CURRENT ALLERGY & CLINICAL IMMUNOLOGY JOURNAL OF THE ALLERGY SOCIETY OF SOUTH AFRICA
Vol 39, No 3 September 2026
- Food allergy in Africa
- ‘Medically unexplained’ – Psychological distress manifesting as somatic symptoms
- Five years of South African pollen data
- Impact of heat on childhood respiratory health
- Diagnostic uncertainty in a presumed case of Good’s syndrome
- Immune checkpoint inhibitors and cutaneous adverse events in oncology treatment
- Primary central nervous system B-cell lymphoma unmasking an inborn error of immunity
- Navigating adolescent autonomy and refusal of treatment
Please note this content is only available for Registered Healthcare Professionals Members.
Should you wish to access this content, please REGISTER or LOGIN on the platform.
GUEST EDITORIAL
Authors: Jonny Peter, Candice Royal
Abstract: The world and the practice of allergy are changing. Many contributing factors could be singled out, but for this congress we have singled out three in particular. First, South Africa has an exceptionally small number of sub-specialist allergists for a population of its size, with by far the most primary allergy care offered by a diverse range of non-allergy healthcare practitioners. We feel this makes the imperative that we train as broad a group of healthcare workers as possible in best-practice allergy care pressing. We need to teach care that is pragmatic, readily implementable at the primary level and achievable without having to employ substantial resources. This is the spirit of the 2026 congress theme, ‘Where allergy meets the non-allergist.’
Review article
FOOD ALLERGY IN AFRICA – EMERGING TRENDS AND AREAS OF GREATEST NEED
Authors: Elham Hossny, Dalia H ElGhoneimy, Rasha El-Owaidy, Ghada Shousha, Sally G Mohammed, Roba M Al-Gaweesh
Abstract: The magnitude of the prevalence and severity of food allergy (FA) on the African continent is underestimated. Many obstacles hinder the proper diagnosis in its developing communities since allergy is under-recognised as a specialty in many African countries and therefore the training of healthcare workers is not always sufficient. Moreover, in-vitro diagnostic tests are not easily accessed and personnel capable of performing oral food challenges (OFC) are scarce. The treatment approach and disease-prevention strategies that are tailored to the local circumstances require multicentre robust studies to be conducted that produce local guidelines compatible with the cultural, social and economic conditions of each African sub-region. This review summarises the currently available data on food allergens, emerging FA trends, management challenges and the common unmet needs. Government support and scientific global partnerships can indeed augment the efforts of African allergists in producing cutting-edge research and providing the utmost care for their food-allergic patients.
Keywords: Africa, allergens, food allergy, health education, sensitisation, serum sIgE
Review article
‘MEDICALLY UNEXPLAINED’ – PSYCHOLOGICAL DISTRESS MANIFESTING AS SOMATIC SYMPTOMS IN THE CONTEXT OF FOOD ALLERGIES
Authors: Nabila Veyej, Candice Royal
Abstract: Advances in medical science have expanded our understanding of the contribution of the gut–brain–immune system axis in the pathogenesis of mental illness. Food allergies, similarly, share gut–brain–immune dysregulation in their pathogenesis. Individuals diagnosed with a food allergy frequently experience significant psychiatric symptoms, which tend to be both under-recognised and under-treated. Children may express psychological distress through somatic symptoms, and functional abdominal pain disorders can present in children as young as three years old, creating an additional layer of diagnostic and management complexity for the treating clinician. Mental and physical health are not dichotomous; a focused multidisciplinary team approach is therefore vital to ensuring the best outcomes.
Keywords: gut–brain axis, functional abdominal pain disorders, food allergy, somatic symptom disorder, disorders of gut–brain interaction
Review article
FIVE YEARS OF SOUTH AFRICAN POLLEN DATA – HOW CAN THIS HELP YOUR ALLERGY PRACTICE?
Authors: Takudzwa Matuvhunye, Andriantsilavo HI Razafimanantsoa, Malebo S Makunyane, Caryn M Upton, Verushka Hansrajh, Dilys M Berman, Jonny Peter
Abstract: Allergic rhinitis affects up to 40% of South Africans, with pollen being the commonest outdoor aeroallergen. It is challenging for clinicians to have a detailed understanding of local pollen data because pollen seasons and vegetation patterns vary substantially across the climatic and biome regions of South Africa. The South African Pollen Monitoring Network (SAPNET) recently published the first five-year national pollen calendars covering seven cities across the country’s major biomes. This clinical review translates the key findings of the SAPNET dataset into practical guidance for practitioners who manage allergic respiratory diseases that are aggravated by pollen exposure. Here we present a clinician-friendly summary of region-specific pollen seasons. It highlights the clinically relevant aeroallergens that are commonly present in the regional aerospora but not included in initial screening panels, to help clinicians consider broadening region-specific testing. The calendars describe prevailing allergenic taxa and their seasonality at sentinel stations and they are intended to inform clinical reasoning, not to quantify individual exposure or replace a patient’s clinical history. We also consider the implications of climate change possibly influencing pollen exposure and allergic disease patterns in South Africa in the coming decades. Practitioners are directed to www.pollencount.co.za for weekly updated counts and city-specific pollen calendars in support of evidence-based allergen-avoidance counselling and to help formulate seasonal management strategies.
Keywords: allergic rhinitis, aeroallergens, pollen calendars, SAPNET, skin-prick testing, Bermuda grass, climate change
Review article
IMPACT OF HEAT ON CHILDHOOD RESPIRATORY HEALTH
Authors: Minenhle S Buthelezi, Prakash Jeena, Rajen N Naidoo
Abstract: Rising global temperatures and the increasing frequency of heatwaves due to climate change pose a significant threat to child health. Children are particularly vulnerable to heat exposure due to physiological, developmental and behavioural factors. Respiratory diseases, including asthma and respiratory tract infections (RTIs), remain leading causes of morbidity and mortality among children globally, particularly in low- and middle-income countries (LMICs). This article synthesises the current evidence regarding the impact of heat exposure on childhood respiratory health, focusing on epidemiological trends, underlying biological mechanisms and interactions with environmental co-exposures. Heat exposure is consistently associated with increased respiratory morbidity in children, particularly asthma exacerbations, including higher rates of emergency department visits, hospitalisations and symptom severity. In a mechanistic manner heat affects respiratory health through direct anatomical and pathophysiological pathways, including dehydration, an increased respiratory rate, airway inflammation and oxidative stress. Indirect pathways involve interactions with air pollution – particularly ozone and particulate matter – and aeroallergens, which exacerbate airway inflammation and immune responses. Heat exposure may also influence immune function and susceptibility to infections. Vulnerability is further amplified by socioeconomic factors, poor housing and schooling conditions, and urban heat-island effects, especially in LMIC settings. Whereas evidence for the association of heat exposure and childhood asthma is robust, further research is needed to clarify associations with infectious respiratory illnesses and long-term impacts. There is a critical need for context-specific research, particularly in LMICs, and to develop integrated clinical strategies and public-health policies to mitigate heatrelated respiratory risks in children.
Keywords: heat, extreme temperature, childhood respiratory health, asthma, respiratory infection
Case report
DIAGNOSTIC UNCERTAINTY IN A PRESUMED CASE OF GOOD’S SYNDROME: AUTOIMMUNITY, IMMUNE DYSREGULATION OR MALIGNANCY
Authors: Mimi Deetlefs, Jonny Peter
Abstract: Good’s syndrome represents a spectrum of thymoma-associated immune dysfunction in which autoimmunity, immune dysregulation and lymphoproliferation overlap. This case emphasises the need for mechanism-based treatment and ongoing surveillance in patients with evolving clinical phenotypes.
Keywords: Good’s syndrome, thymoma, thymoma-associated immunodeficiency, immune dysregulation, large granular lymphocyte expansion, autoimmune cytopaenia, cholestatic liver disease
Case report
IMMUNE CHECKPOINT INHIBITORS AND CUTANEOUS ADVERSE EVENTS IN ONCOLOGY TREATMENT: A CASE REPORT AND REVIEW OF IMMUNE-RELATED MECHANISMS AND MANAGEMENT
Authors: Miguel J Teixeira, Jason Thoresen, Helen C Steel, Theresa M Rossouw
Abstract: Immune checkpoint inhibitors (ICIs) have transformed oncology treatment by enhancing T-cell-mediated anti-tumour immunity through the inhibition of key immune checkpoint regulators. These regulators include cytotoxic T-lymphocyteassociated protein-4 (CTLA-4) and the programmed cell death protein-1 (PD-1)/programmed death ligand-1 (PD-L1) axis. By modulating immune checkpoint signalling, these agents enhance adaptive T-cell responses and can also amplify broader immune activity involving innate and peripheral immune compartments. Despite their clinical benefits, ICIs are associated with a spectrum of immune-related adverse events (irAEs) that result from iatrogenic immune dysregulation. We report the case of a 76-year-old man who developed pruritic dermatitis during immunotherapy, with accompanying significant effects on his sleep and quality of life (QoL). This case illustrates the clinical burden of cutaneous irAEs and emphasises the importance of individualised management approaches. The effective management of these adverse events is critical to maintaining the continuity of immunotherapy while preserving the patient’s QoL.
Keywords: immune checkpoint inhibitors, cancer immunotherapy, immune-related adverse events, biologics, anti-tumour immunity
Case report
PRIMARY CENTRAL NERVOUS SYSTEM B-CELL LYMPHOMA UNMASKING AN INBORN ERROR OF IMMUNITY: A CASE REPORT OF DOCK8 DEFICIENCY
Authors: Boitumelo Pitso, Mampoi TG Jonas, Jan P du Plessis
Abstract: Inborn errors of immunity (IEI) are described as conditions caused by pathogenic variants or monogenic germline variants which result in increased susceptibility to recurrent infections, allergy, autoimmunity, autoinflammatory conditions and malignancy. IEI are caused by damaging germline variants in single genes that result in loss-of-function, gain-of-function or loss-of-expression of the encoded protein. Patients with IEI are at significant risk of malignancy compared to the normal population. Notably, malignancy is the second most common cause of death after infections in these patients. Our case report is of a child who presented with a spectrum of atopy, recurrent infections and malignancy due to an underlying IEI. The underlying genetic mutation was identified as Dedicator of Cytokinesis 8 (DOCK8) deficiency, and this case study highlights the clinical manifestations and the associated risk of malignancy in children with IEI.
Keywords: inborn errors of immunity, atopy, infections, malignancy, dedicator of cytokinesis 8 deficiency, DOCK8
Ethics article
NAVIGATING ADOLESCENT AUTONOMY AND REFUSAL OF TREATMENT
Author: Sharon Kling
Abstract: Adolescents may consent to their own healthcare, but questions arise whether to respect a refusal of treatment, particularly if the treatment is lifesaving. The brain develops throughout adolescence and into adulthood; the high-level decisionmaking ability develops only in later adolescence. The ethical tension is between the child’s best interests (beneficence) and respect for the evolving autonomy of the child (respect for persons). Healthcare professionals have obligations to protect the child, to remove or minimise harm (non-maleficence), and to involve and respect both parents and children in decision-making. Deciding whether adolescent refusal should be respected requires careful consideration of their competence, the gravity and immediacy of the decision to be made and the consequences of the decision. Involving a court should be a very last resort.
Keywords: adolescent autonomy, adolescent decision-making, best interests, adolescent refusal of treatment
LETTER TO THE EDITOR
RE: “SPECIALISED INFANT FORMULAS USED IN THE TREATMENT OF CMPA: A SOUTH AFRICAN PERSPECTIVE”
Authors: Shihaam Cader, Natalie Heydenrych
Abstract: The review provides much-needed, up-to-date guidance for South African healthcare professionals on the use of specialised infant formulas in the management of cow’s milk protein allergy (CMPA). In particular, the inclusion of hydrolysed rice formula, a relatively new option in the South African market, enhances the practical relevance of the article.
ABC of Allergy
Timing is everything: alpha-gal syndrome, IgE-mediated but delayed
Authors: Shaunagh Emanuel, Di Hawarden
Introduction: ‘Are immunoglobulin E (IgE)-mediated allergic reactions always immediate?’ asks one of the students in the tutorial group. Dr Do-a-lot explains that, in most cases, symptoms occur shortly after exposure to an allergen in Type I IgE-mediated reactions, typically within minutes to an hour. Symptoms and signs such as itching, flushing, urticaria, bronchospasm, abdominal discomfort, hypotension and, in severe cases, collapse due to anaphylaxis are typical. Common causes include foods, insect venom and medicines.
DR SPUR’S MYSTERY CASE
A biomarker clue in a teenager with ’severe’ asthma
Authors: Carla van Heerden, Sylvia van den Berg, Miguel Jose Teixeira, Andre van Niekerk
Introduction: The symptoms that you are describing in this patient are indeed characteristic of the lower airway inflammation and hyper-responsiveness seen in asthma, which can be triggered by viruses, allergens, irritants and exercise. Asthma is characterised by chronic airway inflammation and variable airflow limitation, with symptoms such as shortness of breath, chest tightness, wheezing and/or coughing that can vary over time and in intensity. South Africa’s childhood asthma prevalence ranks 25th in the world and the country has the 5th highest asthma mortality rate globally.
Nutrition Tuition
SPRINGTIME POLLEN ALLERGY – OR IS IT POLLEN FOOD ALLERGY SYNDROME?
Author: Jandri Barnard
Introduction: Spring is almost in the air, and for those allergy specialists among us it also means pollen season allergies! But not only pollen allergies. Also pollen allergy reactions arising from foods that are caused by cross-reactions with pollen varieties. These reactions are also known as pollen food allergy syndrome (PFAS) or oral allergy syndrome (OAS), when cross-reactions can vary depending on the pollen type emanating from different sources.1 This can happen when the immune system confuses the proteins in certain raw foods with tree, grass or weed pollens, which are also more predominant during springtime and present as mild itching or tingling in the mouth from the fruit and vegetables being cross-contaminated.