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8/12/2019 Africa - Allergies
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Infections and Food Allergy inAfrica
Daniel Boakye
Noguchi Memorial Institute for
Medical Research
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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
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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
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EuroPrevall / Glofal studies in African countries
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Children from 8 rural and 6 urban schools from Southern Ghana
Study Area
Urban
Rural
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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
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Schoolchildren (2287) aged between 5 and 16 years for whom informedconsents was received from parents.
Study Population
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Infections
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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
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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.
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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
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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
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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
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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
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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
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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
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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)
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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)
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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
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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
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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
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THANK YOU
GHANA TEAM