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Month: January 2015

Perhaps shared therapies can ease double suffering

Perhaps shared therapies can ease double suffering

What’s known as the Asthma-COPD overlap syndrome was reviewed recently in the Allergy and Asthma Proceedings.

The authors adroitly point out that even though physicians try to pigeon-hole diagnoses, many times people’s health problems don’t fit neatly into a single diagnostic category. This is especially true in the spectrum of chronic airway disorders.

More and more people are being seen by physicians who have both asthma and COPD. The conditions are both similar and different.

In general, asthma (also called reversible airways disease — RADS) is completely reversible with therapies, while COPD (chronic obstructive pulmonary disease) is never (by definition) completely reversible; hence, the adjective “chronic.”

Both conditions are caused by inflammation in the airways. In asthma, the inflammatory cell is the eosinophil, while in COPD it is the neutrophil.

Both conditions tend to have genetic links. In asthma it is the genes that cause allergy. In COPD it is the genes that control alpha-1-antitrypsin (an enzyme that protects the lungs from oxidative stresses).

In general, asthma tends to have onset in childhood, whereas COPD occurs in adults.

Asthma is caused primarily by allergy to inhaled pollens, molds, danders and dust mites. COPD is caused primarily by cigarette smoke and biomass pollutants.

Finally, diffusion capacity is normal or high in asthma, but always reduced in COPD. Diffusion capacity is a measurement of the transfer of oxygen from the lungs into the blood stream.

The most important take-home message is that therapies that were previously used exclusively for one diagnosis may work in both because of the overlap. For instance, inhaled steroids which are a mainstay in the treatment of asthma often benefit patients with COPD.

Also, anticholinergics such as Atrovent, Combivent and Spiriva – originally designed exclusively for COPD – may also benefit people with the overlap syndrome. The bottom line is for patients and physicians to be aware of the overlap, and to look for therapies that are individually stylized to a given person’s need.

Dear Doc: Will oral doses replace allergy shots?

Dear Doc: Will oral doses replace allergy shots?

Dear Dr. K:

I’ve read about the newly available oral drops for allergy. Could that replace my current allergy shot?

A quick answer for you is “no;” a longer answer to your question is “perhaps in the future.”

The reason I say “no” is that your current allergy shot contains extracts for nine different grasses, including, Bahia; seven different molds, ragweed and three other Florida weeds; plus seven different trees, including oak.

Right now drop therapy is only available for single allergens and these are extremely limited in their spectrum. For instance, the only serum for grass is for Timothy grass. We have Timothy grass in Florida, but it is a minor contributor to our grass pollen burden, as opposed to the Bahia Grass family and Bermuda grass. The only weed extract available is for short ragweed, one type we have in Florida. More prominent, however, are the giant and southern ragweed plants. And so it goes . . .

It has been known for more than 100 years that allergy immunotherapy works best when all the relevant allergens are addressed.

Another issue is cost. At present, the oral therapy is quite expensive and is not being covered by insurance companies. Part of the reason for the expense is that drug therapy must be done daily requiring a lot of allergy serum.

Finally, like any new modality “the bugs need to be worked out.” One “bug” is that up to 50 percent of people taking oral treatments have unpleasant side effects of mouth and tongue itching, along with stomach upset. These side effects are occurring with just one allergen in the serum so when multiple allergens are available, these problems could become greater nuisances.

Technology always seems to improve current standards, so I have no doubt oral therapy will eventually join allergy shot therapy and perhaps replace it, but there is a long way to go.

GI Tract – gut flora’s humble abode

GI Tract – gut flora’s humble abode


A recent review article in the Journal of Allergy and Clinical Immunology addressed the role of gut microbiota in health and illness.

The author pointed out that the GI tract serves two main functions: 1. Digestion and absorption of foods and nutrients; 2. Immune function. He also pointed out that these don’t operate independently, but rather, are fully intertwined.

The GI tract is the home for the majority of our immune system cells and proteins. This is so because the GI tract is home to billions of microbes that require immune surveillance. Disruptions in these microbes can impact both digestion and immune function.

One example is celiac disease. It is an inherited condition caused by autoimmunity directed against gluten. New research is finding that despite the inherited tendency, many individuals won’t develop the disease if their gut bacteria are normal.

On the other hand, the more disrupted the gut flora, the more likely that the immune system will cause the inflammation that leads to the disease. Sadly, once the disease starts, it leads to greater alteration in the gut flora, which in turn leads to more inflammation – a bad synergism.

Another example is obesity and metabolic syndrome (insulin resistance and high lipids). Two broad observations are relevant: 1. Children who receive multiple courses of antibiotics are more likely to become obese than children who don’t (antibiotics alter gut flora.) 2. Societies whose cows, beef, chickens and pigs receive antibiotics with their food are also more likely to become obese than those who don’t.

In a similar vein, gastric bypass surgery is more effective at both weight loss and improvement in metabolic syndrome than is lap-band surgery. The former leads to a positive improvement in gut flora not seen with lap-banding.

Even more interesting is the fact that in gastric bypass, patients the metabolic syndrome improves even before there is any noticeable weight loss. The bad gut bacteria breakdown fats into more easy-to-absorb particles, hence greater weight gain and higher cholesterol levels.

Finally, in mice experiments: Transfer of healthy gut bacteria from lean mice to obese mice leads to weight reduction in the latter without reduction in caloric content.  

Q – Tips: Exercise as important as medication

Q – Tips: Exercise as important as medication

  • An editorial in the American Journal of Medicine was titled “Exercise is Just as Important as Your Medication.”

The article was very detailed in extolling the numerous health benefits of exercise, but one comment struck me most of all: The editorialist pointed out that unfortunately, physicians or patients themselves set too high a benchmark for the activities. He recommended an approach that was moderate in nature and stylized for each person’s health constraints and abilities.

Q – Tips: broccoli

Q – Tips: broccoli

  • Broccoli is a natural source of glucoraphanin, a compound that generates sulforaphone. The latter is an excellent mechanism to remove and detoxify air pollution that we breathe into our bodies. Hence it has been shown to reduce cancer risk, especially in heavily polluted industrial environments.
Possible summertime peril: Be aware

Possible summertime peril: Be aware

Bathing in warm sulfur spring water has been practiced for centuries for its potential health benefits, but a newly recognized cause for a sudden skin rash is exposure to this water. Unfortunately, it can cause a severe rash in some susceptible individuals.

This is especially true in allergic people who may tend to have dry skin or eczema.

Typically the rash appears suddenly about 24 hours after the water exposure. The rash is red with “punched out” ulcers and pits. The rash is caused by the acidic nature of the hydrogen sulfide, sulfate and sulfur that are in the water.

Many of the aquifers here in Florida are rich in these natural sulfur compounds.