Current Treatment Options in Allergy

Day, Cascia; Peter, Jonny

2025 Current Treatment Options in Allergy

doi: 10.1007/s40521-024-00380-x

Purpose of ReviewDespite global incidence, considerable morbidity, and diverse triggers, CU is poorly characterized amongst diverse African populations. This systematic review aims to describe available African CU studies and unmet needs.Recent FindingsOverall 221 publications were screened and 29 were eligible for full review. These publications represented only 12 of 54 African countries, with 38% from Nigeria. Most publications described CU within the context of dermatology out-patient clinics(21/29), with a CU prevalence of 0.03–10.4%. Two studies detailed CU demographics, with a female predominance and median age of 30–40 years. CU patients reported variable associations with infections, including T.canis(Egypt), and H.pylori(Nigeria and South Africa), with other risk factors including foods, food additives, and low vitamin D levels. UAS was reported for < 100 CU patients, and only two studies detailed and CU co-morbidities, while none addressed other patient-reported outcome or quality-of-life measures, treatment access and/or efficacy.SummaryDespite considerable disease prevalence, CU is poorly detailed in African populations. Further CU studies are required to detail phenotypes, disease severity and describe treatment use and unmet needs.

Jiménez-Maldonado, Libardo; Torres-Duque, Carlos A.; Perna-Reyes, Isabella; Alí-Munive, Abraham

2025 Current Treatment Options in Allergy

doi: 10.1007/s40521-024-00378-5

Purpose of ReviewSevere asthma causes a high burden of morbidity and costs for healthcare systems, especially in low- and middle-income countries, where patients continue to be treated exclusively in primary care settings and face many barriers to accessing high-quality healthcare. Evidence has shown that managing patients with severe asthma in specialized clinics with an interdisciplinary team and continuous and systematic evaluation improves cost-effectively disease outcomes. In this article, we will delve into the main challenges faced and the valuable lessons learned throughout the building and implementation of a severe asthma clinic, in a tertiary respiratory care institution located in Colombia, a middle-income country, and using this documented experience we pose how to build severe asthma clinics/programs applicable to low- and middle-income countries.Recent FindingsIt has been documented that patients with severe asthma in low- and middle-income countries experience multiple barriers in having a proper diagnosis, timely periodic medical and test follow-up appointments, proper educational support, and opportune delivery of medications, perpetuating asthma exacerbations and poor control. Multidisciplinary clinics have been shown to be useful in improving clinical outcomes and reducing costs of severe asthma care in high-income developed countries, but there is very little information on the feasibility of implementing these types of clinics in low- and middle-income countries. Three years ago, with the cumulative experience of our general asthma program, we decided to organize and implement the institutional severe asthma clinic (Asmaire ReXpira) the which, with just this short time of operation, has successfully demonstrated improvement in quality of life, exacerbation rates, and disease control of the patients, with education being the most important tool for achieving these results.SummaryWe have confirmed the feasibility of establishing and the importance of developing an interdisciplinary SAC in a middle-income country, and using this experience we pose that it is also necessary and feasible to build non-complex, lower sophisticated successful SACs in LMICs, despite the challenges that may arise during this process. These SACs, adopting a systematic and multidimensional evaluation of the patients, have shown to decrease rates of clinically relevant asthma exacerbations and systemic steroid use while improving symptom control, lung function, and overall quality of life. We suggest that education stands as the cornerstone of successful SACs, enabling the patients with essential skills for self-managing their disease effectively in both the short and long term.