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Marked differences in the prevalence of allergy between urban and rural environments have been well established. Certain microorganisms encountered in and around farming and rural surroundings can 'train' and modulate the human immune system to protect against certain infectious and non-communicable diseases, including allergies. Research from South Africa has indicated that drinking fermented cow's milk from a young age may protect against allergy even in a urban population. Lactic acid bacteria are important role-players in allergy protection and these organisms are abundant in fermented food products. The questions arise: Can people living in urban areas, at least to some extent, 'replicate' the allergy protective environment of rural people or at least compensate for a lack of exposure to protective organisms? And can they do so safely? In this review we focus on fermented milk and other fermented foods and elaborate on the allergy-protective microbiota favoured by fermentation. [ABSTRACT FROM AUTHOR]

Chronic urticaria is a mast cell-mediated condition, with episodes of urticaria (with or without angioedema) lasting for longer than 6 weeks. It leads to significant patient morbidity and affects both social and occupational functioning. Recurrent episodes of angioedema can also occur in isolation and may be life-threatening. Although state-of-the-art targeted treatments have been published globally, third- and fourth-line treatment options are not always accessible and affordable to patients in South Africa. The immediate availability of emergency medicines for acute, life-threatening angioedema episodes, also remains a major concern, and in the private healthcare sector, medical schemes often requiring extensive authorisation processes before these drugs can be administered to patients. Although medical practitioners are advised to adhere to international management guidelines on urticaria and angioedema, in South Africa, 'off-label', less effective medications are often used in an attempt to achieve symptom control and to treat life-threatening attacks of angioedema. [ABSTRACT FROM AUTHOR]

Papular urticaria is commonly seen in emergency departments and primary healthcare clinics and is often incorrectly diagnosed as atopic eczema. This annoying condition is caused by a chronic relapsing hypersensitivity reaction to mostly biting insects. The lesions are intensely pruritic. Owing to continuous scratching, lesions often become secondarily infected. Although adults are also affected, children are more likely to suffer from papular urticaria. Lesions are typically confined to the skin, but in rarer cases, systemic involvement and even anaphylaxis may ensue in susceptible individuals. Insects may also be vectors of various viruses, bacteria and parasites and can transmit vector-borne diseases, for instance, malaria. Although this is a mostly benign condition that is outgrown, some patients with papular urticaria may have serious underlying systemic illnesses or may be immunocompromised. In this article, common offenders, including fleas, bed bugs and mosquitoes, are discussed; as an underlying cause of papular urticaria, scabies is also highlighted. Diagnostic guidance for primary healthcare practitioners, practical examples of insect and parasite eradication and avoidance strategies, in addition to the supportive treatments available in primary healthcare clinics and emergency departments, are explored. [ABSTRACT FROM AUTHOR]

The Protection of Personal Information Act (POPIA) and the Promotion of Access to Information Act (PAIA) govern the way that businesses collect, store, access and destroy personal client information in a safe and secure manner. The initial deadline for businesses to comply with these Acts was 1 July 2021. Patient information kept at medical practices does not only include personal details, but the nature of this may also be extremely sensitive and intimate. These Acts will therefore also affect members of the medical fraternity. All medical practices and hospitals, regardless of size, are required to be POPIA and PAIA compliant. Medical professionals are strongly advised to familiarise themselves and to comply with these Acts, as serious consequences may arise if a practice or institution is found guilty of non-compliance. [ABSTRACT FROM AUTHOR]

Allergic rhinitis (AR) is a common condition that affects children from a very young age. It is often misdiagnosed as viral rhinosinusitis and erroneously treated with first-line over-the-counter medication, which will not only be ineffective, but may also lead to medication side-effects. Untreated AR can lead to serious complications. Trigger identification can be done using skin-prick testing and serum IgE-measurement – but this should be performed early. However, in certain emerging AR phenotypes – for example, local allergic rhinitis (LAR) – these procedures may have negative results and a nasal allergen challenge should be performed. This review aims to highlight some basic principles of diagnosing, investigating and treating AR in South African children and to compare existing South African guidelines with recently published European guidelines. Early aeroallergen immunotherapy has a disease-altering effect on the natural course of AR, but access to this treatment option is unfortunately too expensive for most patients in South Africa. It is time for health authorities and stakeholders to realise that immunotherapy is more cost-effective than pharmacotherapy in treating this debilitating chronic disease which often seriously interferes with a patient’s quality of life. [ABSTRACT FROM AUTHOR]

Keywords: allergy prevention; amasi; biodiversity; cow's milk; fermentation; microbiota; rural EN allergy prevention amasi biodiversity cow's milk fermentation microbiota rural 1879 1882 4 11/02/21 20211101 NES 211101 ACKNOWLEDGMENTS The authors would like to acknowledge the ilifu cloud computing facility (www.ilifu.ac.za), used for data processing in this study. Results showed that the fresh cow's milk samples (both urban and rural) had significantly higher numbers of amplicon sequence variants (ASVs) and identified taxa compared to I amasi i and CFA. To the Editor, The anti-allergic properties of raw and fermented cow's milk are being explored globally.1,2 Traditionally fermented milk (isiXhosa - " I amasi i ") is consumed regularly by rural South African communities. [Extracted from the article]

MBL is critical in activating the lectin pathway of the complement system. MBL deficiency remains a contentious issue in clinical practice, mainly because low MBL levels may present in completely asymptomatic individuals. However, in some cases, symptomatic patients may present with susceptibility to infections and even immune dysregulation. Infections may range from mild to severe, and may even be life-threatening and fatal. A significant number of patients may remain undiagnosed, merely because interrogating complement function is often postponed until after presumably more common immune problems have been excluded in patients with severe, recurrent or unusual infections. In addition, clinicians are less familiar with the clinical recognition and appropriate choice of special investigations necessary to diagnose MBL and other complement deficiencies. Our case report describes a young girl with a serious underlying inborn error of immunity. She initially presented with recurrent 'innocent' and mild infections. We illustrate that clinically relevant MBL deficiency, if undiagnosed, may have disastrous consequences. We also stress the importance of careful interpretation of MBL quantitative laboratory values and the urgent need for access to more specialised complement-component and genetic testing, especially for patients attending state healthcare facilities. [ABSTRACT FROM AUTHOR]

MBL is critical in activating the lectin pathway of the complement system. MBL deficiency remains a contentious issue in clinical practice, mainly because low MBL levels may present in completely asymptomatic individuals. However, in some cases, symptomatic patients may present with susceptibility to infections and even immune dysregulation. Infections may range from mild to severe, and may even be life-threatening and fatal. A significant number of patients may remain undiagnosed, merely because interrogating complement function is often postponed until after presumably more common immune problems have been excluded in patients with severe, recurrent or unusual infections. In addition, clinicians are less familiar with the clinical recognition and appropriate choice of special investigations necessary to diagnose MBL and other complement deficiencies. Our case report describes a young girl with a serious underlying inborn error of immunity. She initially presented with recurrent 'innocent' and mild infections. We illustrate that clinically relevant MBL deficiency, if undiagnosed, may have disastrous consequences. We also stress the importance of careful interpretation of MBL quantitative laboratory values and the urgent need for access to more specialised complement-component and genetic testing, especially for patients attending state healthcare facilities. [ABSTRACT FROM AUTHOR]

The article examines the complex role of clinician-scientists who balance patient care with in-depth molecular research, reflecting the need to integrate both perspectives. Topics include recent advances in managing recurrent angioedema and atopic dermatitis, the importance of bridging molecular insights with clinical practice for food allergies and mannin-binding lectin deficiency, and the impact of environmental factors on asthma and dermatitis.

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. [ABSTRACT FROM AUTHOR]