Asthma, Allergy and Immunology

Biography

Biography: Hugo P S Van Bever

Abstract

Since the beginning of this century, Food Allergy (FA) has been increasing worldwide and its increase is considered as the second allergy wave. Common foods involved in Singapore are egg (infants), peanuts (preschoolers-rapidly increasing) and seafood (older children-cross-reactivity with house dust mites). Mechanisms are diverse (especially in cow’s milk allergy). The best studied model is the IgE-mediated FA. New findings on FA include the role of transcutaneous sensitization (in children with eczema) and studies on primary prevention of FA, showing that early exposure (and not avoidance) might be the way to go. FA is still a difficult and confusing issue, mainly because FA is still surrounded with many stories, non-scientific data and superstition, leading to misdiagnosis and mistreatment. Furthermore, various concepts of FA are understood wrongly and therefore, approached wrongly, including its difference with food intolerance (usually being an enzymatic problem). In Singapore, often parents come to the clinic with the request to test their child for food allergy because of vague symptoms such as bad school results, sleep problems or tummy pain. Most of these children have no FA and other causes (often psychological causes) are involved. Sometimes parents persist in their search for FA, ending up with all kind of non-scientific diagnostic tests and extensive diets (on the internet), leading to malnutrition and more psychological distress in the child. Moreover, obtaining an accurate picture of the burden of FA is hampered by a lack of uniform, population-based methodologies that incorporate the gold-standard diagnostic method, which is the double-blind, placebo-controlled oral food challenge. For example, self-reported FA ranged from 3% to 35%, which likely reflects study limitations of self-report, varied definitions of FA, and true population variation. Prevalence studies based on incorporation of appropriate food challenges are limited. However, based on these criteria the true prevalence of FA is estimated to be between 1% and 8%, being higher in children than in adults. FA should be approached scientifically. Only this approach will help children and parents appropriately and will avoid useless interventions (extensive diets) which can have a negative effect on the child’s general health.