John James Medical Center

Deakin ACT, Australia

John James Medical Center

Deakin ACT, Australia

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Mullins R.J.,John James Medical Center | Mullins R.J.,Australian National University | Mullins R.J.,University of Canberra | Clark S.,University of Pittsburgh | Camargo Jr. C.A.,Harvard University
Pediatric Allergy and Immunology | Year: 2010

There is little information on the regional distribution of food allergy in Australia. We examined the influence of latitude (a marker of sunlight/vitamin D status) on food allergy, as measured by 2007 infant hypoallergenic formula (IHF) prescription rates in children ages 0-2 yrs. Data were compiled from the 52 statistical divisions in mainland Australia plus the island of Tasmania (n = 53 observations). Data from the Australian Department of Health and Aging and the Australian Bureau of Statistics were analysed by statistical division. There was significant regional variability in hypoallergenic formula prescription rates (per 100,000 population/yr), with the highest rates in southern Australia (14,406) and the lowest in the north (721), compared with a national average of 4099. Geographical factors (decreasing latitude and increasing longitude) were associated with a higher rate of IHF prescriptions, such that rates were higher in southern vs. northern regions, and in eastern compared with western regions. Controlling for longitude, physician density and markers of socioeconomic status, southern latitudes were associated with higher hypoallergenic formulae prescription rates [β, -147.98; 95% confidence interval (CI) = -281.83 to -14.14; p = 0.03]. Controlling for latitude, physician density and markers of socioeconomic status, eastern longitudes were also associated with higher hypoallergenic formulae prescription rates (β, 89.69; 95% CI = 2.90-176.49; p = 0.04). Among young children, hypoallergenic formula prescription rates are more common in the southern and eastern regions of Australia. These data provide support for a possible role of sun exposure/vitamin D status (amongst other potential factors) in the pathogenesis of food allergy. © 2009 John Wiley & Sons A/S.


Mullins R.J.,John James Medical Center | Mullins R.J.,Australian National University | Mullins R.J.,University of Canberra | Clark S.,University of Pittsburgh | Camargo Jr. C.A.,Harvard University
Clinical and Experimental Allergy | Year: 2010

Summary Background The risk factors for food allergy (FA) and anaphylaxis remain uncertain. Objective We examined the association between socio-economic status (SES), geographic remoteness and childhood FA and anaphylaxis in Australia. Methods Sales of infant hypoallergenic formulae (IHF; 2008-2009) and EpiPens (2006-2007) in children aged 0-4 years and hospital anaphylaxis admission rates (2002-2006) in age groups 0-4, 5-14, 15-24, 25-64 and 65+ years were used as proxy markers of FA and anaphylaxis in Australia. Government and commercially derived data were analysed by SES and geographic remoteness (very remote, remote, outer regional, inner regional and major cities). Results Annual IHF sales rates were higher in those with the greatest compared with the least socio-economic advantage (47 830 vs. 21 384 tins/100 000 population; P<0.001). EpiPen sales trends were also higher in those with the greatest socio-economic advantage in all age groups, most marked in those aged 0-4 (1713 vs. 669/100 000; P=0.002) and 5-14 years (1628 vs. 600/100 000; P=0.001). Formula sales rates were higher in major cities than remote/very remote regions (37 421 vs. 6704/100 000; P<0.001) with similar EpiPen sales trends, particularly in ages 0-4 (1166 vs. 601/100 000; P=0.045) and 5-14 years (1099 vs. 588/100 000; P<0.001). Socio-economic advantage and geographic remoteness remained statistically significant in multivariable analysis of prescription rates (P<0.01) and were unchanged by adjustment for health services access. While anaphylaxis admission rates were higher in those with the greatest compared with the least socio-economic advantage in children aged 0-4 years (129 vs. 92/100 000 population/year; P=0.03), the opposite was observed in older age groups (e.g. aged 25-64 years: 43 vs. 76, P=0.01). There was no association between geographic remoteness and anaphylaxis admissions. Conclusion Socio-economic advantage and residence in major cities may be risk factors for developing childhood FA and anaphylaxis. Further study will determine the extent to which economic factors and location of residence also influence access to health services. © 2010 Blackwell Publishing Ltd.


Mullins R.J.,John James Medical Center | Mullins R.J.,Australian National University | Mullins R.J.,University of Canberra | Clark S.,University of Pittsburgh | And 4 more authors.
Pediatric Allergy and Immunology | Year: 2011

Background: Recent studies suggest a possible role for low ultraviolet radiation exposure and low vitamin D status as a risk factor for food allergy. We hypothesized that children born in autumn/winter months (less sun exposure) might have higher food allergy rates than those born in spring/summer. Methods: We compared IgE-mediated food allergy rates by season of birth in 835 children aged 0-4yr assessed 1995-2009 in a specialist referral clinic, using population births as controls. To address potential concerns about generalizability, we also examined national prescriptions for adrenaline autoinjectors (2007) and infant hypoallergenic formula (2006-2007). Results: Although live births in the general ACT population showed no seasonal pattern (50% autumn/winter vs. 50% spring/summer), autumn/winter births were more common than spring/summer births among food allergy patients (57% vs. 43%; p<0.001). The same seasonal pattern was observed with peanut (60% vs. 40%; p<0.001) and egg (58% vs. 42%; p=0.003). Regional UVR intensity was correlated with relative rate of overall food allergy (β, -1.83; p=0.05) and peanut allergy (β, -3.27; p=0.01). National data showed that autumn/winter births also were more common among children prescribed EpiPens (54% vs. 46%; p<0.001) and infant hypoallergenic formula (54% vs. 46%; p<0.001). Conclusions: The significantly higher rates of food allergy in children born autumn/winter (compared to spring/summer), the relationship between relative food allergy rates and monthly UVR, combined with national adrenaline autoinjector and infant hypoallergenic formula prescription data, suggest that ultraviolet light exposure/vitamin D status may be one of many potential factors contributing to childhood food allergy pathogenesis. © 2011 John Wiley & Sons A/S.


Mullins R.J.,Australian National University | Mullins R.J.,University of Canberra | Mullins R.J.,John James Medical Center | Camargo C.A.,Harvard University
Current Allergy and Asthma Reports | Year: 2012

Vitamin D is widely known for its role in bone metabolism, but this sterol hormone also has important immunomodulatory properties. Vitamin D is produced by the conversion of D3 in the skin following UVB exposure, or after ingestion of D2 or D3. At the extremes of latitude, there is insufficient UVB intensity in the autumn and winter months for adequate synthesis of vitamin D to occur. Growing evidence implicates vitamin D deficiency in early life in the pathogenesis of nonskeletal disorders (e. g., type 1 diabetes and multiple sclerosis) and, more recently, atopic disorders. Several studies have reported higher rates of food allergy/anaphylaxis or proxy measures at higher absolute latitudes. Although causality remains to be determined, these studies suggest a possible role for sunlight and/or vitamin D in the pathogenesis of food allergy/anaphylaxis. © 2011 Springer Science+Business Media, LLC.


Mullins R.J.,John James Medical Center | Mullins R.J.,Australian National University | Mullins R.J.,University of Canberra | Clark S.,University of Pittsburgh | And 4 more authors.
Annals of Allergy, Asthma and Immunology | Year: 2012

Background: Although a number of factors have been proposed to explain the increase in food allergy during the last decade, the possibility that vitamin D status may play a pathogenic role has received recent attention. Objective: To determine whether lower levels of neonatal 25-hydroxyvitamin D (25[OH]D) would be observed in children with peanut allergy compared with in population controls. Methods: The concentration of 25(OH)D was measured from neonatal dried blood samples by liquid chromatography tandem mass spectrometry. Levels were compared between children with IgE-mediated peanut allergy younger than 72 months assessed during 2008-2011 in a specialist referral clinic in the Australian Capital Territory and population births matched by sex, birth date, and birth location. Odds ratios were calculated for the matched pairs across quintiles of 25(OH)D. Results: Neonatal 25(OH)D levels ranged from 8 to 180 nmol/L (median, 66 nmol/L; interquartile range, 46-93 nmol/L); only 4 children (3%) had levels less than 25 nmol/L, and 24 (20.9%) had levels greater than 100 nmol/L. No significant association was found between socioeconomic or clinical factors and 25(OH)D levels. Compared with the reference group (50-74.9 nmol/L), levels of 75 to 99.9 nmol/L were associated with lower risk of peanut allergy (P =.02). No further reduction was found at levels of 100 nmol/L or higher, and the risk of peanut allergy at levels less than 50 nmol/L was not significantly different from the reference group. Conclusion: The relationship between neonatal 25(OH)D level and childhood peanut allergy was nonlinear, with slightly higher levels (75-99.9 nmol/L) associated with lower risk than those in the reference group (50-74.9 nmol/L). Vitamin D status may be one of many potential factors contributing to childhood peanut allergy pathogenesis. © 2012 American College of Allergy, Asthma & Immunology.


Mullins R.J.,John James Medical Center | Mullins R.J.,Australian National University | Mullins R.J.,University of Canberra | James H.,University of Virginia | And 2 more authors.
Journal of Allergy and Clinical Immunology | Year: 2012

Background: We have observed patients clinically allergic to red meat and meat-derived gelatin. Objective: We describe a prospective evaluation of the clinical significance of gelatin sensitization, the predictive value of a positive test result, and an examination of the relationship between allergic reactions to red meat and sensitization to gelatin and galactose-α-1,3- galactose (α-Gal). Methods: Adult patients evaluated in the 1997-2011 period for suspected allergy/anaphylaxis to medication, insect venom, or food were skin tested with gelatin colloid. In vitro (ImmunoCAP) testing was undertaken where possible. Results: Positive gelatin test results were observed in 40 of 1335 subjects: 30 of 40 patients with red meat allergy (12 also clinically allergic to gelatin), 2 of 2 patients with gelatin colloid-induced anaphylaxis, 4 of 172 patients with idiopathic anaphylaxis (all responded to intravenous gelatin challenge of 0.02-0.4 g), and 4 of 368 patients with drug allergy. Test results were negative in all patients with venom allergy (n = 241), nonmeat food allergy (n = 222), and miscellaneous disorders (n = 290). ImmunoCAP results were positive to α-Gal in 20 of 24 patients with meat allergy and in 20 of 22 patients with positive gelatin skin test results. The results of gelatin skin testing and anti-α-Gal IgE measurements were strongly correlated (r = 0.46, P <.01). α-Gal was detected in bovine gelatin colloids at concentrations of approximately 0.44 to 0.52 μg/g gelatin by means of inhibition RIA. Conclusion: Most patients allergic to red meat were sensitized to gelatin, and a subset was clinically allergic to both. The detection of α-Gal in gelatin and correlation between the results of α-Gal and gelatin testing raise the possibility that α-Gal IgE might be the target of reactivity to gelatin. The pathogenic relationship between tick bites and sensitization to red meat, α-Gal, and gelatin (with or without clinical reactivity) remains uncertain. © 2012 American Academy of Allergy, Asthma & Immunology.


PubMed | John James Medical Center and University of New South Wales
Type: Journal Article | Journal: Journal of the European Academy of Dermatology and Venereology : JEADV | Year: 2016

Chronic cold urticaria results in significant morbidity, yet information on its natural history is limited.We examined the natural history of chronic cold urticaria and its impact on quality of life.We analysed the characteristics of patients diagnosed with cold urticaria at a community-based specialist allergy practice in the Australian Capital Territory (ACT) between 1995 and 2015. Follow-up data were obtained using a mailed questionnaire. Possible predictive factors of disease severity and symptom duration were evaluated.A total of 99 patients were assessed with a median age of 42 (range 5-81 years); 63% were female and the median age of onset of symptoms was 22 years. Of 41 questionnaire responders (14 10.9 years follow-up; median 12 years), 5- and 10-year resolution rates were 17.9% 6.2% and 24.5% 7.2%, respectively. Whereas 22% reported resolution and 23% described improvement, the remaining 55% reported stable or worsening disease. Most individuals relied on lifestyle modification to ameliorate symptoms rather than medication. Risk factors for persistent disease were intercurrent atopic disease (P = 0.025) and those with longer duration of symptoms at the time of initial assessment (P < 0.001). Secondary causes of cold urticaria were identified in only two patients, both with B-cell malignancy.In a subset of patients, cold urticaria has low rates of spontaneous resolution and results in lifestyle changes and impaired quality of life.


Mullins R.J.,John James Medical Center | Brown S.G.A.,University of Western Australia | Brown S.G.A.,Harry Perkins Institute of Medical Research
Medical Journal of Australia | Year: 2014

Jack jumper ant (JJA) venom allergy is an important cause of anaphylaxis in south-eastern Australia. The efficacy and real-world effectiveness of JJA venom immunotherapy (VIT) to prevent anaphylaxis in allergic patients are now well established, with an evidence base that is at least equivalent to that supporting VIT for allergy to other insect species. The tolerability and safety of JJA VIT are comparable with those of honeybee VIT.


PubMed | John James Medical Center and University of Western Australia
Type: Journal Article | Journal: The Medical journal of Australia | Year: 2014

Jack jumper ant (JJA) venom allergy is an important cause of anaphylaxis in south-eastern Australia. The efficacy and real-world effectiveness of JJA venom immunotherapy (VIT) to prevent anaphylaxis in allergic patients are now well established, with an evidence base that is at least equivalent to that supporting VIT for allergy to other insect species. The tolerability and safety of JJA VIT are comparable with those of honeybee VIT.


PubMed | John James Medical Center, University of Sydney, Childrens Hospital Westmead, Gleneagles Medical Center and Sydney Childrens Hospital
Type: Journal Article | Journal: Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology | Year: 2016

Recent epidemiological studies indicate increases in Australian, UK and US hospital anaphylaxis admission rates.The aim of this study was to determine whether Australian anaphylaxis fatalities are increasing in parallel and to examine the characteristics of fatalities recorded in the National Coronial Information System (NCIS).Time trends in Australian anaphylaxis fatalities were examined using data derived from the Australian Bureau of Statistics (ABS) 1997-2013 and the NCIS 2000-2013, the latter providing additional information to verify cause and identify risk factors.The ABS recorded 324 anaphylaxis fatalities by cause: unspecified (n = 205); medication (n = 52); insect stings/tick bites (n = 41); food (n = 23); and blood products (n = 3). From 1997 to 2013, all-cause fatal anaphylaxis rates increased by 6.2%/year (95% CI: 3.8-8.6%, P < 0.0001) or from 0.054% to 0.099/10(5) population. Fatal food anaphylaxis increased by 9.7%/year (95% CI: 0.25-20%, P = 0.04) and unspecified anaphylaxis deaths by 7.8% (95% CI: 4.6-11.0, P < 0.0001). There was an insignificant change in medication-related fatalities (5.6% increase/year; 95% CI: 0.3% decrease to 11.8% increase, P = 0.06), and sting/bite fatalities remained unchanged. Hospital anaphylaxis admission rates for all-cause, food, unspecified and medication anaphylaxis increased at rates of 8%, 10%, 4.4% and 6.8%/year, respectively. A total of 147 verified NCIS deaths were examined in detail: medication- and sting/bite-related fatalities occurred predominantly in older individuals with multiple comorbidities. Upright posture after anaphylaxis was associated with risk of sudden death (all causes). Seafood (not nuts) was the most common trigger for food-related anaphylaxis deaths.Australian anaphylaxis fatality rates (most causes) have increased over the last 16 years, contrasting with UK- and US-based studies that describe overall lower and static overall anaphylaxis fatality rates (0.047-0.069/10(5) population).

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