Over the last few years there has been a lot of "good starts" when it comes to novel treatments of allergies and asthma. From a vaccine for cat allergies to bronchial thermoplasty for asthmatics, there have been a myriad of treatments, in varying stages of testing, that offer hope for the millions who suffer from environmental and food allergies as well as asthma. As the latest in this line, the FDA recently "fast tracked" a novel approach to desensitizing those with peanut allergies.
This new therapy is Viaskin® Peanut. From their website,
"Epicutaneous immunotherapy (EPIT®) consists in repeated application of antigen with Viaskin® on intact skin. EPIT induces a decrease of allergen specific responses (i.e. decrease of allergen-specific IgE, decrease of TH2 cytokine production, and decrease of local and systemic response after exposure to allergen) and increase of regulatory responses (i.e. increase of allergen-specific IgG2a or IgG4, increase of regulatory T cells (Tregs)."
In plain English, this is a patch that allows small but steady amounts of the peanut allergen (antigen) to be absorbed by the skin. This patch has a small air pocket built into it where it moisture condenses. This allows the antigen to combine with the moisture and be more readily absorbed by the skin. Langerhans cells, specialized immune system cells, capture the allergen in this outermost layer of the skin and migrate it to the lymph nodes. Here is where the modification (desensitization) takes places. As this process repeats it essentially trains the immune system to down-regulate and promote a long term tolerance of the allergen.
Upon reviewing the performance of the patch in earlier rounds of clinical trials, the Food and Drug Administration granted the patch a breakthrough therapy designation. This allows for faster development and review of the treatment. This the first drug designed for food allergies, that has received this designation. So why do certain treatments get this "fast track"? It all comes down to results. From adults to children as young as 12, test results show year long treatments with the patch resulted in patients demonstrating the ability to be exposed to at least ten times the amount of the allergen previously needed to elicit a response.
With this type of treatment, there are no painful shots or needles, or weekly appointments for sublingual drops. This patch bypasses traditional sublingual and desensitization treatments. There's also less risk to the patient actually having an allergic reaction since the allergen never reaches the bloodstream to trigger a full-fledged allergic response.
An easy way to visualize this is to think of a brownie. Before the treatment a patient may have an allergic reaction after eating a brownie that had a single, small piece of peanut in it. After the treatment, the patient could eat a handful of peanuts with no reaction. For those with food allergies, this kind of cushion can represent the difference between a trip to the emergency room after snack time and being just fine.
Now, with the FDA designation, there's a very real chance that this treatment could be available within in the next five years.
For more information on the clinical trials.
For more information on Viaskin and DBV Technologies.
Author: K. Gilmore
Reaching back the furthest is the announcement earlier this month that there was a proposed class action lawsuit filed against Lumber Liquidators. While traditional home improvement is necessarily something you'll see us writing about, this story was of particular note. For many with severe allergies or asthma, a recommendation your allergist or physician will often recommend is to replace your carpet with smooth flooring. This can be anything from linoleum or hardwoods, to tile or laminate. None of these will trap and retain allergens and irritants like carpet does. This story broke on 60 Minutes, and focused on laminate flooring and levels of formaldehyde in the product. As we've often mentioned, formaldehyde is common but powerful volatile organic compound (VOC) linked to a wide variety of conditions. Formaldehyde found in glues, adhesives, new furniture, and carpet can often aggravate respiratory conditions like allergies or asthma and severely impact those with chemical sensitivities. More generally, formaldehyde is a known carcinogen, and the result of long term exposure to any carcinogen is almost always the same - cancer.
At this point, there is plenty to be said on both sides. Some within the flooring industry attack the test or testing methods, which is performed by the California Air Resource Board (CARB), the same folks who test home air purifiers to ensure they do not produce ozone. Others have lambasted the company, Lumber Liquidators, as well as the manufacturers in China. While blame and claims fly, and a court battle is likely to drag on for years, there are a couple things to take from this story.
First, while all laminate does contain some level of this VOC, most have minimal levels that are within limits set by the CARB. CARB has some of the most rigorous testing in the world, with regard to emissions, ozone, and other potential indoor pollutants, and while some may take issue with how this particular test is performed, it's worth noting that the same testing of products sold by other home improvement stores revealed no issues with elevated levels of formaldehyde. Think of this like paint. Most interior paints contain some level of VOCs, but there are some that have lower levels than others.
Second, remember the source. While products of all types, made in a variety of countries, can and do have problems (think of the string of auto recalls in the last several years), in this instance it was only laminate made in China that so dismally failed CARB tests.
I'm not saying every product that comes out of China is bad or dangerous, but by this point, we should have had enough reason to be somewhat leery (drywall in 2001, toxic pet treats in 2007, melamine in milk in 2008, heavy metals found in toys' paint in 2011). Do a little extra research. The internet has a wealth of information, and in a short amount of time you can often double check a company's claim about its product. I'd also advise you to consider the source of your information. "Jimbo's Awesome Blog" might not necessarily be as credible as a piece found on a major news site or National Institute of Health page.
The second story I wanted to mention was likely missed by many, but it involves the drug Breo® Ellipta® by GlaxoKlineSmith. Commonly used to treat those with COPD, there has been scrutiny on the drug over its potential use by adolescents and children or for any condition other than COPD (which is comprised of emphysema and chronic bronchitis). An FDA advisory panel overwhelmingly voted against the use of Breo® Ellipta® in children 12-17. For now, the drug will remain a COPD drug and NOT an asthma medication.
This isn't the first time an issue like this has arisen. Breo® is a two part drug which contains a corticosteroid as well as a long-acting beta-agonist (LABA). LABAs have and continue to be scrutinized for their links to increased risk of death in those who have asthma and use this class of medication. A quick glance at the official Breo® website should give you a pretty clear indicator of this as the warning that this drug is NOT to be used for asthma appears repeatedly on their site.
Lastly, today was not the day to be a Parisian resident with an even numbered license plate, particularly a joyride was on the daily to-do list. As has happened in Paris before, extremely high levels of air pollution has made the city the smoggiest on the planet, if only briefly dethroning Beijing and/or New Delhi. While a view of the skyline may appear rather miserable today, it likely won't last long.
As a final note, April is almost here, and in addition to the dogwoods being in full bloom this weekend, our most dreaded spring allergens are beginning to emerge from their winter slumber. Nicer weather shepherding in weeks of sneezing, congestion, and sinus pressure. Thanks nature!
To see the entire 60 Minutes piece about flooring.
Recently, Jonathan I. Silverberg, M.D., Ph.D, M.P.H., of the Northwestern University Feinberg School of Medicine, Chicago, analyzed data he and his team collected from two U.S. population based samples of adults from 2010 and 2012 (27,157 and 34,613, respectively). For the first time they have begun to calculate the real cost of coping with eczema.
What researchers found was that in contrast to those without eczema, people dealing with the ailment missed more work, made more frequent doctor visits, and paid more out-of-pocket costs. Compared to an employee who didn't have eczema, those coping with the disease spend nearly a full week (six days) more out sick every year. Not only is there a cost associated with missing work and more doctor visits, but those with eczema often paid upwards to $500 more in outof pocket expenses than their counterparts (additional costs ranged from $371 to 489).
When you expand these numbers out over an affected adult population of about 8,000,000, you can see how these numbers very quickly add up in terms of lost time and money dealing with this itch.
Eczema is a manageable skin disease that comes in many different forms. A few symptoms listed by the National Eczema Association include dry sensitive skin, intense itching, recurring rashes, scaly areas, red, inflamed skin, and more. Eczema, also known as atopic dermatitis, can be triggered by a multitude of stimuli such as stress, heat, cleaning products, chemical residues, hormones, and environmental allergens. It is more prevalent in children and many grow out of it as adults, but a significant portion of those effected remain effected.
Although this data is new, it makes sense that those with eczema would need more medical attention, since the skin is the most exposed part of the human body and vulnerable to a plethora of irritants. But why hasn't this new data on the cost of adult eczema been collected until recently? Though many grow out of it as adults, one in twenty adults continues to cope with eczema. Perhaps with that small ratio, it is easily over looked, and with eczema ranging in different forms and severity in symptoms, that may give reason to why it's being overlooked. The notion that many often disregard eczema as a minor nuisance makes it easier for eczema to simply be ignored (similar to how many viewed asthma in the past). This current research, however, can help break some of the misperceptions and demonstrate a very real cost in dealing with this condition.
The hope is that as new data reveals a truer cost of dealing with eczema, it can help to effect change. With more awareness it could encourage improved insurance coverage for those who are suffering from eczema. On another level, this type of information could act as a catalyst to spur research and funding to better understand the ailment and perhaps find a cure for eczema.
To answer some of your Eczema FAQs
Author: R. Power
Bed bugs were common in the U.S. during the early part of the 1900s. If you were alive during the 1930s, you likely had bed bugs in your home. By the middle of the century, bed bugs had largely been eradicated with the use of pesticides. This had its own set of problems as later research showed that many of the chemical pesticides used were extremely toxic. After decades of relative calm, bed bugs made a huge comeback in the early 2000s. With old pesticides now banned, pest control companies and individuals have struggled to eradicate them. Newer chemicals aren't quite as effective as in the past, so often people rely upon washing what can be washed, throwing away what can't, covering their mattress with bed bug proof covers, using extreme heat, and chemicals to corral and kill these tiny pests.
One specific line of research aimed to combat bed bugs has focused on pheromones and how bed bugs communicate. While scientists have had some idea, they hadn't been able to pin down what specific chemicals play a role or the exact role they play. In the past researchers have found that specific compounds they have tried to use as repellents or attractants would work in the laboratory but fail miserably in realistic test applications.
And while the thought of sleeping with tiny little vampire insects who come out at night while you sleep to bite you and feast on your yummy blood repulses pretty much anyone with a heartbeat, researcher Regine Gries bravely offered herself up in the name of science. For nearly five years, she allowed thousands of bed bugs to make a meal from her arms. (To this I say, "Nope, nope, nope, nope") Unlike others, Gries reaction is relatively benign when bitten. While most suffer itching, swelling, and a rash, Gries only develops a slight rash from the bites. So after five years and 180,000 bed bug bites, what have they found? A lot, actually.
In all, researchers discovered five components to the pheromone attractant that bed bugs emit. They also found one compound, histamine that acts as a repellent. So what does all this mean? With additional testing, this information could be used to create pheromone based traps, repelling bed bugs away from certain areas of a room and attracting them with pheromones to traps. Unlike expensive and toxic pesticides, this type of treatment would lack the cost and harmful side effects.
While a consumer-based solution is still some time away, it would appear that researchers are on a track that could keep bed bugs at bay in a much safer way than in the past. And thank a scientist! I'm know I'm not volunteering to be a walking buffet for bed bugs. How about you?
To read the abstract of the research report or to read the press release regarding bed bugs and pheromones.
Author: K. Gilmore
As the latest example of the role bacteria can play in overcoming these diseases, Spanish scientists presented clinical trial results to the 45th Conference on Lung Health in Barcelona. Though this conference or much of the information presented hardly registered a blip in the news, there were many items of importance that surfaced. As previously demonstrated on mice and now hundreds of volunteers, a probiotic derived from a specific bacteria has been shown to moderate the immune response to tuberculosis. When used for two weeks the probiotic essentially teaches the body how to tolerate the mycobacterium tuberculosis preventing the resulting lung infection that is the hallmark of TB.
While the immune system fights disease, in the case of TB, it can actually aid in the progression of the infection. Microphages, a type of white blood cell, engulf and digest debris and microbes within our body. Once the immune system identifies the TB bacteria as a threat, microphages set out to engulf and digest them. Often though, the bacteria isn't destroyed and instead replicates and ultimately kills off the microphage. The probiotic, by encouraging the immune system to ignore the bacteria, reduces its ability to become an active infection and tamps down the inflammation response that is key to this.
While TB was nearly eradicated during the 1950s, thanks to antibiotics, the bacteria has resurfaced in a more virulent active form that is resistant to many of the common antibiotics that have worked in the past. TB affects tens of millions annually and currently requires extensive and often expensive treatments. This makes the Nyaditum resae (name of the new probiotic) even more newsworthy since use requires weeks, not months or years, and the projected cost is about $5 (Yup, FIVE BUCKS!). Here in the U.S., the cost to treat TB can range from as low as $17,000 to as high as $430,000 (for the most drug resistant strains). Instances of TB in the U.S. is relatively low, just over 9500 cases in 2013.
Nyaditum resae is to be first available in India where nearly 1.5 million incidences of TB surface annually. While the initial article I came across used the "c" word, as in cure, that is not quite the case. However, if the probiotic can manage to successfully retrain the immune response to the bacteria, it could theoretically prevent the active, contagious form of the disease, and for most, that's just as good as eradicating it.
A full list of abstracts from the 45th World Conference on Lung Health.
More Posts on the Link Between Microbes and Our Health:
Positive Link Between Absence of Gut Bacteria and Allergy Development
Fungi Diversity In Lungs Link to Asthma
Bacteria Triggers Allergic Response?
Hygiene Hypothesis and Stomach Bacteria
Author: K. Gilmore
Figures courtesy of CDC.gov and TBFacts.org
"If you can contact those extracts with the lining of the mouth then you can desensitize patients to those allergens and essentially cure them of their allergies" explains Dr. Reisacher. Allerdent will be customized to each person's needs, containing the specific allergen(s) that the patient is allergic to. Dereck Lacarubba is a patient who currently participates in this Allerdent experiment, and is allergic to cats, dogs, tree pollen and dust. He claims that it works and tastes just like regular fluoride toothpaste. Further, he says it's been helping him with his environmental allergies day after day.
The current options for allergy immunotherapy (IT) are Subcutaneous Immunotherapy (SCIT), better known as allergy shots, or daily Sublingual Immunotherapy Treatment (SLIT), drops under the tongue. However, there are many obstacles that contribute to less than 5% of allergy rhinitis patients actually receiving either of these types of immunotherapy.
Allergy shots are costly, time consuming, weekly visits for three to five years (and we know how long doctor visits take), and the presence of needles is a problem some, both adults and children alike. SLIT drops are to be taken everyday, and placed under you tongue for two minutes. Like birth control or acid reflux medicine, you can't skip a day or else it will not be as effective as it should be. For many, this stringent routine is difficult to maintain. SLIT is also a method that is currently NOT endorsed by the FDA. That lack of endorsement adds some measure of skepticism to this method allergy immunotherapy.
Allerdent is a very innovative yet simple idea, that takes your existing routine, brushing your teeth, and adds in the practice of receiving immunotherapy. This simple yet novel approach is what makes Allerdent so promising. I would love to kill two birds with one stone, keeping my oral hygiene up while having the ability to snuggle up to a cat without the tidal wave of congestion and itchy, watery eyes that currently accompanies it. I'm sure others are also excited to cross off biweekly doctor's visits from their agendas or cease taking medications that aren't currently FDA approved. Either way, novel approaches like this, regardless of outcome, present a new twist to traditional treatment and pavethe way for the better treatments of the future.
For more information about Allovate or Allerdent.
Author: R. Power
First, though cases have been numbered in the single digits here in the U.S., Ebola has affected the African continent for the better part of four decades. Though known for that long, what this latest outbreak has shown us is that the American public knew little of the disease and that while infections can spread quickly in an increasingly interconnected world, panic and fear always spread faster.
Ebola is a virus that first made itself in 1976, and as of now, unless you're one of the tiny percent of East Africans who are naturally immune or have had and survived the disease, there is no known immunity or vaccine.
Just as a disclaimer, this description can be a bit intense for some readers. The Ebola virus attaches itself to cells, then once inside the cell replicates and causes the cell to burst, destroying the cell and spreading further. This bursting of cells is what triggers your body's inflammatory reaction - the flu-like symptoms of a fever, vomiting, severe headache, and weakness. The virus then attacks the immune system and uses it spread throughout the body. Ebola attacks all organs and disrupts the natural blood clotting process, causing what appears to be a rash under the skin and other internal bleeding. This is also where the name "hemorrhagic fever" comes from. The destruction of cells and organs (organ failure) coupled with bleeding internally and externally is what causes the high mortality rates (nearly 60%) that we see with the Ebola virus.
So how does Ebola spread? It is EXTREMELY important to remember that though deadly, Ebola can only be spread by coming in contact with the bodily fluids of someone who is infected or items that have been contaminated by these things. It is NOT spread through the air. It is NOT spread through water. Symptoms can occur any time within twenty-one days of infection, but up until someone exhibits symptoms, they are not contagious.
Not to make light of the situation, but before fear completely takes hold, it's a good idea to ask a couple questions. Have I been around someone who has Ebola? Have I been in contact with the bodily fluids of someone who has Ebola? If I answer "no" to these questions, then good news, I'm very likely ok! Yes, that's simplistic, but when you consider that this virus ONLY spreads by coming in contact with these things, you can see why it's a good idea to ask these questions before becoming overly fearful. As of this moment in time, you're more likely to be bitten by Luis Suarez (soccer player from World Cup) than to contract Ebola.
Still, with sensationalized coverage on every cable news channel, it's not difficult to get swept up into the fear of "what do I do?!" And it's at this time, that it is good to remember the basics, some of the very same things that are recommended to help prevent the spread of other viruses.
- Wash your hands. Scrubby, scrubby! Thoroughly washing your hands is the most basic and easiest way to prevent the spread of any virus. Remember, hot water, and you don't have to do this aloud, but sing through "Happy Birthday" twice, and you've likely got them good and clean.
- Use hand sanitizer. Avoid ones with triclosan if possible and instead opt for an alcohol-based hand sanitizer.
- Stop touching your face. At the very least, pay more attention to how often you do this. The average person touches his/her face 3-4 times per hour. Assuming you sleep eight hours, that's 50-60 times a day! Viruses enter the body, most often, through the mucous membranes of your eyes, nose and mouth or through broken skin.
You can also cut back on the handshakes. Seriously, limiting personal contact can be helpful in preventing the spread of any virus, but again, if the other person doesn't have the flu, Ebola or some other virus, or if you're not currently living in East Africa, this may be helpful but not terribly so.
Would an air purifier help? For Ebola, no. Again, it's NOT airborne. However, an air purifier equipped with UV or with antimicrobial filters WILL help with the flu and other airborne, seasonal viruses. Cleaning more is also good general advice. Disinfectants, when used properly, can kill microbes and germs that spread viruses. Lastly, avoid contact with bats. Bat soup should be off the table this Halloween.*
Is Ebola scary? Yes. Is it easy to catch? Unless you work in a profession where you are likely to come in contact with it, no. Common sense can be a very good friend when it comes to things like this, while fear and panic can spread faster and farther than any virus.
My mother is a nurse, but where she works, she is highly unlikely to come in contact with anyone remotely affected, so honestly, I worry more about her catching the flu repeatedly. My family all lives in Ohio, but again, the likelihood of any of them coming in contact with the bodily fluids of someone who has the virus is remote. A family member of mine will be flying in the coming weeks, and for her I've a bottle of hand sanitizer, and a mask - the exact same things I used when I flew this past spring, when Ebola was but a passing story on a far away continent.
*Seriously, "avoid contact with bats... and raw meat prepared from these animals" is stated on the CDC site.
For more information, visit the CDCs Ebola site or for more information on this current outbreak, I’ve found this site to give a well-rounded view of the topic.
Author: K. Gilmore
Researchers started by examining the role gut bacteria play in food sensitivities and food allergies in two groups of mice. Playing on the "hygiene hypothesis" researchers put together one group of mice that were raised in a sterile environment. In the other group, the mice were given a large dose of antibiotics at just two weeks of age. After being given peanut extract, both groups were observed, and from here researchers began introduction specific groups of bacteria to see if they had any effect on the allergic response. Specifically, Bacteroides and Clostridia bacteria groups were the focus, two types that are commonly found in wild mice.
The results were very interesting. First, mice that were given antibiotics showed a high sensitivity to the peanut extract. Antibiotics given early in life have recently been shown to be linked to a myriad of problems later on, including things like the development of allergies and asthma. Of the second group, the reaction to the peanut allergen was even more severe with some showing signs of anaphylaxis. While the introducing Bacteroides into the gut of mice had little effect, Clostridia was another story.
In both groups of mice, the introduction of Clostridia bacteria into the mice resulted in reduced allergic responses to the peanut allergen. This is extremely important for two reasons. First, it shows a link between specific gut bacteria and the development of allergies, again highlighting the link between the microbiome and the health of the animal. Second, these results point toward the potential of treating food allergies with the use of probiotics.
This study also refines the "hygiene theory" somewhat. While traditionally, it was suggested that a lack of exposure to germs and microbes early on could lead to the immune system overreacting to innocuous substances like dust mites, peanuts, or pollen, these results would suggest that a more sterile environment or perhaps even an overuse of antibiotics could lead to less diverse and less numerous gut bacteria, which would in turn be setting the stage for allergen sensitivity.
While the notion of treating allergies or food sensitivities with probiotics are still many years away, this latest research solidifies the link between gut bacteria and allergies. More importantly, it opens the door for potentially novel, new treatments of allergies, asthma and possibly other allergic diseases.
To read the abstract of this study.
Allergy-free peanuts? While it may seem a bit farfetched, this is just what they are working on. Started with a cashew extract (oil), researchers are treating the proteins found in the oil with heat and sodium sulfite. You may recognize sodium sulfite, as it's a preservative commonly found in a variety of foods. What this process does is change the molecular look of reaction-causing protein in the cashew, making it more difficult for immunoglobin (IgE - the antibody that kicks off your body's response, aka, allergic reaction) to recognize and bind with the protein.
Test results showed that when mixing unmodified and modified cashew proteins with the IgE of a nut allergic person, 50% fewer of the IgE molecules bonded with the altered proteins. This is important for a few reasons. Even though this isn't the first experiment to attempt this, it is the first that uses a compound generally regarded as safe (GRAS) to disrupt the protein structure of the allergen. It is also important because unlike other treatments, it is aimed at treating the food, not the person. Lastly, its success shows the potential for reducing or possibly even eliminating the binding of IgE to food allergens, the root of the allergic response.
For now results show a allergy-reduced nut, which isn't as helpful a non-allergenic one. However, these results at least point towards the possibility of this as a solution. What's up next for researchers? Modifying whole cashews then ensuring the cashews still taste they way they should! Until then, avoidance remains the best option for most dealing with severe food allergies.
To read the full abstract of the research.
For more information on food allergies.
Author: K. Gilmore
Similar to the mechanism used with successful cancer vaccines, the new dust mite vaccine uses an adjuvant (an agent that enhances the body's immune response) in addition to the antigen (the substance that actually induces the immune system to produce antibodies). The way this works is a package (of the adjuvant and antigen) is introduced to a patient. The adjuvant essentially raises the alarm, calling the immune system forward to what it perceives as an "all hands on deck" situation. The immune system absorbs and disposes of the package, but the tangible result of this is speeding up the adsorption process and increasing the rate of absorption of the vaccine.
In this instance, the adjuvant (CpG) was packaged with the vaccine and given to mice. Not only was the package absorbed 90% of the time but subsequent daily exposure to the dust mite allergen showed higher production of antibodies and lower rates of lung inflammation. While more research is needed, this outcome is one of the very best that researchers could have hoped for.
With nearly 10% of the population allergic to dust mites, they are easily among the most common allergens on the planet. Often found in mattresses, carpet, upholstered furniture and bedding, dust mites are microscopic pests that feed on dead skin cells. They are one reason why your mattress can double in weight after ten years of use. Millions of these tiny creatures call your mattress home, and it is their tiny decomposing body parts and feces that cause the sneezing, wheezing, congestion, and coughing that are commonly associated with dust mite allergies.
The most common methods of coping with dust mite allergies often include a mix of several things, including allergen avoidance (the use of quality allergy bedding covers or a HEPA air purifier, more frequent cleaning and removal of carpet from the home), medication to the treat the symptoms (most commonly antihistamines), and allergy shots (to increase the tolerance of the allergen). Each of these tackle different aspects of the allergy, and even with promising research such as this, a vaccine or simpler longterm solution is still likely several years away.
For more information, see the official University of Iowa press release.
Author: K. Gilmore
P.S. Just in case you were wondering what CpG stands for... the "C" is for cytosine triphospate deoxynucleotide. The "G" is for guanine triphosphate deoxynucleotide, and the "p" is for the phosphodiester that links the two nucleotides. You may recognize cytosine and guanine. They are two of the four bases of DNA (along with adenine and thymine), and that concludes today's biology lesson!