Prevalence of Food Allergies
in Southeast Asia
BW Lee, Dept Paediatrics
National University of Singapore
Session 1: Unders...
2011
Food Allergy:
A ‘hot’ topic
2nd wave of the allergy epidemic?
Food Allergy
J Allergy Clin Immunol 2007
Is there a Food
Allergy Epidemic
in Asia?
Studies reporting Food Allergy Prevalence
in preschool children < 5 years
OFC proven food allergy
Symptoms and sensitisati...
Summary of Prevalence of Food
Allergies in Singapore
Lee AJ and Shek LP Singapore Med J 2014
Peanut Allergy Around the World
0.5
0.6
1.5
3
0.47 0.43 0.4
0
1
1.2
0.38
1.8
2.1
0
0.5
1
1.5
2
2.5
3
3.5
U
K
U
SA
C
anada
...
Peanut Allergy and Country of Birth
3.8
5.5
Odds ratio
(Compared vs
Asia born
Asians)
Asian = Chinese, Malay, Indian, Fili...
Goh DL et al Allergy 1999
Data From Singapore 1999
No peanut anaphylaxis cases
Sarawak Indonesia Thailand
Food Anaphylaxis (n=73)
Median age 6.2 years
19%
12%
12%
11%5%
5%
4%
4%
4%
1%
8%
15%
Peanut
Seafood
Bird's Nest
Egg
Cow mi...
Shellfish
Allergy
Common Food Allergies in Asia
0.7
5.2
0
1
2
3
4
5
6
USA Singapore/Philippines
%
(6-17yr) (14-16yr)
Sicherer S, J Allergy Clin Immunol 2004
Shek LP, J Al...
Shellfish
Most Common Cause of Anaphylaxis in Asia
• Thailand Adults and Children
• Singapore Adults
• Hongkong Adults
• T...
http://tolweb.org/treehouses/?treehouse_id=4455
Order: Decapods
Food Challenge Provocation Dose
• Thai, children – 1g to 63g, cooked prawn
Jirapongsananuruk et al Clin Exp Allergy 2008
•...
Distribution of symptoms during the most severe reaction
to shellfish
0
5
10
15
20
25
30
35
40
45
50
Hives
Swollen eyes & ...
Challenge + -
2/39 shellfish allergy cases
specific IgE to shrimp (-)
shrimp tropomyosin (Pen a 1, Pen m1, Pen I 1, Lit v 1) (-)
dust mi...
Mild Crustacean Seafood Allergy
Tropomyosin – A pan-allergen
• Inhalant-food syndrome
– Dust mites as the sensitizing alle...
Conclusions from reciprocal IgE inhibition Studies:
Mites are the primary sensitizer in humid-climate
It’s Not Always Just
Food Allergy
15 year Old Girl
• Has asthma and allergic rhinitis
• Ingested home-made tempura prawns – fried
coated with Japanese flour...
Gross Appearance of Flour
Areas of light brown discolouration
Anaphylaxis to cow’s milk
formula containing short-chain
galacto-oligosaccharide
(GOS)
Report of 5 Cases
Prebiotic (Carboh...
Anaphylaxis to Cow’s
milk formula
SKIN PRICK TEST
• SPT to CMF negative
• SPT to CMF without PREBIOTICS negative
• SPT to CMF containing GOS positive
A: COW...
0
100
200
300
400
500
0 0.1 1 10 0 0.1 1 10 0 0.1 1 10 0 0.1 1 10 0 0.1 1 10
CD203c(MFI)
Patient 1 Patient 2 Patient 3 Pat...
GOS GRAS dossier 2007
Structure of GOS
GOS is produced by enzymatic
transgalactosylation of lactose
by β-galactosidase
Variable chains of galact...
Fractions of GOS mixture
High-Performance Anion-Exchange Chromatography
with Pulsed Amperometric Detection (HPAEC-PAD)
DP=...
Dose-dependent effect of scGOS fractions on activation of in vitro–
sensitized control basophils
Chiang et al J Allergy Cl...
• Milk product with GOS introduced in Sept 2009
• 3 million cartons sold a day in Vietnam
• 15/16 cases aged 2-15 years ol...
What is the Primary
Sensitizer?
Hoya Antigen Asthma in Japan
• Sea squirt antigen – H
or Hoya antigen
• It is a hexosamine rich
glycoprotein
• Causes occu...
Alpha-Galactose IgE Epitopes
(mammalian CCD)
• Cetuximab: N-linked oligosaccharides contains the a-
gal epitopes
– Immedia...
Cabohydrate Allergen Epitopes
- cross-reactive carbohydrate determinants (CCD)
of N-linked glycans Aalberse RC, J Allergy ...
Plant
(pollen, vegetables,
fruits and natural
rubber latex)
Insect
(Bee venom)
Examples of plant and insect N-glycans
Curr...
Conclusions
• It does not appear that Asia is facing a
food allergy epidemic
– Better oral tolerance?
• Pattern of food al...
Prevalence of Food Allergies in S.E Asia - 2015
Prevalence of Food Allergies in S.E Asia - 2015
Prevalence of Food Allergies in S.E Asia - 2015
Prevalence of Food Allergies in S.E Asia - 2015
Prevalence of Food Allergies in S.E Asia - 2015
Prevalence of Food Allergies in S.E Asia - 2015
Prevalence of Food Allergies in S.E Asia - 2015
Prevalence of Food Allergies in S.E Asia - 2015
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Prevalence of Food Allergies in S.E Asia - 2015

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Published on: Mar 4, 2016
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Transcripts - Prevalence of Food Allergies in S.E Asia - 2015

  • 1. Prevalence of Food Allergies in Southeast Asia BW Lee, Dept Paediatrics National University of Singapore Session 1: Understanding Food Allergies
  • 2. 2011 Food Allergy: A ‘hot’ topic
  • 3. 2nd wave of the allergy epidemic? Food Allergy J Allergy Clin Immunol 2007 Is there a Food Allergy Epidemic in Asia?
  • 4. Studies reporting Food Allergy Prevalence in preschool children < 5 years OFC proven food allergy Symptoms and sensitisation Parental reporting Published data only available from 16/89 countries (those without data not shown) Prescott SL et al WAOJ 2013
  • 5. Summary of Prevalence of Food Allergies in Singapore Lee AJ and Shek LP Singapore Med J 2014
  • 6. Peanut Allergy Around the World 0.5 0.6 1.5 3 0.47 0.43 0.4 0 1 1.2 0.38 1.8 2.1 0 0.5 1 1.5 2 2.5 3 3.5 U K U SA C anada A ustralia Singapore Philippines C hina Thailand %Prevalence Shek et al, J Allergy Clin Immunol, 2010 Gusto Cohort, Singapore (unpublished) Chen et al, Pediatric Allergy Immunol 2011 Tang et al, J Allergy Clin Immunol 2012 Lao-Araya Ped Int 2012 Hourihane et al, J Allergy Clin Immunol 2007 Sicherer et al, J Allergy Clin Immunol 2010 Kagan et al, J Allergy Clin Immunol 2003 Osborne et al, J Allergy Clin Immunol 2011 (Peanut/tree nut)
  • 7. Peanut Allergy and Country of Birth 3.8 5.5 Odds ratio (Compared vs Asia born Asians) Asian = Chinese, Malay, Indian, Filipino Western countries = Australia, New Zealand, United Kingdom, North America and Western Europe Shek et al J Allergy Clin Immunol 2010 Born in the West Asian Caucasian p<0.05
  • 8. Goh DL et al Allergy 1999 Data From Singapore 1999 No peanut anaphylaxis cases
  • 9. Sarawak Indonesia Thailand
  • 10. Food Anaphylaxis (n=73) Median age 6.2 years 19% 12% 12% 11%5% 5% 4% 4% 4% 1% 8% 15% Peanut Seafood Bird's Nest Egg Cow milk Fruits (banana, jackfruit, mango) Fish Treenuts Honey Wheat Others (HDM contaminated flour, Preservatives/colouring) Unknown Singapore (KKH) Paediatric Food Anaphylaxis Jan 2005 to Dec 2009 13 Peanut anaphylaxis over 5 years – 12 Chinese (1 born in Canada), 1 Caucasian Liew WK et al. AP Allergy 2013
  • 11. Shellfish Allergy Common Food Allergies in Asia
  • 12. 0.7 5.2 0 1 2 3 4 5 6 USA Singapore/Philippines % (6-17yr) (14-16yr) Sicherer S, J Allergy Clin Immunol 2004 Shek LP, J Allergy Clin Immunol 2010 Shellfish Allergy Population-based Surveys
  • 13. Shellfish Most Common Cause of Anaphylaxis in Asia • Thailand Adults and Children • Singapore Adults • Hongkong Adults • Taiwan Adults and Children Jirapongsaranuruk O et al Ann Allergy Immunol 2007 Thong B et al Sing Med J 2005 Smit DV et al J Emerg Med 2005 Hsin Y et al Asian Pac J Allergy Immunol 2011
  • 14. http://tolweb.org/treehouses/?treehouse_id=4455 Order: Decapods
  • 15. Food Challenge Provocation Dose • Thai, children – 1g to 63g, cooked prawn Jirapongsananuruk et al Clin Exp Allergy 2008 • Singapore, Adolescents and Adults: 2g to 80g, cooked prawn Gerez et al, unpublished • Canada, Adult (1 patient): 14g, freeze dried, capsule Bernstein et al J Allergy Clin Immunol 1982; 70:205–10
  • 16. Distribution of symptoms during the most severe reaction to shellfish 0 5 10 15 20 25 30 35 40 45 50 Hives Swollen eyes & lips Vomiting & Diarrhoea Abdominal pain Runny nose Itchy throat Throat tightness & Wheezing Coughing Feeling faint or dizzy & Loss of consciousness Redness of skin %ofstudentswithsymptom Fig 1. (n=674) Shek et al, J Allergy Clin Immunol, 2010
  • 17. Challenge + -
  • 18. 2/39 shellfish allergy cases specific IgE to shrimp (-) shrimp tropomyosin (Pen a 1, Pen m1, Pen I 1, Lit v 1) (-) dust mite tropomyosin (Der p 10, Blo t 10) (+) Thayalasingham M et al, Clin Exp Allergy 2015
  • 19. Mild Crustacean Seafood Allergy Tropomyosin – A pan-allergen • Inhalant-food syndrome – Dust mites as the sensitizing allergen – Crustacean shellfish as the cross reactive allergen
  • 20. Conclusions from reciprocal IgE inhibition Studies: Mites are the primary sensitizer in humid-climate
  • 21. It’s Not Always Just Food Allergy
  • 22. 15 year Old Girl • Has asthma and allergic rhinitis • Ingested home-made tempura prawns – fried coated with Japanese flour • Developed urticaria, throat discomfort, severe wheezing 20 min later • Treated at emergency dept for anaphylaxis - SaO2 77%
  • 23. Gross Appearance of Flour Areas of light brown discolouration
  • 24. Anaphylaxis to cow’s milk formula containing short-chain galacto-oligosaccharide (GOS) Report of 5 Cases Prebiotic (Carbohydrate) Triggered Anaphylaxis Chiang et al J Allergy Clin Immunol 2012
  • 25. Anaphylaxis to Cow’s milk formula
  • 26. SKIN PRICK TEST • SPT to CMF negative • SPT to CMF without PREBIOTICS negative • SPT to CMF containing GOS positive A: COW’S MILK FORMULA (numerical refer to diameters weal) Patient 1 2 3 4 5 Positive Histamine 7 x 5 10 x 7 5 x 5 6 x 6 9x7 Negative Control 0 0 0 0 0 Cow’s Milk 0 0 0 0 0 CMF1 with prebiotics scGOS + lcFOS 7 x 6 3 x 3 1 x 1 4 x 4 6x5 CMF1 without prebiotics 0 0 0 0 0 CMF2 with prebiotic scGOS 7 x 6 5 x 3 5 x 5 6 x 6 14x10 Std Vivinal GOS (7.2mg/ml) 3 x 3 7 x 5 0 5 x 5 3 x 3 scGOS = short chain Galacto-oligosaccharides lcFOS = long chain Fructo-oliogosaccharides Chiang et al J Allergy Clin Immunol 2012
  • 27. 0 100 200 300 400 500 0 0.1 1 10 0 0.1 1 10 0 0.1 1 10 0 0.1 1 10 0 0.1 1 10 CD203c(MFI) Patient 1 Patient 2 Patient 3 Patient 4 Patient 5 a-IgE CMF1w/o prebiotics IcFOS 0 0.1 1 10 0 0.1 1 10 0 0.1 1 10 0 100 200 300 400 500 CD203c(MFI) CMF1 CMF2 Std GOS Basophil Activation Tests whole blood Actual GOS concentration in the samples (mg/ml) 0 0.1 1 10 0 0.1 1 10 0 0.1 1 10 0 20 40 60 80 100 120 CD63(%) whole blood Chiang et al J Allergy Clin Immunol 2012 Cow’s milk formula Galacto-oligosaccharide
  • 28. GOS GRAS dossier 2007
  • 29. Structure of GOS GOS is produced by enzymatic transgalactosylation of lactose by β-galactosidase Variable chains of galactose with one molecule of glucose
  • 30. Fractions of GOS mixture High-Performance Anion-Exchange Chromatography with Pulsed Amperometric Detection (HPAEC-PAD) DP=degrees of polymerization Glu or Gal Gal-Glu (Gal)2-Glu (Gal)3-Glu (Gal)4-Glu (Gal)5-Glu (Gal)6-Glu
  • 31. Dose-dependent effect of scGOS fractions on activation of in vitro– sensitized control basophils Chiang et al J Allergy Clin Immunol 2012 Inhibition of scGOS-induced basophil degranulation by the phosphatidylinositol 3-kinase inhibitor wortmannin scGOS activation of basophils requires the PI-3-kinase pathway. This is consistent with IgE-mediated activation.
  • 32. • Milk product with GOS introduced in Sept 2009 • 3 million cartons sold a day in Vietnam • 15/16 cases aged 2-15 years old consumed milk with GOS • 12/15 within 3 to 20 mins of milk consumption. • 3/15 with acute respiratory problems
  • 33. What is the Primary Sensitizer?
  • 34. Hoya Antigen Asthma in Japan • Sea squirt antigen – H or Hoya antigen • It is a hexosamine rich glycoprotein • Causes occupational asthma in oyster shucklers
  • 35. Alpha-Galactose IgE Epitopes (mammalian CCD) • Cetuximab: N-linked oligosaccharides contains the a- gal epitopes – Immediate onset anaphylaxis • Mammalian meat - Pork and Beef: gal-a-1,3-gal-b- 1,4-GlcNAc – Delayed anaphylaxis reaction (3-6 hours) Commins and Platts Mills J Allergy Clin Immunol 2015
  • 36. Cabohydrate Allergen Epitopes - cross-reactive carbohydrate determinants (CCD) of N-linked glycans Aalberse RC, J Allergy Clin Immunol 1981; 68:356–364. • Clinically insignificant – Low titre anti-glycan IgE antibodies – High affinity ‘blocking’ IgG antibodies • ‘False positive’ specific IgE tests
  • 37. Plant (pollen, vegetables, fruits and natural rubber latex) Insect (Bee venom) Examples of plant and insect N-glycans Curr Opin Allergy Clin Immunol. 2013 Aug;13(4):360-4
  • 38. Conclusions • It does not appear that Asia is facing a food allergy epidemic – Better oral tolerance? • Pattern of food allergy is different and may be related to environmental allergens – Inhalant/environmental and food allergens

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