CURRENT ALLERGY & CLINICAL IMMUNOLOGY JOURNAL OF THE ALLERGY SOCIETY OF SOUTH AFRICA
Vol 36, No 3 September 2023
- BENCH AND BEDSIDE: UNITED FOR OPTIMAL PROGRESS AND PRACTICE
- The South African ACARE centre approach to recurrent angioedema without urticaria
- Lipid transfer protein syndrome in a South African paediatric patient
- Mannan-binding lectin deficiency in a child
- Updated map of the moisturiser landscape for atopic dermatitis in South Africa
- The intersection between air quality aerobiology and asthma in South Africa
- Occupational bird mite dermatitis (Gamasoidosis) among workers in a seed house
- Old whines and new throttles: Ethical gene editing for allergies and immunity
Authors: Jonny Peter, Tamara Kerbelker, Pieter de Waal
Abstract: Clinician-scientists navigate the intricate balance between two contrasting realms almost daily – a prospect that is both daunting and enthralling. In the morning, they confront a symptomatic patient, surrounded by a myriad potential differentials and tenfold more underlying molecular pathways to disease. Yet, amid this complexity, a definitive plan is required. A treatment decision must be made, selecting from available drugs, often opting between compounds with multifaceted or poorly elucidated molecular mechanisms. In the afternoon, there may be a deep dive into an immunology dataset – often a culmination of years of arduous labour from dedicated researchers.
Authors: Jonny Peter, Theresa Rossouw
Abstract: We are thrilled to be welcoming everyone to the ALLSA/SAIS 2023 joint meeting, taking place in the captivating city of Cape Town. This meeting is an exciting preamble only a few months before we host the prestigious International Union of Immunological Societies (IUIS) 2023 meeting, scheduled from 27 November to 2 December 2023 at the CTICC. Our congress promises a rewarding blend of invaluable clinical insights and robust, locally relevant immunological data.
THE SOUTH AFRICAN ACARE CENTRE APPROACH TO RECURRENT ANGIOEDEMA WITHOUT URTICARIA
Authors: Cascia Day, Jonny Peter
Abstract: Angioedema is the most common adult allergy presentation at two Cape Town emergency centres. Our tertiary hospital ACARE centre consults 2–3 new referrals a week, with a high burden of angioedema without urticaria. Many practitioners feel comfortable with the work-up of possible mast-cell-mediated angioedema, which occurs together with urticaria. However, the diagnostic work-up, the availability of certain specialised testing – for example, functional C1-INH testing – and the increasing use of treatment trials is less familiar. In this article we present two cases of recurrent angioedema without urticaria which highlight the differences between bradykinin-mediated and mast-cell phenotypes and the way this has an impact on diagnosis and management. We also present an integrated algorithm that is employed at our South African ACARE centre.
Keywords: angioedema, recurrent angioedema without urticaria, bradykinin-mediated phenotypes, mast-cell phenotypes
UPDATED MAP OF THE MOISTURISER LANDSCAPE FOR ATOPIC DERMATITIS IN SOUTH AFRICA
Authors: Stephanie Newman, Thabiso Ndlovu, Kelly Botha, Michael Levin, Carol Hlela, Rannakoe Lehloenya, Jonny Peter
Abstract: Atopic dermatitis is a chronic skin condition associated with a dysfunctional skin barrier that is associated with increased trans-epidermal moisture loss and a reduced water-binding capacity. Daily moisturiser use is recommended as a cornerstone treatment of atopic dermatitis across the disease severity spectrum. Successful moisturiser therapy is what the patient or caregiver will use daily but there are considerable differences in patient preference. New products appear regularly and their costs range widely, making it difficult for healthcare practitioners and patients to understand and compare the available products. In 2018, to address this need, we developed the first edition of the South African Moisturiser Prescriber, which was well received. The aim of this study was to update this prescriber and again survey the landscape of leave-on moisturisers marketed for use by persons with atopic dermatitis. We intended to provide a reliable, easy-to-use resource for atopic dermatitis patients and their providers. We used a similar methodology as in 2018 and, in addition, had support from the Allergy Foundation of South Africa. Seventy-eight products were included to create the second edition of the South African moisturiser prescriber. Median (range) cost per gram was R0.60 (R0.08–R5.37) and the total number of ingredients was 13 (1–36).
LIPID TRANSFER PROTEIN SYNDROME IN A SOUTH AFRICAN PAEDIATRIC PATIENT: A CASE REPORT
Authors: Hilary D Andoh, Michael Levin
Abstract: Lipid Transfer Protein (LTP) syndrome refers to a complex clinical pattern in which affected individuals have allergies to multiple plant foods due to cross-reactions between botanically unrelated pollens and plant foods that contain LTPs. Pollens and plants containing LTPs include mugwort, plane and olive pollens, and peach, apricot and walnut respectively. Published reports of LTP syndrome are few in the paediatric population in non-Mediterranean regions.
Keywords: Lipid Transfer Protein syndrome, cross-reactivity, cross-sensitisation
MANNAN-BINDING LECTIN DEFICIENCY IN A CHILD: IS IT A THING OR NOT?
Authors: Boitumelo Pitso, Chantal Pillay, Pieter de Waal
Abstract: MBL is critical in activating the lectin pathway of the complement system. MBL deficiency remains a contentious issue in clinical practice, mainly because low MBL levels may present in completely asymptomatic individuals. However, in some cases, symptomatic patients may present with susceptibility to infections and even immune dysregulation. Infections may range from mild to severe, and may even be life-threatening and fatal. A significant number of patients may remain undiagnosed, merely because interrogating complement function is often postponed until after presumably more common immune problems have been excluded in patients with severe, recurrent or unusual infections. In addition, clinicians are less familiar with the clinical recognition and appropriate choice of special investigations necessary to diagnose MBL and other complement deficiencies. Our case report describes a young girl with a serious underlying inborn error of immunity. She initially presented with recurrent ‘innocent’ and mild infections. We illustrate that clinically relevant MBL deficiency, if undiagnosed, may have disastrous consequences. We also stress the importance of careful interpretation of MBL quantitative laboratory values and the urgent need for access to more specialised complement-component and genetic testing, especially for patients attending state healthcare facilities.
Keywords: Mannan-binding lectin, complement, complement pathways, complement deficiency, inborn errors of immunity
THE INTERSECTION BETWEEN AIR QUALITY AEROBIOLOGY AND ASTHMA IN SOUTH AFRICA – COULD GREEN SPACES HELP?
Authors: Dorra Gharbi, Aneesa Vanker, Rebecca M Garland, Jonny Peter
Abstract: Global and South African populations continue to increase exponentially, with large flows of persons into urban centres. Urban air quality and bioaerosol are therefore becoming an increasingly important consideration in the face of a growing burden of allergic respiratory diseases. More than 20% of South Africans have asthma, with morbidity being disproportionately high compared to high-income countries (HICs). Air pollutants (particularly particulate matter and ozone), pollen and fungal spores are known triggers and exacerbating factors in asthma and, alarmingly, the levels of air pollutants remain high in hotspot areas despite robust air-quality legislation in South Africa. The concern is that genetically and environmentally vulnerable children in low- and middle-income countries (LMICs) such as South Africa will have asthma triggered and exacerbated disproportionately by poor air quality. Urban green areas are increasingly being recognised by many stakeholders as important possible mitigation tools. However, multiple factors must be considered for having an optimal green space design. In this review, we bring together experts across the fields of health, air quality and aerobiology to outline the intersection between asthma and air quality and/or aerobiology in South Africa. We highlight the importance of careful multidisciplinary green space design as a possible healing tonic. We conclude that detailed studies combining air quality, pollen dispersal and health issues are needed to derive more precise exposure–response functions of the green spaces in South Africa and other LMICs.
Keywords: air quality, green spaces, respiratory health, aerosols
Allergies in the Workplace
OCCUPATIONAL BIRD MITE DERMATITIS (GAMASOIDOSIS) AMONG WORKERS IN A SEED HOUSE
Authors: Zahida Sonday, Gail Todd, Mohamed F Jeebhay
Abstract: Among the occupational skin diseases, bird mite dermatitis (gamasoidosis) is an infrequent and under-reported condition. A report is presented of a group of workers employed in a habitat restoration centre who developed episodes of pruritus and skin rashes associated with bird mites. The mite bites resolved approximately two weeks after each episode, without specific medical intervention and despite ongoing work activities. A workplace health-risk assessment and microscopic analysis of ‘swabs’ of the work environment aided the identification of bird mite as the causative agent. The source of the bird mites was infested red-winged starlings nesting in the roof of the workplace facility. Incidents of gamasoidosis as described are considered occupational dermatoses since they were acquired in the workplace and the diagnosis was based on clinical–parasitological analysis. When diagnosing gamasoidosis, the clinical history and physical examination provide useful clues, but the clinical features of skin lesions of arthropod or other insect bites are very similar. Microscopic detection of the mite is confirmatory.
Keywords: bird mite dermatitis, avian mite dermatitis, gamasoidosis, occupational mites, arthropod reaction
OLD WHINES AND NEW THROTTLES: ETHICAL GENE EDITING FOR ALLERGIES AND IMMUNITY
Author: David Benatar
Abstract: New gene editing technologies are thought to raise novel ethical problems. However, the ethical issues that arise in the context of gene editing are familiar ones, albeit manifesting in a new, invigorating guise. In this paper I first examine some common but spurious objections to gene editing, before considering the real issues and arguing how we should think about them.
Keywords: Ethics, gene editing, harm-benefit, professionalism moral status
DR SPUR’S MYSTERY CASE
PRIMARY IMMUNODEFICIENCY DISORDERS
Authors: Lizelle Nagel, Sylvia van den Berg, André van Niekerk
Abstract: Recurrent or chronic infection with Giardia lamblia is certainly a red flag. While recurrent giardiasis may be associated with travel, daycare centre attendance, contaminated water and food sources, institutionalisation, and socio-economic deprivation, it is also one of the sentinel organisms associated with inborn errors of immunity (IEI).
ABC OF ALLERGY
Authors: Shaunagh Emanuel, Di Hawarden
Abstract: Dr Do-a-lot is flummoxed, and refers a patient with a polymorphic, maculo-papular rash to her dermatologist colleague for evaluation. The report surprises her with a diagnosis of guttate psoriasis, and so she revisits her understanding of the condition.