Red Meat Allergy Caused by Lone Star Tick Linked to Coronary Artery Disease

MedicalResearch.com Interview with:
“Lone Star Tick” by Katja Schulz is licensed under CC BY 2.0Jeffrey Wilson, MD, PhD

Research Fellow, Allergy & Immunology
University of Virginia 

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

Response: Galactose-α-1,3-galactose (α-Gal) represents an oligosaccharide that is present in mammalian products and is the causal allergen in a syndrome of delayed red meat allergy (commonly called α-Gal syndrome). Sensitization to this allergen has been linked to tick bites, specifically the lone star tick in the United States.

Thus, sensitization to α-Gal (and the prevalence of subjects with symptomatic red meat allergy) is relatively common where the lone star tick is common, i.e- the southeast.

For a variety of reasons we hypothesized that specific immune sensitization (which relates to IgE antibody production) to α-Gal would be a risk factor for coronary artery disease. To address this possibility we measured IgE specific to α-Gal in 118 adults subjects from central Virginia who had undergone advanced cardiac imaging with a technique called intravascular ultrasound. Out of the cohort 26% of the subjects in the study had the sensitivity to α-Gal.

The main finding was that subjects with the IgE sensitization to α-Gal had greater amounts of atherosclerosis, as well as atherosclerotic plaques with more unstable characteristics. This association was significant when controlled for traditional cardiovascular risk factors such as hypertension, diabetes and lipids levels.

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Secret Relationship of Regulatory T cells, Tregs, on Basophils

MedicalResearch.com Interview with:
“Basophil” by GreenFlames09 is licensed under CC BY 2.0Jagadeesh BAYRY, DVM, PhD, HDR

Scientist CRCN/Associate Professor-INSERM
Institut National de la Santé et de la Recherche Médicale (INSERM) Unité 1138
Centre de Recherche des Cordeliers
PARIS , FRANCE

 

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

Response: Basophils are rare granulocytes that are important for the protection against helminth parasites. In addition, basophils mediate T helper 2 responses, support B cell differentiation, and thus establish a vital link between innate and adaptive immunity. Although rare in number, basophils are implicated in various pathological conditions due to the fact that they undergo rapid activation in response to a wide range of stimuli they receive. These stimuli induce the release of diverse immune mediators including cytokines and mediators of hypersensitivity reactions histamine and leukotriene. Basophils are well known for their pathogenic role in allergic diseases. Recent data also advocate basophils in the pathogenesis of autoimmune and other inflammatory diseases. Therefore, considering the impact of dysregulated functions of basophils on the immune response in various diseases, we deliberated that it is essential to understand the regulatory mechanisms by which basophils are kept in check.

Among immunoregulatory cells, CD4+CD25+FoxP3+ regulatory T cells (Tregs) have been widely studied for their role in immune tolerance and in the maintenance of immune homeostasis. Tregs modulate autoimmune and inflammatory responses by exerting direct suppressive effects on various immune cells including dendritic cells, T cells, macrophages, monocytes, B cells, neutrophils, natural killer cells, and mast cells. In view of emerging reports on the role of basophils in various pathological conditions, we investigated if Tregs are able to control the activation and functions of basophils.

In contrast to the central dogma on Tregs as immunosuppressors, we discovered that human basophils are refractory to Treg-mediated suppression. On the contrary, we found that Tregs stimulate resting basophils to induce the expression of activation markers CD69, CD203c, and CD13, and release cytokines IL-4, IL-8, and IL-13. Treg-induced activation of basophils involves IL-3 and STAT5 but was not contact-dependent. These results provide evidence of direct positive effects that human Tregs have on basophil activation and reveal a previously unrecognized feature of this cell subset well known for immunosuppressive functions.  Continue reading

Chronic Hives In Children Resolve Slowly

MedicalResearch.com Interview with:

Hives-Urticaria Wikipedia image

Hives-Urticaria
Wikipedia image

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

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

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

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Many Summer Camps Need More Training On Food Allergy Treatment

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

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

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

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

Aspirin Desensitization in Patients With Coronary Artery Disease

MedicalResearch.com Interview with:

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

Dr. Rossini

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

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

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

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

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

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

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ID Fellow Managed Clinic Helps Determine True Penicillin Allergies

MedicalResearch.com Interview with:

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

Dr. Emily Heil

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

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

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

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Currently Available Skin Tests For Amoxicillin Allergy in Children Not Reliable

MedicalResearch.com Interview with:

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

Dr. Moshe Ben-Shoshan

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

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

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

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

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

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CDC Study Finds Anaphylaxis Rare After Vaccinations, With No Fatalities

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

Centers for Disease Control and Prevention
Atlanta, GA

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

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

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

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Signal For Development of Atopic Dermatitis – Eczema – Seen In Early Infancy

Dr. Alan Irvine, MD Professor in Dermatology Department of Clinical Medicine Trinity College DublinMedicalResearch.com Interview with:
Dr. Alan Irvine, MD
Professor in Dermatology
Department of Clinical Medicine
Trinity College Dublin

 

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

Response: Atopic diseases include atopic dermatitis (AD, also know as eczema), food allergy, allergic rhinitis and asthma.  The prevalence of these diseases has increased in recent decades causing considerable morbidity in childhood. The putative “Atopic March” refers to the typical sequence of clinical manifestation of atopic disease, usually initiated by atopic dermatitis from early infancy.

Parental atopy is an independent risk factor for development of atopic disease. The genetic mechanisms and inheritance pattern of atopic diseases are not fully elucidated but recent candidate gene studies and Genome Wide Association Studies (GWAS) have yielded some insights. The most widely replicated and most significant gene to influence atopic dermatitis is Filaggrin (FLG). Filaggrin is a filament binding protein in the stratum Corneum. FLG loss-of-function mutations (FLG mut) occur in 10% of Europeans, imparting an increased risk of atopic dermatitis, food allergy and asthma.  The overall increase in risk of atopic dermatitis conferred by a single FLG loss-of-function mutation is approximately 3.3, with a significant additional and independent effect conferred by intragenic copy number variations in FLG. Importantly FLG mutations increase the risk of developing asthma only in the presence of atopic dermatitis.

While loss-of-function mutations in the skin barrier protein filaggrin (FLG) are a major risk for atopic dermatitis, the pathogenic sequence of disturbances in skin barrier function prior to or during the early development of atopic dermatitis is not fully understood. A more detailed understanding of these events is needed to develop a clearer picture of disease pathogenesis. A robust, non-invasive test to identify babies at high risk of atopic dermatitis would be important in planning early intervention and/or prevention studies.

We found that raised transepidermal water loss at birth and at two months in asymptomatic infants predates the development of atopic dermatitis. This signal is independent of FLG status and parental atopy. Continue reading