For many years now, asthma has been referred to as “The Nocturnal Predator” because of its tendency to exacerbate at night. The traditional explanation given was due to our normal circadian variation in adrenal gland output. Our adrenal glands produce two hormones that are an innate treatment for asthma: adrenalin and cortisone. In fact, many of the pharmaceutical therapies for asthma mimic the body in that they contain forms of adrenalin and cortisone.
Our adrenal glands “wake up” about an hour before we do and release surges of adrenalin and cortisone until about 4 or 5 pm. Then they “shut down” so we can be prepared for our sleep quietude. It is this dramatic drop in adrenal output at night that can allow asthma and other allergies to exacerbate. For many years this physiology was felt to be the total story. But science always moves forward and new research is showing that adrenal variation is just part of the equation.
One very new understanding is that in addition to our brains circadian clock, individual cells including the immune cells also have circadian clocks. When these clocks are disrupted the immune cells do not function optimally and therefore are less able to respond to allergic threats or microbial (virus & bacteria) invasion. As small a clock disruption as that which impacts many students: their school/work schedule versus their weekend schedule can lead to greater difficulty with allergies and infection.
For years, the phenomenon of “everyone getting sick” at the beginning of fall semester has been blamed on the gathering effect of the “herd” that had been separated during the summer. Certainly, this still plays a role, but the clock paradigm is equally important.
This clock effect also helps explain why shift workers and people who travel one or more time zones distant tend to have more allergies and more infections. When bed time versus wake-up times have been studied it turns out that wake-up time is the critical factor. You didn’t hear it from me but tell your teenage children not to sleep in until noon on Saturdays.
Researchers at Utrecht University in the Netherlands recently published a study on food allergy reactions due to undeclared ingredients.
They studied 73 patients with food allergy who had a reaction even though they thought they were avoiding their known food allergies. In 22 patients the scientists could find no explanation for the allergic attack. But in 51 cases analysis of the offending food revealed one to four culprit allergens not listed under “ingredients”.
The most common “undeclared food” was milk followed closely by peanut and sesame. The less common offenders were: tree nuts, egg and celery.
The foods most commonly guilty of containing unlabeled ingredients were cookies and cakes, bread and rolls, chocolates, sauces and dried fruits.
The key sensory proteins for pain, touch, taste, smell and sight have all been identified. In fact, their discoveries have been so important to health wellness that they have led to a number of Nobel Prize awards. However, for forty years the protein for hearing has eluded scientific research. But not any longer, neuroscientists have discovered it. It is named TMC-1 (trans-membrane channel-like protein) and it works via a calcium channel in the inner ear. It stimulates the inner ear hair cells thus playing a crucial role in both hearing and balance.
Its’ discovery should lead to new developments to help the ½ billion humans on the planet who have hearing loss and/or balance problems.
The FDA has recently approved “Sinuva”, a sinus implant to treat nasal polyps. Up to 25% of patients with allergic rhino-sinusitis develop nasal polyps. The polyps can cause nasal discharge, chronic congestion, snoring, tendency to sinus infection and loss of sense of smell. Often the polyps can be treated with nasal steroid sprays and with leukotriene modifier pills such as Singular or Accolate.
But, for some patient’s surgery is the only option. Unfortunately, in many surgical patients the polyps often regrow.
Enter Sinuva, a mometasone-eluting sinus implant. Mometasone is a topical steroid found in skin creams, nasal sprays and asthma sprays. The implant is placed, often following nasal polypectomy and left in place to slowly release the mometasone. Research has shown a dramatic reduction in polyp regrowth. The main side effect was bloody nasal discharge. The cost is $1,275 per nostril.
Adamis Pharmaceuticals has developed a prefilled epinephrine syringe as a cost-effective alternative to the automatic injectors. Currently, the only two available injections for epinephrine to treat severe allergic reactions are Epipen and Auvi=Q. Both work automatically to insert the needle and then deliver the medicine. However, both are expensive and cost constraints have led to some adults and children going without the protection.
The new prefilled syringe requires the patient or a caregiver to remove the needle shield, insert the needle into a muscle, then push the syringe to deliver the medicine and finally to remove the needle.
When studies were conducted on volunteers with no medical background 99% were able to successfully administer the medicine. This new tool called “Symjepi” has been FDA approved and provides a cost saving alternative to the auto-injectors.
Lumify is a new OTC eyedrop that helps “get the red out”. It is a selective alpha-adrenergic agonist that is available by prescription in higher concentrations. But the OTC form works well and unlike some other OTC eye drops, it does not cause rebound redness when you stop using it.
A pet surrogate is available for children/adults with pet allergy. Cats and dogs that look real and move in response to being held or petted are available at JoyForAll.com companion pets.
Previous issues of this newsletter have contained articles about the importance of the gut microbiome and human health in general and more specifically in good immune function. In this regard the use (and overuse) of antibiotics has come under intense scrutiny. This includes therapeutic antibiotics and those used in our food production. The premise here is that the antibiotics kill off some of our healthy microbiome and can lead to an overgrowth of “undesirables”.
A recent article published in “Nature” details research on the impact of non-antibiotic medications on the healthy microbiome. The investigators screened over 1,000 different medicines and found that 24% of them alter the healthy microbiome. The drugs that seemed to be the worst were antipsychotics and other psychoactive drugs, proton pump inhibitors, anti-cancer drugs and hormones.
What is a bit unsettling, is that this same research group has found preliminary evidence that an altered microbiome can promote some psychiatric and neurological diseases. So, the concern is that maybe the treatment that is supposed to help the condition might also contribute to it.
The researchers say more studies are needed to clarify these issues.
The answer is no, yes, or maybe so. I’m not trying to be obtuse, but the answer is different for different people.
Let’s start with the dry eye syndrome. It is very common and affects millions of Americans. Also, it can vary in severity from a mild nuisance to a vision altering severe condition. The common denominator for all people with dry eye syndrome, is compromised ocular lubrication. But, the condition has many causes which can overlap and interact.
Our tears are made by two different tear glands: the lacrimal glands which make the salt water component and the meibomian glands which make the oil component. Dry eye syndrome can be due to inadequate oil production. This imbalance can actually be worsened when the lacrimal glands over-produce the salt water which ends up diluting the oil further. And paradoxically someone with dry eyes might be “tearful”.
Dry eye syndrome can also be due to inadequate lacrimal output. The most common cause for this is certain rheumatologic syndromes especially Sjogren’s Syndrome. But lacrimal deficiency can also occur due to aging, contact lenses, and the drying effect of certain medications such as antihistamines.
Allergic individuals may not have ocular allergy until they develop dry eye syndrome, which leads to a paucity of tears and therefore impedes the natural removal process of allergens from the eye. Then if they take antihistamines to help their allergies they can worsen the drying of the eyes. Other medicines that can contribute to dry eyes include: diuretics, beta – blockers, some antidepressants, birth control pills and some herbal supplements, especially echinacea.
Finally, people who have a reduced blink rate (most commonly seen in Parkinson’s disease) don’t renew the protective tear film on the eyes and experience dry eye issues.
The immune system was once considered an independent, self-regulated system. But research over the past ten years has found that like most of the rest of the human body, it too is under the control of our nervous system.
Some of the early research in this regard was designed to understand why we seem more prone to get sick if we are under stress or depressed. As it turns out the brain does have significant control over certain aspects of the immune system. The brain uses the autonomic (also called automatic) nervous system to exert this influence. One of the main autonomic nerves is the vagus. Japanese scientists at Osaka University have discovered that using mild electrostimulation of the vagus nerve reduces immune mediated inflammation. Preliminary studies in rheumatoid arthritis and Crohn’s disease have shown improvement in both diseases with this therapy. Studies are also underway to determine benefit in reducing the inflammation that causes asthma.
One reason this research is so exciting is that unlike most anti-inflammatory drugs in current use, electrostimulation does not cause immune suppression and therefore avoids the increased risk of infection due to drug therapy.