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Purpose@#The present international survey among healthcare providers aimed to collect data on theoretical knowledge and clinical practices in the diagnosis and management of cow’s milk protein allergy (CMPA) and lactose intolerance (LI) in infants. @*Methods@#A global survey was conducted in several countries with diverse health care settings. The survey consisted of multiple-choice questions in 3 main domains: (1) understanding and clinical practices around CMPA and LI; (2) case scenarios; and (3) diseasespecific knowledge and potential educational needs. @*Results@#Responses were available from 1,663 participants. About 62% of respondents were general practitioners or general pediatricians, and the remainder were pediatric allergists/ gastroenterologists (18%) or other health practitioners (20%). The survey identified knowledge gaps regarding the types of CMPA (IgE-mediated vs. non-IgE-mediated) and the clinical overlap with LI. The survey suggested diverse clinical practices regarding the use of hypoallergenic formulas, as well as misconceptions about the prebiotic benefits of lactose in extensively hydrolyzed formulas in non-breastfed infants with CMPA. Responses to the two case scenarios highlighted varying levels of awareness of the relevant clinical practice guidelines. While respondents generally felt confident in managing infants with CMPA and LI, about 80% expressed an interest for further training in this area. @*Conclusion@#The current survey identified some knowledge gaps and regional differences in the management of infants with CMPA or LI. Local educational activities among general and pediatric healthcare providers may increase the awareness of clinical practice guidelines for the diagnosis and treatment of both conditions and help improve clinical outcomes.
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Rationale: There are worldwide increasing in both prevalence and incidence of allergic disease. Data about prevalence and incidence play an important roles on prevention and management of allergic disease. There are no these datas in Surin province. Our aim was to detect the prevalence of allergic disease in this area.Methodology: A questionnaire survey in 2,005 children aged 6-12 (younger) and 12-18 years (older) at Surin province between January and April of 2007 were studied.Results: The over all return rate was 66.83%. In 6-12 years student the prevalence of allergic rhinitis was most common (32%) and urticaria, atopic dermatitis, allergic conjunctivitis, asthma, food allergy were encountered in 16.9%, 11.3%, 10.7%, 4.4%, 2.9% respectively. In 12-18 years student the prevalence of allergic rhinitis was also most common (41.5%) and atopic dermatitis, allergic conjunctivitis, food allergy, urticaria and asthma were encountered in 32.1%, 14.6%, 13.6%, 11.63%, 2.9%. Rhinorrhea or sneezing (76%) and congestion (63.3%) are the two most common symptoms for allergic rhinitis. Intermittent allergic rhinitis symptom was 30.50% in younger and 33.81% in older children (mean of 31.72%). Persistent allergic rhinitis symptom was 68.11% which had improper treatment with antihistamine (mean of 62.7%). Intranasal corticosteroid was used only 4.3% in younger and 1.1% in older children (mean of 2.7%). Allergic rhinitis children had comorbid asthma 10.84 % in younger and 8.50% in older children (mean of 9.67%). Intermittent asthma symptom was 49.21% in younger and 56.8% in older children (mean of 52%). Persistent asthma symptom was 22.70% which had inappropiate treatment with oral bronchodilators 55.40%. Inhaled corticosteroid was used only 1.59% in younger and 2.70% in older children (mean of 2.15%). Asthmatic children had comorbid allergic rhinitis 63.50% in younger and 80.08% in older children (mean of 72.9%).Conclusion: The prevalence rate of common allergic disease in both younger and older children years and were 32%, 41.5% (allergic rhinitis), 11.3%, 32.1% (atopic dermatitis), 10.7%, 14.6% (allergic conjunctivitis) and 4.4%, 2.9% (asthma). Only 2.7% of allergic rhinitis patient used intranasal corticosteroid and 2.15% of asthmatic patient used inhaled corticosteroid. Allergic rhinitis was the most comorbid disease of asthma.
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Background: Recommendations for allergy prevention in children include feeding with partially hydrolyzed formulas if breast-feeding is not possible or insufficient. Objective: The primary objective of this study was to investigate the allergy preventive effect of partially hydrolyzed formulas compared with cow's milk formulas and breast-feeding during the first five years of life in a retrospective randomized trial. Methods: A retrospective, large-scale intervention study of 3,502 unselected children aged between one and five years recruited between April 2005 and March 2006 was performed. Main outcome parameters were allergic manifestations including cow's milk allergy, atopic dermatitis (AD), chronic rhinitis, and recurrent wheeze. Results: About 35.2% developed allergic manifestations mostly during the first year of life. More males developed atopic diseases than females (OR=1.5; 95%CI=1.300-1.719). Compared with the breast-feeding group, the occurrence of atopic diseases significantly increased in the cow's milk formula group (OR=1.66; 95%CI=1.396-1.957) while it decreased in the partially hydrolyzed formula (pHF) group (OR=0.23; 95%CI=0.160-0.314) during the first four years of life. Considering the risk for the development of atopic diseases determined by atopic risk score, there was a positive association between the high risk score children compared to the low risk ones in both the breast-feeding group and the cow's milk formula group. However, there was no significant association in the pHF group. Compared with the breast-feeding group, the risk estimate for the development of atopic diseases was significantly increased in children with high risk score in the cow's milk formula group but was reduced in the pHF group. Conclusion: The risk of atopic diseases can be reduced with partially hydrolyzed formula in high-risk infants when breast-feeding is insufficient.
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Background: Autosomal recessive chronic granulomatous disease (AR-CGD) is an inherited defect in neutrophil oxidative burst as a result of mutations in one of the three genes, NCF1, NCF2, and CYBA, which respectively encode p47-phox, p67-phox, and p22-phox subunits of the NADPH oxidase complex.Objective: To investigate clinical and molecular characteristics of two unrelated Thai patients with AR-CGD.Methods: A Thai girl who suffered from pulmonary aspergillosis at the age of two months and another unrelated Thai boy presented with recurrent cutaneous abscesses caused by Chromobacterium violaceum since 30 months old, were investigated. The DHR assays revealed abnormalities in both patients but normal results in their mothers, consistent with the diagnosis of AR-CGD. PCR-sequencing of the entire coding regions of NCF1, NCF2, and CYBA was performed.Results: A homozygous c.75_76delGT mutation at the beginning of exon 2 of NCF1 was identified in both individuals. This mutation resulted in a frameshift with premature termination of p47-phox at codon 51 (p.Val25fsX51).Conclusion: The homozygous GT deletion in NCF1 may be a common mutation in Thai patients with AR-CGD. Unlike all other autosomal recessive disorders, AR-CGD caused by NCF1 mutations has a unique mutational pattern, in which there is only one mutation responsible for most patients regardless of their ethnic backgrounds.
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Background and objective: The prevalence of allergic diseases is increasing in Thailand. For the diagnosis of allergic disease, in-vivo and in-vitro clinical tests are required. This paper examined the effectiveness of multiple allergosorbent test (MAST) chemiluminescence assay (CLA) technique of serum allergen-specific immunoglobulin (IgE) in allergic Thai children by comparing the sensitivity and specificity to the skin prick test. Methods: One-hundred children with allergic diseases (age: 3-18 years old; 62 male and 38 female) were included. The diagnosis of allergy was based on patient history, physical finding, and skin prick test. Fourteen allergens (6 aeroallergens and 8 food allergens) were tested for this study. Allergen-specific IgE test was performed in patient serum using the MAST CLA technique Optigen Universal Panel 20. The food allergens were mixed-shellfish, shrimp, mixed-fish, cow milk, peanut, egg white, wheat, and soybean. The results by the skin prick test and the MAST CLA were graded into five levels (0-4), where level 3 and 4 were defined positive and levels 0-2 negative. Results: In the skin prick test, the following aeroallergens were positive: Dermatophagoides pteronyssinus, Dermatophagoides farinae, cockroach (German, American or mixed) and cat, as well as some for food allergens such as mixed-shellfish, shrimp, cow milk, and mixed-fish. In the allergen-specific IgE by MAST CLA, the following aeroallergens were positive: Dermatophagoides pteronyssinus, Dermatophagoides farinae, cat, cockroach-mix and dog. Food allergens were positive for cow milk, wheat, egg white, peanut and soybean. The sensitivity and specificity of the MAST CLA against the skin prick test was more than 50%, while the specificity was more than 88%. The result with the 14 allergen commercial panel combination showed that the sensitivity and specificity was highest. Conclusions: The MAST CLA for the in-vitro determination of allergen-specific IgE in patient serum can be used for screening and diagnosis of allergic Thai children.
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Background: There have been recommendations for allergy prevention in cases of high risk infants; nevertheless, there has been no definite criterium to identify those at risk. Objective: To develop an atopic risk score to identify infants who are at risk and deserve allergy prevention by noting a history of atopic diseases of their 1st degree related family. The scoring is weighted by genetic correlation to each atopic disease to determine the score that is the most appropriate for predictive screening for the development of atopic diseases. Method: This is a retrospective study designed by a team of family pediatricians. Three-thousands five-hundred two children aged 1-5 years from Bangkok and other provinces of Thailand were included between April 2005 and March 2006. From their clinics, the family pediatricians recorded the patients’ family history of atopic diseases by using the atopic risk score that had been designed, and the health status that had been recorded in the past one-five years. Main outcome parameters were allergic manifestations including cow’s milk allergy, atopic dermatitis (AD), chronic rhinitis, and recurrent wheeze. Results: Study subjects were 3,502 children; female (56.4%) and male (43.6%) attending health care facilities in Bangkok and other provinces. The average age of onset of atopic disease was 14.7 months (2 weeks to 5 years) with the median age 9 months. 35.2% had developed atopic diseases mostly during the first year of life (78.3%) and had either a positive or negative family history of atopy. Male children developed significantly more atopic disease than the female with P value \< 0.001 (OR=1.5; 95%CI=1.300-1.719). The association of the atopic risk score with the development of atopic diseases was determined by using odds ratio as risk estimates. All scores from score one were associated significantly with the development of atopic diseases by OR=2.64-3.22 with p-value \< 0.001 and 95%CI. The score that could be used for screening of the high-risk infant, was more than 2. Conclusion: The atopic risk score is a practical method to identify the infants with high risk who deserve allergy prevention.