The Earlier the Merrier—But How?

A recent initiative by a multidisciplinary task force from the German Society of Allergy and Clinical Immunology (DGAKI) and the Society for Pediatric Allergology and Environmental Medicine (GPA) aims to define methods for identifying high-risk populations and early allergic phenotypes to implement primary and secondary prevention strategies based on current scientific knowledge 1. The experts propose a stepwise, structured approach embedded in existing routine preventive pediatric assessments, and a targeted evaluation by specialists of identified high-risk populations. The authors conclude that this standardized algorithm strengthens preventive efforts in atopic diseases while helping to avoid unnecessary testing. We agree that this is genuinely needed in times when more than a third of the population suffers from allergic disease 2. Type 2 inflammatory diseases are chronic, may lead to life-threatening events, significantly impair quality of life for patients and caregivers, and are associated with increased psychosomatic and psychiatric comorbidities 3. Consequently, they generate substantial socioeconomic costs for families and society. Importantly, knowledge of primary, secondary, and tertiary prevention is sufficient to enable guided action. It is well established that early diagnosis and appropriate treatment are key elements in preventing disease progression and reducing the overall burden before severe and/or chronic phenotypes develop. The authors propose leveraging established early-childhood screening examinations within the German healthcare system. They propose structured key assessments based on general questions for allergic disease, with tailored add-on questions to early identify disease-specific relevance in food allergy, atopic dermatitis, childhood asthma, and allergic rhinitis. Basically, the approach has two dimensions. Dimension A focuses on the age-specific likelihood of disease manifestation based on routine assessments, while Dimension B provides trajectory-based individual counseling regarding primary, secondary, and tertiary preventative interventions. From another perspective, a patient-centered strategy identifying both universal and disease-specific components is recommended. Using standardized assessment tools, a subsequent personalized algorithm incorporating risk stratification and diagnostic confirmation may lead to evidence-based counseling and targeted testing. Depending on the findings, the appropriate level of specialist involvement should be defined to ensure a resource-efficient, precision-based approach that enables timely access to specialized care for those who truly need it (Figure 1). The core set, which provides the basis for primary prevention, must be offered at the broadest possible level with orchestrated information campaigns designed in concert with the expert organizations. To conduct the next layers of the onion model, physicians with experience in treating allergic children who are not necessarily specialists will be required, who then, based on complexity and severity, initiate referral to formally allergy-trained experts who regularly treat children. All these measures can be implemented within individual patient care based on existing evidence. However, they require appropriate structural and financial support from policymakers, realistic cost calculations that reflect the burden of allergic diseases, and the empowerment of primary care physicians within a strict, guideline-based framework supported by structured educational programs. Furthermore, the active involvement of general practitioners and pediatricians is essential, as limited reimbursement and resource constraints in this field may otherwise hinder their engagement in the proposed initiative. As highlighted above, regional administrative fragmentation must be reduced, and decision-makers should closely collaborate with allergy specialists in the interest of public health. National and European scientific societies possess the expertise and infrastructure to support implementation at both national and EU levels. Given that more than one-third of the population is affected, greater accountability in healthcare resource allocation and a stronger focus on prevention and modification of disease progression are imperative. If these unmet needs are not addressed, diagnostic approaches performed by insufficiently trained physicians may paradoxically increase disease burden, for example, through unnecessary food avoidance recommendations in sensitized but non-allergic individuals. Importantly, a successful role model that has already demonstrated that prevention programs can work exists: the Finnish Program. It has been demonstrated that nationwide structural interventions with expert-driven recommendations, efficiently communicated to community physicians, can significantly improve allergy and asthma care when implemented consistently and supported by clear communication strategies and strong governmental commitment 9. In conclusion, this initiative to address allergic diseases early in life is urgently needed. It deserves political and financial support and has strong potential for implementation across multiple European healthcare systems. Supported by the Luxembourg National Research Fund on WEAVE program grant C23/BM/18096599/IFAM and the Austria Science Fund on WEAVE program grant 10.55776/I6897, the lower Austrian research fund supported the Danube Allergy Research Cluster. The authors declare no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.