Children’s Chest and Allergy Clinic, University of Pretoria and Steve Biko Academic Hospital, Pretoria

History

The Children’s Chest and Allergy Clinic was initiated in September 2005 when the current director, Professor Robin J Green, joined the university.

Professor Green is a Paediatric Pulmonologist by training but has a passion for Allergology.

Immediately the clinic set standards for patient care and advocacy, development of research directions and training programmes began.

Today the clinic has a reputation for excellence in the practice of allergology and associated disciplines in the city and throughout the country. A number of African centres utilise an association with this centre.

Over the last 4 years the clinic has joined forces with three clinical immunologists to broaden the profile of the clinic to promote clinical care, advocacy and research and teaching in the domain of Primary Immunodeficiencies. This service is the only service offered in the north of South Africa and has been a major programme for the population as well as creating a new profile of academic achievements.

Facilities

The clinic runs a two day per week Allergy service, a full-time in-patient service and a monthly PID clinic.

The clinics and ward base service have the support of a full-time pulmonary technologist, dietician, physiotherapist and psychologist.

The clinic is staffed by 8 full and part-time specialists.

The clinic has the following facilities available for diagnostic processes:

Pulmonary functions (spirometry, challenge testing), exhaled nitric oxide, skin prick testing (aero-allergens, food allergens and drug allergens), PID testing (including genetic testing).

The clinic has the following therapeutic protocols:

• Food allergy diagnostic protocols
• Drug allergy testing protocols
• Asthma management protocol (including acute asthma)
• Allergic and chronic rhinitis management protocols
• Atopic dermatitis management protocols
• Chronic urticaria management protocols
• Isolated angioedema management protocols
• PID management protocols
• Protocols for management of rare allergic conditions

The clinic has a 6-bed ward available for admission of patients with acute severe allergic conditions and for admission of patients who require wet wraps for atopic dermatitis and food challenge testing. In addition, patients are admitted as ‘day patients’ for immunoglobulin replacement therapy.

The clinic has the following associated services:

• Dietician
• Physiotherapy
• ENT support
• Dermatology support
• Ophthalmology support
• Cardiothoracic support

The clinic has access to two laboratory services for allergy testing and PID testing:

1. The NHLS (National Health Laboratory Service)
2. Ampath private laboratory

The NHLS (National Health Laboratory Service) provides basic allergy and immunology testing services for allergy and primary immunodeficiency.

Ampath private laboratory provides both basic and advanced laboratory services for the diagnosis of allergy and primary immunodeficiency. There is collaboration between the NHLS and Ampath to provide a route of access to advanced tests for public sector patients.

The following diagnostic laboratory services are available:

Allergy:

• Allergen-specific IgE testing to a wide variety of allergens (ImmunoCap)
• Allergen-specific IgE component testing (ImmunoCap)
• Allergen-specific blocking IgG4 testing for monitoring of allergen immunotherapy (ImmunoCap)
• ISAC IgE allergen component microarray testing
• Basophil activation testing for drug allergens, inhalant allergens, food allergens and food additives
• T-cell proliferation testing for drug and metal hypersensitivity, including intracellular cytokine determination.
• Skin prick testing for food and inhalant allergy.
• Skin prick testing and intradermal testing for drug allergy.
• Patch testing for contact dermatitis.
• Mast cell tryptase, urinary methylhistamine determination and c-kit mutation analysis for mast cell disorders and anaphylaxis

Immunodeficiency:

• Immunoglobulins, IgG subfractions, vaccine antibody responses (including serotype-specific pneumococcal antibodies).
• Lymphocyte subsets (B,T,NK-cells), CD4, CD8, NKT, T-reg, TH17, etc.
• Extended T-cell phenotyping: T-cell development markers from recent thymic emigrants to memory T-cells, αβ/γδ T-cell receptor type, activation markers, etc.
• T-cell proliferation testing to mitogens and recall antigens.
• B-cell phenotyping and development markers, including class-switched memory B-cells.
• Flow-cytometric testing for protein expression and markers associated with specific primary immunodeficiencies, e.g. Btk, CD40L, CD40, SAP, CGC, IL7-Rα, etc.
• Neutrophil fuction testing, including oxidative burst, phagocytosis, chemotaxis and adhesion deficiencies.
• NK-cell cytotoxicity assays.
• Functional complement assays and MBL level testing.

Genetic testing (focus on primary immunodeficiency):

• Genetic counselling provided for all genetic testing for primary immunodeficiencies (PID).
• NGS for a panel of 100 of the most common PID genes.
• Sanger sequencing for mutation confirmation, targeted gene sequencing and carrier testing.
• Genome microarray testing.
• Whole exome sequencing.
• Cytogenetics and FISH for chromosomal abnormalities.
• Targeted NGS panels for other relevant conditions e.g. cystic fibrosis and primary ciliary dyskinesia.
• HLA typing as well as disease specific loci, e.g. HLA DQ2/DQ8 (Coeliac’s disease)
• International collaboration on challenging genetic diagnoses.

Autoimmunity:

An extensive range of autoantibodies for connective tissue diseases as well as organ-specific autoimmunity.

Personnel:

The clinic is staffed by 9 full and part-time specialists:

• Prof RJ Green
• Prof A Goga
• Prof A van Niekerk
• Dr L van Bruwaene
• Dr S Sesane
• Dr T Pitso
• Dr A Lazarus
• Dr C van Rooyen
• Dr S van den Berg

There is a full-time pulmonary function technologist (Ms O Coetzee)

There is a part-time dietician and physiotherapist.

There are 3 full-time nursing staff trained in asthma and allergy education.

For appointments contact – 012 354-2135

For more information on SA children’s state allergy clinics please see:

• Cape Town https://allergyfoundation-old.local/red-cross-allergy-clinic/
• Bellville https://allergyfoundation-old.local/the-paediatric-allergy-clinic-at-tygerberg-hospital/
• Durban https://allergyfoundation-old.local/paediatric-asthma-and-allergy-clinic-at-inkosi-albert-luthuli-central-hospital-ialch-durban/
• Johannesburg https://allergyfoundation-old.local/the-paediatric-asthma-and-allergy-clinic-at-charlotte-maxeke-johannesburg-hospital/

Contact Us At  012 354-2135