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Atopic Dermatitis: The Need for a Sub-Saharan Perspective

Atopic dermatitis (AD) is one of the most common non-infectious diseases in the world. For over two decades there has been considerable mobilisation to create a robust framework to address this global problem (the International Study of Asthma and Allergies in Childhood [ISAAC] consortium). However, information about Sub-Saharan Africa remains sparse, likely reflecting the increased focus placed on infectious diseases. However, this region harbours the greatest environmental and genetic diversity and thus offers enormous potential for understanding the differential environmental impact on human populations predisposed to allergic diseases. Moreover, it is increasingly clear that many pathologies share the same genetic determinants and this spans both non-infectious and infectious diseases. In this review, we discuss the comparative genetics of the allergic diseases and then expand into infectious diseases, notably malaria. We discuss the considerable overlap in the identified genetic determinants of AD and malaria and develop a hypothesis based on the importance of saliva from mosquito bites, arguably the most prevalent allergen in the region. Following the completion of the first phase of the African Genome project, we stress the significance of more focus on allergic diseases in the region, which will certainly generate an abundance of novel insight into the environmental and genetic determinants of allergy and may also contribute to our understanding of arthropod-borne infectious diseases.