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Author: Stephen J. Klemawesch, MD

New Mobile Check In App!

New Mobile Check In App!

We have launched our new Mobile Check In app. You may download it by clicking the download on the right side of this page, or by scanning the QR Code in the office. You can check in from the parking lot. If you are going to be waiting for your shot in the car just click the box that says “yes, in car” and in the comment section please add the color and make of your car.

Of course, you can still check in from the IPad in the lobby.

“H4” Antihistamine

“H4” Antihistamine

The Journal of Allergy and Clinical Immunology recently published research on an experimental H4-antihistamine investigated at the University of Hanover.  The research is part of a global effort to find more effective therapies for atopic dermatitis (eczema).  The prevalence of atopic dermatitis has doubled in the past 30 years with occurrence in between 15% to 30% of children and 2% to 10% of adults.  It is characterized by chronic relapsing itching of the skin which develops bumps and scaling, and can weep fluid in its severe form.  The itch is very problematic often disrupting life activities and sleep. 

Current therapies include improving skin barrier function through moisturizers and wet wraps, dilute bleach baths to reduce skin bacteria overgrowth, topical and systemic steroids, topical calcineurin inhibitors, topical phosphodiesterase inhibitor, phototherapy, and for very severe cases injectable monoclonal antibodies.  To date, the available antihistamines have proven to be of very modest value.  The traditional antihistamines block either H1: Benadryl, Claritin, Allegra, Zyrtec, Xyzal or H2: Zantac, Pepcid, Tagamet, and Axid.  These are of modest benefit because the skin cells have only a small number of H1 and H2 receptors.  But as it turns out, there are many H4 receptors on skin cells, hence research to find an effective and safe H4 antihistamine. 

The drug ZPL-3893787 just might fit the bill.  Recently developed by German scientists it proved to be extremely effective in a large-scale clinical trial.  It led to a very remarkable lessening of itch but also to healing of the skin.  The H4 receptors in the skin mediate both pruritis and inflammation.  By blocking the H4 receptor “ZPL” seems to both stop the itch and heal the skin.  If further studies give similar results it will prove to be a “God-send” for atopic dermatitis patients.  

Dear Dr. K –

Dear Dr. K –

All three of my children have food allergies.  My two daughters have minor symptoms but my son has eosinophilic esophagitis and has had to have his esophagus dilated twice.  Why the difference? 

The short and sweet answer is gender.  First off, all food allergy is quite common, affecting up to 15% of Americans at some time during their lives.  The resultant symptoms can vary from trivial to life threatening anaphylaxis (such as severe peanut allergy).  Also, the “target organ” of the food allergy can vary from the skin, to the sinuses, to the lungs, to the GI tract.  Eosinophil esophagitis (EOE) tends to be one of the more troublesome manifestations.  The allergy leads to inflammation in the esophagus causing heart burn, reflux, and sometimes strictures, with resultant sticking of food.  If mild the lodged food can be vomited out, but sometimes it has to be removed via endoscopy. 

As it turns out, EOE is four times more common in males than in females.  It also tends to be more severe in males than in females with more frequent development of strictures.  The gender difference turns out to be due to a protective effect of estrogen, specifically 17-Beta-Estradiol.  Estrogen can affect physiologic processes beyond reproductive function by its effect on the immune system.  Estrogen receptors have been found on T and B lymphocytes, other white blood cells and on natural killer cells, all of which can mediate allergic inflammation.  By downregulating the inflammatory response, estrogen protects the esophagus from the severe inflammation that can occur in males. 

Researchers at the University of Michigan and the University of Cincinnati have recently found estrogen receptors in esophageal tissue of both sexes.  Based on these findings they plan to investigate the plausibility of using a dilute estrogen solution to swallow as part of a healing therapy.  They hope

that very dilute concentrations would work in males, but not adversely affect their hormonal balance. 

Cough and Asthma

Cough and Asthma

A recent article in the Journal of Allergy and Clinical Immunology discussed current research into why asthma patients cough. 

The answer, as it seems to be to many complex questions, is multifactorial.  The human brain is the source of a myriad of protective reflexes from blinking to coughing.  Protecting the airway compels a complex and delicate neural network.  Think about the high degree of neurologic coordination required for swallowing without aspirating, even though the esophagus and trachea lie against one another.  There is no question that asthmatics have a more delicate (“hair trigger”) cough reflex.  What makes their cough-nerves more sensitive? 

It seems to be a function of both structural issues and functional issues.  The main structural issue is airway narrowing, which is why asthmatics wheeze and have shortness of breath.  The narrowing of the airway “tugs” on the cough-nerves and by stretching them makes them more sensitive.  One example of this heightened sensitivity is coughing due to laughing.  When we laugh, we move a greater volume of air in and out of our lungs and this in turn leads to very slight cooling of the airway.  This slight cooling is perceived as an airway threat and hence the coughing. 

The functional issue is inflammation.  You can think of this as “burning” the cough-nerve fibers.   Because protecting our airway is so important the cough-nerve fibers are unmyelinated; that is, they don’t have the protective myelin coating that most nerves in the human body have.  This makes them very vulnerable just as a bare copper wire would more easily spark. 

Treating the cough of asthma boils down to expanding the narrowed airways and reducing inflammation. 

Sounds Good to Me!

Sounds Good to Me!

By: Sasha Klemawesch, MD

Do you get misty-eyed every time you’re standing in RayJay, waiting for kickoff, listening to the National Anthem?  Or do other drivers give you the side-eye when they catch you singing R-e-S-p-E-c-T into your air mic while sitting at a red light?  No matter what genre you prefer, everyone has been moved by music at some point. 

Cultures throughout history have recognized and made use of this, specifically, sound’s healing power.  For example, aboriginal healers used the low frequency tones of the Yidaki instrument during their treatment of sick tribal members.  Ancient Egyptians believed vowels to have held sacred power, so priests chanted them for healing prayers.  Priestesses meanwhile played Ras (rattles) and harps during therapeutic rituals, both of them typically doing so in reverberant chambers which augmented the ultrasonic vibrations they were creating. 

This latter phenomenon is the basis for modern science’s foray into sound therapy.  Vibroacoustic treatment as we know it today started in Scandinavia in the 70’s; where early reports cited reduction in muscle tension, pain and anxiety after exposure.  Since then, there have been a variety of research studies done in the area of sound and music therapy, including (more recently):

  1. Just 2 weeks of vibroacoustic treatment using classical music, done 30 min a day for 5 days a week, led to statistically significant reduction in depression among nursing home residents. 
  2. NIH observed a group of patients with issues ranging from cancer to cardiovascular and infectious diseases to mood disorders, who underwent vibroacoustic sound treatment, and found a 53% “cumulative reduction in pain and symptoms” including tension, nausea, and fatigue. 
  3. Yet another study found that vibroacoustic therapy helped decrease maladaptive behaviors and acting-out among children on the Autism spectrum. 

One of the theories behind its effectiveness is the idea that our bodies are constantly using energy (at the cellular level seen as persistent micro-vibrations), and injury, stress or other sicknesses sap the speed and intensity of these micro-vibrations, further compounding fatigue, immunologic dysfunction, and overall chronic illness.  It may seem a little new-agey to those with more western allopathic mindsets, but the goal of vibroacoustic therapy is to replenish this cellular energy and “get us vibrating at the optimal frequency”.  And when you add music to the equation you are accessing a whole additional set of benefits with how much music affects the brain.  Now the eastern vs western, alternative vs allopathic medicine debate is for another time, but it’s hard to argue with the results to date in the vibroacoustic therapy arena.  In fact, you could say, it’s a pretty sound option for treatment!

Mobile Check In is here!

Mobile Check In is here!

We have launched our new Mobile Check In app. You may download it by clicking the download on the right side of this page, or by scanning the QR Code in the office. You can check in from the parking lot. If you are going to be waiting for your shot in the car just click the box that says “yes, in car” and in the comment section please add the color and make of your car.

Of course, you can still check in from the IPad in the lobby.

COVID-19 Update: The office is open our regular hours!

COVID-19 Update: The office is open our regular hours!

We will be open our regular office hours. If you are coming for an allergy shot, please sign in as usual and sit in the marked chairs. If you would like to get your shot in your car or outside, just let us know.

We also have Telephone Visits available, please call the office to schedule. The doctor will call you back to discuss your health concerns.

We are cleaning the office regularly and we do have hand sanitizer available – please wait outside if you have a cough of any type.

Fasting and Health

Fasting and Health

The New England Journal of Medicine recently featured a review article titled “Effects of Intermittent Fasting on Health, Aging and Disease” written in cooperation by the NIH and Johns Hopkins University.  They start out the review by pointing out that it is a blatant misnomer that humans should eat three meals a day plus or minus snacks (excepting the rare individual with special nutritional needs).  They go on to point out that over the million and a half years that humans have evolved our metabolic machinery has been programmed to eat less often and to sustain frequent short fasts.  Then comes the modern era of grocery stores, refrigerators, and fast food restaurants and with it a decline in health fueled primarily by obesity, but also by the uncoupling of healthy metabolic and immunologic pathways. 

The main benefits of fasting are:  the reduction of free-radical production, improved glucose regulation, improved stress resistance and suppression of inflammation.

The two main ways to fast are either intermittent (once a week) fasting for an entire day or by doing “time restricted” eating.  The former can be achieved by reducing your calorie intake to 500 calories for one day a week.  The latter can be achieved by eating your usual daily caloric intake during 6 hours and fasting for 18 hours. 

One of the main benefits of fasting involves the metabolic shift from glucose to ketones as an energy source.  Ketones act not only as an energy source but as potent signaling molecules that slow aging and reduce inflammation. 

The authors go on to cite hundreds of research articles demonstrating the benefit of fasting to help diabetes, cancer (both the development of cancer and its spread), neurodegenerative diseases, asthma, MS, and arthritis. 

Dear Dr K; I recently read about carriers of cystic fibrosis having potential health risks. Is this true?

Dear Dr K; I recently read about carriers of cystic fibrosis having potential health risks. Is this true?

Yes, it is true.  When I was a medical student, I was taught that people who were carriers for the cystic fibrosis gene would not manifest any of the problems of the disease.  As time and science move forward this turns out not to be the case. 

Cystic Fibrosis is inherited as an autosomal recessive disease; that is, it takes the bad gene from both parents to cause the disease.  Carriers have only one copy of the gene which is known as the cystic fibrosis transmembrane conductance regulator (CFTR) protein. 

The frequency for carriers varies by race:

White                     1 in 3,200

Black                       1 in 15,000

Hispanic                 1 in 14,000

Asian                      1 in 35,000

The disease, cystic fibrosis, affects the sinuses, lungs, pancreas, intestinal tract and other organs.  It commonly leads to chronic sinus and lung infections and pancreatic failure. 

Recent epidemiologic studies have revealed that carriers have increased risk for some of the same problems.  Carriers have a greater tendency for sinus and lung infections.  They also have a greater risk to develop bronchiectasis, a chronic infection in the bronchial tubes.  The risk for respiratory failure is higher too.  In the GI tract pancreatitis and pancreatic cancer are more common in carriers. 

To date there is no specific cure for cystic fibrosis, much less the carrier state.  But gene therapy is coming close to being a reality.  In the meantime, being aware of greater risk as a carrier could help early in the intervention and screening for infections and cancer. 

Milk and Health

Milk and Health

Not to be outdone by Johns Hopkins, Harvard Medical Group also published a review in the New England Journal of Medicine about milk and health. 

They start out by “stating the obvious” that the natural function of milk is to nourish and promote the growth of young mammals, not mature ones.  They go on to question the current dietary recommendation of three 8-ounce servings of milk/milk product per day. 

Because cows are bred for high milk production and because they are pregnant during most of the time they are milked, they produce high levels of insulin-like growth factor (IGF-1) and high levels of estrogen and other hormones. 

Exposure to IGF-1 and other hormones has been linked to a greater risk for certain cancers: breast, ovarian, uterus and prostate. 

Cow milk intake has been correlated with the development of diabetes, especially type 1 diabetes owing to cross reactivity between dairy proteins and pancreatic islet cells. 

A long-standing rationale for promoting lifelong milk consumption is to meet calcium requirements for bone health.  The concept is good but the practical outcome is the opposite.  Hundreds of scientific studies show that countries with the greatest milk intake have the poorest bone density.  Yes, milk is rich in calcium, but it also contains certain proteins that leach away the mineral content of our bones.  Countries with the lowest milk intake paradoxically have the best bone health.  Cow milk is also the most common cause for food allergy, at least in Western countries. 

Finally, there is the “fart” issue.  As hard as it seems to believe, the methane produced due to the large industrial scale of milk production is having a measurable effect on green house gases.  The Harvard group calculated that obtaining our protein from alternative sources such as soy, legumes, and grains rather than from milk would reduce global greenhouse gases by 10 percent.