Journal of the Allergy Society of South Africa Vol 36, no 3 September 2023
Clinician-scientists navigate the intricate balance between two contrasting realms almost daily – a prospect that is both daunting and enthralling. In the morning, they confront a symptomatic patient, surrounded by a myriad potential differentials and tenfold more underlying molecular pathways to disease. Yet, amid this complexity, a definitive plan is required. A treatment decision must be made, selecting from available drugs, often opting between compounds with multifaceted or poorly elucidated molecular mechanisms. In the afternoon, there may be a deep dive into an immunology dataset – often a culmination of years of arduous labour from dedicated researchers. This exploration may involve dissecting the repercussions of a single immune gene knockout or scrutinising the molecular and clinical implications of two monoclonal drugs targeting the same entity but engaging different binding epitopes. Colleagues frequently gravitate towards either of these two activities. However, the burgeoning comprehension of immune-based diseases and the spectrum of treatment options are compelling us to bridge these perspectives. Therefore, our joint ALLSA/ SAIS congress emerges as a timely convergence, uniting those who unravel molecular mechanisms with those who administer patient care. Similarly, in the array of articles in this congress-themed journal edition, we have attempted to strike a similar balance.
The Current Allergy and Clinical Immunology Journal (CACI) places the patient and treating physician at its core. Accordingly, we open this edition with two highly clinical and pragmatic articles. Cascia Day and Jonny Peter adopt a case- based approach to dealing with recurrent angioedema without urticaria. Acute angioedema remains a prevalent allergy presentation in emergency departments, often precipitated by medications such as ACE-inhibitors or IgE-mediated allergens. However, concealed within this group are patients with recurrent angioedema with an elusive origin – where the differential encompasses hereditary or acquired bradykinin- mediated angioedema, demanding distinct treatments.
Subsequently, Ms Stephanie Newman, together with two other University of Cape Town MBChB students and several colleagues in dermatology and allergy, provide an update on the highly successful Moisturiser Prescriber. First conceptualised by another student project in 2018, this tool offers guidance on selecting appropriate moisturisers or soap substitutes for daily use – fundamental in the treatment and prevention of atopic dermatitis (AD). The aim of this work is to empower patients and healthcare practitioners alike, allowing them information on ingredient profiles, product availability and costs. The article meticulously outlines selection methodologies and highlights updates in this version.
The subsequent two articles underscore the imperative of harmonising molecular insights and clinical data for optimal patient diagnosis and management. The opening piece, authored by Hilary Andoh and Mike Levin, delivers a case report on food allergy related to lipid transfer protein. The homology between allergens in fruit families and pollens, especially profilins, LTPs, and storage proteins, serves as a vivid illustration of how molecular-level comprehension translates into tangible allergen avoidance counsel.
Boitumelo Pitso, Chantal Pillay and Pieter de Waal then tackle the intricate domain of mannin-binding lectin (MBL) deficiency – in an article aptly titled ‘Is it a Thing or Not?’ Given the broad spectrum of severity and clinical implications associated with MBL deficiency, their exploration navigates this complexity. Encompassing a complex immunodeficiency case, the article delves into MBL’s fundamental immunological roles, outlines accurate sampling methodologies and delineates the way clinicians should synthesise laboratory findings with clinical information to guide appropriate management.
The subsequent articles diverge, each focusing on the dynamic intersections between human health and the evolving environment. Zahida Sonday, Gail Todd and Mohammed Jeebhay present a compelling case of bird-mite dermatitis among workers in a seed house – a narrative that immerses the reader in the realm of acclaimed TV series such as House MD. This case underscores the physician’s obligation to document environmental exposures meticulously and consider workplace inspections.
Shifting the focus to asthma and its intersection with environmental influences, Dorra Garbhi, Aneesa Vanker, Rebecca Garland, and Jonny Peter interweave aerobiology, air-pollution science and medicine across the asthma trajectory. Their discussion navigates the roles of pollen, fungal aerospora, air pollution and social determinants, shedding light on the impact climate change has on South African asthmatic patients. Not to be all doom and gloom, they outlined the important benefits of accessible urban greenspaces, but underscore aeroallergen considerations in the design of future spaces.
The edition concludes with a beloved regular feature – an ABC of Allergy – this time about a crucial cutaneous eczema differential: psoriasis and also a Dr Spur article on the matter of primary immunodeficiency associated with Type-1 diabetes mellitus.
In addition, a thought-provoking ethics article is timely. Distinguished South African philosopher David Benatar acquaints readers with common yet flawed ethical arguments about gene editing, while also delving into the true ethical dilemmas that emerge as humanity wields increasingly powerful genome-editing techniques.
Wishing you an enlightening reading experience
Pieter de Waal