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Author: Stephen J. Klemawesch, MD

Q – Tips: Inhaler use

Q – Tips: Inhaler use

A recent study found that fewer than 50% of asthmatics were compliant with their inhaler use if they didn’t like the device.  Since asthma inhalers come in a variety of formats, be sure to discuss your preference with the prescribing doctor.

Beware the Nocturnal Predator

Beware the Nocturnal Predator

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.

Food Allergy/Undeclared Ingredients

Food Allergy/Undeclared Ingredients

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.

Hearing Protein Discovered

Hearing Protein Discovered

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.

Novel Nasal Polyp Treatment

Novel Nasal Polyp Treatment

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.

Prefilled Adrenalin Syringe

Prefilled Adrenalin Syringe

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.

Q – Tips: Lumify

Q – Tips: Lumify

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.

Gut microbiome and good immune function

Gut microbiome and good immune function

 

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.