CURRENT ALLERGY & CLINICAL IMMUNOLOGY JOURNAL OF THE ALLERGY SOCIETY OF SOUTH AFRICA
Vol 35, No 4 December 2022
- Allergic rhinitis in children
- Non-allergic rhinitis
- Nasal allergen-provocation testing
- Pollen food allergy syndrome (PFAS)
- Occupational skin disease associated with personal protective equipment
- The Protection of Personal Information Act (POPIA) and the Promotion of Access to Information Act (PAIA)
Authors: Dr Pieter de Waal
Abstract: Spring has sprung! This is generally a joyous time of the year when people spend more time outdoors appreciating the full blossom and bloom of nature. Unfortunately, it can also be a ‘troublesome’ season for many individuals with respiratory allergies, especially if they suffer from allergic rhinitis (AR). This condition is recognised as the most common allergic disease globally and significantly affects the quality of life (QoL) of both adults and children. AR is also associated with serious complications and co-morbidities, and by far, not a benign disease. Furthermore, the complications of sensitisation to pollen from grasses, trees and weeds may extend beyond the respiratory tract and may manifest as the Pollen–Food Allergy Syndrome (PFAS). This condition is responsible for a significant number of patients’ reporting ‘new’ food allergies and, in some instances, it may even cause fatal allergic reactions.
ALLERGIC RHINITIS IN CHILDREN: COMPARING SOUTH AFRICAN RECOMMENDATIONS AND EUROPEAN GUIDELINES
Authors: Marinda McDonald, Pieter J de Waal
Abstract: Allergic rhinitis (AR) is a common condition that affects children from a very young age. It is often misdiagnosed as viral rhinosinusitis and erroneously treated with first-line over-the-counter medication, which will not only be ineffective, but may also lead to medication side-effects. Untreated AR can lead to serious complications. Trigger identification can be done using skin-prick testing and serum IgE-measurement – but this should be performed early. However, in certain emerging AR phenotypes – for example, local allergic rhinitis (LAR) – these procedures may have negative results and a nasal allergen challenge should be performed. This review aims to highlight some basic principles of diagnosing, investigating and treating AR in South African children and to compare existing South African guidelines with recently published European guidelines. Early aeroallergen immunotherapy has a disease-altering effect on the natural course of AR, but access to this treatment option is unfortunately too expensive for most patients in South Africa. It is time for health authorities and stakeholders to realise that immunotherapy is more cost-effective than pharmacotherapy in treating this debilitating chronic disease which often seriously interferes with a patient’s quality of life.
Keywords: rhinitis, allergy, immunotherapy, EUFORIA, SAARWG
Author: Tamaryn Daniller
Abstract: Non-allergic rhinitis (NAR) is a chronic highly prevalent condition presenting with symptoms of nasal congestion and obstruction and rhinorrhoea in the setting of a negative allergen test. NAR is more common in females and older individuals, typically those 30–60 years of age. The symptoms tend to be perennial rather than seasonal and may negatively affect quality of life. There is a strong association with obstructive sleep apnoea (OSA), rhinosinusitis, chronic fatigue and cognitive impairment. The diagnosis of NAR may be challenging owing to non-specific symptoms and a lack of definitive diagnostic tests. Uncertain underlying pathophysiology and variably effective therapeutic measures may complicate management further.
Keywords: non-allergic rhinitis, vasomotor rhinitis, non-allergic rhinitis with eosinophilia syndrome, local allergic rhinitis, non-allergic non-infectious rhinitis
NASAL ALLERGEN-PROVOCATION TESTING: A DIAGNOSTIC TOOL IN THE INVESTIGATION OF CHRONIC RHINITIS
Author: Werner Hoek
Abstract: Chronic rhinitis represents a group of conditions with inflammation of the nasal mucosa that develop from underlying pathogenesis of different kinds. Current biomarkers used to diagnose atopy (skin-prick testing and serum-specific IgE testing) are used to divide chronic rhinitis into allergic and non-allergic groups. These tests present some limitations in identifying a responsible allergen in multi-sensitised individuals. They also fail to identify the local allergic rhinitis phenotype. The nasal allergen-provocation test helps with the diagnosis and management of chronic rhinitis patients. This test is, however, under-used in South Africa. This article summarises recent attempts to standardise the test to improve ease of use in clinical practice.
Keywords: nasal allergen-provocation test, chronic rhinitis, local allergy rhinitis
POLLEN–FOOD ALLERGY SYNDROME (PFAS)
Author: Mariana Lloyd
Abstract: Secondary food allergies due to cross-reactivity between pollen and plant food allergens are a significant and increasingly global health issue. The term ‘pollen–food allergy syndrome’ (PFAS) defines a series of clinical symptoms in pollen-sensitised patients after the ingestion of plant-derived food. The symptoms of PFAS range from localised oral symptoms to severe systemic reactions. The exact prevalence of PFAS is uncertain for various reasons, including a wide geographical distribution and the lack of standardised population-based studies. Three highly conserved protein classes responsible for most PFAS cases are the profilin, the pathogenesis-related protein group 10 (PR-10) and non-specific lipid transfer proteins (nsLTPs). It has been postulated that climate change, pollution and agricultural practices may increase the expression of these and other defence proteins in plants, causing an increase in allergen load exposure. With advances in component-resolved diagnostic testing, the role of these other allergens can now be revealed. The diagnosis of PFAS is multifaceted and includes a comprehensive clinical history focusing on inhalant allergy and potential cross-reactivities combined with different in vitro and in vivo tests. A better understanding of the cross-reacting allergens and their characteristics may create an awareness of this allergy syndrome essential to managing such patients correctly.
Keywords: cross-reactivity, inhalant allergens, food allergy, pollen-food allergy syndrome, pollinosis
ALLERGIES IN THE WORKPLACE
OCCUPATIONAL SKIN DISEASE ASSOCIATED WITH PERSONAL PROTECTIVE EQUIPMENT: A CASE SERIES
Authors: A Fourie, M Muvhali, H Carman, T Singh
Abstract: Personal protective equipment (PPE) should be the last-used, hazard-control measure in the workplace; however, it is still the first consideration as a protective measure in many workplaces. The conundrum is that despite its critical role in protecting workers from various exposures, adverse skin conditions can present in some individuals. As the skin condition may progress to a chronic course with an unfavourable prognosis, this case series highlights the importance of diagnosing occupational dermatitis associated with various types of PPE. This is in order to inform risk-based preventative management to protect the worker and sustain work activity. A retrospective review of patients who visited the occupational dermatology clinic from September 2005 to May 2022 was performed. Patients who used PPE were further assessed to determine the type of adverse reactions and causative agents. A total of 36 records of interest were retrieved and analysed further. Allergic (16/36, 44%) and irritant contact dermatitis (13/36, 36%) were the most common diagnoses made. Adverse reactions to gloves (various types) were the most prevalent (25/36, 69%), followed by shoes at 17% (6/36). The majority of cases were from the healthcare industry (24/36, 66%), followed by manufacturing (5/36, 14%) and mining (4/36, 11%). The data for provinces were skewed, with most patients from Gauteng (30/36, 83%), Mpumalanga (4/36, 11%) and Limpopo (2/36, 6%). This study highlights the importance of recognising and diagnosing skin conditions attributed to PPE and emphasises the value of patch-testing to identify putative agents. This informs the process of identifying appropriate alternative PPE for sensitised workers in ensuring their continued safety while on duty.
Keywords: contact dermatitis, skin rash, prevention and control, health and safety, extended use
THE PROTECTION OF PERSONAL INFORMATION ACT (POPIA) AND THE PROMOTION OF ACCESS TO INFORMATION ACT (PAIA): IT IS TIME TO TAKE NOTE
Author: Pieter J de Waal
Abstract: The Protection of Personal Information Act (POPIA) and the Promotion of Access to Information Act (PAIA) govern the way that businesses collect, store, access and destroy personal client information in a safe and secure manner. The initial deadline for businesses to comply with these Acts was 1 July 2021. Patient information kept at medical practices does not only include personal details, but the nature of this may also be extremely sensitive and intimate. These Acts will therefore also affect members of the medical fraternity. All medical practices and hospitals, regardless of size, are required to be POPIA and PAIA compliant. Medical professionals are strongly advised to familiarise themselves and to comply with these Acts, as serious consequences may arise if a practice or institution is found guilty of non-compliance.
Keywords: POPIA, PAIA, HPCSA, ethics, law.
ABC OF ALLERGIES
Authors: Shaunagh Emanuel, Di Hawarden
Abstract: Dr Do-a-lot presents a case of facial swelling to her students. She describes a 42-year-old woman, Mrs Puffy, on treatment for cardiomyopathy, who visits her cardiologist with a three-month history of facial swelling and hoarseness that is severe in the morning and improves over the course of the day. The cardiologist refers the patient to Dr Do-a-lot for assessment of angioedema and possible drug allergy. Mrs Puffy is not on an angiotensin converting enzyme (ACE) inhibitor, but she has been taking angiotensin receptor blockers (ARBs) for a few years.
DR SPUR’S MYSTERY CASE
NEW SYMPTOMS IN A PATIENT WITH SELECTIVE IGA DEFICIENCY
Authors: Carla van Heerden, Sylvia van den Berg, André van Niekerk
Abstract: Dear Dr Spur, a seven-year-old Caucasian girl known to my practice was diagnosed with selective IgA deficiency (sIgAD) two years ago, after recurrent episodes of sinopulmonary infections. Her serum IgA level at the time was <0.07 g/L, with normal IgG and IgM levels and normal vaccine antibody responses. Other causes of IgA deficiency were excluded. She has been doing well on seasonal prophylactic antibiotics and remained infection-free for a year. However, over the past few months her mother noticed frequent episodes of sneezing and a persistent nasal discharge.
ALLSA 2022: ALLERGIES – BEHIND THE MASK
Author: Prof Jonny G Peter
Abstract: Unmasked! That could easily have been the theme for ALLSA 2022, for there’s no doubt that we all really enjoyed being together again in person after two years! Not to speak of the range of topics we came face to face with at this year’s congress. This thanks to the fact that the organising committee packed the programme to ensure the maximum flow of knowledge and academic interactions. However, it became clear that the breaks between sessions were simply not long enough for all the reconnecting and networking that we all so earnestly yearned for this year. Proof of which was that the exhibition hall was constantly abuzz with animated conversations and big smiles, even among the introverts.