calendar of events: - The Childrens Asthma and Allergy Network

calendar of events:
Date
29 August 2009
Saturday
1.30pm-3.30pm
th
( Registration starts @ 1pm)
Event
“ I CAN !” Public Symposium
Program Highlights:
• Boosting my child’s immunity for school
• Asthma & Sports
• What can I do about my child’s frequent sneezing in school?
The Children’s Asthma and Allergy Network
@ University Children’s Medical Institute
Venue
Remarks
Toa Payoh
HDB Hub
Auditorium
*Pre-registration &
prior payment required.
Closing date: 21st August 2009
*Registration fee: $6 per person / $8 per couple
-Free registration for “I CAN !” members and staff of NUHS & NUS only.
-50% off registration fee for members of Abbott Family, NTUC U Family,
staff of NTU, MOE & healthcare professionals.
+ No admission for children below 6 years old.
* Details of the events are correct at the time of print.
Please look out for more information through this channel or www. ican.com.sg nearer the event date.
# For more details or registration, pls call 6772 5566, fax 6772 4453 or email: [email protected]
Newsletter
Some babies are
allergic to cow’s milk.
Fortunately, there’s
a solution.
MICA (P)061/11/2008 | JULY 09
The role of Food Allergy
in children with
Eczema
Prof Hugo Van Bever,
Department of Paediatrics, University Children’s Medical Institute, NUH
Your family’s combined allergy history
determines your baby’s risk.
Reduction in incidence of atopic dermatitis
in high-risk infants at 6 years
6
Incidence (%)
50
36%
40
30
39.1
Relative Risk
Reduction
27.4
20
10
Isomil® 2 Advance® Follow-on Formula, Singapore Mothers’
No.1 Choice* of milk alternative with the goodness of milk.
• While a family history of allergy increases an infant’s allergy risk,
many infants without a family history go on to develop allergy.
1-3
• This has led experts to consider broader use of allergy prevention
strategies, most notably a hypoallergenic formula for bottle-fed infants.
1-3
4
• The latest data confirm the long-term (until six years of age) allergy
preventive effect of NAN HA, particularly against atopic dermatitis.
®
• NAN HA now also contains
BL BIFIDUS, live probiotics that
enhance the intestinal microbiota,
which has been proven to help
reduce the incidence of allergy.
forms in a baby. Skin rashes, wheezing,
5
NAN HA
®
6,7
the common symptoms. Fortunately there’s a
NEW
solution for babies who suffer from cow’s milk
Based on cumulative incidence at 6 years of age. High-risk infants
were exclusively fed the study formulas between birth and four
months of age. All reductions statistically significant.
and 100% free of cow’s milk protein.
Nestlé Nutrition – Our vision is to help enhance quality of life by supporting health and providing care for consumers
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References:
1. Whan U, Chuchalin A, Kowalski ML. Chem Immunol Allergy (Karger, Basel) 2004; 84: 128-134. 2. Exl B-M, Deland U, Secretin M-C et al. Eur J Nutr 2000; 39: 145-156. 3. Hayes T, Wood
RA. Arch Pediatr Adolesc Med 2005; 159: 810-816. 4. Australasian Society of Clinical Immunology and Allergy. Infant Feeding Advice, September 2008. Accessed online 05/05/09: www.
allergy.org.au/content/view/350/287/ 5. von Berg A, Filipiak-Pittroff B, Krämer U et al, for the GINIplus Study Group. J Allergy Clin Immunol 2008; 121: 1442-1447. 6. Baumgartner M, Brown
CA, Secretin MC et al. Nutr Res 1998; 18: 1425-1442. 7. Osborn DA, Sinn J. Cochrane Database Syst Rev 2006; 4: CD003664.
Supports your baby’s growth just like cow’s
milk based formulas
“ The Allergic March “ g
Facilitates 3-times more carbohydrate absorption
than other soy formulas, so that a sensitive
baby has the energy to grow
Fortified with the
system of vital nutrients
– AA and DHA, the building blocks of brain and
eye development; Iron, Taurine and Choline for
mental development and functioning
Let your baby taste the goodness of Isomil® Advance® today.
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Formula, made with high quality soy protein,
Important Notice:
Breastmilk is the best for babies. The World Health Organisation (WHO) recommends exclusive breast-feeding for the first 6 months and should be continued for as long as possible. Unnecessary
introduction of bottle-feeding or other food and drinks should be discouraged since it will have a negative effect on breast-feeding. Consult your doctor for advice if you are unable to breastfeed.
To receive a FREE sample of Isomil® 2 Advance®, simply complete this coupon and mail or fax it to us at 6274 5141. Please allow 4-6 weeks for delivery of sample.
The information in this publication is meant for educational purposes and should not be used as a substitute for medical diagnosis or treatment. Please seek your doctor’s
advice before starting any treatment or if any questions related to your health, physical fitness or medical condition.
Mother’s Name (as in NRIC):
NRIC:
Figure 1: The Allergic March
Address:
Tel: (O)
(H)
Name of Child:
Email:
Date of Birth:
Current Milk Brand:
By filling this form, I accept and agree to future contact from Abbott.
(Note: All sections must be completed. Limited to 1 sample per household. While stocks last. For first time users only.)
ABBOTT LABORATORIES (S) PTE. LTD.
1 Maritime Square #12-01 HarbourFront Centre, Singapore 099253
Abbott Nutrition Careline at 6278 6220 www.abbott.com.sg/family
Brought to you by the leader in paediatric nutrition
I CAN JULY 09
EDITOR: Dr. Irvin Francis Gerez
EDITORIAL TEAM: A/Prof Lynette Shek, A/Prof Daniel Goh, Prof Hugo Van Bever,
Dr Chan Poh Chong, Dr Wendy S Sinnathamby, Dr Chng Seo Yi,
Dr Irene Melinda Louis, Dr Eugene Han, Ms Michelle Tan,
Ms Sharmaine Poh, Ms Chrsitine Loh, Ms Siti Dahlia &
Mr Cruz Jerome Ocampo
The highest degree of allergy (measured by concentrations
of specific IgE in the blood or degree of positive skin prick
tests to allergens) has been detected in children suffering
from both eczema and asthma. It is not yet known whether
there is a real causal relationship between these high levels
of allergy and eczema, or whether this is just an expression
of the atopic constitution (being genetically determined).
In some patients, however, IgE might be important in the
pathogenesis of eczema, while in others it is not. From the
literature, the following observations have been described:
1. Increased total serum IgE has been recorded in
about 80% of patients (less in infants). In addition,
there is a correlation between total serum IgE and
severity of eczema (also in infants).
*Based on full year 2008 sales value data reported by Nielsen MarketTrack for Infant Milk category, Specialty Segment (LF, HA, Soy, Goat’s Milk) in Total Singapore. © 2009, The Nielsen Company.
6/24/09 11:01 AM
This educational publication is printed with the kind sponsorship of:
30% of all children with eczema will develop asthma, and
when considering severe eczema, the prevalence is even
higher (60 – 80%). Switching from eczema to asthma and,
subsequently, rhinitis is also called: “The Allergic March”
(Figure 1). The underlying mechanisms of switching from
eczema to asthma or rhinitis are unknown, but might be
related to specific organ sensitivity to an allergy and to the
type of allergen to which an allergic reaction is developed.
Isomil® 2 Advance® Follow-on Formula is also suitable for infants with diarrhoea, lactose intolerance and galactosemia.
For babies after 6 months
EDITORIAL TEAM
•
protein allergy. Isomil® 2 Advance® Follow-on
Clinically Proven Confidence™
NAN HA RANGE_JAD(A4)_SG.indd 1
•
vomiting, diarrhoea and nausea are some of
®
Standard
formula
•
Cow’s milk protein allergy shows up in many
• A hypoallergenic formula, proven in clinical trials, is recommended
for the prevention of allergy in bottle-fed infants at risk.
®
0
A considerable number of children with eczema (also known
as atopic dermatitis) have signs of other allergic diseases,
such as asthma, rhinitis or food allergy (i.e. urticaria and
angioedema). Usually, the respiratory symptoms (such
as asthma or allergic rhinitis) begin later than the skin
symptoms and many clinicians have noted the peculiar and
unexplained tendency for eczema and asthma to alternate
in their courses. This phenomenon is not constant,
however both can flare simultaneously. Moreover, about
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2. Positive skin prick tests and specific IgE to a number
of inhaled allergens as well as food allergens are
found in the majority of patients with moderate to
severe eczema (not in children with mild eczema).
3. Positive family histories of allergic diseases are
found in the majority of children with eczema.
A positive allergy test (i.e. a skin prick test or the presence
of specific IgE in serum) need not necessarily mean
that the eczema lesions are triggered by this particular
allergen. The prick test (or the determination of specific
IgE in the blood) is known to yield both false positive and
false negative results. A possible explanation for the false
negative results is that the skin lesions are induced by nonIgE-dependent mechanisms. On the other hand, a positive
prick test corresponds to a clinically detectable allergy (by
a positive provocation test) in only about 25% of eczema
patients. Moreover, in young children, prick tests are more
frequently negative than in older children. This is because
eczema is often associated with allergic reactions, and
the presence of allergic reactions does not prove that the
eczema lesions are really caused by the underlying allergy.
Therefore, 3 different situations are possible:
1. food allergens will induce skin reactions, such as
eczema lesions, or urticaria (hives) on top of the
eczema lesions.
2. the underlying allergy is not involved in the eczema
lesions, and has to be considered as an independent
finding.
3. the allergy is a consequence of the eczema, and
is caused because the eczematous skin allows
allergens to penetrate easily into the body (as a
consequence of skin barrier defects). The allergy
can then become involved in the maintaining
of the eczema lesions or remain as a separate
phenomenon.
To prove whether or not an allergy is really involved in
AD, the only valuable test is a provocation test: give the
allergen (usual food) to the child and see what happens.
There are strict scientific criteria for provocation tests. The
best design is the double-blind placebo-controlled test.
In this test neither the investigator nor the patient knows
what allergen is administrated and results are compared
to those of a placebo administration, mainly to exclude the
role of possible underlying psychological factors.
Provocation testing with allergens should always be
performed in a hospital (never at home), as severe reactions
can occur. Therefore, the need of a provocation test should
be judged against its therapeutic consequences, and
against possible risks that can occur.
TABLE: Most common food allergies in children (independent of presence
of eczema)
INFANTS
- cow's milk
PRESCHOOOLERS
- cow's milk
OLDER CHILDREN
- peanut
- eggs
- eggs
- tree-nuts
- wheat
- peanut
- fish
- soy
- tree-nuts
- shellfish
- fish
- sesame
- shellfish
- fruits
- sesame
- bird’s nest
“I CAN !” Public Symposium
Dr. Irvin Francis A. Gerez
Public education is one of the many aspects of our “I CAN !”
Programme. This is in keeping with our objective to
update our patients continually, as well as their parents,
on the latest developments and current available issues in
childhood asthma and allergies.
- fruits
In general, the role
of food allergy is
greater in infants with
eczema
compared
to older children, or
adults whose eczema
is rarely influenced by
dietary factors. In older
children with eczema,
the main triggers are
chronic skin infection
(with Staphylococcus
aureus) and house
dust mite allergy. The
prevalence of food allergy in infants with eczema has
been estimated at up to 40%. However, prevalence of food
allergy is very much dependent on severity of eczema. In
infants with severe eczema, food allergy can be involved
in more than 70% of them. In mild eczema, food allergy is
seldom the cause.
The results from different studies have shown
that food allergy can play a role in eczema, and
most positive reactions to food occur in young
children with severe types of eczema. However,
The first public symposium for 2009 was held on 7 March at
the HDB Hub Convention Centre Auditorium, Toa Payoh. It
was well attended by our “I CAN !” patients, their families and
members of the public. Common questions encountered
in the clinics such as: (a) Are my child’s problems due to
food allergy? (b) Is my child’s cough due to asthma? and
(c) What tests can I do to confirm allergies?, were
extensively addressed by our doctors from University
Children’s Medical Institute, Associate Professor Lynette
Shek Pei-Chi, Dr. Wendy S. Sinnathamby and myself.
and wheat. Other food allergies in eczemacan
occur, but are rare, especially in older children.
The main manifestation of food allergy in older
children is urticaria and/or angioedema
In addition, useful insights on the practical solutions to
common allergic dilemmas seen by parents and caregivers
were also discussed during the question and answer
session. The participants were then treated to a sumptuous
tea reception that ended yet another successful “I CAN !”
event.
Based on the feedback received, participants had found
the talk very informative, useful and interesting.
Join us at our next public symposium on 29 August 2009 at
Toa Payoh HDB Hub, Auditorium. Look out for more details
on our website www.ican.com.sg. See you there!
Peck Ern Wei
In a year, Ern-Wei could compete in
up to 5 competitions, each lasting for
about a week. In the week, he will play
one match everyday. As the physical
exertion was especially intense and
demanding, he looked and felt totally
worn-out after each match. Unlike his
peers, we observed that his recovery
from fatigue was slow. This prompted
us to take action.
Ern-Wei was referred to Dr Irvin Gerez from the University
Children’s Medical Institute at NUH, whose diagnosis was
Exercise Induced Asthma (EIA) after performing several tests
on him. Dr Irvin has been treating his asthmatic condition
for the past year. As per Dr Irvin’s advice, Ern-Wei now
gives himself 2 puffs of Salbutamol (reliever medication),
before any intense or prolonged exercise (such as jogging,
badminton training, competition, etc.), and he is happier now.
As parents, we are more reassured and relaxed as we know
that he can push himself to the limits because he is coping
well with his asthma. We would like to thank Dr Irvin and
nurses in the Asthma Clinic at NUH for treating and taking
care of Ern-Wei.
Mr & Mrs Peck Thian Guan
(Parents of Peck Ern Wei)
ALLERGIC DISEASES IN CHILDREN
Dr Hugo Van Bever
Department of Paediatrics, National University Hospital
The Science, the Superstition
and the Stories
Allergies in children are a common and growing problem. From the author’s experience, many parents lack correct information
on allergy. This has led to wrong approaches in dealing with the problem, with some parents experimenting with all kinds of
non-scientifically proven testing and treatments. Sometimes these treatments can be harmful for the child. The purpose of
this book is to share information and knowledge on allergic disorders in children with everybody, especially parents.
The book comprises twelve chapters, each covering a specific aspect of allergy in children. The first part covers general
issues such as underlying mechanisms, allergens, and epidemiology of allergic diseases. In the second part, specific
allergic diseases are covered. The book ends with considerations on diagnosis and treatment, and offers suggestions for
future research on allergy in children.
This book will provide useful information to the
public, especially parents of allergic children. Based
on current scientific information, the book should
help allergic children obtain optimal diagnosis and
treatment of their allergic diseases.
only a limited number of foods are involved in
eczema. These include eggs, cow’s milk, soy,
“I CAN !” MEMBERS’ CORNER
Get a copy free at the next
20%
DISCOUNT!
“I CAN !” public symposium!
Limited to the
1st 100 participants.
For more details, please refer
to the calendar of events.
Please quote ADC7304
when you order online
at www.worldscibooks.
com/medsci/7304.html
$48
What is “I CAN !”?
• The Children’s Asthma and Allergy Network
(“1 CAN !”) Programme is a comprehensive
integrated programme for children with asthma
and/or allergies, focusing on achieving the
internationally established management goals
to achieve a normal, healthy and unrestricted
lifestyle for all children with asthma and/or
allergies.
What are the benefits?
• Learn more about asthma and allergies and
improve your control.
• Free “1 CAN !” newsletter.
• First to be updated on “1 CAN !” activities Talks, Seminars and Sports/Outdoor Activities.
• Free registration for “1 CAN !” activities.
• Privileges and discounts when you present your
“I CAN !” membership card* at participating
shops.
Who can register as a member?
• Any child age 0 to 16-years-old with asthma and/or allergies
How to register as a member?
• Pick-up a registration form at the NUH Children’s Clinic Lung Function Room 17B or
www.ican.com.sg
• Registration fee is S$15.00 for 2 years (non-refundable)
• Registration is FREE for all University Children’s Medical Institute @ NUH Paediatric
Asthma and Allergy Clinic patients