Download - The Allergy Epidemic Dr Adam Fox Consultant in Paediatric Allergy Guy’s & St Thomas’ Hospital
29 September 2010
The Allergy Epidemic
Dr Adam Fox
Consultant in Paediatric Allergy
Guy’s & St Thomas’ Hospital16 October 2013
Ancient History
2
Modern History
3
• Hay fever – Dr John Bostock first described in 1819
• Based on his own symptoms
• Second paper on 28 cases - took 9 years to acquire
Modern History
allos = "other"
ergon = "reaction"
Clemens Von Pirquet 1874-1929
An inappropriate, potentially harmful reaction by the immune system to a harmless stimulus.
Allergic Diseases
• Eczema
• Asthma
• Allergic Rhinitis
• Food Allergy
• Drug Allergy
• Venom Allergy
• Latex Allergy
5
at least 2
1 other
Alone
0
20
40
60
80
100
Asthma Suspectedall rhinitis
Eczema Oral-gastrointestinal
symptoms
%
Proportion of the children with asthma, suspected allergic rhinitis, eczema and oral-gastrointestinal symptoms in
combination with other allergic manifestations n= 1417
Wickman et al, Allergy 2004
Allergic Disease in 21st Century UK
8
40% of UK children have an allergic diagnosisGupta et al Clin Exp All 2005
3-4 will have eczema but 12 will have suffered at some point
In a classroom of 30 primary school childrenIn a classroom of 30 primary school children
3 or more children are likely to have asthma
In a classroom of 30 primary school childrenIn a classroom of 30 primary school children
4 or more children will be suffering from rhinitis
In a classroom of 30 secondary school childrenIn a classroom of 30 secondary school children
Impact of Allergic Rhinitis
• Significant decrease in Quality of Life
• Effect on exam performance
– 50% increased risk of dropping a grade from mocks to formal exam
Juniper EF et al. Assessment of quality of life in adolescents with allergic rhinoconjunctivitis: development and testing of a questionnaire for clinical trials. J Allergy Clin Immunol. 1994 Feb;93(2):413-23. Juniper EF et al. Measuring quality of life in children with rhinoconjunctivitis. J Allergy Clin Immunol. 1998 Feb;101(2 Pt 1):163-70.Simons FE Learning impairment and allergic rhinitis.Allergy Asthma Proc. 1996 Jul-Aug;17(4):185-9Walker S et al. Hayfever has a significant detrimental impact on national exam performance in UK teenagers: case control study. JACI 2007.
1-2 children are likely to have a food allergy (although 10 may think they have)
In a classroom of 30 primary school childrenIn a classroom of 30 primary school children
Food allergy in the UK?
• Community cohort of 969 children born 2001-2
• Cumulative incidence of FA was 5.0%
• 33.7% of parents reported a food related problem (only 12.9% of these confirmed)
Venter C et al. Allergy. March 2008
Is peanut allergy getting out of control?
Rates of Peanut Allergic in UK Paediatric Cohorts
Allergy Service Provision
• Remains variable
• 27 adult & 20 Paediatric consultants identified in 2010 RCP report
• No significant expansion planned
• Est 2% of appropriate children receive IT (Vance. Clin Exp Allergy 2010)
16
Key UK Organisations
17
The future
• 2848 Australian infants SPT at 12months
• Prevalence of food allergy 10.4%
Summary
• Increasing pattern of disease
• Multisystem problem
• Relative lack of service provision
• Challenging future
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