Carol Hlela

The South African Food Sensitisation and Food Allergy population-based study of IgE-mediated food allergy: validity, safety, and acceptability.

BACKGROUND Few studies exist on food sensitization and challenge-proven food allergy in low- and middle-income countries. OBJECTIVE To describe the study design and methodology to recruit infants from an African population for skin prick testing and oral food challenges and the use of preliminary data to investigate the extent to which the study sample is representative of the target population. METHODS Children 12 to 36 months old were recruited from childcare education facilities in Cape Town. Children underwent skin prick testing to foods. Those with a reactive wheal of at least 1 mm larger than the negative control and not clearly tolerant according to history to a full age-appropriate portion to at least 1 food underwent oral food challenges. Parents who chose not to participate completed a nonparticipant questionnaire. Interim analysis of at least 500 respondents was performed. Demographic features of participating children were compared with those of nonparticipants and the population demographics of the most recent Cape Town census data. RESULTS The response rate was 60.1%, with high participation and completion rates of 96.5% and 97.5%, respectively. Demographics of the completed participant sample were similar to those of the Cape Town census. Use of a nonrespondent questionnaire indicated no selection bias in favor of increased participation of participants with allergy. No ethnic differences in sensitization or food allergy were evident. CONCLUSION The study was safe and feasible and the recruitment was effective and representative of the target population. Future studies will aim to increase the precision of the prevalence of food sensitization and allergy, describe environmental risk factors, and include a rural black African cohort.

A Review and Proposed Approach to the Neutrophilic Dermatoses of Childhood.

Neutrophilic dermatoses (NDs) are inflammatory skin conditions that are not associated with infection. The classification and clinical approach to these conditions in children is poorly described. This review classifies these conditions into five nosological subtypes: Sweets syndrome, pyoderma gangrenosum, aseptic pustules, neutrophilic urticarial dermatoses, and Marshalls syndrome. In addition, we review the various secondary diseases that need to be excluded in the clinical management of the NDs of childhood, with a focus on the autoinflammatory conditions that the reader may not be familiar with. We propose a practical clinical approach to these disorders.

Infective Dermatitis Associated with HTLV-1 Mimics Common Eczemas in Children and May Be a Prelude to Severe Systemic Diseases

Infective dermatitis associated with human T-cell lymphotropic virus type 1 (HTLV-1) (IDH) is a chronic dermatitis that has been observed in a variable proportion of HTLV-1-infected children. IDH may serve as an early clinical marker for HTLV-1 infection and an indicator of increased risk for developing other HTLV-1-associated conditions. Factors that lead only some infected children to develop IDH are poorly understood. The variable clinical presentation of IDH, in particular its chronicity, the morphology and distribution of the lesions, and its clinical resemblance to other cutaneous inflammatory conditions, make it necessary to distinguish it from other common dermatoses.

Focus on the Top Ten Diagnoses Could Reduce Pediatric Dermatology Referrals

There is a sense that many patients seen at referral centers could be managed at a primary health care level. The objective of the current study was to examine the range of diagnoses among consultations at the Red Cross Childrens Hospital in Cape Town, South Africa, to help develop a strategy for targeted education of primary health care personnel. This was a retrospective review of data for children seen at a pediatric dermatology clinic from 2005 to 2010, recorded according to International Classification of Diseases coding and compared with published data from similar clinical settings. There were 13,253 clinic visits, with 4,789 patients seen (median age 4.8 yrs, range 2 days to 18.6 yrs). The top 10 diagnoses accounted for 88.5% of consultations (59.5% atopic eczema [AE], 7.1% seborrheic dermatitis [SD], 4.2% superficial mycoses, 3.1% molluscum contagiosum, 2.8% vitiligo, 2.7% viral warts, 2.4% prurigo or scabies, 2.3% psoriasis, 2.3% hemangioma, 2.1% impetigo). Disease prevalence was somewhat different during the first year of life (AE 43.7%, SD 18.6%, hemangiomas 13.4%). Inflammatory dermatoses (76.6%) were more prevalent than infections and infestations (14.5%). The disease spectrum was similar to that in developed countries, although AE prevalence was higher in this study (followed by London 36%, Greece 35%, and Hong Kong 33%) than in 19 published studies. The top 10 diagnoses accounted for more than 70% of diagnoses in 12 studies. The retrospective nature and setting at a specialist clinic increased bias and limited generalizability. Focused education on the optimal care of common diseases, especially AE, could reduce referrals, improve access, and allow specialists at tertiary centers more time to manage complex and uncommon dermatoses.

Neonatal lupus erythematosus or Sweet syndrome

SLE: systemic lupus erythematosus SLND: Sweet-like neutrophilic dermatosis A 2-month-old baby boy was admitted to our hospital with a diffuse rash. Birth history was uneventful. Prenatal screening serology for HIV and syphilis was negative. The mother was known to have lupus nephritis that had been in remission for 5 years with regular monitoring. On examination, the baby had indurated, erythematous plaques around both eyes, and the conjunctiva and sclera were normal. He had erosions on the hard palate. On the trunk, back, arms, legs, palms, and soles he had striking annular plaques with a raised erythematous border (Figs 1 and 2). He was afebrile, with a normal blood pressure and pulse rate. Respiratory, cerebrovascular, and central nervous system findings were all normal. His developmental milestones were appropriate for age. His blood profile revealed a thrombocytopenia of 37 3 10L (normal range, 140-350 3 10/L), white cell count of 6.12 3 10/L (normal range, 5.5018.003 10/L), hemoglobin level of 9.6 g/dL (normal range, 9.1-13.1 g/dL), and mean corpuscular volume of 79.3 fL (normal range, 77.0-105.0 fL). Our laboratory measures antinuclear antibodies using the EliA connective tissue diseases (EliA CTD Screen) fluoro enzyme immunoassay, and results are reported in a ratio as either negative (\0.7), equivocal (0.7-1.0), or positive ([1.0). Our patient had positive antinuclear antibodies of 24.0, a positive anti-SS-A (Ro) greater than 240 U/mL, and a positive anti-SS-B (La) greater than 320 U/mL. Antiedouble-stranded DNA antibody was not detected, and complement C3 and C4 were normal. Liver function values were elevated, with an increased alanine transaminase of 210 U/L (normal range, 4-35 U/L), aspartate transaminase of

Comment on “Prevention of flares in children with atopic dermatitis with regular use of an emollient containing glycerol and paraffin: A randomised controlled study”

To the Editor, We read with interest the article by Tiplica et al that investigated the use of emollients in patients with atopic dermatitis (AD). Patients were first treated with a potent corticosteroid and then randomized into one of three arms: an emollient containing glycerol and liquid paraffin, a reference emollient cream (Atopiclair), and no emollient. The primary endpoints were the percentage of patients who had one or more flares, assessed using the Scoing Atopic Dermatits severity score. Fewer flares were experienced over 12 weeks with both emollients than in controls and fewer patients required topical corticosteroids in the emollient groups than in the nonemollient group. We had the following concerns. The authors made no mention of bathing practices (eg, soap vs soap-free) or whether antihistamines were used during the study period. Treatment protocols also differed between the study arms. The emollient containing glycerol and paraffin was applied twice a day to the entire body, whereas Atopiclair was used three times a day only on affected areas. These differences in treatment regimens may have confounded the results (the lower response to treatment of the Atopiclair group). The active ingredients of Atopiclair were also not stated, but according to the product website it contains oils (shea and grape seed). The authors demonstrate elegantly that patients with mild to moderate AD who use emollients experience fewer AD flares and use less corticosteroid than patients who do not use emollients. They also demonstrated that simple emollients are effective. We also recently reported that the use of emollients containing 20% glycerine and white soft paraffin—somewhat similar ingredients to those that Tiplica et al tested, were as effective as cetomacrogol and emulsifying ointment in the management of mild to moderate AD. Glycerol and glycerine are often used interchangeably; the latter is a widely available commercial product that contains at least 95% glycerol. Evidence demonstrating the efficacy of moisturizers containing inexpensive, widely accessible ingredients is important for the management of AD in resource-poor countries. Most of the current expensive moisturizers are not proving to be more effective than the standard-of-care inexpensive options.

Cost-effectiveness analysis of introducing HTLV-1 testing in South Africa

We have previously reported a 2013 cross-sectional study of HTLV prevalence among 46,765 South African blood donors. Confirmed HTLV-1 prevalence was 0.16% in Black donors, 0.02% in both White and Coloured donors and 0% in south Asian donors, for an overall prevalence of 0.062% extrapolated to the current blood donor population. Using these data we estimated the cost effectiveness of potential HTLV screening strategies in preventing transfusion transmitted HTLV-1 infection (TTI). Five blood donor screening strategies were considered: no screening; HTLV testing of every donation; HTLV testing each donor one time only; HTLV testing of new donors only; and universal filter leukodepletion without HTLV testing. The size of the population to be screened annually was 831,565 for universal screening, 507,054 for screening all donors once and 133,050 for screening new donors only. Using a prevalence of 0.062% and an assumed transmission efficiency of 10% because of buffy coat removal during red cell production, we calculated intervention and donor management costs and estimated the number of TTI prevented. There would be an estimated 58, 1, 1, 50 and 0.5 potential TTI cases under no screening, universal screening, screening all donors once, screening new donors only, and universal leukodepletion, respectively. The estimated costs per TTI prevented were

PW03-022 – Neutrophilic skin disease and inflammation

0,

The prevalence of human T-cell lymphotropic virus type 1 in the general population is unknown.

31,574,

Affordable moisturisers are effective in atopic eczema: A randomised controlled trial

26,260,