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

The Epidemiology and Aproach

to Management of Food Allergy

in Indonesia

SumadionoIndonesian Pediatric Allergy Immunology

Working Group

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

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

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

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

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)

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%)

Prevalence of Food Allergy in Children

Age below than 3 Years in Jakarta

286 children 30 % had Food Allergy

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

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

(Sumadio, Satria, Riana. 2015),

.

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),

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)

RECOMMENDATIONIndonesia Pediatric Society

DIAGNOSIS AND MANAGEMENTOF COW’S MILK PROTEIN

ALLERGY

Allergy Immunology Working GroupGastrohepatology Working GroupNutrition and Metabolic Diseases

Working Group

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

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

Indonesia data

The safety of a soy-based infant formula in infants with suggestive CMPA

Post Marketing Observational Study, 2011-2012

Symptoms of CMPA

Post Marketing Observational Study, 2011-2012

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

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

RECOMMENDATIONIndonesia Paediatric Society

PIMARY PREVENTION OF ALLERGY

Allergy Immunology Working GroupWorking Group

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

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

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

Thank

You