title: A population-based study of fish allergy in the Philippines, Singapore and Thailand.
abstract: BACKGROUND
  Fish allergy is the third most common food allergy after milk and egg in parts of Europe, but there is little data about prevalence in South East Asia where it is an important part of regular diets.
  
  
  OBJECTIVE
  We aimed to obtain an estimate of the population prevalence of fish allergy among older children in the Philippines, Singapore and Thailand.
  
  
  METHODS
  The population prevalence of fish allergy in 14- to 16-year-old children in the 3 countries was evaluated using a structured written questionnaire which was distributed to students of randomly selected secondary schools. An extended questionnaire to determine convincing fish allergy on the basis of typical clinical manifestations within 2 h of ingestion was administered to those with positive responses.
  
  
  RESULTS
  From a cohort of 25,842 students, responses were 81.1% in the Philippines (n = 11,434), 67.9% in Singapore (n = 6,498) and 80.2% (n = 2,034) in Thailand. Using criteria for convincing food allergy, fish allergy was much higher in the Philippines [2.29%, 95% confidence interval (CI) 2.02-2.56] than in Singapore (0.26%, 95% CI 0.14-0.79) and Thailand (0.29%, 95% CI 0.06-0.52). Weighted multiple logistic regression analyses showed that compared to the Philippines, prevalence rates were lower in Singapore [odds ratio (OR) 0.40, 95% CI 0.27-0.60, p < 0.0001] and Thailand (OR 0.13, 95% CI 0.05-0.33, p < 0.0001). Females were more likely to have fish allergy compared to males for all children combined (OR 1.32, 95% CI 1.11-1.58, p = 0.002). Most allergies appeared mild, as only 28% of cases sought medical consultation at the time of the reaction and 31.2% of cases reported continued exposure despite allergic symptoms.
  
  
  CONCLUSIONS
  Fish allergy in late childhood is more common in the Philippines compared to Singapore and Thailand. Differences in food processing, dietary habits and other cultural practices might be important risk factors for the development of fish allergy in these populations.
authors: National University Health System, Singapore, Singapore.
authors: Gary James
authors: GJ
authors: Connett
authors: Irvin
authors: I
authors: Gerez
authors: Elizabeth Ann
authors: EA
authors: Cabrera-Morales
authors: Araya
authors: A
authors: Yuenyongviwat
authors: Jarungchit
authors: J
authors: Ngamphaiboon
authors: Pantipa
authors: P
authors: Chatchatee
authors: Pasuree
authors: P
authors: Sangsupawanich
authors: Shu-E
authors: SE
authors: Soh
authors: Gaik-Chin
authors: GC
authors: Yap
authors: Lynette Pei-Chi
authors: LP
authors: Shek
authors: Bee-Wah
authors: BW
authors: Lee
mesh_terms: D000293:Adolescent; D000818:Animals; D005260:Female; D005399:Fishes / Q000276:immunology*; D005512:Food Hypersensitivity / Q000453:epidemiology* / Q000276:immunology; D006801:Humans; D008297:Male; D010679:Philippines / Q000453:epidemiology; D015995:Prevalence; D012044:Regression Analysis; D012307:Risk Factors; D012737:Sex Factors; D012846:Singapore / Q000453:epidemiology; D013334:Students; D011795:Surveys and Questionnaires; D013785:Thailand / Q000453:epidemiology