The International Association of Chinese Allergists and Immunologists
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Adrenaline auto-injector has limited availability In Asia

January 12, 2012

 

Anaphylaxis, a systemic allergic reaction, is a potentially life-threatening condition with increasing prevalence in Western countries, especially in children. There has been a similar trend in Asian countries, possibly attributed to increasing globalization and westernization. According to the latest tertiary wide survey in Hong Kong, food allergy is the leading cause of systemic allergic reaction/anaphylaxis amongst children admitted to hospitals. Drug was the second most common cause.

Hong Kong, as one of the most developed metropolitan cities of China and South East Asia, seems having limited availability of adrenaline auto-injector in both public and private hospitals and pharmacies. Five percent of Hong Kong children have food allergy. Despite this prevalence being compatible to most of developed nations, Hong Kong has a much lower relative dispensing rate of adrenaline. Currently, about 1: 10,000 children carry an adrenaline auto-injector in Hong Kong. The case is similar in Singapore. At times, a syringe and an ampoule of adrenaline are provided instead of auto-injectors, which may pose difficulties for untrained people. Thus, there is a real risk of incorrect administration correctly in an emergency situation.

In a validated survey instrument self-administered to members of the World Allergy Organization House of Delegates from 2003 to 2005, the widespread availability of adrenaline auto-injectors  in Europe, United States, Canada, and Australia contrasted sharply with limited availability in Asia, South America, and Africa. This study raises concerns about lack of availability and affordability of adrenaline auto-injectors worldwide for its citizens.

Furthermore, Asia is gaining momentum in its economy and political influences globally. As such, it is becoming a hub for both business and vacationing travelers. Appropriate alignment of anaphylaxis practice with the West is of necessary to safeguard the international travelers’ safety.

Hong Kong is in the midst of organizing a guideline on anaphylaxis management. In order to best prevent anaphylaxis-related morbidity and mortality of its people, we advocate for easy access and distribution of auto-injectable adrenaline. A first step would be to set up of a central registry to monitor anaphylaxis and use of adrenaline auto-injector.

 

 

Dr Marco Ho is a practicing paediatric immunologist/allergist currently based in Hong Kong.

 

Conflict of Interest: None to declare

 
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TBA

 
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      EPI EEEEPEpigenetics in allergy
Epigenetics is a method by which gene expression is controlled without changes in the genetic sequence of coding genes. Along with genetic and environmental influences, epigenetics can result in changes in phenotypes resulting in disease states. Epigenetic modifications may play a role in the development of allergic and immunologic diseases. Most epigenetic changes occur as a result of DNA methylation or by modification of chromatin or histone proteins. Micro-RNAs have been discovered recently that may also effect changes in gene expression by their ability to act as inhibitors of transcription.
One of the possible mechanisms of drug-induced autoimmunity is through DNA methylation. Procainamide and hydralazine are two of several drugs that induce autoimmunity through this mechanism. By affecting gene transcription, epigenetic modification can lead to changes in activation of promoter genes, ultimately affecting important signaling pathways such as NF-B and apoptosis. MicroRNAs are 21-23 nucleotide long highly conserved sequences that bind to specific target genes leading to their inhibition, or in some cases, activation. This is an area of extensive research in many immunological and non-immunological diseases.
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EPIGENETICS IN ALLERGY

Epigenetics is a method by which gene expression is controlled without changes in the genetic sequence of coding genes. Along with genetic and environmental influences, epigenetics can result in changes in phenotypes resulting in disease states. Epigenetic modifications may play a role in the development of allergic and immunologic diseases. Most epigenetic changes occur as a result of DNA methylation or by modification of chromatin or histone proteins. Micro-RNAs have been discovered recently that may also effect changes in gene expression by their ability to act as inhibitors of transcription.
One of the possible mechanisms of drug-induced autoimmunity is through DNA methylation. Procainamide and hydralazine are two of several drugs that induce autoimmunity through this mechanism. By affecting gene transcription, epigenetic modification can lead to changes in activation of promoter genes, ultimately affecting important signaling pathways such as NF-B and apoptosis. MicroRNAs are 21-23 nucleotide long highly conserved sequences that bind to specific target genes leading to their inhibition, or in some cases, activation. This is an area of extensive research in many immunological and non-immunological diseases.

  

 

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