Paediatric Food Allergy: Differences Across Continents, Countries & Regions

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1 Paediatric Food Allergy: Differences Across Continents, Countries & Regions Scott Hackett Consultant Paediatric Immunologist Birmingham Heartlands Hospital

2 Allergy Taiwan Growth of Taiwan allergy papers

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4 Prevalence of allergic rhinoconjunctivitis symptoms ISAAC study, Lancet 1998

5 ISAAC Asthma, rhinoconjunctivitis and atopic eczema Increasing in developing countries Risk factors Paracetamol, use of antibiotics, trucks, not breast feeding, farm animal exposure first year, cats and dogs, smoking, obesity, fast food Absence of rises in previously high asthma centres

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8 Rest of the world What allergens? Asia

9 Airborne Allergens in Bangalore, India; Pendakur 2012 Allergens Common name % sensitised Cynodon dactylon Bermuda grass 22.4 Pennisetum typhoides Pearl millet 5.9 Artemesia scoparia Redstem 15.7 wormword Partheenium Gajar Ghans 8.9 hysterophorus Ageratum conyzoides Goatweed 8.2 Helianthus annuus Sunflower 8.2 Prosopis juliflora Bayahonda blanca 14.2 Cassia siamea Cassod Tree 10.4 Ricinus communis Castor oil plant 8.9 D.pteronyssinus European HDM 58.9 D.farinae American HDM 47

10 Indonesia What is the commonest food allergy? Self-reported food 1.2% to 17% for milk, 0.2% to 7% for egg, 0% to 2% for peanuts fish, 0% to 10% for shellfish, 3% to 35% for any food.

11 Indonesia What is the commonest food allergy? Confirmed food allergy Close to 0% for fish and shellfish, 0% to 3% for milk, 0% to 1.7% for egg, 1% to 10.8% for any food Munasir Asia Pac Allergy. 2013

12 Singapore? Common allergenic foods Eggs Soybeans Peanuts Cow s milk Tree nuts Fish

13 Singapore? Unique food allergens Edible birds nest from swiftlets Royal jelly Buckwheat

14 Food allergy in Asia: How does it compare? Commonest Egg Then milk Lee; Asia Pac Allergy Shellfish (crustaceans and molluscs) most common food allergy in older children and adults, leading causes of food-induced anaphylaxis

15 Food allergy in Asia: Lee; Asia Pac Allergy Peanut and tree nut allergy Not common 0.67% in Korean infants, 0.47 to 0.64% in Singaporean children, 0.43% in Filipino children 0.5 to 1.1% in Taiwan

16 Food allergy in Asia: Lee; Asia Pac Allergy Wheat allergy Leading cause of food-anaphylaxis in Japanese and Korean school children ranked above both shellfish and nuts. Japanese adults, the prevalence of wheat allergy confirmed by skin prick test and serum ω-5 gliadin-specific IgE is 0.21%

17 Food allergy in Asia: Lee; Asia Pac Allergy Fish allergy Uncommon Singapore (0.26%) But Philippines (2.29%)

18 Hen s Egg allergy EuroPrevall study Cow's Milk allergy incidence Food hypersensitivity in UK infants Non-IgE mediated cow's milk allergy

19 EuroPrevall - Egg allergy enrolled DBPCFC offered to 298 children Confirmed in 86 children; incidence 0.84% Range UK 2.18% - Greece 0.07%. Half tolerant within 1 year

20 EuroPrevall Cows Milk allergy Suspected in 358, confirmed in 55 Incidence 0.54% 1% Netherlands and UK - <0.3% Lithuania, Germany and Greece 23.6% had no specific IgE, esp UK, Netherlands, Poland and Italy 69% tolerated 1 year after diagnosis All with non-ige-associated and 57% of those with IgE-associated

21 EuroPrevall Food hypersensitivity in UK infants 1140 infants were recruited; 823 followed up until 2 years old Diagnosis by DBPCFC with symptoms up to 48 hours after challenge

22 EuroPrevall Food hypersensitivity in UK infants Cumulative incidence was 5% IgE-mediated 2.6 % Individual foods Egg 2.7% Cows' milk 2.4% Peanut 0.7% Soy 0.4% Wheat 0.2% Fish 0.1%

23 EuroPrevall Food hypersensitivity in UK infants Predictors for any food hypersensitivity were Wheeze Maternal atopy, Increasing gestational age, Age at first solid food introduction And poor diet

24 EuroPrevall Food hypersensitivity in UK infants Predictors for IgE mediated allergy were Eczema, Rhinitis Lack of healthy diet For non-ige-mediated food allergy Dog in the home, Poor diet, Maternal consumption of probiotics during breastfeeding And age at first solid food introduction

25 Incidence of food hypersensitivity in the first 10 years of life Birth cohort , Isle of Wight 969 recruited, 85.3% assessed Prevalence of food sensitisation 11.2% Challenge proven food hypersensitivity Cumulative 6.8% At 10 years 3.6% majority IgE mediated Arshad

26 Multiple food allergies

27 milk eggs peanut all 3

28 Multiple Food Allergies multiple allergens with possibles also with types of nuts included Median 1 Averages 1.4, 1.6 and

29 Lentil Allergy Second legume allergy Number of patients % allergic to a second legume 95% CI Peanut Pea Baked bean Chick pea Soya

30 Multiple food allergies Not significantly associated with Severity p = 0.6 OAS Spring hay fever Or perennial rhinitis

31 UK Allergy, Sex and Ethnicity

32 Anaphylaxis and ethnicity: higher incidence in British South Asians 426 cases 1/590 ED attendances (0.17%) 105 children Severe cases: 145 (34%) Standardised incidence rates All cases: 34.5 / 100,000 person years Severe anaphylaxis: 12.0 Buka, Allergy. 2015

33 Study findings: in adults, more common in females OR: 1.80 (CI ) p<0.001 Male Female

34 Anaphylaxis more common in South Asians OR: 1.64 (CI ), p<0.001

35 More common in South Asian Children OR 2.37, p= White Asian Mixed Black Population Study

36 More severe in South Asian children South Asian children were 5 times more likely to present with SEVERE anaphylaxis than Caucasian children Severe anaphylaxis South Asian children: 27/51 (47.1%) Caucasian children: 7/41 (17.1%) OR 5.31, p=0.002

37 Summary Wide variations in allergies across the world You can be allergic to whatever you eat Your population is likely to be unique

38 Thank you Any questions?