CURRENT ALLERGY & CLINICAL IMMUNOLOGY JOURNAL OF THE ALLERGY SOCIETY OF SOUTH AFRICA
Vol 37, No 3 September 2024
- Adolescent asthma in South Africa
- Central compartment atopic disease
- A descriptive study of children admitted with acute severe asthma to a tertiary hospital in Johannesburg, South Africa
- Chronic beryllium disease
- Pinpoint popular polymorphous light eruption in an
- HIV-positive patient with resolved discoid lupus erythematosus
- Should we respect patient autonomy at all costs?
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GUEST EDITORIAL
Author: Ahmed Ismail Manjra
Abstract: It has been an honour and privilege to be the Guest Editor of this issue of the Current Allergy and Clinical Immunology Journal. Over the years, the editors, Prof Eugene Weinberg and Dr Di Hawarden, have maintained a very high standard in the quality of the articles published in the journal. It is therefore a daunting task to maintain the high quality of this publication.
REVIEW ARTICLE
ADOLESCENT ASTHMA IN SOUTH AFRICA: A CURRENT OVERVIEW OF RISK FACTORS, BARRIERS TO CONTROL AND RESEARCH PRIORITIES
Authors: R Mphahlele, R Masekela
Background: South Africa has the highest adolescent asthma prevalence in Africa. Previous studies have found that the prevalence, risk factors and outcomes of asthma in adolescents vary with location and socio-economic factors.
Methods: A narrative review of the literature was carried out on the prevalence, risk factors and outcomes of asthmatic adolescents in South Africa, with a focus on research gaps and priorities.
Results: A variety of epidemiological asthma research has been conducted in South Africa; however, generalisable and comparable data have been generated by studies using the Global Asthma Network (GAN) survey and these show a high prevalence of asthma in adolescents (ranging from 13.7% in Durban to 20.3% in Cape Town). As in other sub-Saharan countries, a large proportion of adolescents have severe asthma without a diagnosis and no access to appropriate medication in the form of inhaled corticosteroids. Risk factors for asthma in South African adolescents are modifiable and related mainly to lifestyle and environmental exposures. Research on indoor and outdoor air pollution shows that these risk factors play a significant role in asthma outcomes, although there are only a few of these studies. Barriers to asthma control are patient-, healthcare- and disease-related, and qualitative research highlighting the perceptions and attitudes of those affected by asthma may assist in the co-development of tailored interventions to improve outcomes.
Conclusion: Reducing the burden of asthma in South Africa will require a concerted effort towards prevention through a reduction in exposure, education about asthma, improved access to diagnosis and quality-assured medicines, and improved capacity in asthma diagnostics and clinical trials in children.
Keywords: adolescent asthma, prevalence, asthma education
Research article
A DESCRIPTIVE STUDY OF CHILDREN ADMITTED WITH ACUTE SEVERE ASTHMA TO A TERTIARY HOSPITAL IN JOHANNESBURG, SOUTH AFRICA
Authors: Samuel Otido, Debbie A White
Abstract: The prevalence of asthma is high and the incidence is increasing significantly in Africa. Cases of severe exacerbations of asthma are managed as inpatients and are often used as indicators of asthma care. There is a paucity of data regarding hospitalised paediatric asthma cases in low- and middle-income countries (LMICs). This retrospective study describes the clinical presentation of children admitted to Charlotte Maxeke Johannesburg Academic Hospital in Johannesburg, South Africa, with asthma, and the association, if any, with intensive care unit (ICU) admission. Medical records between the years 2015 and 2020 were reviewed, revealing 134 admissions, with eight children being admitted to the ICU. The median age was four years (IQR 3,7) and the median duration of stay was four days (IQR 4,6). 66% of the children admitted were aged 1–5 years; 52.5% of the admissions were male. Allergic rhinitis was the most common associated comorbidity, at 42.4%. Most children presented with subcostal retractions (88.8%) and hypoxia (74.2%). Two children died from asthma complications. Children who had a known asthma diagnosis at the time of admission were more likely to have been readmitted than those who did not have a prior asthma diagnosis (p = < 0.001). Previous asthma hospitalisation was associated with ICU admission (p = 0.041). Most admissions occurred during the summer months. The trend in hospitalised asthma cases declined over the study period and paediatric asthma mortalities were rare. Further studies are needed to assess risk factors for paediatric asthma hospitalisation, especially in LMICs.
Keywords: hospitalised paediatric asthma case, acute severe asthma, asthma exacerbation, allergic rhinitis
Review article
CENTRAL COMPARTMENT ATOPIC DISEASE: AN EMERGING NEW PHENOTYPE OF CHRONIC RHINOSINUSITIS
Author: Riaz Y Seedat
Abstract: Central compartment atopic disease (CCAD) is a subtype of chronic rhinosinusitis with nasal polyps in which there are polypoid changes of the middle turbinate, superior turbinate and/or posterosuperior nasal septum which result from inhalant allergy. Oedema and polypoid changes of the middle turbinate on nasal endoscopy are a key feature of CCAD. Computed tomography (CT) scans of the paranasal sinuses of patients with CCAD typically show central thickening of the turbinates and the septum. The prevalence of sensitisation to inhalant allergens in patients with CCAD ranges between 70% and 100%, but there is a low prevalence of comorbid asthma. Saline irrigation and intranasal corticosteroids are the mainstay of treatment, with surgery being indicated for patients who do not have adequate symptom control.
Keywords: central compartment atopic disease, chronic rhinosinusitis, allergic rhinitis
Allergies in the Workplace
CHRONIC BERYLLIUM DISEASE: AN UNEXPECTED OCCUPATIONAL HAZARD FOR A JEWELLER
Authors: Miguel J Teixeira, Lizelle Nagel, Dante Plekker, Cassandra van der Merwe, Sylvia van den Berg
Abstract: Beryllium is used widely in industry due to its favourable elemental properties. Its extraction and subsequent incorporation into alloys and composites generate hazardous fumes and dust. Chronic beryllium disease (CBD) is an occupational interstitial lung disease that clinically resembles sarcoidosis. We present a case of a 33-year-old jeweller who developed CBD from exposure to dust while grinding unfinished gemstones. While workplace protection exists for beryllium workers, the health risks in artisans are unrecognised. Most cases are diagnosed in industries primarily involved in the use of beryllium (Table I); however, in our case the exposure to beryllium was unexpected. Lymphocyte proliferation testing for beryllium is a key investigation in patients with suspected CBD. To our knowledge, this is the first reported case of CBD diagnosed in a jeweller in South Africa.
Keywords: beryllium, chronic beryllium disease, occupational health, interstitial lung disease, lymphocyte proliferation test
Case Report
PINPOINT PAPULAR POLYMORPHOUS LIGHT ERUPTION IN AN HIV-POSITIVE PATIENT WITH RESOLVED DISCOID LUPUS ERYTHEMATOSUS
Authors: Agnes R Sema-Ramashala, Mikovhe K Rafumbedzani, Samuel M Risenga
Background: Polymorphous light eruption (PMLE) is a photodermatosis or a type of skin condition induced by exposure to sunlight, which triggers an immunological reaction. It consists of a polymorphic rash that appears upon exposure to the sun and some people regard it as a type of ‘sun allergy’. It occurs in all races, with a predilection for females. Pinpoint papular polymorphous light eruption (PP-PMLE) has been reported in Afro-Americans with a skin phototype four (IV) to six (VI), in whom PMLE expresses itself in the form of pinpoint papules. The papules are 1–2 mm in size and are located in the typical distribution of other variants of PMLE.
Methods: A case of pinpoint PMLE in a 51-year-old human immunodeficiency virus (HIV) positive patient with resolved discoid lupus erythematosus (DLE) is reviewed retrospectively. The laboratory work-up consisted of a skin biopsy and a blood sample for antinuclear antibodies (ANA). The diagnosis of PP-PMLE was based on the history, clinical examination and histopathology.
Results: The case is an HIV-positive female with PP-PMLE with resolved DLE. Skin examination showed pinpoint hypopigmented flat papules on the lateral aspects of the neck, extensor forearms and the anterior aspects of the lower legs (Figures 1–3). The lesions were scanty on the face. The size ranged from 1 mm to 2 mm. The histopathology confirmed PP-PMLE. She responded well to topical steroids, sun avoidance and sunscreen.
Conclusion: PP-PMLE is not uncommon and can be missed or be mistaken for other skin diseases. To date, the researchers have not come across any literature on PP-PMLE in Africans, with most cases having been reported in Afro-Americans.
Keywords: African female, flat hypopigmented papules, photodermatosis, pinpoint papular polymorphous light eruption, human immunodeficiency virus, discoid lupus erythematosus
Ethics article
SHOULD WE RESPECT PATIENT AUTONOMY AT ALL COSTS?
Author: Sharon Kling
Abstract: Codes of ethics and professional guidelines exhort healthcare professionals to respect patients’ autonomy and to honour their right to make informed choices regarding their healthcare. If a patient refuses treatment that the doctor believes is in their best interests, the doctor is obliged to respect their decision if they are competent to make that decision, have been provided with full information about the treatment, and the decision is voluntary and uncoerced. In this article I discuss a case questioning whether clinicians should respect a patient’s prior autonomous decision if the clinical situation has changed.
Keywords: patient autonomy, respect, patient’s best interests
ABC of allergy
New-onset urticaria and angioedema
Authors: Shaunagh Emanuel, Di Hawarden
Abstract: A 20-year-old young, fit, generally healthy male university student attends the emergency room (ER) with an itchy, migratory urticarial rash on his limbs and torso that has been troubling him for two days. He has also noticed that his left eyelid has become swollen. He is anxious because neither he nor any member of his family has ever experienced symptoms like this before. He is systemically well with no cardiovascular or respiratory symptoms and his vital signs are normal.
DR SPUR’S MYSTERY CASE
Connecting the dots in IEI: infections and tumours
Authors: Miguel Jose Teixeira, Lizelle Nagel, Sylvia van den Berg
Introduction: I am seeing a 25-year-old female patient who has a history of frequent respiratory infections since adolescence. She had an uneventful childhood, but started getting infections of increasing frequency and severity during her adolescence, to the point where she required several antibiotic prescriptions per year, and hospital admission at least twice a year for pneumonia. She had chronic productive cough between pneumonia episodes, with features of early bronchiectasis. We diagnosed common variable immunodeficiency (CVID) and prescribed a prophylactic antibiotic. The patient is not using corticosteroids, immunosuppressant medications or anticonvulsants. She receives 75 mcg of L-thyroxine daily for hypothyroidism. While she reports no family members with frequent or atypical infections, there is a history of thyroid disease, inflammatory bowel disease (IBD), leukaemia and gastric cancer affecting several relatives.