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Allergy - Overview

Did you know?
  • Low vitamin D is strongly associated with most types of allergies
  • Recently more Adults have allergies than children (32% vs 27%)
  • There is a 5 to 10 times higher risk of food allergy with low vitamin D
  • People living in cities or having dark skins generally have low vit D and more allergies
  • There is Overwhelming Evidence that vitamin D reduces allergies
          (More Allergy info below)

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Allergies and Vitamin D

Food Allergy

Items in both categories Autoimmune and Infant/Child are listed here:


Food Allergy 5X more likely if low vitamin D – Oct 2014

The link between serum vitamin D level, sensitization to food allergens, and the severity of atopic dermatitis in infancy.
J Pediatr. 2014 Oct;165(4):849-54.e1. doi: 10.1016/j.jpeds.2014.06.058. Epub 2014 Aug 6.
Baek JH1, Shin YH1, Chung IH1, Kim HJ1, Yoo EG1, Yoon JW2, Jee HM1, Chang YE3, Han MY4.
1Department of Pediatrics, CHA University School of Medicine, Seongnam, Korea.
2Myongji General Hospital, Goyang, Korea.
3Department of Food and Nutrition Services, CHA Bundang Medical Center, Seongnam, Korea.
4Department of Pediatrics, CHA University School of Medicine, Seongnam, Korea. Electronic address: drmesh at gmail.com.

Vitamin D Life

Vitamin D deficiency definition varies
This article is similar to many countries: < 20 ng
The lower the vitamin D level, the more allergies each child had

OBJECTIVE: To investigate the association between serum vitamin D levels, sensitization to food allergens, and the severity of atopic dermatitis in infants.

STUDY DESIGN: We investigated serum 25-hydroxyvitamin D (25[OH]D) and specific immunoglobulin E levels to common or suspected food allergens in 226 infants with atopic dermatitis or food allergy. The severity of atopic dermatitis by the Scoring Atopic Dermatitis index and amount of vitamin D intake was measured in subcohort children. Sensitization to food allergens was categorized by the number (non-, mono-, and poly-) of sensitized allergens and the degree (undetected-, low-, and high-level) of sensitization.

RESULTS: Significant differences in 25(OH)D levels were found between groups on number (P = .006) and degree (P = .005) of food sensitization. The polysensitization group had significantly lower levels of 25(OH)D than the nonsensitization (P = .001) and monosensitization (P = .023) group. High-level sensitization group had significantly lower 25(OH)D levels compared with undetected (P = .005) and low-level (P = .009) sensitization group. Vitamin D deficiency increased the risk of

  • sensitization to food allergens (OR 5.0; 95% CI 1.8-14.1), especially to
  • milk (OR 10.4; 95% CI 3.3-32.7) and
  • wheat (OR 4.2; 95% CI 1.1-15.8).

In addition, the9% of US adults believe they have a food allergy Scoring Atopic Dermatitis index was independently related to 25(OH)D levels after adjusting for the level of sensitization (adjusted R(2) = 0.112, P = .031).

CONCLUSIONS: Our results suggest that vitamin D deficiency increases the risk of sensitization to food allergens and that atopic dermatitis may be more severe in infants with vitamin D deficiency.


ImageImage

 Download the PDF from Vitamin D Life.


19% of US adults now believe that they have a food allergy - 2019

Prevalence and Severity of Food Allergies Among US Adults - JAMA
 Download the PDF from Vitamin D Life
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Seems that they do not consider gluten intolerance to be a food allergy


10X more likely to have multiple food allergies if low vitamin D - Sept 2013

1 page item had the following results
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Vitamin D levels and food and environmental allergies in the United States - May 2011

Results from the National Health and Nutrition Examination Survey 2005-2006
The Journal of Allergy and Clinical Immunology, Volume 127, Issue 5 , Pages 1195-1202, May 2011
Shimi Sharief, MD; Sunit Jariwala, MD; Juhi Kumar, MD, MPH; Paul Muntner, PhD; Michal L. Melamed, MD,

Background: Previous research supports a possible link between low vitamin D levels and atopic disease.
However, the association between low vitamin D levels and total and allergen-specific IgE levels has not been studied.

Objective: We sought to test the association between serum 25-hydroxyvitamin D (25[OH]D) deficiency (<15 ng/mL) and insufficiency (15-29 ng/mL) and allergic sensitization measured by serum IgE levels in a US nationally representative sample of 3136 children and adolescents and 3454 adults in the National Health and Nutrition Examination Survey 2005-2006.

Methods: The association of 25(OH)D deficiency with 17 different allergens was assessed after adjustment for potential confounders, including age; sex; race/ethnicity; obesity, low socioeconomic status; frequency of milk intake; daily hours spent watching television, playing videogames, or using a computer; serum cotinine levels; and vitamin D supplement use.

Results: In children and adolescents allergic sensitization to 11 of 17 allergens was more common in those with 25(OH)D deficiency. Compared with sufficient vitamin D levels of greater than 30 ng/mL, after multivariate adjustment, 25(OH)D levels of less than 15 ng/mL were associated with

  • peanut (odds ratio [OR], 2.39; 95% CI, 1.29-4.45),
  • ragweed (OR, 1.83; 95% CI, 1.20-2.80), and
  • oak (OR, 4.75; 95% CI, 1.53-4.94) allergies (P < .01 for all).

Eight other allergens were associated with 25(OH)D deficiency, with P values of less than .05 but greater than .01.
There were no consistent associations seen between 25(OH)D levels and allergic sensitization in adults.

Conclusion: Vitamin D deficiency is associated with higher levels of IgE sensitization in children and adolescents.
Further research is needed to confirm these findings.


Food allergies are associated with both Vitamin D and Vitamin D genes - 2018

Cellular and molecular mechanisms of vitamin D in food allergy
Journal of cellular and molecular medicine, DOI:10.1111/jcmm.13607
Ashlyn Poole, Yong Song, +2 authors Guicheng Brad Zhang

Food allergies are becoming increasingly prevalent, especially in young children. Epidemiological evidence from the past decade suggests a role of vitamin D in food allergy pathogenesis. Links have been made between variations in sunlight exposure, latitude, birth season and vitamin D status with food allergy risk. Despite the heightened interest in vitamin D in food allergies, it remains unclear by which exact mechanism(s) it acts. An understanding of the roles vitamin D plays within the immune system at the cellular and genetic levels, as well as the interplay between the microbiome and vitamin D, will provide insight into the importance of the vitamin in food allergies. Here, we discuss the effect of vitamin D on immune cell maturation, differentiation and function; microbiome; genetic and epigenetic regulation (eg DNA methylation); and how these processes are implicated in food allergies.
 Download the PDF from Vitamin D Life


RTI 36% more likely if low Vitamin D during pregnancy - meta-analysis - May 2018

Prenatal vitamin D status and respiratory and allergic outcomes in childhood: A meta-analysis of observational studies.
Image
Pediatric allergy and immunology, DOI:10.1111/pai.12876
not on sci-hub as of Jan 2019 but can be read in DeepDive
Rosa M Pacheco-González, L Garcia-Marcos, Eva Morales

BACKGROUND: Prenatal vitamin D status may influence offspring's respiratory and allergic outcomes; however, evidence is inconclusive. A systematic review and meta-analysis were conducted on the association between 25-hydroxyvitamin D [25(OH)D] levels in maternal blood in pregnancy or cord blood at birth with the risk of offspring's respiratory and allergic conditions.

METHODS: Two independent researchers conducted systematic searches for observational studies published until May 2017 using defined keywords on vitamin D and health outcomes, including respiratory tract infections (RTIs), wheeze, asthma, atopic eczema, allergic rhinitis, allergic sensitization, and lung function. Random-effects meta-analyses were conducted.

RESULTS: A total of 34 from 547 retrieved articles were included. Increased prenatal exposure to 25(OH)D was inversely associated with risk of RTIs. Comparing the highest with the lowest category of 25(OH)D levels, the pooled odds ratio was 0.64 (95% CI 0.47, 0.87). A positive borderline association was found for lung function at school age (FEV1 z-score coefficient 0.07, 95% CI -0.01, 0.15). No associations were found for wheeze, asthma, atopic eczema, allergic rhinitis, and allergic sensitization.

CONCLUSION: The introduction of public health measures to tackle vitamin D status in pregnancy may reduce the burden of RTIs in offspring. Current evidence does not support an impact on asthma and allergy.


Gut microbiota, probiotics, and vitamin D - May 2011

Journal of Allergy and Clinical Immunology
Volume 127, Issue 5, May 2011, Pages 1087-1094; doi:10.1016/j.jaci.2011.02.015
Ngoc P. Ly MD, MPHa, Corresponding Author Contact Information, E-mail The Corresponding Author, Augusto Litonjua MD, MPHb, Diane R. Gold MD, MPHb and Juan C. Celedón MD, DrPHc
a Division of Pediatric Pulmonary Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, Calif
b Channing Laboratory, Brigham and Women’s Hospital and Harvard Medical School, Boston, Mass
c Division of Pediatric Pulmonary Medicine, Allergy and Immunology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pa

Current evidence supports a role for gut colonization in promoting and maintaining a balanced immune response in early life. An altered or less diverse gut microbiota composition has been associated with atopic diseases, obesity, or both. Moreover, certain gut microbial strains have been shown to inhibit or attenuate immune responses associated with chronic inflammation in experimental models. However, there has been no fully adequate longitudinal study of the relation between the neonatal gut microbiota and the development of allergic diseases (eg, atopic asthma) and obesity. The emergence of promising experimental studies has led to several clinical trials of probiotics (live bacteria given orally that allow for intestinal colonization) in human subjects. Probiotic trials thus far have failed to show a consistent preventive or therapeutic effect on asthma or obesity. Previous trials of probiotics have been limited by small sample size, short duration of follow-up, or lack of state-of-the art analyses of the gut microbiota. Finally, there is emerging evidence that the vitamin D pathway might be important in gut homeostasis and in signaling between the microbiota and the host. Given the complexity of the gut microbiota, additional research is needed before we can confidently establish whether its manipulation in early life can prevent or treat asthma, obesity, or both.

PDF is at the bottom of this page


Food allergies in children 40 % more likely in urban areas (which have less vitamin D) – Sept 2012


Geographic Variability of Childhood Food Allergy in the United States
CLIN PEDIATR September 2012 vol. 51 no. 9 856-861
Ruchi S. Gupta, MD, MPH1,2; Elizabeth E. Springston, BA1; Bridget Smith, PhD3,4; Manoj R. Warrier, MD5,6; Jacqueline Pongracic, MD1,2; Jane L. Holl, MD, MPH1
1 Northwestern University Feinberg School of Medicine, Chicago, IL, USA
2 Children’s Memorial Hospital, Chicago, IL, USA
3 Loyola Stritch School of Medicine, Maywood, IL, USA
4 Edward Hines Jr VA Hospital, Hines, IL, USA
5 Saint Louis University School of Medicine, Saint Louis, MO, USA
6 Allergy, Asthma and Sinus Care Center, Saint Louis, MO, USA
Ruchi S. Gupta, Children’s Memorial Hospital, 2300 Children’s Plaza, Box 157, Chicago, IL 60640, USA Email: rugupta at childrensmemorial.org

Objective The aim of this study was to describe the distribution of childhood food allergy in the United States.

Methods A randomized survey was administered electronically from June 2009 to February 2010 to adults in US households with at least 1 child younger than 18 years. Data were analyzed as weighted proportions to estimate prevalence and severity of food allergy by geographic location. Multiple logistic regression models were constructed to estimate the association between geographic location and food allergy.

Results Data were analyzed for 38 465 children. Increasing population density corresponded with increasing prevalence, from 6.2% in rural areas (95% confidence interval [CI] = 5.6-6.8) to 9.8% in urban centers (95% CI = 8.6-11.0).

Odds of food allergy were graded, with odds in urban versus rural areas highest (odds ratio OR = 1.7, 95% CI = 1.5-2.0), followed by metropolitan versus rural areas (OR = 1.4, 95% CI = 1.2-1.5), and so on. Significance remained after adjusting for race/ethnicity, gender, age, household income, and latitude.

Conclusions An association between urban/rural status and food allergy prevalence was observed.


See also web


106+ Vitamin D Life pages with ALLERG in title

This list is automatically updated

Items found: 104
Title Modified
Vitamin D, mast cells, bones, and allergies - Aug 2022 01 Feb, 2024
Non-oral Vitamin D should be a better form for MS, food allergy, PTSD, etc. – many studies 26 Jan, 2024
Food allergies associated with low Vitamin D - many studies 02 Sep, 2023
Prevention of allergies, eczema, asthma, in children – Vitamin D during pregnancy is a principal solution – July 2023 21 Jul, 2023
Overview Rare Allergic reaction to vitamin D 15 Jul, 2023
People allergic to Lanolin should not be allergic to vegan Vitamin D 20 Mar, 2023
Allergic rhinitis sublingual therapy was 22X more successful if good level of Vitamin D – Feb 2023 15 Mar, 2023
Allergic to multiple foods: 4 in 10 kids, 5 in 10 adults (note: Vitamin D helps) - Dec 2022 06 Jan, 2023
Do you have symptoms of COVID, Flu , RSV, Colds, Allergy - Oct 2022 28 Oct, 2022
Small doses of Vitamin D do not reduce childhood breathing allergies – meta-analysis Oct 2022 18 Oct, 2022
Vitamin D reduces childhood allergic airway diseases (confirmed by metabolomics this time) – May 2022 26 May, 2022
Small vitamin D doses while pregnant do not decrease infant allergies – meta-analysis Feb 2022 03 Feb, 2022
Allergy medications may be improved by Vitamin D (6X for birch pollen in this case) – Aug 2021 21 Aug, 2021
Atopies (allergy, asthma, rhinitis, etc.) variously associated with low Vitamin D and poor Vitamin D Receptor – Aug 2021 04 Aug, 2021
Reasons why some Respiratory Allergy studies find that Vitamin D does not help much – June 2020 21 Jun, 2020
Found again – 400 IU of Vitamin D rarely provides any benefit (infant allergy in this case) – RCT June 2020 11 Jun, 2020
Breastfeeding a child without adding vitamin D increases risk of many food allergies (egg whites in this case) – Jan 2020 12 Jan, 2020
Antibiotics increased the risk of asthma by 47%, and allergies by 25% - Dec 2019 31 Dec, 2019
Childhood allergies (Atopy) 4.8 X more likely if low vitamin D in early pregnancy – Aug 2019 30 Aug, 2019
Allergic reactions to Insect sting decreased by topical Vitamin D (frequent) 09 Aug, 2019
6 year-old children were 5X less likely to have food allergies if supplementing with vitamin D – July 2019 24 Jul, 2019
Allergic Rhinitis in infants treated by 1,000 IU vitamin D daily – June 2019 23 Jul, 2019
Vitamin D appears to fight Diabetes, MS, RA, Lupus, IBD, Hepatitis, Cancer, Psoriasis, Food allergy, etc – June 2019 17 Jul, 2019
Pink eye (seasonal allergic conjunctivitis) associated with low vitamin D and high vitamin E – March 2014 14 Jul, 2019
Children with allergies often depressed and anxious (low micro-nutrients, such as vitamin D, were not mentioned) – July 2019 10 Jul, 2019
6X as many people with allergic rhinitis were severely vitamin D deficient – Jan 2012 30 Jun, 2019
Peanut and Food allergies prevented by Vitamin D 26 Jun, 2019
Food allergies in children may be due to earlier low Vitamin D, Omega-3 and Zinc – Aug 2017 24 Jun, 2019
Prevalence and Severity of Food Allergies Among US Adults (vitamin D is not mentioned) – Jan 2019 24 Jun, 2019
Prenatal Omega-3 somewhat reduced child allergies (should also reduce Omega-6) – RCT June 2018 17 Apr, 2019
Food allergy is linked to season of birth, sun exposure, and vitamin D deficiency – Jan 2019 24 Jan, 2019
Vitamin D and allergy, asthma, atopic dermatitis, food allergy, autoimmune... 145 slides- 2017 30 Dec, 2018
Allergy - Overview 18 Dec, 2018
Childhood Food Allergies (UK 1 in 14) – huge recent increase (low vitamin D) - Dec 2018 04 Dec, 2018
Soy associated with food allergies in mice (perhaps Roundup) – Nov 2018 21 Nov, 2018
Vitamin D and allergy, asthma, atopic dermatitis, food allergy, autoimmune, etc – slides May 2017 02 Jul, 2018
Hypothesis: Allergic diseases have increased because of decreased vitamin D – Oct 2014 01 Jul, 2018
Child Asthma increased 2.1 X by antibiotics, Child milk allergy increased 4.4 X by PPI – April 2018 02 Apr, 2018
Food allergies are associated with Vitamin D thru genes, etc. – March 2018 29 Mar, 2018
Allergic rhinitis in children reduced somewhat during pollen season by just 1,000 IU of vitamin D – RCT Jan 2018 31 Jan, 2018
Rare allergy to Vitamin D cured by progressive Desensitization - 2016 04 Nov, 2017
Milk – Vitamin D deficiency 2X more likely if lactose intolerant, milk allergy, or low fat milk – 2017 03 Nov, 2017
Hypothesis – Australia has highest rate of food allergy due to avoiding the sun – Sept 2015 07 Aug, 2017
Increased cows milk allergy if Folic acid or Folate added to vitamin D during pregnancy – June 2016 05 Apr, 2017
Infant allergy to cow’s milk will go away if have high levels of vitamin D – Jan 2017 19 Jan, 2017
Woman with rare allergy to vitamin D was desensitized in a single day – Dec 2016 21 Dec, 2016
Childhood allergy, asthma and eczema associated with repeated low vitamin D tests – Oct 2016 16 Dec, 2016
Hay fever (allergic rhinitis) risk reduced 20 percent for each 100 IU of vitamin D during early pregnancy – Feb 2016 23 Aug, 2016
Allergies and asthma – overwhelming experimental evidence that vitamin D helps – more studies needed – Dec 2014 03 Aug, 2016
Does too much Vitamin D cause problems – possible for allergies, maybe for falls – Review June 2016 26 Jun, 2016
Food allergies and low vitamin D – thymus may be the connection – June 2016 17 Jun, 2016
More childhood allergies when vitamin D is less than 15 ng – Feb 2011 17 Jun, 2016
3X more allergy to peanuts if child born with low UV – Feb 2011 17 Jun, 2016
Still unsure of association between vitamin D and asthma and allergies – review April 2012 17 Jun, 2016
Vitamin D and Allergic Disease: Sunlight at the End of the Tunnel – Dec 2011 17 Jun, 2016
Less sun (less vitamin D) more anaphylaxis (severe allergic reaction) – June 2014 17 Jun, 2016
Food allergy 12X more likely if low vitamin D and vitamin D binding gene problem – Aug 2015 17 Jun, 2016
Food allergies 6 times higher in South Australia - 2009 28 May, 2016
11X more non-immigrant children allergic to peanuts if vitamin D less than 20 ng – Feb 2013 17 Apr, 2016
Five times less mite allergy when vitamin D added in mid pregnancy and to infant – RCT April 2016 17 Apr, 2016
Increasing amount of omega-3 in mother’s milk resulted in fewer infant allergies – March 2016 04 Apr, 2016
New Zealand – new 50,000 IU vitamin D capsule has soy which can cause allergic reactions – March 2016 09 Mar, 2016
Photosensitivity (sun allergy) and vitamin D 26 Jan, 2016
Allergic to the sun (Polymorphic light eruption) – you may need UVB or vitamin D 26 Jan, 2016
Asthma associated with low vitamin D, independent of allergic status – Nov 2015 25 Nov, 2015
Allergic Rhinitis (hay fever) reduced by just 1,000 IU of vitamin D for 30 days – RCT Sept 2015 02 Nov, 2015
Low vitamin D at birth associated with later milk sensitization, allergic rhinitis and asthma – Nov 2014 22 Oct, 2015
Severe allergy (Anaphylaxis) is increasing and is associated with low vitamin D – Sept 2015 12 Sep, 2015
Huge increase in food allergies in Australia may be due to low vitamin D 05 Sep, 2015
Food allergy and low vitamin D – unsure – June 2013 02 Sep, 2015
Vitamin D, Vitamin A, or Vitamin E association with allergies and asthma – Feb 2012 22 Aug, 2015
Too much vitamin D: 1 pcnt increase in infants with food allergy, too little: 500 pcnt increase in children with food allergy - Aug 2015 16 Aug, 2015
High level of maternal vitamin D and infant food allergy – controversy 16 Aug, 2015
Immune modulation by Vitamin D, food allergy, chart of genes – July 2015 01 Aug, 2015
Allergic rhinitis associated with less vitamin D in men yet more in women – Jan 2014 05 Jul, 2015
Off topic: Large dose of Vitamin A increased allergic reaction in girls by 1.8X – RCT May 2015 02 May, 2015
Increase in vitamin D deficiency may partially explain increases in asthma and allergies – Jan 2015 06 Jan, 2015
Allergies and low vitamin D strongly associated with night shift bakers– Sept 2014 26 Dec, 2014
Allergy to House dust mite greatly reduced by adding just 600 IU of vitamin D – RCT Nov 2014 14 Sep, 2014
One issue of Inflammation and Allergy-Drug Targets has vitamin D items behind paywall– June 2013 03 May, 2014
30 to 40 ng of vitamin D associated with the least peanut allergy – Nov 2012 23 Apr, 2014
Perhaps wool allergy is the cause of some Vitamin D allergy 15 Apr, 2014
Being told you have allergies is associated with less than 10 ng vitamin D – Nov 2011 29 Jan, 2014
Vitamin D in Allergic and Immune Disorders - Nov 2013 18 Nov, 2013
Allergic rhinitis 56 percent more likely if low vitamin D – Nov 2013 23 Oct, 2013
Vitamin D supplements increased probability of allergic rhinitis by 66 percent - 2004 23 Oct, 2013
Is Vitamin D Supplementation Responsible for the Allergy Pandemic – May 2012 27 Jun, 2012
Food allergy 80 percent more likely if have certain genes and vitamin D deficient – Nov 2011 15 Jun, 2012
Vitamin D, Allergy, and genetics – June 2012 15 Jun, 2012
Vitamin D less than 15 ng associated with some allergies – Feb 2011 11 Jun, 2012
Crescendo of papers on Asthma, Allergy, and Vitamin D – Sept 2011 11 Jun, 2012
Allergic diseases in the elderly – Oct 2011 10 Jan, 2012
Vitamin D in asthma and allergy – editorial Dec 2011 05 Dec, 2011
Allergies and bone health may be connected by vitamin D – Sept 2011 31 Aug, 2011
Hypothesis - vitamin D supplements caused allergy pandemic – 2009 04 Aug, 2011
Are microbs – probiotics – vitamin D – allergy – asthma – obesity related – Mar 2011 20 Jul, 2011
Vitamin D and allergy to common mold - Aug 2010 27 Mar, 2011
2X more allergies if 11th womb week was in Spring – Vitamin D or pollen Oct 2010 20 Oct, 2010
Review of vitamin D asthma and allergic diseases – abstract lacks details July 2010 20 Aug, 2010
Mechanisms for hypothesis between sunshine and food allergy - July 2010 07 Aug, 2010
Vitamin D may be linked to food allergies by intestinal flora – July 2010 20 Jul, 2010
Speculation on elderly Food Allergies and Vitamin D – June 2010 17 Jun, 2010
Winter babies are more prone to food allergies 25 Apr, 2010
Low vitamin D newborns getting cows milk formula more likely to get allergies – RCT Oct 2019 No value for &#039;modification_date_major&#039;
Allergy - Overview        
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Attached files

ID Name Comment Uploaded Size Downloads
12521 Food allergies.jpg admin 22 Aug, 2019 50.26 Kb 4852
12520 Severity of Food Allergies Among US - 2019.pdf admin 22 Aug, 2019 344.77 Kb 1113
11198 RTI Meta.jpg admin 13 Jan, 2019 32.17 Kb 5872
11197 Food allergies and Vitamin D and genes.pdf admin 13 Jan, 2019 235.07 Kb 1230
11064 Seasonal allergies.jpg admin 18 Dec, 2018 34.00 Kb 5764
7821 Food allergy 2.2X MORE likely if high vitamin D - 2016.pdf admin 11 Mar, 2017 231.64 Kb 1563
7741 WAO Allergy.pdf admin 20 Feb, 2017 562.05 Kb 1878
4962 Food allergy.pdf admin 22 Jan, 2015 606.87 Kb 2765
4961 Food allergy appendix.jpg admin 22 Jan, 2015 20.47 Kb 12959
4960 Food F4B.jpg admin 22 Jan, 2015 22.58 Kb 13393
3108 Allergy association.jpg admin 08 Oct, 2013 44.74 Kb 14617
1215 Gut microbiota, probiotic-2011.pdf admin 06 Apr, 2012 148.37 Kb 4999