A “pay attention” article was recently published in the Journal of Allergy and Clinical Immunology cautioning adults with asthma to be more aware that aspirin may aggravate their condition.
The authors pointed out that while some adult asthmatics with Aspirin Exacerbated Respiratory Disease (AERD) are cognizant of the negative effects aspirin can have on their health, most are not.
Studies have shown that AERD is more likely to occur if adult asthmatics also have chronic sinus problems and/or nasal polyps. Overall, seven percent of asthmatics have AERD, but 15 percent with severe asthma have it.
Unfortunately there is no simple blood or skin test to diagnose Aspirin Exacerbated Respiratory Disease. Right now, only two ways are available for these patients to become aware of the possibility: 1.) Monitoring their breathing symptoms after ingesting aspirin or other NSAIDS (non-steroid anti-inflammatories). 2.) Doing an aspirin challenge in a doctor’s office by measuring baseline pulmonary function tests and then incrementally increasing doses of aspirin, while repeating the pulmonary tests.
Dear Dr. K: I’m allergic to penicillin but my pharmacist has also labeled me cephalosporin-allergic. I’ve never taken cephalosporin. Should I follow her advice?
I can’t give you an answer with a 100 percent surety, but I can come close. As luck would have it, Kaiser Permanent Health Care just finished a research project on cephalosporin allergy.
Their study included 820,000 patients who received a total of 1.4-million courses of cephalosporin (often prescribed as Keflex). Of these, 66,000 were allergic to penicillin. Only one-half a percent of the 820,000 had an allergy to cephalosporin.
The reason your pharmacy warns of a possible cross-reactivity is that penicillins and cephalosporins share a common structural feature called the Beta-lactam ring. The thing that distinguishes penicillins from cephalosporins are side-chain molecules that attach to the Beta-lactam ring. Luckily, most allergy to penicillin is directed against the side chain and not the ring structure. Hence, there would not be cross-reactivity.
The Kaiser Permanent researchers felt that since the potential for cross-reactivity is so low, penicillin-allergic individuals can go ahead and take cephalosporins in most cases. They did advise members of this group who have had anaphylaxis to consider antibiotic testing prior to receiving cephalosporins. (Also, see first item in Q-Tips this issue.)
Do you remember a previous newsletter article about a crazy British physician with asthma? He was able to put his asthma into total remission by ingesting hookworms. The worms end up living in the GI tract and for some strange reason, they switch the body from the allergy-promoting TH-2 mode to TH-1, which eliminated allergy (See Promising New Asthma Drug this issue.)
Now his crazy Australian brethren are doing research on celiac disease and hookworms. The Australian scientists found that by inducing an experimental hookworm infestation in patients with celiac disease, and at the same time giving them small amounts of gluten, they were able to induce a state of gluten tolerance.
As well as the hookworm treatments work, the downside is that the worms cause the patients to become anemic and, thus, are not a viable long-term treatment. The researchers, however, hope these experiments will lead to a safe method of switching TH-2 to TH-1. One never knows where research can lead.
Research on a very exciting new medicine for asthma was featured several weeks ago in The New England Journal of Medicine. This drug — the first ever to work on both the acute and late phases of allergic response — is an enzyme that inactivates GATA-3 messenger RNA, and is being called SB010.
GATA-3 is a signal that favors T-helper cells to follow the TH-2 pathway, which promotes allergy. TH-1 eliminates allergy. Or, to use a Star Wars analogy: TH-1 is the Force, while TH-2 is the Dark Side of the Force.
All allergic reactions, including asthma, are bimodal; that is, after exposure to the allergen there is an immediate response occurring right away and lasting minutes to a few hours, but also a delayed response that builds gradually and lasts for many days. This late phase accounts for the chronic nature of allergies and asthma.
SB010 blocks both responses. In research done at Hannover Medical Center in Germany, patients received SB010 once a day via nebulizer. The results were immediate and dramatic, with most asthmatics experiencing dramatic reduction in their symptoms — even if they were purposely exposed to their causative allergen, such as cat dander.
Also, the medication was very well tolerated with minimal or no side effects. Other medical centers are also completing research on SB010. Hopefully, this will lead to it soon becoming clinically available.
When the shingles vaccine was being researched and developed, the patient population was studied for five years. These initial studies showed the vaccine to be 90 percent effective after five years.
Based on that research it was therefore felt that Zostavax (shingles vaccine) could be given once in a lifetime. Unfortunately, it is starting to look like that won’t be the case.
Now that longer-term studies are being completed, it is apparent that immunity wanes with time. In fact, efficacy falls to 46 percent after seven years; 14 percent after 10 years, and roughly zero after 11 years.
Since these long-term research projects have just been completed, the medical community awaits advice from the Centers for Disease Control and Prevention (CDC) regarding re-vaccination protocols.
Alas, we’ve entered the “dog days” of Florida heat and humidity. Persons who are allergic to dust mite and/or mold should be aware that even with continuous air conditioning, ambient indoor humidity can creep up and allow dust mites and mold to flourish. Ideal indoor humidity is 50 percent or lower. If your level is higher, consider using a dehumidifier during the summer months.
C. diff (Clostridium difficile) is the most common cause of severe antibiotic-induced diarrhea. New research indicates that once an individual has C. diff, it never totally leaves their GI tract. New guidelines therefore, recommend lifelong use of probiotics.