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Crescent Head, Australia

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. Source


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. Source


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. Source


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. Source


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. Source

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