1.Shellfish/crustacean oral allergy syndrome among national service pre-enlistees in Singapore
Bernard Yu Hor THONG ; Shalini ARULANANDAM ; Sze Chin TAN ; Teck Choon TAN ; Grace Yin Lai CHAN ; Justina Wei Lyn TAN ; Mark Chong Wei YEOW ; Chwee Ying TANG ; Jinfeng HOU ; Khai Pang LEONG
Asia Pacific Allergy 2018;8(2):e18-
BACKGROUND: All Singaporean males undergo medical screening prior to compulsory military service. A history of possible food allergy may require referral to a specialist Allergy clinic to ensure that special dietary needs can be taken into account during field training and deployment. OBJECTIVE: To study the pattern of food allergy among pre-enlistees who were referred to a specialist allergy clinic to work up suspected food allergy. METHODS: Retrospective study of all pre-enlistees registered in the Clinical Immunology/Allergy New Case Registry referred to the Allergy Clinic from 1 August 2015 to 31 May 2016 for suspected food allergy. RESULTS: One hundred twenty pre-enlistees reporting food allergy symptoms other than rash alone were referred to the Allergy Clinic during the study period. Of these, 77 (64.2%) had food allergy. Among those with food allergy, mean age was 19.1 ± 1.5 years. They comprised predominantly Chinese (66.2%) and Malays (20.8%). The most commonly reported foods were shellfish/crustaceans (78%), peanut (15.6%), and egg (6.5%). Self-limiting oral allergy syndrome, OAS (itchy lips and throat with/without lip angioedema) was the most common manifestation (n = 33, 42.9%) followed by anaphylaxis (n = 23, 29.9%). Majority of OAS was from shellfish/crustacean (90.6%); of which shrimp (30.3%), crab (15.2%), and lobster (3.0%) were the most common. Mild childhood asthma (69.7%), allergic rhinitis (6.3%), and eczema (6.1%) were the most common atopic conditions among individuals with shellfish/crustacean OAS. This pattern was similar for shellfish/crustacean anaphylaxis. Skin prick tests were most commonly positive for shrimp (OAS 87.1% vs. anaphylaxis 100%), crab (OAS 95.8% vs. 90.9%), and lobster (OAS 91.7% vs. 63.6%). CONCLUSION: OAS to shellfish/crustaceans was more common than anaphylaxis among this study population of young males referred for food allergy symptoms other than rash alone.
Anaphylaxis
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Arachis
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Asian Continental Ancestry Group
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Asthma
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Eczema
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Exanthema
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Food Hypersensitivity
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Humans
;
Hypersensitivity
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Lip
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Male
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Mass Screening
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Military Personnel
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Ovum
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Pharynx
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Referral and Consultation
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Retrospective Studies
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Rhinitis, Allergic
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Shellfish
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Singapore
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Skin
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Specialization
2.A retrospective study on sequential desensitization-rechallenge for antituberculosis drug allergy
Bernard Yu Hor THONG ; Faith Li Ann CHIA ; Sze Chin TAN ; Teck Choon TAN ; Khai Pang LEONG ; Justina Wei Lyn TAN ; Chwee Ying TANG ; Jin Feng HOU ; Grace Yin Lai CHAN ; Hiok Hee CHNG
Asia Pacific Allergy 2014;4(3):156-163
BACKGROUND: Antituberculosis (anti-TB) drug allergy often involves multiple concurrently administered drugs which subsequently need to be reinitiated as no better alternatives exist. OBJECTIVE: To describe the results of tailored sequential desensitization-rechallenge (D-R) for anti-TB drug allergy. METHODS: Consecutive patients who had undergone D-R to anti-TB drugs between 1 September 1997 and 31 January 2012 were recruited. Following resolution of the acute reaction, anti-TB drug was restarted at 1:6,000 to 1:3 of the final daily dose (FDD), with gradual single or multiple step daily dose escalation to the FDD. Subsequent drugs were sequentially added ≥3 days later when the preceding drug was tolerated. Full blood count and liver function tests were monitored prior to addition of each new drug. RESULTS: There were 11 patients of whom 10 were male, predominantly Chinese (8 patients). Regimens comprised at least 3 drugs: isoniazid (INH), rifampicin (RIF), ethambutol (EMB), pyrazinamide (PZA), or streptomycin. All patients had nonimmediate reactions, with cutaneous eruptions, where maculopapular exanthema (MPE) was the most common (8 patients). Drug-induced hypersensitivity syndrome (DIHS) occurred in 6 patients, and Stevens Johnson syndrome (SJS) in 2 patients. D-R to INH was successful in 7/9 patients (77.8%) and to RIF/EMB/PZA/streptomycin in all. Of the 2 patients who failed INH D-R, 1 developed fever and MPE on day 3, the other MPE on day 8. D-R with INH and RIF respectively was successful in 2 patients with SJS. Among DIHS patients, 1 failed D-R with INH (fever and MPE on day 3). There were 23/25 (92%) successful D-R among the 11 patients. All patients completed TB treatment of ≥5 months' duration with no cases of drug-resistant TB. CONCLUSION: Tailored sequential TB drug D-R is successful where no better alternative therapies are available, with careful dose escalation and close monitoring, and after a careful risk-benefit assessment.
Asian Continental Ancestry Group
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Complementary Therapies
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Drug Eruptions
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Drug Hypersensitivity Syndrome
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Drug Hypersensitivity
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Ethambutol
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Exanthema
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Fever
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Humans
;
Hypersensitivity
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Isoniazid
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Liver Function Tests
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Male
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Pyrazinamide
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Retrospective Studies
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Rifampin
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Risk Assessment
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Stevens-Johnson Syndrome
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Streptomycin