Browsing by Author "Lobo R.C.M."

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    APAAACI clinical pathway on direct provocation testing for penicillin allergy delabeling
    (2023-12-01) Li P.H.; Thong B.Y.H.; Pawankar R.; Jeewandara C.; Lobo R.C.M.; Kang H.R.; Mahesh P.A.; Meng J.; Munkhbayarlakh S.; Le Pham D.; Rerkpattanapipat T.; Tang M.M.; Yamaguchi M.; Latiff A.H.A.; Rengganis I.; Wang J.Y.; Zhang L.; Lucas M.; Li P.H.; Mahidol University
    Background: Allergy to penicillin is commonly reported in many countries and is an overwhelming global public health concern. Penicillin allergy labels can lead to the use of less effective antibiotics and can be associated with antimicrobial resistance. Appropriate assessment of suspected penicillin allergy (often including skin testing, followed by drug provocation testing [DPT] performed by allergists) can prevent the unnecessary restriction of penicillin or delabelling. Many countries in the Asia Pacific (AP) have very limited access to allergy services, and there are significant disparities in the methods of evaluating penicillin allergy. Therefore, a clinical pathway for the management of penicillin allergy is essential. Objectives: To develop a risk-stratified clinical pathway for delabeling penicillin allergy, taking into account the distinct epidemiology, patient/sensitization profiles, and disparities of allergy services or facilities within the AP. Methods: A risk-stratified penicillin allergy delabeling clinical pathway was formulated by the Drug Allergy Committee of the Asia Pacific Association of Allergy, Asthma and Clinical Immunology. and members of the Penicillin Allergy Disparities survey in AP each representing one country/region of the AP. The clinical pathway was tested based on a database of anonymized patients who were sequentially referred for and completed penicillin allergy evaluation in Hong Kong. Results: The clinical pathway was piloted employing a "hub-and-spoke"approach to foster multidisciplinary collaboration between allergists and nonallergists. A simulation run of the algorithm on a retrospective Hong Kong cohort of 439 patients was performed. Overall, 367 (84%) of patients were suitable for direct DPT and reduced the need for skin testing or specialist's care for 357 (97%) skin test-negative individuals. Out of the skin test-negative patients, 345 (94%) patients had a negative DPT. Conclusions: This risk-stratification strategy for direct oral DPT can reduce the need for unnecessary skin testing in patients with low-risk penicillin allergy histories. The hub and spoke model of care may be considered for further piloting and validation in other AP populations that lack adequately trained allergists.
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    Disparities and inequalities of penicillin allergy in the Asia-Pacific region
    (2023-01-01) Li P.H.; Pawankar R.; Thong B.Y.H.; Mak H.W.F.; Chan G.; Chung W.H.; Juan M.; Kang H.R.; Kim B.K.; Lobo R.C.M.; Lucas M.; Pham D.L.; Ranasinghe T.; Rengganis I.; Rerkpattanapipat T.; Sonomjamts M.; Tsai Y.G.; Wang J.Y.; Yamaguchi M.; Yun J.; Mahidol University
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    Perspectives and gaps in the management of food allergy and anaphylaxis in the Asia-Pacific Region
    (2024-05-01) Leung A.S.Y.; Pawankar R.; Pacharn P.; Wong L.S.Y.; Le Pham D.; Chan G.; Rengganis I.; Zhao J.; Wang J.Y.; Woo K.C.K.; Ito K.; Jeong K.; Recto M.; Lucas M.; Nagao M.; Lobo R.C.M.; Munkhbayarlakh S.; Sumadiono S.; Huq S.R.; Ranasinghe T.; Tang M.; Leung A.S.Y.; Mahidol University
    Background: Food allergy (FA), which is a condition that has no effective cure and can result in severe life-threatening allergic reactions, remains a global public health concern; however, little is known about how FAs are currently managed in the Asia-Pacific region. Objective: The main objective of this survey was to evaluate the epidemiology of FA, as well as the availability of resources and practices for management of FA and anaphylaxis by health care providers across Asia. Methods: From June 2022 to September 2022, a questionnaire-based survey comprising 66 questions was electronically sent to member societies of the Asia Pacific Association of Allergy Asthma and Clinical Immunology by using Survey Monkey. Results: A total of 20 responses were received from 15 member countries and territories. Compared with the pediatric data, there was a lack of prevalence data for FA in adults. Except for Australia and Japan, most regions had between 0.1 and 0.5 allergists per 100,000 population and some had fewer than 0.1 allergists per 100,000 population. The perceived rate of FA in regions with a short supply of allergists was high. Although specific IgE tests and oral food challenges were available in all regions, the median wait time for oral food challenges at government facilities was 37 days (interquartile range = 10.5-60 days). Seven regions still relied on prescriptions of ampules and syringes of injectable adrenaline, and adrenaline autoinjectors were not accessible in 4 regions. Oral immunotherapy as FA treatment was available in half of the surveyed countries and territories. Conclusions: Our study offers a cross-sectional evaluation of the management practices for FA in each Asia Pacific Association of Allergy Asthma and Clinical Immunology member country or territory. Urgent actions are required to enhance allergy services, improve the accessibility and affordability of adrenaline autoinjectors, and conduct robust epidemiologic studies.
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    Targeted Gene Sanger Sequencing Should Remain the First-Tier Genetic Test for Children Suspected to Have the Five Common X-Linked Inborn Errors of Immunity
    (2022-07-08) Chan K.W.; Wong C.Y.; Leung D.; Yang X.; Fok S.F.S.; Mak P.H.S.; Yao L.; Ma W.; Mao H.; Zhao X.; Liang W.; Singh S.; Barbouche M.R.; He J.X.; Jiang L.P.; Liew W.K.; Le M.H.T.; Muktiarti D.; Santos-Ocampo F.J.; Djidjik R.; Belaid B.; Ismail I.H.; Abdul Latiff A.H.; Lee W.S.; Chen T.X.; Liu J.; Jin R.; Wang X.; Chien Y.H.; Yu H.H.; Raj D.; Raj R.; Vaughan J.; Urban M.; Berg S.v.d.; Eley B.; Lee A.C.W.; Isa M.S.; Ang E.Y.; Lee B.W.; Yeoh A.E.J.; Shek L.P.; Quynh Le N.N.; Nguyen V.A.T.; Phan Nguyen Lien A.; Capulong R.D.; Mallillin J.M.; Villanueva J.C.M.M.; Camonayan K.A.B.; Vera M.D.; Casis-Hao R.J.; Lobo R.C.M.; Foronda R.; Binas V.W.E.; Boushaki S.; Kechout N.; Phongsamart G.; Wongwaree S.; Jiratchaya C.; Lao-Araya M.; Trakultivakorn M.; Suratannon N.; Jirapongsananuruk O.; Chantveerawong T.; Kamchaisatian W.; Chan L.L.; Koh M.T.; Wong K.J.; Fong S.M.; Thong M.K.; Latiff Z.A.; Noh L.M.; Silva R.d.; Jouhadi Z.; Al-Saad K.; Vignesh P.; Jindal A.K.; Rawat A.; Gupta A.; Suri D.; Yang J.; Au E.Y.L.; Kwok J.S.Y.; Chan S.Y.; Hui W.Y.F.; Chua G.T.; Duque J.R.; Cheong K.N.; Chong P.C.Y.; Ho M.H.K.; Lee T.L.; Wong W.H.S.; Yang W.; Lee P.P.; Tu W.; Yang X.Q.; Lau Y.L.; Mahidol University
    To address inborn errors of immunity (IEI) which were underdiagnosed in resource-limited regions, our centre developed and offered free genetic testing for the most common IEI by Sanger sequencing (SS) since 2001. With the establishment of The Asian Primary Immunodeficiency (APID) Network in 2009, the awareness and definitive diagnosis of IEI were further improved with collaboration among centres caring for IEI patients from East and Southeast Asia. We also started to use whole exome sequencing (WES) for undiagnosed cases and further extended our collaboration with centres from South Asia and Africa. With the increased use of Next Generation Sequencing (NGS), we have shifted our diagnostic practice from SS to WES. However, SS was still one of the key diagnostic tools for IEI for the past two decades. Our centre has performed 2,024 IEI SS genetic tests, with in-house protocol designed specifically for 84 genes, in 1,376 patients with 744 identified to have disease-causing mutations (54.1%). The high diagnostic rate after just one round of targeted gene SS for each of the 5 common IEI (X-linked agammaglobulinemia (XLA) 77.4%, Wiskott–Aldrich syndrome (WAS) 69.2%, X-linked chronic granulomatous disease (XCGD) 59.5%, X-linked severe combined immunodeficiency (XSCID) 51.1%, and X-linked hyper-IgM syndrome (HIGM1) 58.1%) demonstrated targeted gene SS should remain the first-tier genetic test for the 5 common X-linked IEI.