Current Allergy & Clinical Immunology - latest Issue
Volume 29, Issue 3, 2016
Author Mike LevinSource: Current Allergy & Clinical Immunology 29, pp 138 –139 (2016)More Less
We are proud to launch the Allergy Foundation of South Africa (AFSA) at the ALLSA Conference 2016. AFSA is a recently established non-profit company (NPC) closely allied to the Allergy Society of South Africa. AFSA strives to save lives, enhance the quality of life and reduce the cost of healthcare for South Africans suffering from allergic disorders and primary immune deficiencies.
Source: Current Allergy & Clinical Immunology 29, pp 140 –144 (2016)More Less
Wheeze is common in infants and young children. Asthma is but one cause and it is obviously important to exclude or include as it is amenable to specific therapy. It is also obvious that the pre-school or young child is not just a smaller variety of the older child or adult and this is especially true of asthma, where special situations exist with regard to diagnosis and treatment. Although there is a differential diagnosis for the major symptoms that constitute asthma in this age group, no child should be left to wheeze or cough without the possibility of asthma being considered and excluded. New guidelines and reports suggest that differentiation of virally induced wheeze from multi-trigger wheeze (or toddler asthma) is less important than making an attempt to manage the child. If an infant, or young child, has a chronic wheeze and is atopic or responds to a bronchodilator, asthma is more likely and therapy should be tried. If, however, there is no response to the therapy, investigate for other causes. Remember that in South Africa wheeze may also be produced by chronic infections, gastro-oesophageal reflux, cardiac failure, cystic fibrosis and a host of other sinister conditions. Therapeutically, for mild and intermittent wheeze the choice of inhaled corticosteroid (ICS) or a leukotriene antagonist may be valuable options. Therapy is intermittent and should be started pre-emptively. However, for more severe and frequent symptoms regular use of ICS (moderate dose) is clearly the best therapeutic option.
Source: Current Allergy & Clinical Immunology 29, pp 146 –150 (2016)More Less
Asthma and COPD are two distinct diseases but may overlap, especially in older patients. Typically, asthma patients have marked variability in their airflow obstruction with significant reversibility in response to both bronchodilator and corticosteroid therapy. However, it has become increasingly clear that many patients with asthma may develop fixed airflow obstruction, whereas many patients with COPD exhibit some bronchodilator reversibility. The term 'Asthma-COPD Overlap Syndrome' (ACOS) has been coined to describe patients who have features of both but, as yet, there is no validated definition for the combination of features. Patients with ACOS have worse outcomes than those with asthma or COPD alone: more frequent exacerbations, poorer quality of life, more rapid decline in lung function, higher mortality and greater healthcare use. The Global Initiative for Asthma (GINA) and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) have recently published guidelines for the diagnosis and treatment of patients with asthma, COPD or ACOS.
Multiple-drug intolerance syndrome
Case records from the multi-disciplinary drug hypersensitivity clinic : guest reviewAuthor J.G. PeterSource: Current Allergy & Clinical Immunology 29, pp 152 –156 (2016)More Less
Multiple-drug intolerance syndrome (MDIS) is a condition where patients experience adverse drug reactions to three or more unrelated drugs. The immunological mechanism is unknown, hence the preferred labelling as 'intolerance' as opposed to 'allergy'. MDIS prevalence in South Africa is unknown, but may be as high as 2.1% according to international electronic medical record data. The majority of specialist physicians have encountered these complicated, sometimes frustrating, but always challenging patients.
MDIS patients have high rates of healthcare and medication use, and are highly prone to developing new adverse drug reactions. Risk factors include female gender and multiple non-life-threatening co-morbidities, but not atopy. Antibiotics, particularly cephalosporins and quinolones, together with NSAIDs are the common offending drug classes. The severity of reactions is often overestimated, but life-threatening anaphylaxis or severe cutaneous drug reactions are reported. Optimal management involves the judicious use of drug provocation testing in a safe environment to provide patients and treating physicians with safe drugs as and when medically indicated. Multiple costly in vitro and in vivo drug allergy testing should be limited.
This brief review first presents an illustrative case from our newly established multi-disciplinary drug hypersensitivity clinic and then provides a literature review on the risk factors, proposed mechanisms and optimal management of MDIS.
Source: Current Allergy & Clinical Immunology 29, pp 158 –163 (2016)More Less
Chronic cough, defined by the majority of studies and guidelines as a cough that lasts longer than four weeks, is common in the paediatric population, but the true prevalence and burden of disease remains difficult to define. It is now understood that the aetiology of chronic cough in children differs from that in adults. Children with chronic cough should be managed with paediatric-specific algorithms because those who are treated in this manner have improved clinical outcomes. Recent studies have focused on protracted bacterial bronchitis as a major cause of chronic cough in pre-school children and its role as a possible precursor of bronchiectasis. Recognising those children with possibly serious underlying diseases is critical to preventing delayed diagnosis and poor outcomes. However, it is equally important not to over-investigate those children who have an isolated non-specific cough. Clinicians should be familiar with the vast list of important causes of a chronic cough as well as the history-taking and clinical skill to define patients at risk of having a potentially serious disease in order to manage them timeously and appropriately.
Author O. RaynhamSource: Current Allergy & Clinical Immunology 29, pp 164 –169 (2016)More Less
Nasal obstruction and subsequent partial upper-airway obstruction can result in troublesome morbidity for the child. It is one of the most common reasons for the presentation of children to the doctor, whether allergologist, paediatrician, general practitioner or ear, nose and throat (ENT) surgeon. This article offers a straightforward and practical approach to managing the most common causes of nasal obstruction in the paediatric population.
Eosinophilic oesophagitis in children : management options for inducing and maintaining disease control : guest reviewAuthor M.A. FurmanSource: Current Allergy & Clinical Immunology 29, pp 172 –175 (2016)More Less
Over the past decade the incidence of eosinophilic oesophagitis (EoE) has risen significantly and has become a common condition seen in paediatric gastroenterology centres around the world. The association with atopic disease is well known, and treatment options remain concentrated on acid suppression, dietary eliminations and topical corticosteroids. One of the greatest challenges is planning long-term disease management. Currently there is little published data on maintenance treatment for EoE in children. Many children remain on long-term elimination diets or topical steroids and undergo multiple repeat endoscopies. Large multicentre studies are required to gain a better understanding of this challenging condition, to standardise maintenance treatment and to find better methods for reliable disease surveillance.
Source: Current Allergy & Clinical Immunology 29, pp 176 –178 (2016)More Less
'I wish my life and decisions to depend on myself, not on external forces of whatever kind. I wish to be the instrument of my own, not of other men's acts or will. I wish to be a subject, not an object: to be moved by reasons, by conscious purposes, which are my own, not causes which affect me, as it were, from outside. I wish to be somebody, not nobody: a doer - deciding, not being decided for, self-directed and not acted upon by external nature or by other men as if I were a thing, or an animal, or a slave ... I wish, above all, to be conscious of myself as a thinking, willing, active being, bearing responsibility for my choices and able to explain them by references to my own ideas and purposes.' Isaiah Berlin, 1969
Author Vania Chongo-FarukSource: Current Allergy & Clinical Immunology 29, pp 180 –188 (2016)More Less
The demand for cosmetic and hairdressing services is high. The hairdressing industry has grown to become an important source of wealth and income internationally, with informal salons and hairdressing being more common in low-income settings. The daily exposure to a wide variety of repetitive practices, substances and chemicals puts hairdressers at an increased health risk for some conditions - particularly on the skin and respiratory and musculoskeletal systems - as the workers are exposed to a diverse range of chemicals (irritants and allergens) and ergonomic risk factors. By means of a case study we illustrate the challenges a medical practitioner faces in trying to identify the causal agent responsible for a health condition at work in a trade where products contain numerous changing chemicals, yet the same chemicals may be ingredients in personal hygiene products, food and medicines to which the worker is non-occupationally exposed. It indicates the necessity of identifying the potentially hazardous chemicals through good detective work, including a detailed workplace visit and report, an exposure and task-directed history of work, hobbies and activities of daily living together with relevant special investigations in order to achieve the best management of the clinical condition.
Source: Current Allergy & Clinical Immunology 29 (2016)More Less
Source: Current Allergy & Clinical Immunology 29, pp 190 –192 (2016)More Less
Dr Do-a-Lot's student presents short notes on egg allergy: Egg is a common cause of allergic reactions in children. Egg allergy occurs in about 2% of infants and children and is often present in the first year of life, especially in children with eczema. Most egg-allergic children develop tolerance to egg proteins in early childhood, but in cases where levels of antibodies to ovomucoid are high it is less likely that the allergy will be outgrown.
Author E. TankamaSource: Current Allergy & Clinical Immunology 29, pp 194 –195 (2016)More Less
Allergic reactions to fruits are commonly described, resulting most frequently in symptoms of the oral allergy syndrome (pollen fruit syndrome), and less often in more severe reactions and anaphylaxis. The flesh or pulp of the fruit is most commonly the cause of such reactions. Less commonly described are allergic reactions to the seeds ('pips') of fruits, reported in only a handful of case reports, but probably under-recognised. This case report describes a young boy, with a known allergy to peanuts, who experiences an allergic reaction when biting into seeds of both apples and watermelons, but is tolerant of the fruit pulp. It is one of very few cases in the literature that describe an allergy to a non-citrus fruit seed.
Source: Current Allergy & Clinical Immunology 29, pp 196 –197 (2016)More Less
In this article in our series on primary immunodeficiency, Dr Goodheart, a paediatrician, is consulted regarding an interesting referral from the surgeons in her hospital. Brendan, a four-year-old boy, is admitted to the surgical ward presenting with fever and abdominal pain. He has pain and abdominal palpation with guarding and decreased air entry is heard over the right lower lobe of his lungs. He also complains of headaches and is mildly jaundiced but, strangely, he does not appear to be acutely ill.
Source: Current Allergy & Clinical Immunology 29, pp 198 –201 (2016)More Less
Macrophage activation syndrome (MAS) is an uncommon condition in which hyperinflammation and excessive cytokine release lead to excessive stimulation of T-lymphocytes and macrophages and result in a characteristic clinical picture of haematological dysfunction and multiple organ failure. This condition occurs most commonly in the context of inflammatory conditions such as systemic juvenile idiopathic arthritis (sJIA). MAS is currently classified as one of the forms of secondary haemophagocytic lymphohistiocytosis (HLH). The diagnosis of MAS is clinically important as specific therapy may be required and a missed diagnosis may lead to high mortality. Unfortunately, the diagnosis is often not easily made due to the broad range of presenting features and their overlap with other potential complications of sJIA, such as severe infection. Also, no single clinical or laboratory test is able to diagnose MAS conclusively. In this review we highlight some of the most important clinical and laboratory features, diagnostic criteria, outcomes and management of MAS.
Source: Current Allergy & Clinical Immunology 29, pp 202 –213 (2016)More Less
Ascaris infection and sensitisation in rural and urban Xhosa children with and without atopic dermatitis
Case report: allergy to apple seeds in a peanut-allergic child
Urticaria mystery cases - not just scratching on the surface
A case of paradoxical bronchoconstriction due to benzalkonium chloride
Correlation between pro-inflammatory alleles and clinical and laboratory markers of allergy in Xhosa South Africans
Case study: can shellfish allergy cause anaphylaxis in iodinated contrast media?
Clinical audit of suspected sodium benzoate-associated angioedema and/or urticaria
Desensitisation to l-asparaginase for childhood leukaemia
Reactions to food additives
Hyper IgE syndrome: decoding novel mutations in black Africans
Socio-economic status and the prevalence of food sensitisation and food allergy in urban Cape Town children
Factors having an impact on asthma control in children in a low- to medium income country study: a retrospective study
Sensitisation profiles of workers tested with bakery flour allergens
Component resolved diagnostics and peanut allergy
De-labelling penicillin allergic patients: a tool for antibiotic stewardship