Master of Philosophy in Allergology

Purpose

The primary purpose of the qualification is to provide clinical training for specialists who wish to sub-specialise in Allergology and register with the HPCSA as sub-specialists. This training will enable the qualifying learners to sit the College of Medicine of South Africa Certificate in Allergy examination, which is the required qualification for registration of the sub-speciality with the HPCSA.

The qualification will train registered paediatricians, registered physicians and registered family practitioners (who have a fellowship of the College of Medicine in family practice, or equivalent post qualifying learner qualification from a recognised institute of higher education) in the field of Allergology.

Rationale

Allergology refers to the science and practice of allergy and is primarily concerned with the immunology, diagnosis, treatment and prevention of allergic diseases. Allergic diseases are an increasing cause of chronic illness in South Africa and now affect approximately 20% of the population.

Allergic diseases are a significant burden in the health services and are under-diagnosed and inadequately treated. In addition to the burden in the community, allergic diseases are also an important cause of occupational disease. There are over 400 allergens known to cause allergic disease and new allergies are emerging every year. Several indigenous African allergens have recently been identified and characterised (e.g. Kikuyu and Buffalo grass, Rhinkals snake venom, Abalone {Haliotis Midae}).

Medical practitioners only receive brief training in Allergology in the under Qualifying Learner medical curriculum and the emphasis on allergic diseases in the training of specialist paediatricians, physicians and family practitioners is small. A Diploma: Allergology is offered by the College of Medicine of South Africa to improve the knowledge of practitioners in the field of allergy, but the level of competence required is below that of a specialist.

Specialists are required to assess, diagnose and treat patients with complex allergies and the Allergologist would have specialised skills in the investigation, diagnosis and clinical management of anaphylaxis, food allergy, food intolerance, the oral allergy syndrome, drug allergy, occupational allergy, rhinitis, conjunctivitis, asthma, allergy to stinging insects, cutaneous allergies (urticaria and atopic dermatitis) and angioedema.

This requires detailed knowledge and understanding of the physiology, pharmacology, immunology, biochemistry, molecular biology of the allergic response, a knowledge of regional and indigenous African flora and biodiversity, specialist knowledge of preventive strategies, health economics, primary care and public health aspects of allergic diseases. The Allergologist is also a specialist in allergen immunotherapy and desensitisation for life threatening allergies.

Full specialists in Allergology are registered in the USA, Australia and many European countries. The World Allergy Organisation has defined the Key clinical competencies appropriate for patients with allergic or immunologic diseases in a position statement entitled "Requirements for physician training in Allergy" (Allergy Clin Immunol Int, J World Allergy Org, 2006; 18(3): 92-97).

This Master of Philosophy proposal for sub-specialisation in Allergology is in line with the requirements of the World Allergy Organisation for "Third Level Care", in which the practitioner has in depth knowledge of and is competent to diagnose and treat all allergic diseases. Since allergic diseases constitute a vast field and may occur in the context of other complex diseases, usually treated by specialists (e.g. drug allergy), it is necessary that sub-specialisation in Allergology should follow specialisation in paediatrics, internal medicine or specialist family practice and that the Allergologist would be competent to simultaneously diagnose and treat allergic diseases affecting several organs superimposed on other diseases (e.g. lungs, skin, upper airways) holistically, with firm understanding of the importance of the interaction of environment, exposure and genetic susceptibility to disease and appropriate treatment in the context of other organ diseases.

Recognition of Prior Learning (RPL)

The institution conducts RPL in terms of the policy and guidelines of the institution to recognise other forms of formal, informal and non-formal learning and experience.

In cases where learners do not comply with the formal admission requirements, the institution applies its RPL policy.

Entry Requirements

The minimum entry requirement for this qualification is

• Cognate Bachelor Honours, NQF Level 8.

The qualification consists of Coursework (Clinical Allergology Part 1) (120 credits) and a Research Dissertation (60 credits), both al NQF Level 9.

The qualifying learner will demonstrate

1. Specialised knowledge of immunology, biochemistry and molecular biology of the allergic response.
2. Broad knowledge of the global epidemiology of allergic diseases and major and regional epidemiological studies in the field of allergy.
3. A detailed understanding of the pathophysiology, clinical manifestations and treatment of major allergic diseases such as food allergies and intolerance, drug allergy, allergic urticaria and angioedema, asthma, allergic rhinitis, allergic eczema, occupational allergies, and diseases involving mast cell activation (e.g. mastocytosis), hyper IgE syndromes, eosinophilic diseases (e.g. eosinophilic oesophagitis), allergic reactions to parasites and the allergic march: a full knowledge of major international position statements in the field of asthma and rhinitis (e.g. ARIA, GINA and NAEPP Asthma Guidelines). Mechanisms of asthma and Gell and Coomb hypersensitivity reactions.
4. A specialised knowledge of allergens (over 400), their immunogenicity, epitope specificity, local occurrence, and entymology, seasonality, stability, cross reactivity, availability, stability and safety as testing reagents, regional aerobiology, possibility to act as adjuvants and suitability for vaccines and evidence based allergen avoidance measures. For food allergens the role of excipients and preservatives and stabilisers in precipitating adverse reactions to foods, laws pertaining to food labelling, safety of vaccines (e.g. prepared in egg yolk or gelatine). In the case of drug allergens sufficient knowledge of the drug structure to recommend non-cross reacting alternatives and to identify other drugs which could pose a risk to the patients (e.g. Penicillins versus Cephalosporins). A knowledge of allergens which fall within those covered by the Occupational Health and Safety act and its regulations on hazardous chemical substances and biological agents (as well as the compensation for Occupational injuries and disease act).
5. Knowledge of regional allergens: in particular aeroallergens (their seasonality, aerobiology and pollen monitoring), local sea food allergens and potential for allergenicity (e.g. Abalone), the classification of South African sea food allergens and potential for sharing common allergens (e.g. tropomyosin), relationships between grain allergens (and their potential for causing exercise induced anaphylaxis), familiarity with the characterisation of African indigenous allergens and implications for disease expression and immunotherapy.
6. Knowledge of diagnostic Allergology in the clinic. This would include indications for commercial skin prick testing and applicability to the South African context, testing with fresh extracts, titrated skin prick testing, drug allergy skin prick testing, oral challenge testing, double blind placebo controlled food challenge testing, atopy patch testing and physical tests, e.g. ice cube testing for cold urticaria as well as non-specific inhalational challenge tests (histamine/methacholine) and specific inhalation tests where appropriate. The Qualifying Learner would need to know the indications, contra indications, safety aspects and negative and positive predictive value of such testing for known allergens and would be competent in treating adverse reactions to such procedures and the facilities, the ethical and consent procedures required for such testing in the clinic or in the ICU.
7. Knowledge of injected and sublingual immunotherapy for venom and for inhalant allergens. This would include a detailed knowledge of immunotherapy protocols, indications, precautions, MCC approval procedures for certain vaccines, patient follow up and determination of end points, seasonality constraints, considerations for patients with multiple allergy or chronic medications which could influence the outcome of a long term immunotherapy Qualification.

The following Associated Assessment Criteria apply in an integrated way to all the Exit Level Outcomes

• Assess patients daily under supervision in Allergy Clinics.
• Present cases to supervisors in the clinical situation as well as formally at departmental meetings.
• Show clinical competence regarding knowledge and clinical reasoning and clinical judgement and decision making.
• Do reading on all the topics listed in the syllabus to keep up to date with current knowledge, practice and developments in the field.
• Participate in the regular Allergy Journal Club of the Allergy Departments.
• Participate in and read for the monthly tutorials/workshops.
• Undertake research at the appropriate level using appropriate methods.
• Present the results of the research in a dissertation that meets the requirements for a Master's Degree.

Integrated Assessment

Learners will see patients in the Allergy Clinics on a daily basis under supervision initially and will be expected to present cases to their supervisors in the clinical situation as well as formal case presentations to departmental meetings. Clinical competence will be assessed with respect to knowledge and clinical reasoning and clinical judgement and decision making.

A series of tutorials/workshops will be arranged throughout the year on selected topics to ensure that the learners are kept up to date on new developments/protocols/treatment approaches in Allergology. These will require participation and reading by both learners as well as the tutorial/workshop facilitator. It is envisaged that one general topic will be discussed at length in a seminar each month (e.g. anaphylaxis, new developments in food allergy, approach to drug allergy) and that the learners will read around a specific topic for that particular month. These tutorials/workshops will be developed in conjunction with the available tutors and their particular interest areas. The Learners will complete a 3000 words literature review on the subject of their chosen research project in Allergology.