CURRICULUM VITAE

Nama : Sumadiono, dr SpA(K)

Tempat/ tanggal lahir : Nganjuk, 9-10-1956
Pekerjaan/jabatan : Staf Bagian Ilmu Kesehatan Anak FKUGM

Riwayat pendidikan formal :

Dokter umum : Fakultas kedokteran Unair, lulus tahun 1982
Spesialis anak : Fakultas kedokteran UGM, lulus tahun 1994
Konsultan Alergi Imunologi Anak: Ikatan Dokter Anak Indonesia 2002
Riwayat pendidikantambahan:
Molecular Biology (ICMR Kobe, Japan, 1996)
Basic Immunology (VU Amsterdam, The Netherland, 1997)
Pediatric clinic/treatment (VU Amsterdam, The Netherlands, 1998 & 1999)
Pediatric Allergy Immunology (Saskatoon, Canada, 2003)
Medical Education: PBL (UM Mastrich, The Netherlands, 2004)
Trends in Medical Education (NUS, Singapore, 2004)
Workshop: Intraarticular Injection (IRA, 2005)
Riwayat Organisasi:
- Ketua Sub Bag Alergi Imunologi Dept IKA FK UGM
- Komisi Evaluasi Kolegium IKA
- Anggota APAPARI Board (Asa Pasific Ascociation of Pediatric Allergy, Respirology &I mmunology)
- Ketua UKK Alergi Imunologi IDAI (2008-2011, 2011-2014)
- Ketua Peralmuni Cabang DIY
- Ketua IDAI Cabang DIY
 Soy Formula
as An Alternative Choice in Treatment
of Cows Milk Protein Allergy

Sumadiono
Department of Childhealth
Faculty of Medicine Gadjah mada University
5 Jenis Susu formula
...Susu Sapi

...Susu Kedelai
...Susu Terhidrolisa Parsiil
...Susu Terhidrolisa Ekstensif
...Susu Asam Amino
5 Indikasi:
...Susu Sapi: normal

...Susu Kedelai:
1.Alergi Susu Sapi (ASS)
2. Vegetarian
3. Intoleransi Laktose
...Susu Terhidrolisa Parsiil: Prevensi Alergi
...Susu Terhidrolisa Ekstensif: Prevensi dan Terapi ASS
...Susu Asam Amino: Terapi ASS berat
Brand KAMAS
...Susu Sapi

...Susu Kedelai:
- SGM Ananda Soya
- Nutribaby Royal Soya
...Susu Terhidrolisa Parsiil:
SGM Ananda PHPro & Nutribaby Royal Allerpre
...Susu Terhidrolisa Ekstensif:
Nutri baby Royal Pepti Junior
...Susu Asam Amino: Neocate
Issue Safety Susu Kedelai ??

• Alergi
• Kandungan Aluminium
• Nutrisi
• Estrogen/Hormonal
• Fitat/Absorbsi mikronutrient
ALLERGY  GLOBAL ARISING DISEASES
Pasien POLI IMUN ANAK RSUP Dr Sardjito,
April (sd tgl 27) 2015
Nefritis lupus
HSP
3% 3%

Dermatitis
Atopi
11%

SLE berat
14%

Food Allergy
4%
Rhinitis Allergica
29%

Urtikaria
14%

Food Allergy
Juvenile dermatomycositis 14%
4%
Urtikaria
4%
 Characteristic of Allergen Sensitization
in Children in Yogyakarta (2014)

No Allergens %
1. house dust mite 21.3%
2. shrimp 11.8 %
3. crab 10.9 %
4. cocroach 8.7%
5. dog 8.4%
6. cat 7.6%
7. tree 4.2%
8. cotton 4.0 $
8. grass 3.8%
9. tomatoes 3.8 %
10. milk 3.3 %
11 . pineapple 3.1 %
12. egg whites 3.1 %
13. egg yolks 2.4 %
14. soy 2.2 %
15.. fish 1.8 %
 Exclusive breastfeeding practice during 6 months

Exclusive breast feeding

100%
90% 19% 13%
13% Partially breast feeding
32%
80%
52%
70% 61%
67% Mostly breast feeding
60%
67%
50%
40%
30%
20%
No breast feeding
10%
0%
1st mo 2nd mo 3rd mo 4th mo 5th mo 6th mo

No breastfeeding
Mostly breastfeeding
with increasing age of baby
Partial breastfeeding
Exclusive breastfeeding
 Exclusive breast feeding: tend to
decrease
 CMA Diagnosis
History
Clinical manifestation
Skin prick test
IgE RAST (Radio Allergo Sorbent Test)
Elimination and provocation test

Vandenplas Y, et al, Arch Dis Child, 2007 ; 92:902-908

Rekomendasi IDAI : Diagnosis dan Tata Laksana Alergi Susu Sapi, 2009
 Diagnosis Alergi

Skin Prick Test

 Invalid tests

Electrodermal Skin Test –VEGA test - Bioresonance

CMA Diagnosis Non IgE
History Mediated
Taking Atopy
Patch Test
Sign &
Symptoms IgE
Mediated
Skin
Prick Test Specific
IgE Elimi-
nation
&
Provo-
cation
 Milk Formulas and Indications
No Protein Lactosa Fat Indication

1. Partially H. Partially H N N Prevention

2. Free N 0%/ N Lact. Intolerance

Lactose, Glucosa Diarhea
polymer
3. Extensive H. Extensive N N Prevention, CMA
casein
4. Extensive & Extensive N MCT55% CMA, Fat Malabs
MCT, Casein
 Indonesian CMA Management
Recommendation
Exclusive Breast Feeding Group
 Continue Breast feeding 2013/2014
 Mother: Avoid Cows Milk Protein (minimum 6 month)

Cows Milk Formula Group

 Baby: Avoid Cows Milk
 Replace eHF  Mild-Moderate (min. 6 month)
 Amino Acid Formula  Severe (min. 6 month)

SOY FORMULA :
If: Cost, Availability, Taste
(start from early life with education)
 AVALABILITY

• Amino Acid Formula : -- +

• Extensive Hydrolize Formula :+
• Partiall Hydrolize Formula :+
• Cow’s Milk Formula : +++
• Soy Formula : ++
 TASTE
• Amino Acid Formula : Verry bitter & fishy
• Extensive Hydrolize F. : Very bitter
• Partiall Hydrolize F. : Bitter
• Soy Formula : Quite nice
• Cow’s Milk Formula : Nice
 Cost of Milk Formula

Indonesian Income
per Capita: Rp. 85.000/day
Cost of Milk Formula

Europe Income
per Capita ??
 9/14/2011

Soy Allergy ??
`````````````````````````````````````````````````
```````````````````````````````````
 Aluminium
Kandungan AL > pada formula kedelai > formula susu sapi
dan ASI.

Formula kedelai 200 mL/kg/hari hanya <0,5 mg/kg/hari.

Msh << tolerable intake ( FAO/WHO): 1 mg/kg/hari

American Academic Pediatric (AAP):  bukan masalah

keamanan bagi bayi kecuali pada bayi prematur atau bayi
dengan gagal ginjal.

ESPGHAN Committee on Nutrition. J Ped Gastroenterol Nutr. 2006;42:352-61

Vandenplas Y, Castrellon P G, Rivas R, Gutierrex C J, Garcia L D, Jimenez J E, Anzo A, Hegar
B, Alarcon P. British Journal of Nutrition 2013 1:21
Soy Nutrtition??
Similar in Normal & Developmental in Term Infants,
Comparation: Soy Formula & Milk Formula
 Fitoestrogen ??
 Isoflavon dalam bentuk genistein, daidzein dan glycitein
 dampak perk seksual, reproduksi, neuroendokrin,
neurobehaviour, dan fungsi tyroid.
 Pada kajian ilmiah: fitoestrogen dalam kedelai  efek estrogen
yang lemah.

Kajian metaanalis:
pola pertumbuhan, metabolisme, tulang, reproduksi, endokrin,
sistem imun, dan fungsi neurologi  sama susu formula sapi
 Susu formula isolat protein kedelai
merupakan alternatif

ESPGHAN Committee on Nutrition. J Ped Gastroenterol Nutr. 2006;42:352-61

Lancet 1997; 350;815-6
Fitat ??

Isolat protein kedelai mengandung fitat

sebesar 1-2%, yang dapat mengganggu
absorpsi mineral dan trace elements.

Reduksi kandungan fitat telah dilakukan

pada semua produk formula dengan isolat
protein kedelai sehingga meningkatkan
absorpsi dan availabilitas zink, tembaga,
dan mineral lain .