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The Asia Allergy Birth Cohort (A2BC) network consolidates data from multiple independently established birth cohorts across Asia to enhance research on host–environment interactions in allergic diseases. These cohorts, established at different times with various methodologies, are reliable data sources. Our aim is to introduce the content, variables, and outcomes of these cohorts while highlighting their differences, laying the groundwork for future collaborative research. The A2BC network includes 10 cohort studies on allergic diseases from six Asian countries. Enrollment criteria, study aims, and an initial inventory were discussed and confirmed through five business meetings. A common database was developed to assess the study characteristics of these observational cohorts on allergic diseases, though harmonization efforts are retrospective. Five studies collected data on specific immunoglobulin E responses to various inhalant and food allergens, while six cohorts conducted skin prick tests. Lung function measurements were included in some studies, but without standardized procedures across cohorts. Asthma and allergic rhinitis were primarily assessed using questionnaires or doctor diagnoses, while assessments of eczema and food allergies varied across studies. The A2BC network also examines early‐life environmental factors such as delivery mode, antibiotic usage, diet, and air pollutants, although these exposures were measured differently across the cohorts. Despite differences in the origins, methods, and objectives of each cohort, pooling data and conducting joint analyses offer valuable insights into the relationship between environmental exposures and allergic disease outcomes in Asian children. This approach can serve as a foundation for future collaborative research. [ABSTRACT FROM AUTHOR]

Allergic diseases such as asthma, atopic dermatitis, and food allergies are a burgeoning health challenge in the Asia‐Pacific region. Compounding this, the region has become increasingly susceptible to the impacts of climate change. The region has weathered extreme precipitation, intense heat waves, and dust storms over the recent decades. While the effects of environmental and genetic factors on allergic diseases are well understood, prevailing gaps in understanding the complex interactions between climate change and these factors remain. We aim to provide insights into the various pathways by which climate change influences allergic diseases in the Asia‐Pacific population. We outline practical steps that allergists can take to reduce the carbon footprint of their practice on both a systemic and patient‐specific level. We recommend that allergists optimize disease control to reduce the resources required for each patient's care, which contributes to reducing greenhouse gas emissions. We encourage the responsible prescription of metered dose inhalers by promoting the switch to dry powder inhalers for certain patients, at each clinician's discretion. We also recommend the utilization of virtual consultations to reduce patient travel while ensuring that evidence‐based guidelines for rational allergy management are closely adhered to. Finally, eliminating unnecessary testing and medications will also reduce greenhouse gas emissions in many areas of medical care. [ABSTRACT FROM AUTHOR]

We conclude there is no convincing evidence that midpregnancy onset gestational diabetes mellitus and maternal glycaemia is associated with the development of eczema, rhinitis and wheeze in the offspring, independent of pre-existing diabetes. The mixed-effect regression model, which considers repeated measures of eczema, rhinitis and wheeze across all time points longitudinally, also demonstrated no consistent significant associations between GDM and maternal glucose levels with these clinical outcomes (Figure 1 and Table S1). [Extracted from the article]

However, our results suggest that higher n-3 to n-6 PUFA ratios may be linked to increased risk of early life wheezing illness. Keywords: allergic sensitization; eczema; polyunsaturated fatty acids; rhinitis; wheeze EN allergic sensitization eczema polyunsaturated fatty acids rhinitis wheeze 1 7 7 11/29/22 20221101 NES 221101 The increasing global prevalence of allergic diseases makes it imperative to identify modifiable risk factors for allergic disease development. We hypothesized that higher n-3 metabolites is protective against inflammation and allergy and that higher total n-3:total n-6 PUFAs, higher (DHA + EPA):AA and LA:AA ratios and lower ALA:(EPA + DHA) during pregnancy are associated with decreased pro-inflammatory cord blood cytokines at birth and consequently decreased risk of offspring allergic diseases in the first 8 years of life. [Extracted from the article]

Thereafter, currently active AD diagnosis, reflecting point prevalence, was performed by physicians on the same day using standard Hanifin and Rajka criteria,7 which were used as the reference to evaluate diagnostic accuracy of caregiver-reported history of physician-diagnosed AD. In conclusion, the study findings indicate the significant, yet unexplored, influence of recall bias when using caregiver report in estimating lifetime AD prevalence in young children, potentially leading to underestimation of actual AD cases, which may be especially critical in populations with low disease prevalence rates. Keywords: accuracy; atopic dermatitis; caregiver; diagnosis; eczema; prevalence; report EN accuracy atopic dermatitis caregiver diagnosis eczema prevalence report 1 4 4 01/05/22 20220101 NES 220101 ACKNOWLEDGMENTS We thank Dr Rahul Nair and Dr Pui Ling for their help in dental examination. [Extracted from the article]

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. [ABSTRACT FROM AUTHOR]

The article presents a study which discusses impact of immunoglobulin E (IgE) sensitization and rhinitis on inflammatory biomarkers and lung function in adolescents with and without asthma. Topics include evaluation of effect of rhinitis and sensitization on lung function, including the periphery of the airway system, measures of spirometry, impulse oscillometry for participants in longitudinal birth cohort study, and analysis of blood samples for eosinophils.

The article discusses early childcare enrollment and childhood wheezing disorders related phenotypes. It mentions that children attending childcare are at increased risk of viral respiratory infections and viral-induced wheezing disorders. Other topics include null effects of early childcare attendance against asthma development, development of respiratory allergy in later childhood, and Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort methodology.

In this study, we found no association between maternal blood levels of carotenoids, vitamin A, and vitamin E at delivery with the development of allergen sensitization, eczema, rhinitis, and wheeze with use of nebulizer/inhaler in the offspring in first five years of life. To our knowledge, this is the first study with the longest follow-up of children, to have investigated relationships between objective measurements of carotenoids, vitamin A, and vitamin E in maternal blood with allergic outcomes in offspring up to five years old. The strengths of this study are the objective measurement of carotenoids, vitamin A, and vitamin E in maternal plasma, which are not subjected to recall bias. Vitamins A and E during pregnancy and allergy symptoms in an early childhood-lack of association with tobacco smoke exposure. [Extracted from the article]

Abstract: Emerging evidence for the early introduction of allergenic foods for the prevention of food allergies, such as peanut allergy in Western populations, has led to the recent publication of guidelines in the USA and Europe recommending early peanut introduction for high‐risk infants with severe eczema or egg allergy. Peanut allergy is, however, much less prevalent in Asia compared to the West. Varying patterns of food allergy are seen even within Asian countries—such as a predominance of wheat allergy in Japan and Thailand and shellfish allergy in Singapore and the Philippines. Customs and traditions, such as diet and infant feeding practices, also differ between Asian populations. Hence, there are unique challenges in adapting guidelines on early allergenic food introduction to the Asian setting. In this paper, we review the evidence and discuss the possible approaches to guide the timely introduction of allergenic food in high‐risk infants in Asia. [ABSTRACT FROM AUTHOR]

It is generally accepted that allergic diseases are not curable and not preventable, but mainly controllable using pharmacotherapy (i.e. symptomatic medication). Recent research, however, demonstrated that a number of specific interventions can lead to (partial) primary prevention of allergy, especially of atopic dermatitis ( AD) and food allergy ( FA). Three types of primary prevention strategies have been successfully studied: early administration of bacterial products (most studies are on probiotics), early moisturizing in infants at risk for AD and early exposure to allergenic foods (peanut and egg). Results of these studies indicate that the stage might have been set. Surely, much more research needs to be carried out before advice can be given in clinical practice. This opinion article discusses the three types of beneficial interventions and gives ideas for future research, which might show the way for better strategies in primary prevention of allergic diseases. [ABSTRACT FROM AUTHOR]

A case study is presented for a 6-year-old girl with bilateral breast buds and has been diagnosed with idiopathic central precocious puberty at the age of 5 years and 4 months. The patient has developed generalized urticaria following dosage of intramuscular (IM) injection of triptorellin. She was referred to an allergy specialist and received safe optimal medical therapy.

Background: Different maternal psychological states during pregnancy have been associated with wheeze-rhinitis-eczema symptoms in children. However, previous studies were limited and it was unclear whether the type of prenatal psychological state was associated with a particular symptom. We examined the association of maternal depression and anxiety during pregnancy with wheeze-rhinitis-eczema symptoms in infancy. Methods: In a longitudinal birth cohort (GUSTO) of 1152 mother-child pairs, wheeze-rhinitis-eczema symptoms in the infants during the first year of life were collected by parental report. Maternal depressive and anxiety symptoms were assessed at 26 weeks of gestation using the Edinburgh Postnatal Depression Scale (EPDS) and State Trait Anxiety Inventory (STAI). Logistic regression analyses were performed with adjustment for potential confounders. Results: An increased risk of wheezing was found in infants of pregnant women with probable depression (EPDS ≥ 15) [odds ratio (OR) = 1.85 (95% confidence interval (CI) 1.10-3.12)], and an increased risk of rhinitis was associated with maternal anxiety [STAI state ≥ 41: OR = 1.42 (95% CI 1.04-1.93); STAI trait ≥ 43: OR = 1.38 (95% CI 1.01-1.88)]. After adjusting for known risk factors for the development of allergic disease, these associations remained significant [EPDS ≥ 15: adjusted OR = 2.09 (95% CI 1.05-4.19); STAI state ≥ 41: adjusted OR = 1.82 (95% CI 1.17-2.82); STAI trait ≥ 43: adjusted OR = 1.70 (95% CI 1.10-2.61)]. However, maternal psychological states were not associated with infantile eczema. Conclusion: This study suggests that there may be an independent effect of prenatal depression on wheezing and anxiety on rhinitis in infancy. [ABSTRACT FROM AUTHOR]

Background: Rhinitis is common in early childhood, but allergic rhinitis is considered a later manifestation of the atopic march. This study aimed to evaluate rhinitis (allergic and non-allergic) in the first 18 months of life, its link with other atopic manifestations and the role of respiratory viruses. Methods: Subjects (n = 1237) of the Singapore GUSTO birth cohort were followed up quarterly until 18 months of age with questionnaires to screen for rhinitis symptoms lasting at least 2 wk and with monthly calls to positive subjects to detect prolonged/ recurrent rhinitis symptoms (total duration ⩾4 wk). Anterior nasal swabbing for molecular-based virus detection was conducted during these visits and near (within a month) rhinitis episodes. Skin prick testing to common environmental and food allergens was conducted at the 18 month visit. Results: Prolonged/recurrent rhinitis was significantly associated with history of parental atopy (mother: aOR = 2.17; father: aOR = 1.82) and atopic comorbidities of eczema (aOR = 2.53) and wheeze (aOR = 4.63) (p < 0.05), though not with allergen sensitization. Although the frequency of nasal respiratory virus detection during scheduled quarterly visits did not differ between prolonged/recurrent rhinitis and matched controls (p > 0.05), virus detection was higher in swabs obtained within a month following rhinitis episodes in prolonged/recurrent rhinitis subjects compared with scheduled visits (adjusted p = 0.04). Conclusions: Based on the duration of rhinitis symptoms, this study defined a subset of early childhood rhinitis which was associated with atopic predisposition and comorbidities. Persistent respiratory viral shedding may contribute to the symptomatology. Whether this entity is a precursor of subsequent childhood allergic rhinitis will require longer follow-up. [ABSTRACT FROM AUTHOR]

To cite this article: Van Bever HPS, Lee BW, Shek L. Viewpoint: The future of research in pediatric allergy: What should the focus be? Pediatric Allergy Immunology 2012: 23: 5-10. Abstract Allergic diseases have been increasing during the last three decades, and exact reasons for this are still debated. Despite intense ongoing research, a lot of aspects of allergic diseases are still poorly understood, resulting in limitations in current therapeutic approach to allergies. In this viewpoint, important unanswered research questions are raised mainly on novel therapeutic approaches to allergic children, and suggestions for future research are raised. Three aspects of pediatric allergy are distinguished: the prevention, control, and cure. [ABSTRACT FROM AUTHOR]

Wong IYZ, Soh SE, Chng SY, Shek LP-C, Goh DYT, Van Bever HPS, Lee BW. Compliance with topical nasal medication - An evaluation in children with rhinitis. Pediatr Allergy Immunol 2010: 21: 1146-1150. © 2010 John Wiley & Sons A/S It is our impression that children with rhinitis often dislike or struggle with the administration of topical nasal sprays and drops. This study aims to investigate children's acceptance of topical nasal sprays/drops, and to identify patient factors that may affect their acceptance. An interview (by WYZI) questionnaire survey was carried out on parents/guardians of children aged 1-15 with rhinitis, where information on the diagnosis and treatment, patients' use and responses to these medications, and their preferred treatment routes were collected. Two hundred questionnaires were completed, of which 194 were valid for analysis. The mean age of patients was 7.54 yr; male to female ratio was 1:1.6, and Chinese made up the majority (62.4%). About one quarter (24.7%) of children disliked the use of topical nasal sprays/drops sufficiently to affect compliance with the medication. Furthermore, of those who could indicate their preferred route of drug administration (n = 75), 73% indicated a preference for oral medication, while only 11% preferred the nasal route. Topical nasal sprays/drops were more acceptable in older children (7-15 yr) compared to the younger ones (1-6 yr) (OR = 2.383, CI 1.223-4.644). The acceptance of nasal sprays/drops was not associated with gender, ethnic group, concurrent use by other family members, length and amount of usage, and the response to therapy. A substantial proportion of children prescribed topical nasal sprays/drops did not find it acceptable. Age played a significant factor to the acceptance of the use of topical nasal sprays/drops. [ABSTRACT FROM AUTHOR]

Shek LP, Chong AR, Soh SE, Cheong N, Teo ASM, Yi FC, Giam YC, Chua KY, Van Bever HP. Specific profiles of house dust mite sensitization in children with asthma and in children with eczema. Pediatr Allergy Immunol 2010: 21: e718–e722. © 2010 John Wiley & Sons A/S Sensitization to house dust mites (HDM) is highly prevalent among the young atopic population in Singapore. Previously published data suggest that individuals with skin allergies show preferred sensitization to Dermatophagoides pteronyssinus while individuals with pure respiratory allergies show preferred sensitization to Blomia tropicalis. The aim of our study was to compare the sensitization profiles between children with asthma and those with eczema to D. pteronyssinus and B. tropicalis and their specific allergens. A total of 60 children, 30 with asthma and 30 with eczema were recruited. IgE levels specific for a panel of HDM allergens from the two mite species were measured using enzyme-linked immunosorbent assay. The asthma group showed highest sensitization to Blo t5 while the eczema group showed highest sensitization to Der p5. Comparison between the two disease groups showed that the eczema group had significantly higher IgE levels for Der p (p = 0.042) and its allergens Der p1 (p = 0.019) and Der p5 (p = 0.001). Generally, the eczema group was more sensitized to the panel of allergens compared to the asthma group. Individuals with asthma and those with eczema showed different sensitization profiles to HDM. These findings highlighted possible mechanisms for different manifestation of allergy. [ABSTRACT FROM AUTHOR]

Atopic diseases are known to co-exist and are interrelated. Their co-existence in a patient increases disease burden and morbidity. We sought to study the prevalence of co-existing atopic conditions over time and its associated risk factors among Singapore children. Data was collected from two respective The International Study of Asthma and Allergies in Childhood surveys conducted in 1994 and 2001. Data on asthma, rhinitis and eczema were obtained from the responses to questions about wheezing, exercise-induced wheezing, nocturnal cough, rhinitis symptoms, rash, and diagnoses of asthma, rhinitis and eczema in the last 12 months. Data on demographic and known risk factors were also obtained. The prevalence of children who have had more than one atopic disorder increased significantly from 6.0% in 1994 to 10.2% in 2001 (p < 0.001). Parental history of atopic disease, maternal educational level, male gender and smoke exposure were significantly associated with co-existent atopic symptoms in the child. Among Singapore schoolchildren, there was a significant prevalence of co-existent atopic disease and this prevalence was rising. The influences of both genetic and environmental factors were likely to have contributed to these observations. [ABSTRACT FROM AUTHOR]

Fish allergy is common in countries where consumption is high. Asian nations are amongst the world’s largest consumers of fish but the allergen profiles of tropical fish are unknown. This study sought to evaluate the allergenicity of four commonly consumed tropical fish, the threadfin ( Polynemus indicus), Indian anchovy ( Stolephorus indicus), pomfret ( Pampus chinensis) and tengirri ( Scomberomorus guttatus). Immunoglobulin E (IgE) cross-reactivity with parvalbumin of cod fish (Gad c 1), the major fish allergen, was also studied. Detection of tropical fish and cod specific-IgE was performed by UniCap assay, and skin prick tests were also carried out. The IgE-binding components of tropical fish were identified using IgE immunoblot techniques, and cross-reactivity with Gad c 1 was assessed by ELISA inhibition and IgE immunoblot inhibition. Clinically, nine of 10 patients studied were allergic to multiple fish. All patients exhibited detectable specific-IgE to cod fish (10 of 10 skin prick test positive, eight of 10 UniCap assay positive) despite lack of previous exposure. The major allergen of the four tropical fish was the 12-kDa parvalbumin. IgE cross-reactivity of these allergens to Gad c 1 was observed to be moderate to high in the tropical fish studied. Parvalbumins are the major allergens in commonly consumed tropical fish. They are cross-reactive with each other as well as with Gad c 1. Commercial tests for cod fish appear to be sufficient for the detection of tropical fish specific-IgE. [ABSTRACT FROM AUTHOR]

There is no exact explanation for the increase in allergic diseases that occurred since the last two decades. An increased allergen exposure and/or a decreased bacterial load cannot explain the phenomenon completely. Other causal factors that rose at the beginning of the 1980s must be taken into consideration. Important changes at that time in our management of children were the worldwide switch from aspirin to paracetamol, the introduction of broad-spectrum antibiotics such as cephalosporins and the advice to avoid dust and pets in newborns from allergic families. General application of these new approaches, in itself or in combination, might be responsible, at least in part, for the increase of allergic diseases in children. [ABSTRACT FROM AUTHOR]