africa - allergies

8/12/2019 Africa - Allergies

1/22

Infections and Food Allergy inAfrica

Daniel Boakye

Noguchi Memorial Institute for

Medical Research


2/22

Food allergy in Africa Studies and published information on food

allergies are almost non-existent

Most of the information come fromdeveloped countries even those for

developing countries


3/22

Hygiene Hypothesis and rationale

Is food allergy less prevalent in developingcountries? it is well-accepted that lifestyle-related factors

(hygiene, diet, pollution, infections, sedentariness)

influence the prevalence of hay fever and asthma

The developing countries are in most cases at a

stage where developed countries were someyears back relative to allergic disorders offer an opportunity to understand the underlying

mechanisms of allergic disorders


4/22

EuroPrevall / Glofal studies in African countries


5/22

Children from 8 rural and 6 urban schools from Southern Ghana

Study Area

Urban

Rural


6/22

EuroPrevall / Glofal studies Prevalence and intensity of parasitic infections

Questionnaires (adapted to local situation) Do your child have any adverse food reaction?

Which food causes an adverse reaction?

SPT with house dust mite, cockroach, peanut, andsome additional locally important foods (Fresh localfoods mango, orange, papaya, pineapple, banana &apple by prick to prick )

IgE serology for house dust mite, cockroach and peanutplus some additional locally important foods extract


7/22

Schoolchildren (2287) aged between 5 and 16 years for whom informedconsents was received from parents.

Study Population


8/22

Infections


9/22

Prevalence and intensity of infections

21.5(7-71,5)38(4-72)11(2-27)24(7-78)S.haematobium

1960(510-8350)0(0-0)1000(500-3540)2040(500-8740)Ascaris

240(110-440)120(120-120)240(160-360)200(80-610)Trichuris

280(120-760)80(80-80)600(340-1750)280(120-760)Hookworm

Intensity - Median(IQR)

224(10.3%)2(0.5%)21(3.9%)201(16.2%)S.haematobium

134(6.6%)0(0.0%)13(2.5%)121(10.6%)Ascaris

42(2.1%)1(0.3%)15(2.95)26(2.3%)Trichuris

206(10.25)1(0.3%)6(1.2%)199(17.4%)Hookworm

357(17.7%)2(0.6%)31(6.0%)324(28.3%)Any Geohelminth

506(25.5%)4(1.1%)51(9.9%)451(40.3%)Any Helminth

Infection

Helminth

53(2.75)1(0.35)4(0.95)48(4.3%)+++

134(6.9%)3(0.8%)7(1.5%)124(11.1%)++

279(14.3%)9(2.4%)20(4.3%)250(22.5%)+

Intensity, (N=1948)

487(24.8%)14(3.8%)34(7.3%)439(39.0%)

Infection (N=1965))

Malaria

n(%)n(%)n(%)n(%)

Allurban privateurban publicruralInfection


10/22

SPT- 1695 Subjects testedPrevalence of SPT Positives

Mang

o

Banana

Papaya

Orange

Pine

apple

Apple

Peanut

0.0

0.5

1.0

1.5

2.0

2.5Rural

Urban Public

Urban Private

Total

Food Type

%withincategory

Results

Pineapple and peanut are the most frequent SPT

positives across area categories though Mango is

just as high in the Urban public children.


11/22

With the exception of rice and industrially prepared oils, there are

urban rural differences in food consumption.

Food consumption patterns among our rural and urban study participants.

N. (%) N. (%)

STAPLESRice

No 238 45.33 355 46.59

Yes 287 54.67 407 53.41

Corn

No 44 8.38 661 86.75

Yes 481 91.62 101 13.25

PROTEINS

Chicken

No 449 85.52 696 91.34

Yes 76 14.48 66 8.66

Fish

No 17 3.24 154 20.21

Yes 508 96.76 608 79.79

Eggs

No 456 86.86 587 77.03Yes 69 13.14 175 22.97

Ground nut daily

No 347 33.24 697 66.76

Yes 180 73.17 66 26.83

COOKING OILS

Industrial Oil

No 317 60.38 431 56.56

Yes 208 39.62 331 43.44

Homemade Palmoil

No 185 35.24 594 77.95

Yes 340 64.76 168 22.05

0.000

0.000

0.172

0.000

0.657

0.000

0.001

0.000

Food Area P value

Rural Urban

Results


12/22

Reported Adverse Reactions

Pineapple 16 12.3

Kontomire 13 10.0

Beans 18 13.8

Cassava* 13 10.0

Groundnut 9 6.9Okro 8 6.2

Other foods 53 40.8

TOTAL 130 100

FOOD ITEM No. %

So which of these reported reactions are due to food allergy?

-Time of reaction after consumption?

-Type of reaction?

Pineapple and Beans topped

the adverse reaction

prevalence list.

Followed by Kontomire ( a

Spinach-like vegetable) and

Cassava.

Adverse reactions does notdiscriminate between allergy,

intolerance and other food

associated reactions.

Results


13/22

Symptoms with ingestion of foodsAs a Percentage %

of all reported symptoms

Itching, tingling or swelling in the mouth, lips or throat 42 19.35

Diarrhoea or vomiting (other than food poisoning) 73 33.64

Headaches 23 10.6

Runny or stuffy nose 16 7.37

A rash, nettle sting-like rash or itchy skin 18 8.29

Breathlessness 10 4.61

Red, sore or running eyes 11 5.07

Difficulty swallowing 11 5.07

Stiffness in joints 9 4.15Fainting or dizziness 4 1.84

TOTAL NUMBER OF REPORTED SYMPTOMS 217 100

Did illness associated with eating food include any of the following: Number

Results

The most frequent symptoms associated with food consumption are

Primarily vomiting and diarrhoea

Followed by Itching, tingling or swelling in the mouth, lips and throat

Foods reported to cause reactions within minutes are the same ones most

prevalent for any adverse reaction


14/22

Symptoms with ingestion of foods

Food associated with reported itching in minutes

0

5

10

1520

25

30

35

40

45

Pineapple Kontomire Groundnut Other foods

Food

%allfoo

Results

While cassava and beans are

responsible for vomiting and

diarrhoea symptoms.

Foods associated with vomiting or diarrhoea in minutes

0

10

20

30

40

50

60

70

Cassava Beans Pineapple Other foods

Food

%

allfoo

Pineapple and

Kontomire are

responsible for

itching, tingling and

swelling in mouth and

throat


15/22

Nested matched case-control

All 105 food SPT positives are cases who areage, sex and school matched with two controls

for each of the food types

Characteristics of Case Control Studies

Controls Cases Total

No. 168 104 272

Mean Age 11.5 11.6 11.6Sex

Female 85 54 139

% 50.6 52.4 51.3

rural 84 54 138

% 50 51.4 50.5urban p ubl ic 46 26 72

% 27.4 24.8 26.4

urban pr ivate 38 25 63

% 22.6 23.8 23.1

Results


16/22

Food reactions in cases and controls

ID_NO Foods reported to Cause Reaction Reaction time within:

DY203 Fruits eg.Banana, Orange Minutes

GP023 Potato, Fresh fruit, Herrings Hours

GP061 Mango Hours

GP074 Gari (dried cassava), Rice porridge Minutes

GR152 Pineapple, Banana Minutes

GR285 Pineapple Minutes

IP245 Groundnut, oily foods, Pineapple Hours

NB062 Pawpaw and pineapple Minutes

NB090 Pineapple Minutes

AB133 Okro sou and kenke * Hours

AB147 Okro soup, stew, gari MinutesAN033 Soybeans Hours

DY062 Okro Minutes

GP001 No Food Listed? Hours

GP031 Fresh fish Hours

GP065 Rice Hours

TP073 Konkonte and pork MinutesTP076 Cassava cooked foodb, Pineapple Minutes

TP080 Egg, Nutmeg Minutes

TP086 Sweet Porridge ** Minutes

IgE Sensitised

SPT positive to food causing adverse reaction

CASES

CONTROLS

Reported food reaction

0

5

10

15

20

25

cases controls

%R

epo

rtedfoodreac

Results

!!! Limited Data

Cases have double the

proportion of reported food

reactions than controls

5 out of 10 cases are SPT

reactive to the same reported

food causing reaction, 4 of

whom are also IgE sensitised


17/22

mango

SPT+

SPT-

0.01

0.1

1

10

100

IgE(kU/L)

peanut

SPT+

SPT-

0.01

0.1

1

10

100

IgE(kU/L)

orange

SPT

+SPT-

0.01

0.1

1

10

100

IgE(kU/L)

banana

SPT

+SPT-

0.01

0.1

1

10

100

IgE(kU/L)


18/22

pineapple

SPT+

SPT-

0.01

0.1

1

10

100

IgE(kU/L)

apple

SPT+

SPT-

0.01

0.1

1

10

100

IgE(kU/L)

pawpaw

SPT+

SPT-

0.01

0.1

1

10

100

IgE(k

U/L)


19/22

Although there is currently limited data for those

with IgE sensitisation information andquestionnaires, cases appear to have double theproportion of reporting adverse reactions tofoods.

There was also a statistically significantcorrelation between increasing units of specificIgE and risk of being a case.

With the exception of apple, cases show at least70% prevalence of specific IgE sensitisation inall food categories.

Matched case-control study


20/22

Further studies and future Need for DBPCFC

Analysis of data to determine the role ofinfections (prevalence and intensity)

Complete epidemiological surveys (supportneeded)

Need to know the prevalence of food allergies inGhanaian immigrant populations

What is the prevalence of sensitivity to imported

tropical foods such as pineapple in Europe Development of a setup for allergy testingservices as a practical follow up of EU research


21/22

Collaborators NMIMR

Abena Amoah, Benedicta Obeng Korle-Bu Teaching Hospital

Dr Audrey Forson

LUMC Prof. Maria Yazdanbakhsh & team

University of Amsterdam

Dr Ronald van Ree IFR

Clare Mills


22/22

THANK YOU

GHANA TEAM

africa - allergies

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