Anaphylaxis to galacto‐oligosaccharides – an evaluation in an atopic population in <scp>S</scp>ingapore

Soh, Jian Yi; Huang, Chiung‐Hui; Chiang, W. C.; Llanora, Genevieve; Lee, A. J.; Loh, Wenyin; Chin, Y. L. C.; Tay, Victoria Yu Jia; Chan, Yiong Huak; Dianne, D.; Lee, B. W.

doi:10.1111/all.12645

Cited by 11 publications

(10 citation statements)

References 8 publications

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“…Further investigation proved that the trigger was galacto-oligosaccharide, a prebiotic added to cow's milk formula [36]. Since 2009, we have identified 25 confirmed cases among schoolchildren and adults, 16 of whom have been described in previous publications [36][37][38]. These subjects reacted to galacto-oligosaccharide-supplemented formula milk with the predominant symptoms of dyspnoea, wheeze, angioedema, and urticaria.…”

Section: Discussionmentioning

confidence: 85%

Cause and Clinical Presentation of Anaphylaxis in Singapore: From Infancy to Old Age

Goh¹,

Soh

Loh³

et al. 2018

Int Arch Allergy Immunol

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Background: The study objective was to compare age-related differences in the cause and clinical presentation of anaphylaxis. Methods: We conducted a prospective study of patients visiting the emergency department for anaphylaxis. Data were collected from 3 emergency departments from 1 April 2014 to 31 December 2015. Patient electronic records with the diagnoses of allergy, angioedema, urticaria, and anaphylaxis (ICD-9 codes 9953, 9951, 7080, 9950, 7089) were screened and cases fulfilling World Allergy Organisation criteria for anaphylaxis were included. Results: A total of 426 cases of anaphylaxis were identified with a median age of 23 years (range 3 months to 88 years and 9 months). The causes of anaphylaxis were food (n = 236, 55%), drugs (n = 85, 20%), idiopathic (n = 64, 15%), and insect bites or stings (n = 28, 7%). The most common food was shellfish (n = 58, 14%) and the most common drugs were non-steroidal anti-inflammatory drugs (n = 26, 6%). There were more cases of food anaphylaxis in children than in adults (72 vs. 42%, p < 0.001) and more cases of drug anaphylaxis in adults than in children (28 vs. 10%, p < 0.001). Compared to patients of other ages, infants and young children had more gastrointestinal symptoms (adjusted odds ratio [aOR] 2.1, 95% CI 1.1-3.9), while schoolchildren and adolescents had more respiratory symptoms (aOR 2.7, 95% CI 1.4-5.2). Adults had more cardiovascular symptoms (aOR 2.9, 95% CI 1.8-4.6) and hypotension (aOR 3.7, 95% CI 2.1-6.8) compared to children. However, 42% of the infants lacked blood pressure measurements. Conclusions: Knowledge of age-related variation in the cause and clinical presentation of anaphylaxis aids in diagnosis and acute management.

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Section: Discussionmentioning

confidence: 85%

Cause and Clinical Presentation of Anaphylaxis in Singapore: From Infancy to Old Age

Goh¹,

Soh

Loh³

et al. 2018

Int Arch Allergy Immunol

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“…demonstrated that these patients were sensitized to short chain (sc) GOS rather than to cow's milk or long-chain fructo-oligosaccharides 116 . These reactions occur more commonly in atopic individuals, and GOS allergy was estimated to occur in about 3.6% of the atopic Singaporean population 118 . The primary sensitizer for GOS allergy in South East Asia currently remains unknown, but it is postulated to be a trigger that is specific to Asia.…”

Section: Food Allergensmentioning

confidence: 99%

Challenges of managing food allergy in the developing world

Hossny

Ebisawa

El-Gamal

et al. 2019

World Allergy Organization Journal

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Food allergy (FA) is currently a significant health care problem in the developing world. Widely varying study populations and methodologies, the use of surrogate markers such as self report or hospitalization rates due to anaphylaxis rather than objective methods, limits robust estimation of FA prevalence in low income settings. Also, allergy is under-recognized as a clinical specialty in the developing world which compromises the chance for accurate diagnosis. In this review, most published data on food allergens from developing or low income countries are displayed. The diagnostic challenges and limitations of treatment options are discussed. It seems that FA is an under-appreciated health care issue in the developing world, and accurate determination of its burden in low-income settings represents an important unmet need. Multicenter surveillance studies, using standardized methodologies, are, therefore, needed to reveal the true extent of the problem and provide epidemiological clues for prevention. Preventive strategies should be tailored to fit local circumstances in different geographic regions. In addition, studying the gene environment interactions and impact of early life microbiota on the expression of FA in developing communities would be worthwhile. Efforts and resources should be directed toward public health education and training of health care providers dealing with food allergic patients.

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“…Chiang et al demonstrated that all five patients were sensitized to short‐chain (sc) GOS and fractions of scGOS containing 3 sugar units or greater but not to cow's milk or long‐chain fructo‐oligosaccharides. The prevalence of GOS allergy has now been estimated to be around 3.6% in the atopic Singaporean population . In contrast to α‐Gal/red meat allergy, the primary sensitizer for GOS allergy remains unknown, but postulated to be a substance geographically restricted to Asia.…”

Section: Anaphylaxis Triggers—east Vs Westmentioning

confidence: 99%

“…The prevalence of GOS allergy has now been estimated to be around 3.6% in the atopic Singaporean population. 48 In contrast to α-Gal/red meat allergy, the primary sensitizer for GOS allergy remains unknown, but postulated to be a substance geographically restricted to Asia.…”

Section: Galacto-oligosaccharide Allergy First Came To Attention Inmentioning

confidence: 99%

Anaphylaxis – Lessons learnt when East meets West

Tham

Leung

Lee

et al. 2019

Pediatric Allergy Immunology

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The rapidly increasing prevalence of allergic disorders over the past 2 decades highlights the need to understand the epidemiology of anaphylaxis. In Europe, the United States, and Australia, the incidence of anaphylaxis is estimated to be between 60 and 950 cases per 100 000 population, with a lifetime prevalence of anaphylaxis of 0.05%‐2%. The incidence appears to be increasing over time. Although the existing Asian literature is heterogeneous and limited by under‐reporting, it also suggests a similar increasing trend in anaphylaxis incidence in Asia. Anaphylaxis triggers in Asia, such as the predominance of shellfish and wheat in older children and adolescents, differ from those seen in Western populations. Triggers unique to Asia such as traditional Chinese medications, galacto‐oligosaccharides, and food delicacies have also been reported. Low usage of adrenaline as first‐line treatment of anaphylaxis is evident across all countries and is particularly concerning. There is a need to establish prospective, standardized protocols for anaphylaxis data collection and reporting, to enhance the collective understanding of anaphylaxis and its burden, gaps in management and to identify areas for future research and intervention in each region. Understanding of the underlying reasons explaining the difference between East and West will facilitate future primary preventive strategies.

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Anaphylaxis to galacto‐oligosaccharides – an evaluation in an atopic population in Singapore

Cited by 11 publications

References 8 publications

Cause and Clinical Presentation of Anaphylaxis in Singapore: From Infancy to Old Age

Cause and Clinical Presentation of Anaphylaxis in Singapore: From Infancy to Old Age

Challenges of managing food allergy in the developing world

Anaphylaxis – Lessons learnt when East meets West

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