Food allergy fears: New survey reveals insufficient data, research, and management in most APAC countries

A cross-sectional survey initiated by the Asia Pacific Association of Allergy Asthma and Clinical Immunology (APAAACI) set out to assess the current disease burden, resource availability, and management practices of food allergies among healthcare providers in the region.

The survey comprised a comprehensive questionnaire of 66 questions distributed to 16 member countries of APAAACI from June to September 2022. These questions delved into respondents' demographics, regional prevalence of food allergies, availability of allergy services, and the management of food allergies, including the prescription of adrenaline.

The survey also included specific inquiries about the management of food allergies and anaphylaxis in respondents' practices, both before and during the COVID-19 period and it has garnered responses from Australia, Bangladesh, China, Hong Kong SAR, Indonesia, Japan, Korea, Malaysia, Mongolia, Philippines, Singapore, Sri Lanka, Taiwan, Thailand, and Vietnam.

Analysis of the 20 valid responses revealed that 15% of respondents exclusively cared for adult patients, 35% for paediatric patients, and 50% for both adult and paediatric patients. The median years of experience in the allergy and immunology specialty among respondents were 20 years.

Survey findings ​

Prevalence rates of food allergies across the Asia-Pacific region reveal varying burdens, with Australian infants leading at 10%, followed by Chinese infants and toddlers at 7.7%. In Australian school-age children (10-14 years), the prevalence is 5%, while Korean school-age children (6-16 years) experience a 4% prevalence. Singaporean infants and Thai pre-school children show rates of 0.5% and 0.45%, respectively.

For children under 5 years, the primary food allergens are cow's milk (83%) and egg white (78%). In the 5 to12 years old age group, shellfish (61%), peanuts (39%), tree nuts, and egg white (33%) are common allergens. Among 13 to 17 years old, shellfish (78%), peanuts (44%), and tree nuts and fish (33%) are predominant.

In adults, prevalence varies from 1-10% in Vietnam, 6-10% in Indonesia, around 5% in Japan and Taiwan, 2-4% in Australia, and 1% in Singapore. Seafood, including fish and shellfish (69%), is consistently the most common allergen, with others including wheat, fruits, peanuts, tree nuts, herring, and eggplant.

Food allergy patients are mainly managed by allergists/immunologists (81%) and general paediatricians (75%), with general practitioners (50%) playing a substantial role in certain regions. Internists and respiratory physicians (31%) and gastroenterologists (13%) are less commonly involved.

The availability of allergists/immunologists varies widely, with paediatric allergists ranging from 0.1 to 0.5 per 100,000 population. Adult allergists are scarce, particularly in Hong Kong, Indonesia, Japan, Malaysia, Mongolia, Philippines, and Vietnam.

Support from allergy nurses is available "always" or "frequently" in half of respondents' practices and "sometimes" or "rarely" in the other half.

Adrenaline autoinjectors, crucial for anaphylaxis management, are limited in the Asia-Pacific region, with 31% reporting unavailability. Ampules and injectable adrenaline syringes are commonly prescribed in 54% of regions. In regions with available autoinjectors, Epipen is the most common brand (62%), followed by Anapen and Jext (7.7%).

Respondents generally reported minimal changes in the likelihood of admitting anaphylactic patients to the hospital before and after the COVID-19 pandemic.

How much more needs to be done? ​

Food allergy is an incurable condition with the potential for life-threatening allergic reactions. Despite its severity, there is a lack of comprehensive literature on management practices and healthcare services in Asia.

According to researchers, the true prevalence of food allergy in Asia, particularly among adults, remains elusive, often relying on self-reported data, reflecting a "perceived" rate rather than an accurate representation of the situation.

Allergic diseases necessitate a multidisciplinary approach, with allergists playing a central role. While the Asia-Pacific region generally has a higher proportion of paediatric allergists, the onset of allergic reactions such as asthma occurs later in life, emphasizing the need to enhance training capacity for adult allergists.

Promoting the allergy specialty is crucial for improving patient outcomes and increasing awareness of effective allergy management.

Several factors contribute to the limited availability of adrenaline autoinjectors, including high costs, regional production gaps, and a lack of prescription guidelines. Researchers advocate for public health measures to prioritize widespread availability, addressing these obstacles to prevent unnecessary morbidity and mortality.

“There is an urgent call for robust epidemiological studies in Asia to produce accurate and reliable incidence and prevalence of food allergy across time, to breach the gap between the demand and supply of allergy services and to enhance the availability and accessibility of adrenaline autoinjector and allergen-specific immunotherapy.” ​Researchers wrote.

Source: Journal of Allergy and Clinical Immunology: Global

Perspectives and Gaps in the Management of Food Allergy and Anaphylaxis in the Asia-Pacific Region​

https://www.sciencedirect.com/science/article/pii/S2772829323001273​

Authors: Agnes Sze Yin Leung et al.