Food Allergy in Turkey

Transcription

1 Food Allergy in Turkey Isil B Barlan Pediatric Allergy/ Immunology Marmara University Istanbul Brussels/ 07

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3 Age distribution in Turkey over 65 % 65 %5 %

4 Median age Total male female

5 studies on food allergy

6 Prevalence of asthma in children in Turkey: %. ISAAC phase II study: current wheeze, 11.5% physician diagnosed asthma,6.9% Turktas I,et al.turk J Pediatr Saraclar Y et al.ann Allergy Asthma Immunol 2003

7 Asthma and allergic diseases in schoolchildren: third cross-sectional survey in the same primary school in Ankara,Turkey Demir AU, et al. Pediatr Allergy Immunol,2004 Surveys: 1992, 1997, 2002 n: 1064,age: 6-14 They reported no increased trend for asthma -8.3, 9.8, 6.4% - and other allergic diseases.

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11 -Current prevalence of asthma and allergic diseases decreased among schoolchildren in Ankara, during the last 10 yr. -ingestion of milk and red meat could have a role in the occurence of asthma and hay fever. -Detailed assessment of dietary habits is required to test this hypothesis.

12 Prevalence of CMA: Elimination diet 21 Prevalence of CMA : 21 / 1348 = % 1.55 Altıntas D, et al. A prospective study of cow s milk allergy in Turkish infants. Acta Pediatr 1995;84:1320.

13 Seasonal rhinitis,clinical characteristics and risk factors for asthma Kalyoncu AF, et al.a ret Int Arch Allergy Immunol,2005 N:774,dx with SR Mean age: 29 Positive SPT in 90%,timothy grass, the most common The most common accompanying allergic diseases were food hypersensitivity in 14%, asthma 13.4%.

14 The most common clinical manifestation of FH were oral allergy (49.1%), and cutaneous symptoms (38.9%).

15 Aim : Foods responsible from the food allergy : 174 children with food allergy, seen betw Dx with spc IgE and compatible symptoms or (+) challenge test Soyer O,et al.poster in 2007 Meeting of Turkish Society of Allergy

16 Age <1 Food Allergy ,1 1,6 2,1 2,6 Egg Hazel-pea-walnut* Red meat Cows milk Wheat Other Lentil-peas Age 1 Food Allergy ,5 4,3 5,7 5,8 7,2 10,1 Meat Tomatoes Fish Other Egg Hazel-pea-walnut* Lentil-peas Wheat carrot-corn-tomates-sesame-soya patatos-corn-sesame-soya-letture-kiwi Cows milk Percent Percent

17 Anaphlaxis (-) Anaphylaxis (+) Severe anaphylaxis Mild anaphylaxis Red meat (n=12) Fish (n=5) Hazel-pea-walnut* (n=40) Lentil-chickpea-green pea (n=12) Egg (n=79) Cows milk (n=96) Egg (n=79) Red meat (n=12) Fish (n=5) Hazel-pea-walnut* (n=40) Lentil-chickpea-green pea (n=12) Cows milk (n=96) Percent

18 In food allergy, symptoms, severity and the prognosis is mainly determined by the type of causitive food.

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20 Aim To develop mouse model of food allergy To investigate the risk of developing allergic reactions in the recipient mouse upon passive transfer of CD4+ T cells from the donor

21 +2h i.p OVA 21+2h h C.Ö

22 Size and numbers of goblet cells,ratio of villus/crypt in the mouse model of FA

23 C.Ö Airway histopathology in the recipient mice

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25 CD4+ T cells from mesenteric lymph nodes of mice with allergen-induced immediate-type hypersensitivity reactions in the gut are able to transfer the phenotype of experimental asthma.

26 Two life styles: 1-westernized one Live in the west part with higher income Not much breast-feeding Consumption of fast foodless infections more allery

27 2-traditional one Live in the east part with lower income Longer duration of breast-feeding Early start with yogurt and CM More infections Less allery

28 3-immigrants from the poorest part of Turkey to central Europe

29 Prevalence of allergic disease in Turkish immigrants

30 Lower prevalence of asthma and atopy in Turkish children living in Germany Kabesh M,et al.eur Respir J, Aim:to evaluate the prevalence of asthma, atopic diseases in Turkish children living in Germany

31 Conducted betw yrs old pupils Questionnaire (non-isaac) SPT PFT Bronchial challenge

32 6490 families Asthma ever Turkish 5.3 % 9.4 % A.D 1.6 % 13.9 % BHR 3.9 % 7.7 %

33 It is proposed in this study that lower prevalence of atopic disorders in Turkish group is in part owing to a selection bias ass with immigration.

34 Ethnicity,childhood environment and atopic disorder Hjern A et al, Clin Exp Allergy,2000 Aim:to evaluate the influence of ethnicity& country of birth for the prevalence of atopic disorders

35 Parents n Asthma % All RC % Country of birth Sweden Turkey

36 Children Asthma% All RC % Eczema% Sweden Turkey

37 This study demonstrates that ethnicity is an important determinant of atopic disorder independent of the external environment Differences in life style: Turkish group have a longer duration of breastfeeding higher dietary fibre content

38 Cultural adaptation is ass with atopy and wheezing among children of Turkish origin living in Germany Gruber C, et al. Clin Exp All 2002 Aim:to evaluate rates of sensitization and atopic disease among children in Germany with German or Turkish ethnicity and different degrees of cultural adaptation

39 Only Turkish / German German Turkish German sensitiza tion Wheeze ever Wheeze past yr itchy rash

40 Results of this study suggests that environmental rather than genetic differences account for this epidemiological trend.

41 Induction of mucosal tolerance: Allergen exposure Induction of Treg cells

42 Induction of oral tolerance is associated with, in situ production of Foxp3 + regulatory T cells. Mucida D, et al.oral tolerance in the absence of naturally occurring Tregs. J Clin Invest Reciprocally, Foxp3 deficiency, results in the development of severe food allergies. Chatila TA. Role of regulatory T cells in human diseases. J Allergy Clin Immunol 2005.

43 Fox p 3 mutation in humans: Immune disregulation Polyendocrinopathy Enteropathy- X-linked syndrome (IPEX) Neonatal autoimmune type I diabetes with islet cell destruction by infiltrating T cells. Autoimmunity including polyendocrinopathy, autoimmune hemolytic anemia and autoimmune enteropathy severe allergic inflammation with eczema and food allergy. High levels of IgE.intense peripheral eosinophilia

44 Talal Chatila, J Allergy Clin Immunol 2005.

45 Induction of mucosal tolerance: Allergen exposure inductionof T reg cells early in life stimulator for the immune system :gut flora

46 Homing mechanisms that underlies the spread of allergen responsive T cells primed in the gut to other target organs can be harnessed for therapeutic purposes.

47 Thank you,

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