​Atopic diseases constitute a cluster of intricate immune-related conditions, including asthma, food allergy, anaphylaxis, allergic rhinitis, ocular allergy, hymenoptera venom allergy, and atopic dermatitis. These conditions can manifest in various ways, often occurring together, and are also connected with non-atopic mechanisms. People with atopic diseases have a higher risk of developing other non-allergic conditions, such as autoimmune diseases, obesity, neurodevelopmental disorders, depression and anxiety, structural airway abnormalities, and infections, compared to those without atopic conditions.

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In 2018, the annual costs of asthma and allergic diseases in Finland were €1,5–1,8 billion, over 80% of which are indirect costs. We have implemented the “Finnish Allergy Programme 2008‐2018” and were able to decrease costs and improve health and tolerance to allergic diseases. Our next goal is to understand the timing of host-environmental interactions behind allergic sensitization patterns and the development of atopic diseases and comorbidities.

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Our main aims are linked to the Finnish Allergy Programme and are as follows: 1) Study the epidemiology of atopic diseases and allergic sensitization profiles in Finland; 2) Measure the burden of atopic diseases (allergies, asthma, and atopic eczema) as well as comorbidities in Finland; 3) Evaluate and improve the current use of diagnostic tests for atopic diseases; 4) Evaluate the use and effectiveness of allergen immunotherapy; and 5) Assess the direct and indirect costs related to atopic diseases and comorbidities.

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Data will be collected from 1.1.2012 to 31.12.2023 on adults and children throughout Finland from several data lakes (approx. 2 milj. patients). All IgE test results (based on whole allergen extracts and allergen components) will be collected from Synlab – the nation-wide laboratory service provider for Terveystalo – and from other major regional laboratories (e.g., Huslab, Fimlab, Tykslab, Nordlab, and Islab). Patient selection from the Terveystalo data lake will be based on performed allergen IgE and lung function measurements, diagnostic codes, and prescribed medication related to atopic diseases. In addition, random samples of matched cohorts will be generated for each study question to represent non-atopic control populations (i.e., with no elevated specific IgE levels, no diagnosis of asthma, atopic eczema, allergic rhinitis, or any other allergic conditions). Along with the Terveystalo data, information about medication purchases will be collected from the Finnish Social Insurance Institute (KELA). Additional data will be collected on food allergies from Helsinki University Hospital and Tampere University Hospital data lake.

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All data will be managed as coded, and patients will not be contacted. According to Finnish law, approval from the Ethics Committee is not required, and informed consent is not necessary to obtain from the subjects and/or their guardians. The Finnish Social and Health Data Permit Authority (FinData) grant permits for the secondary use of social and health care data.

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Open-source tools (R/Python + Jupyter stack) and other statistical software (Stata or SPSS) will be used. Due to the inherent skewness of the real-world distributions, bootstrap analysis for confidence intervals will also be employed. For the retrospective cohorts, propensity score matched 1:1 or 1:2 control groups will be created using characteristic and potential confounding variables. Some of the input data will be mined from the patient texts using Natural Language Processing methods. These include ordinary rule-based and regular expression-based methods for pattern matching and more sophisticated neural network-based methods, which are especially useful in classifying multiple different inputs into well-defined classes.

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In the future, more cost savings could be achieved by further improving diagnosis, treatment, and rationalizing the practice of allergies and related atopic and non-atopic diseases. The 10-year Finnish Allergy Programme has set firm foundations on which to build. We will investigate the prevalence, comorbidities, diagnosis, treatment, and burden of asthma, food allergy, anaphylaxis, allergic rhinitis, hymenoptera venom allergy, ocular allergy, and atopic dermatitis. By the proposed study, we will uncover previously unexplored factors related to asthma, allergic diseases, and their comorbidities and create ways to improve their diagnostics, reduce costs, and prevent them from progressing.