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CURRICULUM VITAE
Name : Sumadiono, dr SpA(K)Place/date of birth : Nganjuk, 9-10-1956Occupation : Staff of Pediatric Dept.UGM Yogyakarta
Educations :General Doctor : Fac. Of Medicine Unair, Surabaya, 1982Pediatrician : Fac of Medicine UGM, Yogyakarta 1994Allergy 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
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The Epidemiology and Aproach
to Management of Food Allergy
in Indonesia
SumadionoIndonesian Pediatric Allergy Immunology
Working Group
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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
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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
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Allergy Prevalence:is tend to increase
6,9%
9,0%
4,9%
8,9%
14,2%
3,9%
13,9%
12,3%
24,6%
0%
5%
10%
15%
20%
25%
Jakarta Pusat (1990) ISAAC Jakarta Timur
(2001)
EAAEL Jakarta (2006)
Asma Rinitis alergi Dermatitis atopiAsthma Allergic Rhinitis Atopic Dermatitis
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Characteristic of Allergic Diseases
In Children in Yogyakarta
N: 447
33.8%
17.3%
9.1%
AR DAAllergic
Rhinitis
Atopic
dermatitis
• Sumadiono (2014) Paper presented at APAPARI conference, Yogyakarta
Asthma
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Exclusive breastfeeding is very important
67%61%
52%
32%19%
13%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1st mo 2nd mo 3rd mo 4th mo 5th mo 6th mo
No breastfeeding Mostly breastfeeding
Partial breastfeeding Exclusive breastfeeding
Exclusive breast feeding
Mostly breast feeding
No breast feeding
Partially breast feeding
with increasing the age of the baby
Exclusive breast feeding was tend to decrease
Risk of allergy will be increase in the future(Zakiudin, 2012)
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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%)
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Prevalence of Food Allergy in Children
Age below than 3 Years in Jakarta
286 children 30 % had Food Allergy
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FOOD HYPERSENSITIVTY IN PRESCHOOL
AND SCHOOL AGE CHILDREN
Sumadiono, Satria CD, Parantri A, Rossi WU.
Department of Childhealth, Faculty of Medicine,
Universitas Gadjah Mada Yogyakarta Indonesia
Allergic Rhinitis 29.25%
Asthma 4.26%
Atopic Dermatits 1.06%)
2014
Diseases in Food Sensitivity
in Preschool & School Children
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FOOD HYPERSENSITIVTY IN PRESCHOOL
AND SCHOOL AGE CHILDREN
Sumadiono, Satria CD, Parantri A, Rossi WU.
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%).
2014
Allergens of Food Sensitivity
in Preschool & School Children
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(Sumadio, Satria, Riana. 2015),
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.
Proportion of crab allergen sensitization
on the incidence of allergic diseases in children
0
5
10
15
Allergic rhinitis Asthma Atopic dermatitis
13
4 4
Crabs
The most common clinical manifestation of crab allergen
sensitization was allergic rhinitis
(Sumadio, Satria, Riana. 2015),
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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)
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RECOMMENDATIONIndonesia Pediatric Society
DIAGNOSIS AND MANAGEMENTOF COW’S MILK PROTEIN
ALLERGY
Allergy Immunology Working GroupGastrohepatology Working GroupNutrition and Metabolic Diseases
Working Group
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Exclusive Breast Feeding Group
The mother continue to breast feeding
and Avoid Cows Milk Protein (6 month)
Indonesian CMA Management
Recommendation
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
2013/2014
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Study Population Prevalence (%)
Soy sensitization Soy allergy
Western countries
United States6 CMA 59.4 14
Finland8 CMA 20 10
Finland9 CMA 31 0
Asian countries
Japan13 National survey ND 1.4
Food allergy ND 11
Japan11 Food allergy 20 ND
Thailand12 CMA ND 17
Munasir Z et al CMA 17,5% 4%
Studies on soy protein sensitization and allergy
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Indonesia data
The safety of a soy-based infant formula in infants with suggestive CMPA
Post Marketing Observational Study, 2011-2012
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Symptoms of CMPA
Post Marketing Observational Study, 2011-2012
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Results – symptoms resolution
Dermatology
Gastrointestinal
Respiratory
94.5
97.7
87.6
Resolution of CMPA-suggestive symptoms during observation period (%)
Post Marketing Observational Study 2011-2012
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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
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RECOMMENDATIONIndonesia Paediatric Society
PIMARY PREVENTION OF ALLERGY
Allergy Immunology Working GroupWorking Group
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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
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PIMARY PREVENTION OF ALLERGY
Risk
Yes
Pregnancy
Baby
No diet retriction
No contact to smoke
Brestfeeding
Extensively Brestfeeding
Solid food
Environtment No contact to smoke
If no brestfeeding
Hydrolyze Formula
Start at 4-6 months
No solid food retriction
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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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Thank
You