sublingual Immunotherapy Clinical Trials," in the Journal of Allergy and Clinical Immunology (2009) [5].

In addition to the SLIT initiative, a special WAO task force focused on allergen-specific immunotherapy prepared a document about whose aim is captured by its title, "Speaking the Same Language: The World Allergy Organization Subcutaneous Immunotherapy Systemic Reaction Grading System." It was published in the Journal of Allergy and Clinical Immunology in 2010 [6].

WAO delegates attended a meeting held in Berlin, December 2008, to contribute to new guidelines on urticaria, "EAACI/GA²LEN/EDF/WAO Guideline: Definition, Classification and Diagnosis of Urticaria," which was published in Allergy in 2009 [7] and "EAACI/GA²LEN/EDF/WAO Guideline: Management of Urticaria" in the same issue [8].

Other WAO position papers were developed and published to support and promote the specialty of allergy and help set standards for clinical practice and training and are as follows:

• "What is an allergist? A position statement of the WAO Specialty and Training Council." [9]

• "Requirements for physician competencies in allergy: key clinical competencies appropriate for the care of patients with allergic or immunologic diseases--a position statement of the World Allergy Organization." [10]

• "Recommendations for competency in allergy training for undergraduates qualifying as medical practitioners--a position paper of the World Allergy Organization." [11]

WAO produced another publication, the first "State of World Allergy Report: Allergy and Chronic Respiratory Diseases", which published in the World Allergy Organization Journal (WAO Journal) in 2008, [12] to stress the importance of providing national allergy services for the burgeoning numbers of allergy patients in the world, and this downloadable online resource is a useful resource for allergists and allergy societies wishing to improve local allergy service provision.

I am personally indebted to the Chairpersons, all of the members of the Committees, and the WAO staff for the outstanding work they did.

Education

WAO continued its educational outreach globally with its Global Resources In Allergy and Immunology (GLORIA). International placements were hosted in Singapore, the Philippines, Georgia, Honduras, India, Dubai, and Bangladesh. In the United States, in association with the American College of Allergy, Asthma and Immunology, 25 placements were hosted at regional and local allergy society meetings. Also successful were WAO seminars and conferences, which supported invited lecturers in South Africa, Mongolia, Argentina, the United Arab Emirates, and Italy. Four successful "World Allergy Forum" symposia were held at the annual meeting of the American Academy of Allergy Asthma and Immunology and the Congress of the European Academy of Allergy and Immunology (EAACI). In addition to these live lectures and symposia, all the associated materials such as abstracts and slides can be accessed on the WAO Web site. Eighty-four "travel grants" were awarded to young scientists to attend and present their work at the XI World Allergy Congress in Buenos Aires, Argentina in 2009 [13].

Advocacy

The WAO "Emerging Societies Program" reaches out to allergists and physicians who care for patients with allergy in countries where no formal allergy society exists, or allergy as a specialty is still emerging. A major milestone of the program was reached in 2008 with the successful launch of the first WAO allergy training school in Venezuela. Regional General Practitioners received training from local and international allergists to create a collaborative allergy care network. In 2009, WAO collaborated with the American College of Allergy, Asthma and Immunology (ACAAI), EAACI, and American Academy of Allergy Asthma and Immunology (AAAAI) to host a "WAO Allergy Training School" for the middle east/northern Africa region at the first Middle East-Asia Allergy Asthma Immunology Congress in Dubai, United Arab Emirates, in March 2009. Existing knowledge and skills were developed; local experts were encouraged to further develop the specialty of allergy and to widen the provision of patient care.

A very important initiative, the development of the WAO White Book on Allergy began at the end of 2008. Thanks to the incredible hard work of Ruby Pawankar, we were able to show a draft of the book during the World Allergy Congress at the end of 2009. The Executive Summary was published in 2010 and distributed during the WAO International Conference in Dubai, United Arab Emirates (WISC 2010). The full WAO White Book on Allergy was published in 2011 and is available from WAO online [14]. This is a great achievement for the field of allergy and for the World Allergy Organization. I would like to personally congratulate coeditors, Ruby Pawankar, Stephen Holgate, and Richard Lockey, and all of the authors.

Initiative 2. Deepen WAO's Relationship with Other Scientific Societies Worldwide

As noted in the discussion above of education and advocacy efforts, partnerships with other scientific societies flurished in many ways during these 2 years. Other collaborations are described below.

• WAO contributed to the GA²LEN/GAIN project developing Web-based educational materials on anaphylaxis and a poster on the emergency management of anaphylaxis for display in European Emergency Rooms.

• WAO representatives attended the 2008 EAACI/GA²LEN Urticaria guidelines meeting, expanding the output to a global recommendation.

• WAO and Genetic and Rare Diseases Information Center (GARD) collaborated on a global survey of allergy diagnostic methods, preparatory to the development of inexpensive allergy diagnostic tools.

• Interasma hosted the winter 2008 WAO Board meeting; WAO experts contributed to the Interasma scientific program.

• The WAO sublingual immunotherapy meetings brought together many international scientific organizations.

• WAO agreed with the International Primary Care Respiratory Group to develop an immunotherapy document for general practitioners.

Initiative 3. Exploit Web Technology and The WAO Web Site: "We Should Reach Every Allergist in the World"

WAO is indebted first to Richard Lockey, Juan Carlos Ivancevich, and the WAO staff for their outstanding work and dedication to these WAO online initiatives.

The WAO Web site at http://www.worldallergy.org is designed to provide easy access worldwide to allergy and clinical immunology knowledge and information. During 2008-2009, numerous new programs and opportunities were added to the WAO Web site and traffic grew. By 2009, there were an average of 45,000 visitors each month and 30% of them were new visitors, for about an average of 445,000 hits each month. Visitors largely came to the site to get information about allergy and immunology meetings and the WAO Congress, access the WAO Journal, listen to WAO Expert Interviews, and study Interactive Case Reviews or synopses from the Allergic Diseases Resource Center or the new Clinical Allergy Tips.

Online continuing medical education was launched in 2008 with the first comprehensive Web-based learning activity on food allergy in 2008, followed by the second module on Drug Allergy in 2009. The library of educational synopses in the Allergic Diseases Resource Center grew to more than 40 concise overviews, all peer reviewed, on clinical allergy topics for practicing allergists and immunologists.

Distance learning was launched with the successful hosting by the WAO also of 3 live lectures or webinars. Speakers gave lectures from the University of South Florida, US, as their audiences watched, listened, and interacted from the Highlights in Allergy and Respiratory Disease Conference, Genoa, Italy, the World Congress on Asthma, Monaco, and the first Middle East-Asia Allergy, Asthma, Immunology Congress (in Dubai). Those historical lectures are archived on the WAO Web site http://www.worldallergy.org/educational_programs/webinars.php.

Initiative 4. Empower the World Allergy Organization Journal

During his presidential mandate (2006-2007), Michael Kaliner promoted the prospect of a new journal for WAO and continuing this effort during my presidential mandate (2008-2009), WAO dedicated vast resources to realize this goal. World Allergy Organization Journal (WAO Journal) was launched in January 2008 as an online-only publication at http://www.waojournal.org. It was the only allergy journal to be fully online and free to WAO members through the WAO Web site. The WAO Journal covers a broad spectrum of the interdisciplinary field of research and clinical practice in allergy and clinical immunology. By the close of 2009, the journal had published more than 100 articles, including Original Articles, Review Articles, Letters to the Editor, Book Reviews, and Editor Comments. Three new series were introduced in 2009: Notes of Allergy Watchers, Clinical Reviews in Allergy and Immunology, and Basic and Clinical Translational Science. As an online-only peer-reviewed journal, the publication process is swift and new issues are posted on time every month and often earlier than the issue date. The success of the new journal launch is due to the leadership of the WAO Board of Directors and tireless efforts of founding Editor-in-Chief, Prof Johannes Ring and current Editor-in-Chief, Dr Lanny Rosenwasser, and the dedication of the WAO Journal Editorial Board.

Initiative 5. WAO Surveys as A Leading New Initiative

WAO's federal structure provides a unique network for global surveys about allergy, and the Specialty and Training Council conducted surveys on general/adult and pediatric clinical allergy services and allergy training.

Building on the WAO Special Committee on Anaphylaxis international survey on the availability of epinephrine autoinjectors worldwide in 2007, a 2008 survey of member societies gathered data on how anaphylaxis is diagnosed and treated in health care settings in their respective countries. These combined results form the basis of the WAO international guidelines for the assessment and management of anaphylaxis, which launched at WAC 2009.

The Asthma Special Committee conducted a survey of member societies to find out the major allergens involved in exacerbations of severe and chronic asthma and to learn whether national definitions of severe asthma exist. The information obtained will inform a WAO educational program based on the new 2009 World Health Organization definition of Severe Asthma.

The Drug Allergy Special Committee conducted a survey on in vivo methods used in the diagnosis of allergic reactions to major drug classes. The information obtained will be the first step to reaching a global consensus about the best way to diagnose drug hypersensitivity reactions and sharing the clinical expertise on this major clinical problem.

The Evidence Based Medicine and Methodology Special Committee developed a survey to establish educational needs in Evidence-Based Medicine for an Evidence-Based Medicine workshop during WAC 2011.

In collaboration with regional and global allergy and respiratory organizations, the WAO Climate Change and Allergy Special Committee piloted a survey to ascertain the extent of the effect of climate change on allergen prevalence and disease expression. The World Allergy Organization Journal published a review article by the Special Committee in 2011, "Climate Change, Migration, and Allergic Respiratory Diseases: An Update for the Allergist." [15]

The Clinical Trials in Allergy and Clinical Immunology Special Committee developed a preliminary survey to investigate the value of creating a global network of allergy research centers in association with GA²LEN and EAACI.

Initiative 6. Make the XXI World Allergy Congress the Most Successful to Date

Buenos Aires, Argentina, was the location of WAO's biennial World Allergy Congress (WAC 2009) from December 6 to 10, and brought together a faculty of international standing and delegates from around the world for a total of 5110 in attendance and with 84 travel grants awarded. Allergic diseases affect hundreds of millions of people throughout the world, and the prevalence is increasing, impacting the public health of all nations. Ongoing research provides new information that can be applied to the daily practice of medicine. That is why, every 2 years, the Congress is the most exciting international gathering of allergists and other related specialties from all over the world (Figures 1, 2, 3).

Figure 1

The official logo of the XXI World Allergy Congress, Buenos Aires, December 6-9, 2009.

Figure 2

Attendance at the Immunotherapy Day of WAC 2009.

Figure 3

C.E. Baena Cagnani & G.W. Canonica, Chairs of WAC 2009, leading a WAC session.

Conclusions

To conclude, I would like to extend a sincere thank you to the WAO Board of Directors and special thanks to the members of the Executive Committee who were always supportive and collaborative. A particular mention should be made of the WAO staff for their involvement and dedication. Without all of them, I would not have been able to accomplish such a productive presidential mandate.