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Leung ASY, Tham EH, Pacharn P, Xing Y, Trinh HKT, Lee S, Ahn K, Chatchatee P, Sato S, Ebisawa M, Lee BW, Wong GWK. Disparities in pediatric anaphylaxis triggers and management across Asia. Allergy 2024; 79:1317-1328. [PMID: 38462795 DOI: 10.1111/all.16098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/04/2024] [Accepted: 02/21/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND The epidemiology and management of anaphylaxis are not well-reported in Asia. METHODS A regional pediatric anaphylaxis registry was established by the Asia-Pacific Research Network for Anaphylaxis (APRA), using standardized protocols for prospective data collection, to evaluate the triggers and management of anaphylaxis in the Asia-Pacific region. Pediatric patients below 18 years presenting with anaphylaxis across four Asian countries/cities (Thailand, Singapore, Hong Kong (HK), and Qingdao) were included. Allergen triggers, symptoms, anaphylaxis severity, and management were compared. RESULTS Between 2019 and 2022, 721 anaphylaxis episodes in 689 patients from 16 centers were identified. The mean age at anaphylaxis presentation was 7.0 years (SD = 5.2) and 60% were male. Food was the most common trigger (62%), particularly eggs and cow's milk in children aged 3 years and below. In school-age children, nut anaphylaxis was most common in HK and Singapore, but was rare in the other countries, and wheat was the top allergen in Bangkok. Shellfish anaphylaxis was most common in children aged 7-17. Adrenaline was administered in 60% of cases, with 9% given adrenaline before hospital arrival. Adrenaline devices were prescribed in up to 82% of cases in Thailand but none in Qingdao. CONCLUSIONS The APRA identified food as the main trigger of anaphylaxis in children, but causative allergens differed even across Asian countries. Fewer than two-thirds of cases received adrenaline treatment, pre-hospital adrenaline usage was low, and adrenaline device prescription remained suboptimal. The registry recognizes an unmet need to strengthen anaphylaxis care and research in Asia-Pacific.
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Affiliation(s)
- Agnes Sze Yin Leung
- Department of Paediatrics, Prince of Wales Hospital, Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Elizabeth Huiwen Tham
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Punchama Pacharn
- Department of Pediatrics, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yuhan Xing
- Department of Paediatrics, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Hoang Kim Tu Trinh
- Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Sooyoung Lee
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Kangmo Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Pantipa Chatchatee
- Department of Pediatrics, Division of Allergy and Immunology, Faculty of Medicine, HAUS IAQ Research Unit, King Chulalongkorn Memorial Hospital, Chulalongkorn University, The Thai Red Cross Society, Bangkok, Thailand
| | - Sakura Sato
- Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Kanagawa, Japan
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Kanagawa, Japan
| | - Bee Wah Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Gary Wing Kin Wong
- Department of Paediatrics, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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Lee SL, Lau YL, Wong WHS, Tian LW. Childhood Wheeze, Allergic Rhinitis, and Eczema in Hong Kong ISAAC Study from 1995 to 2015. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192416503. [PMID: 36554390 PMCID: PMC9779471 DOI: 10.3390/ijerph192416503] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/29/2022] [Accepted: 12/06/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND The prevalence of allergic diseases has been increasing in developing areas but has reached a plateau in many developed areas. Regular surveys are imperative to assess the disease burden for the prioritization of resource allocation. OBJECTIVES We examined the change in the prevalence of wheezing, allergic rhinitis (AR), and eczema in school-aged children with possible associative factors and possible health effects of school air quality. METHODS This was the third repeated cross-sectional study conducted in 2015-2016 using the International Study of Asthma and Allergies in Childhood (ISAAC) protocol. Our first and second surveys were conducted in 1994-1995 and 2000-2001, respectively. Regarding the third survey, we recruited 3698 children aged 6-7 from 33 local schools in 18 districts. Air quality, temperature, and humidity were also measured. The changes in prevalence, multiple regression, and GLIMMIX procedure were analyzed. RESULTS From our first survey to our third survey, the increased prevalences for lifetime wheeze, current wheeze, lifetime rhinitis, current rhinitis, current rhinoconjunctivitis, lifetime chronic rash, and current chronic rash were 4.2%, 2.1%, 12.5%, 12.6%, 14.2%, 3.9%, and 4.1%, respectively. Increased prevalence of parental atopy had the strongest association with an increased prevalence of each of these seven health outcomes. There was no significant association between school air pollutant levels and the prevalence of health outcomes. CONCLUSIONS There was an increase in the prevalence of wheezing, allergic rhinitis, and eczema across the surveys. The most important associated risk factor identified was the increased prevalence of a parental history of atopy.
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Affiliation(s)
- So-Lun Lee
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong
- Department of Paediatrics, Duchess of Kent Children’s Hospital, Hong Kong
| | - Yu-Lung Lau
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - Wilfred Hing-Sang Wong
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - Lin-Wei Tian
- School of Public Health, The University of Hong Kong, Hong Kong
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Norbäck D, Hashim Z, Ali F, Hashim JH. Asthma symptoms and respiratory infections in Malaysian students-associations with ethnicity and chemical exposure at home and school. ENVIRONMENTAL RESEARCH 2021; 197:111061. [PMID: 33785322 DOI: 10.1016/j.envres.2021.111061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/20/2021] [Accepted: 03/18/2021] [Indexed: 06/12/2023]
Abstract
Little is known on respiratory effects of indoor chemicals in the tropics. We investigated associations between asthma and respiratory infections in Malaysian students and chemical exposure at home and at school. Moreover, we investigated differences in home environment between the three main ethnic groups in Malaysia (Malay, Chinese, Indian). Totally, 462 students from 8 junior high schools in Johor Bahru participated (96% participation rate). The students answered a questionnaire on health and home environment. Climate, carbon dioxide (CO2), volatile organic compounds (VOC), formaldehyde and nitrogen dioxide (NO2) were measured inside and outside the schools. Multilevel logistic regression was applied to study associations between exposure and health. Totally 4.8% were smokers, 10.3% had wheeze, 9.3% current asthma, and had 18.8% any respiratory infection in the past 3 months. Malay students had more dampness or mould (p < 0.001), more environmental tobacco smoke (ETS) (p < 0.001) and more cats (p < 0.001) at home as compared to Chinese or Indian students. Wheeze was associated with ethnicity (p = 0.02; lower in Indian), atopy (p = 0.002), current smoking (p = 0.02) and recent indoor painting at home (p = 0.03). Current asthma was associated with ethnicity (p = 0.001; lower in Chinese) and para-dichlorobenzene in classroom air (p = 0.008). Respiratory infections were related to atopy (p = 0.002), ethylbenzene (p = 0.02) and para-dichlorobenzene (p = 0.01) in classroom air. Para-dichlorobenzene is used in Asia against insects. In conclusion, chemical emissions from recent indoor painting at home can increase the risk of wheeze. In schools, para-dichlorobenzene can increase the risk of current asthma and respiratory infections while ethylbenzene can increase the risk of respiratory infections.
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Affiliation(s)
- Dan Norbäck
- Uppsala University, Department of Medical Science, Occupational and Environmental Medicine, University Hospital, 75185, Uppsala, Sweden.
| | - Zailina Hashim
- Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, UPM, Serdang, Selangor, Malaysia
| | - Faridah Ali
- Primary Care Unit, Johor State Health Department, 80100, Johor Bahru, Malaysia
| | - Jamal Hisham Hashim
- Faculty of Health Sciences, Universiti Selangor, 40000, Shah Alam, Malaysia; Department of Community Health, National University of Malaysia, 56000, Kuala Lumpur, Malaysia
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Lai L, Zhang T, Zeng X, Tan W, Cai L, Chen Y. Association between Physician-Diagnosed Asthma and Weight Status among Chinese Children: The Roles of Lifestyle Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051599. [PMID: 32121663 PMCID: PMC7084854 DOI: 10.3390/ijerph17051599] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 02/12/2020] [Accepted: 02/18/2020] [Indexed: 02/07/2023]
Abstract
Childhood asthma and obesity have posed a parallel epidemic over the past few decades. However, whether asthma diagnosis is associated with obesity, and what the roles of lifestyle factors play in this relationship, remained unclarified. This study aimed to investigate the association between asthma and weight status in Chinese children and explore the potential mediating and/or modifying roles of lifestyle factors in the association. In this cross-sectional study, 16,837 children aged 6–12 years were recruited from Guangzhou, China. Participants’ information on physician-diagnosed asthma was collected from parents, and data on physical activity, screen time, and sleeping were reported in a validated questionnaire. Height and weight were objectively measured, and weight status was classified by body mass index (BMI). Multiple logistic regression analysis and mediation analysis were used. Results showed that asthmatic children were at significantly higher risk of obesity (odds ratio (OR) 1.51, 95% confidence interval (CI) 1.03, 2.21) compared with non-asthmatic children. More importantly, this increased risk was even greater in children with moderate-to-vigorous physical activity <60 min/d and children with screen time >2 h/d (both Pinteraction < 0.05). Also, a positive relationship of asthma with overweight was found in children with screen time >2 h/d (OR 3.92, 95% CI 1.56, 9.88), while a negative association was observed between asthma and underweight in children aged 9–12 years (OR 0.23, 95% CI 0.06, 0.92). Mediation analysis indicated that these associations were not mediated by physical activity, screen time, or sleeping. The findings suggested that physician-diagnosed asthma was associated with higher risks of overweight and obesity, and these risks might be exacerbated by insufficient physical activity and prolonged screen time.
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Affiliation(s)
- Lijuan Lai
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (L.L.); (X.Z.)
| | - Ting Zhang
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China;
| | - Xia Zeng
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (L.L.); (X.Z.)
| | - Weiqing Tan
- Health Promotion Centre for Primary and Secondary Schools of Guangzhou Municipality, Guangzhou 510020, China;
| | - Li Cai
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (L.L.); (X.Z.)
- Correspondence: (Y.C.); (L.C.); Tel.: +86-020-8733-4627 (Y.C.); Fax: +86-020-8733-0446 (Y.C.)
| | - Yajun Chen
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (L.L.); (X.Z.)
- Correspondence: (Y.C.); (L.C.); Tel.: +86-020-8733-4627 (Y.C.); Fax: +86-020-8733-0446 (Y.C.)
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Abstract
Allergic conjunctivitis (AC), which may be acute or chronic, is associated with rhinitis in 30%-70% of affected individuals, hence the term allergic rhinoconjunctivitis (AR/C). Seasonal and perennial AC is generally milder than the more chronic and persistent atopic and vernal keratoconjunctivitis. Natural allergens like house dust mites (HDM), temperate and subtropical grass and tree pollen are important triggers that drive allergic inflammation in AC in the Asia-Pacific region. Climate change, environmental tobacco smoke, pollutants derived from fuel combustion, Asian dust storms originating from central/north Asia and phthalates may also exacerbate AR/C. The Allergies in Asia Pacific study and International Study of Asthma and Allergies in Childhood provide epidemiological data on regional differences in AR/C within the region. AC significantly impacts the quality of life of both children and adults, and these can be measured by validated quality of life questionnaires on AR/C. Management guidelines for AC involve a stepped approach depending on the severity of disease, similar to that for allergic rhinitis and asthma. Topical calcineurin inhibitors are effective in certain types of persistent AC, and sublingual immunotherapy is emerging as an effective treatment option in AR/C to grass pollen and HDM. Translational research predominantly from Japan and Korea involving animal models are important for the potential development of targeted pharmacotherapies for AC.
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Affiliation(s)
- Bernard Yu-Hor Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433, Singapore
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Chen L, Pi L, Fang J, Chen X, Ke N, Liu Q. High incidence of dry eye in young children with allergic conjunctivitis in Southwest China. Acta Ophthalmol 2016; 94:e727-e730. [PMID: 27226346 DOI: 10.1111/aos.13093] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 03/17/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE To identify the prevalence of dry eye in pediatric population with allergic conjunctivitis in Southwest China. METHODS A single-centre, prospective, case-control study conducted between May 2015 and December 2015 included 40 children, 3-6 years of age, with seasonal allergic conjunctivitis (SAC) or perennial allergic conjunctivitis (PAC) and 40 age- and gender-matched children undergoing medical healthy examination without history of allergy or dry eye as a control. A dry eye score system (DESS) was administered to both groups. Slit-lamp examinations including tear film break-up time (TFBUT) and fluorescent corneal staining (FCS) were performed. Correlation analyses were performed to evaluate associations between measures of dry eye and signs and symptoms of AC. RESULTS The prevalence of dry eye was 97.5% (78/80 eyes) in cases and 27.50% (22/80 eyes) in controls. Mean DESS score was 4.75 ± 2.22 in the case group and 0.80 ± 1.22 in the control group (p < 0.001). Symptoms of dry eye in the case group were mild (<6). Mean tear film break-up time was 6.54 ± 1.48 seconds in the case group and 10.04 ± 1.79 seconds in the control group (p < 0.001). Mean FCS scores were 0.79 ± 1.34 and 0.21 ± 0.57, respectively (p = 0.001). The DESS score and TFBUT were both associated with the duration of allergic conjunctivitis. CONCLUSION The incidence of dry eye assessed by TFBUT was higher in young children with SAC and PAC than in controls. However, subjective symptoms of dry eye (DESS) were inconsistent with objective signs, indicating that close attention should be paid to the evaluation and treatment of dry eye in pediatric population with AC.
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Affiliation(s)
- Lin Chen
- Department of Ophthalmology; Children's Hospital; Chongqing Medical University; Chongqing China
| | - Lianhong Pi
- Department of Ophthalmology; Children's Hospital; Chongqing Medical University; Chongqing China
| | - Jing Fang
- Department of Ophthalmology; Children's Hospital; Chongqing Medical University; Chongqing China
| | - Xinke Chen
- Department of Ophthalmology; Children's Hospital; Chongqing Medical University; Chongqing China
| | - Ning Ke
- Department of Ophthalmology; Children's Hospital; Chongqing Medical University; Chongqing China
| | - Qing Liu
- Department of Ophthalmology; Children's Hospital; Chongqing Medical University; Chongqing China
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Oliveira-Santos S, Motta-Franco J, Barreto I, Solé D, Gurgel R. Asthma in adolescents--Prevalence trends and associated factors in northeast Brazil. Allergol Immunopathol (Madr) 2015; 43:429-35. [PMID: 25201760 DOI: 10.1016/j.aller.2014.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 05/21/2014] [Accepted: 05/25/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Asthma is the most common chronic disease affecting children and adolescents (AD). We evaluated the prevalence of asthma and associated factors in adolescents living in a developing region in northeast Brazil using the ISAAC (International Study of Asthma and Allergies in Childhood) methodology. METHODS According to the ISAAC protocol, AD (13-14 year olds, n=3,043 in 2003 and 3,009 in 2011-12) answered the standardised written questionnaire by themselves. In addition, in 2011-12 a random sample of these AD (n=430) also answered a complementary questionnaire (associated factors) and underwent a skin prick test with aeroallergens (Dermatophagoides pteronyssinus, Blomia tropicalis, Blatella germanica, Periplaneta americana, dog dander, cat dander, mixed grass pollen and mixed moulds, including 10mg/mL histamine and negative controls). Data were analysed by univariate and multivariate analysis using Poisson regression. RESULTS The prevalence of asthma in 2011-12 in Aracaju was 12.8%, which is lower than that recorded in 2003 (18.7%). Individuals with a dog outside the home (PR=0.93; 95%CI=0.88-0.98; p=0.018) and those with an older sibling (PR=0.94; 95%CI=0.91-0.98; p=0.005) were identified as protective. The presence of smokers in the residence (PR=1.04; 95%CI=1.00-1.09; p=0.039) was associated with an increased risk of developing asthma. CONCLUSIONS The prevalence of asthma was significantly lower than the last ISAAC figures reported for Aracaju. Tobacco smoking, a preventable factor, continues to be associated with an increase in the occurrence of asthma and other associations may concur with the hygiene hypothesis.
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Affiliation(s)
- S Oliveira-Santos
- Master in Health Science, Federal University of Sergipe, Aracaju, Brazil.
| | - J Motta-Franco
- University Hospital, Federal University of Sergipe, Aracaju, Brazil
| | - I Barreto
- Department of Statistics, Federal University of Sergipe, Aracaju, Brazil
| | - D Solé
- Department of Paediatrics, Federal University of São Paulo, São Paulo, Brazil
| | - R Gurgel
- Department of Medicine, Federal University of Sergipe, Aracaju, Brazil
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Retrospective review on the use of topical cyclosporin a 0.05% for paediatric allergic conjunctivitis in Hong Kong Chinese. ScientificWorldJournal 2014; 2014:396987. [PMID: 25386595 PMCID: PMC4214101 DOI: 10.1155/2014/396987] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 09/17/2014] [Indexed: 11/23/2022] Open
Abstract
Purpose. To evaluate the efficacy of using topical cyclosporin A 0.05% (Restasis) for the treatment of paediatric allergic conjunctivitis. Methods. This retrospective study included consecutive cases of paediatric allergic conjunctivitis treated with Restasis between 2010 and 2013. Subjects with follow-up time less than 3 months after using Restasis were excluded. Itch severity score, symptom score, and sign score were compared before (baseline) and 3 months after using Restasis. Results. In 27 eyes of 14 patients (mean age 10.8 ± 3.2 years), 44.4% had allergic conjunctivitis, 33.3% had vernal keratoconjunctivitis, and 22.2% had atopic keratoconjunctivitis. The mean duration of ocular symptoms was 20.4 ± 13.2 months. 92.6% of subjects were using steroid eye drop before Restasis. After 3 months of topical Restasis, there were statistically significant reductions in the symptom, sign, and itch severity scores compared with baseline (all P ≤ 0.001) and 78.6% of subjects were able to be tapered off steroid eye drops.
Conclusion. Topical Restasis was effective and safe in significantly reducing ocular itchiness, sign, and symptom scores at 3 months after use in paediatric allergic ocular conditions.
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Patil VK, Arshad SH. Dusting the cause for the time trends in asthma. Clin Exp Allergy 2014; 43:1092-4. [PMID: 24074326 DOI: 10.1111/cea.12181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- V K Patil
- Division of Clinical and Experimental Sciences, School of Medicine, University of Southampton, Southampton, UK; The David Hide Asthma & Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, UK
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Wong GWK, Kwon N, Hong JG, Hsu JY, Gunasekera KD. Pediatric asthma control in Asia: phase 2 of the Asthma Insights and Reality in Asia-Pacific (AIRIAP 2) survey. Allergy 2013; 68:524-30. [PMID: 23414255 DOI: 10.1111/all.12117] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND We conducted Phase 2 of the Asthma Insights and Reality in the Asia-Pacific (AIRIAP 2) survey in 2006 to determine the level of asthma control in this region and the validity of the Asthma Control Test (ACT) and childhood ACT (C-ACT) in relation to asthma control. METHODS Pediatric participants (0 to <16 years; N = 988) with diagnosed asthma and current asthma symptoms or taking anti-asthma medications were recruited from 12 geographic areas in Asia. The survey consisted of the AIRIAP 2 questionnaire (asthma symptoms, use of urgent healthcare services and anti-asthma medication) and the ACT or C-ACT (English or Chinese translations only), both administered in the participant's preferred language. A symptom control index based on the Global Initiative for Asthma criteria (except lung function) was used to classify asthma control status. RESULTS Most participants had inadequately controlled asthma ('uncontrolled' = 53.4%, 528/988; 'partly controlled' = 44.0%, 435/988). Only 2.5% (25/988) had 'controlled' asthma. Demand for urgent healthcare services (51.7%, 511/988) and use of short-acting beta-agonists (55.2%, 545/988) was high. The optimal ACT and C-ACT cutoff score for detecting uncontrolled asthma (compared with controlled or partly controlled asthma) was determined to be ≤19 (receiver operating characteristic analysis) with good agreement between the ACT and C-ACT and the symptom control index. CONCLUSIONS Findings from this survey show that asthma control is suboptimal in many children in the Asia-Pacific region. Practical tools, such as the ACT or C-ACT, may help clinicians assess asthma control and facilitate adjustment of asthma medication.
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Affiliation(s)
- G. W. K. Wong
- Department of Paediatrics and School of Public Health; The Chinese University of Hong Kong; Shatin; New Territories; Hong Kong
| | | | - J. G. Hong
- Shanghai First People's Hospital; Shanghai Jiaotong University; Shanghai; China
| | - J.-Y. Hsu
- Taichung Veterans General Hospital; Taichung; Taiwan
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Wong GWK, Leung TF, Ko FWS. Changing prevalence of allergic diseases in the Asia-pacific region. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2013; 5:251-7. [PMID: 24003381 PMCID: PMC3756171 DOI: 10.4168/aair.2013.5.5.251] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 11/06/2012] [Indexed: 01/15/2023]
Abstract
Asia-Pacific is one of the most densely populated regions of the world and is experiencing rapid economic changes and urbanization. Environmental pollution is a significant problem associated with the rapid modernization of many cities in South Asia. It is not surprising that the prevalences of asthma and allergies are increasing rapidly, although the underlying reasons remain largely unknown. Many studies from this region have documented the changing prevalence of allergic diseases in various parts of the world. However, the methodologies used were neither standardized nor validated, making the results difficult to evaluate. The International Study of Asthma and Allergies in Childhood (ISAAC) has provided a global epidemiology map of asthma and allergic diseases, as well as the trend of changes in the prevalence of these diseases. Allergic sensitization is extremely common in many Asian communities. However, the prevalence of allergic diseases remains relatively rare. The rapid urbanization in the region, which increases environmental pollution and can affect the rural environment, will likely increase the prevalence of asthma and allergies in Asia.
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Affiliation(s)
- Gary W K Wong
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
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12
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Oei SM, Thien FCK, Schattner RL, Sulaiman ND, Birch K, Simpson P, Del Colle EA, Aroni RA, Wolfe R, Abramson MJ. Effect of spirometry and medical review on asthma control in patients in general practice: a randomized controlled trial. Respirology 2011; 16:803-10. [PMID: 21401801 DOI: 10.1111/j.1440-1843.2011.01969.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Although guidelines for asthma emphasize the importance of spirometry for continuity and evaluation of care, it is underused in general practice. The objective of this study was to investigate the effect of spirometry and medical review on asthma control in general practice over 12 months. METHODS Patients were recruited through 31 practices, which were randomly allocated to one of three groups: Group A had 3-monthly spirometry with medical review, Group B spirometry only before and after the trial, and Group C usual care. Asthma control data were analysed by intention to treat using non-parametric tests and logistic regression models fitted to allow for confounders, repeated measures and clustering by practice. RESULTS The trial was completed by 195 patients (Group A 69, Group B 78, Group C 48). Asthma control improved in all groups during the 12 months trial, most impressively in Group A (odds ratio per 3 months = 1.27, 95% confidence interval: 1.08-1.49, P = 0.004), but the difference between the groups' respective 3-monthly changes was not significant. At 6 months, asthma control in Group A had increased more from baseline than in Groups B + C (P = 0.006). CONCLUSIONS Regular spirometry with medical review was associated with improved asthma control in general practice patients, while there was less improvement in either the spirometry only or usual care group. The mechanisms of this improvement may include appropriate adjustment of medication and improved compliance.
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Affiliation(s)
- Siao Ming Oei
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred, Melbourne, Victoria, Australia
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Boonchai W, Desomchoke R, Iamtharachai P. Trend of contact allergy to cosmetic ingredients in Thais over a period of 10 years*. Contact Dermatitis 2011; 65:311-6. [DOI: 10.1111/j.1600-0536.2011.01978.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Abstract
Allergic conjunctivitis (AC) represents a spectrum of disorders, comprising seasonal allergic conjunctivitis (SAC), perennial allergic conjunctivitis (PAC), atopic keratoconjunctivitis (AKC), vernal keratoconjunctivitis (VKC) and giant papillary conjunctivitis. Of these ocular allergy types, SAC and PAC are the most common.The most striking difference within this group of ocular diseases is that SAC and PAC remain self-limited without ocular surface damage, while AKC and VKC can compromise the cornea, causing ulcers and scarring and can ultimately lead to vision loss. Data on AC in the Asia Pacific is scarce however some understanding of prevalence of the condition has been obtained from the International Study of Asthma and Allergies in Childhood (ISAAC) studies and more recently from the Allergies in Asia Pacific study as well as some information from individual country surveys. Unfortunately none of this data has been collected using validated survey instruments specifically designed for AC. Surveys such as ISAAC have been predominantly concerned with respiratory allergic symptoms with questions added that incorporate some ocular symptoms. These questionnaires do not detect individuals who may have AC in the absence of allergic rhinitis. Using hospital ophthalmology outpatient populations for prevalence studies of ocular allergy immediately introduces a bias towards the more severe, complex forms of the condition as patients with the milder forms of SAR and PAR will rarely present to a hospital outpatient clinic. There is a real need for the development of validated questionnaires specifically addressing ocular allergy. There are no widely accessible studies examining prevalence of the complex forms of ocular allergy (AKC, VKC) in Asia Pacific region. This review will provide an overview of ocular allergy, its classification, clinical presentation and differential diagnosis, and will also discuss what is known about the epidemiology of ocular allergy in the Asian Pacific region.
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Affiliation(s)
- Constance H. Katelaris
- University of Western Sydney and Campbelltown Hospital, Campbelltown 2560 NSW, Australia
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Yura A, Kouda K, Iki M, Shimizu T. Trends of allergic symptoms in school children: large-scale long-term consecutive cross-sectional studies in Osaka Prefecture, Japan. Pediatr Allergy Immunol 2011; 22:631-7. [PMID: 21466587 DOI: 10.1111/j.1399-3038.2011.01159.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Trends in the prevalence rates of allergic symptoms in children have been discussed extensively, but it remains uncertain which symptoms increase or decrease over time owing to the lack of large-scale long-term consecutive cross-sectional studies performed on a representative population of children. OBJECTIVE To clarify the trends in the prevalence rates of allergic symptoms in Japanese children. METHODS Total population questionnaire surveys were conducted 15 times from 1975 to 2006 for all children attending public elementary schools in Osaka Prefecture, Japan, with the number of subjects ranging from 460,000 to 900,000. Parents of the children completed the questionnaire about allergic symptoms and other symptoms, including wheeze, physician-diagnosed atopic dermatitis, rhinitis, and itching eyes. RESULTS Response rates were consistently over 90%. The prevalence of wheezing was constant until 1983, then increased from 1983 until 1993, then stabilized at about 4.4%. The lifetime prevalence of atopic dermatitis increased to 24% by 1993, and then decreased. The prevalence of rhinitis increased to 25% by 2003, whereas the prevalence of non-seasonal symptoms plateaued from 1993 on at 11% and vernal symptoms increased. The prevalence of itching eyes continued to increase to 21% in 2006, and vernal symptoms increased sharply. CONCLUSIONS In Osaka Prefecture, Japan, the turning point when the prevalence of wheezing in schoolchildren had begun to increase was 1983. And the turning point when the increase in the prevalence of wheezing, atopic dermatitis, and non-seasonal allergic rhinitis turned to decrease or constant was 1993. The prevalence of rhinitis and itching eyes in spring was still increasing in 2006.
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Affiliation(s)
- Akiko Yura
- Department of Public Health, Kinki University Faculty of Medicine, Osaka, Japan.
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16
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17
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Jamrozik E, Musk AW. Respiratory health issues in the Asia-Pacific region: an overview. Respirology 2011; 16:3-12. [PMID: 20920119 PMCID: PMC7192219 DOI: 10.1111/j.1440-1843.2010.01844.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 07/06/2010] [Indexed: 12/16/2022]
Abstract
The Asia-Pacific region is home to a large heterogeneous population whose respiratory health is influenced by diverse social, economic and environmental factors. Despite this variability, the most prevalent causes of respiratory morbidity and mortality are tobacco smoking, infection, and air pollution. This review aims to summarize current respiratory health issues in the region including smoking-related diseases especially COPD, lung cancer and infectious problems such as pandemic influenza, the severe acute respiratory syndrome coronavirus, bacterial pneumonia and tuberculosis, as well as the contribution of air pollution to respiratory disease. Published data on trends in the epidemiology and management of respiratory diseases and are summarized; finally, the limitations of available data and projections for the future of respiratory health in the region are discussed.
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Affiliation(s)
- Euzebiusz Jamrozik
- Faculty of Medicine and Dentistry, University of Western Australia, Australia.
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18
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The epidemiology of ocular and nasal allergy in the United States, 1988-1994. J Allergy Clin Immunol 2010; 126:778-783.e6. [PMID: 20920769 DOI: 10.1016/j.jaci.2010.06.050] [Citation(s) in RCA: 156] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 05/14/2010] [Accepted: 06/18/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND Allergies give rise to the fifth-leading group of chronic diseases. However, the specific prevalence of ocular allergy is poorly described. OBJECTIVE We sought to provide a more accurate representation of the epidemiology of ocular allergy in the United States. METHODS The National Health And Nutrition Examination Survey III performed in the United States from 1988-1994 was the source for the data collected. Items from the questionnaire regarding ocular and nasal allergy symptoms in relation to skin prick testing were stratified by age, race, region, and sex. RESULTS The sample size is 20,010: 1,285 (6.4%) reported ocular symptoms, 3,294 (16.5%) reported nasal symptoms, 5,944 (29.7%) reported both ocular and nasal symptoms, and 9.487 (47.4%) were asymptomatic. Forty percent of the population reported at least 1 occurrence of ocular symptoms in the past 12 months. Those 50 years and older have a higher frequency of isolated ocular symptoms (P < .001). There is an increase in the frequency of symptoms in those younger than 50 years in the populations of subjects with ocular and nasal symptoms combined and isolated nasal symptoms (P < .001). Ocular symptoms are more frequent than nasal symptoms in relation to animals (P < .001), household dust (P < .001), and pollen (P < .001). CONCLUSION This analysis provides the first representation of the epidemiology of ocular allergy in the United States. Up to 40% of the population, the highest reported to date, have experienced ocular symptoms at least once in their lifetime, with a peak of symptoms in the months of June and July.
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Abstract
Although nasal allergy has been prominent in allergy research, ocular allergy is increasingly recognized as a distinct symptom complex that imposes its own disease burden and reduction in patients' quality of life. In the past year, knowledge of the relationships between allergic conjunctivitis and allergic rhinitis has increased. Allergic conjunctivitis is highly prevalent and has a close epidemiologic relationship with allergic rhinitis. Both conditions also exhibit similar pathophysiologic mechanisms. Pathways of communication are thought to increase the likelihood of an inflammatory reaction at both sites following allergen exposure of nasal or ocular tissue. Clinical trials of intranasal therapies have demonstrated efficacy in allergic conjunctivitis and rhinitis. Newer intranasal steroids decrease ocular symptoms, potentially achieving efficacy by suppressing the naso-ocular reflex, downregulation of inflammatory cell expression, or restoration of nasolacrimal duct patency. Proposed pathophysiologic interactions between allergic rhinitis and ocular allergy underscore the need for therapies with efficacy in both symptom sets.
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Gappa M, Ferkol T, Kovesi T, Landau L, McColley S, Sanchez I, Tal A, Wong GWK, Zar H. Pediatric respiratory medicine--an international perspective. Pediatr Pulmonol 2010; 45:14-24. [PMID: 20014351 DOI: 10.1002/ppul.21165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although Pediatric Respiratory Medicine as a subspecialty has a long tradition and is well established in some countries, there is a wide variation across different regions of the world with regard to e.g. recognition of the discipline, training requirements, training facilities and clinical needs. This review summarizes the situation in North America (US and Canada), South America, Asia, Australia, Israel and Europe with the aim to highlight commonalities and differences and, ultimately, to further support continuous development of paediatric Respiratory Medicine Worldwide.
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Affiliation(s)
- Monika Gappa
- Children's Hospital and Research Institute for the Prevention of Allergies and Respiratory Diseases in Children, Marien Hospital, Wesel, Germany.
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