CURRENT ALLERGY & CLINICAL IMMUNOLOGY JOURNAL OF THE ALLERGY SOCIETY OF SOUTH AFRICA
Vol 35, No 2 June 2022
- Emollients – latest and greatest uses in atopic dermatitis
- Treating atopic dermatitis with topical glucocorticosteriods
- Therapeutic patient education in atopic dermatitis
- Targeting interleukin 4 receptor alpha in atopic dermatitis
- Emerging targeted therapies for atopic dermatitis
- ‘Just chill!’ – Cold urticaria: a South African perspective
- GA²LEN ADCARE – Responding to the need for ongoing education in atopic dermatitis
- Contact dermatitis in a cosmetologist
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Authors: Jonny G Peter
Abstract: Atopic dermatitis (AD) or eczema is common and is frequently the earliest manifestation of atopic disease. AD affects children and adults in all population groups. It is a chronic disease with a wide range of severity, from mild to life-threatening; its morbidity has a profound negative impact on all domains of life quality.
EMOLLIENTS – LATEST AND GREATEST USES IN ATOPIC DERMATITIS
Authors: Carol Hlela, Beauty Osei-Sekyere, Akua Yeboah Senyah1
Abstract: Moisturisers improve the barrier function of the stratum corneum by providing it with water and lipids. They therefore form the cornerstone in atopic dermatitis therapy and should be included in management plans. They are important components of both active treatment, maintenance and the prevention of atopic dermatitis flares. A number of studies have shown that they reduce symptoms and signs of atopic dermatitis, including pruritus, erythema, fissuring and lichenification. It is important to recognise, though, that not all moisturisers are the same. As a result, the prescriber should be guided by clinical need, affordability, availability and informed patient choice.
Keywords: emollients, atopic dermatitis, moisturisers, atopic eczema, dry skin, stratum corneum
TREATING ATOPIC DERMATITIS WITH TOPICAL GLUCOCORTICOSTEROIDS
Authors: Lindinkululeko J Nkehli, Rannakoe J Lehloenya
Abstract: Topical glucocorticosteroids (TCS) and emollients are the mainstay of treatment for atopic dermatitis (AD). In AD, TCS are used to relieve symptoms, manage acute flares and increase the intervals between flares. When they are used appropriately, they are both safe and effective. In cases of severe disease they may be combined with systemic therapies. The appropriate use of the correct TCS is important in optimising efficacy while at the same time limiting adverse effects. Important factors to consider before initiating TCS for AD are: potency, the delivery vehicle, the frequency of application, the duration of treatment, the patient’s age and the body surface area to be treated. The correct application of a sufficiently strong TCS for long enough are requirements for optimal outcomes in the management of AD. In order to achieve this, it is necessary to have a basic understanding of the way in which TCS work, how to use them while maximising their benefits and minimising their well-known adverse effects.
Keywords: topical glucocorticosteroids, atopic dermatitis
THERAPEUTIC PATIENT EDUCATION IN ATOPIC DERMATITIS
Author: Susanna MH Kannenberg
Abstract: The successful management of chronic diseases such as atopic dermatitis relies greatly on adherence to treatment. The likelihood of adherence requires much more than a simple transfer of knowledge: a change in individuals’ behaviour towards health is needed. One of the critical components of this change is therapeutic patient education. This form of education is an evolving concept: it aims to empower patients and their caregivers with the knowledge and skills to be able to manage disease autonomously. Despite the obvious challenges, this Darwinist approach to healthcare should be embraced in medicine, and in particular in the care of atopic dermatitis patients, in order to ensure an improvement in patients’ (and their caregivers’) quality of life.
Keywords: atopic dermatitis, eczema, self-management, education, adherence
GA²LEN ADCARE – RESPONDING TO THE NEED FOR ONGOING EDUCATION IN ATOPIC DERMATITIS FOR HEALTHCARE PROVIDERS GLOBALLY AND CURRENTLY IN SOUTH AFRICA
Authors: Ingrid van Hofman, Katarina Stevanovic, Cathrin Meesch, Antonella Muraro, Nikolaos G. Papadopoulos, Marcus Maurer, Carsten Bindslev-Jensen, Jonny Peter, Giorgio Walter Canonica, Torsten Zuberbier
Abstract: Effective continuing education in dermatology for healthcare providers can be supported by various measures such as literature, webinars, online tools and lectures. The Global Allergy and Asthma European Network (GA²LEN) has developed a compact training programme on allergic diseases, including but not limited to atopic dermatitis, alopecia areata, allergic rhinitis, asthma, pruritus, angioedema, urticaria and anaphylaxis and food allergy. In this article we present the impact of and argue for the continuing need for GA2LEN training programmes on the basis of a review of data from the past six global educational programmes. These data indicate the efficacy of ongoing education and the updating of healthcare professionals’ knowledge and the need for continuing education in South Africa.
Keywords: education, atopic dermatitis, alopecia areata, training programme, GA²LEN ADCARE
TARGETING INTERLEUKIN 4 RECEPTOR ALPHA IN ATOPIC DERMATITIS – FOCUS ON PRECLINICAL MODELS
Authors: Sabelo Hadebe, Frank Brombacher
Abstract: Skin is the largest organ of the human body, which means it is in the first line of defence in protecting its host from external agents such as bacteria, fungi, viruses and other infectious agents. What shapes a healthy skin micro-environment is direct contact of skin-resident commensals with structural cells such as keratinocytes and resident immune cells that help maintain the integrity of the barrier. Environmental stressors can dysregulate this tightly regulated balance between skin-resident microbiota and immune cells that protect the skin, causing aberrant inflammatory conditions. Genetic predisposition is another factor that influences this skin-microbiota dysregulation and it is observed in conditions such as atopic dermatitis (AD) or psoriasis. How immune cells help maintain this skin barrier is of significant interest, particularly for therapies that may be directed at the host. Recent studies put Type-2 immunity at the centre in immune-cell-driven skin resolution, repair after injury and pathogenesis during immune dysregulation. Interleukin receptor alpha (IL-4Rα) is central to Type-2 immunity and is a target for many inflammatory conditions of the skin, such as AD. In this review, we discuss IL-4Rα immunity, genetics and signalling in the context of pre-clinical models of AD.
Keywords: skin, IL-4Rα, bacteria, type 2 responses, infections
EMERGING TARGETED THERAPIES FOR ATOPIC DERMATITIS IN THE SOUTH AFRICAN CONTEXT
Authors: Bianca M Tod, Willem I Visser
Abstract: Atopic dermatitis (AD) is a potentially debilitating condition, due to its negative effects on quality of life. Traditional treatments should be initiated in AD patients primarily. Unfortunately, current algorithms fail to offer reliable, targeted, safe and acceptable options to all AD patients. An improved understanding of AD pathogenesis and the increasingly targeted drugs the pharmaceutical industry is able to design, have resulted in a multitude of new investigational therapies for AD. Several novel therapeutic targets are being exploited. Only two agents, out of more than 70 in the pipeline, are currently relevant in the South African context. The first is dupilumab, a subcutaneously administered biologic which blocks IL-4 and IL-13, relevant to adaptive immune-system dysfunction in AD. Dupilumab is registered in South Africa and is currently being used in adult AD patients with moderate-to-severe disease, who do not respond to standard therapies. Dupilumab has demonstrated good efficacy and safety in both clinical and real-world studies. It is a financially costly treatment option. The second agent is upadicitinib, a JAK inhibitor currently undergoing the registration process. Hopefully, South African patients with AD will be able to benefit from the range of novel therapeutic strategies in the near future.
Keywords: atopic dermatitis, treatment, biologics, dupilumab, Janus kinase inhibitors
‘JUST CHILL!’ COLD URTICARIA: A SOUTH AFRICAN PERSPECTIVE
Authors: Cascia Day, Jonny G Peter
Abstract: Cold urticaria is a rare but potentially life-threatening disease that is part of the chronic inducible urticarias. Unfortunately, the diagnosis is often delayed as clinicians need to have a high level of suspicion in order to diagnose and test for this condition. In this article we provide a brief overview of the topic and discuss patients in a South African context. We also highlight the risk factors for cold anaphylaxis (angioedema, acral swelling, oropharyngeal symptoms, earlobe itch and previous systemic reaction to Hymenoptera venom) as these are high-risk patients who require a prescription for adrenaline, an anaphylaxis plan and education about avoiding cold.
Keywords: cold urticaria, chronic inducible urticarias, high-risk patients
TREATMENT OF ATOPIC DERMATITIS IN CHILDREN – ETHICAL CONSIDERATIONS
Author: Sharon Kling
Abstract: Corticosteroid phobia (‘corticophobia’) is fairly common in allergy practice. In atopic dermatitis (AD) parents fear that topical corticosteroids cause thinning of the skin, and often use complementary and alternative medicine (CAM) instead of or in conjunction with conventional medicine. This article describes a case in Australia where parents were found criminally negligent after their nine-month-old daughter died from septicaemia because of untreated AD. Ethical and legal aspects of CAM are discussed.
Keywords: atopic dermatitis, treatment, children, corticophobia
ALLERGIES IN THE WORKPLACE
CONTACT DERMATITIS IN A COSMETOLOGIST AND THE RAMIFICATION OF OCCUPATIONAL AND NON-OCCUPATIONAL EXPOSURES IN DISEASE PROGNOSIS
Authors: Anna Fourie, Tanusha Singh
Abstract: Cosmetologists may specialise in different types of beauty treatment, including hairdressing, the application of cosmetics, manicures or pedicures (including nail adornment) and body massage therapy. In this case, a 27-year-old cosmetologist with work-aggravated contact dermatitis is discussed. She developed severe contact dermatitis of the hands. The case illustrates the challenges in determining whether the condition is occupational or work-aggravated, which is important in limiting exposure to the causative agents. As the reactions were around her fingernails and on her fingers and she worked with hairdressing chemicals, the patient was asked to submit herself to testing to determine whether she was sensitised to the chemicals used in hairdressing and/or nail treatment or adornment processes. Using both hairdressing and meth(acrylate) series of patches, patch tests were done to determine whether the hairdressing products she used regularly and/or the acrylate-based nail products, which are applied to both her clients’ and her own nails, were the causative agents. Sensitisation to substances from both series was detected and the chemicals were found in both the products used in the workplace and those for personal use. The importance and the complexity of managing patients with both occupational and non-occupational exposures are highlighted in this study.
Keywords: cosmetologist, hairdressing, contact dermatitis, occupational exposure, non-occupational exposure
ABC OF ALLERGIES
SKIN MANIFESTATIONS OF ADVERSE REACTIONS TO MEDICATIONS
Authors: Shaunagh Emanuel, Di Hawarden
Abstract: Jim wriggles out of his rash vest after a long session in the waves at Muizenberg. He is alarmed to find that the sun-exposed areas of his body have turned a ruddy red, but his torso is unaffected. He visits Dr Do-a-lot who discovers that he has recently started a course of doxycycline (a tetracycline antibiotic) for his mild acne. She diagnoses a photosensitivity reaction. Skin manifestations are the commonest presentation of adverse reactions to medications. Any medication can cause a skin rash, but some types of drugs (like antibiotics, opioids, NSAIDs, chemotherapeutic agents, psychotropic medications, and anticonvulsants) tend to cause them more often than most.
DR SPUR’S MY STERY CASE
THE CASE OF THE CHILD WHO IS ALWAYS SICK
Authors: Sylvia van den Berg, Cathy van Rooyen, André van Niekerk
Abstract: Thank you for asking this very important question – it’s one of many with which your clinical colleagues struggle. The diagnosis of inborn errors of immunity is not always easy, especially among the many sick children general practitioners and paediatricians see in daily practice. These children can present with very common and non-specific complaints. Unless children are severely affected, the question always arises: When should I start investigating? Which tests should I request initially and when can I safely stop investigating?