Nut allergy prevalence and differences between Asian-born children and Australian-born children of Asian descent: a state-wide survey of children at primary school entry in Victoria, Australia

BACKGROUND

Asian infants born in Australia are three times more likely to develop nut allergy than non-Asian infants, and rates of challenge-proven food allergy in infants have been found to be unexpectedly high in metropolitan Melbourne. To further investigate the risk factors for nut allergy, we assessed the whole-of-state prevalence distribution of parent-reported nut allergy in 5-year-old children entering school.

METHODS

Using the 2010 School Entrant Health Questionnaire administered to all 5-year-old children in Victoria, Australia, we assessed the prevalence of parent-reported nut allergy (tree nut and peanut) and whether this was altered by region of residence, socio-economic status, country of birth or history of migration. Prevalence was calculated as observed proportion with 95% confidence intervals (CI). Risk factors were evaluated using multivariable logistic regression and adjusted for appropriate confounders.

RESULTS

Parent-reported nut allergy prevalence was 3.1% (95% CI 2.9-3.2) amongst a cohort of nearly 60 000 children. It was more common amongst children of mothers with higher education and socio-economic index and less prevalent amongst children in regional Victoria than in Melbourne. While children born in Australia to Asian-born mothers (aOR 2.67, 95% CI 2.28-3.27) were more likely to have nut allergy than non-Asian children, children born in Asia who subsequently migrated to Australia were at decreased risk of nut allergy (aOR 0.1, 95% CI 0.03-0.31).

CONCLUSION

Migration from Asia after the early infant period appears protective for the development of nut allergy. Additionally, rural regions have lower rates of nut allergy than urban areas.

Which infants with eczema are at risk of food allergy? Results from a population-based cohort

BACKGROUND

The relationship between early onset eczema and food allergy among infants has never been examined in a population-based sample using the gold standard for diagnosis, oral food challenge.

OBJECTIVE

We characterised the risk of challenge-proven food allergy among infants with eczema in the general population.

METHODS

One-year-old infants (n = 4453 meeting criteria for this analysis) were assessed for history of eczema, received a nurse-administered eczema examination and underwent skin prick testing to peanut, egg and sesame. Those with a detectable wheal to one of the test foods underwent an oral food challenge irrespective of wheal size. The risk of food allergy, stratified by eczema severity and age of onset, was estimated using multivariate logistic regression with population sampling weights.

RESULTS

One in five infants with eczema were allergic to peanut, egg white or sesame, compared to one in twenty-five infants without eczema (OR 6.2, 95% CI 4.9, 7.9, P < 0.001). The prevalence of peanut allergy was low in the absence of eczema (0.7% 95% CI 0.4, 1.1). Infants with eczema were 11.0 times more likely to develop peanut allergy (95% CI 6.6, 18.6) and 5.8 times more likely to develop egg allergy (95% CI 4.6, 7.4) by 12 months than infants without eczema. 50.8% of infants (95% CI 42.8, 58.9) with early eczema onset (<3 months) who required doctor-prescribed topical corticosteroid treatment developed challenge-proven food allergy.

CONCLUSION AND CLINICAL RELEVANCE

Eczema, across the clinical severity spectrum in infancy, is a strong risk factor for IgE-mediated food allergy. Infants with eczema were six times more likely to have egg allergy and 11 times more likely to have peanut allergy by 12 months than infants without eczema. Our data suggest that a heightened awareness of food allergy risk among healthcare practitioners treating infants with eczema, especially if early onset and severe, is warranted.

The prevalence and socio-demographic risk factors of clinical eczema in infancy: a population-based observational study

BACKGROUND

Socio-demographic predictors for the development of clinically observed, infantile eczema have not been formally examined in a large population-based study. Few studies of eczema risk factors have included current, objective eczema outcomes as well as parent-reported history.

OBJECTIVES

We aimed to measure the population prevalence of infantile eczema using novel sampling methodology, and identify socio-demographic risk factors for eczema in the first year of life.

METHODS

A population-based cross-sectional study of infantile allergy (the HealthNuts study, n = 4972, response rate 74.1%) was conducted from 2008-2011 in Melbourne, Australia. Infants were examined for current eczema at age 12 months (mean 12.7, SD 0.7). Parents provided information about the infants' history of eczema and demographic factors. Factors associated with eczema were modelled using multinomial logistic regression.

RESULTS

The population prevalence of observed eczema at 12 months was 20.3% (95% CI 19.0, 21.5), while cumulative prevalence for parent-reported eczema was 28.0% (95% CI 26.7, 29.4). The strongest predictors of eczema were maternal eczema and asthma (multinomial (M)-OR 1.7, P < 0.001, and M-OR 1.4, P = 0.007), male sex (M-OR 1.4, P < 0.001), and East Asian ethnicity (M-OR 1.6, P < 0.001) with over 80% of infants with all risk factors exhibiting eczema. East Asian parents, particularly recent migrants, reported fewer allergies than other parents.

CONCLUSIONS AND CLINICAL RELEVANCE

Approximately, one in three infants developed eczema by 12 months of age. East Asian infants are at increased risk of eczema despite their parents having lower rates of allergy than non-Asian parents. Gene-environment interactions may explain the differential effect seen in this minority group.

Characterization of plasma cytokines in an infant population cohort of challenge-proven food allergy

BACKGROUND

Sensitization to food allergens indicates the production of food-specific IgE; however, sensitization is not a definite indicator of allergic reaction upon ingestion (N Engl J Med, 344, 2001, 30: J Allergy Clin Immunol, 120, 2007, 491). Currently, food challenge is the best approach to identify the presence or absence of allergy. While 95% positive predictive values (PPVs) thresholds for sIgE can assist with identifying increased likelihood of allergy among those who are sensitized, there are no specific biological markers that differentiate between allergic and sensitized individuals.

OBJECTIVES

To determine whether plasma serum cytokine profiles predict (i) sensitization to peanut and egg and (ii) food allergy among sensitized infants.

METHODS

Peanut-sensitized (PT) and egg-sensitized 14-month-old infants and nonsensitized controls enrolled in HealthNuts, a population-based study of food allergy, underwent an oral food challenge (OFC). Blood was collected within 1 h after OFC. Serum levels of Th1, Th2 and regulatory cytokines were determined in allergic (n = 79), sensitized (n = 40) and nonsensitized, nonallergic (n = 37) infants by multiplex assay.

RESULTS

Food-sensitized infants had significantly higher plasma IL-4, IL-13, IL-12p70 and lower IL-10 levels compared to nonsensitized infants. IL-10 and IL-6 levels were significantly higher in sensitized compared with allergic infants. Egg-allergic infants had significantly higher IL-13 and IL-12p70 levels compared to peanut-allergic (PA) infants.

CONCLUSION

Levels of Th2-related cytokines in plasma are higher in food-sensitized infants, irrespective of clinical food allergy status. In contrast, IL-10 levels appear to predict food allergy among sensitized infants. Differences in IL-13 and IL-12p70 between egg- and peanut-allergic infants could help explain the different resolution rates of the allergies.

Older men's health. Sociocultural and ecological perspectives

This article identifies a set of conditions that renders the morbidities and earlier deaths of men as the outcome. The article also discusses four factors that affect older men's health and longevity: culture, class, race and ethnicity, and social organization and participation.

Regulation of board-and-care homes: research to guide policy

Information about board-and-care homes reported in the media and in federal committee hearings indicates that they are shoddy and exploitative environments that do not provide adequate care. Research done in board-and-care homes in recent years, however, demonstrates that they can provide adequate care and a satisfying environment for some of the people they serve. Policy at the federal, state, and local levels should be guided by both the need to assure the health and safety of board-and-care residents and the needs of residents and operators identified in scientific studies.

Psychological well-being of elderly board and care home residents

This paper examines the effect of several social and physical environmental features of small unregulated board and care homes on the psychological well-being of elderly residents. Data were collected from operators (N = 177) and residents (N = 285) of board and care homes in five counties in Ohio. The social aspects of the environment such as peer relationships had a more significant impact on resident's psychological well-being than aspects of the physical environment.

An anthropological approach to community diagnosis in family practice

Developing a community oriented family practice requires gathering information about the community, its health problems and resources, and organizing these data into a community diagnosis. Viewing the community from both the insider and outsider perspectives allows the clinician to use social indicator data as well as subjective data from residents in the community. This paper describes the application of anthropological concepts in the process of community diagnosis within an urban teaching family practice.

The impact of forced residential relocation on the health of the elderly hotel dweller

This paper reports on a prospective study designed to assess the impact of involuntary relocation from one community setting to another on the self-perceived physical, functional, and emotional health status of older persons living in urban residential hotels. The research design was quasiexperimental and took advantage of a naturally occurring urban renewal project. Older persons (n = 38) living in five hotels marked for demolition and a randomly selected comparison group (n = 32) living in similar and contiguous hotels were interviewed 3 to 6 months prerelocation and again 3 to 6 months postrelocation. In general, there were few adverse changes in health associated with relocation as it was implemented with this population.

The geriatric patient in ecological perspective

A hallmark of family medicine is the concern for the individual in the context of family and local community. For the geriatric patient in particular, these concerns far exceed the capabilities of the traditional biomedical model. A problem-solving approach to clinical problems is proposed which extends beyond pathophysiology to include biographical and ecological considerations. A case of an older couple is presented that serves to illustrate the importance of a multilevel approach to patient care and management.