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FOOD ALLERGIES and HYPERSENSITIVITIES AMONG CHILDREN in SOUTH KARELIA Occurrence, Inheritance and Seasonality

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FOOD ALLERGIES and HYPERSENSITIVITIES AMONG CHILDREN in SOUTH KARELIA Occurrence, Inheritance and Seasonality D 1090 OULU 2011 D 1090 UNIVERSITY OF OULU P.O.B. 7500 FI-90014 UNIVERSITY OF OULU FINLAND ACTA UNIVERSITATIS OULUENSIS ACTA UNIVERSITATIS OULUENSIS ACTA SERIES EDITORS DMEDICA Kaisa Pyrhönen ASCIENTIAE RERUM NATURALIUM Kaisa Pyrhönen Senior Assistant Jorma Arhippainen FOOD ALLERGIES AND BHUMANIORA HYPERSENSITIVITIES Lecturer Santeri Palviainen CTECHNICA AMONG CHILDREN Professor Hannu Heusala IN SOUTH KARELIA DMEDICA Professor Olli Vuolteenaho OCCURRENCE, INHERITANCE AND SEASONALITY ESCIENTIAE RERUM SOCIALIUM Senior Researcher Eila Estola FSCRIPTA ACADEMICA Director Leila Risteli GOECONOMICA Professor Jari Juga EDITOR IN CHIEF Professor Olli Vuolteenaho PUBLICATIONS EDITOR Publications Editor Kirsti Nurkkala UNIVERSITY OF OULU, FACULTY OF MEDICINE, INSTITUTE OF HEALTH SCIENCES, FACULTY OF SCIENCE, DEPARTMENT OF MATHEMATICAL SCIENCES; ISBN 978-951-42-9394-8 (Paperback) TAMPERE UNIVERSITY HOSPITAL, DEPARTMENT OF PEDIATRICS, PAEDIATRIC RESEARCH CENTRE; ISBN 978-951-42-9395-5 (PDF) SOUTH KARELIA DISTRICT OF SOCIAL AND HEALTH SERVICES; ISSN 0355-3221 (Print) OULU UNIVERSITY HOSPITAL, UNIT OF GENERAL PRACTICE ISSN 1796-2234 (Online) ACTA UNIVERSITATIS OULUENSIS D Medica 1090 KAISA PYRHÖNEN FOOD ALLERGIES AND HYPERSENSITIVITIES AMONG CHILDREN IN SOUTH KARELIA Occurrence, inheritance and seasonality Academic dissertation to be presented with the assent of the Faculty of Medicine of the University of Oulu for public defence in the Auditorium of Kastelli Research Centre (Aapistie 1), on 15 April 2011, at 12 noon UNIVERSITY OF OULU, OULU 2011 Copyright © 2011 Acta Univ. Oul. D 1090, 2011 Supervised by Professor Esa Läärä Professor Simo Näyhä Docent Minna Kaila Reviewed by Professor Markku Koskenvuo Docent Erkka Valovirta ISBN 978-951-42-9394-8 (Paperback) ISBN 978-951-42-9395-5 (PDF) http://herkules.oulu.fi/isbn9789514293955/ ISSN 0355-3221 (Printed) ISSN 1796-2234 (Online) http://herkules.oulu.fi/issn03553221/ Cover Design Raimo Ahonen JUVENES PRINT TAMPERE 2011 Pyrhönen, Kaisa, Food allergies and hypersensitivities among children in South Karelia. Occurrence, inheritance and seasonality University of Oulu, Faculty of Medicine, Institute of Health Sciences, P.O. Box 5000, FI-90014 University of Oulu, Finland; University of Oulu, Faculty of Science, Department of Mathematical Sciences, P.O. Box 3000, FI-90014 University of Oulu, Finland; Tampere University Hospital, Department of Pediatrics, Paediatric Research Centre, Medical School Building Finn-Medi 3 , FI-33014 University of Tampere; South Karelia District of Social and Health Services, P.O. Box 24 , FI-53101 Lappeenranta; Oulu University Hospital, Unit of General Practice, P.O. Box 5000 , FI-90014 University of Oulu Acta Univ. Oul. D 1090, 2011 Oulu, Finland Abstract The aim of the South Karelian Allergy Research Project (SKARP) was to quantify the occurrence of children’s food allergy and food-associated hypersensitivity symptoms and their associated factors. The study population comprised all children born between April 2001 and March 2006 and living in the province of South Karelia, in the south-eastern part of Finland. The questionnaire survey was conducted in co-operation with the child health clinics in the area in 2005–2006. Concurrently with but independently of the questionnaire study, the results of allergy tests regarding the same child population were collected from patient records. The participation rates in the questionnaire study were 54% (644/1194) among the newborn infants and 69% (3308/4779) among the children aged 1 to 4 years. The lifetime prevalence of parent-reported food allergies was 9% and that of parent-perceived food-associated hypersensitivity symptoms 21% by the age of 4 years. In addition, another 19% of children adhered to an elimination diet without previous symptoms associated with any food items. The prevalence of children with such diets decreased by age. Up to the age of 4 years, 19% of the participants had undergone a food allergy test and 8% of the participants had obtained a positive result in these tests. Physician-diagnosed food allergies and food allergies based on the tests were more common for milk, egg and cereals than for other food items. The tested children and those with a positive test result were only slightly overrepresented among the participants. Allergic manifestations in either biological parent doubled and in both biological parents tripled the incidence of a positive food allergy test. The spring season coinciding with the end of the first trimester of pregnancy predicted sensitisation to food items in the children. In early childhood, food allergies and food hypersensitivities were found to be common in a child population. New population-based knowledge regarding the inheritance of these conditions was obtained. Additionally, an association was observed between the timing of the 11th gestational week in spring and the sensitisation to food items, the detailed reasons and immunological mechanisms of which must be confirmed in further studies. Keywords: child, cohort, diagnostic test, epidemiology, food allergy, food hypersensitivity, heredity, participation rate, population, seasonal, the SKARP Pyrhönen, Kaisa, Ruoka-allergiat ja yliherkkyydet lapsilla Etelä-Karjalassa. Esiintyvyys, periytyvyys ja vuodenaikaisuus Oulun yliopisto, Lääketieteellinen tiedekunta, Terveystieteiden laitos, PL 5000, 90014 Oulun yliopisto; Oulun yliopisto, Luonnontieteellinen tiedekunta, Matemaattisten tieteiden laitos, PL 3000, 90014 Oulun yliopisto; Tampereen yliopistollinen sairaala, Lastentautien vastuualue, Lastentautien tutkimuskeskus, Lääketieteen laitos, Finn-Medi 3, 33014 Tampereen yliopisto; Etelä-Karjalan sosiaali- ja terveyspiiri, PL 24, 53101 Lappeenranta; Oulun yliopistollinen sairaala, Yleislääketieteen yksikkö, PL 5000, 90014 Oulun yliopisto Acta Univ. Oul. D 1090, 2011 Oulu Tiivistelmä Etelä-Karjalan allergiatutkimus (EKAT) käynnistettiin selvittämään lasten ruoka-allergioiden ja ruokayliherkkyysoireiden esiintyvyyttä ja niihin liittyviä tekijöitä. Tutkimusväestöön kuuluivat kaikki ne Etelä-Karjalan maakunnan alueella asuvat lapset, jotka olivat syntyneet huhtikuun 2001 ja maaliskuun 2006 välisenä aikana. Kyselyaineisto kerättiin yhteistyössä alueen neuvoloi- den kanssa vuosina 2005–2006. Kyselytutkimuksen kanssa samanaikaisesti mutta siitä riippu- mattomasti kerättiin samaa lapsiväestöä koskevat allergiatestitulokset alueen potilasrekistereistä. Kyselytutkimuksen osallistumisaste oli vastasyntyneiden ikäluokassa 54 % (644/1194) ja isommilla lapsilla 69 % (3308/4779). Kolmannen ikävuoden loppuun mennessä vanhemmat ilmoittivat 9 %:lla lapsista todetun ruoka-allergiaa ja lisäksi 21 %:lla ruokayliherkkyys perustui ainoastaan vanhempien havaintoihin. Näiden lisäksi 19 % lapsista vältti yhtä tai useampaa ruo- ka-ainetta ilman, että minkään ruoka-aineen olisi todettu aiheuttaneen oireita. Dieettien noudat- tajien osuus väheni selvästi tarkasteltaessa ikäluokkia yksivuotiaista neljävuotiaisiin. Kolmannen ikävuoden loppuun mennessä ruoka-allergiatestattuja oli 19 % ja positiivisen testituloksen saa- neita 8 % tutkimukseen osallistuneista. Lääkärin toteamat ja testeihin perustuneet ruoka-allergi- at olivat tavallisempia maidolle, kananmunalle ja viljoille kuin muille ruoka-aineille. Aller- giatestatuilla ja positiivisen testituloksen saaneilla oli vain lievä yliedustus kyselytutkimukseen osallistujien joukossa verrattuna kyselyyn vastaamattomiin. Allergiset sairaudet toisella biologi- sella vanhemmalla kaksinkertaistivat ja molemmilla vanhemmilla kolminkertaistivat positiivi- sen ruoka-allergiatestin ilmaantuvuuden. Raskauden ensimmäisen kolmanneksen lopun ajoittu- minen kevääseen ennakoi syntyvän lapsen herkistymistä ruoka-aineille. Varhaislapsuuden ruoka-allergioiden ja -yliherkkyyksien todettiin olevan tavallisia väestös- sä. Näiden sairauksien periytyvyydestä saatiin uutta väestötietoa. Lisäksi havaittiin yhteys 11. raskausviikon ajoittumisen kevääseen ja ruoka-aineille herkistymisen välillä. Yhteyden yksityis- kohtaiset syytekijät ja immunologiset mekanismit täytyy ehdottomasti vahvistaa jatkotutkimuk- sin. Asiasanat: diagnostinen testi, EKAT, epidemiologinen, kohortti, lasten, osallistumisaste, periytyvyys, ruoka-allergia, ruokayliherkkyys, vuodenaika, väestö To all children and their families living in the province of South Karelia, Finland 8 Acknowledgements In April 2002, Emeritus Professor of Dermatology Matti Hannuksela gave me the idea to design a questionnaire for parents regarding food allergies in their children. I promptly began developing the first questionnaire and the study plan. I am extremely grateful to Professor Hannuksela for the inspiring idea and for his skilfull and encouraging supervision in the beginning of this project. The material for this academic dissertation was collected and the SKARP was carried out and conducted in collaboration with the Institute of Health Sciences, University of Oulu, Finland. I would like to thank the director of the Institute of Health Sciences, Professor Sirkka Keinänen-Kiukaanniemi for her support and positive attitude towards the SKARP study, which enabled me to finish my academic dissertation. I wish to express my sincere gratitude to my principal supervisor, Professor of Biometry Esa Läärä for his contribution, support and sharing his invaluable expertise in statistical and epidemiological issues throughout this project, and for his teaching skills, patience with and trust in my capacity to learn the epidemiological approach and to understand the methods of epidemiology.
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