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CURRENT ALLERGY & CLINICAL IMMUNOLOGY JOURNAL OF THE ALLERGY SOCIETY OF SOUTH AFRICA
Vol 38, No 2 June 2025
- Will the proliferation of biologicals for asthma or eczema treatment lead to universal accessibility?
- Chronic urticaria: Is universal access to treatment possible?
- A step-wise diagnostic approach to the pre-school child with recurrent upper respiratory tract infection
- Asthma in children
- Chronic urticaria secondary to an orthopaedic implant
- Assessment of work-related asthma knowledge and attitudes among asthmatic pharmaceutical workers
- Beneficence: Our guiding principle?
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EDITORIAL
Authors: Eugene Weinberg, Di Hawarden
Abstract: Eric Bateman, great visionary, internationally renowned pulmonologist, teacher, researcher and athlete passed away in January 2025. Much has been said and written about his academic achievements, but I (Di) had the privilege of knowing him as a fellow runner before I encountered him as an academic. In this kindly reprinted Obituary, we honour Eric, his athletic achievements and his support of Allergy and Clinical Immunology at University of Cape Town (UCT). If you wish to seek his monument you will find it in the modern 5-storey UCT Lung Unit on the campus of the UCT Medical School built according to his vision and planning that opened in 1998. Eric attended many of our joint and stand-alone congresses as an invited speaker, and has contributed to our journal. We will miss him.
Review article
WILL THE PROLIFERATION OF BIOLOGICALS FOR ASTHMA OR ECZEMA TREATMENT LEAD TO UNIVERSAL ACCESSIBILITY?
Author: John O Warner
Abstract: Several precisely targeted biological therapies for asthma have either been approved for use or are in clinical trials. However, currently, their high costs have compromised universal accessibility. This poses ethical dilemmas for clinicians; and media hype in advance of full health-economic and clinical evaluation undermines the doctor–patient relationship. At present the focus is on parenteral injection-administered monoclonal antibodies (MoAbs), with anti-IgE and anti-Th-2 cytokines (Interleukins 4,5 and 13) now being incorporated into guidelines for severe poorly cortico-steroid-responsive disease. Many other targets are under investigation, leading to a proliferation of new MoAbs. In addition, small molecules which are effective by oral administration, targeting as they do receptor signal transduction processes such as Janus Kinases (JAKs), have potential value in asthma therapy. It is hoped that the increasing number of therapeutic options for treating severe asthma will, through market competition, reduce costs and make universal accessibility a reality. Single doses of recent novel MoAbs, small molecules and gene-expression modifiers have very long durations of action and will possibly be another route towards favourable health-economic evaluation.
Keywords: asthma, allergy, monoclonal antibodies, signal transduction inhibitors, ethics
Review article
CHRONIC URTICARIA: IS UNIVERSAL ACCESS TO TREATMENT POSSIBLE?
Authors: Helen Hoenck, Cathryn McDougall, Jonny Peter
Abstract: Chronic urticaria (CU) is a common and debilitating skin disorder that is characterised by recurrent pruritic wheals either with or without angioedema. CU is divided into two subtypes: chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU). CSU is the more common; however, they often coexist. Although CSU has a significant burden of disease globally, epidemiological data from Africa remain scarce, with studies suggesting a higher prevalence of concomitant angioedema compared to global estimates. Current treatment guidelines recommend a stepwise approach to managing CSU: progressing from second-generation antihistamines to biologic therapies such as omalizumab and, in refractory cases, cyclosporine. Access to omalizumab in the local South African context remains extremely limited. In addition, up to one-third of patients with access to omalizumab may have a partial or an inadequate response. There is a clear need for innovative targeted therapies in the management of CSU. This review explores the emerging therapies for CSU, including Bruton’s tyrosine kinase (BTK) inhibitors, anti-IL-4 receptor antibodies and anti-KIT antibodies. Although this pipeline of novel therapies is promising, universal access to both existing and novel therapies remains a challenge in our resource-limited setting. As allergists, there is an ongoing need for us to continue our advocacy of access to appropriate therapy that will lead to an improved quality of life for CSU patients.
Keywords: chronic urticaria, chronic spontaneous urticaria, chronic inducible urticaria, angioedema, targeted therapy
Case Report
CHRONIC URTICARIA SECONDARY TO AN ORTHOPAEDIC IMPLANT
Authors: J Thoresen, MJ Teixeira
Abstract: Chronic urticaria is a multifactorial disease characterised by diverse pathomechanisms. It imposes a substantial burden on patients, having a significant impact on their quality of life, interruption of sleep and subsequent development or exacerbation of mental health disease. Although chronic urticaria is treated with high-dose second-generation antihistamines, a subset of patients remain refractory, with no identifiable or apparent cause. A variety of cutaneous hypersensitivity reactions to metallic implants, including urticaria, have been reported throughout the literature. We present a case of a 17-year-old male with an initial diagnosis of chronic spontaneous urticaria (CSU) which was refractory to high-dose antihistamines. A review of his medical history highlighted a previous open reduction and internal fixation (ORIF) of a titanium ankle plate and screws that were placed in situ for a closed fracture prior to presentation. Lymphocyte transformation tests (LTTs) to both titanium and aluminium revealed a stimulation index (SI) of 12 and 9, respectively. The patient was subsequently referred to orthopaedics for the explantation of the implant, after which his symptoms completely resolved.
Keywords: chronic spontaneous urticaria, lymphocyte transformation tests, titanium, orthopaedic hardware
Review article
ASTHMA IN CHILDREN: A GENERAL PRACTICE PERSPECTIVE
Authors: J Thoresen, MJ Teixeira
Abstract: Asthma is a chronic non-communicable disease that affects children and adolescents globally. Asthma affects more than 20% of children in South Africa. The prevalence of asthma, and specifically severe asthma, is increasing. Although South Africa’s asthma prevalence is 25th in the world, the country has the 5th highest asthma mortality rate worldwide. This still underestimated and poorly managed condition has a significant impact on families and healthcare systems, leading to school absenteeism, regular visits to primary care facilities and emergency units, including hospitalisations. Early detection and appropriate management are essential to reduce morbidity and improve patient outcomes. Primary healthcare (including both public and private practice) is commonly the first point of care for children with asthma. In this article we consider a simple approach to the diagnosis, assessment and management of asthma in children, focused on primary care in the South African context.
Keywords: asthma, GINA guidelines, general practice, paediatrics, primary healthcare
Review article
A STEP-WISE DIAGNOSTIC APPROACH TO THE PRE-SCHOOL CHILD WITH RECURRENT UPPER RESPIRATORY TRACT INFECTION
Author: Eftyhia Vardas
Abstract: Respiratory infections in infants and children under six years of age constitute a common reason for medical consultations. The child with recurrent respiratory infections presents a diagnostic challenge because there is no consensus on deciding the number of upper respiratory tract infections in this age group that qualify as recurrent infections, even though this is the initial and necessary step in the approach to these patients. The duration and type of these infections, their severity, the sites of infection and the nature of the organisms involved are the other important factors that guide the clinical decisions about the required diagnostic interventions to be taken, the immediate and long-term management requirements and the most appropriate treatment. The diagnostic approach aims to differentiate the normal child from one of the other likely categories which may present with recurrent upper respiratory tract infections in this age group, the atopic child, the child with chronic disease or the child with an inborn error of immunity (IEI). The frequency, severity and associated underlying chronic diseases or IEI are revealed on history-taking, examination and, if indicated, with minimal screening laboratory and X-ray tests.
Keywords: recurrent respiratory infections, infants, children
Allergies in the Workplace
ASSESSMENT OF WORK-RELATED ASTHMA KNOWLEDGE AND ATTITUDES AMONG ASTHMATIC PHARMACEUTICAL WORKERS IN JOHANNESBURG
Authors: Arisha Maharaj, Zubaydah Kirsten, T Singh
Background: Globally, an estimated 17% of asthma in adults, could be attributed to the work environment and therefore be preventable. Work-related asthma (WRA), a preventable yet significant occupational health concern, has received limited attention among pharmaceutical workers despite the sector’s economic importance. This highlights the importance of workers’ having adequate knowledge of and a positive attitude to WRA.
Objective: To assess the knowledge of and attitudes to WRA among pharmaceutical workers in Johannesburg. Methods: A quantitative cross-sectional study was conducted among 322 workers with various roles in Johannesburg’s pharmaceutical industry. Data were collected electronically using a structured questionnaire and analysed using descriptive statistics and logistic regression models, which were adjusted for age and sex.
Results: Pharmaceutical workers with 20–30 years of service had a significantly higher WRA knowledge than those with less experience (ORA = 4.29, 95% CI: 1.23–14.92). Atopic workers were more knowledgeable about the risks of WRA than non-atopic workers (ORA 27.30, 95% CI 11.02–67.61). Workers who reported being ‘very often’ exposed to drug fumes had significantly higher unadjusted odds of WRA knowledge compared to those who reported ‘never’ being exposed (OR = 3.93, 95% CI: 1.31–11.79). Similarly, workers who were always exposed to preservatives (OR = 4.58, 95% CI: 1.58–13.39) and latex (OR = 12.30, 95% CI:5.09–23.25) were also more knowledgeable about WRA than those less exposed to them. Smokers had better attitudes to WRA than non-smokers (OR = 2.66, 95% CI 1.25–5.68).
Conclusion: Factors such as work experience, smoking status and atopy affected pharmaceutical workers’ knowledge of and attitudes to WRA. Work experience was associated with improved knowledge, suggesting the value of cumulative experience and targeted training. The findings highlight the need to strengthen education and training interventions to improve knowledge and awareness of WRA among all workers. These findings may contribute to advancing occupational health practices by promoting safer work environments and mitigating the burden of WRA in the pharmaceutical sector.
Keywords: occupational asthma, workplace exposure, hazards, training, education
Ethics article
BENEFICENCE: OUR GUIDING PRINCIPLE?
Author: Sharon Kling
Abstract: The principle of beneficence means doing good. It refers to putting patients’ interests before that of the healthcare professional (HCP) provided that no extreme sacrifice is required. For HCPs in particular, beneficence means providing the best treatment possible to our patients and acquiring the knowledge and clinical skills necessary to do so. Paternalism, on the other hand, is the intentional overriding of one person’s known preferences or actions by another person, where the person who overrides justifies their action by appealing to the goal of benefitting the person or of preventing or mitigating harm to the person whose preferences or actions are overridden. Beneficence is not absolute and it is constrained by the principles of respect for autonomy, non-maleficence and justice.
Keywords: beneficence, autonomy, non-maleficence, justice, paternalism
Nutrition tuition
EGG EXCLUSION, NOT ONLY FOR EASTERTIME
Author: Jandri Barnard
Introduction: I discuss eggs, not in the sense of Easter eggs, but rather poultry eggs and the allergy that can develop from eating them. Egg allergy affects about 2% of infants and children, usually together with another food allergy, while the adult onset of egg allergy is a rare condition. Most diagnoses are made around three years of age, but resolution can occur within 10–15 years from diagnosis. Adult-onset egg allergy has been found to be associated with a previous personal history of atopy or another food intolerance. Some studies have indicated that stressful conditions or the alteration of intestinal microbiota could also be responsible for the loss of tolerance towards some food antigens, leading to intestinal inflammatory disorders that include Crohn’s disease, coeliac disease or ulcerative colitis.
ABC of Allergy
The Immune System
Authors: Shaunagh Emanuel, Di Hawarden
Introduction: Dr Do-a-lot commences the new block with an introduction to the immune system. She describes it as a miraculous symphony of cells and signals – vigilant, adaptive, and precise. When its finely tuned balance falters, however, it can fail to protect, or even turn against the body, causing disease. In order to embark on the topic her students need to understand which cells, molecules, proteins and organs play a role in immunity, and what threats the immune system might encounter.
DR SPUR’S MYSTERY CASE
The Case of Asthma, Autoimmunity and an Unexpected Diagnosis
Authors: Sylvia van den Berg, Marieke Brauer, André van Niekerk
Introduction: This case raises concern for an underlying combined immunodeficiency, given the significant T-cell impairment and inadequate responses to both T-cell-dependent and T-cell-independent vaccines
Obituary
ERIC BATEMAN WAS A LEADING SOUTH AFRICAN ULTRA-DISTANCE ATHLETE AND PHYSICIAN OF GLOBAL SIGNIFICANCE
Author: Stephen Granger
Introduction: Bateman succeeded in many areas of life, as husband and father to five children (and grandfather to eleven), in both the practice and teaching of medicine (he was UCT Professor Emeritus in pulmonology and medicine at the time of his passing) and in athletics.
