BACKGROUND

The Philippines has a wide variety of plant species with potential to produce allergenic pollen grains. Most of the study subjects which are residents in Manila tested positive to Fabaceae and Amaranthaceae. Weeds, especially the Amaranthaceae and Fabaceae families, are relevant triggers of allergy as they are highly adaptive and can grow despite adverse weather conditions. However, only a few allergens have been identified among these families and listed in the International Union of Immunological Societies allergen nomenclature database. Currently, local pollen grains are being processed at the Medical Research Laboratory of our institution to produce crude pollen extracts for use in specific diagnostic skin tests and in subcutaneous immunotherapy of patients with respiratory allergies all over the country. However, these extracts have not been characterized and data of cross-reactivity is limited.

OBJECTIVES

This study aimed to evaluate the IgE binding activity of allergen extracts from Philippine weeds and trees, and determine their cross-reactive components.

METHODS

Pollen extracts from Amaranthus spinosus (pigweed), Mimosa pudica (makahiya), Tridax procumbens (wild daisy), Albizia saman (acacia), Leucaena leucocephala (ipil-ipil), Mangifera indica (mango), and Cocos nucifera (coconut) were extracted and analyzed for crossreactivity using ELISA and Western blot. 

RESULTS

Cross-reaction was observed between ipil-ipil and coconut, and between makahiya and wild daisy. IgE bound to protein components at ~20, 18, and 15 kDa of the weeds, while for the trees, IgE bound to protein components at ~35 and ~15 kDa which may be responsible for the cross-inhibitions observed.

CONCLUSION

Data may contribute to the development of immunotherapeutic strategies and diagnostic applications for respiratory allergies, comprising the production of standardized panel of allergens thus eliminating unwanted side effects and providing patients with safer diagnosis and therapy.

Plants ; Pollen ; Allergens ; Amaranthus ; Arecaceae

BACKGROUND

Allergic respiratory diseases are prevalent in the Philippines, with allergic rhinitis and asthma occurring at 20% and 8.7% of the population, respectively. The diagnosis of respiratory allergies is achieved by a combination of patient history and different screening tools, especially for the identificati on of the allergic triggers such as allergy skin prick test (SPT) and serum-specific IgE enzyme-linked immunosorbent assays (sIgE ELISA). The Philippines, being a tropical country, have a wide variety of plant species with potential to produce allergenic pollen grains. Knowledge of the sensitization profiles of Filipino allergic patients to our local pollen allergens is currently limited.

OBJECTIVES

The aim of this study is to determine the sensitization profile of patients with respiratory allergies (allergic rhinitis and/or asthma) through the allergy skin prick test (SPT) using allergenic local pollen extracts. It also aimed to determine if there is a positive agreement between the SPT and sIgE ELISA positivity rate and whether the results have relationship with the pollen purity and the protein content of the extracts.

METHODS

Pollen allergens were extracted from Amaranthus spinosus (pigweed), Mimosa pudica (makahiya), Tridax procumbens (wild daisy), Imperata cylindrica (cogon), Oryza sativa (rice), Pennisetum polystachion (foxtail grass), Sorghum halepense (Johnson grass), Albizia saman (acacia), Cocos nucifera (coconut), Leucaena leucocephala (ipil-ipil), and Mangifera indica (mango). SPT was performed at the Allergy Clinic of the University of the Philippines-Philippine General Hospital on patients with allergic rhinitis and/or bronchial asthma. Blood samples were collected from patients who developed wheal diameters of 3 mm or more than the negative control. Sera were tested against the same pollen extracts using ELISA.

RESULTS

Of the one hundred sixty-five (165) patients who submitted for skin prick test, 129 showed positive SPT results to the pollen extracts. Weeds were the most sensitizing (51.9%-58.1%). Blood samples were collected from these patients and tested for sIgE ELISA and among them, 71 were positive in the sIgE ELISA. Highest sensitization rates in sIgE ELISA were found in coconut, pigweed, Johnson grass, and rice. The highest positive agreements or the proportion of patients with positive sIgE ELISA among those with positive SPT were in coconut, followed by Johnson grass, pigweed, and rice. Most of the pollen sensitized patients on SPT are polysensitized.

CONCLUSION

SPT is a safe, simple, and rapid method for the diagnosis of IgE-mediated allergy. The lower number of positive patients in sIgE ELISA may be attributed to the low serum IgE levels and low quantities of effectual allergen components in extracts. Results of both SPT and ELISA must be correlated with a patient's clinical history, particularly the patient’s exposures, and physical examination.

Pollen ; Rhinitis ; Asthma

Background: In response to the pandemic brought about by COVID-19, vaccines were developed immediately. Together with adhering to safety protocols, vaccines are needed to help decrease the mortality and morbidity. As with any other, COVID-19 vaccines are evaluated based on efficacy and safety. Real world data is important in the recommendation of vaccines. Objectives: This study aims to assess the short-term safety of BNT162b2 COVID-19 vaccines administered to Filipino adolescents from October 15, 2021 to December 15, 2021 at the Philippine General Hospital. The number and type of local and systemic reaction within 7 days of vaccination were determined. Methods: This is a retrospective cohort study. The review of the recorded events was done through an electronic diary that was accessed from the official Electronic Medical Records of University of the Philippines-Philippine General Hospital (UP-PGH). This included solicited and prespecified local and systemic reactions that occurred within 7 days of receipt of vaccine dose. Descriptive statistics was used to present the data. Results: Out of the 1,756 BNT162b2 vaccines administered (Dose 1- 890; Dose 2- 866), 13% (N=221) indicated having adverse reaction. Injection site pain was the overall most common reaction with majority (81%) experiencing it within 7 days of vaccination. Systemic reactions made up 60% of the reactions after Dose 1 and 85% of the reactions after Dose 2. This includes tiredness, headache and fever. None of the reactions required hospitalization or further workup. Conclusion BNT162b2 vaccine has a good safety profile among adolescents vaccinated at UP-PGH, since most of the reported adverse events within 7 days of vaccination were local and systemic reactogenic reactions that did not necessitate hospitalization or work-up. No serious adverse events were reported. Further follow-up is suggested to assess longer term safety.
COVID-19 Vaccines ; mRNA Vaccines

Objective: This pilot study investigated whether serum B-type Natriuretic Peptide (BNP), bioelectrical impedance analysis (BIA), and left ventricular end-diastolic diameter (LVEDD) can be used to predict fluid overload and clinical outcomes in pediatric sepsis. Methods: Pediatric sepsis patients were enrolled. BNP, BIA, and LVEDD were obtained on admission and on Day 3. Diagnostic performances of BNP, BIA, LVEDD and correlation with fluid status were obtained. Results: Twenty-two patients were enrolled. Day 3 BNP was higher in non-survivors (9241 vs. 682.2 pg/mL, p=0.04) and day 3 LVEDD Z-score was lower in non-survivors (-3.51 vs. -0.01, p=0.023). There was no difference in the fluid balance between survivors and non-survivors. Admission BNP >670.34pg/mL predicted vasopressor use with a sensitivity of 85.71% and specificity of 86.67% while ΔBNP>5388.13pg/mL predicted mortality with 100% sensitivity. Day 3 LVEDD <22mm predicted mortality with a sensitivity of 94.74%. Cumulative fluid balance was strongly correlated with BIA and LVEDD (r=0.65, p=0.001; r=0.74, p<0.001 respectively). The median length of stay in hospital days for non-survivors was not significantly different from survivors (4 [1-12] vs. 8 [6-12] days,p=0.21). Conclusion Rise in BNP levels appear to be independent of fluid status and is a good predictor of mortality, vasopressor, and mechanical ventilator use but not of length of hospital stay. LVEDD and BIA are good estimates of cumulative fluid balance but not as predictors of mortality, vasopressor, mechanical ventilator use, and length of hospital stay. Significance of the outcomes of the study was limited due to the small sample size.
Natriuretic Peptide, Brain ; Echocardiography

Background. Asthma is a complex disorder characterized by variable and recurring symptoms, airflow obstruction, bronchial hyperresponsiveness, and an underlying inflammation. Asthma is one of the most common chronic diseases in the world and its burden of disease is exceedingly high. According to current guidelines, the asthma action plan is a cornerstone in the management and control of asthma exacerbations. Written action plans are now recommended for all children with asthma as part of initial home management of acute wheezing episodes and exacerbations. Translating the written asthma action plan to Filipino and testing it for cultural content validity and reliability will make it useful on a wider scale in our country, help reduce morbidity, and improve asthma control in the Filipino pediatric population.

Objectives. To perform content and cultural validation and reliability testing of the Filipino Written Asthma Action Plan (FWAAP).

Methods. The Written Asthma Action Plan was translated to Filipino following conventional translational steps: 1) forward translation, 2) back translation, 3) pilot testing and validation, 4) final translated version. We conducted a cross-sectional study and administered the FWAAP during pilot testing among children and caregivers with asthma attending an asthma clinic.

Results. We included 31 patients. The participants considered the FWAAP to be relevant to their disease, understandable, concise and useful in the management of asthma. The tool was shown to be highly consistent (Cronbach's alpha coefficient = 0.9235 showing that the. Seigel and Castellan's Kappa (Inter-rater or Inter-observer consistency) showed inter-rater agreement of 0.9615 (kappa of 0.7787) and 0.923 (kappa of 0.8846) respectively showing adequate inter-rater agreement.

Conclusion. The Filipino asthma action plan is a reliable and valid tool for managing asthma in the home setting.

Asthma

Background. The increasing prevalence of autism has significantly impacted the health care spending of many families worldwide. To date, families from low to middle-income countries are burdened with out-of-pocket spending as their local health care systems have yet to incorporate autism-related services into the health care infrastructure.

Objectives. This study aimed to determine the direct costs of diagnosing and caring for children with autism and analyze its impact on the Filipino family.

Methods. The cross-sectional study consisted of a self-administered questionnaire that looked at parents' employment status, family income, and the direct costs for consultations, diagnostic tests, therapy, education, and medications. Study participants were parents living with their child diagnosed with autism, ages 2 to 6 years old at the time of the study.

Results. One hundred fifty-eight parents participated in the survey for the cost of care for children with autism. Sixty-seven (42.4%) of parents received government or subsidized medical services for their children's consultation and/ or intervention, while the rest went to private centers or hospitals. The total costs for all evaluations that confirmed the autism diagnosis ranged from ?1,356 to ?44,634 and averaged ?7,411.80 per child. Overall, the mean cost of interventions post-diagnosis, including therapy, education, medications, and developmental evaluations for the first year, was ?38,868 or ?3,239 per month (21% percent of the monthly expenditures for a household with an income of ?15,000/month). The total cost of care per child was closely related to the family's revenue in the sample population. Families with higher incomes also had higher expenditures for autism-related services.

Conclusion. Autism imposes a significant economic burden on Filipino families, particularly the minimum-wage household earners who spent a higher proportion of their budget (21%) on autism-related services. The wide range of total costs for the care of the children in the study may be explained by the wide variability of the expenses for the services, differences in access to services, socioeconomic status, and the wide variation in needs of children with autism due to the nature of the condition.

Autistic Disorder

Background: In response to the pandemic brought about by COVID-19, vaccines were developed immediately. Together with adhering to safety protocols, vaccines are needed to help decrease the mortality and morbidity. As with any other, COVID-19 vaccines are evaluated based on efficacy and safety. Real world data is important in the recommendation of vaccines. Objectives: This study aims to assess the short-term safety of BNT162b2 COVID-19 vaccines administered to Filipino adolescents from October 15, 2021 to December 15, 2021 at the Philippine General Hospital. The number and type of local and systemic reaction within 7 days of vaccination were determined. Methods: This is a retrospective cohort study. The review of the recorded events was done through an electronic diary that was accessed from the official Electronic Medical Records of University of the Philippines-Philippine General Hospital (UP-PGH). This included solicited and prespecified local and systemic reactions that occurred within 7 days of receipt of vaccine dose. Descriptive statistics was used to present the data. Results: Out of the 1,756 BNT162b2 vaccines administered (Dose 1- 890; Dose 2- 866), 13% (N=221) indicated having adverse reaction. Injection site pain was the overall most common reaction with majority (81%) experiencing it within 7 days of vaccination. Systemic reactions made up 60% of the reactions after Dose 1 and 85% of the reactions after Dose 2. This includes tiredness, headache and fever. None of the reactions required hospitalization or further workup. Conclusion BNT162b2 vaccine has a good safety profile among adolescents vaccinated at UP-PGH, since most of the reported adverse events within 7 days of vaccination were local and systemic reactogenic reactions that did not necessitate hospitalization or work-up. No serious adverse events were reported. Further follow-up is suggested to assess longer term safety.
COVID-19 Vaccines

Allergic diseases, such as asthma, allergic rhinitis, eczema, and food allergy, are preventable diseases. Primary prevention strategies of allergic diseases have been in scrutiny. Effective prevention strategies maybe started prenatally, postnatally, during infancy, and even during childhood. These guidelines have been prepared by the Philippine Society of Allergy, Asthma and Immunology and the Philippine Society for Pediatric Gastroenterology, Hepatology and Nutrition. They aim to provide evidence-based recommendations for the dietary primary prevention of allergic diseases in children. The primary audience of these guidelines is all healthcare practitioners who manage patients with potential allergic conditions. These guidelines are based on an exhaustive review of evidences, mostly systematic reviews, randomized controlled trials, and cohort studies. However, there are still many gaps in the evidence of dietary primary prevention of allergic diseases.
Allergy and Immunology ; Asthma ; Child ; Cohort Studies ; Delivery of Health Care ; Eczema ; Food Hypersensitivity ; Gastroenterology ; Humans ; Hypersensitivity ; Primary Prevention ; Rhinitis, Allergic

BACKGROUND: Grass pollen grains are important causes of respiratory allergies. The Philippines has a different grass flora compared to that of western countries, so pollen extracts have to be processed for use in the diagnosis and treatment of respiratory allergies. The local pollen extracts available in clinical practice have not yet been characterized, which is important in improving extract quality.
OBJECTIVE: This study aims to perform physicochemical characterization through protein content determination and gradient sodium-dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) of extracts from four grasses: Cynodon dactylon (bermuda grass), Axonopus compressus (carabao grass), Imperata cylindrica (cogon), and Saccharum spontaneum (talahib) and immunologic characterization by identifying its IgE-binding component through immunoblot.
METHODS: This is a descriptive study. The pollen grains were processed into allergen extracts and protein contents were determined. The extracts were separated by gradient SDS-PAGE and subjected to immunoblotting. Bands were visualized using Fluorchem C2 aided with Alpha View Software.
RESULTS: Total protein in the pollen extracts ranged from 281.3-968.61 µg/ml. Protein bands of bermuda were in the 14.4-66.3 kDa range, carabao grass at 3.5-66.3 kDa, cogon at 3.5-200 kDA, and talahib at 21.5-66.3 kDa. A single IgE-binding protein band was seen on immunoblot at 55.4 kDa using a single serum sample.
CONCLUSION: Protein contents of the allergen extracts vary. The molecular weights of the different protein bands seem to correspond to known groups of grass pollen allergens. There was only one IgE-binding protein band seen on preliminary immunoblot.

Allergens ; Bermuda ; Cynodon ; Electrophoresis, Polyacrylamide Gel ; Galectin 3 ; Immunoblotting ; Immunoglobulin E ; Molecular Weight ; Philippines ; Poaceae ; Pollen ; Respiratory Hypersensitivity ; Saccharum ; Sodium ; Sodium Dodecyl Sulfate

BACKGROUND: Prevalence surveys are important to aid in assessing the current burden of diseases, which will impact on the public health agenda as well as preventive interventions and health policies. Three previous local surveys on asthma prevalence of Filipino adults have been carried out. This is the fourth local survey and is also a part of the second NNHeS study, which is carried out every five years. The purpose of the survey is to determine the trend in asthma prevalence and to aid in formulating and evaluating local initiatives.
OBJECTIVE: To determine the prevalence of asthma among Filipino adults
METHODOLOGY: Using a multi-staged cluster sampling methodology, this study evaluated 7,202 adults at least 20 years old, from 3,744 households, 79 provinces and 17 regions. A pre-validated written questionnaire for wheezing among children based on the International Study of Asthma and Allergies of Childhood (ISAAC) was used as the survey instrument. This instrument was adopted since it has been widely used as a case definition for asthma, which allows for comparison of prevalence outcomes across time and population.
RESULTS: The overall prevalence of asthma based on wheezing for the past 12 months was 8.7% (SE 0.4%). Males had a higher prevalence of wheezing for the past 12 months at 9.4% (SE 0.5%) compared to females at 8.2% (SE 0.5%). The overall prevalence of asthma based on wheezing at any time was 14.3% (SE 0.5%). Males had a higher prevalence of wheezing at any time of 14.8% (SE 0.7%) compared to females at 13.8% (SE 0.6%). The prevalence of adult asthma in the rural area was slightly higher than in the urban area (15.3% vs 13.3%), but the difference was not statistically significant.
CONCLUSION: The overall prevalence of adult asthma in the Philippine based on the second NHHeS is 8.7%. This figure is lower than previous reported local prevalence data. The prevalence of adult asthma in the rural and urban setting is almost similar.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Young Adult ; Asthma ; Characteristics ; Health Policy ; Hypersensitivity ; Philippines ; Prevalence ; Public Health ; Respiratory Sounds