Allergy-Associates

Dermatoporosis is a newly minted word to describe the age-related decline of our largest organ: our skin. We have similar terms for other organs: congestive heart failure, COPD, macular degeneration and osteoporosis.  

The value of a new term is that it directs patient/physician attention to the problem and ways to improve it. Other than advancing age, other risk factors include solar damage, topical or systemic steroids, renal disease, COPD, anticoagulant use and lack of exercise. A common (physiologic) denominator to all these risk factors is loss of extra cellular matrix (ECM). The ECM is the vital scaffolding that supports and nourishes our skin cells and is comprised of an interwoven network of collagen and elastin fibers. The principal constituent of ECM is hyaluronic acid, which is produced by a cellular organelle, the hyaluronosome. A depleted ECM leads to skin thinning and skin fragility which in turn lead to the purpura (flat bruises) and skin tears that occur.  

Dermatoporosis can be prevented or improved by some simple measures. Using sunscreen or solar clothing reduce UV damage. Topical retinoids help thicken the skin and improve resilience Emollients with alpha-hydroxy acid also increase skin thickness. In women topical DHEA (dehydroepiandrosterone) is of significant value. Finally, ensuring adequate dietary protein intake helps. 

The novel technology that allowed the development of the covid vaccines is now finding new applications. 

Messenger RNA (mRNA) works in concert with DNA in almost all living organisms. With its single strand it carries genetic information from double stranded DNA to the ribosomes where new proteins are synthesized with the information coded in the RNA. This mechanism has been co-opted to produce vaccines. In the case of COVID vaccines, a small amount of the spike in protein from the corona virus in templated on the RNA which then instructs the ribosomes to produce this protein. Since it is a foreign protein, the immune system recognized it foreign nature and automatically makes antibodies to destroy it. Thus, providing vaccine protection.  

Now research is using this template to create a vaccine for metastatic pancreatic cancer. Researchers at Sloan Kettering use individual patient cancer cell and use the mutant cancer protein to generate mRNA sequences for these “red flags” which alerts the immune system to destroy them. Similar technologies are being used in metastatic melanoma and colon cancer. 

• UVA (wavelength 320-400 nm) accounts for 95% of terrestrial radiation 

• UVB (wavelength 290 – 320 nm) accounts for the other 5% 

• Both cause photoaging, hyperpigmentation and skin cancer 

• UVB causes sun burn 

• UVB is strongest midday and in the warm months 

• UVA is relatively constant day round and year-round. 

• UVA is not filtered out by glass, but UVB is 

• SPF (sun protection factor) is the ratio of the amount of UV light required to cause sunburn on sunscreen protected skin to the amount required on unprotected skin 

• SPF protection is based on a 2mg/cm² thickness of application. Most consumers only apply .5 mg/cm² (a thinner layer) and therefore don’t receive the desired protection 

• Blocking agents are either organic (octinoxate, homosalate, octisalate, oxybenzone, avobenzone, ecamsule, ensulfizole) or inorganic (titanium dioxide and zinc oxide)  

• Octinoxate, homosalate, octisalate, and ensulfizole only block UVB 

• Zinc oxide and titanium dioxide block both UVA and UVB but zine offers better UVA protection 

• All organic sunscreens can cause allergic contact allergy especially oxybenzone 

• Organic sunscreens are absorbed systemically, and animal studies raise estrogen and lower testosterone levels 

• Oxybenzone has been shown to impact kidney function 

• Oxybenzone and octinoxate are detrimental to sea corals 

• UPF is ultraviolet protection fact of solar clothing 

• A UPF of 30-49 provides very good protection and a UPF of 50+ excellent protection 

Should I skip exercising on the day I get my allergy shot? Aerobic exercise? Weight/resistance exercise? 

The simple answer is “No”, but you know I love to palaver, so here’s the long answer!  

First off, Americans in general do not get any or adequate exercise so I don’t want to contribute to unhealthy behavior. By the way you posed your question I suspect you might have been a girl scout and learned field expediencies for snake bite. Part of that tutelage is “lie still and especially don’t run”. The reason for that admonition is increased cardio-blood flow would circulate the venom more quickly.  

But that snake wisdom does not pertain to allergy shots. These are administered subcutaneously and not intramuscularly. Thus, using your muscles either aerobically or with weights does not impact the shot. Some people experience mild awareness that they received their shot in terms of some local itching/warmth. The adrenal release of extra cortisol and adrenaline that occurs with exercise can abrogate this.  

With respect to intramuscular shots such as pneumonia, tetanus and flu, it is still ok to exercise the recipient arm but best done in moderation for a day or two. 

OK, sorry for the acronyms but I just couldn’t resist. CRISPR stands for clustered regularly interspaces short palindromic repeats, so maybe you’ll forgive me. HANE is hereditary angioneurotic edema (commonly known as Hereditary Angioedema). The New England Journal of Medicine recently published research done at Amsterdam University using the CRISPR gene editing tool to treat/cure hereditary angioedema.  

HAE is a genetic disorder that is autosomal dominant (only requires one defective gene) that affects one in 50,000 people, but it can be a debilitating and sometimes fatal condition that requires lifelong treatment. These treatments are both preventative and crisis management in nature. The work, but they require frequent dosing to achieve control. Because of this the Amsterdam Scientists did a small study (27 patients) to see if gene editing could fix the problem. They used the CRISPR technology to edit the gene which encodes Kallikrein BI (KLKBI) the primary source of PR kallikrein. This editing resulted in a reduction in total plasma kallikrein levels which had been the cause of the angioedema attacks. The levels were reduced by 86% and 73% of the patients ended up attack free. Currently, gene editing therapy costs 3 to 4 million dollars do the cost will need to come down to make it economically viable. 

Broncho-vaxom is an extract of respiratory bacteria that is used outside the United States to treat and prevent bronchitis and sinusitis. It is a mixture of lipopolysaccharides from these bacteria: Hemophilus influenza, Streptococcus pneumoniae, Klebsiella pneumoniae, Staphylococcus aureus, Streptococcus pyogenes, Streptococcus sanguinis and Moraxella catarrhalis.  

It has been evaluated using placebo controlled blinded studies in both children and adults. In adults with COPD, it reduced the frequency of infection by 29% and in smokers/ex-smokers by 40%. In children it reduced sinus/ear/bronchial infections by 52%.  

It is an oral formulation that works via the gut-lung axis. Pathogens are detected by our immune system by pattern recognition receptors found on dendrite cells. Exposing our gut dendrite cells to the broken-down bacteria teaches them better recognition of these bacteria and this new knowledge is transferred to our respiratory membranes. It also leads to specific antibody production of IgA and IgG Directed against these bacteria. Finally, it improves cilial function (the tiny little hairs on our respiratory membranes that sweep out bacteria) and reduces air way inflammation. Another condition helped by Broncho-Vaxom is bronchiectasis, a difficult to treat form of chronic bronchitis. Finally, there is also research ongoing to use it to prevent the development of asthma in small children. Boston Children’s Hospital has a large ongoing study in this regard. 

Despite the headline, this is not an “R Rated” article, but rather a discussion of hormonal molecular physiology. Cortisol and testosterone might seem to be totally different compounds but they are actually very closely related. Cortisol’s formula is C₂₁H₃₀O₅ while that of testosterone is C₁₉H₂₈O₂, plus they share the identical five hydrocarbon ring structure. Another similarity is that they both can reduce immune function. This is one reason males are more prone to illness than females.  

Our adrenal glands primarily produce aldosterone, cortisol and adrenalin, but also small amounts of the sex hormones estrogen, progesterone and testosterone.  

Our gonads produce estrogen, progesterone and testosterone in different proportions based on our sex. It all comes down to slight modifications of the hydrocarbon ring structure that they all have in common.  

It has been known for quite some time that elevated cortisol, either exogenous (from our adrenal glands) or exogenous (from pharmaceuticals), impairs immune function.  

The higher the elevation the greater the immune suppression. What has more recently been learned is that testosterone has a similar effect even at normal levels but more so at higher levels.  

The main reason for elevation of endogenous cortisol is stress, both acute and chronic. This is one reason people frequently get sick on a trip or a vacation. Our adrenal glands make adaptive changes for even the pleasant disruptions of locale, diet, activity, sleep and wake times associated with travel. The attendant elevation of cortisol makes illness more likely. 

The immune dysregulation from cortisol and testosterone occurs in both the innate and adaptive arms of over immune function. Over innate immune system, which is the more primitive system and shared with less complex organisms, works to a large degree by pattern recognition receptors. These receptors are suppressed by cortisol and testosterone. The adaptive arm of over immune function relies on its ability to proliferate the formation/function of both T-cells and B-cells. This ability is suppressed by cortisol and testosterone. Moreover, they also promote lymphocyte apoptosis (cellular suicide).