Ingestion of mammalian meat and alpha-gal allergy: Clinical relevance in primary care

Background: An allergic reaction to mammalian meat has recently been reported in rural parts of South Africa and throughout other parts of the world. The cause of this allergic reaction is because of an oligosaccharide antigen known as galactose-alpha-1, 3-galactose (alpha-gal) found in mammalian meat. Hard ticks in various parts of the world have been identified as a cause of sensitisation to the alpha-gal antigen. However, mechanisms of sensitisation in Africa are poorly understood. Aim: The aim of this article is to review current literature on the alpha-gal allergy and mammalian meat ingestion and the family physician’s role in diagnosing and managing this condition. Method: Indexes were searched using the keywords in the following electronic databases: Elsevier Science Direct, Google Scholar, Medline and PubMed. Results: Clinical presentation of the alpha-gal allergy occurs typically as a delayed anaphylaxis occurring within 3–6 hours after the ingestion of mammalian meat. A subset of patients described in South Africa presented with a rapid onset of symptoms occurring within 45 minutes. Furthermore, some of these patients present with abdominal symptoms only, which may be mistaken as food poisoning. Diagnosis is based on a history of reaction to mammalian meats (especially to fatty portions or organs) and serum specific alpha-gal antibodies. The main management of the alpha-gal allergy is avoidance of red meat and in mild reactions treatment with oral H1 receptor antihistamines. Conclusion: Sensitisation to the alpha-gal allergy results in adverse reactions to red meat, with tolerance to turkey, chicken and fish. A family physician can safely manage this condition

Consensus statement of the management of severe, difficult-to-treat atopic dermatitis in adults and adolescents in South Africa and the role of biologics

The first biological agent for treatment of moderate-to-severe atopic dermatitis (AD), dupilumab, has recently been introduced to South Africa and guidance is required as to its place in therapy. Consequently, an expert panel was convened to reach consensus on 14 statements relevant to contemporary management of AD and the use of dupilumab. In summary, the objectives of therapy are to reduce skin inflammation and pruritus, restore skin-barrier function, avoid flares, and improve quality of life. Useful comprehensive scoring tools to assess severity of AD and guide decisions to step up from topical to systemic therapy (including to a biologic agent), include SCORing Atopic Dermatitis (SCORAD), Eczema Area and Severity Index (EASI) and Dermatology Life Quality Index (DLQI). In addition, a photographic record of pre-treatment and follow-up assessments is helpful. When systemic therapy is required, options include cyclosporin, which should be limited to short-term use, and off-label use of methotrexate. Systemic corticosteroids should be considered only in short courses for rescue therapy in the event of flares. New classes of medication for the treatment of moderateto- severe AD are in various stages of development. The two most prominent classes of new therapies are biologics and small molecules. Dupilumab is the first fully humanised monoclonal antibody (MAB) biologic approved for the treatment of moderate-to-severe AD. It is an effective and well-tolerated, long-term treatment and has a favourable safety profile.https://journals.co.za/journal/caciam2022Paediatrics and Child Healt

Predictive values of alpha-gal IgE levels and alpha-gal IgE: Total IgE ratio and oral food challenge-proven meat allergy in a population with a high prevalence of reported red meat allergy

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Allergic rhinitis: Review of the diagnosis and management: South African Allergic Rhinitis Working Group

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