Perspectives and gaps in the management of food allergy and anaphylaxis in the Asia-Pacific Region

Background

Food allergy (FA), which is a condition that has no effective cure and can result in severe life-threatening allergic reactions, remains a global public health concern; however, little is known about how FAs are currently managed in the Asia-Pacific region.

Objective

The main objective of this survey was to evaluate the epidemiology of FA, as well as the availability of resources and practices for management of FA and anaphylaxis by health care providers across Asia.

Methods

From June 2022 to September 2022, a questionnaire-based survey comprising 66 questions was electronically sent to member societies of the Asia Pacific Association of Allergy Asthma and Clinical Immunology by using Survey Monkey.

Results

A total of 20 responses were received from 15 member countries and territories. Compared with the pediatric data, there was a lack of prevalence data for FA in adults. Except for Australia and Japan, most regions had between 0.1 and 0.5 allergists per 100,000 population and some had fewer than 0.1 allergists per 100,000 population. The perceived rate of FA in regions with a short supply of allergists was high. Although specific IgE tests and oral food challenges were available in all regions, the median wait time for oral food challenges at government facilities was 37 days (interquartile range = 10.5-60 days). Seven regions still relied on prescriptions of ampules and syringes of injectable adrenaline, and adrenaline autoinjectors were not accessible in 4 regions. Oral immunotherapy as FA treatment was available in half of the surveyed countries and territories.

Conclusions

Our study offers a cross-sectional evaluation of the management practices for FA in each Asia Pacific Association of Allergy Asthma and Clinical Immunology member country or territory. Urgent actions are required to enhance allergy services, improve the accessibility and affordability of adrenaline autoinjectors, and conduct robust epidemiologic studies.

The impact of excessive weight gain on hypertension, steroid induced diabetes, and disease parameters in pediatric systemic lupus erythematosus patients

Systemic inflammation, corticosteroids therapy, and reduced physical activity may predispose the accumulation of body fat in patients with systemic lupus erythematosus (SLE). However, less is known about its impact in children.(1,2) This study aims to explore the impact of excessive weight gain on pediatric SLE patients.

Hubungan antara Kadar 25-OH D3 dengan Derajat Fungsi Ginjal pada Pasien Lupus Sistemik Eritematosus

Latar belakang. Defisiensi vitamin D banyak ditemukan pada anak lupus eritematosus sistemik (LSE) dibandingkan dengan anak normal. Berbagai penelitian membuktikan defisiensi vitamin D berkontribusi terhadap perkembangan chronic kidney disease. Belum ada penelitian hubungan vitamin D dengan derajat fungsi ginjal pada anak Lupus. Tujuan. Mengetahui hubungan antara 25-hidroksivitamin D dengan derajat fungsi ginjal pada anak Lupus.Metode. Menggunakan desain cross sectional dengan melibatkan 62 anak Lupus di bagian Ilmu Kesehatan Anak RSUP Dr. Sardjito yang telah mendapatkan protokol dari Januari 2014 sampai April 2018. Hubungan antara kadar serum 25-hidroksivitamin D dan derajat fungsi ginjal dianalisis menggunakan Independent T-test, sedangkan jenis kelamin, kalsium, steroid, dan aktivitas penyakit dengan uji chi-square. Defisiensi vitamin D didefinisikan konsentrasi 25-hidroksivitamin D<20 ng/ml, sedangkan gangguan ginjal didefinisikan GFR<90/ml/mnt/1.73m2.Hasil. Sebagian besar subyek berjenis kelamin perempuan, 93,5% vs 6,5% dengan rerata usia 14,6±3,1 tahun, dan rerata skor Mex-SLEDAI 7,6±5,6. Secara keseluruhan 66% subyek penelitian mengalami defisiensi vitamin D. Analisis dengan Independent T-tes menunjukkan rerata vitamin D yang mengalami gangguan ginjal 14,14±4,9 lebih rendah dibandingkan normal dengan rerata 19,43±10,3 dengan perbedaan yang bermakna p=0,004. Jenis kelamin, kalsium, steroid, dan aktivitas penyakit tidak berpengaruh signifikan terhadap derajat fungsi ginjal, p>0,05.Kesimpulan. Terdapat hubungan signifikan 25-hidroksivitamin D dengan derajat fungsi ginjal pada anak lupus.

Outcome predictors in patients with juvenile idiopathic arthritis receiving intraarticular corticosteroid therapy

Background Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children. It can continue into adulthood and cause severe joint damage, resulting in disability and decreased quality of life. Objective To determine the predictors of clinical outcomes in JIA patients receiving intra-articular corticosteroid injections (IACS). Methods We conducted a retrospective cohort study of children with JIA receiving IACS therapy in Dr. Sardjito General Hospital from 1 January 2012 to 31 December 2017 by reviewing data from medical records. The dependent variables were disabilities and early remission time. Independent variables included age at diagnosis, JIA subtype, duration of disease at first diagnosis, timing of IACS, exposure to oral systemic therapy, as well as anti-nuclear antibodies (ANA), rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) test results. External variables were gender and nutritional status. Results Of 36 patients who received intraarticular corticosteroid injections, 28 (77.8%) experienced remission, and 16 (50%) experienced disabilities. Female subjects (OR 5.296; 95%CI 1.143 to 24.548; P=0.027) and subjects with ESR >26 mm/h (OR 2; 95%CI 1.259 to 3.170; P=0.043) were more likely to have disabilities. Use of oral corticosteroids for ≤3 months and IACS treatment ≤ 3 months after diagnosis were  predictors of early remission time (OR 6.897; 95%CI 1.869 to 25 and OR 3.290; 95%CI 1.195 to 9.091, respectively). However, only oral corticosteroid had a significant correlation in multivariate analysis. Conclusion Female gender and ESR > 26 mm/h predict disabilities in JIA patients receiving IACS. Duration of oral corticosteroid ≤3 months and early IACS within 3 months of diagnosis correlate to earlier remission time. Shorter duration of oral corticosteroid is the only significant predictor for earlier remission time in JIA patients receiving IACS therapy.

Predictors of mortality in children with systemic lupus erythematosus

Background Systemic lupus erythematosus (SLE) is a multisystem chronic disease with a relatively high mortality rate in children, despite improvements in prognosis and survival rate over the past decade. Studies on the predictors of mortality in children with SLE, especially in low- and middle-income countries, are limited. Objective To determine the predictors of mortality of children with SLE. Methods This was case-control study using data from medical records of children with SLE at Dr. Sardjito Hospital, Yogyakarta, Indonesia, between 2009 and 2017. Subjects were children aged <18 years diagnosed with SLE. Cases were those who died within one year of diagnosis; the controls were those who were discharged alive. From subjects’ medical records, we collected clinical data including age, sex, date of diagnosis, nutritional status, anti-dsDNA antibody, antinuclear antibody (ANA), hypertension, disease activity based on the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score, proteinuria, thrombocytopenia, mortality/survival outcome, date of death, cause of death, and clinical data including fever, seizures, antibiotic used, microbial culture outcomes, and infection-related diagnoses. We performed bivariate analysis of the association between predictor variables (SLEDAI score, proteinuria, infection, hypertension, and seizures) and mortality outcome (survival or death), followed by logistic regression analysis. Results Eighty-four patients with SLE were included, of which 72 were female.  Median age at diagnosis was 14 (range 4-18) years. Twenty-three patients (27%) died within one year after diagnosis. The most common causes of death were infection and renal failure in 8/23 and 7/23 subjects, respectively. On bivariate analysis, the variables significantly associated with mortality were hypertension (OR 3.34, 95%CI 1.22 to 9.14) and infection (OR 3.71; 95%CI 1.36 to 10.12). Seizures, proteinuria, and SLEDAI score were not found to be significantly associated with mortality. On logistic regression analysis, infection was the only significant predictor of mortality (OR 3.22; 95%CI 1.15 to 9.05). Conclusion Among the factors studied, infection is significantly associated with mortality in children with SLE.  

Immunotherapy and probiotic treatment for allergic rhinitis in children

Background Allergic rhinitis is a global health problem that is increasing in prevalence. Many kinds of therapy have been tried, such as antihistamines, probiotics, and immunotherapy. Immunotherapy may restore the patient’s normal immunity against the specific allergen, while probiotics may modify the natural course of allergy. Objective To evaluate probiotics and immunotherapy for improving clinical symptoms of allergic rhinitis. Methods This randomized controlled trial (RCT) involved 64 patients, aged 3-18 years, and diagnosed with persistent allergic rhinitis in the Department of Child Health, Sardjito General Hospital from April 2016 until May 2017. Patients were randomly allocated into three therapy groups: group A (standard therapy/cetirizine only), group B (standard and probiotic therapy), and group C (standard therapy and immunotherapy). Clinical symptoms of allergic rhinitis including sneezing, rhinorrhea, and itchy nose, were evaluated for 7 weeks and classified as improved or not improved. The significance of the data was analyzed using proportion test. Results Sixty-four patients completed 7 weeks of therapy, 15 subjects in group A, 26 in group B, and 23 in group C. Group C showed significantly more improvement of sneezing and rhinorrhea compared to both group A (Z=5.71; Z=7.57, respectively) and group B (Z=2.82; Z=6.90, respectively). However, itchy nose was not significantly improved in group C compared to group B (Z=0.50), but was significantly improved in group C compared to group A (Z=10.91). Group B had significant improvement of sneezing, rhinorrhea, and itchy nose compared to group A (Z=3.81, Z=2.86, and Z=10.91, respectively). Conclusion The combined standard-immunotherapy group has significantly superior improvement compared to the combined standard-probiotic group and the standard therapy group, in terms of sneezing and rhinorrhea in children with persistent allergic rhinitis.

Factors associated with pericardial effusion in pediatric systemic lupus erythematosus

Background Cardiovascular involvement in systemic lupus erythematosus (SLE) has been reported to range from 4-78%. Complications can affect all structures of the heart, including the endocardium, myocardium, pericardium, and valves. Pericarditis is the most common manifestation, with an incidence of 11-54% in SLE patients. Pericardial effusion is often observed in patients with pericarditis, and can be confirmed by echocardiography. Objective To determine factors associated with pericardial effusion in children with SLE. Methods We conducted a restrospective cross-sectional study by reviewing medical records of children with SLE aged less than 18 years who underwent echocardiography at the Dr. Sardjito Hospital. Yogyakarta, from January 2011 to March 2018. Patients with congenital heart disease or incomplete medical records were excluded. A multivariate logistic regression analysis was done to determine factors that independetly associated with pericardial effusion. Results Among 165 children with SLE, 73 fulfilled the inclusion criteria. The prevalence of pericardial effusion was 54.8%. Median age was 13 (range 5-17) years and the female-to-male ratio was 8:1. Hemolytic anemia (OR=4.135; 95%CI 1.039 to 16.453; P=0.044) was significantly associated with pericardial effusion. Conclusion Hemolytic anemia is significantly associated with pericardial effusion in children with SLE.

Perbandingan Diagnosis Systemic Lupus Erythematosus Menggunakan Kriteria American College of Rheumatologi dan Systemic Lupus International Collaborating Clinics

Latar belakang. Systemic lupus erythematosus (SLE) merupakan penyakit autoimun yang melibatkan multi organ dengan spektrum klinis dan imunologis yang luas. Kriteria diagnostik SLE pertama kali diperkenalkan oleh American College of Rheumatology (ACR) pada 1971 dan telah mengalami revisi pada 1982 dan 1997. Tujuan. Membandingkan kriteria ACR dan kriteria SLICC dan menilai agreement antara kriteria SLICC dan ACR untuk menegakkan diagnosis SLE.Metode. Penelitian studi cross-sectional terhadap pasien SLE yang dirawat di bagian Anak RS Sardjito Yogyakarta antara Januari 2009-Juni 2015. Metode total sampling digunakan pada penelitian ini. Pengumpulan data dilakukan melalui rekam medis, untuk menilai masing-masing kriteria pada saat anak terdiagnosis SLE, kemudian dilakukan penilaian agreement di antara kedua kriteria tersebut.Hasil. Didapatkan 64 anak didiagnosis SLE dan 46 (71,9%) memenuhi kriteria ACR. Sebanyak 39 (60,9%) memenuhi kriteria SLICC. Penelitian ini mendapatkan overall agreement yang baik (ρ0=0,70) di antara kedua kriteria tersebut, dengan chance-corrected agreement κ=0,33, atau dinyatakan cukup.Kesimpulan. Kriteria SLICC memiliki agreement yang cukup baik dengan kriteria ACR. Kriteria SLICC dapat dipertimbangkan sebagai alternatif metode untuk menegakkan diagnosis SLE pada anak. Perlu penelitian lanjutan untuk menilai kemungkinan penerapan kriteria ini untuk menggantikan kriteria ACR yang telah dipakai secara luas sebelumnya.

Faktor Risiko Kematian Neonatus dengan Penyakit Membran Hialin

Latar belakang.Angka kematian bayi (AKB) menurut Survei Demografi dan Kesehatan Indonesia (SDKI) pada tahun 2002-2003 adalah 35 per 1000 kelahiran hidup. Dua pertiga kematian bayi merupakan kematian neonatal dan disebabkan terutama oleh persalinan prematur. Penyakit membran hialin (PMH) merupakan penyebab terbanyak dari angka kesakitan dan kematian pada bayi prematur. Tujuan.Mengetahui faktor-faktor risiko yang memengaruhi kematian pasien PMH yang dirawat di Instalasi Maternal Perinatal RSUP Dr. Sardjito.Metode. Rancangan penelitian yang digunakan adalah kasus-kontrol berdasarkan data sekunder dari data dasar neonatus dan catatan medik pasien bayi baru lahir yang dirawat dan didiagnosis PMH di RSUP Dr.Sardjito, Yogyakarta selama tahun 2007 – 2011.Hasil. Proporsi kematian neonatus dengan penyakit membran hialin di RSUP Dr. Sardjito selama 2007 – Oktober 2011 adalah 52%. Faktor risiko kematian neonatus dengan penyakit membran hialin yang bermakna secara statistik adalah asfiksia dengan OR 4,97 (IK 95% 2,39-10,28). Analisis dengan metode regresi logistik menunjukkan bahwa asfiksia merupakan faktor risiko independen kematian neonatus dengan penyakit membran hialin (aOR 5,15, IK 95% 2,43-10,91). Kesimpulan.Asfiksia merupakan faktor risiko independen kematian neonatus dengan penyakit membran hialin. Penanganan asfiksia dengan resusitasi yang tepat diperlukan untuk menurunkan risiko kematian neonatus dengan penyakit membran hialin. S

Studi Observasional Pasca-Pemasaran Formula Isolat Protein Kedelai pada Bayi dengan Gejala Sugestif Alergi Terhadap Protein Susu Sapi

Latar belakang. Fomula berbasis isolat protein kedelai banyak digunakan untuk anak-anak dengan alergi susu sapi di Indonesia. Namun, diperlukan penelitian untuk mendapatkan gambaran penerimaan orangtua dan toleransi saluran cerna pada penggunaan formula isolat protein kedelai.Tujuan. Pertama, menentukan penerimaan orangtua terhadap pemberian suatu isolat protein kedelai pada bayi yang diduga mengalami alergi terhadap protein susu sapi. Kedua, mengetahui toleransi saluran cerna pada pemberian susu formula tersebut.Metode. Suatu studi pasca-pemasaran, prospektif, multisenter yang dilakukan di Jakarta, Bandung, Surabaya, Yogyakarta, Solo, dan Denpasar sejak September 2011 sampai April 2012. Subyek berusia antara 6 bulan hingga 1 tahun dengan gejala dugaan alergi terhadap protein susu sapi yang diberikan formula isolat protein kedelai dan diamati selama 4 minggu. Luaran yang diharapkan adalah penerimaan orangtua terhadap pemberian formula isolat protein kedelai dan toleransi saluran cerna terhadap pemberian isolat protein kedelai.Hasil. Diteliti 534 subyek yang dapat dianalisis selama periode penelitian. Mayoritas orangtua (84%) merasa puas dengan formula isolat protein kedelai, 83% orangtua berencana untuk melanjutkan pemberian susu formula karena berkurang (31,5%) dan hilangnya gejala yang diduga akibat alergi susu sapi (32,4%). Gejala klinis yang diduga akibat alergi terhadap protein susu sapi menurun pada setiap kunjungan berikutnya. Tidak ada efek samping serius yang dilaporkan selama periode penelitian.Kesimpulan. Penelitian ini menemukan tingkat penerimaan orangtua dan toleransi saluran cerna yang baik terhadap pemberian formula isolat protein kedelai kepada bayi dengan gejala sugestif alergi terhadap protein susu sapi. Formula isolat protein kedelai cukup aman dijadikan sebagai formula alternatif pengganti pada anak dengan alergi susu sapi.

ASI Eksklusif sebagai Faktor Protektif Rinitis Alergi pada Anak

Latar belakang. Prevalensi rinitis alergi di dunia semakin meningkat termasuk di Indonesia. Rinitis alergi menyebabkan penurunankualitas hidup sehingga sedini mungkin dicegah agar proses tumbuh kembang anak optimal. Faktor pencegah di antaranya denganpemberian air susu ibu (ASI) secara eksklusif.Tujuan. Mengetahui apakah pemberian ASI eksklusif merupakan faktor protektif terhadap rinitis alergi pada anak di Provinsi DaerahIstimewa Yogyakarta.Metode. Rancang penelitian berupa kasus kontrol berpasangan, analisis Mc.Nemar, dan conditional logistic regression. Populasi targetmurid sekolah dasar di Yogyakarta dengan rinitis alergi sebagai kasus (diagnosis berdasarkan kriteria AIRA, kuesioner ISAAC, ujitusuk kulit). Matching berdasarkan umur dan jenis kelamin. Informasi pemberian ASI dengan wawancara dan kuesioner.Hasil. Subjek penelitian adalah 55 kasus dan 55 kontrol. Alergen terbanyak menimbulkan alergi adalah kutu rumah. PemberianASI eksklusif terhadap rinitis alergi mempunyai rasio odds 0,23; IK95% 0,08-061; p=0,23. Paparan asap rokok terhadap alergimempunyai rasio odds 3,07; IK95% 1,23-7,68; p=0,016.Kesimpulan. ASI eksklusif merupakan faktor protektif terhadap rinitis alergi pada anak.

Probiotic therapy on children with allergic rhinitis

phils in nasal secretions of patients with allergic rhinitis may cause persistent nasal blockage. A common therapy for allergic rhinitis is oral or intranasal corticosteroids. However, corticosteroids carry the risk of disrupting growth and development in children. Probiotic treatment in allergic rhinitis patients works by manipulating the bacterial ecosystem of the digestive tract, stimulating the balance of Th1 and Th2 immune responses.Objective To assess the effects of probiotic supplementation on eosinophil levels in nasal secretions, duration of allergic episodes, and total nasal symptom scores in children aged 2-18 years with allergic rhinitis.Methods A randomized, double-blind, controlled trial was performed on children aged 2 to 18 years who visited Sanglah Hospital, Denpasar, between March to July 2012 due to allergic rhinitis. Fifty-five eligible subjects were involved in the study. Subjects were randomly allocated to receive either standard therapy (antihistamines) and probiotics or standard therapy and placebo for 30 days. Mann-Whitney test was used for statistical non-parametric unpaired samples analysis. P values of <0.05 were considered to be statistically significant.Results Fifty-five subjects with allergic rhinitis were randomized into either the probiotic group (27 subjects) or the placebo group (28 subjects). We found that the median (range) nasal eosinophil percentage reduction before the study compared to after 30 days of treatment was higher in the probiotic group than in the placebo group (34 (15-65) vs 6 (0-24) %, respectively, P<0.0001). Median (range) duration of allergic rhinitis episode in the probiotic group was shorter compared to the placebo group (48 (0-96) hours vs 72 (6-168) hours, respectively; P<0.0001). The median (range) total nasal symptom score was also lower in the probiotic group compared to the placebo group (2 (0-3) vs 5 (1-6), respectively; P<0.0001).Conclusion Probiotic supplementation reduces the percentage of nasal eosinophils, duration of allergic rhinitis episode, and total nasal symptoms.

Randomized double blind trial of ciprofloxacin prophylaxis during induction treatment in childhood acute lymphoblastic leukemia in the WK-ALL protocol in Indonesia

OBJECTIVES

Toxic death is a big problem in the treatment of childhood acute lymphoblastic leukemia (ALL), especially in low-income countries. Studies of ciprofloxacin as single agent prophylaxis vary widely in success rate. We conducted a double-blind, randomized study to test the effects of ciprofloxacin monotherapy as prophylaxis for sepsis and death in induction treatment of the Indonesian childhood ALL protocol.

METHODS

Patients were randomized to the ciprofloxacin arm (n = 58) and to the placebo arm (n = 52). Oral ciprofloxacin monotherapy or oral placebo was administered twice a day. All events during induction were recorded: toxic death, abandonment, resistant disease, and complete remission rate.

RESULTS

Of 110 patients enrolled in this study, 79 (71.8%) achieved CR. In comparison to the placebo arm, the ciprofloxacin arm had lower nadir of absolute neutrophil count during induction with median of 62 (range: 5-884) versus 270 (range: 14-25,480) × 10(9) cells/L (P < 0.01), greater risks for experiencing fever (50.0% versus 32.7%, P = 0.07), clinical sepsis (50.0% versus 38.5%, P = 0.22), and death (18.9% versus 5.8%, P = 0.05).

CONCLUSION

In our setting, a reduced intensity protocol in a low-income situation, the data warn against using ciprofloxacin prophylaxis during induction treatment. A lower nadir of neutrophil count and higher mortality were found in the ciprofloxacin group.

Effects of Phyllanthus niruri on the severity of the common cold in children

Background Common cold is a self􀀵limited disease, howeverit poses a significant burden on productivity and communityhealth. Unfortunately, there has been no standard medicationfor childhood common cold, whereas some herbs \\lith immune􀀵modulating properties, such as Phyllanthus niruri extract (PNE),might be beneficial but has not been thoroughly studied.Objective To evaluate the effect of PNE administration on theseverity of common cold symptoms in children.Methods We performed a randomized, double􀀵blind, controlledtrial in children aged 2􀀵6 years who were diagnosed Mth a commoncold at primary health care centers in Sewon and Jetis in Bantul,as well as in Gondomanan and Gedongtengen in Yogyakarta.Subjects were collected by consecutive sampling and parentswere interviewed. We assessed illness severity by Hemila scoringfor the common cold.Results A total of 100 subjects were included Mth 50 subjects ineach intervention group. After treatment, there was no significantdifference in common cold severity between the PNE and thecontrol groups for all symptom score components, including cough(0.87 vs 0.71, P􀀽0.36), nasal symptom (0.90 vs 1.10, P􀀽0.54),coryza ( 0.44 vs 1.10, P=0.54), and systemic symptom (0.10 vs0.10, P􀀽0.94).Conclusion Administration of PNE for 6 days did not provide asignificant benefit in reducing the severity of the common coldcompared to placebo in children aged 2 - 6 years. [PaediatrIndanes.2012;52:346-51].

Influence of zinc on severity of common cold in children

Background Symptomatic treatment of common cold in childrendoes not reduce the duration and severity of disease. Since zinc hasbeen used to enhance cellular and humoral immunity, it has thepotential to reduce the severity of the common cold. However, theeffects of zinc on the common cold have been inconclusive. Theuse of zinc to treat cold symptoms deserves further studies.Objective To determine the effect of zinc supplementation onthe severity of the common cold in children.Methods We performed a randomized, double􀁁blind, controlledtrial in children aged 3􀁁 5 years who were diagnosed Mth a commoncold at primary health care centers in Gedongtengen, Umbulharj 0I and Kotagede II, Yogyakarta. Subjects were collected byconsecutive sampling and their parents were interviewed. Severityof illness was categorized as mild, moderate or severe.Results One hundred fourteen patients with common cold weredivided into 2 groups of 57 subjects each. One group receivedzinc supplementation while the other group received a placebo.Subjects with fever received additional paracetamol. After 7 daysof treatment, there were no significant differences in clinicalimprovement in the zinc group (80.7%) compared to that of theplacebo group (78.9%), P􀁂O.83.Conclusion The severity of the common cold in children aged3􀁁5 years was not significantly different in those who receivedzinc supplementation compared to placebo. [Paediatr Indones.2012;52:324-8].

IgE-mediated soy protein sensitization in children with cow’s milk allergy

Background Soy-based formula as an alternative to cow's milkformula is preferable to extensively hydrolyzed protein formulabecause of the lower cost and more acceptable taste. However,cow's milk allergy patients can subsequently develop a sensitivityto soy protein.Objective To compare soy protein sensitization in children withand without an allergy to cow's milk.Methods This study was conducted in Yogyakarta from September2007 until March 2008. Subjects were children aged below 4years with an atopic history. Subjects were divided into 2 groups:those with a positive skin prick test to cow's milk and thosewith a negative skin prick test to cow's milk (control group).Both groups were given soy formula and tested at 6 weeks forsensitization to soy.Results There were 45 children in each group. Age, sex, andatopic history were similar in both groups. We found no soyprotein sensitization (negative skin prick results) in all subjectsfrom both groups.Conclusion Risk of immunoglobulin E-mediated sensitizationto soy protein was not proven in children with cow's milk allergy.[Paediatr lndones. 2012;52:67-71).

Sensitization to indoor allergens and frequency of asthma exacerbations in children

Background The rapid increase in asthma incidence has implicated the importance of environmental influences over genetic influences. Sensitization to perennial indoor allergens has been associated with increased asthma symptoms.Objective To examine the correlation between sensitization to indoor allergens and frequency of asthma exacerbations in children.Methods A cross-sectional study was carried out on asthmatic children aged 6 to 12 years in the Department of Child Health, Udayana University Medical School /Sanglah Hospital, Denpasar. Degree of sensitization was assessed by mean wheal diameter (positive defined as 3 mm greater than negative control) for seven common indoor allergens. Frequency of asthma exacerbation for three consecutive months prior to data collection was retrospectively reviewed.Results Positive skin test results for one or more allergens were found in 84 of 89 (94%) asthmatic children. Higher frequency of asthma exacerbations weakly correlated with the number of allergens with positive sensitization (r=0.284; P=0.007). Mean wheal diameter of each allergen did not correlate to the frequency of asthma exacerbations. In addition, the frequency of asthma exacerbations was independent for parental and sibling atopic history, preceding respiratory infections, use of asthma controllers and passive environmental tobacco smoke exposure.Conclusions Sensitization to common indoor allergens correlates weakly with frequency of asthma exacerbations. 

Yogyakarta Pediatric Cancer Registry: an international collaborative project of University Gadjah Mada, University of Saskatchewan, and the Saskatchewan Cancer Agency

INTRODUCTION

In July 2001, a 'twinning' project was undertaken between University Gadjah Mada, Indonesia, and the Saskatchewan Cancer Agency, Canada to create a computerised Pediatric Cancer Registry at Sardjito Hospital, Yogyakarta city.

OBJECTIVES

To analyse information from the Yogyakarta Pediatric Cancer Registry (YPCR) in order to i) determine the prevalence of pediatric cancers in Yogyakarta Special Region and, ii) compare the demographics of pediatric malignancies in the Special Region (population: 3.3 million), with those of the Saskatchewan Cancer Registry in the province of Saskatchewan (population: 1 million).

METHODOLOGY

In May 2001, a computer dedicated to the YPCR was installed at Sardjito Hospital. Bilingual (English/Indonesian) data capture forms were developed for data extraction from hospital health records. Data items were then entered into a data base using the Statistical Package For Social Sciences (SPSS) program. Two projects were initiated: i) a prospective study from 2000-2009 of pediatric cancer cases from the YPCR, and ii) a comparison of demographics from both Cancer Registries during the time period 1996-2003. Comparative data were obtained for age, sex, diagnoses, and referral patterns. Results were analysed using the SPSS software program.

RESULTS

i) In the 10 year prospective study, 1,124 pediatriccancer cases were accrued in the Yogyakarta Registry, the majority being in the age group 0-5 years. Male:female: 7:1. Leukemias were the most common diagnosis, followed by retinoblastoma and neuroblastoma. The majority of patients (68%) were referred from outside the catchment area of Yogyakarta Special Region. ii) In the 8 year archival comparative analysis, the most striking contrasts were a higher proportion of children with retinoblastoma and negligible numbers of pediatric brain tumors in the Yogyakarta Registry.

CONCLUSION

This is the first published report of a computerised pediatric cancer registry in Indonesia. The differences in diagnostic frequencies noted above may, in part, be due to comparisons between the population-based Saskatchewan Cancer Registry versus the hospital-based Yogyakarta Pediatric Cancer Registry. The contrasts in demographics are multifactorial, and require further investigation.