Correspondence Address:
Prof. Aroonwan Preutthipan
FCCP Division of Pediatric Pulmonology and Sleep Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400
Thailand

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The prevalence of food allergy was estimated to be 7%–8% in children.[1] Its prevalence has been increasing over the past two decades.[2] In this issue of Pediatric Respirology and Critical Care Medicine, Shaun Chad Lee presented an extensive review of existing literatures about food allergy in school children particularly in Asia.[3] Twenty-eight studies from 10 Asian countries published between 1994 and 2022 were included. The prevalence and kinds of food allergy varied widely among countries and age groups of the children. The alphabetical order list of common allergenic food reported in children were egg, fruits, milk, nuts, sea food, soy, and wheat. The author stated that the prevalence of food allergy in Hong Kong was higher than that in mainland China, Russia and India.[4] Moreover the incidence of food anaphylaxis, which was the most serious adverse reaction of food allergy, has doubled from 2009 to 2019 in Hong Kong.[5] One fifth of anaphylactic reactions occurred in day-care and school settings.[6] Since anaphylaxis was life threatening and could occur suddenly anytime, the author emphasized the crucial roles of school staff to prevent and give emergency management to anaphylaxis at the school. In addition, school staff should be trained to recognize anaphylaxis and administer intramuscular epinephrine to the children effectively in the event of anaphylaxis. Despite the increasing trend of food allergy and anaphylaxis, awareness and training on food allergy management were found to be lacking in the school settings in Asian countries. So far there were a small number of published articles from Japan and Korea focusing on the preparation and measures taken to prevent food-related adverse reactions at the school.[7],[8] The author proposed a nice schematic diagram of potential interventions to improve schools’ anaphylaxis management such as food allergens labeling, school epinephrine autoinjectors, etc. The author concluded that it would be more effective if the government of each country agreed and supported through policymaking and legislation.

Another interesting research in this issue was conducted by Sweta Sadani and Mrinalini Das from India which focused on empyema thoracis in children.[9] They found that Staphylococcus aureus was the major causative organism isolated from the culture of pleural fluid. This finding was similar to another 2 reports from Thailand[10] and India.[11] In this current series, 3 out of 42 patients died. Unfortunately, the authors did not report the causes of death. Four patients developed pneumothorax and one patient had bronchopleural fistula. Unfortunately, all patients were managed by only antibiotics and chest tube drainage. No patients received intrapleural fibrinolytics nor surgical interventions. In the future, it would be helpful to perform a well-designed, multicentered, randomized, clinical trial study to demonstrate scientifically whether the fibrinolysis and/or surgical interventions could decrease the mortality rate and complications of empyema thoracis.

Furthermore, Professor Moharmmad Ashkan Mosehi from Shiraz Univeristy of Medical Sciences, Iran suggested an excellent idea towards the progress of pediatric interventional bronchoscopy.[12] In recent years, newer advance techniques used in adults’ fiberoptic bronchoscopy such as cryobiopsy, balloons, stents, lasers, electrocautery knives, cryotherapy have been successfully performed in children as well. The removal of airway foreign bodies, formerly needed rigid bronchoscopy, could be done through a fiberoptic bronchoscope’s channel. Asian Paediatric Pulmonology Society (APPS) might be the best group to establish a collaboration among Asian pediatric pulmonologists in order to facilitate educational resource and training to broaden the beneficial role of fiberoptic bronchoscopy to younger and smaller patients.

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Conflicts of interest

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References