Allergies, Author Interviews, NIH, Pediatrics / 05.01.2017

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 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%. (more…)
Allergies, Asthma, Author Interviews, Flu - Influenza, Pediatrics, Vaccine Studies / 14.11.2016

MedicalResearch.com Interview with: 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%. (more…)
Allergies, Author Interviews, Pediatrics / 03.11.2016

MedicalResearch.com Interview with: 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. (more…)
Allergies, Author Interviews, NIH / 26.10.2016

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 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. (more…)
Allergies, Author Interviews, Dermatology / 25.09.2016

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. (more…)
Allergies, Author Interviews, JAMA, Pediatrics / 21.09.2016

MedicalResearch.com Interview with: 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. (more…)
Allergies, Author Interviews / 13.09.2016

MedicalResearch.com Interview with: 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.). (more…)
Allergies, Author Interviews, Pediatrics / 07.09.2016

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 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. (more…)
Allergies, Asthma, Author Interviews, Pediatrics / 25.08.2016

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. (more…)
Allergies, Author Interviews, Infections / 23.08.2016

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 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. (more…)
Allergies, Author Interviews, JAMA, Pediatrics / 08.04.2016

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 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 . (more…)
Allergies, Asthma, Author Interviews, OBGYNE, Pulmonary Disease / 05.04.2016

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). (more…)
Allergies, Author Interviews, Genetic Research / 26.03.2016

MedicalResearch.com Interview with: 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. (more…)
Allergies, Author Interviews, Immunotherapy / 14.03.2016

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. (more…)
Allergies, Asthma, Author Interviews, JAMA, Pediatrics, Pulmonary Disease / 09.02.2016

MedicalResearch.com Interview with: 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. (more…)
Allergies, Author Interviews, Dermatology / 08.02.2016

MedicalResearch.com Interview with: 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. (more…)
Allergies, Asthma, Author Interviews, JAMA / 04.02.2016

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 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.​ (more…)
Allergies, Author Interviews, Science / 15.01.2016

More on Allergies on MedicalResearch.com 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. (more…)
Allergies, Author Interviews / 16.12.2015

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. (more…)
Allergies, Author Interviews, BMJ, Gastrointestinal Disease / 16.12.2015

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. (more…)
Allergies, Author Interviews, Pediatrics / 18.11.2015

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. (more…)
Allergies, Anemia, Author Interviews, FDA / 18.11.2015

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@). (more…)
Allergies, Asthma, Author Interviews, Emergency Care, Pediatrics / 07.11.2015

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.  (more…)
Allergies, Asthma, Author Interviews, Pediatrics / 03.11.2015

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. (more…)
Allergies, Author Interviews, CDC, Pharmacology, Vaccine Studies / 07.10.2015

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. (more…)
Allergies, Author Interviews, Pediatrics / 12.09.2015

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. (more…)
Allergies, Asthma, Author Interviews, Microbiome, Pulmonary Disease / 28.08.2015

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. (more…)