NEWSLETTER SECOND EDITION - SEPTEMBER 2012 ALLSA REPORT FROM THE CHAIRMAN INSIDE THIS ISSUE SECOND EDITON SEPTEMBER

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INSIDE THIS ISSUE TITLE PAGE CHAIRMAN S REPORT 1 ALLSA NEWS Dr Ahmed Manjra Dr Gloria Davis 2 3 ALLSA 2013 CONGRESS 4 INTERNATIONAL CONGRESS DATES UPDATE: Paediatric Refresher Course UCT Paediatric

1 NEWSLETTER SECOND EDITION - SEPTEMBER 2012 ALLSA REPORT FROM THE CHAIRMAN Thank you for the wonderful response to the Newsletter. There has been such a great response I am trying to make this a monthly feature. INSIDE THIS ISSUE TITLE PAGE CHAIRMAN S REPORT 1 ALLSA NEWS Dr Ahmed Manjra Dr Gloria Davis 2 3 ALLSA 2013 CONGRESS 4 INTERNATIONAL CONGRESS DATES UPDATE: Paediatric Refresher Course UCT Paediatric update Allergic Rhinitis Guidelines Figure1. Algorithm for diagnosis and management of rhinitis in South Africa PATIENT EDUCATION Allergic Rhinitis I have included our first revision of our patient education brochures, namely Allergic Rhinitis. ALLSA EXCOM are in the process of reworking and rewriting all our brochures. These should be available on the web in the next few months. We made a decision not to print these but to have them loaded in a printable version for easy valuable resource of our Society. So whilst on the topic of Allergic Rhinitis you may have seen the updated Guideline on Allergic Rhinitis by the South African Allergic Rhinitis working Group published in the SAMJ recently. I have decided to include an extract from this here in the newsletter because it may prompt you to reading the full article. Allergic Rhinitis is our commonest allergic disease in South Africa and many patients remain poorly controlled and symptomatic. Quality of life impairment results and individuals with nasal symptoms feel lousy. I have added a new section. I want to use this feature to introduce you to those individuals in South Africa who have been prominent Allergy Researchers and exposed local allergy problems in our country. The first such person is Gloria Davis. I also have a feature on your Executive Members and our first story is about Ahmed Manjra, past Chair of the Society. I have also included a list of national and international congresses that you may want to attend. Finally I want to mention that the Minister of Health has just signed into law the promulgation of Allergology for sub-specialisation in Paediatrics, Internal Medicine and Family Medicine. The HPCSA have accepted this promulgation and ALLSA has been instrumental in creating a policy for Grandfathering of Allergologists in South Africa. We are currently testing the process and if we are successful in getting the HPCSA to register individuals I will share the document with you in the next newsletter so those of you who believe you should be recognised as Allergologists may apply. Enjoy this issue. Robin Green SECOND EDITON SEPTEMBER

ALLSA NEWS: INTRODUCING AHMED ISMAIL MANJRA Ahmed is past Chairman of ALLSA, his second term in this role.

He was in the first group of doctors to get the Diploma in Allergology in 2003 and was the first recipient of the Eugene Weinberg Gold Medal for outstanding performance in this examination.

He is also an International Fellow of the American Academy of Allergy, Asthma and Immunology and currently works in Private Practice as a Specialist Paediatrician in Durban where he is acknowledged

Ahmed has 43 peer-reviewed publications to his name, has written a book and a book chapter.

2 ALLSA NEWS: INTRODUCING AHMED ISMAIL MANJRA Ahmed is past Chairman of ALLSA, his second term in this role. Ahmed obtained his MBChB from the University of Kwa-Zulu Natal and then an FCP in Paediatrics from the College of Medicine of SA. He was in the first group of doctors to get the Diploma in Allergology in 2003 and was the first recipient of the Eugene Weinberg Gold Medal for outstanding performance in this examination. He then went on to obtain a Masters degree in Clinical Pharmacology from the University of Kwa-Zulu Natal in He is also an International Fellow of the American Academy of Allergy, Asthma and Immunology and currently works in Private Practice as a Specialist Paediatrician in Durban where he is acknowledged as an expert in allergic diseases. He has a large allergy practice and sees referrals from general practitioners and specialists for tertiary level care in Allergology. Ahmed has 43 peer-reviewed publications to his name, has written a book and a book chapter. He has given a number of local and international lectures to medical audiences and is a sought after speaker. Ahmed is a founding member of the South African Childhood Asthma Working Group and South African Allergic Rhinitis Working Group. He is Chairman of the South African Atopic Eczema Working Group. He serves on the Editorial Advisory Board of Current Allergy and Clinical Immunology and is Founder and present Editor of The South African Paediatric Review. Ahmed has been involved in a great deal of science relating to Allergy in South Africa and has led the Allergy Society with distinction over many years. SEPTEMBER 2012 SECOND EDITION 2

ALLSA NEWS: FOCUS ON GLORIA DAVIS Gloria has been a keen observer of allergic trends in the population of children in Gauteng, South Africa for some 20 years.

3 ALLSA NEWS: FOCUS ON GLORIA DAVIS Gloria has been a keen observer of allergic trends in the population of children in Gauteng, South Africa for some 20 years. First working in the Allergy Clinic at the Chris Hani Baragwanath Hospital with David Luyt, Karen Simmanck and Melony Dance, she analysed the skin prick test positivity of the asthmatic children there, and found a staggeringly high prevalence of House Dust Mite allergy in children, most of whom had never been to the coast. This led her to measure HDM levels in the bedding and in the carpets of children from Soweto and here too she found levels of this bug that were not insignificant. She went on to propose that even low levels of HDM antigen could trigger sensitivity in asthmatic children. Gloria has published 14 peer-reviewed publications locally and abroad highlighting her research findings. She has prompted much local and international debate in allergy circles and her numerous congress presentations around the globe have sparked massive interest. She has put Gauteng on the world allergy map and many authors have subsequently gone on to duplicate her original findings. Gloria has been a major supporter of the Allergy Society of South Africa over many years, attending most of the Congresses that have been held since She has often been invited to lecture. She has also served ALLSA through involvement in local Journal Clubs and other Gauteng based initiatives. Gloria has served the patients of Gauteng by providing allergy services to many generations of allergy sufferers. She is one of the most courteous and competent doctors working in allergy in SA and she runs a most successful allergy practice in Parkview, Johannesburg. Thank you for what you have done for ALLSA and allergy in South Africa, Gloria. SEPTEMBER 2012 SECOND EDITI0N 3

4 ALLSA 2013 CONGRESS SECOND EDITION SEPTEMBER

5 I INTERNATIONAL CONGRESS LIST WISC WAO INTERNATIONAL SCIENTIFIC CONGRESS 6 9 DECEMBER 2012 HYDERABAD INDIA AAAAI ANNUAL MEETNG FEBRUARY 2013 SAN ANTONIO TEXAS; USA EAACI - WAO INTERNATIONAL CONGRESS JUNE 2013 MILAN ITALY UPDATE PAEDIATRIC REFRESHER COURSE FEBRUARY 2013 UNIVERSITY OF CAPE TOWN PAEDIATRIC UPDATE 1 3 MARCH 2013 SANLAM AUDITORIUM HATFIELD CAMPUS UP. UNIVERSITY OF PRETORIA ALLERGIC RHINITIS GUIDELINES A report from the South African Allergic Rhinitis Working Group Green RJ, Hockman M, Friedman R, Vardas E, Cole P, Halkas A, Feldman C, on behalf of the South African Allergic Rhinitis Working Group (SAARWG) The SAARWG has suggested an algorithm for the diagnosis and management of rhinitis in South African patients (Figure 1). This condition remains common, important and troubling to patients. Every effort should be made to target therapy correctly. Reference: Green RJ, et al. S Afr Med J 2012;102(8): SECOND EDITION SEPTEMBER

6 Figure1. Algorithm for diagnosis and management of rhinitis in South Africa Symptoms (Blocked Nose, rhinorrhoea, sneezing, itch) Rhinitis Signs (allergic facies) Complications (sinusitis, chronic otitis media, obstructed breathing) Evaluation for Asthma Allergy Testing Note Co-morbidities Treat Asthma if present SPT Selected ImmunoCAP Profiles Sinusitis OME NO Routine Total IgE Obstructed Breathing Atopic Eczema Allergic Non-Allergic Rhinitis Rhinits Mild or Seasonal (uncommon in SA) Moderate-Severe (common in SA) Infant Evaluation for Cause Treat Treat as for AR (Vasomotor) (if no other cause found) Non Sedating Anti-Histamine Intranasal Corticosteroid Avoidance Saline All Medications Are Off Label - Urgent studies of Efficacy and Safety Required Allergens, Irritants Dangerous Medications (Topical vasoconstrictors for longer than 7-10 days, overthe-counter preparations) Educate Patients Follow up regularly SEPTEMBER 2012 SECOND EDITI0N 6

7 PATIENT EDUCATION ALLERGIC RHINITIS Introduction Allergic problems of the nose are very common in Southern Africa and affect almost 40% of people. This allergic problem is often regarded as a rather trivial condition, but the truth is that consequences of allergic rhinitis may produce many untoward complications that have not been adequately appreciated. The basis of nasal allergic problems results from the interaction of common inhaled allergens with specialise cells called mast cells in the nasal mucous membrane. The reaction results in the release of powerful chemical agents of which histamine is the best known. These substances cause very severe swelling of the mucous membrane lining the nasal passages, intense itching and sneezing and the production of copious amounts of watery mucus. Allergic nasal disorders are decided into two main types; the intermittent form which is also known as seasonal allergic rhinitis or more commonly as hay-fever, and secondly the year-round form known as persistent or perennial allergic rhinitis. Persistent Allergic Rhinitis in this form of allergic rhinitis, symptoms are present throughout the year. Excessive sneezing especially in the mornings and evenings, and a very blocked nose are the main complaints. Intense itching of the nasal passages is not a feature of this condition. Allergic salute patients also complain of sleep disturbance and headaches and tend to be rather lethargic and unhappy. The majority of sufferers are sensitive to allergens present in the environment throughout the year, e.g. housedust mites, fungal spores and animals. In many parts of South Africa grass flowers for much of the year and even this so-called seasonal allergen causes problems most of the year round. Patients with this condition often have a typical appearance known as the allergic facies. They are often pale with rather long, mournful faces, have dark rings under their eyes (the allergic shiners) and have dry lips due to mouth breathing. Many people have a clear line across the nose known as allergic salute. Associated problems are very common and include abnormalities of the teeth and sinuses, ear problems and post-nasal drip. The diagnosis is readily established on the patient s story of the complaint, and skin prick tests or ImmunoCAP RAST tests. The latter is done on a small sample of the patient s blood and requires a laboratory to analyse results. In the majority of cases house-dust mites or cats or dogs are identified as the causative allergen. Treatment follows essentially the same lines as for hay-fever, except that environmental control (i.e. avoidance of the allergen) may be useful, e.g. removing pets from the home. Steroid nose sprays are generally necessary. Copyright: Allergy Society of South Africa Written by Prof Eugene Weinberg. Updated by Prof Robin Green 2012 See the Allsa Website at: This is an extract only SEPTEMBER 2012 SECOND EDITI0N 7

Paediatric Pulmonology Report 2014

Paediatric Pulmonology Report 2014 STATS Out-Patients 1864 visits ASTHMA BRONCHIE CYSTIC FIBROSIS JANUARY 72 12 16 FEBRUARY 118 37 20 MARCH 139 36 16 APRIL 89 26 24 MAY 122 31 15 JUNE 114 25 10 JULY 155