While food allergies and eczema are among the most common chronic non-communicable diseases in children in many countries worldwide, quality data on the burden of these diseases is lacking, ...particularly in developing countries. This 2012 survey was performed to collect information on existing data on the global patterns and prevalence of food allergy by surveying all the national member societies of the World Allergy Organization, and some of their neighbouring countries. Data were collected from 89 countries, including published data, and changes in the health care burden of food allergy. More than half of the countries surveyed (52/89) did not have any data on food allergy prevalence. Only 10% (9/89) of countries had accurate food allergy prevalence data, based on oral food challenges (OFC). The remaining countries (23/89) had data largely based on parent-reporting of a food allergy diagnosis or symptoms, which is recognised to overestimate the prevalence of food allergy. Based on more accurate measures, the prevalence of clinical (OFC proven) food allergy in preschool children in developed countries is now as high as 10%. In large and rapidly emerging societies of Asia, such as China, where there are documented increases in food allergy, the prevalence of OFC-proven food allergy is now around 7% in pre-schoolers, comparable to the reported prevalence in European regions. While food allergy appears to be increasing in both developed and developing countries in the last 10-15 years, there is a lack of quality comparative data. This survey also highlights inequities in paediatric allergy services, availability of adrenaline auto-injectors and standardised National Anaphylaxis Action plans. In conclusion, there remains a need to gather more accurate data on the prevalence of food allergy in many developed and developing countries to better anticipate and address the rising community and health service burden of food allergy.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Crustacean shellfish allergy is an important cause of food allergy and anaphylaxis in Asia. The major allergen in shellfish allergy is tropomyosin, a pan-allergen that is also found in house dust ...mites and cockroaches. Tropomyosins from house dust mites (HDMs) have a high sequence homology to shellfish tropomyosins, and cross-reactivity between HDM and shrimp tropomyosins has been demonstrated. Exposure to inhaled tropomyosins from house dust mites has been postulated to be the primary sensitizer for shellfish allergy, in a reaction analogous to the oral allergy (inhalant-food) syndrome. This notion is supported by indirect data from the effects of HDM immunotherapy on shellfish allergy, and strong correlations of shellfish and HDM sensitization. HDM immunotherapy has been reported to induce both shrimp allergy in non-allergic patients and shrimp tolerance in shrimp-allergic patients. Epidemiological surveys have also demonstrated a strong correlation between shellfish and HDM sensitization in both hospital-based and community-based studies. Unexposed populations have also been shown to develop sensitization-shellfish sensitization in orthodox Jews with no history of shellfish consumption was associated with HDM sensitization. Reciprocally, HDM sensitization in an Icelandic population living in a HDM-free environment was associated with shrimp sensitization. In vitro IgE inhibition studies on sera in shrimp-allergic Spanish patients indicate that mites are the primary sensitizer in shrimp-allergic patients living in humid and warm climates. Current data supports the hypothesis that tropomyosin is the link between HDM and shellfish allergies. The role of tropomyosin in HDM and shellfish allergies is a fertile field for investigation as it may provide novel immunotherapeutic strategies for shellfish allergy.
Anaphylaxis – Lessons learnt when East meets West Tham, Elizabeth H.; Leung, Agnes S. Y.; Pacharn, Punchama ...
Pediatric allergy and immunology,
November 2019, 2019-11-00, 20191101, Volume:
30, Issue:
7
Journal Article
Peer reviewed
The rapidly increasing prevalence of allergic disorders over the past 2 decades highlights the need to understand the epidemiology of anaphylaxis. In Europe, the United States, and Australia, the ...incidence of anaphylaxis is estimated to be between 60 and 950 cases per 100 000 population, with a lifetime prevalence of anaphylaxis of 0.05%‐2%. The incidence appears to be increasing over time. Although the existing Asian literature is heterogeneous and limited by under‐reporting, it also suggests a similar increasing trend in anaphylaxis incidence in Asia. Anaphylaxis triggers in Asia, such as the predominance of shellfish and wheat in older children and adolescents, differ from those seen in Western populations. Triggers unique to Asia such as traditional Chinese medications, galacto‐oligosaccharides, and food delicacies have also been reported. Low usage of adrenaline as first‐line treatment of anaphylaxis is evident across all countries and is particularly concerning. There is a need to establish prospective, standardized protocols for anaphylaxis data collection and reporting, to enhance the collective understanding of anaphylaxis and its burden, gaps in management and to identify areas for future research and intervention in each region. Understanding of the underlying reasons explaining the difference between East and West will facilitate future primary preventive strategies.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
Background There has been a substantial increase in the prevalence of peanut and tree nut allergy in Western populations in the last 2 decades. However, there is an impression that peanut and tree ...nut allergy is relatively uncommon in Asia. Objective To evaluate the prevalence of peanut, tree nut, and shellfish allergy in schoolchildren in 2 Asian countries (Singapore and Philippines). Methods A structured written questionnaire was administered to local and expatriate Singapore (4-6 and 14-16 years old) and Philippine (14-16 years old) schoolchildren. Results A total of 25,692 schoolchildren responded to the survey (response rate, 74.2%). Of these, 23,425 responses fell within the study protocol's 4 to 6 and 14 to 16 year age groups and were included in the analysis. The prevalence of convincing peanut and tree nut allergy were similar in both local Singapore (4-6 years, 0.64%, 0.28%; 14-16 years, 0.47%, 0.3%, respectively) and Philippine (14-16, 0.43%, 0.33%, respectively) schoolchildren, but was higher in the Singapore expatriates (4-6 years, 1.29%, 1.12%; 14-16 years, both 1.21%, respectively; 4-6 years, expatriates vs local Singaporeans: peanut, P = .019; tree nut, P = .0017; 14-16 years, P > .05). Conversely, shellfish allergy was more common in the local Singapore (4-6 years, 1.19%; 14-16 years, 5.23%) and Philippine (14-16 years, 5.12%) schoolchildren compared with expatriate children (4-6 years, 0.55%; 14-16 years, 0.96%; P < .001). When data were pooled, respondents born in Western countries were at higher risk of peanut (adjusted odds ratios 95% CIs: 4-6 years, 3.47 1.35-8.93; 14-16 years, 5.56 1.74-17.76) and tree nut allergy (adjusted odds ratios 95% CIs: 4-6 years, 10.40 1.61-67.36; 14-16 years, 3.53 1.00-12.43) compared with those born in Asia. Conclusion This study substantiates the notion that peanut and tree nut allergy is relatively low in Asian children, and instead shellfish allergy predominates. Environmental factors that are yet to be defined are likely to contribute to these differences.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
5.
Primary Prevention of Allergy - Is It Feasible? Ng, Pauline Poh-Lin Chan; Tham, Elizabeth Huiwen; Lee, Bee-Wah
Allergy, asthma & immunology research,
07/2023, Volume:
15, Issue:
4
Journal Article
Peer reviewed
Open access
The allergy epidemic has been attributed to environmental influences related to urbanization and the modern lifestyle. In this regard, various theories exploring the role of microbes (hygiene, old ...friends, microbiota, and biodiversity hypotheses), and the epithelial barrier (epithelial, dual allergen exposure and vitamin D hypotheses) have been proposed. These hypotheses have guided clinical studies that led to the formulation of intervention strategies during the proposed window of opportunity dubbed as the "first thousand days." The most significant intervention is a paradigm shift from allergen avoidance to early introduction of allergenic foods, particularly egg and peanut, around 6 months of age for the prevention of food allergy. This recommendation has been adopted globally and included in allergy prevention guidelines. Other strategies with less robust clinical evidence include: encouraging a healthy balanced diet, rich in fish, during pregnancy; continuing allergenic food intake during pregnancy and lactation; vitamin D supplementation in pregnant women with asthma; discouraging social indications for caesarean section delivery; judicious use of antibiotics in early childhood; daily emollient use from birth in high risk babies; and avoiding cow's milk formula use in the first week of life. However, if early supplementation with cow's milk formula is required, continuing at least 10 mL of formula daily until age 2 months may be considered. Translating these strategies to public health and clinical practice is still a work in progress. Long-term population studies are crucial to assess the feasibility of these measures on allergy prevention.
ABSTRACT
Background
There has been limited data regarding the incidence of anaphylaxis in Asia. We aim to describe patterns in patient characteristics, triggers and clinical presentation of childhood ...anaphylaxis in Singapore.
Methods
This was a retrospective review of emergency electronic medical records of children with anaphylaxis. Patients with the allergy‐related diagnoses of anaphylaxis, angioedema, allergy and urticaria based on ICD‐9 codes were screened. Cases fulfilling the World Allergy Organization criteria for anaphylaxis were included.
Results
A total of 1188 cases of anaphylaxis were identified with a median age of 6.3 years. Extrapolating data from the study sites, from 2015 to 2022, the incidence rate of childhood anaphylaxis emergency visits in Singapore doubled from 18.9 to 38.8 per 100,000 person‐years, with an incidence rate ratio (IRR) of 2.06 (95% confidence interval CI 1.70–2.49). In 2022, the incidence rate of food anaphylaxis was 30.1 per 100,000 person‐years, IRR 2.39 (95% CI 1.90–3.01) and drug anaphylaxis was 4.6 per 100,000 person‐years, IRR 1.89 (95% CI 1.11–3.25). The incidence rate in children aged 0–4 years quadrupled during the study period. Common triggers were egg (10.4%), peanut (9.3%), tree nut (8.8%), milk (8%), shellfish (7.8%) and non‐steroidal anti‐inflammatory drug (4.4%). The majority (88.6%) of patients were treated with intramuscular adrenaline. Total number of allergy‐related visits did not increase over time between 2015 and 2019. Rates of severe anaphylaxis, namely anaphylactic shock and admission to high‐dependency and intensive care, did not increase over time, with a mean incidence of 1.6, IRR 0.85 (95% CI 0.40–1.83) and 0.7, IRR 1.77 (95% CI 0.54–5.76) per 100,000 person‐years, respectively.
Conclusion
While the number of emergency visits due to childhood anaphylaxis has increased, the number of cases of allergy‐related visits, anaphylactic shock and anaphylaxis requiring high‐dependency and intensive care did not rise.
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Prevalence of allergic diseases in infants, whose parents and siblings do not have allergy, is approximately 10% and reaches 20-30% in those with an allergic first-degree relative. Intestinal ...microbiota may modulate immunologic and inflammatory systemic responses and, thus, influence development of sensitization and allergy. Probiotics have been reported to modulate immune responses and their supplementation has been proposed as a preventive intervention.
The World Allergy Organization (WAO) convened a guideline panel to develop evidence-based recommendations about the use of probiotics in the prevention of allergy.
We identified the most relevant clinical questions and performed a systematic review of randomized controlled trials of probiotics for the prevention of allergy. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations. We searched for and reviewed the evidence about health effects, patient values and preferences, and resource use (up to November 2014). We followed the GRADE evidence-to-decision framework to develop recommendations.
Currently available evidence does not indicate that probiotic supplementation reduces the risk of developing allergy in children. However, considering all critical outcomes in this context, the WAO guideline panel determined that there is a likely net benefit from using probiotics resulting primarily from prevention of eczema. The WAO guideline panel suggests: a) using probiotics in pregnant women at high risk for having an allergic child; b) using probiotics in women who breastfeed infants at high risk of developing allergy; and c) using probiotics in infants at high risk of developing allergy. All recommendations are conditional and supported by very low quality evidence.
WAO recommendations about probiotic supplementation for prevention of allergy are intended to support parents, clinicians and other health care professionals in their decisions whether to use probiotics in pregnancy and during breastfeeding, and whether to give them to infants.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Practical algorithms for managing common gastrointestinal symptoms in infants Vandenplas, Yvan, M.D., Ph.D; Gutierrez-Castrellon, Pedro, M.D; Velasco-Benitez, Carlos, M.D ...
Nutrition (Burbank, Los Angeles County, Calif.),
2013, January 2013, 2013-Jan, 2013-01-00, 20130101, Volume:
29, Issue:
1
Journal Article
Peer reviewed
Open access
Abstract Objective In early infancy, various gastrointestinal symptoms (e.g., constipation, regurgitation, crying/fussiness, infantile colic, and excessive gas) are common problems and may result in ...numerous visits to pediatricians. Worldwide, this often results in switching infant formulas because parents (and sometimes doctors) believe these symptoms reflect a formula intolerance. However, in many cases, these infants are growing and developing normally. This study was performed to offer family pediatricians consensus-based algorithms on the management of the most common gastrointestinal symptoms in infants. Methods A group of pediatric gastroenterologists and pediatric allergists from Europe, USA, Latin America, and Asia developed guidelines and practical algorithms to assist general pediatricians in addressing this challenge. Results Five such practice recommendations were developed after a thorough literature review. These algorithms should not be considered as an “evidence-based guideline”; on the contrary, the authors are convinced that challenging these proposals will result in updated and improved versions. Conclusion To date, these algorithms, based on the published literature, are the result of a broad consensus of pediatric gastroenterologists from different continents.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Atopic dermatitis (AD) is a common chronic inflammatory skin condition in children. In Asia, the prevalence of AD is increasing, which is largely attributed to environmental and socioeconomic factors ...including family income, parental education, lifestyle and metropolitan living. Current clinical guidelines recommend a stepped approach in the management of eczema in children, with treatment steps tailored to the severity of the eczema. To address the skin barrier dysfunction, skin hydration and the application of emollients is essential. There is evidence supporting the use of bleach baths as an antimicrobial therapy against Staphylococcus aureus. In patients in whom topical treatment fails, wet wrap therapy may be considered as a treatment option before considering systemic therapies. In the second part of this article, the economic burden of AD is addressed. AD not only negatively impacts the child’s quality of life but also that of the whole family and is associated with a burden on healthcare costs and society. AD in an infant will lead to frequent additional visits to the pediatrician, to additional and partially expensive treatment costs and, in rare cases, to hospitalization. It is thus of utmost importance to define efficient strategies to not only treat AD but also to decrease the risk of developing the disease.
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BFBNIB, NMLJ, NUK, PNG, UL, UM, UPUK
It is generally accepted that allergic diseases are not curable and not preventable, but mainly controllable using pharmacotherapy (i.e. symptomatic medication). Recent research, however, ...demonstrated that a number of specific interventions can lead to (partial) primary prevention of allergy, especially of atopic dermatitis (AD) and food allergy (FA). Three types of primary prevention strategies have been successfully studied: early administration of bacterial products (most studies are on probiotics), early moisturizing in infants at risk for AD and early exposure to allergenic foods (peanut and egg). Results of these studies indicate that the stage might have been set. Surely, much more research needs to be carried out before advice can be given in clinical practice. This opinion article discusses the three types of beneficial interventions and gives ideas for future research, which might show the way for better strategies in primary prevention of allergic diseases.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
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