Biotransformation : can we apply this to allergy and immunology?

During medical training all doctors are taught the importance of the cytochrome P450 (CYP) system and the detoxification functions of the liver. An important challenge for pharmaceutical companies is launching new pharmaceutical entities that have an acceptable safety profile and this usually entails finding molecules with a limited effect on the CYP system. Biotransformation seems to be a novel concept in allergy and immunology but ironically it has been used extensively in the medical field over many decades. This article is aimed at providing a differential diagnosis to those patients that do not quite fit the allergic picture/profile, using the concept of biotransformation to analyse them and ideally find a new solution to their disease profile. Examples of these extraordinary patients include those with numerous drug reactions but with no common ‘allergic’ trigger, recurring upper airway infections or chronic otitis media and common variable immunodeficiency, difficult to control asthmatics with concomitant inflammatory diseases like ulcerative colitis and the ‘allergic’ rhinitic with no obvious causative allergen.http://www.allergysa.org/journal.htmam201

An ideal children's chest and allergy clinic

The practice of Allergology has reached great heights in the last 2 years. South Africa has progressed from having Diplomates in Allergology to the recognition of sub-specialist Allergologists in Paediatrics, Internal Medicine and Family Practice. This is a new era for those of us interested in bringing the science of Allergology to our patients and already there is a sense that Allergology has joined other subspecialities in our country, to advance this aspect of science and medicine. However, the number of subspecialists in Allergology will remain small for many years and in the mean time, we will need our Allergy Diplomates, and other interested clinicians, to uphold the practice of Allergology in their own practices. This article is intended to provide a useful philosophical guide to what would make the general allergy clinic better able to meet the needs of patients. In this article we provide some ideas firstly for the ideal Children’s Chest and Allergy Clinic. We believe that allergic children and their parents want three things. They want an answer (a diagnosis), then they want a treatment (a therapeutic strategy) and lastly they want a therapeutic strategy that works or leads to a solution (improved quality of life). This article will suggest ways to achieve this in your own clinic.http://www.allergysa.org/journal.htmam201

A case for revising the strength of the relationship between childhood asthma and atopy in the developing world

Introduction. Asthma is the commonest chronic condition of children. Diagnosis remains difficult and many surrogate markers are used, such as documenting evidence of atopy.Method. Two studies investigated the role of atopy in childhood asthma. The first documented the prevalence and nature of allergy sensitivities in a group of asthmatic children compared with non-asthmatic children in Pretoria, South Africa. The second enrolled a random sample of asthmatic children and their mothers attending the Children’s Chest and Allergy Clinic at Steve Biko Academic Hospital, Pretoria. Children were classified as having atopic or non-atopic asthma. Mothers completed a questionnaire to reveal atopic features.Results. In the first study, only 45.0% of asthmatic children had a positive skin-prick test (SPT), as opposed to 16.2% of control children. This is a lower proportion than in many reported international studies. In the second study, 64 children with atopic asthma and 36 with non-atopic asthma were studied, along with their mothers. The proportion of children with atopic asthma did not differ for mothers with and without a positive SPT (p=0.836), a history of asthma (p=0.045) or symptoms suggestive of an allergic disease (p=1.000), or who were considered to be allergic (p=0.806). The odds ratio (OR) of a child having atopic asthma when he or she had a mother with a doctor-diagnosed history of asthma was 4.76, but the sensitivity was low (21.9%).Conclusion. The data demonstrate that fewer asthmatic children in South Africa are atopic than was previously thought. Also, all maternal allergic or asthmatic associations are poor predictors of childhood atopic asthma. Despite the increased risk of atopic asthma in a child of a mother who has a doctor diagnosis of asthma (OR 4.76; p=0.045), this is a poor predictor of atopic asthma (sensitivity 21.9%

A case for revising the strength of the relationship between childhood asthma and atopy in the developing world

INTRODUCTION. Asthma is the commonest chronic condition of children. Diagnosis remains difficult and many surrogate markers are used, such as documenting evidence of atopy. METHOD. Two studies investigated the role of atopy in childhood asthma. The first documented the prevalence and nature of allergy sensitivities in a group of asthmatic children compared with non-asthmatic children in Pretoria, South Africa. The second enrolled a random sample of asthmatic children and their mothers attending the Children’s Chest and Allergy Clinic at Steve Biko Academic Hospital, Pretoria. Children were classified as having atopic or non-atopic asthma. Mothers completed a questionnaire to reveal atopic features. RESULTS. In the first study, only 45.0% of asthmatic children had a positive skin-prick test (SPT), as opposed to 16.2% of control children. This is a lower proportion than in many reported international studies. In the second study, 64 children with atopic asthma and 36 with non-atopic asthma were studied, along with their mothers. The proportion of children with atopic asthma did not differ for mothers with and without a positive SPT (p=0.836), a history of asthma (p=0.045) or symptoms suggestive of an allergic disease (p=1.000), or who were considered to be allergic (p=0.806). The odds ratio (OR) of a child having atopic asthma when he or she had a mother with a doctordiagnosed history of asthma was 4.76, but the sensitivity was low (21.9%). CONCLUSION. The data demonstrate that fewer asthmatic children in South Africa are atopic than was previously thought. Also, all maternal allergic or asthmatic associations are poor predictors of childhood atopic asthma. Despite the increased risk of atopic asthma in a child of a mother who has a doctor diagnosis of asthma (OR 4.76; p=0.045), this is a poor predictor of atopic asthma (sensitivity 21.9%).http://www.samj.org.zaam201

Cytomegalovirus pneumonia occuring soon after initiation of highly active antiretroviral therapy in an infant

A two-month-old HIV-infected infant was ventilated for very severe Pneumocystis jiroveci pneumonia. After successful extubation, he was started on antiretroviral therapy. He developed a proven cytomegalovirus infection, localising as pneumonia. This required repeated ventilation. He was extubated after six weeks and completed 32 days of ganciclovir.http://www.sajei.co.za/index.php/SAJE

Chronic rhinitis in South Africa : update 2013

The term rhinitis implies inflammation of the lining of the nose. Characteristic symptoms are a blocked nose, anterior and posterior rhinorrhea, sneezing and itching. Not all cases of chronic rhinitis have an allergic basis. Chronic non-allergic rhinitis is defined as a condition where ongoing rhinitic symptoms are present for many months (as for persistent allergic rhinitis) but there is no IgE basis. Many common conditions may present as chronic rhinitis, which will need to be investigated and managed on their own merits. Not all cases of chronic rhinitis respond to allergic rhinitis therapy: continued attempts to manage chronic rhinitis as allergic rhinitis may be hampered by pathophysiological conditions where other specific therapy may be required. Chronic rhinitis impacts on patient quality of life, and therefore therapy is important. Managing patients with chronic rhinitis requires attention to patient education in order to achieve the maximal therapeutic benefit of medication. This update is intended to provide clinicians with a sound basis for management of a common condition.Aspen HealthCare provided an unrestricted grant for the meeting of the South African Allergic Rhinitis Working Group (SAARWG).http://www.samj.org.zaam2014ay201

Effectiveness of dementia follow-up care by memory clinics or general practitioners: randomised controlled trial

Objective To examine the effectiveness of post-diagnosis dementia treatment and coordination of care by memory clinics compared with general practitioners