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Pharmacists are trusted health care professionals. Many patients use over-the-counter (OTC) medications and are seen by pharmacists who are the initial point of contact for allergic rhinitis management in most countries. The role of pharmacists in integrated care pathways (ICPs) for allergic diseases is important. This paper builds on existing studies and provides tools intended to help pharmacists provide optimal advice/interventions/strategies to patients with rhinitis. The Allergic Rhinitis and its Impact on Asthma (ARIA)-pharmacy ICP includes a diagnostic questionnaire specifically focusing attention on key symptoms and markers of the disease, a systematic Diagnosis Guide (including differential diagnoses), and a simple flowchart with proposed treatment for rhinitis and asthma multimorbidity. Key prompts for referral within the ICP are included. The use of technology is critical to enhance the management of allergic rhinitis. However, the ARIA-pharmacy ICP should be adapted to local healthcare environments/situations as regional (national) differences exist in pharmacy care.

Pharmacists are trusted health care professionals. Many patients use over-the-counter (OTC) medications and are seen by pharmacists who are the initial point of contact for allergic rhinitis management in most countries. The role of pharmacists in integrated care pathways (ICPs) for allergic diseases is important. This paper builds on existing studies and provides tools intended to help pharmacists provide optimal advice/interventions/strategies to patients with rhinitis. The Allergic Rhinitis and its Impact on Asthma (ARIA)-pharmacy ICP includes a diagnostic questionnaire specifically focusing attention on key symptoms and markers of the disease, a systematic Diagnosis Guide (including differential diagnoses), and a simple flowchart with proposed treatment for rhinitis and asthma multimorbidity. Key prompts for referral within the ICP are included. The use of technology is critical to enhance the management of allergic rhinitis. However, the ARIA-pharmacy ICP should be adapted to local healthcare environments/situations as regional (national) differences exist in pharmacy care. 74 7 1219 1236

Background. In the subtropical climate of South Africa, grasses of the subfamily Panicoideae are predominant. Bermuda grass has previously been shown to be an important local allergen, and immunoglobulin E (IgE) epitopes of Bermuda grass extracts are known to be distinct from those of the Pooid pollen extracts. Following our demonstration of sensitivity in 43% of patients grass-allergic to the Panicoid, Kikuyu grass, we have studied the closely related buffalo grass, Stenotaphrurn secundaturn, indigenous to the Western Cape region, the east coast of Africa and the oceanic islands such as Mauritius; and Eragrostis, another common indigenous grass with a wide distribution.Objective. To partially characterise the allergens of buffalo pollen, and examine its immunological relationships with local common grasses such as Eragrostis and Kikuyu.Methods. Grass-allergic patients were evaluated clinically, and skin prick tests (SPTs) and radio-allergosorbent tests (RASTs) to Bermuda and grass mix were performed. Sera of timothy grass-sensitive patients from Belgium were also included in this study. Pollen extract from buffalo grass was characterised by specific IgE binding by means of immunoblotting and enzyme-linked immunosorbent assay (ELISA). Crossreactivity between the grasses was studied by means of inhibition of IgE binding.Results. More than 90% of grass-sensitive patients were found to have IgE antibodies to Buffalo and Eragrostis pollen. Inhibition of ELISA and immunoblots revealed that extracts of these grass pollens could significant inhibit IgE binding to the local grass pollens, Kikuyu, buffalo, Eragrostis and Bermuda on solid phase, but 100% inhibition was never achieved, indicating that cross-reactive but also unique epitopes are present. We also identified a subset of patients with negative RASTs to Bermuda, and minimal inhibition by Bermuda pollen extract.Conclusion. Buffalo and Eragrostis are important aeroallergens in the Cape, dispersed during the long dry, windy summer. Our data suggest that the local grasses are major sensitisers, and that South African diagnostic panels should include extracts of buffalo and Eragrostis grasses.

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The global increased prevalence of allergy is such that between 20-30% of the world's population now suffers from some form of allergic disease, with considerable and continuing increases in prevalence over the last three decades [1]. Although the specialty of allergy is practiced and recognized in most developed countries, even some developed countries lack adequate resources to manage the local burden of allergic disease. In many developing countries there are few or no allergy specialists due to either the prevailing healthcare infrastructure, to socio-economic reasons, and/or to the lack of recognition of allergy as a clinical specialty. There is often minimal or no inclusion of allergy education/training in the undergraduate medical curriculum, and this shortfall must be addressed if the increasing burden of allergic diseases is to be managed. The majority of patients with common allergic diseases around the world are treated by primary care physicians, and not by trained specialists. However, a lack of appropriate education and training in allergy at the undergraduate level leaves many medical graduates with low baseline knowledge and skills in the science and practice of allergy. In addition, because it is a relatively new discipline, education and training in allergy in medical schools has lagged behind scientific and clinical developments in this field, and there are few allergy specialists available to teach this multidisciplinary subject. This phenomenon is described by the World Health Organization as the knowledge/practice gap. Unless allergy training is included as an essential part of undergraduate medical education at the clinical level, many physicians will qualify with inadequate competency to manage the diagnosis and treatment of allergic diseases at the primary care level. Thus, a cycle of lack of basic knowledge about the most common allergic diseases, lack of recognition of allergic disease at the clinical level, and inadequate knowledge and skills in the diagnosis and treatment of allergic diseases will be perpetuated. To help break this cycle the World Allergy Organization (WAO) presents broad guidelines for the curriculum of education and training of medical students in the immune mechanisms of allergic responses, and the commonest manifestations of clinical allergy. Inclusion of these educational guidelines into curriculum development will provide medical graduates with the basic knowledge required to recognize and treat common allergic diseases during postgraduate training or as a general practitioner (care level 1), and the knowledge of when to refer the more complex problems to appropriate organ-based or allergy specialists (care levels 2 and 3) [2]. These guidelines outline optimal curriculum content, and are offered for consideration and modification to meet local needs and healthcare provision structures. Although certain immunodeficiency states may accompany allergies or may need to be considered in the differential diagnosis of allergic diseases, this document is not intended to provide a comprehensive guideline on the teaching of immune deficiencies to medical students.

Allergic diseases are on the increase, affecting 30-40% of the population. Histamine remains the most important mediator of clinical reactions in allergic diseases such as rhinitis, urticaria, and food and drug allergies. The need for more effective and safe antihistamines is critical and intensive drug development has become more demanding and competitive. Although the old “first generation” antihistamines were effective, major limitations included their strong potential for sedation and their anti-cholinergic side effects. Not only could patients not function well in their normal daily activities, but these medications posed an important risk for safety, particularly for motor vehicle drivers and machine and precision instrument operators. Unacceptable side effects were a particular problem in the elderly. In May 2001, CONGA, an international consensus group, convened to formulate guidelines for the development of new antihistamines. Several important areas were reviewed and a document of recommendations was published, focusing specifically on the safety and efficacy aspects of antihistamines. South African Family Practice Vol. 47(7) 2005: 24-28

Meningococcal disease remains one of the most serious bacterial infections in both Western and developing countries. Despite recent advances in treatment the mortality rate remains at about 12%.1 There is a group of South Africans who are particularly vulnerable to this disease. They are individuals with genetically determined deficiencies of individual terminal complement proteins, in particular of the sixth component of complement (C6).2 The human complement system forms part of the humeral immune system and consists of a series of proteins.3 The interaction of antigen (such as components of bacterial outer membranes) and antibody leads to activation of the first component C1q, and consequent activation of part or all of the complement cascade. This has a number of biological effects including the formation on the membrane of the membrane attack complex (MAC) from components C5b, C6, C7, C8 and C9. The MAC is able to mediate lysis of some mammalian cells such as red blood cells, as well as lysis of bacteria and certain viruses. This action of complement has been recognised for many years as playing a major role in defence against infection.4 In addition, MAC action is often sublytic on nucleated host cells, and this interaction can sometimes stimulate cellular biosynthesis and act in a pro-inflammatory manner.5 Many other complement proteins, and products of complement activation, also interact with the cellular immune system and the inflammatory system. If activation is caused by pathological processes such as ischaemia, complement can be an important contributor to host tissue necrosis.6 The effects of complement activation are very complex and can be detrimental as well as beneficial.