Infections and Food Allergy in Africa

Daniel Boakye Noguchi Memorial Institute for Medical Research

Food allergy in Africa

Studies and published information on food allergies are almost non-existent Most of the information come from developed countries even those for developing countries

Hygiene Hypothesis and rationale

Is food allergy less prevalent in developing countries?
it is well-accepted that lifestyle-related factors (hygiene, diet, pollution, infections, sedentariness) influence the prevalence of hay fever and asthma

The developing countries are in most cases at a stage where developed countries were some years back relative to allergic disorders
offer an opportunity to understand the underlying mechanisms of allergic disorders

EuroPrevall / Glofal studies in African countries

Study Area Rural Urban

Children from 8 rural and 6 urban schools from Southern Ghana

EuroPrevall / Glofal studies

Prevalence and intensity of parasitic infections Questionnaires (adapted to local situation)
Do your child have any adverse food reaction? Which food causes an adverse reaction?

SPT with house dust mite, cockroach, peanut, and some additional locally important foods (Fresh local foods mango, orange, papaya, pineapple, banana & apple by prick to prick ) IgE serology for house dust mite, cockroach and peanut plus some additional locally important foods extract

Study Population

Schoolchildren (2287) aged between 5 and 16 years for whom informed consents was received from parents.

Infections

Prevalence and intensity of infections

Infection rural urban public urban private All n(%) Malaria Infection (N=1965)) n(%) n(%) n(%)

439(39.0%) Intensity, (N=1948) + ++ +++ Helminth Infection Any Helminth Any Geohelminth Hookworm Trichuris Ascaris S.haematobium Intensity - Median(IQR) Hookworm Trichuris Ascaris S.haematobium 280(120-760) 200(80-610) 2040(500-8740) 24(7-78) 451(40.3%) 324(28.3%) 199(17.4%) 26(2.3%) 121(10.6%) 201(16.2%) 250(22.5%) 124(11.1%) 48(4.3%)

34(7.3%)

14(3.8%)

487(24.8%)

20(4.3%) 7(1.5%) 4(0.95)

9(2.4%) 3(0.8%) 1(0.35)

279(14.3%) 134(6.9%) 53(2.75)

51(9.9%) 31(6.0%) 6(1.2%) 15(2.95) 13(2.5%) 21(3.9%)

4(1.1%) 2(0.6%) 1(0.3%) 1(0.3%) 0(0.0%) 2(0.5%)

506(25.5%) 357(17.7%) 206(10.25) 42(2.1%) 134(6.6%) 224(10.3%)

600(340-1750) 240(160-360) 1000(500-3540) 11(2-27)

80(80-80) 120(120-120) 0(0-0) 38(4-72)

280(120-760) 240(110-440) 1960(510-8350) 21.5(7-71,5)

Results

SPT- 1695 Subjects tested

Prevalence of SPT Positives
2.5

%w ith inc a te g o ry

2.0 1.5 1.0 0.5 0.0

R ural U rban Public U rban Priv ate T otal

M an go B an an a P ap ay a O ra ng e P in ea pp le

Food Type

Pineapple and peanut are the most frequent SPT positives across area categories though Mango is just as high in the Urban public children.

A pp le P ea nu t

F oo d co nsum ption patterns am o ng our rural and urb an stud y p articip ants.
F oo d Ru ral N. ST APLES Rice No Yes Corn No Yes PRO T EINS Ch icken No Yes F ish No Yes Eg gs No Yes G rou nd n ut daily No Yes CO O KING O IL S In du strial O il No Yes Ho m em ade Palm o il No Yes (%) N. Area Urb an (%) P value

Results

238 287 44 481

45.33 54.67 8.38 91.62

355 407 661 101

46.59 53.41 86.75 13.25

0.657

0.000

449 76 17 508 456 69 347 180

85.52 14.48 3.24 96.76 86.86 13.14 33.24 73.17

696 66 154 608 587 175 697 66

91.34 8.66 20.21 79.79 77.03 22.97 66.76 26.83

0.001

0.000

0.000

0.000

317 208 185 340

60.38 39.62 35.24 64.76

431 331 594 168

56.56 43.44 77.95 22.05

0.172

0.000

With the exception of rice and industrially prepared oils, there are urban rural differences in food consumption.

Results

Reported Adverse Reactions

FOOD ITEM Pineapple Kontomire Beans Cassava* Groundnut Okro Other foods TOTAL No. 16 13 18 13 9 8 53 130 % 12.3 10.0 13.8 10.0 6.9 6.2 40.8 100
Pineapple and Beans topped the adverse reaction prevalence list. Followed by Kontomire ( a Spinach-like vegetable) and Cassava. Adverse reactions does not discriminate between allergy, intolerance and other food associated reactions.

So which of these reported reactions are due to food allergy? -Time of reaction after consumption? -Type of reaction?

Symptoms with ingestion of foods

Did illness associated with eating food include any of the following: Number Itching, tingling or swelling in the mouth, lips or throat 42 73 Diarrhoea or vomiting (other than food poisoning) Headaches 23 Runny or stuffy nose 16 18 A rash, nettle sting-like rash or itchy skin Breathlessness 10 Red, sore or running eyes 11 Difficulty swallowing 11 9 Stiffness in joints Fainting or dizziness 4 TOTAL NUMBER OF REPORTED SYMPTOMS 217

Results

As a Percentage % of all reported symptoms 19.35 33.64 10.6 7.37 8.29 4.61 5.07 5.07 4.15 1.84 100

The most frequent symptoms associated with food consumption are Primarily vomiting and diarrhoea Followed by Itching, tingling or swelling in the mouth, lips and throat Foods reported to cause reactions within minutes are the same ones most prevalent for any adverse reaction

Results

Symptoms with ingestion of foods

Pineapple and Kontomire are responsible for itching, tingling and swelling in mouth and throat
Foods associated w ith vom iting or diarrhoea in m inutes
70 60 % all food 50 40 30 20 10 0 Cassav a Beans Food Pineapple Other foods

Food associated w ith reported itching in m inutes

45 40 35 30 25 20 15 10 5 0 Pineapple Kontomire Groundnut Other foods Food

% all food

While cassava and beans are responsible for vomiting and diarrhoea symptoms.

Results

Nested matched case-control

Characteristics of Case Control Studies Controls Cases Total 168 104 11.5 11.6 85 50.6 84 50 46 27.4 38 22.6 54 52.4 54 51.4 26 24.8 25 23.8 No. Mean Age Sex Female % rural % urban public % urban private % 272 11.6 139 51.3 138 50.5 72 26.4 63 23.1

All 105 food SPT positives are cases who are age, sex and school matched with two controls for each of the food types

Results

Food reactions in cases and controls

ID_NO DY203 GP023 GP061 GP074 GR152 GR285 IP245 NB062 NB090
% Reported food react

Foods reported to Cause Reaction CASES Fruits eg.Banana, Orange Potato, Fresh fruit, Herrings Mango Gari (dried cassava), Rice porridge Pineapple, Banana Pineapple Groundnut, oily foods, Pineapple Pawpaw and pineapple Pineapple CONTROLS Okro soup and kenkey* Okro soup, stew, gari Soybeans Okro No Food Listed? Fresh fish Rice Konkonte and pork

Reaction time within: Minutes Hours Hours Minutes Minutes Minutes Hours Minutes Minutes
25 20 15 10 5 0

Reported food reaction

cases

controls

AB133 AB147 AN033 DY062 GP001 GP031 GP065 TP073 TP076 TP080 TP086

Cassava cooked food b, Pineapple Egg, Nutmeg Sweet Porridge **

Hours Minutes Hours Minutes Hours Hours Hours Minutes Minutes Minutes Minutes

!!! Limited Data Cases have double the proportion of reported food reactions than controls 5 out of 10 cases are SPT reactive to the same reported food causing reaction, 4 of whom are also IgE sensitised

IgE Sensitised SPT positive to food causing adverse reaction

mango
100 10
100 10

peanut

IgE (kU/L)

1 0.1 0.01
SP T+ SP T-

IgE (kU/L)

1 0.1 0.01
SP T+ SP T-

orange
100 10 100 10

banana

IgE (kU/L)

1 0.1 0.01
SP TSP T+

IgE (kU/L)

1 0.1 0.01
SP T+ SP T-

pineapple
100 10 100 10

apple

IgE (kU/L)

1 0.1 0.01
SP TSP T+

IgE (kU/L)

1 0.1 0.01

pawpaw

100 10

IgE (kU/L)

1 0.1 0.01
SP T+ SP T-

SP T+

SP T-

Matched case-control study

Although there is currently limited data for those with IgE sensitisation information and questionnaires, cases appear to have double the proportion of reporting adverse reactions to foods. There was also a statistically significant correlation between increasing units of specific IgE and risk of being a case. With the exception of apple, cases show at least 70% prevalence of specific IgE sensitisation in all food categories.

Further studies and future

Need for DBPCFC Analysis of data to determine the role of infections (prevalence and intensity) Complete epidemiological surveys (support needed) Need to know the prevalence of food allergies in Ghanaian immigrant populations What is the prevalence of sensitivity to imported tropical foods such as pineapple in Europe Development of a setup for allergy testing services as a practical follow up of EU research

Collaborators
NMIMR
Abena Amoah, Benedicta Obeng

Korle-Bu Teaching Hospital

Dr Audrey Forson

LUMC
Prof. Maria Yazdanbakhsh & team

University of Amsterdam
Dr Ronald van Ree

IFR
Clare Mills

THANK YOU

GHANA TEAM