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Author: Stephen J. Klemawesch, MD

Oh, those bloomin’ Florida oak trees . . .easy to love, but so tough to live with

Oh, those bloomin’ Florida oak trees . . .easy to love, but so tough to live with

 If you live in Florida you might develop paranoia about oak trees and allergy. Our prodigious oak tree population accounts for the most severe form or our pollen seasons – spring tree season.

They also provide a home for a special type of fire ant that can drop down on people to sting them. Finally, they can also be a source of Pyemotes herfsi, the oak leaf itch mite. This mite belongs to the biological class Arachnida (which includes all spiders), and to the subclass Acarina. All of the members of this class have 8 legs. Unlike spiders, however, these mites are extremely small – 0.2 millimeters – and are difficult to see with the naked eye.

They fall off the oak leaves on to unsuspecting people and cause a bite that is extremely itchy. The resultant rash is a red, raised area about the size of a mosquito bite, but with a tiny central pustule or blister.

Typically, the bites occur on exposed skin of the face, neck, arms and legs. Luckily, the mite does not burrow into the skin or lay eggs, so, it is one bite per mite and then it’s gone. Unfortunately, since the mites are so small they can be blown by the wind, and have even been documented to travel through screened windows.

Here in Florida the Pin Oak is the most common of the oak species to be invaded by the mites.

Prevention includes protective clothing and the use of insect repellant containing DEET. Treatment is symptomatic with the use of cool compresses, oral antihistamines and topical steroid creams.

Phytochemicals a turn-on for gut-protective tissue growth

Phytochemicals a turn-on for gut-protective tissue growth

 A recent article in the journal Science discussed research on immunity based on gut function.

The researchers focused on a gut protein receptor called AhR (aryl hydrocarbon receptor), which when activated, leads to the healthy development of lymphoid tissue in the GI tract. This receptor is turned on my phytochemicals found primarily in fruits and vegetables. The vegetables richest in these phytochemicals are cruciferous vegetables such as broccoli, cabbage and brussels sprouts.

On the other hand, processed foods and foods rich in saturated fats turn off AhR.

When AhR switching leads to lymphoid development it provides a healthy environment in the GI tract. It prevents the gut from being populated by unhealthy bacteria.

Inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis occur when there is gut inflammation and AhR is turned off.

Research is being done to find medicines that turn on AhR, but probably the best medicine is a diet rich in vegetables and fruit.

Dear Doc: Please review ‘computer rash’

Dear Doc: Please review ‘computer rash’

Dear Dr. K: In one of your old newsletters you wrote about a computer rash. I think I have developed it but I can’t remember the details.

The condition is called Erythema Ab Igne. The rash is a lacy reticular redness that has a mild itch or burning sensation. It can also be mildly tender to the touch. It is caused by chronic exposure to an external heat source. In the article you mentioned I discussed how chronic laptop computer, actually sitting on the lap, can cause the rash to appear on the thighs.

This has been described in a wide variety of situations including use of hot water bottles, heating pads, electric blankets, space heaters, car heaters, hot bricks, infrared lamps, wood and coal stoves.

The rash is not a burn and can only occur with repeated exposure to the heat source. Similarly, the rash doesn’t immediately go away with cessation of the exposure. It can take months for it to resolve.

Cow milk allergy research: Mixed results, but vaccine testing provides some hope

Cow milk allergy research: Mixed results, but vaccine testing provides some hope

 Cow milk allergy is one of the most common food allergies and can lead to a variety of clinical symptoms affecting the respiratory, GI, GU, and dermatologic systems. It can even occur in infants who are exclusively nursed if their mothers are ingesting cow milk.

Because of the frequency and potential severity of the allergy there has been great effort to find a vaccine for cow milk allergy. Recently, researches at Johns Hopkins University publicized the results of their work on a milk vaccine for children. They studied sublingual (under the tongue), and oral (swallowed) vaccines.

Just as is the case with allergy shots, the procedure uses a regimen of gradually increasing doses of the allergic item (allergen). The maintenance dose was different for the two methods; 7 mg. for the sublingual vaccine and 2,000 mg. for the oral vaccine.

The oral vaccine was more effective, with 50 percent of the children being desensitized; compared to only 10 percent in the sublingual group.

However, there were more allergic side effects during the build-up of the oral vaccine than with the sublingual vaccine.

The children that were successfully desensitized were able to safely consume cow milk without their original allergy response. Unfortunately, if the vaccine was stopped, the allergic condition quickly returned, which was a source for mild pessimism by the Johns Hopkins researchers.

Dear Doc: One-time flu shot in the pipeline?

Dear Doc: One-time flu shot in the pipeline?

Dear Dr. K: I heard there is work being done on a one-time flu shot. Is this true?

Yes, Virginia, there is a Santa Claus and with any luck, there may also be a one-time flu vaccine. Before I discuss this new research let me review the current vaccine.

Traditional influenza vaccines target the globular outer region of the viral hemaggluttinin protein. This part of the protein is constantly changing and accounts for the new strains of flu seen each year. Moreover, for each year’s vaccine to work, scientists must accurately predict these new strains so that the vaccine is effective.

The new vaccine research is targeting the stem of the hemaggluttinin protein, which rarely changes. This stem protein is found across the board in all influenza strains. Thus, eliciting antibody production to this common protein will create broadly neutralizing immunity to all flu viruses. Therefore, one vaccine will prevent all types of flu.

Researchers have already tested this vaccine in mice and it protected them from a lethal dose of flu. If further tests in animals have success, human studies will soon follow.

Indoor plants: Put ‘em to work

Indoor plants: Put ‘em to work

Household HVAC (heating and air conditioning) systems use filters that are good for removing particles such as dust, mold and pollen, but have no benefit for removing volatile pollutants.

There are chemical filters that are produced, but they are extremely expensive and beyond the budget of most private households. Such filters typically are used for special clean-room research or in NASA’s space vehicles.

Indoor plants offer a viable alternative to man-made filters. The most common indoor pollutants that can cause respiratory harm are formaldehyde, benzene and trichloroethylene.

The most common sources of formaldehyde are carpeting, particle board, new clothing, foam insulation, plywood and some household cleaners.

Sources of benzene are tobacco smoke, gasoline, synthetic film, plastics, inks, dyes, some detergents and resins. Sources of trichloroethylene are dry cleaning, inks, paints, varnishes, lacquers and adhesives.

Certain plants are more effective at removing one chemical than another. The plants that work best for formaldehyde are spider plant, ivy, aloe vera, Boston fern, ficus and schefflera. The best plants for benzene are ivy, peace lily, peperonia, daisy and chrysanthemum. The best plants for trichloroethylene are arrowhead, dracaena, ivy, mother-in-law’s tongue and parlor palm.

As you may have noted, ivy plant leaves do have the broadest spectrum of chemical absorption.

Keep in mind that plants cannot only remove harmful chemicals, but they also add oxygen to the air.

Even in food families: we get along with some relatives better than others

Even in food families: we get along with some relatives better than others

Food families have similar proteins and this can lead to cross-reactive allergy. That having been said, not all families have the same degree of cross-reactivity.

Peanut allergy is often severe but, luckily, has one of the lowest levels of cross-reactivity with other legumes. There is only a 5 percent risk of cross-reactivity for peanut with beans, peas and soybeans.

Cow-milk allergy is the highest (at 90 percent), with other mammals and milks from sheep and goat. Yet, people with cow-milk allergy almost never react to mare’s milk, donkey’s milk or dolphin’s milk.

Shellfish cross-reactivity is high at 75 percent. Thus if an individual is allergic to shrimp, he or she has a three in four chance of also being allergic to lobster, crabs or crawfish. This high degree of cross-reactivity is not true for non-crustacean shellfish such as clams and oysters.

Fish cross-reactivity is roughly 50 percent.

Tree nut allergy is about 35 percent cross-reactive across the board. However, certain nuts seem more closely linked. Pistachio is very similar to cashew, walnut to pecan and almond to hazelnut. Nut allergy does not translate to seed allergy such as sesame seed, but sesame, poppy and sunflower tend to be cross-reactive with one another.

On a practical level, if an individual with a specific food allergy has already tolerated other foods in the same family, that person should continue to be safe in eating these family-related foods. Still, foods in the same family that have not yet been tried should be considered suspect, and the individual may want to undergo allergy testing to determine the safety of the particular food.

Add one to the OK list for coffee and tea drinkers

Add one to the OK list for coffee and tea drinkers

 Coffee and tea have long been known to have antimicrobial benefit. Because of this knowledge, researchers at the Medical University of South Carolina decided to study whether drinking these beverages impacted the carrier rate of methicillin-resistant Staphylococcus aureus, the multi-drug-resistant staph infection known as MRSA.

An estimated 3-million Americans are carriers of MRSA. This represents almost two percent of the population. By monitoring nasal swab cultures, the university scientists were able to demonstrate a 50 percent reduction in carrier state of MRSA in individuals who drink coffee and or tea. No reduction in carrier state was seen in people who drink sodas, even if they contain caffeine.

For millions of asthmatics, hopeful gene therapy studies

For millions of asthmatics, hopeful gene therapy studies

The lead article in The New England Journal of Medicine in September discussed novel research on genetic variation in asthma. More than 300-million people worldwide have asthma, and up to 20 percent of these show poor or no response to corticosteroid medication, which is usually their main controller medicine.

Researchers at Harvard speculated this lack of response to corticosteroid medicines might be genetically linked and they sought to find the gene.

By screening 530,000 single-nucleotide polymorphisms (SNPs – pronounced snips) in a large group of asthmatics they discovered one SNP called rs37973 that showed up in the non-steroid responders. Furthermore, they discovered that rs37973 decreases the effectiveness of gene GLCCI-1, which is the gene that controls response to steroids.

Their hope is that new therapies will soon be discovered that “up-regulate” (turn on) the depressed GLCCI-1 gene.