Objective:Transplant a liver from an HIV-positive mother to her HIV-negative child to save the child's life.Design:A unique case of living donor liver transplantation from an HIV-positive mother to her HIV-negative child in South Africa. Two aspects of this case are ground-breaking. First, it involves living donation by someone who is HIV-positive and second it involves controlled transplant of an organ from an HIV-positive donor into an HIV-negative recipient, with the potential to prevent infection in the recipient.Methods:Standard surgical procedure for living donor liver transplantation at our centre was followed. HIV-prophylaxis was administered preoperatively. Extensive, ultrasensitive HIV testing, over and above standard diagnostic assays, was undertaken to investigate recipient serostatus and is ongoing.Results:Both mother and child are well, over 1 year posttransplantation. HIV seroconversion in our recipient was detected with serological testing at day 43 posttransplant. However, a decline in HIV antibody titres approaching undetectable levels is now being observed. No plasma, or cell-associated HIV-1 DNA has been detected in the recipient at any time-point since transplant.Conclusion:This case potentially opens up a new living liver donor pool which might have clinical relevance in countries where there is a high burden of HIV and a limited number of deceased donor organs or limited access to transplantation. However, our recipient's HIV status is equivocal at present and additional investigation regarding seroconversion events in this unique profile is ongoing.

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Several clinical niches have been identified that harbor patients at increased risk of NP-C.

True food allergy is less prevalent than common ly perceived. Up to 34% of individuals or parents think that they or a family member has a food allergy and 22% avoid particular foods because the food may possibly contain an allergen. However, only 1 6% of persons test positive on full evaluation, which may include doubleblind placebocontrolled food challenges. [14] Epidemiology of IgEmediated food allergyThe prevalence of food allergy varies significantly based on geographical region, allergens tested, diagnostic criteria, population age and concurrent atopic conditions.[5] Variations in food allergy definitions and inconsistencies in study design make studies on food allergy prevalence difficult to compare. Self reporting significantly overestimates food allergy prevalence up to 10fold; [4] hence, objective measurements are necessary to establish a true food allergy diagnosis. Similarly, sensitisation to foods is much higher than clinically relevant allergies; therefore, sensitisation should always be combined with more objective information to prove allergies. Food challenge testing is the optimal way of proving food allergy, albeit labour and cost intensive. Recent large populationbased studies, such as the EuroPrevall study in Europe [6] and HealthNuts study in Australia, [7] have used food challenge testing and can be considered flagship studies of food allergy prevalence. Prevalence of food allergyDespite the large number of foods that can cause immunoglobulin E (IgE)mediated reactions, most prevalence studies have focused on the most common allergenic foods, i.e. cow's milk, hen's egg, peanut, tree nut, wheat, soya, fish and shellfish. [8] Food allergy peaks during the first two years of life, and then diminishes towards late childhood as tolerance to several foods develops over time. Based on metaanalyses and large populationbased studies, the true prevalence of food allergy varies from 1% to >10%, depending on the geographical area and age of the patient.[919] Allergy prevalence to the most common allergenic foods is summarised in Table 1. The prevalence of food allergy in South Africa (SA) is currently being studied. An unselected population of 211 Xhosa highschool students showed an overall sensitisation to foods of 5%. [20,21] Preliminary data from the South African Food Sensitisation and Food Allergy (SAFFA) study, [22] which is investigating food allergy in an unselected cohort of 1 3yearolds, show a prevalence of skin prick tests of ≥1 mm (11.6%), ≥3 mm (9.9%) and ≥7 mm (4.2%) to all foods tested. Challengeproven food allergy to any food is 1.8% after the preliminary analysis; recruitment is ongoing. Correspondence to : C Gray (claudiagray.paediatrics@gmail.com) Despite the large number of foods that may cause immunoglobulin E (IgE)mediated reactions, most prevalence studies have focused on the most common allergenic foods, i.e. cow's milk, hen's egg, peanut, tree nut, wheat, soya, fish and shellfish. ARTICLE Epidemiology of IgEFood allergy peaks during the first two years of life, and then dim...

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Up to 34% of individuals or parents think that they or a family member has a food allergy and 22% avoid particular foods because of the mere possibility that the food may contain an allergen, when in fact only between 1% and 6% test positive on full evaluation. [1] A working group was constituted of medical professionals with interest and expertise in food allergy in South Africa (SA) with representation from the Allergy Society of South Africa (ALLSA), the South African Gastroenterology Society (SAGES) and the Association for Dietetics in South Africa (ADSA). The structure and content of the document was networked, individuals were allocated sections to write and a draft document was compiled. A meeting was then held to discuss the draft document, resolve controversial issues and achieve a consensus document. The document is endorsed by ALLSA, SAGES and ADSA. Definitions Adverse reactions to food can be divided into psychological reactions (food aversion), organic reactions (e.g. peptic ulcer disease), anatomical reactions (e.g. strictures), toxic reactions (e.g. food poisoning) and nontoxic reactions (Fig. 1). [2] Non-toxic reactions imply an individual hypersensitivity to the food, either immune-mediated (food allergy) or not immunemediated [3] (food intolerance) (Fig. 2). Non-REVIEW South African food allergy consensus document 2014

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