Editorial: Allergies and Anti-allergy Drug Discovery in Africa

Sabelo Hadebe ^1,2* Andrew Glory Mtewa ³ Mushagalusa Kasali Félicien ⁴ Jonathan Peter ⁵ Precious Takondwa Makondi ⁶

• ¹ University of Cape Town, Cape Town, South Africa
• ² Division of Immunology, Faculty of Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa
• ³ Chemistry Section, Department of Applied Studies, Malawi University of Science and Technology, Limbe, Malawi
• ⁴ Official University of Bukavu, Bukavu, South Kivu, Democratic Republic of Congo
• ⁵ Division of Allergology and Immunology, department of medicine, Faculty of health sciences, University of Cape Town, Cape Town, South Africa
• ⁶ Kamuzu Central Hospital, Lilongwe, Malawi

There is a paucity of data on the immunogenetics and pharmacogenetics in asthma in people of African ancestry which has implications on drug dosing and tailored therapeutic doses. Mabelane et al. (2023), reviewed literature on the prevalence of asthma across Africa and the diaspora. While asthma drug access and adherence might affect treatment outcomes, there is a reasonable number of patients who don't respond to these drugs. Minor allele frequency differences at pharmacogenetic loci between populations might explain treatment failure or adverse reactions in people of African ancestry or admixed populations. There are several minor allele frequencies that have been identified in inhaled corticosteroids pathways, short acting b-adregenic agonist (SABA) and long acting b-adregenic agonist (LABA) pathways. These variants are associated with either reduced salmeterol/formoterol (in case if LABA), albuterol (in case of SABA) and corticosteroid. The study highlighted key variants in African ancestry in each of these pathways that could influence lung function and worsening of asthma and the possibility of these variants being used as predictive markers for corticosteroid response. Lunjani et al., (2024) skinned individuals, contrast between normal and dyspigmented skin which can have negative impact on the patients with darker skin, higher than normal pruritus in darker skin individuals and larger mast cells degranulation pattern, which is linked to higher TH2 cell proliferation and IgE in HIV infected people. The authors argue that although there is a significant clinical overlap between HIV photodermatitis conditions, taking good clinical history, clinical examination with the assistance of skin biopsy, and photo testing are helpful in identifying photodermatitis and in distinguishing phototoxic from photoallergic reactions. Konyana et al., (2024) In this editorial, we have highlighted the works done noting the rising prevalence of allergic diseases in Africa, emphasizing the need for more research addressing the existing information gap on immunogenetics, pharmacogenetics, and tailored treatments for African populations. We have noted findings that include differences in asthma drug responses due to genetic variants, challenges in diagnosing atopic dermatitis (AD) in dark-skinned individuals, and the complexity of HIV-associated photodermatitis. We have also underscored the importance of studying genetic, local environmental and socioeconomic factors influencing allergies. From the work done, we recommend advancing genome-wide association studies, improving diagnostic criteria for AD, and timely identification of adverse drug reactions in HIV patients to reduce morbidity and mortality.