Most Homes Harbor Multiple Allergens

MedicalResearch.com Interview with:

Dr. Salo

Dr. Salo

Dr. Pӓivi Salo, PhD Epidemiologist
National Institute of Environmental Health Sciences
NIH

MedicalResearch.com: What is the background for this study?

Response: Indoor allergens are important risk factors for asthma and respiratory allergies. Only a few studies have investigated residential allergen exposures on a national scale; the National Health and Nutrition Examination Survey (NHANES) 2005-2006 is the largest and most comprehensive study to date.

MedicalResearch.com: What are the main findings?

Response: Our findings show that exposure to multiple allergens is common in U.S. homes; over 90% of homes had three or more detectable allergens, and 73% of homes had at least one allergen at elevated levels. The presence of pets and pests contributed strongly to elevated allergen levels. Housing characteristics also mattered – elevated exposure to multiple allergens was more likely in mobile homes, older homes, rental homes, and homes in rural areas. For individual allergens, exposure levels varied greatly with age, sex, race, ethnicity, and socioeconomic status. Differences were also found between geographic locations and climatic conditions.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: Understanding factors that affect allergen levels in homes is important because elevated allergen levels can trigger and exacerbate symptoms in people who suffer from asthma and allergies. We hope that our findings provide beneficial information to a wide audience from patients to clinicians, identifying factors that influence levels of exposure to individual and multiple allergens

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: The relationships between allergen exposures, allergic sensitization, and disease are complex. Further research is needed to determine how allergen exposures interact with other environmental and genetic factors that contribute to asthma and allergies.

MedicalResearch.com: Is there anything else you would like to add?

Response: We also compared allergen exposures and previously reported allergic sensitization patterns from this national survey to provide a more complete picture. The allergy focused component in NHANES 2005-2006, which we developed in collaboration with the National Institute of Allergy and Infectious Diseases (NIAID) and the Centers for Disease Control and Prevention (CDC), allowed national comparisons for the first time. The observed differences and overlaps reflect the complex nature of the relationships between allergen exposures, allergic sensitization, and disease.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Salo P, Wilkerson J, Rose KM, Cohn RD, Calatroni A, Mitchell HE, Sever ML, Gergen PJ, Thorne PS, Zeldin DC. 2017. Bedroom allergen exposures in US households. J Allergy Clin Immunol; doi: 10.1016/j.jaci.2017.08.033(link is external) [Online 30 November 2017].

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

 

 

 

 

 

 

Up To 40% of Food Allergic Adolescents Experience Severe Reactions

MedicalResearch.com Interview with:
“Peanuts” by Daniella Segura is licensed under CC BY 2.0Vicki McWilliam

Murdoch Children’s Research Institute (MCRI)

MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Food allergy affects up to 10% of children and 2-3% of adults, and appears to increasing in prevalence. The rise in food allergy prevalence has coincided with increased reports of anaphylaxis. Previous research has shown that adolescents are most at risk of experiencing adverse food reactions and appear to be at higher risk of anaphylaxis fatalities but are an understudied age group in food allergy research.

In a large population representative sample of 10,000 10-14 year olds in Melbourne, Australia we found that alarmingly over 40% had experienced an allergic reaction in the past year and almost 10% reported potentially life threatening reactions. Consistent with other research peanut and tree nuts were the most common trigger foods for reactions and those with nut allergy were most at risk of anaphylaxis. Having more than two food allergies doubled the risk of a food allergic reaction compared to those with a single food allergy. Surprisingly, reactions were found to occur most commonly at home rather than restaurants or school.

Continue reading

EMSY Gene Linked To Peanut and Other Food Allergies

MedicalResearch.com Interview with:

“Peanuts” by Daniella Segura is licensed under CC BY 2.0

Aida Eslami, Ph.D.
Postdoctoral Research Fellow
Dr. Denise Daley’s research group
Centre for Heart and Lung innovation
Providence Heart + Lung Institute
St. Paul’s Hospital
Vancouver, BC 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Peanut allergy and food allergies in general are caused by a combination of both genetic and environmental factors. Currently, the genetic basis of peanut allergy is unclear due to a lack of studies on food related allergies.

Our study was comprised of 850 individuals with peanut allergy from the Canadian Peanut Allergy Registry (CanPAR), and nearly 1,000 individuals without peanut allergy and other food allergies. We looked at over 7.5 million genetic markers through a genome-wide association study (GWAS) to identify genes potentially associated with peanut allergy and other food allergies. Our findings are based on results from the CanPAR in combination with the results from other countries: USA, Australia, Germany and the Netherlands.

We identified a gene that is associated with both peanut allergy and other food allergies. This gene is called c11orf30/EMSY and has previously been shown to be involved in other conditions such as asthma, eczema, and allergic rhinitis.

Continue reading

How Do Viruses Trigger Cough In Asthmatic Children, Even Without Allergies

MedicalResearch.com Interview with:

Giovanni Piedimonte, MD Steven and Nancy Calabrese Endowed Chair for Excellence in Pediatric Care, Research, and Education Professor & Chair of Pediatrics Cleveland Clinic Lerner College of Medicine Case Western Reserve University

Dr. Piedimonte

Giovanni Piedimonte, MD
Steven and Nancy Calabrese Endowed Chair for Excellence in Pediatric Care, Research, and Education
Professor & Chair of Pediatrics
Cleveland Clinic Lerner College of Medicine
Case Western Reserve University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study proves that asthmatic children already have a hyperactive calcium channel that’s extremely sensitive to environmental triggers.

If these children contract a virus, such as RSV, the hyperactive channel causes more severe symptoms that may require care in a hospital setting.

When a child developed asthma or bronchitis in the past, doctors thought these conditions could only be triggered by environmental allergens. There was no explanation why two out of three children ages five and under who wheeze and cough – and still test negative for allergies.

We needed to explore the mechanisms of the calcium molecule and the epithelial cells, which seem to trigger these symptoms without an allergic reaction. If the molecule’s behavior is producing the cough, we just need to figure out how to control the molecule to properly deactivate the cough mechanism in the asthmatic child

Continue reading

Chronic Hives In Children Resolve Slowly

MedicalResearch.com Interview with:

Hives-Urticaria Wikipedia image

Hives-Urticaria
Wikipedia image

Elena Netchiporouk, MD, FRCPC, MSc
Dermatology Resident – PGY5 and
Dr. Moshe Ben-Shoshan, MD, FRCPC, MSc
McGill University

MedicalResearch.com: What is the background for this study?

Response: We have followed a pediatric cohort of 139 patients with chronic urticaria (CU) (hives) between 2013 and 2015 in a single tertiary care center and assessed the comorbidities, the rate of resolution and determined predictors of resolution.

Continue reading

Small Kit Can Easily Detect Food Allergens On-Site

MedicalResearch.com Interview with:

Lee, Hakho, PhD Department of Systems Biology Harvard Medical School Boston, Massachusetts

Dr. Lee

Lee, Hakho, PhD
Department of Systems Biology
Harvard Medical School
Boston, Massachusetts

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The incidence of food allergy is increasing worldwide, particularly among children, and yet no handy test is available for general public. We wanted to solve this issue. Our pilot test showed wide variation in allergen contents in packaged food products and restaurant meals. Hidden allergens (like gluten in salad dressing, likely from additives) were also found.

Continue reading

When Should Babies Be Introduced To Peanuts, Eggs and Cow’s Milk?

MedicalResearch.com Interview with:

Dr. Malcolm Sears, Professor  MB, ChB, FRACP, FRCPC, FAAAAI Co-director of the CHILD Study Division of Respirology, Department of Medicine, McMaster Universi

Dr. Sears

Dr. Malcolm Sears, Professor
MB, ChB, FRACP, FRCPC, FAAAAI
Co-director of the CHILD Study
Division of Respirology, Department of Medicine,
McMaster University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Canadian Healthy Infant Longitudinal Development (CHILD) Study is a longitudinal birth cohort study commenced in 2008 with 3,495 families across Canada.  We recruited the mothers during pregnancy and are following their children to age 5 with the intent of determining the underlying developmental causes of allergy and asthma.

In the current analysis, we have looked at the relationship between the timing of first introduction of three “allergenic” foods (milk products, egg and peanut) and the likelihood of sensitization to these foods at age 1 year.  We found that earlier introduction was associated with a reduced risk of sensitization, which is consistent with some recent randomized controlled trials.  For instance, infants who avoided cow’s milk product in their first year of life were nearly four times as likely to be sensitized to cow’s milk compared with infants who did consume cow’s milk products before age 12 months.  Similarly, infants who avoided egg or peanut in the first year were nearly twice as likely to be sensitized to those foods compared to infants who consumed them before 12 months of age.

Continue reading

Asthma Outcomes Worse in Low Income Groups

MedicalResearch.com Interview with:

Wanda Phipatanakul, MD, MS Associate Professor of Pediatrics Harvard Medical School Director, Asthma Clinical Research Center Boston Children's Hospital Asthma, Allergy and Immunology Boston, MA 02115

Dr. Phipatanakul

Wanda Phipatanakul, MD, MS
Associate Professor of Pediatrics
Harvard Medical School
Director, Asthma Clinical Research Center
Boston Children’s Hospital
Asthma, Allergy and Immunology
Boston, MA 02115

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Observational studies have limitations in their ability to examine disparities in asthma, as these studies have relied on self-reported measures of medication use, asthma diagnosis, severity, outcomes, and access to care.

Using data collected from a randomized controlled trial, we found that subjects with lower income had a significantly higher number of asthma treatment failures and asthma exacerbations, independent of race, BMI, education, perceived stress, baseline lung function, hospitalizations, inhaled corticosteroid adherence, inhaled corticosteroid dose, environmental allergen sensitization, and second-hand smoke exposure.

Continue reading

Vitamin D Supplements Will Probably Not Help Asthma or Atopic Dermatitis

MedicalResearch.com Interview with:

Brent Richards, MD, MSc</strong> Associate Professor of Medicine William Dawson Scholar / FRQS Clinical Research Scholar Departments of Medicine, Human Genetics, Epidemiology and Biostatistics McGill University Senior Lecturer, King's College London (Honorary)

Dr. Brent Richards

Brent Richards, MD, MSc
Associate Professor of Medicine
William Dawson Scholar / FRQS Clinical Research Scholar
Departments of Medicine, Human Genetics, Epidemiology and Biostatistics McGill University
Senior Lecturer, King’s College London (Honorary)

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Some previous epidemiological studies have suggested that low vitamin D levels are associated with increased rates of asthma, atopic dermatitis—an itchy inflammation of the skin—and elevated levels of IgE, an immune molecule linked to atopic disease (allergies). In our study, we looked at genetic and health data on more than 100,000 individuals from previous large studies to determine whether genetic alterations that are associated with vitamin D levels predispose people to the aforementioned conditions.

We found no statistically significant difference between rates of asthma (including childhood-onset asthma), atopic dermatitis, or IgE levels in people with and without any of the four genetic changes associated with lower levels of 25-hydroxyvitamin D, the form of vitamin D routinely measured in the blood.

Continue reading

Exposure To Furry Pets During Pregnancy and Babyhood May Help Keep Your Child Lean

MedicalResearch.com Interview with:

Anita Kozyrskyj, PhD Department of Pediatrics Faculty of Medicine & Dentistry University of Alberta

Dr. Anita Kozyrskyj

Anita Kozyrskyj, PhD
Department of Pediatrics
Faculty of Medicine & Dentistry
University of Alberta

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We have known for a while that early-life exposure to household pets can reduce risk for allergic disease; new studies also suggest a benefit in preventing overweight. Our pilot study in 2013 showed that postnatal pet exposure increases the number of different beneficial microbes in the infant gut. My team of 12, including first author and Albert Innovates-Health Solutions (AIHS) postdoctoral fellow Hein Min Tun, took the science one step closer to understanding this connection in our recently published work in the Microbiome journal. In a study of 746 infants from the Canadian Healthy Infant Longitudinal Development Study (CHILD) birth cohort, we investigated the impact of pet exposure during pregnancy or afterwards on infant gut microbes, and whether this depended on how infants were born.

In infants born vaginally or by cesarean section, pet exposure during pregnancy or pre and postnatally up to 3 months after birth increased the amounts of 2 bacteria found on dogs and cats. One is Ruminococcus, linked to lower rates of allergies in children. The other is a relatively unknown microbe, Oscillospira, reported to promote leanness. Another important finding suggested that contact with pets during pregnancy could reduce transmission of vaginal GBS (group B Streptococcus) during birth.

Continue reading

Could Babies From Wealthier Families Reduce Egg Allergies By Eating Them Earlier?

MedicalResearch.com Interview with:

Dr. Debra Palmer (BSc, BND, PhD) on behalf of my fellow co-authors on this publication Childhood Allergy and Immunology Research University of Western Australia

Dr. Debra Palmer

Dr. Debra Palmer (BSc, BND, PhD)
on behalf of my fellow co-authors on this publication
Childhood Allergy and Immunology Research
University of Western Australia

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We conducted a multicentre trial, Starting Time of Egg Protein (STEP) involving 820 infants, and found a 25% risk reduction in egg allergy with early regular egg intake from 4-6.5 months compared with egg avoidance to 10 months of age, although this did not achieve statistical significance.

So we also investigated in exploratory analyses whether the effect of regular egg introduction in solid foods was modified by any maternal, family or infant characteristics. Our results found that infants from families of higher socioeconomic status and those families who consume few eggs per week could benefit by less egg allergy at 12 months of age from regular egg intake once they start eating solid foods.

Continue reading

Number Of Epipen Prescriptions for Kids Skyrockets

MedicalResearch.com Interview with:
Lavanya Diwakar, FRCPath

Honorary consultant in immunology
Queen Elizabeth Hospital, Birmingham, and
Research fellow in health economic
University of Birmingham
Birmingham UK

MedicalResearch.com: What is the background for this study?

Response: The rate of anaphylaxis (serious, potentially life threatening manifestation of allergy) has increased in the last decade. There have been some reports from other countries about an increase in the number of adrenaline autoinjectors being prescribed in children, but this has not been systematically examined in the UK.
We looked at a database of patient records from over 500 general practices, THIN (the Health Improvement Network), between 2000 and 2012. We found nearly 24,000 children who had been identified as being at risk of anaphylaxis by General Practitioners and prescribed epipens.

Continue reading

Many Summer Camps Need More Training On Food Allergy Treatment

MedicalResearch.com Interview with:
Margaret T. RedmondMD
Nationwide Children’s Hospital
Columbus, Ohio 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Food allergies are becoming more prevalent and can cause a life threatening reaction if not managed correctly. Much of the previous focus has been on food allergy in the school setting and little was known about the camp setting.

Analysis of survey data from camp directors, medical personnel and staff reveal that there are deficiencies of training and policy at camps that could place food allergic campers at increased risk of reaction. A prospective registry of epinephrine administration from 51 camps revealed an increased rate of epinephrine administration compared to school data. Continue reading

Mouse Allergens Drives Asthma Symptoms In Many Children

MedicalResearch.com Interview with:

Elizabeth C. Matsui, MD MHS Professor of Pediatrics, Epidemiology, and Environmental Health Sciences Johns Hopkins University Baltimore, MD 21287

Dr. Matsui

Elizabeth C. Matsui, MD MHS
Professor of Pediatrics, Epidemiology, and Environmental Health Sciences
Johns Hopkins University
Baltimore, MD 21287 

MedicalResearch.com: What is the background for this study?

Response: We designed this study after our previous work indicated that mouse allergy was common among low-income children living in some urban neighborhoods in the US, that these children also had high levels of mouse allergen exposure in their homes, and that children who are both allergic to mice and exposed to high levels of mouse allergen are at greater risk of asthma symptoms, emergency room visits and hospitalization.   Given this background, we designed a randomized clinical trial to determine if an intensive professionally delivered mouse intervention was better than education about mouse control in reducing asthma symptoms and lowering home mouse allergen levels.

Continue reading

Sleep Duration and Exhaled Nitric Oxide in Asthma and Health Adults

MedicalResearch.com Interview with:
Rauno Joks, MD

Associate Professor of Clinical Medicine
Chief, Division of Allergy & Immunology
Program Director, Allergy &Immunology Fellowship
SUNY Downstate Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There are circadian and circannular patterns to many diseases, including allergy and asthma. Humans spend roughly one-third of their lifetimes asleep. Your immune system never sleeps, but shifts its activity when you sleep.

It is known that asthma disease activity can be worse at night – the reasons for this are complex, and may involve changes in allergic responses.

We found, in a preliminary study of both adults with and without asthma, that longer duration of nighttime sleep was associated with lower levels of exhaled nitric oxide, a biomarker which is elevated in exhaled breath of those with allergic asthma. This may carry over into the afternoon as well, but the sample size was too small to fully conclude that.

Continue reading

Aspirin Desensitization in Patients With Coronary Artery Disease

MedicalResearch.com Interview with:

Roberta Rossini, MD, PhD USC Cardiologia, Cardiovascular Department Bergamo, Italy

Dr. Rossini

Dr. Roberta Rossini, MD, PhD
USC Cardiologia, Cardiovascular Department
Bergamo, Italy 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Aspirin (ASA) is stilll the cornerstone of antithrombotic therapy in patients with coronary artery disease, especially after PCI, both

in the acute and the chronic phase of treatment. However, ≈2% of patients have hypersensitivity to ASA. ASA desensitization may represent a valid approach. Desensitization protocols generally involve gradual increases in patient exposure to ASA with the goal of mitigating or abolishing immune-mediated reaction. However, many desensitization protocols require several days to be completed, making them unpractical. This may also contribute to the limited experience with applying ASA desensitization protocols in real-world practice in patients with CAD.

We previously reported the results of a pilot investigation supporting the feasibility of performing a rapid (<6 hours)

Aspirin desensitization protocol in patients undergoing PCI with stent implantation (Rossini R, Angiolillo DJ, Musumeci G, Scuri P, Invernizzi P, Bass TA, Mihalcsik L, Gavazzi A. Aspirin desensitization in patients undergoing percutaneous coronary interventions with stent implantation. Am J Cardiol. 2008;101:786–789. doi: 10.1016/j.amjcard.2007.10.045). The encouraging findings from our pilot feasibility investigation prompted the design of a larger scale multicenter investigation aimed to assess the safety and efficacy of a rapid aspirin  desensitization protocol in patients with a history of ASA hypersensitivity undergoing coronary angiography.

Continue reading

Allergic Rhinitis: Three Years of Immunotherapy Gives Longer Lasting Symptom Control

MedicalResearch.com Interview with:
Stephen R. Durham, MD

Imperial College, London, and Royal Brompton and Harefield Hospitals
NHS Foundation Trust
London, United Kingdom

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Allergic rhinitis affects 1 in 4 the UK population and may compromise sleep and work/school performance and be associated with bronchial asthma. When nasal steroids and antihistamines do not work or cause side effects, allergen immunotherapy is an alternative. Immunotherapy using high doses of grass pollen allergen as monthly injections or daily tablets under the tongue are highly effective. Treatment for 3 years not only gives sustained improvement on treatment but also long-term benefits and disease remission for at least 2-3 years after stopping treatment.

This single centre study at Imperial College London and Royal Brompton Hospital London included 106 adults with severe Hayfever followed up for 3 years, 2 years on treatment and 1 year after stopping treatment. In this double-blind trial, 3 randomised groups took sublingual immunotherapy, subcutaneous immunotherapy and placebo treatment. 92 completed the trial. Results showed that 2 years treatment with both modalities did not result in persistent benefit at year 3, although the researchers found that both treatments were effective compared to placebo during years 1 and 2.

Continue reading

Moisturizers Reduce Severity of Eczema

MedicalResearch.com Interview with:

Dr. Esther van Zuuren

Dr. Esther van Zuuren

Esther van Zuuren MD
on behalf of the authors
Department of Dermatology
Leiden University Medical Center
Leiden, Netherlands

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In view of the high prevalence of eczema and the exponential increase in number of clinical trials over recent years, the NIHR designated this clinical topic, emollients and moisturisers for eczema, as a high priority. Widely prescribed as the basis of eczema management the treatment strategy is often supported by a mixed array of reviews and guidelines. Evidence for the effectiveness of emollients and moisturisers is also of variable quality.

Eczema is a chronic skin disorder, the main symptoms being dry skin and intense itching with a significant impact on quality of life. As dry skin is an important feature, moisturisers are a cornerstone of eczema treatment, but there was uncertainty about their efficacy and whether one moisturiser is preferable to another. The main finding of our review is that indeed moisturisers are effective.

Continue reading

When Should Babies Eat Peanut-Containing Foods?

MedicalResearch.com Interview with:

Anna Nowak-Wegrzyn, MD Associate Professor of Pediatrics Icahn School of Medicine at Mount Sinai Jaffe Food Allergy Institute New York, NY 10029

Dr. Anna Nowak-Wegrzyn

Anna Nowak-Wegrzyn, MD
Associate Professor of Pediatrics
Icahn School of Medicine at Mount Sinai
Jaffe Food Allergy Institute
New York, NY 10029

MedicalResearch.com: What is the background for this study?

Response: Peanut allergy can be fatal, is usually life-long and has no cure. Considering a dramatic increase in prevalence of peanut allergy over the past decades, affecting estimated 2-3% of infants and young children in the US, there is a dire need for prevention. Prior studies determined that risk of peanut allergy is highest in the infants with severe eczema, those with mutations in filaggrin gene resulting in an impaired skin barrier function and those not eating peanut but exposed to peanut in the household dust. In addition, the prevalence of peanut allergy was 10-fold higher among Jewish children in the United Kingdom compared with Israeli children of similar ancestry. In Israel, peanut-containing foods are usually introduced in the diet when infants are approximately 7 months of age and consumed in substantial amounts, whereas in the United Kingdom children do not typically consume any peanut-containing foods during their first year of life.

Based on these observations, a landmark clinical trial (Learning Early about Peanut Allergy, LEAP) has been designed to evaluate whether early introduction of peanut into the diet of infant considered at high risk for peanut allergy can reduce the risk of peanut allergy compared to avoidance of peanut. LEAP and other studies suggested that peanut allergy can be prevented by introduction of peanut-containing foods in infancy. The overall reduction in peanut allergy among the infants in the LEAP trial randomized to an early introduction group compared to those who avoided peanut until age 5 years was 81%.

Continue reading

Many Children With Asthma Still Not Receiving Flu Vaccine

MedicalResearch.com Interview with:

Deepa Patadia, MD Wexner Medical Center The Ohio State University

Dr. Deepa Patadia

Deepa Patadia, MD
Wexner Medical Center
The Ohio State University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Influenza vaccination is recommended every autumn for all children 6 months of age and older. It is particularly important for children with asthma, who are at high risk of hospitalization or severe illness if they contract influenza infection. The rates of influenza vaccination in children with asthma have not previously been well studied, but Healthy People 2020 has set a target goal to vaccinate 70% of all children for influenza. We found that rates of vaccination in our large primary care population was much lower than the target rate, with less than 50% of all children receiving the vaccine each year over a 5 year period; however rates were higher in children with asthma, albeit still only at 55%.

Continue reading

Mite Allergy Develops in Childhood “Like An Avalanche”

MedicalResearch.com Interview with:

Dr. Daniela Posa, MD Department of Paediatric Pneumology & Immunology Charité–Universitätsmedizin Berlin Berlin, Germany

Dr. Daniela Posa

Dr. Daniela Posa, MD
Department of Paediatric Pneumology & Immunology
Charité–Universitätsmedizin Berlin
Berlin, Germany

MedicalResearch.com: What is the background for this study?

Response: Allergy to house dust mites contributes to chronic rhinitis and asthma in hundreds million children and adults worldwide, causing tremendous health and economic burden in high- and middle-income countries. The disease is caused by antibodies called immunoglobulin E (IgE), it starts in childhood and can be controlled with drugs and allergen avoidance. However, there is no cure, hence primary and secondary prevention of mite allergy is a global research priority. We wanted to discover how allergy to mites starts and evolves and why some children develop more severe sensitization and symptoms than others.

Continue reading

Dust Mite Allergen Proteins More Abundant Than Non-Allergen Dust Mite Proteins

MedicalResearch.com Interview with:

Geoffrey Mueller, Ph.D. Staff Scientist Genome Integrity and Structural Biology Laboratory National Institute of Environmental Health Sciences National Institutes of Health Research Triangle Park, NC 27709

Dr. Geoffrey Mueller

Geoffrey Mueller, Ph.D.
Staff Scientist
Genome Integrity and Structural Biology Laboratory
National Institute of Environmental Health Sciences
National Institutes of Health
Research Triangle Park, NC 27709

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: While allergic disease is a wide spread problem, it is actually a select few proteins, called allergens, that initiate allergy symptoms. This study was focused on looking for fundamental biochemical differences between allergens and non-allergens derived from the house dust mite.

We found that the mite allergens, as a group, are distinctly different from the non-allergens in that they are more highly produced, and more stable. Previous anecdotal evidence suggested that these properties would lead to more allergens surviving the journey from the source (either mites or pollens) to a person. In addition, the greater stability of allergens may influence the decision making of the immune system to target these proteins as dangerous instead of harmless.

Continue reading

Early Immune Intervention May Prevent Atopic March of Eczema and Allergies

MedicalResearch.com Interview with:
Emma Guttman-Yassky, MD, PhD

Professor of Dermatology and Immunology
Vice Chair of the Department of Dermatology at the Icahn School of Medicine and
Amy S. Paller, MD
Walter J. Hamlin Professor
Chair of the Department of Dermatology at Northwestern

MedicalResearch.com: What is the background for this study?

Response: Researchers for the first time have identified the skin phenotype of pediatric eczema or atopic dermatitis (AD) in infants, opening the door for personalized treatment approaches for young children with eczema. The study, led by researchers at the Icahn School of Medicine at Mount Sinai and Northwestern University’s Feinberg School of Medicine, was published online today in the Journal of Allergy and Clinical Immunology.

Emma Guttman-Yassky, MD, PhD, Professor of Dermatology and Immunology, and Vice Chair of the Department of Dermatology at the Icahn School of Medicine, and Amy S. Paller, MD, Walter J. Hamlin Professor and Chair of the Department of Dermatology at Northwestern, investigated lesional and non-lesional skin biopsies from 19 AD infants under the age of five, and compared them to age-matched pediatric controls, in addition to adult AD biopsies. The researchers found that the non-lesional, or normal-appearing, skin of young children with early eczema is already highly abnormal with significant immune activation, simulating that of lesional skin of adults with many years of active disease.

Continue reading

Early Introduction May Reduce Peanut and Egg, But Not Gluten, Allergies in Children

MedicalResearch.com Interview with:

Dr Robert Boyle Senior lecturer in paediatric allergy honorary consultant, Paediatric allergist Imperial College Healthcare NHS Trust

Dr. Robert Boyle

Dr Robert Boyle
Senior lecturer in paediatric allergy
honorary consultant, Paediatric allergist
Imperial College Healthcare NHS Trust

MedicalResearch.com: What is the background for this study? What are the main findings?

 
Editors’ note: Please discuss food introduction with your child’s pediatrician before embarking on any new foods.

Response: Food allergy is a common problem which may be getting more common.

We have known for over 100 years that feeding egg to animals such as guinea pigs can prevent egg allergy. However randomised trials of allergenic food introduction for preventing food allergy in human infants have not been done until the past 5 years, and have so far yielded mixed results. One trial for peanut allergy was positive, with less peanut allergy in infants who were fed the food from early in life compared with infants who avoided it for 5 years. Other trials have yielded null findings, but may have been too small to yield a conclusive result. We used a technique called meta-analysis to combine the results of all previous trials of timing of allergenic food introduction and risk of food allergy. We also evaluated other allergic and autoimmune diseases.

Our analysis yielded conclusive results for both egg and peanut – that early introduction of these foods into an infant’s diet might reduce their risk of egg and peanut allergy by around 40-70%. We were surprised to see null findings in our meta-analysis of timing of gluten or wheat introduction and risk of coeliac disease (gluten intolerance) which is a different type of allergy to egg and peanut allergy. This suggests that early introduction of allergenic foods does not reduce risk of all types of food allergy.

Continue reading

Triclosan in Household Dust Linked To Antibiotic Resistance

MedicalResearch.com Interview with:

Erica Marie Hartmann PhD Assistant Professor Dept. of Civil & Environmental Engineering Northwestern University Evanston, IL 60208

Dr. Erica Hartmann

Erica Marie Hartmann PhD
Assistant Professor
Dept. of Civil & Environmental Engineering
Northwestern University
Evanston, IL 60208

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The antimicrobial chemical triclosan has been found in almost every dust sample that has ever been tested worldwide, and we already know that triclosan can cause an increase in antibiotic resistance genes in wastewater. This study is the first to show a link between antibiotic resistance genes and antimicrobial chemicals in indoor dust, which people tend to come into contact with more than wastewater.

This finding is important because the World Health Organization has identified a huge information gap in community-acquired antibiotic-resistant infections; the use of antimicrobial chemicals in homes and other non-medical buildings could be contributing to the development of antibiotic resistance outside of hospital settings. This study was published in the wake of the FDA decision last week to ban the use of triclosan and several other antimicrobial chemicals in soaps. While the FDA decision is a good first step, it’s not the end the problem. Antimicrobial chemicals like triclosan are in a lot of different products. Right now, we don’t know how much of the triclosan we see in dust comes from soap vs. other products (building materials, paints, plastics, etc.).

Continue reading

Food Allergies May Be Higher In Children Who Receive Antibiotics During First Year

MedicalResearch.com Interview with:

Bryan L. Love, PharmD, BCPS-AQ ID Associate Professor Department of Clinical Pharmacy & Outcomes Sciences South Carolina College of Pharmacy - University of South Carolina Columbia, South Carolina 29208-0001

Dr. Bryan Love

Bryan L. Love, PharmD, BCPS-AQ ID
Associate Professor
Department of Clinical Pharmacy & Outcomes Sciences
South Carolina College of Pharmacy
University of South Carolina
Columbia, South Carolina 29208-0001

MedicalResearch.com: What is the background for this study?

Response: In the US, food allergy has become one of the more common childhood medical conditions diagnosed in young children. Antibiotics are frequently prescribed in young children, and research continues to reveal that as many as 30% of antibiotic prescriptions are not appropriate.* We sought to examine if there was an association between antibiotic prescription and food allergy diagnosis.
Continue reading

Children With Food Allergies More Likely To Develop Asthma and Allergic Rhinitis

MedicalResearch.com Interview with:
David A. Hill, M.D., Ph.D.
Fellow Physician
Division of Allergy and Immunology
The Children’s Hospital of Philadelphia
Philadelphia, PA 19104-3375

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Eczema, asthma, allergic rhinitis, and food allergies are among the most common childhood medical conditions in the United States. Importantly, disease rates for these conditions are thought to be changing, prompting the need for continued surveillance.

In our study, we examined electronic medical record data of over 1 million children to measure incidence and prevalence rates of these conditions in our community. We found that 1 in 5 children seen in our network are diagnosed with asthma, a rate that is among the highest in the nation. Additionally, the large size of our study allowed us to measure the extent to which food allergies are associated with asthma or allergic rhinitis. In this analysis, we found that children with food allergies are 2 to 3 times more likely to develop asthma or allergic rhinitis, as compared with children without food allergy.

Continue reading

ID Fellow Managed Clinic Helps Determine True Penicillin Allergies

MedicalResearch.com Interview with:

Emily L. Heil, PharmD, BCPS-AQ ID Assistant Professor Department of Pharmacy Practice and Science University of Maryland School of Pharmacy 20 N Pine St Baltimore, Maryland 21201

Dr. Emily Heil

Emily L. Heil, PharmD, BCPS-AQ ID
Assistant Professor
Department of Pharmacy Practice and Science
University of Maryland School of Pharmacy
20 N Pine St
Baltimore, Maryland 21201

MedicalResearch.com: What is the background for this study?

Response: As many as nine out of ten people who think they are allergic to penicillin are, in fact, not allergic when penicillin allergy skin testing is performed. This mistaken belief, confirmed in multiple other studies and a matter of concern of the U.S. Centers for Disease Control and Prevention (CDC), has widespread implications given that patients who report penicillin allergies tend to get suboptimal antibiotic therapy compared with patients who do not. Penicillin skin testing (PST) can clarify allergy histories but is often limited by access to testing. We aimed to implement an infectious disease (ID) fellow managed PST program and to assess the need for PST via national survey. Our study found that inpatient Penicillin skin testing can be successfully managed by ID fellows, thereby promoting optimal antibiotic use. Our study showed that by testing patients for penicillin allergy via skin test, we could improve their care: 80 percent of patients were able to switch to more effective antibiotic therapy once they were tested.

Continue reading

Children With Atopic Diseases Are Less Physically Active

MedicalResearch.com Interview with:

Dr. Jonathan L. Silverberg MD PhD MPH Assistant Professor in Dermatology Medical Social Sciences and Preventive Medicine Northwestern University, Chicago, Illinois

Dr. Jonathan Silverberg

Dr. Jonathan L. Silverberg MD PhD MPH
Assistant Professor in Dermatology
Medical Social Sciences and Preventive Medicine
Northwestern University, Chicago, Illinois 

MedicalResearch.com: What is the background for this study?

Dr. Silverberg: We previously demonstrated that children with atopic disease have higher cardiovascular risk. One possible explanation for this association is that children with atopic disease are more sedentary. Indeed, children with atopic disease have a number of risk factors for sedentary behavior, including poor sleep and flaring of asthma and eczema from vigorous activity.

MedicalResearch.com: What are the main findings?

Dr. Silverberg: We found that children with asthma had decreased vigorous physical activity and less sports participation. In particular, severe atopic disease and atopic disease accompanied by sleep disturbance were associated with less vigorous physical activity or participation in sports and more time watching television and playing video games.

MedicalResearch.com: What should readers take away from your report?

Dr. Silverberg: Asthma, atopic dermatitis and hay fever are chronic diseases can negatively impact children’s health behaviors. This study demonstrates that children with atopic disease are less physically active and more sedentary. It is important for clinician’s to recognize the effects of these disorders.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Silverberg: Asthma, atopic dermatitis and hay fever are chronic diseases can negatively impact children’s health behaviors. This study demonstrates that children with atopic disease are less physically active and more sedentary. It is important for clinician’s to recognize the effects of these disorders.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Associations of Physical Activity and Sedentary Behavior with Atopic Disease in United States Children

Strom, Mark A. et al.
The Journal of Pediatrics , Volume 0 , Issue 0

DOI: http://dx.doi.org/10.1016/j.jpeds.2016.03.063

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

More Medical Research Interviews on MedicalResearch.com

 

 

Currently Available Skin Tests For Amoxicillin Allergy in Children Not Reliable

MedicalResearch.com Interview with:

Moshe Ben-Shoshan, MD, M.Sc. Assistant Professor Division of Pediatric Allergy and Clinical Immunology Department of Pediatrics McGill University Health Center Montreal, Quebec, Canada

Dr. Moshe Ben-Shoshan

Moshe Ben-Shoshan, MD, M.Sc.
Assistant Professor
Division of Pediatric Allergy and Clinical Immunology
Department of Pediatrics
McGill University Health Center
Montreal, Quebec, Canada

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Ben-Shoshan: Given that up to 10% of children treated with amoxicillin are tagged as allergic usually with no confirmatory tests (given high waiting times to see an allergist and controversy regarding confirmatory tests) we aimed to assess the accuracy of the graded provocation challenge (PC) . Unlike previous studies we challenged ALL 818 children presenting with rashes on amoxicillin treatment .

We were able to show that almost 95% tolerated the challenge while 17 had immediate reactions (within 1 hour ) and 31 had non immediate reactions .

We found that although it is suggested to do skin tests ( with PrePen and pen G ) to diagnose immediate amoxicillin allergy only 1 of 17 had a positive skin test indicating poor sensitivity of this test. In addition among all those with negative challenge that we followed over 3 years 10% had mild skin reactions when they received subsequent full treatment .

Continue reading

First Trimester Use of Rhinocort Linked To Respiratory Defects in Newborns

MedicalResearch.com Interview with:
Anick Bérard PhD FISPE
Research chair FRQ-S on Medications and Pregnancy and
Director Réseau Québécois de recherche sur le médicament (RQRM) and
Professor, Research Chair on Medications, Pregnancy and Lactation
Faculty of Pharmacy,University of Montreal
and Director, Research Unit on Medications and Pregnancy
Research Center
CHU Ste-Justine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Intranasal corticosteroid (Nasacort) use during pregnancy for the treatment of seasonal allergies has increased over the past decade. Nasacort is now available over the counter since October 2013 in the US and January 2015 in Canada. Given that seasonal allergies are prevalent during pregnancy and that a medication available over-the-counter is likely to be used frequently, we aimed to study the risk of using Nasacort during gestation. Furthermore, given the potential public health impact, the objectives of our study were to assess the safety of intranasal triamcinolone exposure during pregnancy on the occurrence of major congenital malformations, small-for-gestational-age (SGA) newborn, and spontaneous abortions.

Use of intranasal triamcinolone during the first trimester of pregnancy was not significantly associated with the risk of overall congenital malformations (OR 0.88, 95%CI 0.60-1.28; 31 exposed cases) compared to non-exposure; it was however associated with the risk of respiratory defects (OR 2.71, 95%CI 1.11-6.64; 5 exposed cases). This is important given that a medication given for the treatment of respiratory diseases is associated with respiratory defects in newborns.

Pregnancy exposure to intranasal triamcinolone was not significantly associated with the risk of spontaneous abortions (OR 1.04, 95%CI 0.76-1.43; 50 exposed cases). No association was found between 2nd or 3rd trimester exposure to intranasal triamcinolone and the risk of SGA (OR 1.06, 95%CI 0.79-1.43; 50 exposed cases).

Continue reading

Hello, Peanut! Offers Simple, Controlled Solution for Peanut Introduction to Babies

MedicalResearch.com Interview with:

Dr. David Erstein MD MPH Founder of Assured Bites

Dr. David Erstein

Dr. David Erstein MD MPH
Founder of Assured Bites
Board certified allergist

MedicalResearch: What is the background for peanut allergy? Why is introducing peanuts to infants important?

Dr. Erstein: Peanut allergy is one of the most common food allergies and is commonly associated with anaphylaxis, a sudden and potentially deadly condition. According to Food Allergy Research & Education, the number of children in the U.S. with a peanut allergy more than tripled between 1997 and 2008. For these reasons, peanut allergy is a hot topic and often studied condition.

There has been important emerging food allergy research including the highly publicized Immune Tolerance Network’s “Learning Early About Peanut” (LEAP) study published in the New England Journal of Medicine in 2015 and the newly announced LEAP-On study presented at the American Academy of Allergy, Asthma, and Immunology (AAAAI) Annual Meeting this month. Contrary to previous guidelines, both LEAP studies advise parents of high risk infants that early and continued consumption of peanuts reduces the chance of peanut allergy development. An additional newly announced Enquiring About Tolerance (EAT) study from the 2016 AAAAI annual meeting reported early consumption of peanuts benefits even the general population of infants from developing peanut allergies, not just high risk infants.

MedicalResearch: Can you tell us about Hello, Peanut!™? How may it reduce peanut allergies? 

Dr. Erstein: Hello, Peanut! is the first-ever guided method for introducing peanuts to infants. It is the only product of its kind currently on the market for parents to offer a simple, controlled solution for peanut introduction to babies as young as 5 months, which, as the cutting edge medical research suggests reduces their chances of developing a peanut allergy.

The Hello, Peanut! Introduction System contains packets of peanut and sprouted oat blends designed to be mixed into pureed foods over seven days. The amount of peanut in each packet gradually increases daily. After this introductory phase, maintenance packets are recommended for use until the infant can eat peanut in spread or whole form.  Hello, Peanut! does not require a prescription or administration by a physician and can be fed to babies at home.

MedicalResearch: Is there anything else you would like to add?

Dr. Erstein: Hello, Peanut! is USDA organic, non GMO, dairy free, and all natural. It’s geared toward the general infant population who have no known peanut allergies and is not designed to treat or cure peanut allergies. Parents of high risk infants (Egg allergy, eczema, and/or family history of food allergies) need to consult with their pediatrician prior to peanut introduction. Hello, Peanut! is FDA registered as an early introduction system and is pending FDA approval for its ability to prevent peanut allergies.

To find out more and purchase Hello, Peanut!, please visit www.hello-peanut.com.

 

Note: Content is Not intended as medical advice or an endorsement. Please consult your health care provider regarding your specific medical condition and questions. 

More Medical Research Interviews on MedicalResearch.com

Epigenetic Mechanism Linked To Increased Allergies in Fall and Winter Births

MedicalResearch.com Interview with:

Dr Gabrielle A. Lockett PhD Postdoctoral Research Fellow Asthma Genetics Laboratory, Faculty of Medicine, University of Southampton

Dr. Gabrielle Lockett

Dr Gabrielle A. Lockett PhD
Postdoctoral Research Fellow
Asthma Genetics Laboratory,
Faculty of Medicine,
University of Southampton

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Lockett: Season of birth has been known for decades to influence a huge range of traits, such as height and lifespan, as well as the risks of diseases such as allergy and schizophrenia. But until now the mechanism for season of birth effects was unknown. This study discovered that epigenetic marks (specifically DNA methylation) on the genome are associated with season of birth in 18-year-olds, suggesting that this could be a mechanism for such long-lasting birth season effects.

Epigenetic marks on the genome are known to both influence gene expression and to change in association with environmental exposures. This study is the first to identify DNA methylation associated with season of birth. This discovery therefore extends our knowledge of environmental exposures that are able to affect the epigenome.

The study also went on to further examine the genes identified to contain birth season-associated DNA methylation. Groups of these genes have functions related to development, cell death and the cell cycle, suggesting that season of birth alters the epigenetic regulation of these processes in particular. There was also suggestive evidence that season-associated DNA methylation could be on the functional pathway to allergic disease outcomes.

Continue reading

New Protocol Uses Fewer Allergy Shots For Hay Fever Control

MedicalResearch.com Interview with:
Stacy L. Rosenberg, MD
UPMC Montefiore Allergy and Immunology Fellow

MedicalResearch.com: What is the background for this study?

Dr. Rosenberg: Allergy shots or allergen immunotherapy (AIT) is an effective therapy for allergic rhinoconjunctivitis (hay fever).  Low adherence has been a significant barrier, whereas rush immunotherapy to environmental allergens provides rapid build-up and offers quicker efficacy, which may improve adherence.  However, there have been concerns for increased risk of systemic reactions with rush protocols.  We describe a new protocol for modified rush AIT that offers quicker build-up towards a maintenance dose with improved safety and lower risk of systemic reactions.  We also hypothesize that there are specific characteristics that distinguish patients who develop systemic reactions in the setting of modified environmental rush immunotherapy (MERIT).

MedicalResearch.com: What are the main findings?

Dr. Rosenberg: Overall, MERIT has a good safety profile.  A subset of patients did develop systemic reactions, which were mild.  Lower BMI was associated with systemic reactions and there was a trend between history of urticaria (hives) and younger age with development of systemic reactions.  Significantly more patients with systemic reactions had allergen extracts containing cat, dust mite, and weed pollen.  Neither gender, asthma, nor anaphylaxis history were associated with an increased risk of systemic reactions.

Continue reading

No Evidence Hydrolysed Baby Formula Reduces Risk of Allergic Conditions

MedicalResearch.com Interview with:

Dr. Robert J Boyle Pediatric Allergist Imperial College London

Dr. Robert Boyle

Dr. Robert J Boyle
Pediatric Allergist
Imperial College London

MedicalResearch.com: What is the background for this study?

Dr. Boyle: For infants who are fed with formula milk, special hydrolysed formula is widely recommended if they are at risk of allergies, on the basis that this might reduce their risk of eczema and/or milk allergy.

It is not clear whether the research evidence supports this recommendation or not. 

MedicalResearch.com: What are the main findings?

Dr. Boyle: We found 37 trials in over 19,000 infants, but we found very few high quality trials.

There was evidence that trials of hydrolysed formula with a negative outcome are sometimes not published.

We found no consistent evidence that hydrolysed formula reduces risk of eczema, milk allergy or other allergic problems.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Boyle: There is no need to use a hydrolysed formula for allergy prevention.

The World Health Organization recommends that infants are breastfed at least until the age of 2 years, because breastmilk is much better for infant health than any other type of milk.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Boyle: Future research into improving infant formula milk needs careful regulation, to ensure that the information that arises from the research is of high quality and useful to patients.

MedicalResearch.com: Is there anything else you would like to add?

Response: Some forms of hydrolysed formula are used under medical supervision to help feed children with specific medical problems.

This new research does not affect that practice. 

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Boyle Robert J, Ierodiakonou Despo, Khan Tasnia,Chivinge Jennifer, Robinson Zoe, GeogheganNatalie et al. Hydrolysed formula and risk of allergic or autoimmune disease: systematic review and meta-analysis
Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

Dr. Robert Boyle (2016). No Evidence Hydrolysed Baby Formula Reduces Risk of Allergic Conditions

Wheezing in Early Childhood Linked to Reduced Lung Function By Adolescence

MedicalResearch.com Interview with:

Dr. Meghan B. Azad PhD Assistant Professor Department of Pediatrics & Child Health and Community Health Sciences University of Manitoba Associate Investigator, Canadian Healthy Infant Longitudinal Development (CHILD

Dr. Meghan Azad

Dr. Meghan B. Azad PhD
Assistant Professor Department of Pediatrics & Child Health and Community Health Sciences University of Manitoba and
Children’s Hospital Research Institute of Manitoba
Associate Investigator, Canadian Healthy Infant Longitudinal Development (CHILD) Study

Medical Research: What is the background for this study?

Dr. Azad: Asthma is the most common reason for children to miss school or be admitted to hospital, and accounts for over 30% of Canadian healthcare billings for children. Although many treatments exist to manage asthma symptoms, it is a lifelong disease and there is no cure.  Prevention is the best approach to reduce the global burden of asthma, and our study provides important new information to inform asthma prevention strategies.  

Medical Research: What are the main findings?

Dr. Azad: Wheezing is common in babies and young children.  Our study looked at the long-term implications of wheezing in early life, using data from the Canadian Asthma Primary Prevention Study (CAPPS).

We followed 320 children from Winnipeg and Vancouver from before birth until adolescence, and found that specific patterns of early wheezing (from age 0 to 7) were associated with decreased lung function and increased risk for asthma by age 15.

By age 15, children who wheezed consistently through infancy and early childhood had the worst lung function (9% lower compared to non-wheezers) and the highest asthma risk (11 times higher). Even children with “transient early wheeze” (those who wheezed as babies but not as young children) had reduced lung function (5% lower) and increased asthma risk (4 times higher) as teenagers.

Continue reading

Chronic Hives and Self Reported Penicillin Allergy Often Co-Exist

MedicalResearch.com Interview with:

Dr. Susanna Silverman

Dr. Susanna Silverman

Susanna Silverman, MD
Allergy & Asthma Care of New York 

Medical Research: What is the background for this study?

Dr. Silverman: Approximately 10% of the general population has self-reported penicillin allergy.  Because hives and rash are often attributed to drug allergy, we began to think about certain conditions that may be confused with penicillin allergy.  Chronic urticaria, which is defined as the presence of hives for six weeks or longer, is one such condition.  We were interested in looking at the prevalence of self-reported penicillin allergy in patients with chronic urticaria, and the prevalence of chronic urticaria in patients with self-reported penicillin allergy.

Medical Research: What are the main findings?

Dr. Silverman: Our study found that in patients seen at the University of Pennsylvania Allergy and Immunology clinic, the prevalence of self-reported penicillin allergy in patients with chronic urticaria was approximately three times higher than in the general population.  Similarly, the prevalence of chronic urticaria in patients with self-reported penicillin allergy was three times higher than in the general population. This suggests that in some patients, self-reported penicillin allergy may be due to chronic urticaria, not true drug allergy.

Continue reading

Immunotherapy Shows Promise For Severe Sinusitis With Nasal Polyps

MedicalResearch.com Interview with:

Prof Dr. Dr. h.c. Claus Bachert Head Upper Airways Research Laboratory (URL) Chief of Clinics ENT-Department University Hospital Ghent Ghent, Belgium

Prof. Claus Bachert

Prof Dr. Dr. h.c. Claus Bachert
Head Upper Airways Research Laboratory (URL)
Chief of Clinics ENT-Department
University Hospital Ghent
Ghent, Belgium

Medical Research: What is the background for this study? What are the main findings?

Prof. Bachert: Chronic sinusitis with nasal polyposis represents mucosal inflammation, and polyps in the nasal cavity and sinuses, which result in long-term symptoms of nasal obstruction and congestion, reduction in or loss of sense of smell, and loss of quality of life. Patients with nasal obstruction or congestion have a two-fold higher risk of sleep dysfunction, increased fatigue, and decreased work productivity. About 40 percent of chronic sinusitis with nasal polyps patients develop asthma, which often is non-allergic late-onset disease. Treatment options consist of nasal and systemic glucocorticosteroids; long-term or repeated treatment with oral GCS carries a great risk of side effects in these patients. Surgery of the sinuses is another option, but recurrence of polyps is frequent. Further treatment options are highly needed.

About 85% of nasal polyps represent a type 2 inflammation, with increased eosinophils and IgE formation. Dupilumab is an investigational therapy that inhibits signaling of IL-4 and IL-13, two key cytokines required for type 2 (Th2) immune responses. Dupilumab has been successfully administered in patients with asthma and atopic dermatitis.

The current randomized, double-blind, placebo-controlled group study enrolled 60 adult patients with chronic sinusitis with nasal polyposis refractory to intranasal corticosteroids at 13 sites in the United States and Europe. Following four weeks of mometasone furoate nasal spray (MFNS) run-in, patients in the study received 300 milligrams (mg) of dupilumab or placebo once per week subcutaneously for 16 weeks, after an initial loading dose of 600 mg. All patients in the study continued to receive daily MFNS. Eligible patients had bilateral nasal polyposis and showed chronic symptoms of sinusitis, despite treatment with an intranasal corticosteroid for at least two months. Fifty-eight percent of patients in the study had received prior nasal surgery for their condition.  ​

We found that dupilumab treatment was associated with significant improvements in endoscopic, clinical, radiographic, and pharmacodynamic end points after 16 weeks.

Significant improvements in quality of life and in major symptoms, such as sense of smell, nasal congestion, and nocturnal awakenings,were reported. In those patients with asthma, also lung function and asthma control were significantly better with Dupilumab compared to placebo. Dupilumab was generally well tolerated, and no serious adverse events were considered to be related to dupilumab.​

Continue reading

Children With Food Allergies May Have Overactive Immune System From Birth

More on Allergies on MedicalResearch.com

Yuxia Zhang PhD Population Healthy and Immunity Division Walter + Eliza Hall Institute Parkville VIC 3052 Australia

Dr. Yuxia Zhang

MedicalResearch.com Interview with:
Yuxia Zhang PhD
Population Healthy and Immunity Division
Walter + Eliza Hall Institute
Parkville VIC 3052 Australia 

Medical Research: What is the background for this study?

Dr. Zhang: There has been a dramatic increase in hospital presentations due to food allergy over recent decades, most among children under five years of age. In Melbourne Australia, up to one in every 10 babies develop food allergy during the first year of life. To understand the mechanisms underlying the increased incidences of allergy and other diseases in children, Associate Professor Peter Vuillermin and colleagues established the Barwon Infant Studies (BIS), following and collecting bio-speciments  from pregnant mothers and their babies. Together with my colleagues Prof. Leonard  Harrison and Mr. Gaetano Naselli from the Walter and Eliza Hall Institute of Medical Research, we examined the immune cell composition and function in cord blood in babies who developed food allergy compared to allergy-free babies at one year of age.   

Medical Research: What are the main findings?

Dr. Zhang: Our initial observation was that in cord blood the proportions of CD14+ monocytes and CD4+T cells were inversely associated. In infants who developed food allergy, there was a higher ratio of CD14+monoctypes/CD4+T cells and a lower ratio of naive natural regulatory T cells (nTreg).  The reduced nTreg frequency was also independently discovered by Dr. Fiona Collier in the BIS fresh blood cohort. CD14+ monocytes are the foot-solders of the immune system, which immediately release inflammatory cytokines upon infection. These inflammatory cytokines then guide the unexperienced CD4+T cells down to different paths to control infection. nTreg cells police the immune system to prevent unwanted damages during the elimination of the infections. Despite this widely accepted view of how our immune system are activated,  we do not know if and how these interactions may cause an allergic reaction in babies. Through a series of in vitro experiments, we found that the inflammatory cytokines- most likely in the mucosal sites where food allergy was initiated-could lead the development of both CD4+T cells and nTregs towards a Th2-type immune phenotype. These Th2-type immune cells secrete large amount of IL-4, a cytokine through which may cause allergic reactions to some foods.

Continue reading

Do All Beta Lactam Antibiotics Need To Be Avoided In Patient With Reported Allergy?

Meghan Jeffres, PharmD Assistant Professor | Dept of Clinical Pharmacy Skaggs School of Pharmacy and Pharmaceutical Science University of Colorado Anschutz Medical Campus Aurora, CO 80045

Dr. Meghan Jeffres

MedicalResearch.com Interview with:
Meghan Jeffres, PharmD

Assistant Professor | Dept of Clinical Pharmacy
Skaggs School of Pharmacy and Pharmaceutical Science
University of Colorado Anschutz Medical Campus
Aurora, CO 80045 

Medical Research: What is the background for this study? What are the main findings?

Dr. Jeffres: There are over 500,000 hospitalizations annually in the U.S. in which patients will have a reported allergy against first line antibiotics. Beta-lactams are the largest group of antibiotics which include penicillins, cephalosporins, and carbapenems. These antibiotics are the first line treatment against most serious bacterial infections; however, they are also the class of antibiotics to which patients are most commonly allergic. Patients labeled as allergic to one of these antibiotics are often prescribed second line antibiotics. Previous studies have shown that the use of second line antibiotics are more expensive, result in more adverse events, and longer hospital stays.

We theorized that patients labeled as penicillin, cephalosporin, or carbapenem allergic treated with non-beta-lactams would have higher rates of clinical failure, but lower rates of allergic reactions, than patients treated with beta-lactams. Analysis of the data revealed that patients treated with non-beta-lactams did indeed have higher rates of clinical failure. Unexpected findings of the study were the low number of new allergic reactions which occurred in 16 patients, less than 3% of the study population.

Continue reading

House Dust Mites May Play a Role in Inflammatory Bowel Disease

Meri K Tulic PhD Université de Nice Sophia-Antipolis Immune Tolerance Nice, France The International Inflammation 'in-FLAME' Network Worldwide Universities Network

Dr. Meri Tulic

MedicalResearch.com Interview with:
Meri K Tulic PhD

Université de Nice Sophia-Antipolis
Immune Tolerance
Nice, France
The International Inflammation ‘in-FLAME’ Network
Worldwide Universities Network 

Medical Research: What is the background for this study? What are the main findings?

Dr. Tulic: We know that damaged epithelial gut barrier is a hallmark of gut inflammatory diseases including inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). It has been long known that respiratory allergens such as house-dust mites (HDM) are the main causes of epithelial destruction in the lungs and initiation of allergic airway disease such as asthma. We set out to test whether  house-dust mites may also be present in the human gut and may contribute to intestinal barrier dysfunction. In this paper, we have shown that  house-dust mites is found in the gastrointestinal system of ~50% of all healthy subjects tested and it has detrimental effect on gut barrier function. The mechanisms include its direct destruction of tight-junction proteins which normally hold adjoining epithelial cells together, resulting in increased gut permeability. This process is driven by cysteine-proteases contained within the mite. In healthy individuals this effect is likely to be regulated by increased production of regulatory IL-10 (an anti-inflammatory mediator); our preliminary data indicate that a defect in regulatory responses may exist in IBS patients.

Continue reading

Summer Newborns May Be Least Likely To Develop Allergic Disorders

Professor of Pediatrics Hans Bisgaard, MD, DMSc Copenhagen Prospective Studies on Asthma in Childhood Herlev and Gentofte Hospital, University of Copenhagen, Denmark.

Prof. Bisgaard

MedicalResearch.com Interview with:
Professor of Pediatrics Hans Bisgaard, MD, DMSc

Copenhagen Prospective Studies on Asthma in Childhood
Herlev and Gentofte Hospital,
University of Copenhagen, Denmark

Medical Research: What is the background for this study?

Prof. Bisgaard: Birth season has been reported to be a risk factor for several immune-mediated diseases, although the critical season varies depending on the disease. Autoimmune diseases are generally associated with spring births, whereas asthma and allergies are more common among subjects born in fall and winter. Because many of these diseases, such as asthma, rheumatoid arthritis, and multiple sclerosis, have an underlying immune-mediated pathology, we hypothesized that this association might be mediated by differential changes in neonatal immune phenotype and function with birth season. We therefore sought to investigate the influence of season of birth on neonatal immunity by a combined analysis of immune cells subsets from cord blood and inflammatory mediators in the airways of neonates from the Copenhagen Prospective Study on Asthma in Childhood (COPSAC) 2010 birth cohort.

Medical Research: What are the main findings?

Prof. Bisgaard: We found a birth season–related fluctuation in neonatal immune cell subsets and in early-life airway mucosal immune function. The seasonal airway immune pattern was associated with the number of activated and regulatory T cells in cord blood whereas it was independent of concomitant presence of pathogenic airway microbes. Specifically, summer newborns presented with the lowest levels of all cell types and mediators and thereby seem to display the most quiescent immune status. Fall births presented mainly with an enhanced type 2 profile (eosinophils and IL-13), along with high TNF-a, IL-12p70, IL-10, and IL-2 levels, suggesting recent immune activation; whereas winter newborns had the highest levels of most cell types and mediators, including an anti-bacteria/ fungi–associated type 17 response (neutrophils, IL-17, and IL-1b), an antiviral response (pDCs and NK cells), increased eosinophil counts and an IL-5–mediated type 2 response. These season-linked immune profiles were similar to the known immune pathology of type 2 immune-mediated diseases associated with the fall and winter birth seasons, suggesting that immune function in early life might be biased toward the trajectory to later disease development.

Continue reading

FDA Study Compares Anaphylactic Risk of IV Iron Products

Cunlin Wang, MD, PhD Division of Epidemiology I, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research US Food and Drug Administration

Dr. Wang

MedicalResearch.com Interview with:
Cunlin Wang, MD, PhD
Division of Epidemiology I,
Office of Surveillance and Epidemiology,
Center for Drug Evaluation and Research
US Food and Drug Administration

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Wang:  IV Iron has been known for its risk of anaphylactic reaction, but there has been little research on the comparative safety of individual IV Iron products from a large population-based study. This study included 688,183 new users of IV iron not on dialysis from the U.S. Medicare program over a ten-year span (January 2003 to December 2013). The main findings of the study are:  the risk for anaphylaxis at first exposure was higher for iron dextran than non-dextran IV iron products combined (iron sucrose, gluconate and ferumoxytol).  When individual IV Iron products were compared, the data suggested that iron dextran has the highest risk of anaphylaxis and Iron sucrose has the lowest risk, estimated both at the first time exposure and after cumulative exposures.  The low and high molecular weight dextran products could not be individually identified during most of study period. However,  from January 2006 through March 2008, during which the use of two dextran products could be distinguished, there was very low use of high molecular weight dextran (Dexferrum@). This suggested that the study results likely represent the risk of the low molecular weight dextran (Infed@).

Continue reading

Model Predicts Children At High Risk For Asthma Related Acute Care Visits

MedicalResearch.com Interview with:
Jill Hanson, MD
Children’s Mercy Hospital
Kansas City MO 

Background from the American College of Allergy, Asthma & Immunology

“Asthma is the most common chronic disease in children, and one of the most difficult to manage, which is one of the reasons there are so many emergency department visits for asthma sufferers in the US.”

Medical Research: What are the main findings of this study?

Dr. Hanson: Our study of asthmatic children found that the number of historical asthma-related acute care visits (i.e. urgent care, emergency department and inpatient admissions) was predictive of future asthma-related acute care visits. 

Continue reading

Children Have Lower Risk of Asthma In Home With Dog

Dr. Tove Fall, PhD Associate Professor in Epidemiology Ingelsson Group Upssala University

Dr. Tove Fall

MedicalResearch.com Interview with:
Dr. Tove Fall, PhD
Associate Professor in Epidemiology
Ingelsson Group
Upssala University

Medical Research: What is the background for this study? What are the main findings?

Dr. Fall: We wanted to make use of the Swedish national dog registers to study the question of whether children exposed to dogs are at lower risk of asthma and compare this to children living in farming environments. Previous studies on this question has been inconclusive. We linked health and population data from all children born in Sweden from 2001-2010 with dog ownership data, and with this detailed data set, we found that children in dog-households had 13% lower risk for asthma at age 6, accounting for factors such as parental asthma, area of residence and socioeconomic status. Children in farming households were at even lower risk, which is consistent with many previous studies.

Continue reading

CDC Study Finds Anaphylaxis Rare After Vaccinations, With No Fatalities

MedicalResearch.com Interview with:
Michael M. McNeil, MD, MPH

Centers for Disease Control and Prevention
Atlanta, GA

Medical Research: What is the background for this study? What are the main findings?

Dr. McNeil : Anaphylaxis is an uncommon potentially life-threatening allergic reaction which can occur immediately (usually within minutes) after exposures to food, drugs, venom and vaccines. More than 100 million people in the U.S. receive vaccinations each year. Most vaccines have the potential to trigger anaphylaxis, but the rates at which it occurs after vaccination are not well known. The CDC study examined data from the Vaccine Safety Datalink (VSD), a collaborative project between CDC and 9 integrated healthcare organizations, which contains vaccination records on more than 9 million patients. The study sought to determine the rates of anaphylaxis after all vaccines combined and some individual vaccines including seasonal influenza vaccines given to children and adults.  Patients studied received vaccinations between January 1, 2009 – December 31, 2011.  Electronic medical record data was screened for patients with specific diagnostic codes for anaphylaxis or who had received epinephrine prescriptions as a treatment for potential anaphylaxis. Researchers were able to look at data from 25,173,965 vaccinations during 17,606,500 visits to healthcare providers.

The researchers identified 33 confirmed vaccine-triggered anaphylaxis cases that occurred after more than 25 million vaccine doses. The rate of anaphylaxis was calculated at 1.31 per million doses for all vaccines, and 1.35 per million for seasonal inactivated influenza vaccines. Patients ranged in age from 4 to 65 with a median age of 17. None of the patients with anaphylaxis were below the age of 4 years old. Only one of the 33 patients was hospitalized, and none died as a result of anaphylaxis. A majority (85%) of the case-patients had pre-existing atopic disease including previous anaphylaxis, asthma, and allergies.

Continue reading

Furry Pets May Reduce Allergies in Kids By Changing Gut Bacteria

Merja Nermes, MD Dept. of Pediatrics Turku University Hospital Turku, FinlandMedicalResearch.com Interview with:
Merja Nermes, MD

Dept. of Pediatrics
Turku University Hospital
Turku, Finland

Medical Research: What is the background for this study? What are the main findings?

Response: Earlier it was thought that exposure to pets early in childhood was a risk factor for developing allergic disease.  Later epidemiologic studies have given contradictory results and even suggested that early exposure to pets may be protective against allergies, though the mechanisms of this protective effect have remained elusive. Our results are the first to show that specific bifidobacteria present in pets can be transferred to the infant gastrointestinal tract during a close contact.  Bifidobacteria in general are a part of the microbiota in healthy breast fed infants, and many studies have shown that human-specific bifidobacteria have beneficial effects to health, e.g. lower the risk of allergic disease. The same might hold true for bifidobacteria of animal origin which may  enhance and strengthen the development of the infants´ immune system to be protective against allergies.

Our results showed that animal-derived bifidobacteria were found in a higher proportion in infants of pet-keeping families than in those without such exposure.  We also found  that  B. thermophilum (pet-derived Bifidobacterium) was associated  with a lower risk for atopic sensitization  at  6 months of age.

Continue reading

Sublingual Immunotherapy Not Currently Recommended For Asthma Control

Rebecca Normansell MA MB BChir Cochrane Airways Population Health Research Institute St George’s, University of London

MedicalResearch.com Interview with:
Rebecca Normansell MA MB BChir
Cochrane Airways
Population Health Research Institute
St George’s, University of London

 

 

Medical Research: What is the background for this study?

Response: Asthma is a common, long-term, respiratory condition which affects over 300 million people worldwide. It is a burden not only for the individual with asthma but also for the health services that care for them and the wider economy, due to days lost from work and school.

Asthma therapies aim to prevent attacks and improve symptoms by reducing airway constriction and inflammation, but they come with their own risks of side effects. For example, long-term high-dose inhaled corticosteroids have been associated with growth restriction in children and long-acting beta2-agonists as mono-therapy have been associated with increased risk of death in people with asthma.

There is growing interest in developing novel treatments for asthma and one such treatment is specific allergen immunotherapy. Immunotherapy has the potential to be a useful approach for asthma as it is thought that for approximately half of people with asthma, allergies are an important trigger for their symptoms and attacks. Immunotherapy can be delivered by injection (subcutaneously) or under the tongue (sublingually) and aims to bring about immune tolerance.

Immunotherapy has already been demonstrated to be effective in certain conditions, such as allergic rhinitis and wasp and bee sting allergy, but its effectiveness and safety in asthma is less clear. In fact, immunotherapy is not recommended at all for use in people with severe or uncontrolled asthma due to the risk of triggering a serious respiratory reaction.

Medical Research: What are the main findings?

Response: Our review looked for trials in which people with asthma who were given sublingual immunotherapy (SLIT) were compared with those given placebo, or who continued usual asthma care. We found 52 randomised controlled trials which met our inclusion criteria, allocating over 5,000 people to either SLIT or placebo/usual care. Most of the participants had mild asthma and were allergic to either house dust mite or pollen.

Despite the large number of eligible trials we were only able to perform a limited meta-analysis. This is because most of the trials did not report the efficacy outcomes we were most interested in: exacerbations and quality of life. Asthma symptoms and medication use were both more frequently reported, but often using different, un-validated scales so we did not perform a meta-analysis for these outcomes.

However, we were able to combine serious adverse event data from 22 trials involving 2560 participants and data for all adverse events from 19 trials including 1755 participants. SLIT did not appear to be associated with an increased risk of serious adverse events, although very few events were observed overall. SLIT was associated with a small increase in the risk of all adverse events, which in absolute terms equated to an increase from 222 per 1000 people in the control group to 327 per 1000 (95% confidence intervals 257 to 404). Importantly, many of these events were mild and transient local reactions and did not generally result in participants withdrawing from the trial.

Continue reading

Abnormal Lung Microbiome Linked To Severe Asthma

Yvonne J. Huang, MD Assistant Professor, Division of Pulmonary & Critical Care Medicine University of Michigan Health System Ann Arbor, MI  48109-5642
MedicalResearch.com Interview with:
Yvonne J. Huang, MD

Assistant Professor, Division of Pulmonary & Critical Care Medicine
University of Michigan Health System
Ann Arbor, MI  48109-5642

 

Medical Research: What is the background for this study?

Dr. Huang: Asthma is a disease with many different clinical manifestations, and it is likely that multiple mechanisms play a role in asthma. Understanding the biological processes that contribute to this heterogeneity is an important goal of current translational research in asthma. One hypothesis that dates back several decades is whether asthma, at least in some forms, is linked to chronic airway infection or colonization by particular species of bacteria.  Results of early investigations in this regard were mixed, in part due to reliance on less sensitive methods to detect bacterial infection, but a new spin on this hypothesis has emerged in recent years.   This stems from the technological advances that now enable one to molecularly profile all bacteria present in a sample, such as via sequence analysis of conserved bacterial genes (such as that for 16S ribosomal RNA). 16S rRNA-based methods are now commonly used to profile bacterial microbiota in a variety of human niches, including in studies of respiratory disease.

Prior to our current study, a few investigations had shown that the lower respiratory microbiome in adult asthmatics differs in bacterial composition (i.e. the types and relative abundance of bacteria present), compared to healthy controls.   In a previous study of patients with mild-moderate asthma, we also had found that clinical features of asthma, such as bronchial hyper-responsiveness, were associated with increased abundance of specific bacterial groups.  However, whether similar relationships between clinical features and the  microbiome exist in severe asthma was unknown, which we addressed in the current study.

Continue reading

Pre-Labor C-Section Affects Newborn’s Immune System

Professor of Pediatrics Hans Bisgaard, MD, DMSc Copenhagen Prospective Studies on Asthma in Childhood Herlev and Gentofte Hospital,  University of Copenhagen, Denmark.

Prof. Bisgaard

MedicalResearch.com Interview with:
Professor of Pediatrics Hans Bisgaard, MD, DMSc
Copenhagen Prospective Studies on Asthma in Childhood
Herlev and Gentofte Hospital,
University of Copenhagen, Denmark

Medical Research: What is the background for this study?

Prof. Bisgaard: Programming of the immune response in perinatal life seems to contribute to the increased prevalence of immune-mediated diseases

We hypothesized that initiation of labor could affect the developing newborn immune system.

Medical Research: What are the main findings?

Prof. Bisgaard: Pre-labor cesarean section is associated with a distinct and gestational age-related distribution of circulating immune cells in newborns suggesting that changes in specific immune compartments occur during the approach of labor.

Continue reading