Araya Yuenyongviwat

A Population-Based Study of Fish Allergy in the Philippines, Singapore and Thailand

Background: Fish allergy is the third most common food allergy after milk and egg in parts of Europe, but there is little data about prevalence in South East Asia where it is an important part of regular diets. Objective: We aimed to obtain an estimate of the population prevalence of fish allergy among older children in the Philippines, Singapore and Thailand. Methods: The population prevalence of fish allergy in 14- to 16-year-old children in the 3 countries was evaluated using a structured written questionnaire which was distributed to students of randomly selected secondary schools. An extended questionnaire to determine convincing fish allergy on the basis of typical clinical manifestations within 2 h of ingestion was administered to those with positive responses. Results: From acohort of 25,842 students, responses were 81.1% in the Philippines (n = 11,434), 67.9% in Singapore (n = 6,498) and 80.2% (n = 2,034) in Thailand. Using criteria for convincing food allergy, fish allergy was much higher in the Philippines [2.29%, 95% confidence interval (CI) 2.02–2.56] than in Singapore (0.26%, 95% CI 0.14–0.79) and Thailand (0.29%, 95% CI 0.06–0.52). Weighted multiple logistic regression analyses showed that compared to the Philippines, prevalence rates were lower in Singapore [odds ratio (OR) 0.40, 95% CI 0.27–0.60, p < 0.0001] and Thailand (OR 0.13, 95% CI 0.05–0.33, p < 0.0001). Females were more likely to have fish allergy compared to males for all children combined (OR 1.32, 95% CI 1.11–1.58, p = 0.002). Most allergies appeared mild, as only 28% of cases sought medical consultation at the time of the reaction and 31.2% of cases reported continued exposure despite allergic symptoms. Conclusion: Fish allergy in late childhood is more common in the Philippines compared to Singapore and Thailand. Differences in food processing, dietary habits and other cultural practices might be important risk factors for the development of fish allergy in these populations.

Recent 5-year trends of asthma severity and allergen sensitization among children in southern Thailand

BACKGROUND Asthma is a major public health issue that affects morbidity. The greater severity of asthma requires more health care resource utilization. OBJECTIVE To investigate the possible changes in disease severity and allergen sensitization of children with asthma in an interim period of 5 years. METHODS We retrospectively reviewed the charts of 200 patients with established asthma in the pediatric allergy clinic. The data were collected in different time periods with 100 consecutive cases in each group starting in January of 2004 and in January of 2009. All patients underwent a skin prick test (SPT) to common allergens, with positive and negative controls. SPTs with a mean wheal diameter 3 mm greater than a negative control were considered test-positive. RESULTS The mean ages of patients in the 2004 and 2009 groups were 7.54 and 7.73 years. Compared with patients in the 2004 group, the 2009 group had more severe asthma (p = 0.006). The distribution of asthma severity was mild (intermittent and mild persistent) 98.0% in 2004 and 87.9% in 2009, and moderate to severe persistent 2.0% in 2004 and 12.1% in 2009. The prevalence of patients sensitized to both house dust (HD) and house dust mites (HDM) increased from 21.2% in 2004 to 34.3% in 2009 (p =0.007). Sensitization to allergens of HD, HDM and cockroach increased to 14.1% in 2009 from 9.1% in 2004 (p =0.021). CONCLUSIONS During the years between 2004 and 2009, asthma severity increased with increasing sensitization to HD, HDM and cockroach. Awareness of these changes and further studies are required.

Achieving good adherence to inhaled corticosteroids after weighing canisters of asthmatic children

Background: The metered-dose inhalers (MDIs) currently available for inhaled corticosteroid delivery do not offer an integrated dose counter; therefore, it is difficult to evaluate adherence of patients. The present authors developed a linear regression equation using canister weight to calculate the number of doses actuated from the MDIs. This study aimed to assess medical adherence after the integration of regular weighing of the canisters into the routine service. Methods: A cohort study was carried out between May 2013 and April 2014. Children aged less than 8 years with a diagnosis of asthma were recruited. The duration of adherence assessment was 24 weeks. Participants had a regular schedule every 8 weeks to obtain a new FLIXOTIDE® 125 inhaler. Parents were asked to collect the discarded MDI canisters, which were then weighed by a laboratory scale. The weight of each canister was replaced in the regression equation to calculate the number of doses actuated from the MDIs. Results: A total of 52 asthmatic children participated in the study. The median age was 52.7 months. At the end of 24 weeks, 44, 33, and 23 discarded MDI canisters were collected from visits 1, 2, and 3, respectively. The median percentages of adherence were 96.8%, 96.3%, and 96.3%, respectively. In 11 discarded canisters (11%), the remaining medication was more than 30% of the labeled doses. Approximately 90% of the participants had no asthma exacerbation during 24-week study period. Conclusion: High adherence rates were achieved after integration of canister weighing into the asthma care service.