Mary Anne Castor
Verified @up.edu.ph
Associate Professor Division of Allergy and Immunology Department of Pediatrics College of Medicine-Philippine General Hospital
University of the Philippines Manila
EDUCATION
Doctor of Medicine: University of the Philippines College of Medicine
RESEARCH, TEACHING, or OTHER INTERESTS
Medicine, Pediatrics, Perinatology and Child Health, Immunology, Epidemiology
Scopus Publications
Scopus Publications
Anastasia Demidova, Karl Philipp Drewitz, Parisut Kimkool, Nikolina Banjanin, Vladyslava Barzylovich, Erna Botjes, India Capper, Mary Anne R. Castor, Pasquale Comberiati, Emma E. Cook,et al.
Wiley
AbstractBackgroundIgE‐mediated food allergy (FA) is a global health concern with substantial individual and societal implications. While diverse intervention strategies have been researched, inconsistencies in reported outcomes limit evaluations of FA treatments. To streamline evaluations and promote consistent reporting, the Core Outcome Measures for Food Allergy (COMFA) initiative aimed to establish a Core Outcome Set (COS) for FA clinical trials and observational studies of interventions.MethodsThe project involved a review of published clinical trials, trial protocols and qualitative literature. Outcomes found as a result of review were categorized and classified, informing a two‐round online‐modified Delphi process followed by hybrid consensus meeting to finalize the COS.ResultsThe literature review, taxonomy mapping and iterative discussions with diverse COMFA group yielded an initial list of 39 outcomes. The iterative online and in‐person meetings reduced the list to 13 outcomes for voting in the formal Delphi process. One more outcome was added based on participant suggestions after the first Delphi round. A total of 778 participants from 52 countries participated, with 442 participating in both Delphi rounds. No outcome met a priori criteria for inclusion, and one was excluded as a result of the Delphi. Thirteen outcomes were brought to the hybrid consensus meeting as a result of Delphi and two outcomes, ‘allergic symptoms’ and ‘quality of life’ achieved consensus for inclusion as ‘core’ outcomes.ConclusionIn addition to the mandatory reporting of adverse events for FA clinical trials or observational studies of interventions, allergic symptoms and quality of life should be measured as core outcomes. Future work by COMFA will define how best to measure these core outcomes.
Maria Katrina Diana M. Cruz, RCh, MSc, Mary Anne R. Castor, MD, Krystal M. Hate, MSc, Gregg Austine M. Balanag, BS, Roche Dana C. Reyes,et al.
University of the Philippines Manila
Background. Allergic respiratory diseases are prevalent in the Philippines, with allergic rhinitis and asthma occurring at 20% and 8.7% of the population, respectively. The diagnosis of respiratory allergies is achieved by a combination of patient history and different screening tools, especially for the identificati on of the allergic triggers such as allergy skin prick test (SPT) and serum-specific IgE enzyme-linked immunosorbent assays (sIgE ELISA). The Philippines, being a tropical country, have a wide variety of plant species with potential to produce allergenic pollen grains. Knowledge of the sensitization profiles of Filipino allergic patients to our local pollen allergens is currently limited.Objectives. The aim of this study is to determine the sensitization profile of patients with respiratory allergies (allergic rhinitis and/or asthma) through the allergy skin prick test (SPT) using allergenic local pollen extracts. It also aimed to determine if there is a positive agreement between the SPT and sIgE ELISA positivity rate and whether the results have relationship with the pollen purity and the protein content of the extracts.Methods. Pollen allergens were extracted from Amaranthus spinosus (pigweed), Mimosa pudica (makahiya), Tridax procumbens (wild daisy), Imperata cylindrica (cogon), Oryza sativa (rice), Pennisetum polystachion (foxtail grass), Sorghum halepense (Johnson grass), Albizia saman (acacia), Cocos nucifera (coconut), Leucaena leucocephala (ipil-ipil), and Mangifera indica (mango). SPT was performed at the Allergy Clinic of the University of the Philippines- Philippine General Hospital on patients with allergic rhinitis and/or bronchial asthma. Blood samples were collected from patients who developed wheal diameters of 3 mm or more than the negative control. Sera were tested against the same pollen extracts using ELISA.Results. Of the one hundred sixty-five (165) patients who submitted for skin prick test, 129 showed positive SPT results to the pollen extracts. Weeds were the most sensitizing (51.9%-58.1%). Blood samples were collected from these patients and tested for sIgE ELISA and among them, 71 were positive in the sIgE ELISA. Highest sensitization rates in sIgE ELISA were found in coconut, pigweed, Johnson grass, and rice. The highest positive agreements or the proportion of patients with positive sIgE ELISA among those with positive SPT were in coconut, followed by Johnson grass, pigweed, and rice. Most of the pollen sensitized patients on SPT are polysensitized.Conclusion. SPT is a safe, simple, and rapid method for the diagnosis of IgE-mediated allergy. The lower number of positive patients in sIgE ELISA may be attributed to the low serum IgE levels and low quantities of effectual allergen components in extracts. Results of both SPT and ELISA must be correlated with a patient's clinical history, particularly the patient’s exposures, and physical examination.
Chee Mun Chan, Amir Hamzah Abdul Latiff, Lokman Mohd Noh, Intan Hakimah Ismail, Intan Juliana Abd Hamid, Woei Kang Liew, Youjia Zhong, Narissara Suratannon, Rapisa Nantanee, Fatima Johanna Santos-Ocampo,et al.
Frontiers Media SA
IntroductionWith increased diagnostic capabilities and treatment modalities in the field of primary immunodeficiencies (PID), many pediatric patients survive beyond childhood and experience a change of care to the adult-oriented healthcare system. Unfortunately, the transition pathways for PID are less clearly defined, resulting in deterioration of quality of care in adulthood. Hence, this is the first regional study to address PID clinicians’ opinions on practices and challenges of transition care in 7 Southeast Asia (SEA) countries.MethodsWe adopted a cross-sectional study design through an online survey platform to enquire opinions of transition practices from expert representatives in 7 SEA countries.ResultsRegionally, 3 out 7 countries reported having no practice of transition care. Among cited challenges were reluctant adaptation by patients and caregivers to unfamiliarized adult healthcare systems, inadequate ratio of adult immunologists to patients and lack of facilities for transfer.Discussion and conclusionOur study provides evidence to advocate policy makers on the importance of standardized integration of transition practice towards betterment of transiting PID patients into adulthood.
Katrina Faith A. San Gabriel, Roxanne Casis Hao, Mary Anne R. Castor, Marysia Stella T. Recto, and Madeleine W. Sumpaico
University of the Philippines Manila
Background. Asthma is a complex disorder characterized by variable and recurring symptoms, airflow obstruction, bronchial hyperresponsiveness, and an underlying inflammation. Asthma is one of the most common chronic diseases in the world and its burden of disease is exceedingly high. According to current guidelines, the asthma action plan is a cornerstone in the management and control of asthma exacerbations. Written action plans are now recommended for all children with asthma as part of initial home management of acute wheezing episodes and exacerbations. Translating the written asthma action plan to Filipino and testing it for cultural content validity and reliability will make it useful on a wider scale in our country, help reduce morbidity, and improve asthma control in the Filipino pediatric population.
 Objectives. To perform content and cultural validation and reliability testing of the Filipino Written Asthma Action Plan (FWAAP).
 Methods. The Written Asthma Action Plan was translated to Filipino following conventional translational steps: 1) forward translation, 2) back translation, 3) pilot testing and validation, 4) final translated version. We conducted a cross-sectional study and administered the FWAAP during pilot testing among children and caregivers with asthma attending an asthma clinic.
 Results. We included 31 patients. The participants considered the FWAAP to be relevant to their disease, understandable, concise and useful in the management of asthma. The tool was shown to be highly consistent (Cronbach’s alpha coefficient = 0.9235 showing that the. Seigel and Castellan’s Kappa (Inter-rater or Inter-observer consistency) showed inter-rater agreement of 0.9615 (kappa of 0.7787) and 0.923 (kappa of 0.8846) respectively showing adequate inter-rater agreement.
 Conclusion. The Filipino asthma action plan is a reliable and valid tool for managing asthma in the home setting.
Maria Isabel O. Quilendrino, Mary Anne R. Castor, Nenacia Ranali Nirena P. Mendoza, Jacqueline R. Vea, and Niña T. Castillo-Carandang
University of the Philippines Manila
Background. The increasing prevalence of autism has significantly impacted the health care spending of many families worldwide. To date, families from low to middle-income countries are burdened with out-of-pocket spending as their local health care systems have yet to incorporate autism-related services into the health care infrastructure.
 Objectives. This study aimed to determine the direct costs of diagnosing and caring for children with autism and analyze its impact on the Filipino family.
 Methods. The cross-sectional study consisted of a self-administered questionnaire that looked at parents’ employment status, family income, and the direct costs for consultations, diagnostic tests, therapy, education, and medications. Study participants were parents living with their child diagnosed with autism, ages 2 to 6 years old at the time of the study.
 Results. One hundred fifty-eight parents participated in the survey for the cost of care for children with autism. Sixty-seven (42.4%) of parents received government or subsidized medical services for their children's consultation and/ or intervention, while the rest went to private centers or hospitals. The total costs for all evaluations that confirmed the autism diagnosis ranged from ₱1,356 to ₱44,634 and averaged ₱7,411.80 per child. Overall, the mean cost of interventions post-diagnosis, including therapy, education, medications, and developmental evaluations for the first year, was ₱38,868 or ₱3,239 per month (21% percent of the monthly expenditures for a household with an income of ₱15,000/month). The total cost of care per child was closely related to the family’s revenue in the sample population. Families with higher incomes also had higher expenditures for autism-related services.
 Conclusion. Autism imposes a significant economic burden on Filipino families, particularly the minimum-wage household earners who spent a higher proportion of their budget (21%) on autism-related services. The wide range of total costs for the care of the children in the study may be explained by the wide variability of the expenses for the services, differences in access to services, socioeconomic status, and the wide variation in needs of children with autism due to the nature of the condition.
Carol Stephanie C. Tan‐Lim, Natasha Ann R. Esteban‐Ipac, Marysia Stella T. Recto, Mary Anne R. Castor, Roxanne J. Casis‐Hao, and Aimee Lou M. Nano
Wiley
AbstractBackgroundAtopic dermatitis is the most common chronic skin disease affecting the pediatric population. Probiotics have been proposed to be effective in preventing the development of pediatric atopic dermatitis. Although studies show promise for the use of probiotics, the evidence is still inconclusive due to significant heterogeneity and imprecision.ObjectiveTo determine the comparative effectiveness of the different types of probiotic strains in preventing the development of atopic dermatitis among pediatric patients.MethodologyA systematic search of Cochrane Library, MEDLINE, TRIP Database, and Centre for Research and Dissemination was conducted. Manual search of the reference lists and search for unpublished articles were also done. All randomized controlled trials available from inception until April 12, 2020, on the use of probiotics in the prevention of atopic dermatitis among children were included. The comparator groups considered are other probiotic strains and placebo. The primary outcome of interest was the development of atopic dermatitis. Two authors independently searched for articles, screened the articles for inclusion, appraised the articles using the Cochrane risk of bias tool version 2, and extracted the data. In case of disagreement, the two authors discussed the source of disagreement until consensus was reached. If consensus was not reached, an independent third party reviewer was consulted. Frequentist network meta‐analysis was conducted using STATA 14 software. The ranking probabilities and surface under the cumulative ranking curve (SUCRA) values were obtained to determine ranking of the different probiotic strains based on efficacy and safety data.ResultsWe included 21 original studies represented by 35 records and a total of 5406 children with atopic dermatitis as diagnosed by clinicians or fulfillment of validated diagnostic criteria. All studies were randomized placebo‐controlled trials. The top 3 probiotic preparations in terms of efficacy in reducing the risk of atopic dermatitis are Mix8 (Lactobacillus paracasei ST11, Bifidobacterium longum BL999), LP (Lactobacillus paracasei ssp paracasei F19) and Mix3 (Lactobacillus rhamnosus GG, Bifidobacterium animalis ssp lactis Bb‐12). Mix8 compared with placebo probably reduces the risk of atopic dermatitis based on low‐quality evidence (RR = 0.46, 95% CI 0.25‐0.85). Mix3 compared with placebo also probably reduces the risk of atopic dermatitis based on low‐quality evidence (RR = 0.50, 95% CI 0.27‐0.94). It is uncertain whether LP compared with placebo reduces the risk of atopic dermatitis due to very‐low‐quality certainty of evidence (RR = 0.49, 95% CI 0.20‐1.19). In terms of adverse events, LGG may slightly lead to less adverse events compared with placebo based on low‐quality evidence (RR = 0.70, 95% CI 0.32‐1.52). Mix4 may slightly lead to more adverse events compared with placebo based on low‐quality evidence (RR = 1.06, 95% CI 0.02‐51.88). Based on subgroup analysis of studies involving infants, Mix3 compared with placebo probably reduces the risk of atopic dermatitis based on low‐quality evidence (RR = 0.46, 95% CI 0.22‐0.97). In the subgroup analysis of studies where probiotics were administered to pregnant women and to infants, LRH compared with placebo probably reduces the risk of atopic dermatitis based on moderate‐quality evidence (RR = 0.54, 95% CI 0.26‐1.11).ConclusionCertain probiotic preparations demonstrate efficacy in reducing the risk of developing atopic dermatitis when administered to pregnant women, infants, or both.
Carol Stephanie C Tan-Lim, Juan Miguel L Murillo, Marysia Stella T Recto, and Mary Anne R Castor
BMJ
Eosinophilic gastroenteritis is a rare inflammatory disorder of the gastrointestinal tract. Although commonly associated with allergic diseases, it is also rarely associated with autoimmune disorders. This case report describes a 17-year-old Filipino male with eosinophilic gastroenteritis, manifesting as abdominal pain, vomiting and diarrhoea. He had no allergic diseases, but he was previously diagnosed with chronic bullous disease. His symptoms improved with the initiation of corticosteroids. To date, this is the first case report of a patient with eosinophilic gastroenteritis and chronic bullous disease.
Carol Stephanie C. Tan-Lim, Mary Anne R. Castor, Marysia Stella T. Recto, Roxanne J. Casis-Hao, and Aimee Lou M. Nano
Ovid Technologies (Wolters Kluwer Health)
Background Anaphylaxis is a severe and life-threatening systemic hypersensitivity reaction. The incidence of anaphylaxis has increased significantly in recent years. Objective To identify predictors of serious outcomes among patients with anaphylaxis seen in the national tertiary hospital of the Philippines from 2015 to 2019. Methods Data was collected retrospectively through search of the medical records section and census reports on all patients diagnosed with anaphylaxis seen at the national tertiary hospital from 2015 to 2019. The patients’ clinical profile, management, and outcome were extracted. Multiple logistic regression analysis was used to determine the association of clinical characteristics and physicians’ management with the development of serious outcomes. Variable selection procedure through backward elimination method was used to determine significant predictors of serious outcomes of anaphylaxis. Data analysis was done using Stata 14 software. Results There were 300 patients with anaphylaxis seen at the Philippine national tertiary hospital from 2015 to 2019. Of the 300 patients, 179 were female (57.9%). The median age of the patients was 26 years old, with an interquartile range of 33 years. Only 75 patients (25%) had a past history of allergic disease. Majority of the patients (70%) had comorbidities. Drugs were the most common trigger of anaphylaxis (81.3%). Antibiotics were the most common type of drugs implicated (27%). Serious outcomes were noted in a total of 31 patients (10.3%). The significant predictors of serious outcomes in anaphylaxis are age (p = 0.034) and cofactors including use of beta-blockers and presence of acute infection (p < 0.001). Conclusion In the Philippine national tertiary hospital, the incidence of anaphylaxis increased by 240% in the past decade. Predictors of serious outcome in anaphylaxis include increased age and presence of cofactors such as beta-blocker use and presence of acute infection.
Carol Stephanie C. Tan-Lim and Mary Anne R. Castor
Ovid Technologies (Wolters Kluwer Health)
Primary immunodeficiency disorders, although rare, pose a significant burden in the quality of life of afflicted patients and their families. The most common of these disorders are caused by B-cell defects. A total of 6 patients were seen and diagnosed in a national tertiary hospital in the Philippines from 1996 to 2018. These patients were admitted due to various infections, and were subsequently diagnosed to have B-cell defects. Four out of the 6 patients have genetic studies confirming the diagnosis of X-linked agammaglobulinemia. One patient succumbed to sepsis at 10 years of age, while the rest are on follow-up at the Philippine General Hospital for intravenous immunoglobulin infusion.
Site Administrator, Ruzanne M. Caro, Marysia T. Recto, Josefino G. Hernandez, Madeleine W. Sumpaico, Ramon Antonio B. Lopa, Mary Anne R. Castor, Arsenio Claro A. Cabungcal, Julia G. De Leon, Jose Ryner C. Carrillo,et al.
University of the Philippines Manila
Introduction Allergic rhinitis is a common disease entity that may be easily misdiagnosed and mistreated. It is a global concern, affecting 10% to 25% of the population worldwide, that has to be controlled since it can be disabling affecting the quality of life of patients. The Philippine Society of OtolaryngologyHead and Neck Surgery is currently updating its 2006 guideline on Allergic Rhinitis. The Section of Rhinology, Department of Otorhinolaryngology together with the Section of Allergy and Immunology, Departments of Pediatrics and Internal Medicine, came up with practice parameters in the diagnosis and management of adult and pediatric patients suspected to have allergic rhinitis to guide clinicians in managing these patients. Locally, it is the first collaboration of otorhinolaryngologists and allergists. Scope of the Guideline This practice parameter was developed to guide general physicians, otorhinolaryngologists and allergists in the diagnosis and management of adult and pediatric patients with allergic rhinitis in an ambulatory care setting. Objectives This guideline aims to (1) assist general physicians, otorhinolaryngologists and allergists diagnose true allergic rhinitis; (2) evaluate current techniques and practices in diagnosing allergic rhinitis; and (3) describe treatment and management options for allergic rhinitis. Development process The Section of Rhinology of the Department of Otorhinolaryngology and Section of Allergy and Immunology of the Departments of Pediatrics and Internal Medicine of the UP-Philippine General Hospital convened a working group to create a consensus document to be used primarily for the Allergic Rhinitis Clinic, a joint clinic of the aforementioned sections in the Out-Patient Department of the UP-PGH, and to serve as a guide to general physicians, otorhinolaryngologists and allergists. The working group agreed to come up with an algorithm for the diagnosis and management of a patient with allergic rhinitis. Clinical questions were subsequently formulated based on the algorithm. The members then searched for relevant literature (including clinical practice guidelines, systematic reviews) in the National Library of Medicine’s PubMed database, Herdin database and unpublished local articles on allergic rhinitis. Appraisal of literature was done by an epidemiologist and evidence was presented and discussed within the working group. Applicability and availability of the diagnostic tests and therapeutic interventions were considered. All materials were assessed for relevance and further classified according to levels of evidence and grades of evidence based on guidelines. Recommendations were based on nominal approval of the working group. The document was then presented to stakeholders--consultants and residents of four clinical departments (Family Medicine, Internal Medicine, Otorhinolaryngology, Pediatrics), medical interns, medical students, nurses and patients. The opinions of the stakeholders were considered in the final draft.
Maria Isabel O. Quilendrino, Mary Anne R. Castor, Nenacia Ranali Nirena P. Mendoza, Jacqueline R. Vea, and Nina T. Castillo-Carandang
Elsevier BV