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Nov 11

Allergy to house dust mites
House dust mites are the most common cause of asthma, allergic rhinitis and sometimes eczema. In Malaysia, house dust mites are found in all localities surveyed with 80% homes containing several species of mite in high numbers. In one Malaysian study, millions of mites were found multiplying in the mattresses of most homes throughout the country. The two most prominent house dust mites found locally are Blomia tropicalis and Dermatophagoides pteronyssinus. These two species have unique allergens that do not cross-react and should preferably be tested separately in a patient suspected of house dust mite allergy. About 85% of patients allergic to dust mites react to both species but the other 15% react to one or the other species.

Dust mites feed mainly on skin scales (derived from humans or mammalian pets), fungi, hair/fur and body fragments of dead insects. The life span of the adult mite is about 2 to 3 months and during this period it will lay about 50 eggs per month. These eggs hatch and mature in about twenty-five days in the tropics. The major allergen of the house dust mite is derived from the fecal pellets (each dust mite defecates about 50 pellets daily) and dead dust mite parts. The fecal pellets are about 20 microns in size and can reach the upper airways of people breathing them. Fecal allergens contain enzymes that allow the allergen to penetrate mucosal surfaces rapidly and cause immune allergic sensitization.

Exposure to high levels of house dust mite allergens during infancy increases the risk of allergic sensitization and the development of asthma in later life. In Malaysia about 90% of children with asthma or allergic rhinitis are positive for house dust mites. In adults with asthma the prevalence rate of mite sensitization is close to 70%. Many adults with non-specific chronic cough are often positive to house dust mite allergens. Many patients with eczema also react to house dust mites. All patients with asthma or allergic rhinitis should undergo allergy tests for house dust mites to identify the causal factors for long term management of their clinical symptoms. Many studies have emphatically demonstrated that reduction of exposure to the mites in the home environment significantly lead to the improvement of allergic symptoms. One company in Malaysia has experience in home management of house dust mites. They also supply allergy products (mattress/pillow allergicovers, anti-dust mite sprays and air-filters.)

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Nov 09

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Can totally breast fed babies develop severe allergy symptoms?
In a family with a history of allergy special care is needed to avoid allergens during pregnancy and also during the early development of the baby. Even babies who are totally breast fed can develop allergic reactions. Food allergens in the mother’s diet can appear in her breast milk within 2 to 6 hours. Even aeroallergens such as pollen allergens and house dust mite allergens that the mother is exposed to can appear in the breast milk. The allergens in the breast milk can sensitize the baby or provoke symptoms in babies who are already sensitized. Allergy symptoms can develop in predisposed infants continuously exposed to food allergens or aeroallergens in breast milk.

Previously, several allergy symptoms including regurgitation, vomiting, colic, diarrhoea, and eczema have been reported in breast feed infants. Elimination of the offending food allergens from the mother’s diet corrected the symptoms in the babies. In Malaysia we have found allergic skin reaction in exclusively breast fed infants. We tested the infant’s blood for specific IgE antibodies to common foods in the mother’s diet. We have found IgE-mediated response to cows milk, eggs, and wheat in different infants. In one infant with severe allergic disorder of skin the IgE antibody response in the baby was directed to many allergens in the mother’s diet. Thus parents need to be aware of the possibility of allergy symptoms developing in their infant via the breast milk particularly in families with a history of allergy. We recommend that special dietary precautions be taken during lactation for mothers of high-risk families.

In North Europe many parents with history of allergy plan their babies so that the later part of the pregnancy and early lactation falls outside spring and early summer when the air pollen counts are high to reduce exposure to pollen allergens.

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Nov 07

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What is the alternative to breast feeding?
If possible the babies should be breast fed. However there are many mothers for one or other reasons cannot breast feed their babies. There is wide range of cows milk formulas’ available. Until recently there was not much difference between these cows milk formulas. Nowadays various components are added, for instance essential fatty acids, healthy bacteria and vitamins to competitively market these foods. Nonetheless, since cow’s milk, a highly allergenic food, is the first foreign protein given in large quantities to the newborn baby, it is not surprising to find cows milk is the major cause of milk allergy in about 10% of the infants.

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Recently, a new infant formula containing partially hydrolyzed cows milk whey formula (Nan HA) has been introduced. The highly allergenic proteins in the cows milk have been treated enzymatically to make them less allergenic. Over 20 research studies throughout the world including Singapore, demonstrates that this hypoallergenic formula significantly reduces the development of allergy. The use of partially hydrolyzed whey formula in infants for the first four to six months of life significant reduced the manifestations of allergic diseases for 5 to 10 years. In a study performed in Singapore a significant reduction in atopic disorders at 12, 24, 36 and 60 months was found in infants who were on partially-hydrolyzed hypoallergenic milk formula for 4 months. These observations suggest long term benefits detectable way past the period of direct intervention with the partially hydrolyzed milk formula. Some studies have suggested that partially hydrolyzed cows milk formula should be preferentially introduced for at least 4 months to all babies if the infant’s mother opts not to breast feed.

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