Food Allergy – Indian
Scenario
Dr. Ashok Gupta
Asso. Prof. of Pediatrics, SMS Medical College, Jaipur
Deputy Executive Director, International Society of Tropical Pediatrics
Executive, International Pediatric Academic Leaders Association
Medical Advisor, Food Allergy and Anaphylaxis Network, USA
Member, EAACI Committee on Patient Group for Food Allergy
Epidemiology of Diseases in India
S. No.
Disease
Total Cases
Deaths
Year
1
Acute Respiratory Infection
1,18,54,345
3736
2007
2
Acute Diarrhea Disease
94,78,813
2328
2007
3
Measles
26986
4
Malaria
1363279
1066
2007
5
Japanese Encephalitis
4017
989
2007
6
Dengue
5395
69
2007
1995
Continued…
• No registry of Food Allergy Patients
• No Medical college has a degree course in
Allergy
• Demographic projections predict 22% of
the total population suffer from some
allergy (250 million)
Case
• Avinash – 8 year, Male, h/o Peanut Allergy
visiting from USA
– Consumes packaged food with inadequate
information, develops anaphylaxis
– July 6, 2010, Union Minister of Health, GOI
accepted Food Allergy as a serious health
problem
Case
Anil – 1 yr. Male
• Milk Ingestion
induces – flushing,
swelling, breathing
difficulty
• Milk anaphylaxis
Case
Shrichand – 5 yrs. Male
• Repeated papular urticaria
• Partial response to antihistamines
• Allergy test – wheat allergy
• Improved on wheat withdrawal
Case
Vicky – 5 yrs. male
• Chronic Diarrhea
• Failure to thrive
• Rickets
• Multiple nutritional
deficiencies
• Celiac Disease
Adverse Food Reactions may be mistaken
for allergy
Non-immunologic
Toxic / Pharmacologic
Non-Toxic / Intolerance
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Bacterial food poisoning
Heavy metal poisoning
Scombroid fish poisoning
Caffeine
Alcohol
Histamine
Adapted from Sicherer S, Sampson H. J Allergy Clin
Immunol 2006;117:S470-475.
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Lactase deficiency
Galactosemia
Pancreatic insufficiency
Gallbladder / liver disease
Hiatal hernia
Gustatory rhinitis
Anorexia nervosa
Idiosyncratic
Adverse Food Reactions
IgE-Mediated
(most common)
• Systemic
(Anaphylaxis)
• Oral Allergy
Syndrome
• Immediate
gastrointestinal
allergy
• Asthma/rhinitis
• Urticaria
• Morbilliform
rashes and
flushing
• Contact urticaria
Immunologic
• Eosinophilic
esophagitis
• Eosinophilic
gastritis
• Eosinophilic
gastroenteritis
• Atopic dermatitis
Non-IgE Mediated
Cell-Mediated
• Celiac disease
• Protein-Induced
Enterocolitis
• Protein-Induced
Enteropathy
• Eosinophilic proctitis
• Dermatitis
herpetiformis
• Contact dermatitis
Natural history of food allergy
• Generally - reproducible reaction: same person,
same food, same, similar or related symptoms
• May progress from dermatitis or hives to
vomiting & wheeze to Asthma and Anaphylaxis
• ~ 85% of individuals with allergies to cows milk,
egg, wheat, soy become tolerant by 3 yrs of age
• Allergy to peanut, nuts, seafood is typically
permanent
10
Allergens Common in India
• Any food can be allergenic
• Patterns of common allergens differ across
regions and cultures
• Dairy, eggs, peanuts, tree nuts such as walnuts,
almonds and cashews, fish, shellfish, soya,
wheat, seasame top the list
• Incidence of allergies to milk, eggs and wheat
less frequent then in the West
• Dals (Pulses) such as chickpeas more common
allergy to rice has been reported
Allergy distribution
• Evenly distributed
• More in urban and semi urban areas as
compared to rural areas
• Changing food pattern moving away from
Traditional Dal, Rice, Vegetables to Fast
Food, Ice cream, Chocolate additionally
increased Houses have Carpets & Pet
Foodhypersensitivity
Food hypersensitivity
Food allergy
IgE-mediated food
allergy
Food hypersensitivity
Food allergy
IgE-mediated allergy
Non-IgE- mediated
e.g. celiac disease
Non-allergic
food hypersensitivity
Non IgE-mediated food
allergy
Non-allergic-food
hypersensitivity
Enzymatic
- lactose intolerance
Pharmacological
- biogenic amines
e.g. histamine, tyramine
Allergens from a single site
No. of Tests- 66778 (2008 & 2009)
Name of Allergen
Percentage allocation
Mite
36.1
Cockroach
32.5
Asp.Fum.
28.8
H.dust
21.8
Bermuda grass
21
Shrimp
18
Johansson grass
15.9
Wheat
12.4
IgE mediated Food Allergens in patients
with Asthma and allergic rhinitis.
No. of patients- 1860 patient.
Curd
Rice
Citrus
Banana
Milk
blackgram
Egg
Chicken
Fish
48 %
43%
35 %
27 %
12 %
9.7 %
2.7 %
1.5 %
1.2%
Studies on large scale surveys
• Moshe Ben-Shoshan etal, Montreal,
Canada – Population based study on
Peanut, Tree nut, Fish, Shellfish, and
Sesame allergy prevelance in canada
• EuroPrevall
• Gerez etal – Singapore Medical Journal
Definition of Food Allergy
• Perceived food allergy – Self reported
• Probable Food Allergy – Self reporting /
Physician confirmed
• Confirmed Food Allergy – Convincing
clinical history of IgE reaction / positive
SPT
Methodology
• Telephone surveys
• Trained Interviewer
• Respondents 18 years older with no
language mental hearing barriers
• Questionnaire
• Statistical Analysis
No. of New Celiac cases
120
100
80
Celiac Patient
60
40
20
0
2002
2004
2006
2008
2010
Distribution of Celiac Diseases
Cases
24%
Rural
Urban
76%
Compliance
• Rising incidence of symptomatic celiac patients
• Need for appropriate education of parents,
children & medical personal
• Need for strategies of prevention
- Delayed introduction of gluten
- Breast Feeding
• High index of suspicious in children with Typical
presentations & in asymptomatic IDA,
Hypothyroid, 1st degree relicts.
• IDD & Hypothyroid not responding to treatment
need to be screamed.
• Regulatory mechanism for labeling & assessing of
gluten free products.
KAP Anaphylaxis
Medical College Faculty & Residents - 32%
General Practioner
9.2%
Food Allergy diagnosis
Medical College Faculty & Residents - 44 %
General Practioners
11.2%
Conclusions
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Food allergy on the rise
Need for establishing a national registry
Urgent need to educate medical personnel
Social & Psychological cost to the patient
and the family
• Food labeling
• Scientific support on preventing food
allergy & making food safe
• Quality control of marketed foods