Quick – Tips: Air Fresheners
Keep in mind that air-fresheners are an oxymoron. They don’t freshen the air; they pollute it with chemicals and scents that have an adverse effect on people with respiratory allergies.
Flu shot value supercedes fear of many;
Dear Dr.K: I’ve never taken the flu shot because my father got Guillian-Barré syndrome from the 1976 swine flue vaccine. Now that I’m 50, I worry about getting really sick from influenza. Do you think I can take the flue shot?
In a word, “yes.”
For those readers who don’t know about Guillian-Barré, let me explain. Now that polio is almost non-existent, Guillian-Barré is the most common cause for acute paralysis worldwide. Even though fewer than 5 percent of affected people die, it still can be a very serious problem. Typically, the weakness (paralysis) starts in the peripheral muscles of the feet and hands and moves upward.
Most of the cases occur after a pre-existing respiratory tract infection or diarrheal illness. The single most common cause for Guillian-Barré is a G.I. bug caused by campylobacter jejuni (a bacteria known to be a main cause of bacterial food-borne disease in many developed countries). Other common pathogens capable of causing it are cytomagalo virus (an infection caused by a member of the herpes virus family); Epstein-Barr virus (which is very common and usually mild); varicella-zoster virus (chickenpox and shingles viruses), and mycoplasmas (stealthy bacteria that can cause acute and chronic diseases at multiple sites).
In 1976 there were a number of individuals who got Guillian-Barré after receiving the swine flu (H1N1) vaccine. Subsequent seasonal flu vaccines over the past 36 years have not been associated with this risk. In fact, in 2009, the National Institutes of Health and the Centers for Disease Control had some concern that the H1N1 vaccine that year might have the same potential as the 1976 H1N1 vaccine, but this turned out not to be the case.
The reason that an antecedent infection can trigger Guillian-Barré is because of a phenomenon called molecular mimicry. Lipooligosacchoride is a big word for a small molecule that is a major component of the myelin, which is the protective coating on our nerve fibers. Certain viruses and bacteria have the molecule in their outer membranes. When susceptible individuals who are infected mount an immune response to kill the infecting organism, they make antibodies against the lipooligosaccoride. Unfortunately, this also attacks the same molecule (molecular mimicry) found on the nerve sheaths.
Thus, the individuals’ nerves are attacked by their own immune system.
Luckily, there are modern immune therapies that can help slow and turn off this auto-immune attack, and thereby lessen the severity of the illness.
Egg Desensitization
Researchers at Duke University recently have completed a multi-year study of oral desensitization for egg allergy. They studied 55 children between five and eleven years of age with severe egg allergy.
Forty children were randomized to receive the oral vaccine while 15 received a placebo vaccine.
After 22 months of daily vaccine intake, all 55 children underwent a food challenge with egg. One-hundred percent of the placebo-treated children had an allergic reaction to the egg challenge; only 25 percent of the vaccine-treated children reacted allergically.
The vaccine therapy was discontinued after 22 months. Two months later the 40 children who received the true vaccine were re-challenged with egg. Of the children who had negative challenges at 22 months, half had a reappearance of their allergy. The children who were able to eat the egg challenge with no reaction, however, remained free of symptoms at 30 and 36 months. That is, they had a permanent resolution of the allergy that persisted even off the vaccine.
Don’t despair at urgent, post-meal, ‘uh-oh’ moments
Postprandial Diarrhea Syndrome (PPDS) – the unexpected and urgent bowel movement shortly after eating a meal – was the topic of a recently review article in The American Journal of Medicine. The authors of this review (from the Mayo Clinic) commented that this condition is often given the all-embarrassing moniker of irritable bowel syndrome (IBS).
But they go on to say that unlike IBS, where no cause is known, PPDS can have a treatable cause. The most common of these are food allergy, celiac disease, maldigestion due to bile acid malabsorption, pancreatic deficiency or an a-glucosidase deficiency.
Food allergy is best diagnosed by allergy skin testing. The treatment is avoidance of the allergenic foods. Celiac disease is an immune (non-allergic) reaction to gluten and can be diagnosed by blood test or intestinal biopsy. Again, the treatment is avoidance of wheat and other grains.
Bile acid malabsorption is best diagnosed by an empirical trial of a taking a bile acid-binding resin. There are sophisticated GI tests that can be done, but these are usually only available in a research medical setting. If the bile-acid binding resin controls the symptoms, then it is continued as a maintenance therapy.
Pancreatic insufficiency (lack of the digestive enzymes produced by the pancreas) can be diagnosed by a fecal fat analysis. Treatment consists of taking replacement pancreatic enzymes orally.
A-glucosidase deficiency is the lack of one or more enzymes that break down certain sugars. The most common ones are deficiency of sucrase, glucoamylase, maltase and isomaltase. Treatment involves avoidance of foods that contain the specific sugars.
Before embarking on a diagnostic trip for PPDS it is important to have proper gastro-intestinal evaluation to rule out more serious underlying conditions, such as cancer, Crohn’s disease or other inflammatory bowel diseases.
White blood cell type counts
An article in The American Journal of Respiratory and Critical Care Medicine discussed recent research of the heterogeneity or diversity of asthma. The thrust of the research project was to try to explain the variable benefit that asthmatics receive from inhaled corticosteroids.
It has been observed for quite some time that while many asthmatics show a marked improvement in their breathing with the use of inhaled steroids, there are others whose response to steroids is modest or nonexistent. Inhaled steroids have been a mainstay in asthma management for years. Because it is known that asthma occurs due to inflammation in the airways, steroids are potent anti-inflammatories and, hence, the predictable nature of their benefit.
Inflammation is defined as the incursion of white blood cells from the blood stream into the inflamed tissue. As it turns out, the type of white blood cell found in asthmatics determines how they respond to steroids. If the white blood cell is an eosinophil, then the patients have greatly benefitted by the inhaled steroids. If the white blood cell is a neutrophil, then steroids have been much less effective.
The researchers used a relatively test called sputum cytology. They collected multiple samples of sputa from a large number of asthmatics. These were sent to a special pathology lab to determine the type of anti-inflammatory cell: eosinophil or neutrophil. The researchers had already separated the asthmatics into groups of “steroid responders” and “steroid non-responders.” The two groups matched up perfectly with the cell type eosinophil or neutrophil respectively.
Dear Doc: Frustrating research reports can be latest steps toward goals of wisdom and scientific truth
Dear Dr. K: It seems as if medical research often countermands itself. First we hear niacin improves lipid health, then that it doesn’t affect health outcomes. Medicine for osteoporosis is deemed good; then we learn it might make brittle bones. Is there any research we can believe?
I understand your concern and confusion and will try to provide practical answers.
First you have to realize we live in an informational society grounded in instant dissemination of ideas through a variety of media and the Internet. Keep in mind there is a difference between information, knowledge, and then, wisdom.
In a way each is a step in the process of true and accurate understanding. Often, simple data or information is misconstrued because of lack of applicable knowledge or true wisdom.
For instance it is known that lower lipid values have health benefit. It also is known that niacin lowers lipid values. Unfortunately a simple assumption was made that, therefore, niacin must have health benefits. The first two bits of information were simple data that unfortunately led to an incorrect assumption.
Eventually, health outcome studies with niacin therapy were done. It was at this point that knowledge replaced data in that these studies failed to show a clinical health benefit, despite better laboratory numbers.
All scientific endeavors move forward by fits and starts. Hypotheses are made, data are collected and then theories are proposed. What can seem to be a solid theory can later be disproved or refined.
A good case in point is Newtonian physics — the principles of which work well enough to have allowed the success of the Apollo missions to the moon, but are unable to properly handle phenomena that approach light speed. For that we need Einstein’s principles of space and time.
Instead of being disheartened when new research changes previous beliefs, be glad that truth is being continually sought, however circuitous the path may be.
Quick Tips – Saline Nasal Gel
Topical saline nasal gel can be beneficial for many special needs. Because it is a gel, it has more staying power than simple mists. It is beneficial for people using CPAP or nasal oxygen canulas.
It also helps prevent nasal dessication with air travel or visiting climes found in a dry desert or the mountains.
Mother’s milk, delayed solids: Food allergy prevention standards, but we can always learn from new data
This month’s issue of the Journal of Allergy and Clinical Immunology has a symposium on food allergy.
Until recently it has been recommended that a good strategy to reduce risk of children developing food allergy was to promote exclusive nursing as a food source, to have the mother avoid highly allergenic foods and to delay weaning with introduction of solid foods.
However, despite the implementation of this approach in a number of countries in Asia, Europe and North and South America, there has been no reduction in the incidence of food allergy. The recommendations were made based on individual facts that are true, but that unfortunately do not lead to the desired outcome.
It is definitely true that mother’s milk is the best and most complete of infant nutrition. It is also true that mother’s milk contains a host of proteins and immune globulins that provide protective immunity to the infant. It is also true that early exposure to foods other than mother’s milk can lead to the development of food allergy.
From all these facts it was assumed the feeding recommendations also would be the best course to follow.
Once the potential benefit of this dietary approach was actually studied however, it was quickly learned that it did not provide the desired results. As it turns out a crucial fact that was previously unknown makes a pivotal difference.
If infants have early exposure to non-breast milk foods through skin contact, this is what leads to allergic sensitization. This has been born out in animal model research. Paradoxically, the food allergy development through skin contact can actually be prevented by early oral exposure to the food, e.g., from parents’ hands, kisses, etc. A good example of this phenomenon has actually been recognized for quite some time and it has to do with nickel allergy.
If a child’s first exposure to nickel is from pierced ears (skin exposure), there is up to a 40 percent chance of the child developing nickel allergy. If, on the other hand the child has oral nickel exposure from placement of orthodontic braces prior to ear piercing, the risk of nickel allergy is almost zero.
At this point in time the American Academy of Allergy has no specific recommendation. There are, however, numerous randomized controlled studies that are being conducted comparing the early exposure to foods such as peanut, milk, wheat and egg versus strict avoidance of these foods. Such studies will lead to a new evidence-based recommendation on how to prevent food allergy.
Vaccine Research addresses serious worldwide uptick in food allergy
Another part of the Journal of Allergy and Clinical Immunology’s food allergy symposium addressed European research on food vaccines. Impetus for this research is the worldwide increase in food allergy and also the increasing frequency of anaphylactic shock from food allergy.
Since vaccine therapy has proven successful in treating respiratory allergies and has also worked to prevent recurrent anaphylaxis from insects, it stands to reason that it could help eliminate food allergy and prevent food-related anaphylaxis.
Four types of vaccines for food allergy have been studied in Europe (and other countries): oral, sublingual, epicutaneous and subcutaneous.
All of these methods have proven to be of some benefit. Unfortunately, the ones that lead to the best improvement seem to have more side effects. Between the two ingestion vaccines (immunotherapy), oral immunotherapy leads to better reduction in allergy than sublingual.
The oral route commonly leads to GI side effects such as heartburn, nausea, vomiting, cramps and diarrhea. The sublingual route was much less likely to cause these symptoms, but did lead to itching and swelling in the mouth. Epinephrine shots had to be given twice as often for reactions in the oral group as compared to the sublingual group.
But patients who were successfully treated from both groups were able to ingest the implicated food – such as peanut – without going into allergic shock.
Subcutaneous immunotherapy, which is how traditional allergy shots are given, was more effective than epicutaneous immunotherapy. But once again, the more effective format led to more frequent vaccine reactions and to greater need for epinephrine to treat some of the reactions. When either of these techniques was successful, it again allowed the patient to safely ingest the offending food.
The European study group is conducting new and longer studies of these various forms of immunotherapy. The studies will include children, adolescents and adults. They also are adding studies to compare the use of pharmaceutical-grade food extracts versus the use of the entire native food as a vaccine substrate to see which works better and is safer.
Quick Tips – local honey
The use of local honey has been recommended as a non-medicinal way of treating allergy. As it turns out, it can either help or hurt. In order for “local honey” to actually help, it has to be taken in incrementally increasing doses, much the same way an allergy shot is built up. The benefit is extremely modest. Remember, bees carry entomophilous pollen, whereas anemophilous (airborne) pollen accounts for most allergies. Just using regular amounts of honey on cereal or in tea can worsen allergy due to the random exposure to the pollen it contains.