15 research outputs found
Allergic rhinitis in South Africa : 2012 guidelines
BACKGROUND: Allergic rhinitis (AR) is an important disease in
South Africa. The South African Allergic Rhinitis Working Group
(SAARWG) has published previous guidelines for AR diagnosis
and management. Areas of concern have arisen that require
additional information, including the management of AR in
infancy, appropriate and inappropriate allergy testing, cost of AR
management, diagnosis and distinguishing the condition from
sinusitis, use of over-the-counter medications, and the concept of
the ‘united airway’.
RECOMMENDATIONS: Clinicians should consider the possibility of
AR in infants with recurrent nasal symptoms. Allergy testing should
be used wisely and based on local allergens. Total IgE testing is not
routinely required to prove allergy. Acute and chronic sinusitis
should be considered in conjunction with AR; treatment of rhinitis
will improve these conditions. Over-the-counter medications
should be used sparingly and with caution. Concern for long-term
use of topical decongestants must be noted. Asthma should always
be considered in AR diagnosis. Immunotherapy is available in SA
and may be extremely useful in selected AR patients.
CONCLUSION: The SAARWG proposed an algorithm for the
diagnosis and management of rhinitis in South Africa. AR is
common, important and troubling to patients; therefore, every
effort should be made to target therapy correctly. Patient education
is important in the management of AR.An unrestricted grant
from Aspen/GSK Pharmaceuticals for sponsorship of the working group
meeting on 10 - 12 February 2012.http://www.samj.org.z
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
Updated recommendations for the management of upper respiratory tract infections in South Africa
Background. Inappropriate use of antibiotics for non-severe upper respiratory tract infections (URTIs), most of which are viral, significantly adds to the burden of antibiotic resistance. Since the introduction of pneumococcal conjugate vaccines in South Africa in 2009, the relative frequency of the major bacterial pathogens causing acute otitis media (AOM) and acute bacterial rhinosinusitis (ABRS) has changed. Recommendations. Since URTIs are mostly viral in aetiology and bacterial AOM and ABRS frequently resolve spontaneously, these recommendations include diagnostic criteria to assist in separating viral from bacterial causes and hence select those patients who do not require antibiotics. Penicillin remains the drug of choice for tonsillopharyngitis and amoxicillin the drug of choice for both AOM and ABRS. A dose of 90 mg/kg/d is recommended for children, which should be effective for pneumococci with high-level penicillin resistance and will also cover most infections with Haemophilus influenzae. Amoxicillin-clavulanate (in high-dose amoxicillin formulations available for both children and adults) should be considered the initial treatment of choice in patients with recent antibiotic therapy with amoxicillin (previous 30 days) and with resistant H. influenzae infections pending the results of studies of local epidemiology (β-lactamase production ≥15%). The macrolide/azalide class of antibiotics is not recommended routinely for URTIs and is reserved for β-lactam-allergic patients.Conclusion. These recommendations should facilitate rational antibiotic prescribing for URTIs as a component of antibiotic stewardship. They will require updating when new information becomes available, particularly from randomised controlled trials and surveillance studies of local aetiology and antibiotic susceptibility patterns.
Allergic rhinitis : review of the diagnosis and management : South African Allergic Rhinitis Working Group
DATA AVAILABILITY : The authors confirm that the data supporting the findings of
this study are available within the article.BACKGROUND : Allergic rhinitis (AR) has a significant impact on the community as a whole with
regard to quality of life and its relationship to allergic multi-morbidities. Appropriate diagnosis,
treatment and review of the efficacy of interventions can ameliorate these effects. Yet, the
importance of AR is often overlooked, and appropriate therapy is neglected. The availability
of effective medications and knowledge as to management are often lacking in both public and
private health systems.
METHODS : This review is based on a comprehensive literature search and detailed discussions
by the South African Allergic Rhinitis Working Group (SAARWG).
RESULTS : The working group provided up-to-date recommendations on the epidemiology,
pathology, diagnosis and management of AR, appropriate to the South African setting.
CONCLUSION : Allergic rhinitis causes significant, often unappreciated, morbidity. It is a complex
disease related to an inflammatory response to environmental allergens. Therapy involves
education, evaluation of allergen sensitisation, pharmacological treatment, allergen
immunotherapy (AIT) and evaluation of the success of interventions. Regular use of saline; the
important role of intranasal corticosteroids, including those combined with topical
antihistamines and reduction in the use of systemic steroids are key. Practitioners should have
a thorough knowledge of associated morbidities and the need for specialist referral.
CONTRIBUTION : This review summarises the latest developments in the diagnosis and
management of AR such that it is a resource that allows easy access for family practitioners
and specialists alike.https://www.safpj.co.zaam2024ImmunologyOtorhinolaryngologyPaediatrics and Child HealthSDG-03:Good heatlh and well-bein
Allergic rhinitis in South Africa – Update 2014
The SAARWG met on the 8th and 9th February 2014 to discuss and review
important concepts in allergic rhinitis diagnosis and management. The theme
of that meeting was to lead clinicians through the ideal „Allergy Clinic‟ and the
diagnostic facilities that may be offered to patients who present for
management at such a clinic. The content of that meeting forms the basis of
this update. The main reason for this statement is two-fold. Firstly, patients
with allergic diseases require careful examination and secondly, they may
need a set of diagnostic modalities. All physicians who see such patients must
be knowledgeable of the interpretation of such tests. This review will focus
specifically on the clinical tools and diagnostic modalities employed in the
management of those conditions.http://reference.sabinet.co.za/sa_epublication/cacihttp://www.allergysa.org/journal.htmhb201
Updated recommendations for the management of upper respiratory tract infections in South Africa
CITATION: Brink, A. J., et al. 2015. Updated recommendations for the management of upper respiratory tract infections in South Africa. South African Medical Journal, 105(5):345-352, doi:10.7196/SAMJ.8716.The original publication is available at http://www.samj.org.zaBackground. Inappropriate use of antibiotics for non-severe upper respiratory tract infections (URTIs), most of which are viral, significantly adds to the burden of antibiotic resistance. Since the introduction of pneumococcal conjugate vaccines in South Africa in 2009, the relative frequency of the major bacterial pathogens causing acute otitis media (AOM) and acute bacterial rhinosinusitis (ABRS) has changed.
Recommendations. Since URTIs are mostly viral in aetiology and bacterial AOM and ABRS frequently resolve spontaneously, these recommendations include diagnostic criteria to assist in separating viral from bacterial causes and hence select those patients who do not require antibiotics. Penicillin remains the drug of choice for tonsillopharyngitis and amoxicillin the drug of choice for both AOM and ABRS. A dose of 90 mg/kg/d is recommended for children, which should be effective for pneumococci with high-level penicillin resistance and will also cover most infections with Haemophilus influenzae. Amoxicillin-clavulanate (in high-dose amoxicillin formulations available for both children and adults) should be considered the initial treatment of choice in patients with recent antibiotic therapy with amoxicillin (previous 30 days) and with resistant H. influenzae infections pending the results of studies of local epidemiology (β-lactamase production ≥15%). The macrolide/azalide class of antibiotics is not recommended routinely for URTIs and is reserved for β-lactam-allergic patients.
Conclusion. These recommendations should facilitate rational antibiotic prescribing for URTIs as a component of antibiotic stewardship. They will require updating when new information becomes available, particularly from randomised controlled trials and surveillance studies of local aetiology and antibiotic susceptibility patterns.http://www.samj.org.za/index.php/samj/article/view/9995Publisher's versio