CURRICULUM VITAE Name : Sumadiono, dr SpA(K) Place/date of birth : Nganjuk, 9-10-1956 Occupation : Staff of Pediatric Dept.UGM Yogyakarta Educations : General Doctor : Fac. Of Medicine Unair, Surabaya, 1982 Pediatrician : Fac of Medicine UGM, Yogyakarta 1994 Allergy Immunology Consultant: Indonesian College of Pediatric, 2002 Other Educations: Molecular Biology (ICMR Kobe, Japan, 1996) Basic Immunology (VU Amsterdam, The Netherland, 1997) Pediatric clinic/treatment (VU Amsterdam, The Netherlands, 1998 & 1999) Pediatric Allergy Immunology (Saskatoon, Canada, 2003) Medical Education: PBL (UM Mastrich, The Netherlands, 2004) Trends in Medical Education (NUS, Singapore, 2004) Workshop: Intraarticular Injection (IRA, 2005) Organizations: - Chair of Allergy Immunology Devision, Pediatric Dept. Fac. Of Medicine UGM Yogyakarta - Evaluation commission of Indonesian Collegium of Pediatric - APAPARI Board - Chair of Indonesian Pediatric Allergy Immunology Working Group (2008-2011, 2011-2014) - DIY Branch Chair of Indonesian Allergy Immunology Ascociation - DIY Branch Chair of Indonesian Pediatric Society
The Epidemiology and Aproach to Management of Food Allergy in Indonesia Sumadiono Indonesian Pediatric Allergy Immunology Working Group
Food allergy Is one of important issues in children because food is needed for children s growth & development Indonesia does not have a great number of studies on food allergy
We adapted some of recommendations that could be suitable in our settings to diagnose & mangement of food allergy in our country Studies in local settings used skin prick test (SPT) food specific immunoglobulin E (sige) elimination & provocation
Allergy Prevalence: is tend to increase 25% 24,6% 20% 15% 14,2% 13,9% 12,3% 10% 5% 6,9% 9,0% 4,9% 8,9% 3,9% 0% Jakarta Pusat (1990) ISAAC Jakarta Timur (2001) EAAEL Jakarta (2006) Asthma AsmaAllergic Rinitis Rhinitis alergi Dermatitis atopi Atopic Dermatitis
Characteristic of Allergic Diseases In Children in Yogyakarta 33.8% 17.3% 9.1% Allergic Rhinitis AR Atopic dermatitis DA Asthma Sumadiono (2014) Paper presented at APAPARI conference, Yogyakarta N: 447
Exclusive breastfeeding is very important Exclusive breast feeding 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 13% 19% 32% 52% 61% 67% 1st mo 2nd mo 3rd mo 4th mo 5th mo 6th mo Partially breast feeding Mostly breast feeding No breast feeding No breastfeeding Mostly breastfeeding with increasing the age of the baby Partial breastfeeding Exclusive breastfeeding Exclusive breast feeding was tend to decrease Risk of allergy will be increase in the future (Zakiudin, 2012)
In Jakarta 2012: From 42 atopic dermatitis Was sensitized by: white egg (31%), cow s milk (23.8%), chicken (23.8%), yolk egg (21.4%), nuts (21.4%), wheat (21.4%)
Prevalence of Food Allergy in Children Age below than 3 Years in Jakarta 286 children 30 % had Food Allergy
FOOD Diseases HYPERSENSITIVTY in Food Sensitivity IN PRESCHOOL AND SCHOOL AGE CHILDREN in Preschool & School Children Sumadiono, Satria CD, Parantri A, Rossi WU. 2014 Department of Childhealth, Faculty of Medicine, niversitas Gadjah Mada Yogyakarta Indonesia Allergic Rhinitis 29.25% Asthma 4.26% Atopic Dermatits 1.06%)
FOOD Allergens HYPERSENSITIVTY of Food Sensitivity IN PRESCHOOL AND SCHOOL AGE CHILDREN in Preschool & School Children Sumadiono, Satria CD, Parantri A, Rossi WU. 2014 Department of Childhealth, Faculty of Medicine, Universitas Gadjah Mada Yogyakarta Indonesia Shrimp (12.63%) Crab (11:52%) Tomatoes (4.38%) Egg whites (3.5%) Cows Milk (3:46%) Chicken meat (2.96%) Chocolate (2.9%) Egg yolks (2:41%) Orange (2.23%) Pineapple (2.2%) Banana (2.2%) Soy (2.12%) Apples (1.86%) Fish (1.8%) Peanut (1.6%) Ppear (1.53%) Watermelons (1,53%) Wheat (1.35%) Beef (1.34%) Manggo (1.23%) Nuts (1.08 %) Grapes (0.92%) Avocado (0.92%) Papaya (0.92%) Rice (0.31%).
(Sumadio, Satria, Riana. 2015),
. Proportion of crab allergen sensitization on the incidence of allergic diseases in children Crabs 15 13 10 4 4 5 0 Allergic rhinitis Asthma Atopic dermatitis The most common clinical manifestation of crab allergen sensitization was allergic rhinitis (Sumadio, Satria, Riana. 2015),
The most common food sensitization was shrimp The most common disesease was allergic rhinitis 61 subjects: 12 (19.7%) with shrimp sesitization Severe allergic rhinitis 37 (60.6%) No correlation between shrimp sensitization with severity of allergic rhinitis in children (p=0.511). (Regie, Sumadiono, Satria, 2014)
RECOMMENDATION Indonesia Pediatric Society DIAGNOSIS AND MANAGEMENT OF COW S MILK PROTEIN ALLERGY Allergy Immunology Working Group Gastrohepatology Working Group Nutrition and Metabolic Diseases Working Group
Indonesian CMA Management Recommendation Exclusive Breast Feeding Group The mother continue to breast feeding and Avoid Cows Milk Protein (6 month) 2013/2014 Cows Milk Formula Group Baby: Avoid Cows Milk Formula Replace to ehf Mild-Moderate Manifestation (6 month) Replace Amino Acid Formula Severe manifestation (6 month) Use SOY FORMULA : If: problems in Cost, Availability, Taste of formula treatment
Studies on soy protein sensitization and allergy Study Population Prevalence (%) Soy sensitization Soy allergy Western countries United States 6 CMA 59.4 14 Finland 8 CMA 20 10 Finland 9 CMA 31 0 Asian countries Japan 13 National survey ND 1.4 Food allergy ND 11 Japan 11 Food allergy 20 ND Thailand 12 CMA ND 17 Munasir Z et al CMA 17,5% 4%
Indonesia data The safety of a soy-based infant formula in infants with suggestive CMPA Post Marketing Observational Study, 2011-2012
Symptoms of CMPA Post Marketing Observational Study, 2011-2012
Results symptoms resolution Post Marketing Observational Study 2011-2012 Resolution of CMPA-suggestive symptoms during observation period (%) 87.6 Respiratory 97.7 Gastrointestinal 94.5 Dermatology
Results safety analysis From 535 subjects measured for safety evaluation: the soy-based formula was well tolerated in most subjects (86.0 % subjects) No serious adverse event reported during the study period. Post Marketing Observational Study, 2011-2012
RECOMMENDATION Indonesia Paediatric Society PIMARY PREVENTION OF ALLERGY Allergy Immunology Working Group Working Group
Which babies require prevention of allergy? Card as early detection of risk of allergies Socialization this card to pediatricians, obstetricians, general practitioners and also midwifes
PIMARY PREVENTION OF ALLERGY Risk Yes Pregnancy No diet retriction No contact to smoke Baby Brestfeeding Solid food Environtment Extensively Brestfeeding If no brestfeeding Hydrolyze Formula Start at 4-6 months No solid food retriction No contact to smoke
Conclusion Food Allergy is one of important problem in children The prevalence is increasing Accurate diagnosis is needed to prevent mismanagement We still need national data to evaluate the burden of food allergy and its impact to Indonesian population
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