Prevalence and risk factors of childhood asthma, rhinitis and eczema in Hong Kong

Objective:   To assess the prevalence and risk factors of childhood asthma and allergies in Hong Kong and compare with that in Singapore and Great Britain.
Methodology:   Parents of 3618 randomly selected 6- to 7-year-old children responded to a questionnaire prepared by the International Study of Asthma and Allergies in Childhood (ISAAC) together with supplementary questions on risk factors.
Results:   The 12-month prevalences of wheezing, rhinitis symptoms and itchy rash were 9.2%, 35.1% and 4.2%, respectively. Wheezing in the past year was significantly associated with rhinitis symptoms in the past year, itchy rash in the past year, rhinitis interfering with daily activities moderately or severely, kept awake by itchy rash in the past year, parental wheezing (one or both parents), frequent upper respiratory tract infections (URTI), born in Hong Kong and male sex. For girls, the prevalence of wheezing in the past year was lowest when they were born in July/August and highest when born in January/February.
Conclusions:   The prevalence of allergic disorders in Hong Kong was comparable to that in Singapore and Great Britain. Several potential risk factors such as parental wheezing, frequent URTI, born in Hong Kong, male sex and month of birth in girls were identified.     

Coronary risk factors in Turkish schoolchildren: Randomized cross-sectional study*

Abstract Background : There is a strong association between the extent of atherosclerotic lesions in aorta and coronary arteries and antemortem risk factors in children and young adults. Cardiovascular diseases are the most common cause of death in adults in Turkey. However, the data about the extent of coronary risk factors in Turkish children is very limited. The aim of this cross‐sectional study was to investigate the prevalence of coronary risk factors in Turkish schoolchildren living in Eski?ehir, Turkey. Methods : A randomly selected population of 4026 schoolchildren, aged between 7 and 18 years, residing in urban and rural parts of Eski?ehir were evaluated for coronary risk factors, using previously predicted risk threshold values. Results : Hypertension was found in 4.8% of the girls and 3.8% of the boys, 14.9% of the girls and 10.8% of the boys had abnormal lipid values, 18.2% of the girls and 26.4% of the boys had elevated total body fat percentages, 20.7% of the girls and 14.5% of the boys had physical inactivity and 3.8% of the girls and 11.4% of the boys were regular smokers. Urban children had higher rates of hypercholesterolemia; however, rural children had higher rates of physical inactivity. When the modifiable risk factors were considered, excluding family history, 47.7% of the children had at least one risk factor and 11.7% of them exhibited two or more risk factors. Conclusions : Turkish schoolchildren living in Eski?ehir had considerably high levels of coronary risk factors. The interventional measures established in childhood, during which the lifestyle and habits responsible for coronary heart diseases are acquired, will be very effective for preventing and modifying the risk factors predisposing children to coronary heart disease.     

早期预测食物过敏高风险儿童方法探讨

目的探讨联合多种危险因素获得的过敏风险评分预测食物过敏高风险儿童的价值。方法采用问卷调查方式获得≤3岁婴幼儿的过敏危险因素信息,以多元logistic逐步回归分析婴幼儿食物过敏危险因素,计算各危险因素对食物过敏的阳性预测值,依据回归方程计算过敏风险评分,通过ROC曲线评价过敏风险评分在筛查食物过敏高风险儿童中的价值。结果获得78例确诊为食物过敏及156例非过敏性疾病的≤3岁婴幼儿的回顾性调查信息。其中过敏性疾病家族史、剖宫产、孕期使用抗生素或解热镇痛药、孕期吸烟或接触吸烟环境、孕期接触杀虫剂或驱蚊剂、家中饲养宠物均是婴幼儿发生食物过敏的危险因素(P0.05)。过敏家族史预测食物过敏的阳性预测值为63.2%,ROC曲线下面积(AUC)为0.696(95%CI:0.620～0.771)。当联合多因素获得的过敏风险评分≥2.85时,其预测食物过敏的AUC为0.804(95%CI:0.746～0.863),灵敏度为0.526,特异度为0.910,尤登指数为0.436。结论多危险因素联合指标筛查食物过敏高风险儿童的预测价值高于过敏家族史。     

Prevalence and risk factors of allergies in Turkey: Results of a multicentric cross-sectional study in children

The Prevalence And Risk Factors of Allergies in Turkey (PARFAIT) study was planned to evaluate prevalence and risk factors of asthma and allergic diseases and also to find out which geographical variables and/or climatic conditions play a role determining the prevalence of allergic diseases in Turkish school children. Study was planned as cross-sectional questionnaire-based. About 25,843 questionnaires from 14 centers were appropriate for analysis. Parental history of allergy, having an atopic sibling and other atopic disease in index case was significant risk factors for all allergic diseases. Breast feeding decreased the risk of current asthma (OR: 0.92, CI: 0.86-0.99) and wheezing (OR: 0.93, CI: 0.87-0.99) but not allergic rhinitis and eczema. Respiratory infection in the past was an important risk factor for the occurrence of allergic diseases especially for asthma which was increased 4.53-fold. Children exposed to household smoke were significantly at higher risk of asthma, wheezing, and allergic rhinitis (OR: 1.20, CI: 1.08-1.33; OR: 1.21, CI: 1.09-1.34; and OR: 1.32, CI: 1.21-1.43, respectively). All allergic diseases were increased in those children living in areas which have altitude of below 1000 m and mean yearly atmospheric pressure above 1000 mb. The study has suggested that household and country-specific environmental factors are associated with asthma, wheezing, allergic rhinitis, and eczema risk during childhood in Turkey.     

Addressing risk management difficulties in children with food allergies

Risk is a concept inherent in every medical procedure. It can be defined as the probability of an adverse event in a defined population over a specified period of time. In the frame of food allergy management, it might be related to a diagnostic procedure, a treatment, or the consumption of foods. The risk of an adverse event can also be augmented by individual factors. This rostrum article discusses various aspects faced by children with food allergies in the light of risk, and their practical implications. Identifying personal risks for severe reaction, such as unstable asthma, and correcting them whenever possible also contribute to a reduction of the risk inherent to food allergy. Among the facets discussed, oral food challenges (OFC) are the most common diagnostic procedures implying an inherent risk. The risk of OFCs can be minimized by correct indication and timing of the test, a safe setting, as well as by ensuring that the patient is otherwise well without potential stressor potentially increasing the risk of a more severe reaction. Oral immunotherapy (OIT) has been studied as a potential treatment for increasing the threshold dose for reaction, and thus reducing the risk of accidental reaction. Nevertheless, the procedure is not devoid of risk as the patients may and do often react during the course of the procedure. Ingestion of trace amounts in processed foods, mainly in community settings such as restaurants, schools, or day care, represents a potential risk of reactions, although for a minority of patients. Precautionary allergen labeling (PAL) is a widespread strategy to reduce the potential risk of reactions due to traces. However, PAL is currently inefficient due to inconsistent labeling, also not indicating a clear maximum amount possibly present in the manufactured food. Finally, cost-effectiveness needs to be considered in risk management, as many risk reduction procedures are clearly not cost-effective.     

Comparison of food allergy prevalence among Chinese infants in Chongqing, 2009 versus 1999

Background: Food allergy prevalence is increasing in developed countries, but these results have not yet been verified in developing countries, especially in China. Our aim was to determine whether the prevalence and characteristics of food allergy have changed over the last 10 years in Chongqing, China. Methods: Two cross‐sectional studies were performed, 10 years apart (1999 and 2009) using the same diagnostic methods in the same age group (0–24 months) of the same clinic in Chongqing, China. A total of 401 infants were randomly selected for the present study. Food allergy was confirmed by food challenge. spss 15.0 was used to analyze the difference in prevalence. Results: Food allergy prevalence increased significantly from 3.5% in 1999 to 7.7% in 2009 (P= 0.017). The prevalence of a positive skin‐prick‐test response was also increased (from 9.9% to 18%; P= 0.002). Egg and cow's milk were still the most common food allergens, which cause skin and gastrointestinal symptoms in most infants. Conclusion: This is the first study in China to indicate time trends in food allergy prevalence and characteristics. Our data show that in the 10‐year period from 1999 to 2009, the prevalence of food allergy seems to have increased in China.     

Recurrent abdominal pain in school children revisited: fitting adverse food reactions into the puzzle

The diagnostic work-up of children seeking health care because of recurrent abdominal pain is a clinical challenge. Food hypersensitivity might be one of the aetiologies behind this symptom. Neither the understanding of possible immune mechanisms nor endoscopic or histological findings have yet contributed to reliable diagnostic tests.

Conclusion: The possibility of adverse food reactions should be evaluated among other abnormalities behind recurrent abdominal pain in children. Still, the diagnosis of immune-mediated food reactions depends on open or blinded food challenge.     

Fish and shellfish allergy in children: Review of a persistent food allergy

The increased consumption of fish and shellfish has resulted in more frequent reports of adverse reactions to seafood, emphasizing the need for more specific diagnosis and treatment of this condition and exploring reasons for the persistence of this allergy. This review discusses interesting and new findings in the area of fish and shellfish allergy. New allergens and important potential cross‐reacting allergens have been identified within the fish family and between shellfish, arachnids, and insects. The diagnostic approach may require prick to‐prick tests using crude extracts of both raw and cooked forms of seafood for screening seafood sensitization before a food challenge or where food challenge is not feasible. Allergen‐specific immunotherapy can be important; mutated less allergenic seafood proteins have been developed for this purpose. The persistence of allergy because of seafood proteins’ resistance after rigorous treatment like cooking and extreme pH is well documented. Additionally, IgE antibodies from individuals with persistent allergy may be directed against different epitopes than those in patients with transient allergy. For a topic as important as this one, new areas of technological developments will likely have a significant impact, to provide more accurate methods of diagnosing useful information to patients about the likely course of their seafood allergy over the course of their childhood and beyond.