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Month: December 2014

Allergy ties to additives studied

Allergy ties to additives studied

The University of Maryland recently published data about increased incidence of allergy in children correlating with the amount of residues of triclosan and paraben found in their urine.

Triclosan is a chemical that has been added to many personal care and medical products, including soap and toothpaste. It is added for its antimicrobial properties. Paraben is added to food, pharmaceuticals and personal care products, also for its antimicrobial properties.

Both have been previously shown to have immune-modulating properties (in addition to their antimicrobial property). In this particular study there was a strong relationship between urinary levels of these chemicals and the development of a variety of allergies: asthma, eczema and food allergy.

The unstated — but implied – recommendation is to limit childhood exposure to these chemicals

Promising asthma drug in pipeline

Promising asthma drug in pipeline

A research study of a new drug given to steroid-dependent asthmatics has produced exciting results.

Reported in a recent article in The New England Journal of Medicine, the new asthma drug, Mepolizamab, was tested at various medical centers around the globe, including the University of Pittsburgh.

Mepolizamab is a humanized monoclonal antibody that inactivates interleukin– 5. Interleukin– 5 is a cell communicator that recruits eosinophils (allergic cells) into the lungs.

The eosinophil is a form of white blood cell that causes airway inflammation — asthma’s hallmark.

The remarkable outcome of this study revealed the participants enjoying a marked reduction or cessation of steroid medication, while having improvement in their asthma, along with fewer flare-ups.

The drug was administered by injection once a month and was relatively free of side effects. The main ones were headache and sore throat.

The drug has not finished all its clinical trials for FDA approval, but it should soon. For now the only other monoclonal asthma therapy is Xolair, which binds to the allergic antibody IgE.

Dear Doc: Explain sprue/celiac disease immune reactions

Dear Doc: Explain sprue/celiac disease immune reactions

Dear Dr. K: My gastroenterologist said that my blood pressure pill, Benicar, caused me to develop sprue. Can this be true?

To answer your question in a broad sense: “Yes;” but in a strict sense, “No.”

To better understand this yes/no scenario a few definitions would be helpful.

Sprue (also known as celiac disease) is a form of GI upset with diarrhea caused by an immune reaction to gluten. The immune reaction leads to inflammation in the intestinal wall, with resultant atrophy of the villi.

The villi are critical for properly digesting food (due to enzymes found on the villi), and for properly absorbing food (due to increasing absorptive surface area).

Benicar (Olmesartan) is one of a family of anti-hypertensives known as angiotensin receptor blockers. It has been implicated in a number of cases of chronic diarrhea, with biopsies that show villous atrophy.

However, unlike in sprue, there is no inflammation and also unlike in sprue, the illness does not improve with avoiding gluten. It does however, improve with going off the Benicar which allows the villi to regrow.

The Mayo Clinic has had a keen interest in this issue, and has even found some patients on Benicar with mild villous atrophy, but no symptoms.

What is reassuring about this research is that treatable conditions are being discovered for a large group of individuals previously labeled with “IBS” (Irritable bowel syndrome). The term syndrome means no known cause, but does not imply a cause can’t be found.

Even tiny whiff enough to trigger allergic reaction

Even tiny whiff enough to trigger allergic reaction

A review of food reactions in children from inhalation was recently published in an issue of Allergy and Asthma Proceedings.

As an introduction, the authors remind readers we are able to smell foods because of tiny aerosolized particles of food. In some children, even this tiny amount of exposure can lead to allergic symptoms.

The foods most commonly implicated in this mischief are: fish, nuts, legumes, grains and cow milk.

Up to 10 percent of children allergic to fish will have some type of allergic response to seafood odors or fumes. Typically, this is eye itching, sneezing or wheezing.

Of interest, shellfish were much less likely to cause inhalation problems than “swimming” fish.

The incidence of airborne nut allergy was smaller with three percent of children with tree nut allergy reacting to the smell, and one percent of peanut-allergic children reacting. (Even though peanut is a legume, it was studied in the nut category because there are so many children with peanut allergy.)

Again, common symptoms seen were eye itch, sneezing and wheezing. But some children suffer hives and even anaphylaxis from nut odor inhalation.

The most common legumes to cause inhalation allergy are soy, chick peas, peanut-like lupines and green beans. The spectrum of symptoms: eye itch, sneezing and wheezing, but also intense itching in the mouth and throat in some children.

The cereal grains most likely to cause problems are rice, buckwheat and wheat. Buckwheat is more common a cause than expected because many children have ongoing exposure from buckwheat chaff being used in stuffed animals.

And while cow milk is a common cause for inhalation allergy, some children are sensitized from powdered formulas being mixed in their presence.

Also, as mentioned in a previous newsletter, some asthma inhalers contain small amounts of milk protein as a stabilizer.

Many ways for mold to catch hold

Many ways for mold to catch hold

The Tampa Bay Times recently featured an article detailing the closure of a city building due to mold contamination. The Madeira Beach building was more than 60 years old and had been flooded several times over the years.

The message here is that any Florida building can have unhealthy mold issues.

The most common causes are water incursion, and heating and cooling system (HVAC) issues. Water incursion can be due to flooding, broken pipes and roof leaks. HVAC issues include leaks in the air handler/duct system and compressor/air handler mismatch. The latter situation occurs when the BTU capacity of the compressor is too high for the system. This leads to rapid cooling of the air before it can be adequately dehumidified, with resulting moist, cool air leading to mold growth in the system.

One good resource to investigate possible indoor mold issues is via the environmental specialist at the Pinellas County Health Department.

Q-Tips: Streptomycin Allergy

Q-Tips: Streptomycin Allergy

  • The recent Annals of Allergy published an article about a 10-year-old girl who suffered anaphylaxis from antibiotic residue on blueberries. The child was not known to be allergic to blueberries and later tests proved this fact. The blueberry orchard was treated with streptomycin and the child did show a positive allergy test to this antibiotic.
Q-Tips: Beta Blockers

Q-Tips: Beta Blockers

  • The family of drugs known as beta-blockers have long been known to be potential aggravators of allergy, Now, new recent research (published in Cutis), shows that beta-blockers can lead, in some people, to the development of psoriasis.