Goat's milk (GM) allergy commonly occurs together with cow's milk (CM) allergy due to cross-reactivity between highly homologous proteins. We present an unusual case of GM anaphylaxis in a CM tolerant child.
Anaphylaxis ; Child ; Food Hypersensitivity ; Humans ; Hypersensitivity ; Milk Hypersensitivity ; Milk

INTRODUCTION: This study aimed to investigate the trend and seasonality of infection due to respiratory syncytial virus (RSV) at KK Women's and Children's Hospital (KKH) in Singapore and to examine the risk factors for mortality among children with RSV infection requiring admission to the paediatric intensive care unit (PICU). METHODS: A retrospective study was conducted at KKH on children with RSV infections who were admitted to the PICU between January 2004 and December 2010. The medical records of children who died from RSV infections were reviewed. Linear regression was performed to determine the risk factors for RSV mortality. RESULTS: RSV infection was documented in 5,785 children during the study period; the infection was noted to be occurring throughout the year, with a small increase in prevalence between the months of June and August every year. Among 85 (1.5%) out of 5,785 children who were admitted to the PICU for RSV infection, 74 (1.3%) survived and 11 (0.2%) died. Multivariate logistic regression analysis showed that haemodynamically significant cardiac disease (odds ratio [OR] 12.2, 95% confidence interval [CI] 0.9-16.7, p = 0.05), immunodeficiency (OR 71.4, 95% CI 8.2-500, p < 0.001) and metabolic disease (OR 71.4, 95% CI 4.3-1,000, p = 0.003) were independent risk factors for mortality in RSV infections. Prematurity increased the risk of admission to the PICU but was not significantly associated with mortality. CONCLUSION Children with haemodynamically significant cardiac disease, immunodeficiency and metabolic disease were at higher risk of death after hospitalisation for RSV-related illnesses. These children should be considered for palivizumab prophylaxis.

BACKGROUND: The prevalence of peanut allergy (PA) among children has increased significantly over the past decade. Even though the prevalence of PA in Singapore is considered low, peanut is the top trigger for food-induced anaphylaxis in Singaporean children.OBJECTIVE: To describe the demographic characteristics and clinical features of children with PA.METHODS: This is a 5-year retrospective review of children diagnosed with PA based on clinical history coupled with a positive skin prick test to peanut or positive oral food challenge results.RESULTS: There were 269 patients (53.9% males) with a clinical diagnosis of PA. The median age at first allergic presentation for the PA group was 24 months old, with interquartile range of 13–39 months. The most common form of peanut introduced was roasted peanut. The rate of peanut anaphylaxis was 7.1%. Concomitant tree nut sensitization was found in 32.3% of this cohort, predominantly to cashew nut. Majority of them have a personal history of atopy – 75.8% with eczema, 63.6% with allergic rhinitis, and 19.7% with asthma.CONCLUSION: This is the first large review of peanut-allergic children in Singapore. Prospective population-based studies are needed to establish the true prevalence and risk factors associated with the development of this potentially life-threatening condition.
Anacardium ; Anaphylaxis ; Arachis ; Asia ; Asthma ; Child ; Cohort Studies ; Diagnosis ; Eczema ; Humans ; Nuts ; Peanut Hypersensitivity ; Prevalence ; Prospective Studies ; Retrospective Studies ; Rhinitis, Allergic ; Risk Factors ; Singapore ; Skin ; Trees

BACKGROUND: The predictive decision points for both peanut skin prick test (SPT) wheal size and serum IgE concentrations, in peanut-sensitized children, have not been evaluated in Singapore. OBJECTIVE: We aim to derive clinically useful predictive decision points to be used for risk stratification of oral food challenge (OFC) in peanut-sensitized patients. METHODS: Patients with a positive SPT to peanut, performed during a 4-year period between 2012 and 2016, were included in a retrospective chart review. The patients were assessed for their peanut allergy status based on a convincing clinical history. Their first SPT and serum IgE results done at presentation to our centre were used. RESULTS: There were 269 patients with a clinical diagnosis of peanut allergy based on recent immediate reaction to peanut and 59 patients whom were tolerating peanuts regularly. There were 251 patients sensitized to peanut, without prior known peanut exposure. A wheal size of ≥8 mm and a peanut-specific IgE of ≥6 kU/L each provided for a 95% positive predictive value of clinical reaction to peanuts; the larger the wheal size on SPT, the higher the probability. CONCLUSION: The cutoff values derived in this study can help clinicians in the risk assessment of OFC in peanut-sensitized patients. Prospective studies using OFCs for the diagnosis of peanut allergy are needed to confirm the diagnostic performance of these tests in predicting OFC outcomes.
Arachis ; Child ; Diagnosis ; Humans ; Immunoglobulin E ; Peanut Hypersensitivity ; Prospective Studies ; Retrospective Studies ; Risk Assessment ; Singapore ; Skin

Dystrophinopathy is the commonest form of muscular dystrophy and comprises clinically recognized forms, Duchenne dystrophy and Becker dystrophy. Mutations in the dystrophin gene which consist of large gene deletions (65%), duplications (5%) and point mutations (30%) are responsible for reducing the amount of functional dystrophin protein in skeletal muscle fi bres leading to fi bre destruction and disease. The aims of this study are to investigate the detection rate, types and distribution of large gene deletions in Malaysian dystrophinopathy patients using the multiplex polymerase chain reaction (MPCR). MPCR of 18 “hot-spot deletion” regions along the dystrophin gene was performed on DNA from 48 muscle biopsy-confi rmed cases of dystrophinopathy. A positive detection rate of 58% (28/48) was observed, where 84% (16/19) Indian, 35% (6/17) Chinese and 50% (6/12) Malay ethnic groups showed deletions in their dystrophin genes. The Malaysian Indians appear to have a higher prevalence for large gene deletions compared to the Chinese and Malays. Further analyses of 42 confi rmed positive cases (present 28 plus previous 14 cases) by MPCR showed the majority of deletions were in the mid-distal region of the dystrophin gene (81% in exons 45-60). The MPCR is a specifi c and sensitive method for confi rmation of gene deletions responsible for dystrophinopathy.

BACKGROUND: There has been an increasing trend of nut allergies in Singapore. OBJECTIVE: The aim of this study was to review the clinical characteristics of children with cashew nut allergy. METHODS: A retrospective analysis was conducted in a tertiary paediatric referral centre in Singapore from 2008 to 2015. A total of 99 subjects with positive specific IgE (≥0.35 IU/L) to cashew nut were identified. Clinical features including demographics, clinical reaction to cashew nut, associations with other nuts and test specific measurements were recorded. RESULTS: The results showed that cutaneous symptoms (71.2%) were the most common allergic manifestations. Anaphylaxis occurred in 3.8% of children. In addition, all cashew nut allergic subjects were cross-reactive (either sensitized or allergic) to pistachio. Cross-reactivity rate with peanuts was 53.8%. There was a strong prevalence of atopy among cashew nut allergic subjects. CONCLUSION: In conclusion, cashew nut allergy is a significant tree nut allergy in Singapore.
Anacardium ; Anaphylaxis ; Arachis ; Child ; Demography ; Humans ; Immunoglobulin E ; Nut Hypersensitivity ; Nuts ; Pistacia ; Prevalence ; Referral and Consultation ; Retrospective Studies ; Singapore

BACKGROUND: Although it is known that children with food allergies are at risk of impaired growth, this has not been well studied in South-East Asia. OBJECTIVE: The aim of this cross-sectional study is to survey the growth of children with food allergies in Singapore and the factors impacting it. METHODS: Anthropometric data, demographic data, type of food allergy, foods eliminated, and atopic comorbidities were recorded. Malnutrition was defined using World Health Organization standards (≤-2 z-score for weight-for-height [WH], weight-for-age [WA], and height-for-age [HA]).
Asia ; Child ; Comorbidity ; Cross-Sectional Studies ; Data Collection ; Diagnosis ; Eczema ; Food Hypersensitivity ; Growth Disorders ; Humans ; Hypersensitivity ; Immunoglobulin E ; Malnutrition ; Nutritionists ; Overweight ; Singapore ; Skin ; Thinness ; World Health Organization

INTRODUCTIONThis study aimed to determine compliance with noninvasive home ventilation in children with obstructive sleep apnoea and the factors affecting this compliance.

METHODSWe retrospectively reviewed 51 children who were prescribed noninvasive home ventilation for the management of obstructive sleep apnoea from 1 January 2000 until 31 May 2008. Noninvasive ventilation was started based on positive polysomnogram, i.e. obstructive apnoea hypopnea index ≥ 1/hr. Compliance was defined as the use of noninvasive ventilation ≥ 4 days/week.

RESULTSNoninvasive home ventilation was started at a median age of 11.5 years. In all, 21 (41.2 %) children were reported to be compliant with treatment. Univariate analysis revealed that the female gender (p = 0.017), presence of asthma (p = 0.023), presence of genetic syndromes (p = 0.023), use of bi-level ventilation versus continuous positive airway pressure (p = 0.027), and funding from the social work department (p = 0.049) were associated with compliance with noninvasive home ventilation. Logistic regression revealed the presence of asthma (p = 0.008) and female gender (p = 0.047) to be significantly associated with compliance with treatment. However, factors such as counselling prior to initiation of treatment, severity of obstructive sleep apnoea before initiation of treatment, obesity, use of humidification, and polysomnogram indices were not found to be associated with treatment compliance.

CONCLUSIONOnly 41.2% of the children in this study were reported to be compliant with noninvasive home ventilation. The female gender and the presence of asthma were associated with treatment compliance. Future research focusing on effective methods to improve compliance with noninvasive home ventilation in children should be undertaken.

Adolescent ; Asthma ; Child ; Child, Preschool ; Comorbidity ; Continuous Positive Airway Pressure ; Female ; Humans ; Infant ; Male ; Obesity ; complications ; Patient Compliance ; Polysomnography ; Regression Analysis ; Retrospective Studies ; Rhinitis, Allergic ; complications ; Sleep Apnea, Obstructive ; complications ; therapy

BACKGROUND: We have noticed changes in paediatric anaphylaxis triggers locally in Singapore. OBJECTIVE: We aimed to describe the demographic characteristics, clinical features, causative agents and management of children presenting with anaphylaxis. METHODS: This is a retrospective study of Singaporean children presenting with anaphylaxis between January 2005 and December 2009 to a tertiary paediatric hospital. RESULTS: One hundred and eight cases of anaphylaxis in 98 children were included. Food was the commonest trigger (63%), followed by drugs (30%), whilst 7% were idiopathic. Peanut was the top food trigger (19%), followed by egg (12%), shellfish (10%) and bird's nest (10%). Ibuprofen was the commonest cause of drug induced anaphylaxis (50%), followed by paracetamol (15%) and other nonsteroidal anti-inflammatory drugs (NSAIDs, 12%). The median age of presentation for all anaphylaxis cases was 7.9 years old (interquartile range 3.6 to 10.8 years), but food triggers occurred significantly earlier compared to drugs (median 4.9 years vs. 10.5 years, p < 0.05). Mucocutaneous (91%) and respiratory features (88%) were the principal presenting symptoms. Drug anaphylaxis was more likely to result in hypotension compared to food anaphylaxis (21.9% vs. 2.7%, Fisher's exact probability < 0.01). There were 4 reported cases (3.6%) of biphasic reaction occurring within 24 h of anaphylaxis. CONCLUSION: Food anaphylaxis patterns have changed over time in our study cohort of Singaporean children. Peanuts allergy, almost absent a decade ago, is currently the top food trigger, whilst seafood and bird's nest continue to be an important cause of food anaphylaxis locally. NSAIDs and paracetamol hypersensitivity are unique causes of drug induced anaphylaxis locally.
Acetaminophen ; Anaphylaxis ; Anti-Inflammatory Agents, Non-Steroidal ; Arachis ; Child ; Cohort Studies ; Drug Hypersensitivity ; Food Hypersensitivity ; Humans ; Hypersensitivity ; Hypotension ; Ibuprofen ; Ovum ; Retrospective Studies ; Seafood ; Shellfish ; Singapore

Sublingual immunotherapy has gained acceptance amongst the paediatric community as it is very well tolerated and is safe. The adverse effects of this therapy is minimal consisting mainly of local side effects within the oral cavity such as itching of the mouth, swelling of the lips and less frequently abdominal pain, wheezing and urticaria has been described. This report is to highlight another local side effect of sublingual immunotherapy which has been observed in 3 of our patients. This is pigmentation of the gums which can occur anytime during the course of the immunotherapy. It resolves on stopping the immunotherapy and is likely due to a local inflammatory process occurring in the gums of these children. There is no associated pain or itching with the pigmentation. It can persist as long as the child is on the immunotherapy.
Abdominal Pain ; Child ; Gingiva ; Humans ; Immunotherapy ; Lip ; Mouth ; Pigmentation ; Pruritus ; Respiratory Sounds ; Sublingual Immunotherapy ; Urticaria