MENSSANA

MOBILE EXPERT AND NETWORKING SYSTEM FOR SYSTEMATICAL ANALYSIS OF NUTRITION BASED ALLERGIES

According to the World Health Organization food allergies have become one of the most important problems of public health [1]. Current treatment is based on the identification and avoidance of allergens. Coherent information from patients’ diaries is needed to identify individual allergens. A goal of the project is to develop a Personal Allergy Assistant® (PAA), based on modern mobile computing and database technology. This makes it possible to build-up a scientific database for the systematic identification of allergies. The PAA should help to distinguish permitted from prohibited food-products as well as to generate coherent patient diaries.

• Support Evidence Based Medicine (EBM) in the area of food allergies
• Develop a Personal Allergy Assistant (PAA) and Knowledge Base System :
  • Provide an easy to use tool for allergic persons, distinguish permitted and prohibited food products
• Definition of a standardised Electronic Patient Record for Allergies (EPRA) :
  • Coherent patient diaries, acquisition of patient anamnesis, representation of allergy tests
• Conducting a controlled clinical trial to evaluate health economic effects, quality of life
• Implementation of a food allergies specific information portal for patients and health professionals
• Creation of a database containing the ingredients of food products
• Patient education through direct feedback of the PAA and thus supporting secondary prevention
• Creation of a local competence centre for “Information Technology and Allergy”

Within the last decades the overall frequency and intensity of food allergies in particular have significantly increased. The WHO (World Health Organization) considers food allergies to be the 4th major problem of public health around the world [1]. A population study in France that was conducted on 33 110 persons has established that the prevalence of food allergies is estimated at 3.24% (range 3.04% - 3.44%) [2].

Today the management of food allergies consists in educating the patient to avoid ingesting the responsible allergen and to initiate therapy in case of an unintended ingestion [3]. Patients are required to keep food diaries to identify individual allergens in the daily food (e.g. instant meals). Unfortunately, while purchasing their food, people are left alone with ingredient descriptions that are difficult to read and understand. This makes it also very hard to document and control the ingested foods. Furthermore, studies have shown that significant amounts of the data in paper diaries is fudged or fabricated [4]. In “parking lot diaries”, just prior to an appointment with a nurse or a doctor, a patient fills in the past week or two of experiences.

Support of food allergy patients by Information and Communication Technologies (ICT) To overcome the mentioned obstacles, a major goal of the project is to develop a Personal Allergy Assistant (PAA), based on modern mobile computing and database technology. A PAA could help to easily distinguish permitted from prohibited food-products and allow the patients to select healthy foods. On the other hand, the use of electronic, computer-based diaries promises a much higher compliance of the collected data [4].

Our project partner, the IMSIE in Cologne has conducted a study [5] where they concluded that the use of handheld computers in clinical trials resulted in:

• An increase in data quality;
• A shortened time frame needed to close the database;
• A clear demonstration of the benefit of electronic reminders for protocol compliancy.

MENSSANA has developed a food product database containing the ingredients of food available in Luxembourg and parts of Europe. Collaborations are ongoing with patient self-help groups, associations and food producers.

Based on the idea of the free encyclopedia Wikipedia (www.wikipedia.org), we complement this product database with the independent food database Wikifood (www.wikifood.eu) containing information provided by patients and users. EAN-13 Barcodes are used to identify the food products of each country. This EAN code is printed on the product package in human readable number and in barcode format.

We will perform a clinical trial comparing PAA- to conventionally treated food-based allergy patients. A qualified allergologist will regularly review patient data. A study duration of one year is planed to compensate for season related differences. During the study there will be a continuous collection and evaluation of data. Additionally, after the end of the study a data collection is carried out by means of questionnaires. It corresponds to the first patient interview to ensure a comparability of the results.

A Steering Committee manages the project’s functional, technical and strategic aspects. Besides leading managers of the CR Santec, international renowned experts in the field of allergy research are members of this steering committee. Namely, Prof. Dr. Paul van Cauwenberge (University of Gent), Dr. Wolfgang Jorde (Mönchengladbach), Prof. Dr. Ing. Ralph Mösges (University of Cologne), Prof. Dr. Georg Schlöndorff (Aachen), and Dr. Thorsten Zuberbier (Charité Hospital Berlin). Technical advice is given by Prof. Dr. Georg J. Schneider (Trier).

A detailed calculation of health care costs in PAA- vs. conventional treated patients will be performed. This analysis will include costs of hospitalization, physician time, medications, laboratory services and ancillary services together with the operating costs of the expert system.

Standard questionnaires will assess quality of life: SF 36, for quality of life, BDI for depression and STAI for anxiety.

Dipl.Ing. Norbert Rösch, (MPH)

Project manager biomedical engineering and Public Health Centre de Recherche Public Henri Tudor, SANTEC

phone: +352 42 59 91 - 250

fax : +352 42 59 91 - 333

References

1. United Nations Environment Programme, International Labour Organisation, World Health Organization, International Programme On Chemical Safety, Environmental Health Criteria No 212 - Principles And Methods For Assessing Allergic Hypersensitization Associated With Exposure To Chemicals , 1999
2. KANNY G., MONERET-VAUTRIN D-A., FLABBE J. : Population Study of Food Allergies in France Journal of Allergy & Clinical Immunology, Volume 108, Number 1, July 2001
3. SAMPSON HA: Allergic Disorders – Food Allergies Journal of Allergy and Clinical Immunology, Volume 111, Number 2, February 2003
4. STONE AA., SHIFFMAN S., SCHWARTZ J., BRODERICK J., HUFFORD M. : Patient non-compliance with paper diaries ; British Medical Journal, Volume 324, May 2002
5. KOOP A, MATESIC R, MÖSGES R: Erfahrungen beim Einsatz von Palm-PDAs in einer klinischen Studie. In: Koop A, Bludau HB (Hrsg.) Mobiles Computing in der Medizin. Shaker Verlag, Aachen, 45-59, 2001