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Author: Stephen J. Klemawesch, MD

Allergic clock might tick in our favor

Allergic clock might tick in our favor

Research scientists in Tokyo have been working on resetting the allergic clock in mice to lessen their tendency to allergy.

Our daily circadian clock, which is critical for many of our biological systems, is located in a special area in the hypothalamus of our brain called the light-sensitive central oscillator. It is programmed by the varying exposure to light and dark. In turn, it signals all the peripheral oscillators (clocks) found in individual cells throughout the body. This includes the allergy-causing mast cells.

This nerve signaling is done via the release of “clock” proteins that can activate or suppress the cell function. As it turns out, most mammals, including humans, are least likely to have allergy symptoms the first four hours of the new day, and more likely to have symptoms overnight. In fact, asthma is sometimes called the “nocturnal predator” because of this circadian tendency to flare at night.

The Tokyo researchers used small amounts of one of these “clock” proteins (called casein kinase) to keep the mouse mast cells in the low-reactive mode. It worked amazingly well to lessen both the severity and frequency of their allergic reactions. The next step in this research is to extend these findings to humans.

Caring for childhood eczema clearer

Caring for childhood eczema clearer

Just-published research of eczema in children – and the accompanying sleep interruption it causes the kids and their parents – has led to a recommended treatment.

University of Nevada researchers compared the benefit of antihistamines versus topical steroids to control the itch/scratching in children with eczema.

They found that both forms of therapy were effective. In fact, they were equally good in preventing sleep disturbance from nocturnal itch – a particularly vexing symptom for families because it causes significant loss of sleep.

And, because the children are unattended in bed, their scratching often causes significant trauma to their skin.  All but five percent of the Nevada study group responded positively to the use of antihistamines.

This led the researchers to recommend their use in all children with eczema

Dear Doc: Exercise-induced symptoms confusing

Dear Doc: Exercise-induced symptoms confusing

Dear Dr. K: Dear Dr. K.: My husband and I both have allergies and we are both triathletes. When we exercise my husband’s nasal congestion always improves, while mine seems to get worse. What’s going on?

The answer to your question is statistics.

Your husband is on the good side of statistics and you are on the bad side. What I mean is that in the majority of people with allergies exercise helps open the nasal passages. It does this by two main mechanisms: neurologic and chemical. In most persons, exercise increases preferentially the sympathetic nerves that control blood vessel size, constricting these blood vessels, and thus, improving nasal patency (being open or expanded).

Exercise also releases “adrenal-like” chemicals that exert the same effect on the nasal blood vessels.

In a small number of people, exercise preferentially stimulates the parasympathetic nerves, which dilate nasal blood vessels and cause congestion. This phenomenon is called exercise-induced rhinitis. It is similar to a related phenomenon in asthmatics called exercise-induced-bronchospasm.

One predisposing factor to exercise-induced-rhinitis is deviation of the nasal septum. Apparently, people with septal deviation have a chronic disparity in air flow through the two nostrils. For some reason, this makes the parasympathetic nerves more sensitive, and thus their adverse response to exercise.

Growing up on a farm can protect against allergies

Growing up on a farm can protect against allergies


It has been observed for many years that living on a farm reduces the risk for children to develop allergies and asthma. To better understand this protective effect, researchers at the University of Munich conducted a study of thousands of children from birth to age 6.

It turns out that a major protective factor was the consumption of unprocessed cow’s milk, as opposed to pasteurized milk.

Before addressing the milk issue, readers should know that growing up on a farm lessens the chance for allergies in general. This benefit is felt to be part of the hygiene hypothesis of allergy; that is, city dwellers who grow up in a “clean environment” have idle immune systems which allow the immune system to get into “allergic mischief.”

Farm children are exposed to a variety of animals, manure and dirt which keeps the immune system occupied and less likely to go into allergic mode.

The hygiene issue aside, farm children who drank boiled or pasteurized milk were not as “protected” from allergy as their young farm friends who drank raw milk.

As it turns out, the difference is that pasteurization reduces polyunsaturated fats (PUFAs) that are protective. These same PUFAs are dietary precursors for natural anti-inflammatory mediators made by our immune systems.

Children with high PUFA intake make lots of these natural anti-inflammatory molecules and benefit from the protection against allergic/asthmatic inflammation.

Raw milk is available from local cattle ranchers.

Singing lessons prove big benefit

Singing lessons prove big benefit

An amazing 96 percent of patients with lung conditions attending a “Singing for Breathing” program in the United Kingdom (UK) report improvement.

Research done by UK scientists has shown that singing therapy can improve lung function in a variety of conditions including asthma, COPD and cystic fibrosis.

The program consists of six weeks of twice-weekly voice lessons, followed by once-a-week maintenance classes. It is sponsored by the British Lung Foundation and is held at 55 clinics across Great Britain.

The British scientists feel that singing improves lung function in a variety of ways:

First of all, it strengthens the muscles of respiration: the diaphragm, the intercostal muscles and the chest wall muscles. Secondly, it helps dilate the airways by substantial exhalation and greater air movement. Thirdly, training the laryngeal muscles helps prevent laryngospasm that often occurs in asthmatics and COPD patients. Fourthly, the positive effects associated with singing help both airway patency (openness) and chest wall muscle function. Finally, participants were trained to try singing a sustained note as a mechanism to stop a coughing/wheezing attack prior to reaching for a rescue inhaler. More often than not, the sustained note was therapeutic.

Q – Tips: Ragweed Season

Q – Tips: Ragweed Season

This is ragweed season. Remember that certain foods can boost allergic symptoms to ragweed if eaten during this season: Melons, especially cantaloupe and honeydew; bananas, and chamomile – whether taken in food or drink, or even in personal products such as shampoo.

Chicken or egg? 5-year-old not confused

Chicken or egg? 5-year-old not confused

Poets and philosophers long have argued chicken/egg algorithms. And scientists have argued food allergy/eczema scenarios. For years it was felt food allergy was the seminal event preceding eczema.

The natural history and logic of this position are hard to dismiss. Even a 5-year-old who recently completed his allergy testing to better understand his skin rash, (which showed strong positives to both egg white and egg yolk), asked me why he needed to have these tests for his “eggs-ema.” Wasn’t it obvious to the doc that eggs were the cause?

As it turns out, it’s the eczema that causes the food allergy. Or actually in more technical terms, it’s the loss in skin-barrier function that causes food allergy. The primary fault in eczema is a less-than-ideal barrier response of the skin, due to reduced production of a barrier protein called filaggrin. This allows skin absorption of food, which in turn leads to the development of food allergy. The loss of barrier function antedates the actual appearance of the eczema rash.

Ironically, once the food allergy develops, it becomes a strong driving force to worsen the eczema.

Allergenic children born that way

Allergenic children born that way

Infants who have food allergy display a pro-inflammatory profile at the time of birth in their umbilical cord blood.

So say research scientists at the University of Melbourne. They found that the length of a woman’s labor seemed to lead to greater numbers of white blood cells that produce inflammatory proteins (called cytokines). In other words: short labor also leads to less chance of food allergy; long labor leads to a greater chance of food allergy.

Dear Doc: How long can I count on my Epipen?

Dear Doc: How long can I count on my Epipen?

Dear Dr. K: I keep an Epipen for “just in case,” but so far I have never had to use it. I keep replacing it when it expires, but it is expensive. Is it possible to use it past its expiration date? 

The answer is “yes, probably.”

The “probably” is based on the clarity of the liquid. If, when you look through the syringe and the medicine is clear, then it’s both safe and effective. If the liquid is yellow or cloudy, then discard it.

The Medical Letter, which is a nonprofit academic resource for physicians and hospitals seeking non-pharmaceutical company-biased information, actually addressed these issues in their December issue. They actually cited their research studies done on epipens.

The first study looked at pens that were from 1 to 90 months past their expiration. This showed a percentage reduction in potency correlated with the number of post-expiration months; i.e., pens one-month past expiration had 1 percent reductions in potency, while pens 90 months past had 90 percent reductions.

A second study evaluated pens 36 months past expiration and found them to be from 84 to 100 percent potent.

A third study looked at epipens stored on EMS vehicles that were from one to 11 years expired. These devices retained from 3 to 31 percent of their potency. The Medical Letter pointed out that exposure to greater heat in the ambulances will speed the degradation of the active medicine.

Data from the U.S. Department of Defense/FDA Shelf-Life Extension Program, which tests the stability of drugs past their expiration dates, showed that in a study of 3,000 different drugs 88 percent of them remained stable and fully active 66 months past expiration. High heat and humidity do accelerate degradation of many drugs.

This publication did say that ophthalmic (eye) medicines should never be used beyond expiration, even though the medication may be stable, because bacterial contamination occurs with repeat use. Authors also pointed out that certain dry powder inhalers such as Advair Diskus slowly absorb moisture once the device is removed from its foil container. This “gums up” the delivery in devices past expiration.