"The Allergy Epidemic: Are Filipino Children at Greater Risk?"

Allergies have become increasingly more common in Canada and in the Philippines. Are Filipino children at greater risk? 

Please see Dr. Andrea Fong's article published in the Pilipino Express: 

http://www.pilipino-express.com/news/2111-the-allergy-epidemic.html.

Information from the study will help researchers compare the rates of allergic diseases in Filipino children with the information they have on the general Winnipeg and Canadian populations. It will also allow them to compare it with the rates of allergic diseases in children in the Philippines where a similar survey has been done. 

It is important that Filipino parents of all children younger than 18 years old, regardless if they have allergies or not, participate in this survey. Enrolment criteria is one or both parents must be of Filipino ancestry and their child(ren) must be under 18 years of age, with or without food allergies.

The survey the can be accessed online at www.surveymonkey.com/s/filipinoallergy.

Filipino children between the ages of 11 - 17 can also fill out the survey themselves by going to 

www.surveymonkey.com/s/filipinoallergyteen.

ARE WE TOO CLEAN? GERMS MAY BE OUR BEST FRIENDS!

The human body is home to about 100 trillion microbes, bacteria, or organisms. Many of these live on our skin and in our intestines (gut).

A lot of these bacteria are harmless and many are very helpful. Only a tiny number are disease causing germs. Ideally, they live together in a fine balance keeping us healthy and preventing the disease causing bacteria from making us sick.

Researchers at the University of Colorado are learning just how important it may be to our overall health to keep these organisms growing and in balance. A healthy balance means a healthy immune system, which helps to prevent infection, chronic diseases including allergy and asthma, and even cancer.

A baby’s balance of bacteria in its gut begins as it passes through the birth canal.The balance changes with breast feeding and the introduction of food. By age 3, the baby’s gut bacteria is similar to the parents.

The environment we live in influences the balance of the microbes in our bodies. For example, people living on a farm seem to have lower rates of asthma and allergies, possibly because they are exposed to more bacteria in their environment. They may have a greater variety of protective bacteria. People living in the same home tend to have a similar bacterial balance. Exposure to certain animals, such as dogs, sometimes affects the balance in a good way.

Sadly, our bacterial balance is changing because of our diet, lifestyle, antibiotic use, and the cleanliness of our environment. Researchers are starting to think that the increase in chronic diseases such as asthma, may begin in the gut. The bacterial imbalance may affect the health of the lining of the intestines, affecting the immune system.

What are some things we can do to restore or keep our bacterial balance in check?

• Take antibiotics only when needed.
• Maintain a healthy diet: by avoiding processed foods, eating more whole grains and complex carbohydrates, eating lots of fruits, raw or lightly cooked vegetables, as well as fermented foods such as kimchi, yoghurt and sauerkraut.
• Be reasonable about cleanliness. Allow children to get dirty, play with pets and play in the great outdoors. Children need to be in contact with all kinds of germs in our environment in order to develop a healthy immune system.
• Hug, kiss, and get close to your baby. Smothering them with love AND germs will do them good!

Source: Some of my Best Friends are Germs by Michael Pollan, New York Times, May 2013

Early Environmental Determinants of Asthma Risk in a High-risk Birth Cohort

Introduction:

Asthma is a complex disease resulting from both genetic and environmental influences. Some studies have shown that exposure to certain indoor particles (eg from tobacco smoke, dust mites, viruses, pets, etc) early in life seems to increase the chance of developing asthma. Others have found these same environmental exposures have no effect. The CAPPS (The Canadian Childhood Asthma Primary
Prevention Study) researchers wanted to look at environmental factors that influence the development of asthma in children who are genetically at higher risk of developing asthma.  

Children are genetically at higher risk of developing asthma if at least one parent or a sibling has asthma or, at least two of parents or siblings have allergies or eczema. 

Research question:

What factors increase the chances of high risk children developing asthma by 7 years of age?

Can certain changes in the environment protect these children from developing asthma?

What was done:

Researchers followed 380 mothers of high risk children from the third trimester of pregnancy till the child was 7 years old.

The families were randomly assigned to the intervention group or the control group.

Families were from Winnipeg and Vancouver

The intervention group: Researchers helped theses families reduce exposure to house dust mite, tobacco smoke, and pets in the home.  Breast feeding was encouraged and solids were delayed until the child was 6 months old.

The control Group: The control group followed the usual care with advice from their doctors and no input from researchers. 

Both groups' indoor environment was assessed during home visits before the birth of the child, and at 2, 4, 8, 12, 18, 24 months, and at 7 years after the birth. The prevalence of a specific respiratory virus (RSV) was also assessed over the first 2 years of life. At the age of 7 years all of the children were seen by a pediatric allergist for assessment.  Allergy skin tests were done.

Results:

18.7% of children were diagnosed with asthma by 7 years of age.

The following factors increased the chances of a child developing asthma:

• The development of allergies (eczema, food or environmental allergies) in the first few years of life. 
• Having a mother or older siblings with asthma. 
• Being male. More boys than girls developed asthma. 
• Living in Winnipeg. More children in Winnipeg developed asthma than in Vancouver, perhaps because children in Winnipeg had higher rates of allergies (51.1% vs 39.5%).  This may be related to climate differences and the indoor environment. 
• The child having Respiratory Syncytial virus (RSV) infection in the first year of life.
• Owning a dog in the first year of life.

Conclusions:

• What happens in the first year of life seems most important.
• Children in the intervention group, where intervention measures were applied prior to birth and for the first year of life, had a significantly lower risk (14.9%) for developing asthma by the age of 7 years than the control group (23%).
• Having a dog in the home and the child having an RSV infection both in the first year of life are more important than the same exposure in later years
• It is not clear which intervention specifically made a difference.  The first year of life may be a “window of opportunity” for intervention measures to help prevent asthma in high risk children. 
• Inherited risk factors ie: the presence of asthma in the mother, or older siblings, was the strongest predictor that the child would also develop asthma. 
• The intervention measures undertaken (decreasing exposure to house dust mite, tobacco smoke, and pets in the home, increasing breast feeding delaying solids until the child was 6 months old) did not significantly change the effects of inherited risk factors or family history in the development of asthma. 

Pediatr Allergy Immunol 2008: 19: 482–489. Early environmental determinants of asthma risk in a high-risk birth cohort. Chan-Yeung M, Hegele RG, Dimich-Ward H, Ferguson A, SchulzerM, Chan H, Watson W, Becker A. 

Allergy Sufferers Should Mind their Fruits and Vegetables

We all need to eat fruit and vegetables but some of them can cause serious reactions for people with seasonal allergies. Find out which ones. Dr. Allan Becker talks with Marcy Markusa, host from CBC Information Radio Manitoba.  Follow the link below to hear Dr. Becker's conversation.

http://www.cbc.ca/player/AudioMobile/Information%2BRadio%2B-%2BMB/ID/2388307402/

Major Cat Allergen levels in the home of patients with asthma and their relationship to sensitization to cat dander.

Introduction: Many studies have shown that dust mite and cat are the most common indoor allergies.

Allergies, in particular allergies to furry animals, increase the risk of chronic asthma and of emergency visits due to asthma attacks.

Cat allergy is very common, even for people who don’t own a cat. Previous studies have shown that cat allergen can be found in the carpets and mattresses of homes where cats are kept but also in homes where a cat has never been present.  

Research questions:

• How much cat allergen can be found in the homes of asthmatic patients? 
• How does having a cat affect the amount of allergen found?
• Does the concentration of cat allergen in a home affect skin allergy tests to cats?
• Does climate affect the amount of cat allergen found in a home?

What was done:  120 adults and children with asthma participated in the study. Participants lived in Winnipeg, Manitoba or in Vancouver, British Columbia.

Questionnaires: Participants answered questions about their asthma control, use of medication, smoking habits and asthma triggers.  They were also asked if there was a cat living in the home or if they frequently visited someone with a cat. 

Home visits: Each home was visited four times (once every season). Dust samples were collected from the bedrooms and the mattresses using a portable vacuum  cleaner and a special filter.

Skin testing: All participants were allergy tested to 11 different environmental allergens, including cats.  Skin testing was done at the beginning of the study.

Results:  90% of the children and 80% of the adults had allergies. Cat allergy was the most common allergy with 60% of the participants being allergic to cats.   Although only 15% of the homes had one or more cats, cat allergen was found in almost all (92%) of the homes. Homes with cats had the highest amount of cat allergen.

           

In Winnipeg, the amount of cat allergen found in homes without a cat was higher in winter and in spring.  In Vancouver, the amount of cat allergen in homes without a cat was the same all year round.

The amount of cat allergen was the same all year round in all homes that did have a cat.   

The incidence of cat allergy was the same for the participants that had a cat in the home as it was for participants that did not have a cat in the home.

The amount of cat allergen in the home did not seem to affect the risk of having a positive skin test to cats.

Conclusions: It is impossible to completely avoid cat allergen. A certain amount of cat allergen is present in almost all Canadian homes.

The amount of cat allergen in a home can be quite high, even if the home is cat-free. Indirect contact with a cat (visiting a friend with a cat) influences the amount of allergen found in a cat-free home. 

This may explain why so many people with asthma develop a cat allergy even if they have never had a cat.

Seasons only affect the amount of cat allergen in homes that DO NOT have a cat. High concentrations of cat allergen are present all year round if a cat lives in the home.

Having a cat free home does not seem to prevent the development of cat allergy but it does decrease the amount of cat allergen in the home. We still don’t know how much cat allergen is needed to develop a cat allergy or allergic symptoms. The amount needed to develop symptoms of asthma differs greatly from one person to another.

It is still very important for patients with asthma who are allergic to cats to minimize their exposure as much as possible.

Ann Allergy Asthma Immunol. 1995 Oct;75(4):325-30.Major cat allergen (Fel d I) levels in the homes of patients with asthma and their relationship to sensitization to cat dander. Quirce S, Dimich-Ward H, Chan H, Ferguson A, Becker A, Manfreda J, Simons E, Chan-Yeung M.