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.

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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.

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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

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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.

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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.

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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.

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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.

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Skin Testing Plus APP May Reduce Overdiagnosis of Penicillin Allergy

MedicalResearch.com Interview with:
Kimberly Gold Blumenthal, M.D
Assistant Professor of Medicine
Massachusetts General Hospital

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

Response: Over-reported penicillin allergies negatively impact patient care, as alternative drugs that are often used can be less effective, more toxic, more broad-spectrum (killing all of the good bacteria and leaving patients increasingly vulnerable to C.diff colitis), and more expensive. Most hospitalized patients who have a recorded penicillin allergy are not actually allergic. This has drawn attention by national organizations such as the CDC, National Quality Forum, and both allergy and infectious diseases professional societies. The message is clear: Address reported penicillin allergies in some way to improve care.
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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.

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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.

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Protein Found To Enhance Ability To Kill MRSA

MedicalResearch.com Interview with:

Warren Leonard, M.D. NIH Distinguished Investigator Laboratory of Molecular Immunology NHLBI, NIH

Dr. Warren Leonard

Warren Leonard, M.D.
NIH Distinguished Investigator
Laboratory of Molecular Immunology
NHLBI, NIH

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

Response: TSLP is a cytokine that has been well studied in the context of T cell helper type 2 (TH2) responses and the promotion of atopic diseases. TSLP is naturally expressed at barrier surfaces, such as the skin; however, its role in skin infections was not previously explored.

In our study, we investigated whether TSLP plays a role in host defense to Staphylococcus aureus skin infections, using the most common strain of methicillin-resistant S. aureus (MRSA) present in the United States.

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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%.

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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.

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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.

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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.

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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.

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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.).

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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.
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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.

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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.

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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).

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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. 

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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@).

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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.

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Scientists Get Closer To A Vaccine Against Allergies

Dr. Christine McCusker MD Associate Professor, Department Pediatrics Meakins-Christie Laboratories McGill University and the MUHCRI, Montreal Quebec, CanadaMedicalResearch.com Interview with:
Dr. Christine McCusker MD
Associate Professor, Department Pediatrics
Meakins-Christie Laboratories
McGill University and the MUHCRI, Montreal
Quebec, Canada

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

Dr. McCusker: When the body is exposed to new substances, the immune system must evaluate the “threat” and choose the type of response that will best protect the host. Allergies and allergic asthma develop after the response to “allergens” follows the TH2-type inflammatory pathway instead of the non-inflammatory tolerant pathway.  Evidence suggests that there is some plasticity in this “choice” and thus it may be possible to influence the immune response to preferentially choose the tolerant pathway when exposed to allergens. We therefore treated very young mice to a molecule designed to inhibit activation of the TH2 pathway.

We showed that this early treatment resulted in long-lasting protection from the development of allergies.  Instead of allergic responses, vaccinated animals developed tolerant responses to allergens and did not show any signs of allergies or asthma.  Importantly, while the influence of the treatment was long-lasting, the molecule itself is rapidly removed from the system. Continue reading

Exclusive Breastfeeding Does Not Reduce Allergies by Age 7

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?

Dr. Bisgaard: Extended breast-feeding is recommended for
newborn children at risk of allergy-associated diseases, but the
evidence of a protective effect on sensitization and these diseases
remains elusive.

Medical Research: What are the main findings?

Dr. Bisgaard: Exclusive breastfeeding does not affect
sensitization in early childhood or associated diseases at 7 years
of age in at-risk children.

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Chronic Rhinosinusitis Varies By Bacterial Microbiome

Vijay R. Ramakrishnan, MD Assistant Professor University of Colorado Department of Otolaryngology Aurora, CO 80045MedicalResearch.com Interview with:
Vijay R. Ramakrishnan, MD
Assistant Professor
University of Colorado
Department of Otolaryngology
Aurora, CO 80045

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

Dr.
Ramakrishnan: Chronic rhinosinusitis (CRS) is an extremely common problem, associated with major quality of life alterations and financial burden. Bacteria are thought to play a role in the initiation or sustenance of the disease, at least in a subset of CRS patients. Chronic rhinosinusitis is probably a group of heterogeneous diseases with different pathways that result in the same endpoint. Here, we study the bacterial microbiome of a large group of CRS and healthy sinuses, and discover that a few clinical subtypes display unique bacterial microbiome profiles and that the microbiome may predict outcomes from severe Chronic rhinosinusitis patients electing to undergo surgery.

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Epigenetics: More Than 30 Genes Affect Allergies and Asthma

Dr. Liming Liang PhD Assistant Professor of Statistical Genetics Departments of Epidemiology and Biostatistics, Harvard School of Public Health, Boston, Massachusetts Dr. Liming Liang PhD
Assistant Professor of Statistical Genetics
Departments of Epidemiology and Biostatistics,
Harvard School of Public Health, Boston, Massachusetts

 

Allergies affect 30% of the population and 10% of children suffer from asthma. Researchers in the United Kingdom, the United States, Sweden and Canada report in Nature that they have discovered more than 30 genes that have strong effects on Immunoglobulin E (IgE), allergies and asthma. IgE is the antibody that triggers allergic responses.

Amongst the genes are promising novel drug targets for treating allergies and asthma.

The researchers also found that the genes are concentrated in eosinophils, a white cell that ignites inflammation in asthmatic airways. The genes indicate when the eosinophils are activated and primed to cause the most damage.

Therapies that neutralise eosinophils already exist, but they are very expensive and only efficacious in some asthmatics. The newly found activation signals provide a possible means of directing treatments by predicting who will respond before starting therapy.

The research team used a novel technique to discover these genes, known as an “epigenome wide association study (EWAS)”. Epigenetic changes to DNA do not alter the underling sequence of the genetic code but can still be passed on as cells divide. They program the cells to form specialised types and tissues.

Epigenetic changes are most easily detected by alterations in methyl molecules that are attached at the side of the DNA chain. The researchers therefore concentrated on 27,000 methylation hotspots known as CpG islands that are positioned near many genes. They tested whether methylation levels in these islands in white cells from UK families with asthma was correlated with the level of the IgE in the blood.

To be sure of their positive results the researchers tested whether they held true in additional volunteers with high and low levels of IgE from Wales and further asthmatic families from Québèc.

They found strong associations between IgE and CGI methylation at 36 places in 34 genes. Some of the IgE-related genes were known to be present in eosinophil cells. The researchers therefore separated eosinophils from the blood of 24 subjects and showed all 34 genes to have their strongest effects in asthmatics with high IgE levels.

The paper shows the power of epigenome wide association analyses. Previous genetic association studies for IgE levels (looking at changes in DNA sequences) had only found genes that could explain 1% of individual differences in IgE, and did not discover any novel therapeutic targets or pathways underlying IgE regulation

By contrast the epigenetic associations accounted for more than 13% of IgE variation, 10 fold higher than that derived from traditional genetics. The associations identify novel potential drug targets for allergic diseases as well as biomarkers that may determine which patients will respond to particular therapies.

The increased power from epigenetic studies comes at the cost of controlling for many factors such as ageing and gender that are not important for simple genetic studies. The authors had to use advanced statistical techniques to be sure of their results, and as well as testing their validity in multiple additional sample sets.

The Freemasons’ Grand Charity, the Wellcome Trust and grants from the Québec Government provided the principal funding for the study.

Citation:

An epigenome-wide association study of total serum immunoglobulin E concentration

Liming Liang, Saffron A. G. Willis-Owen, Catherine Laprise, Kenny C. C. Wong, Gwyneth A. Davies, Thomas J. Hudson, Aristea Binia, Julian M. Hopkin, Ivana V. Yang, Elin Grundberg, Stephan Busche, Marie Hudson, Lars Rönnblom, Tomi M. Pastinen, David A. Schwartz, G. Mark Lathrop, Miriam F. Moffatt, William O. C. M. Cookson. An epigenome-wide association study of total serum immunoglobulin E concentration. Nature, 2015; DOI: 10.1038/nature14125

 

 

Majority of Asthma Patients Do Not Use Inhalers Correctly

Rana Suzette Bonds, MD The University of Texas Medical BranchMedicalResearch.com Interview with:
Rana Suzette Bonds, MD
The University of Texas Medical Branch

MedicalResearch: What is the background for this study?

Dr. Bonds: Both anaphylaxis and asthma can be life threatening disorders requiring prompt treatment. Each disorder can be successfully treated with medication which is delivered by devices designed for self-administration. Unfortunately there has been evidence in the literature that patients frequently do not use the devices appropriately. We sought to determine which factors were associated with incorrect use of metered dose inhalers and epinephrine autoinjectors, and to determine if rates of correct use have improved since earlier reports.

MedicalResearch: What are the main findings?

Dr. Bonds: Sixteen percent of patients used the epinephrine autoinjector properly and 7 percent of patients used the metered dose inhaler correctly. The most common error with the autoinjector was not holding the unit in place for at least 10 seconds after triggering. For patients using the metered dose inhaler the most commonly missed step was exhaling to functional residual capacity or residual volume prior to actuating the canister. Male sex, Caucasian race, and previous medical education correlated with correct use of epinephrine autoinjector device.

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Study Finds Fewer Childhood Allergies In Homes Where Dishes Washed By Hand

Dr. Bill Hesselmar University of Gothenburg SwedenMedicalResearch.com Interview with:
Dr. Bill Hesselmar

University of Gothenburg
Sweden

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

Dr. Hesselmar: The hygiene hypothesis is the background for this study, and the hypothesis states that children’s immune system need to be stimulated by bacteria and microbes to mature in a proper way prevent the children from developing immune mediated diseases such as allergies. There are increasing support for the hygiene hypothesis, with less allergies found in children from milieus with a rich microbial exposure such as: growing up on a farm or in a developing country, in children with many siblings, and after vaginal delivery as compared to caesarean section. Even though these findings are interesting from a theoretical point of view, they can’t be use in primary prevention since you can’t recommend anyone to live by a farm. We are investigating if there are harmless “microbial sources” in different daily life-situations that are good enough to stimulate children’s immune system. So far we have observed two such possible sources, the sharing of children’s pacifier (Pediatrics 2013) and hand dishwashing (this study). These are, however, only observational data – we have only found an association between hand dishwashing and a lower risk of allergy, we don’t know for sure that the lower risk of allergy was just because of the hand dishwashing. So far we regard it as an “interesting observation”, which need to be confirmed in new studies before any general conclusions could be made.

The main findings was a lower risk of allergy (Odds Ratio 0,57) in children from hand dishwashing families as compared to children from families who use machine dishwashing.        Continue reading

Infant Gut Microbiome Linked to Allergic Predisposition

Christine Cole Johnson, PhD, MPH Senior Staff Epidemiologist & Henry Ford Distinguished Scientist Department Chair Department of Public Health Sciences Henry Ford Hospital and Health System Detroit MichiganMedicalResearch.com Interview with:
Christine Cole Johnson, PhD, MPH
Senior Staff Epidemiologist & Henry Ford Distinguished Scientist
Department Chair Department of Public Health Sciences
Henry Ford Hospital and Health System Detroit Michigan

 

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

Dr. Johnson: Our research group is focused on the environmental and infant gut microbiomes. We are interested in studying what environmental, lifestyle and behavioral factors affect the microbial community of the baby’s gastrointestinal tract, and how that microbial community composition affects the development of allergic disorders. We have been following a birth cohort called WHEALS in Detroit and its suburbs since 2003, collecting data on potential risk and preventive factors as well as environmental samples and stool samples from the babies. We have used sequencing of the v4 region of the 16s rRNA gene, common and unique to all bacteria, to develop a fingerprint of the bacterial community in the stool samples.

We have found that many variables shown in the past by ourselves and others to allergic disorders are associated with different types of bacterial communities, such as breastfeeding, mode of delivery, first born status, socioeconomic status, pets in the home, levels of endotoxin in the home, and environmental tobacco smoke. Current breastfeeding is the most important variable at both 1 and 6 months, and at one month, mode of delivery is next most important. Endotoxin levels in house dust samples, a crude marker of bacteria levels, are important at 1 month but even more important at 6 months.

We also found that certain bacterial community patterns in the baby’s gut impact whether or not they have parental-reported allergic symptoms when exposed to cats and dogs when the children are about 4 years of age.

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Genetics Plays Large Role in Allergic Esophagitis

Dr. Hakon Hakonarson MD PhD The Center for Applied Genomics, The Children’s Hospital of Philadelphia Department of Pediatrics, The Perelman School of Medicine, University of Pennsylvania Philadelphia, Philadelphia, PennsylvaniaMedicalResearch.com Interview with:
Dr. Hakon Hakonarson MD PhD

The Center for Applied Genomics, The Children’s Hospital of Philadelphia
Department of Pediatrics, The Perelman School of Medicine,
University of Pennsylvania Philadelphia, Philadelphia, Pennsylvania

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

Dr. Hakonarson: We have built the world’s largest pediatric biobank at the Center for Applied Genomics at CHOP. Eosinophilic esophagitis (EoE) is among the projects we have sampled in collaboration with the EoE Center in collaboration with Dr. Spergel. We have nearly 1,000 samples now of this relatively rare disorder, which is now well powered for GWAS.  We previously  reported association of the TSLP locus with Eosinophilic esophagitis. Here we report genome-wide significant associations at four additional loci; c11orf30 and STAT6, which have been previously associated with both atopic and autoimmune diseases, and two EoE-specific loci, ANKRD27 that regulates the trafficking of melanogenic enzymes to epidermal melanocytes and CAPN14, that encodes a calpain whose expression is highly enriched in the esophagus in EoE.  This discovery not only improves our understanding of the pathobiology of  EoE, but also represents novel targets for the development of new therapies to treat the disease.

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Childhood Skin Prick Allergies Remain Predictive of Future Allergies

MedicalResearch.com Interview with:
Maria Pesonen MD, PhD
Specialist in Dermatology
Assistant Chief Medical Officer
Finnish Institute of Occupational Health
Occupational Medicine Helsinki, Finland

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

Dr. Pesonen: Skin prick test is a widely used, established methods in assessing immediate (i.e. immunoglobulin E-mediated) sensitization. However, the knowledge on long-term reproducibility and predictive value of skin prick testing in children has been limited. We assessed the predictive value of skin prick testing in the setting of a follow-up study on healthy, unselected newborns, who were followed up to age 20 years with skin prick testing with 11 common allergens, structured interview and clinical examination at ages 5, 11 and 20 years. The reproducibility of skin prick test positivity at age 5 years was 100% at ages 11 and 20 years, i.e. none of the skin prick positive subjects turned negative during the follow-up. Gaining of new sensitizations to aeroallergens was common. Skin prick test positivity at age 5 years predicted allergic symptoms at ages 11 (sensitivity 28%, specificity 94%) and 20 years (sensitivity 23%, specificity 91%), but not atopic dermatitis.
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Cow’s Milk May Be Protective Against Childhood Infections

Georg Loss, PhD Dr. von Hauner Children’s Hospital Ludwig Maximilians University of Munich Munich, GermanyMedicalResearch.com Interview with:
Georg Loss, PhD
Dr. von Hauner Children’s Hospital
Ludwig Maximilians University of Munich
Munich, Germany


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

Dr. Loss: In this large population based cohort study we observed that consumption of fresh unprocessed cow’s milk protected from respiratory infections, febrile illness and inflammation of the middle ear during the first year of life. The risk of developing these conditions was reduced by up to 30%, and the effect was diminished if the milk was heated at home before consumption. Conventionally pasteurized milk retained the ability to reduce the risk of febrile illness, while exposure to the higher temperatures used in UHT (Ultra-heat-treatment) processing eliminated the effect altogether. Importantly, the positive impact of fresh milk could be clearly separated from the confounding effects of other elements of the children’s nutrition. Furthermore, infants fed on unprocessed milk were found to have lower levels of the C-reactive protein, which is a measure of inflammation status.

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Chronic Contact Dermatitis May Promote Skin Cancer Development

MedicalResearch.com Interview with:
Shawn Demehri, M.D., Ph.D. Instructor of Medicine Division of Dermatology Washington University in St. Louis andShawn Demehri, M.D., Ph.D.
Instructor of Medicine
Division of Dermatology
Washington University in St. Louis and

 

Wayne M. Yokoyama, M.D. Howard Hughes Medical Institute Rheumatology Division Washington University Medical Center St. Louis, MO 63110-1093Wayne M. Yokoyama, M.D.
Howard Hughes Medical Institute
Rheumatology Division
Washington University Medical Center
St. Louis, MO 63110-1093

MedicalResearch: What are the main findings of the study?

Research: This bedside to bench research has clearly demonstrated a cause and effect relationship between chronic allergic contact dermatitis and skin cancer development. This research originated from a clinical case of invasive skin cancer that developed in the context of chronic allergic contact dermatitis to a nickel-containing metal implant. Using animal models, we have demonstrated that chronic exposure to a contact allergen creates an inflammation that drive skin cancer development.
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Adverse Reactions to Cephalosporin Antibiotics Reviewed

Eric Macy, MS, MS Allergy & Immunology Kaiser Permanente Medical Group-AllergyMedicalResearch.com Interview with:
Eric Macy, MS, MS
Allergy & Immunology
Kaiser Permanente Medical Group-Allergy

 

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

Dr. Macy:

  • Cephalosporins are currently widely and relatively safely used in individuals with a history of a penicillin “allergy” in their medical record.
  • Cephalosporin associated anaphylaxis is very rare, even in individuals with a history of penicillin “allergy”.
  • Cephalosporin associated serious cutaneous adverse reactions are extremely rare.
  • Cephalosporin associated Clostridium difficile and serious nephropathy are relatively common.
    Continue reading

Passive Exposure to Tobacco Linked to Increased Allergies in Children

Dr. Wojciech Feleszko Department of Pediatric Respiratory Diseases and Allergy The Medical University of Warsaw Działdowska Warsaw, PolandMedicalResearch.com Interview with
Dr. Wojciech Feleszko
Department of Pediatric Respiratory Diseases and Allergy
The Medical University of Warsaw
Działdowska Warsaw, Poland


MedicalResearch: What are the main findings of the study?

Dr. Feleszko: We combined data from nineteen population-based cohort studies of 24 000 children and we found that household exposure to tobacco smoke after birth has immunomodulating effects.  We demonstrated an increased sensitivity to allergens, measured by serum IgE and skin testing which may contribute to the increased development of allergy in children exposed postnatally to household tobacco smoke. Continue reading

Link Between Environmental Greenness and Allergies Explored

Elaine Fuertes Institute of Epidemiology I, Helmholtz Zentrum München, German Research Centre for Environmental Health Neuherberg, Germany and School of Population and Public Health University of British Columbia, Vancouver, British Columbia, CanadaMedicalResearch.com Interview with:
Elaine Fuertes
Institute of Epidemiology I, Helmholtz Zentrum München, German Research Centre for Environmental Health Neuherberg, Germany and
School of Population and Public Health
University of British Columbia, Vancouver, British Columbia, Canada

MedicalResearch: What are the main findings of the study?

Answer: The main finding of our study was that despite the use of identical study designs and statistical methods, the level of greenness (measured using the Normalized Difference Vegetation Index) around a child’s home address was differentially associated with the development of allergic health outcomes among children living in two areas in Germany.

In our urban study centre, which includes the city of Munich, we found that higher greenness levels around a child’s home increased their risk of developing allergic rhinitis and experiencing eyes and nose symptoms. In contrast, greenness around the home appeared to be protective for allergic rhinitis, nose and eye symptoms and sensitization to inhalant allergens in the second more rural study centre investigated.

These observations emphasize that the effects of greenness around the home on respiratory health is complex and multifaceted, and are based on 5,803 German children followed from birth to 10 years as part of the GINIplus and LISAplus birth cohorts.

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Socioeconomic Disparities in Prevalence of Childhood Food Allergies

dr_julie_wangMedicalResearch.com Interview with:
Julie Wang, MD
Associate Professor of Pediatrics
Division of Allergy and Immunology
Icahn School of Medicine at Mount Sinai
New York, NY 10029

 

MedicalResearch: What are the main findings of the study?

Dr. Wang: The results of this study demonstrate that differences in prevalence of reported food allergies exist in elementary schools representing diverse socioeconomic and racial/ethnic characteristic.  In this study, we conducted a survey at 4 elementary schools in New York City, 2 private schools that had a predominantly White student body with over 80% of families having paid a full tuition of over $35,000 per year and 2 public charter schools that had a primarily Black and Hispanic student body where over 90% of students qualified for free or reduced price school lunch.  The results show a high rate of reported food allergy, with rates significantly higher in the private school population as compared to the public charter school population.

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After Outgrowing One Food Allergy, Some Patients Develop Second Allergic Reaction to Same Food

Jonathan M. Spergel, M.D., Ph.D. The Children's Hospital of Philadelphia Chief, Allergy Section Co-director, Center for Pediatric Eosinophilic Disorders Associate Professor of Pediatrics Perelman School of Medicine at the University of PennsylvaniaMedicalResearch.com Interview with:
Jonathan M. Spergel, M.D., Ph.D.
The Children’s Hospital of Philadelphia
Chief, Allergy Section
Associate Professor of Pediatrics
Perelman School of Medicine at the University of Pennsylvania

MedicalResearch.com: What are the main findings of the study?

Dr. Spergel: We were examining patients with Eosinophilic Esophagitis, an unique food allergy of the esophagus.   We found a subset of patients, who in the past had IgE mediated reaction to the food (hives, anaphylaxis) and had outgrown it.  Two-three years after outgrowing the food, then the patients developed Eosinophilic Esophagitis to the same food.
MedicalResearch.com: Were any of the findings unexpected?

Dr. Spergel: Yes, this finding indicated two important things:

  1. You can get two different reactions to the same food.
  2. The mechanism of the reactions for IgE-mediated reactions and Eosinophilic Esophagitis are different.

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

Dr. Spergel: For patients and clinician, if someone has outgrown the food allergy.  But, then gets new symptoms, it could be the food that they had outgrown.

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

Dr. Spergel:  This research raises two important questions.

  1. How often does this happen?  How many patients that outgrown their food allergy will develop a different reaction to the same food?
  2. Is there a better to treat patients with Eosinophilc Esophagitis or food allergy due to this difference in mechanism?

Citation:

Maggadottir et al, “Development of Eosinophilic Esophagitis to Food after Development of IgE Tolerance to the Same Food, abstract 990, presented March 2, 2014 at the AAAAI Annual Meeting.

Lung Cancer: Allergic Disease History Might Decrease Risk

Mariam El-Zein, PhD. Associée de recherche/ Research associate Unité d'épidémiologie et biostatistique / Epidemiology & Biostatistics Unit INRS-Institut Armand-Frappier Université du QuébecMedicalResearch.com Interview with:
Mariam El-Zein, PhD.
Associée de recherche/ Research associate
Unité d’épidémiologie et biostatistique / Epidemiology & Biostatistics Unit
INRS-Institut Armand-Frappier
Université du Québec

MedicalResearch.com: What are the main findings of the study?

Answer: The overall indication is that a prior history of allergic diseases (asthma, eczema or hay fever) might decrease lung cancer risk. There was a 36% (odds ratio= 0.64, 95% confidence intervals: 0.44-0.93) reduction in lung cancer risk among subjects who reported a history of asthma. Hay fever was associated with a 67% (odds ratio= 0.33, 95% confidence intervals: 0.19-0.59) reduction in lung cancer risk. Smoking was accounted for using a comprehensive smoking index that takes into account multiple dimensions of smoking behaviour (i.e., smoking status, intensity, duration, and time since cessation). A lower risk of lung cancer (reduction by 37%; odds ratio= 0.63, 95% confidence intervals: 0.38-1.07) was found among those having had eczema, but was not statistically significant.
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Pregnancy Exposure to Colds, Dust Mites and Offspring Atopic Dermatitis, Hayfever

Sabina Illi, Dipl.-Stat., MPH University Children's Hospital Lindwurmstr. 4 80337 Munich GermanyMedicalResearch.com Interview with:
Dr. Sabina Illi, Dipl.-Stat., MPH
University Children’s Hospital
Lindwurmstr. 4
80337 Munich Germany

MedicalResearch.com: What are the main findings of the study?

Answer: We observed that the offspring of atopic pregnant women that showed symptoms of atopy during pregnancy, i.e. atopic dermatitis or hay fever, had a higher risk of having the respective atopic disorder themselves. However, we do not know whether this is due to timing, i.e. pregnancy, or whether it merely mirrors the severity of maternal disease.

Furthermore, in our study pregnant mothers with repeated colds during pregnancy were at increased risk of having a child that wheezed at pre-school age, this was statistically independent of the intake of medication.
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