CURRENT ALLERGY & CLINICAL IMMUNOLOGY JOURNAL OF THE ALLERGY SOCIETY OF SOUTH AFRICA
Vol 38, No 3 September 2025
- Climate change and its impact on asthma in South Africa
- Chronic rhinosinusitis: To what extent does allergy play a role?
- Long-term pulmonary sequelae of lower respiratory tract infection
- Autoimmune/inflammatory syndrome induced by adjuvants
- Occupation allergic conjunctivitis associated with kelp exposure
- Parental refusal of treatment
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EDITORIAL
Author: Prof Debbie A White
Abstract: It is an honour to have been invited to guest edit this ‘Congress’ edition of the Current Allergy and Clinical Immunology Journal of 2025. Thank you to Prof Eugene Weinberg and Dr Di Hawarden for the kind invitation and to Mrs Robyn Marais, the journal’s production editor, for her hard work in putting this excellent journal together. Thank you to my congress co-organisers, Prof André van Niekerk, Prof Jonny Peter and Dr Candice Royal, for their assistance and advice along the way. It’s enormously appreciated.
Review article
CLIMATE CHANGE AND ITS IMPACT ON ASTHMA IN SOUTH AFRICA
Authors: Caryn M Upton, Jonny Peter
Abstract: South Africa is experiencing climate-related warming 1.5 times faster than the global average, which is driving shifts in meteorological and environmental conditions that exacerbate respiratory health risks. More extreme weather events, including heatwaves, floods and wildfires, combined with increasing aeroallergens, mould growth and poor air quality, are contributing to increased rates of asthma and allergic respiratory diseases, at the same time driving morbidity and mortality. While these risks are real and growing, they also present an opportunity to strengthen climate-health resilience. Existing health and environmental monitoring systems remain fragmented and unevenly distributed. Linking environmental exposure data to respiratory health outcomes is essential if public health planning and adaptation are to be effective. This narrative review highlights and contextualises the current evidence on climate-related respiratory risks in South Africa, with a focus on asthma. It highlights recent national studies, identifies key data and policy gaps and introduces SA- CARES, a sentinel-based early-warning system for respiratory health as a model for pre-emptive integrated surveillance. Coordinated investment in data integration, healthcare preparedness and community engagement will be key to building adaptive capacity and advancing climate-resilient health policy in South Africa and other low- and middle-income countries.
Keywords: climate change, asthma, aeroallergens, air pollution, sentinel surveillance
Review article
CHRONIC RHINOSINUSITIS: TO WHAT EXTENT DOES ALLERGY PLAY A ROLE?
Authors: Meshandree Naidoo, Debbie A White
Abstract: Chronic rhinosinusitis (CRS) is a common and burdensome inflammatory disease of the nasal mucosa and paranasal sinuses that affects approximately 5-12% of the population worldwide. CRS can significantly impair productivity, reduce quality of life and place a substantial burden on healthcare systems globally. Whereas multiple factors contribute to its pathogenesis, the role of allergy in CRS remains a subject of ongoing debate. However, advances in the field of allergy pathophysiology and endotype-driven inflammation may lead to more precise management strategies in the future. This review examines the evidence linking allergic pathways to CRS, outlines pathophysiological mechanisms and discusses the diagnostic and therapeutic implications for clinical practice.
Keywords: chronic rhinosinusitis, epithelial dysfunction, Type 2 inflammation, allergy
Review article
LONG-TERM PULMONARY SEQUELAE OF LOWER RESPIRATORY TRACT INFECTION
Authors: Charl Verwey, Keketso Mopeli, Diane Gray, Kitso Mrubata, Ziyaad Dangor
Abstract: Lower respiratory tract infection (LRTI) is a major public health concern. Apart from being a driver of paediatric mortality, the survivors of LRTI are also prone to develop long-term clinical and lung function sequelae, further putting a strain of healthcare systems, especially in low- and middle-income countries.
There is an increase in clinical symptoms, including cough, frequent and infrequent wheezing, and admission for all- cause LRTI and wheezing, after a LRTI during infancy. Pulmonary function is also affected after LRTI, with a long-term increase in respiratory rate and pulmonary resistance and a decrease in lung compliance. Specific long-term pulmonary syndromes, such as bronchiectasis and post-infectious bronchiolitis obliterans may also develop. Programs aimed at alleviating childhood LRTI and encouraging long-term follow-up of affected children will go a long way in improving overall lung health for children and reduce the strain on healthcare facilities.
Keywords: long-term pulmonary sequelae, lower respiratory tract infection
Case Report
AUTOIMMUNE/INFLAMMATORY SYNDROME INDUCED BY ADJUVANTS (ASIA) AFTER A DENTAL PROCEDURE
Authors: Miguel J Teixeira, Michelle Rosslee, Ilse Sparks, Lizelle Nagel
Abstract: Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) is an immune-mediated condition triggered by environmental adjuvants, including certain metals. Nickel-titanium (NiTi) alloys, which are commonly used in endodontics, have been implicated in hypersensitivity reactions, but their role in ASIA remains uncertain and under-recognised. Here we describe the case of a 47-year-old male who developed cutaneous and systemic symptoms following a root canal procedure. Over several months, his symptoms worsened progressively. Despite multiple pharmacological treatments, his symptoms persisted until an inadvertently retained fragment of a nickel-titanium file was removed by having the affected molar extracted. Within days, he experienced a significant improvement, with the normalisation of inflammatory markers. This case study highlights the importance of obtaining a detailed dental, surgical and occupational history in any patient presenting with chronic, recurrent and presumably spontaneous urticaria and unexplained chronic systemic inflammation.
Keywords: root canal, adjuvant-induced autoimmune/inflammatory syndrome, ASIA, metal hypersensitivity, Shoenfeld’s syndrome, nickel-titanium alloy
Allergies in the Workplace
OCCUPATIONAL ALLERGIC CONJUNCTIVITIS ASSOCIATED WITH KELP EXPOSURE IN A SEAWEED-PROCESSING PLANT
Authors: Dorothy Ngajilo, Shahieda Adams, Tanusha Singh, Munyadziwa Muvhali, Mohamed F Jeebhay
Background: Ecklonia maxima, or sea bamboo, is a species of kelp belonging to brown seaweed (Phaeophyta), a group of macroscopic multicellular marine algae. It is playing an increasingly significant role in aquaculture and the production of various bioactive products, including plant-growth regulators. Whereas the respiratory problems related to seaweed exposure have been documented, work-related ocular conditions have not previously been reported. This article describes the case of an administrative assistant employed in a kelp-processing facility who presented with a two-year history of recurrent work-related ocular symptoms associated with secondary exposure to kelp and its products.
Methods: The clinical assessment included ophthalmological examination and allergological evaluation, comprising skin- prick tests to common inhalant allergens and kelp, in addition to patch testing and specific IgE to kelp. A workplace visit was conducted to evaluate possible work-related exposures. Additional investigations included a computed tomography (CT) scan of the sinuses, pulmonary function testing, autoimmune disease screening and a corneal biopsy.
Results: Occupational allergic conjunctivitis associated with kelp was diagnosed. The diagnosis was supported by the patient’s history of occupational exposure, work-related ocular symptoms and a positive skin-prick and patch test to fresh kelp. The workplace investigation identified potential exposure to kelp fragments and irritant chemicals such as hydrogen peroxide and acetic acid.
Conclusion: This case highlights probable occupational allergy to kelp, presenting primarily as a conjunctivitis, mediated by IgE and non-IgE-medicated mechanisms and aggravated by irritant exposures. It underscores the need for further research into the mechanisms underlying this clinical presentation and the specific allergenic components causing sensitisation in occupational settings.
Keywords: occupational allergic conjunctivitis, kelp exposure, allergenic components, sensitisation
Ethics article
PARENTAL REFUSAL OF TREATMENT FOR ATOPIC DERMATITIS IN THEIR CHILD
Author: Sharon Kling
Abstract: Parental refusal of beneficial treatment for their child creates an ethical tension between respect for parental autonomy and beneficence, that is, the best interests of the child. Parents are considered the appropriate decision-makers for their children and generally make decisions that promote their children’s well-being. Clinicians have a responsibility to protect their child patients and to ensure their well-being. This article explores the ethical dilemma of parental refusal of the use of topical corticosteroids to treat childhood atopic dermatitis.
Keywords: parental refusal of treatment, atopic dermatitis, corticosteroid phobia, best interests of the child, paediatric ethics
ABC of Allergy
Immunity in Action
Authors: Shaunagh Emanuel, Di Hawarden
Introduction: Here, Dr Do-a-lot completes her introductory lecture on the immune system. She emphasises that it is a highly coordinated defence force that not only defends the host against pathogenic microbes, but also helps them to eliminate toxins and allergenic substances. In order to achieve this, it must be able to distinguish self from non-self.
DR SPUR’S MYSTERY CASE
A case of fragile defences
Authors: Petri Swanepoel, Sylvia van den Berg, André van Niekerk
Introduction: I am treating a ten-month-old boy diagnosed with di George syndrome. He has a history of failure to thrive, which was mostly attributed to his cardiac anomalies (more specifically, a ventricular septal defect which has since been repaired). I am concerned about his infection history. Over the past four months he has experienced multiple episodes of upper respiratory tract infections characterised by nasal congestion, clear to mucopurulent rhinorrhoea, intermittent low-grade fever, cough (initially dry, progressing to a productive cough with occasional wheezing), feeding difficulties and refusal of feeds during episodes. He does not have any palatal anomalies.
Nutrition Tuition
THE DANGER OF HIDDEN ALLERGY INGREDIENTS IN POPULAR PRODUCTS
Author: Jandri Barnard
Introduction: The worldwide craze for this chocolate bar took the world by storm after a TikTok video by influencer Maria Vehera in December 2023 was viewed by millions. It was originally developed in 2021 when Sarah Hamouda experimented with different chocolate filling combinations to combat her food cravings during pregnancy. After being (almost) satisfied herself, her partner and chef Nouel Catis Omamalin developed and marketed this product as part of the Fix Dessert Chocolatier series. Being a British Egyptian who had lived in Dubai since 2015, her choice of the name ‘Dubai Chocolate’ was inspired by the original place of its creation.