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Children of Asian ethnicity in Australia have higher risk of food allergy and early onset eczema than those in Singapore

Children of Asian ethnicity in Australia have higher risk of food allergy and early onset eczema than those in Singapore
Children of Asian ethnicity in Australia have higher risk of food allergy and early onset eczema than those in Singapore

Background: In Western countries, Asian children have higher food allergy risk than Caucasian children. The early-life environmental exposures for this discrepancy are unclear. We aimed to compare prevalence of food allergy and associated risk factors between Asian children in Singapore and Australia. Methods: We studied children in the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort (n = 878) and children of Asian ancestry in the HealthNuts cohort (n = 314). Food allergy was defined as a positive SPT ≥3 mm to egg or peanut AND either a convincing history of IgE-mediated reaction at 18 months (GUSTO) or a positive oral food challenge at 14-18 months (HealthNuts). Eczema was defined as parent-reported doctor diagnosis. Results: Food allergy prevalence was 1.1% in Singapore and 15.0% in Australia (P<0.001). Egg introduction was more often delayed (>10 months) in Singapore (63.5%) than Australia (16.3%; P<0.001). Prevalence of early-onset eczema (<6 months) was lower in Singapore (8.4%) than Australia (30.5%) (P<0.001). Children with early-onset eczema were more likely to have food allergy than those without eczema in Australia [aOR 5.11 (2.34-11.14); P<0.001] and Singapore [aOR4.00 (0.62-25.8); P = 0.145]. Conclusions: Among Asian children, prevalence of early-onset eczema and food allergy was higher in Australia than Singapore. Further research with larger sample sizes and harmonized definitions of food allergy between cohorts is required to confirm and extend these findings. Research on environmental factors influencing eczema onset in Australia and Singapore may aid understanding of food allergy pathogenesis in different parts of the world.

Asian children, GUSTO, eczema, food allergy, healthnuts
0105-4538
3171-3182
Suaini, Noor H. A.
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Loo, Evelyn Xiu-Ling
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Peters, Rachel L.
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Yap, Gaik Chin
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Allen, Katrina J.
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van Bever, Hugo
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Martino, David J.
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Goh, Anne Eng Neo
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Dharmage, Shyamali C.
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Colega, Marjorelee T.
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Chong, Mary Foong-Fong
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Ponsonby, Anne-Louise
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Tan, Kok Hian
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Tang, Mimi L. K.
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Godfrey, Keith
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Lee, Bee Wah
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Shek, Lynette Pei-Chi
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Koplin, Jennifer J.
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Tham, Elizabeth Huiwen
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Suaini, Noor H. A.
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Loo, Evelyn Xiu-Ling
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Peters, Rachel L.
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Yap, Gaik Chin
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Allen, Katrina J.
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van Bever, Hugo
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Martino, David J.
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Goh, Anne Eng Neo
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Dharmage, Shyamali C.
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Colega, Marjorelee T.
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Chong, Mary Foong-Fong
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Ponsonby, Anne-Louise
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Tan, Kok Hian
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Tang, Mimi L. K.
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Godfrey, Keith
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Lee, Bee Wah
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Shek, Lynette Pei-Chi
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Koplin, Jennifer J.
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Tham, Elizabeth Huiwen
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Suaini, Noor H. A., Loo, Evelyn Xiu-Ling, Peters, Rachel L., Yap, Gaik Chin, Allen, Katrina J., van Bever, Hugo, Martino, David J., Goh, Anne Eng Neo, Dharmage, Shyamali C., Colega, Marjorelee T., Chong, Mary Foong-Fong, Ponsonby, Anne-Louise, Tan, Kok Hian, Tang, Mimi L. K., Godfrey, Keith, Lee, Bee Wah, Shek, Lynette Pei-Chi, Koplin, Jennifer J. and Tham, Elizabeth Huiwen (2021) Children of Asian ethnicity in Australia have higher risk of food allergy and early onset eczema than those in Singapore. Allergy: European Journal of Allergy and Clinical Immunology, 76 (10), 3171-3182. (doi:10.1111/all.14823).

Record type: Article

Abstract

Background: In Western countries, Asian children have higher food allergy risk than Caucasian children. The early-life environmental exposures for this discrepancy are unclear. We aimed to compare prevalence of food allergy and associated risk factors between Asian children in Singapore and Australia. Methods: We studied children in the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort (n = 878) and children of Asian ancestry in the HealthNuts cohort (n = 314). Food allergy was defined as a positive SPT ≥3 mm to egg or peanut AND either a convincing history of IgE-mediated reaction at 18 months (GUSTO) or a positive oral food challenge at 14-18 months (HealthNuts). Eczema was defined as parent-reported doctor diagnosis. Results: Food allergy prevalence was 1.1% in Singapore and 15.0% in Australia (P<0.001). Egg introduction was more often delayed (>10 months) in Singapore (63.5%) than Australia (16.3%; P<0.001). Prevalence of early-onset eczema (<6 months) was lower in Singapore (8.4%) than Australia (30.5%) (P<0.001). Children with early-onset eczema were more likely to have food allergy than those without eczema in Australia [aOR 5.11 (2.34-11.14); P<0.001] and Singapore [aOR4.00 (0.62-25.8); P = 0.145]. Conclusions: Among Asian children, prevalence of early-onset eczema and food allergy was higher in Australia than Singapore. Further research with larger sample sizes and harmonized definitions of food allergy between cohorts is required to confirm and extend these findings. Research on environmental factors influencing eczema onset in Australia and Singapore may aid understanding of food allergy pathogenesis in different parts of the world.

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Accepted/In Press date: 14 February 2021
e-pub ahead of print date: 22 March 2021
Published date: October 2021
Additional Information: Funding Information: This research was supported by the Singapore National Research Foundation under its Translational and Clinical Research (TCR) Flagship Programme and administered by the Singapore Ministry of Health's National Medical Research Council (NMRC), Singapore-NMRC/TCR/004-NUS/2008; NMRC/TCR/012-NUHS/2014. This work was also supported by the National Medical Research Council, NMRC/CSA/022/2010 and NRF370062-HUJ-NUS (Project 10). Additional funding is provided by the Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore. K. M. Godfrey is funded by the UK Medical Research Council (MC_UU_12011/4) and the National Institute for Health Research (NIHR Senior Investigator (NF-SI-0515-10042) and NIHR Southampton Biomedical Research Centre (IS-BRC-1215-20004). E. H. Tham is supported by the National Medical Research Council (NMRC) Research Training Fellowship grant [MH 095:003\008-225] and the Transition Award [MOH-000269] from NMRC, Singapore. The HealthNuts study was funded by the National Health & Medical Research Council (NHMRC) of Australia, Ilhan Food Allergy Foundation and AnaphylaxiStop. Support for research at the Murdoch Children's Research Institute was provided by the Victorian Government's Operational Infrastructure Support Program. N. H. A Suaini received funding from the NHMRC Centre for Food and Allergy Research Drs Suaini, Loo, Peters, Yap, Allen, Bever, Martino, Goh, Dharmage, Colega, Fong, Ponsonby, Tan, Lee, Shek, Koplin and Tham have nothing to disclose. Dr. Tang reports personal fees from Prota Therapeutics, personal fees from Abbott Nutrition, personal fees from Nestle Health Science, personal fees from Bayer Pharmaceuticals, outside the submitted work. Dr. Godfrey reports other from Nestle Nutrition Institute, grants from Nestec, outside the submitted work; in addition, Dr. Godfrey has a patent Phenotype prediction issued, a patent Predictive use of CpG methylation issued, a patent Maternal Nutrition Composition pending, a patent vitamin B6 in maternal administration for the prevention of overweight or obesity in the offspring issued, and a patent Composition and its use pending. The authors acknowledge the contribution of the rest of the GUSTO study group which includes Lee Yung Seng, Wei Wei Pang, Pratibha Agarwal, Dennis Bier, Arijit Biswas, Shirong Cai, Jerry Kok Yen Chan, Cornelia Yin Ing Chee, Helen Y. H. Chen, Audrey Chia, Amutha Chinnadurai, Chai Kiat Chng, Shang Chee Chong, Mei Chien Chua, Chun Ming Ding, Eric Andrew Finkelstein, Doris Fok, Marielle Fortier, Yam Thiam Daniel Goh, Joshua J. Gooley, Wee Meng Han, Mark Hanson, Christiani Jeyakumar Henry, Joanna D. Holbrook, Chin-Ying Hsu, Hazel Inskip, Jeevesh Kapur, Birit Leutscher-Broekman, Sok Bee Lim, Seong Feei Loh, Yen-Ling Low, Iliana Magiati, Lourdes Mary Daniel, Michael Meaney, Susan Morton, Cheryl Ngo, Krishnamoorthy Niduvaje, Anqi Qiu, Boon Long Quah, Victor Samuel Rajadurai, Mary Rauff, Jenny L. Richmond, Anne Rifkin-Graboi, Allan Sheppard, Borys Shuter, Leher Singh, Wing Chee So, Walter Stunkel, Lin Lin Su, Soek Hui Tan, Rob M. van Dam, Sudhakar K. Venkatesh, Inez Bik Yun Wong, P. C. Wong and George Seow Heong Yeo. We would also like to thank the GUSTO Executive committee, research staff and all parents and children who participated in the GUSTO study. The HealthNuts study group is made up of the HealthNuts investigators, including Professor Melissa Wake, A/Prof Adrian Lowe, Professor Lyle Gurrin, Professor Colin Robertson and Professor Terry Dwyer. We thank the parents and children who participated in the HealthNuts Study and the staff of Melbourne?s Local Government Areas for access to community Immunization Clinics. We would also like to thank the HealthNuts safety committee: Associate Professor Noel Cranswick (Australian Paediatric Pharmacology Research Unit, Murdoch Childrens Research Institute), Dr Joanne Smart (Department of Allergy and Immunology, Royal Children?s Hospital, Melbourne, Australia) and Professor Jo Douglass (Director, Department of Allergy and Immunology, Royal Melbourne Hospital, Melbourne, Australia). We thank ALK Abello, S.A. Madrid, Espa?a for providing the allergens for the skin prick tests. We also thank the HealthNuts study research staff: Nicholas Osborne, Megan Mathers, Dean Tey, Marnie Robinson, Giovanni Zurzolo, Leone Thiele, Helen Czech, Deborah Anderson, Carley Garner and John Molloy. Funding Information: This research was supported by the Singapore National Research Foundation under its Translational and Clinical Research (TCR) Flagship Programme and administered by the Singapore Ministry of Health's National Medical Research Council (NMRC), Singapore‐NMRC/TCR/004‐NUS/2008; NMRC/TCR/012‐NUHS/2014. This work was also supported by the National Medical Research Council, NMRC/CSA/022/2010 and NRF370062‐HUJ‐NUS (Project 10). Additional funding is provided by the Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore. K. M. Godfrey is funded by the UK Medical Research Council (MC_UU_12011/4) and the National Institute for Health Research (NIHR Senior Investigator (NF‐SI‐0515‐10042) and NIHR Southampton Biomedical Research Centre (IS‐BRC‐1215‐20004). E. H. Tham is supported by the National Medical Research Council (NMRC) Research Training Fellowship grant [MH 095:003\008‐225] and the Transition Award [MOH‐000269] from NMRC, Singapore. The HealthNuts study was funded by the National Health & Medical Research Council (NHMRC) of Australia, Ilhan Food Allergy Foundation and AnaphylaxiStop. Support for research at the Murdoch Children's Research Institute was provided by the Victorian Government's Operational Infrastructure Support Program. N. H. A Suaini received funding from the NHMRC Centre for Food and Allergy Research Publisher Copyright: © 2021 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.
Keywords: Asian children, GUSTO, eczema, food allergy, healthnuts

Identifiers

Local EPrints ID: 447237
URI: http://eprints.soton.ac.uk/id/eprint/447237
ISSN: 0105-4538
PURE UUID: 60b940ee-01ef-4110-9510-b5373dceee73
ORCID for Keith Godfrey: ORCID iD orcid.org/0000-0002-4643-0618

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Date deposited: 05 Mar 2021 17:31
Last modified: 17 Mar 2024 06:21

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Contributors

Author: Noor H. A. Suaini
Author: Evelyn Xiu-Ling Loo
Author: Rachel L. Peters
Author: Gaik Chin Yap
Author: Katrina J. Allen
Author: Hugo van Bever
Author: David J. Martino
Author: Anne Eng Neo Goh
Author: Shyamali C. Dharmage
Author: Marjorelee T. Colega
Author: Mary Foong-Fong Chong
Author: Anne-Louise Ponsonby
Author: Kok Hian Tan
Author: Mimi L. K. Tang
Author: Keith Godfrey ORCID iD
Author: Bee Wah Lee
Author: Lynette Pei-Chi Shek
Author: Jennifer J. Koplin
Author: Elizabeth Huiwen Tham

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