CURRENT ALLERGY & CLINICAL IMMUNOLOGY JOURNAL OF THE ALLERGY SOCIETY OF SOUTH AFRICA
Vol 39, No 1 March 2026
- The labelling of food additives
- Glyphosates and plastic waste
- Ultra-processed food: the NOVA food classification and the overlap with food allergies
- Hidden allergens in immediate food allergies
- From shelf to gut: the role of emulsifiers in inflammatory bowel disease pathogenesis
- Ethics of food-allergen avoidance and food labelling
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GUEST EDITORIAL
Author: Marinda McDonald
Abstract: Being the guest editor of the journal that shaped my early career has been a profound pleasure and privilege. As a young doctor who, in the previous century, was interested in allergies, I came to regard the Current Allergy and Clinical Immunology journal (CACI) as a trusted source of information on the subject. I was young and fresh-faced then and naively believed that medical school had taught me everything I needed to know. But as my interest in allergies grew, I came to realise that medical school is not the end but only the start of a lifelong journey characterised by study, curiosity and growth. As medical students way back then we would ask the librarian to conduct a literature search and we were then handed a dot-matrix printout containing a collection of relevant abstracts. We could then select three articles to research a topic.
Review article
THE LABELLING OF FOOD ADDITIVES: WHAT HEALTHCARE PRACTITIONERS SHOULD KNOW AND TEACH
Author: Idonette van Zyl
Abstract: Food additives, although often listed last in the ingredient lists on food labels, are far from insignificant in the impact they have on human health. Although many additives are safe, some are among the so-called ‘hidden triggers’ of clinical reactions that are easily overlooked. Growing scientific evidence links synthetic additives – including artificial colourants, preservatives, emulsifiers and non-caloric sweeteners – to a range of adverse effects such as altered behaviour, inflammation and gastrointestinal dysbiosis. Additives are commonly present in ultra-processed foods (UPFs), which are also typically high in energy, sugar, fat and salt and low in protein, fibre and micro-nutrients. Excessive UPF intake has been associated with gut microbiome alterations and an increased risk of food allergies. Although South African and international food-labelling regulations require additives to be declared in ingredient lists, they are not mandated to appear in the ‘contains’ allergen statement, unless in some cases they are derived from an allergen such as calcium lactate (milk). The effective management of additive sensitivities depends upon the ability of consumers to identify and avoid these compounds – a process complicated by overwhelming ingredient lists, confusing labelling and regulatory gaps. Healthcare practitioners play a crucial role in patient education, food-label literacy and promoting a dietary intake that focuses on minimally processed whole foods. Given the growing evidence of harm from food additives, both regulatory reform and raising public awareness of food additives are urgently needed.
Keywords: food additives, food labelling, labelling regulations, healthcare practitioners, public education
Review article
GLYPHOSATES AND PLASTIC WASTE: UNVEILING THE HIDDEN DANGERS OF XENOBIOTICS ON HUMAN HEALTH AND THE MICROBIOME
Authors: Marinda McDonald, Taryn Lee Bortz, Pieter de Waal
Abstract: Xenobiotics, including pesticides, heavy metals, plastics and cosmetics, are widespread environmental contaminants that have an impact on human health. Chronic low-level exposure to glyphosate and microplastics can cause epigenetic changes, DNA damage, oxidative stress and immune disruption and may contribute to diseases such as cancer and immune disorders. These substances are prevalent in food and water, are linked to gut microbiota alterations and dysbiosis and can compromise intestinal health, trigger inflammation and affect cytokine levels. In addition, plastics often contain endocrine disruptors that interfere with hormonal functions. Regulatory assessments face challenges due to their reliance on industry data, overlooked co-formulant toxicity and conflicts of interests. Approval and regulation, especially for glyphosate, remain debated amid limited long-term safety studies.
Keywords: glyphosates, microplastics, nanoplastics, roundup, pesticides, microbiome, dysbiosis
Review article
ULTRA-PROCESSED FOOD: THE NOVA FOOD CLASSIFICATION AND THE OVERLAP WITH FOOD ALLERGIES
Author: Lindsay Archibald-Durham
Abstract: Food allergy has become an increasing public health concern worldwide, particularly among children. In parallel, the consumption of ultra-processed foods (UPFs), as defined by the NOVA Food Classification, has risen dramatically. This review explores the emerging evidence linking UPF intake to food allergy and related outcomes such as asthma, wheezing and eczema. Proposed mechanisms include gut microbiome dysbiosis, increased intestinal permeability, altered immune tolerance and the inflammatory effects of additives and advanced glycation end products (AGEs). Current evidence supports dietary recommendations to reduce UPF consumption and encourage whole-food nutrient-rich diets in order to manage and prevent allergies.
Keywords: ultra-processed foods, Nova Food Classification System, food allergy, microbiome, immune system
Review article
HIDDEN ALLERGENS IN IMMEDIATE FOOD ALLERGIES
Author: Marshé Maharaj-Setlalekgosi
Abstract: Food allergy is an adverse immunologic reaction that occurs reproducibly on exposure to a specific food. Exposure usually occurs after ingestion, but in sensitive individuals it can occur after contact and smell. Whereas major allergens are well characterised, hidden allergens remain an under-recognised cause of severe and unexplained allergic reactions. This review discusses uncommon and concealed allergenic sources, including spices (eg, celery, mustard, fenugreek), seeds (eg, sesame, lupin), herbs and plant-based additives. It briefly discusses emerging allergens, cross-reacting allergens, co-factors, atypical or delayed allergen presentations such as pink peppercorn, alpha-gal, gibberellin-regulated proteins, parasite-related allergens and allergen contamination via food additives. Improved clinical awareness and diagnostic approaches are critical to identifying hidden allergens, especially those in patients presenting with idiopathic or recurrent anaphylaxis.
Keywords: food allergy, hidden allergens, adverse immunologic reactions
Review article
FROM SHELF TO GUT: THE ROLE OF EMULSIFIERS IN INFLAMMATORY BOWEL DISEASE PATHOGENESIS
Authors: Nisha Naka, Tim De Maayer
Abstract: The global rise in inflammatory bowel disease (IBD) is attributed to environmental rather than genetic factors, with Westernised diets and ultra-processed foods (UPFs) playing a central role. Emulsifiers, which are common additives in UPFs, are under scrutiny for their possible contribution to gut inflammation. Preclinical studies, particularly in mice, demonstrate that emulsifiers such as carboxymethylcellulose, polysorbate 80 and carrageenan disrupt gut microbiota, impair mucosal barriers and trigger pro-inflammatory responses. Although these findings mirror abnormalities in patients with IBD, limitations in translating animal data to human beings persist due to the differences in physiology and exposure levels. Human evidence remains largely observational, with studies indicating higher emulsifier intake among IBD patients and associations between UPF consumption and Crohn’s disease. However, causality is as yet unproven. Emerging interventional trials, including the ADDAPT study, suggest that low-emulsifier diets may improve the symptoms and remission rates in patients with IBD. Dietary therapies such as exclusive enteral nutrition and the Crohn’s Disease Exclusion Diet indirectly support emulsifier avoidance. As precision medicine advances, understanding the mechanistic role of emulsifiers may inform preventive and therapeutic strategies for IBD. Further robust human trials are essential to clarify their impact and guide dietary recommendations in the context of rising non-communicable diseases linked to Western dietary patterns.
Keywords: inflammatory bowel disease, emulsifiers, ultra-processed foods
Case report
THE IMPACT OF CHILDHOOD ATOPIC DERMATITIS ON CAREGIVER QUALITY OF LIFE AT RAHIMA MOOSA MOTHER AND CHILD HOSPITAL
Authors: Rulani Makondo, Nombuyiselo Mvulane, Lindinkululeko Jabulile Nkehli
Background: Atopic dermatitis (AD) is a pruritic inflammatory skin disorder that affects the quality of life (QoL) of those children affected by it and imposes additional caregiving burdens on their caregivers. This study investigated the psychosocial effects of childhood AD on caregivers’ QoL at a South African tertiary hospital. It explored the links between disease severity and sociodemographic factors.
Methods: A total of 180 AD patient–caregiver pairs were recruited into the study between February and June 2022. Caregiver QoL was measured using the Dermatitis Family Impact (DFI) questionnaire and disease severity was classified using the Scoring Atopic Dermatitis (SCORAD) index.
Results: The mean caregiver QoL score was 9.8 (SD 7.3). Based on our classification, 35.6% (n = 64) of caregivers reported a normal QoL, whereas 27.2% (n = 49) experienced a mild impact on QoL, 26.1% (n = 47) a moderate impact and 11.1% (n = 20) a severe impact. Disease severity was predominantly mild (72%), followed by moderate (20%) and severe (8%). We found there to be a significant positive correlation between disease severity and QoL impact (p < 0.001). The most affected QoL aspects were emotional distress, expenditure, sleep disturbance, food preparation and housework disruption. In addition, patient age, disease duration and treatment duration correlated inversely with QoL scores. Except for marital status, the QoL impact was independent of caregiver sociodemographic factors.
Conclusion: Our findings indicate that childhood AD adversely affects caregiver QoL in a South African tertiary hospital setting, with the impact correlating directly with disease severity. Clinicians managing paediatric AD should therefore assess caregivers’ psychosocial well-being and offer support to improve both patient and caregiver outcomes.
Keywords: atopic dermatitis, quality of life, dermatitis family impact questionnaire
Case report
ALLERGY-RELATED SIALODOCHITIS – THE FIRST REPORTED CASE IN AFRICA
Authors: Thomas Braithwaite, Estie Meyer, Ashmitha Rajkumar, Brendon Price, Cascia Day
Summary: Allergic-related sialodochitis (ARS) is a rare, under-recognised salivary-gland dysfunction marked by recurrent salivarygland swelling, mucus plugs, eosinophilic infiltration and elevated serum total IgE and serum peripheral eosinophils. It is most reported in Asia. ARS affects middle-aged women and individuals with atopy. Diagnosis requires a high index of clinical suspicion and the exclusion of mimics. Management is individualised, combining as it does conservative, medical, interventional and emerging biologic therapies.
Keywords: allergic-related sialodochitis, ARS, eosinophilic sialodochitis, allergic parotitis, sialodochitis fibrosis, Kussmaul disease
Research article
WET WRAP THERAPY USED FOR CHILDREN WITH ATOPIC DERMATITIS AT A PAEDIATRIC OUTPATIENT CLINIC IN A RESOURCE-CONSTRAINED SETTING: A FIVE-YEAR RETROSPECTIVE STUDY
Authors: Jayandree Gounden, A’ishah Da Costa, Sharon Kling, Liezl Smit
Introduction: Moderate-to-severe atopic dermatitis (AD) has a negative impact on both children and families. Despite there being various treatment modalities, not all of them are accessible in resource-constrained settings. This study aimed to describe the use and outcomes of an outpatient wet wrap therapy (WWT) package of care in such a setting.
Methods: This was a retrospective cross-sectional observational study. It included patients between the ages of two months and 15 years with moderate-to-severe AD who received WWT at the paediatric allergy clinic at Tygerberg Hospital from 1 January 2017 to 31 December 2021. Hospital records were used to collect demographic and clinical characteristics, allergy comorbidities, WWT management, and outcomes.
Results: Of 472 patients, 121 had AD (25.6%) and 45 (37.2%) of them received WWT. Common comorbidities were asthma (33.3%), allergic rhinitis (AR, 42.2%) and food allergies (44.4%). More than half (57.8%) required only one WWT at the clinic during the study period before the resolution of symptoms occurred. Only one child (2.2%) developed a secondary skin infection within two weeks of treatment.
Conclusion: WWT is a feasible, safe and effective outpatient treatment option for children with moderate-to-severe AD. The WWT protocol could be introduced in other resource-constrained settings and outside of sub-specialist services.
Keywords: atopic dermatitis, wet wrap therapy, paediatric outpatients, allergy, food sensitivity
ABC of Allergy
Allergy and Hypersensitivity Nomenclature Guidelines
Authors: Shaunagh Emanuel, Di Hawarden
Introduction: Dr Do-a-lot discusses the 2023 European Academy of Allergy and Clinical Immunology (EAACI) guidelines that elaborate on allergy and hypersensitivity nomenclature. She asks her students to present cases that illustrate the new categories, and asks for a summary of the revised framework that extends the classic four Gell and Coombs types into nine distinct categories that reflect the now better understood mechanistic diversity and clinical reality of hypersensitivity reactions. The guidelines are a more inclusive and nuanced classification that encompasses not only adaptive immune responses but also barrier defects, metabolic influences and direct cellular interactions with chemicals. In response, the students prepare a simplified infographic to show where their case presentations fit into the scheme. They start by presenting a case to illustrate the final category and then work backwards, because the later categories represent the most recent updates.
DR SPUR’S MYSTERY CASE
The case of the oddly un-specific antibodies
Authors: Miguel Jose Teixeira, Sylvia van den Berg, Lizelle Nagel
Introduction: Selective IgA deficiency is the most common IEI. It is characterised by an isolated decrease in serum IgA, normal IgM and IgG levels, and normal vaccine responses to protein and polysaccharide vaccines. The diagnosis can be considered after the age of four years in patients with persistently lowserum IgA.
Nutrition Tuition
UNRAVELLING THE EFFECTS OF FOOD ADDITIVES IN PROCESSED FOODS
Author: Jandri Barnard
Introduction: Food additives are among the ‘hidden triggers’ of clinical signs and symptoms that are easily overlooked when the focus is on more common food allergy symptoms. According to the Joint FAO/WHO Expert Committee on Food Additives (JECFA), food additives are defined as ‘substances intentionally added to food to maintain or improve its safety, freshness, taste, texture or appearance’. They are characterised as being either synthetic or natural substances and cannot be consumed as a foodstuff on their own.