Research emanating from Sydney, Australia reports the use of a form of Vitamin B3 (Niacin) to prevent skin cancers. With the pharmacy name Nicotinamide, it is the “amide” form of the vitamin and as such, doesn’t cause the unpleasant side effects of niacin. These include flushing, itching, headache and changes in blood pressure.
Nicotinamide has been used for its anti-inflammatory properties in some other types of skin conditions such as eczema and pemphigus. It seems to work in preventing skin cancers and pre-cancers because it is an essential co-factor for producing adenosine triphosphate (ATP). Ultra-violet radiation depletes ATP in the skin, which is essential for repairing sun-damaged DNA. If DNA is not repaired, the cells go astray and become cancerous.
Patients in the Australian study had a 23-to-30 percent reduction of skin cancers as compared to the placebo group. Also, there was a 20 percent reduction in actinic keratosis (pre-skin cancer lesions) in the Nicotinamide group as compared to the placebo group.
EoE is the acronym for eosinophilic esophagitis. Once thought to be an uncommon condition, it is now recognized as one of the most common reasons for feeding problems in infants and for dysphagia (difficulty swallowing) and food impaction in adults.
Until the early 1990s EoE was lumped in with the GERD diagnosis (gastroesophageal reflux disease). But in the ‘90s researchers started to recognize that EoE was a different critter. The clinical symptoms were different from classic GERD, and the patients tend not to respond to acid suppression therapy, or anti-reflux surgery.
In children EoE causes feeding problems, vomiting and abdominal pain. In adolescents and adults it causes discomfort with swallowing and food impaction episodes. The reason for these symptoms is inflammation in the esophagus caused by the presence of the white blood cell – eosinophil (as opposed to acid-related inflammation in GERD).
The eosinophil can be seen on biopsies taken from the esophagus during upper endoscopy. It is believed the eosinophils infiltrate the esophagus in response to either or both allergens and altered microbiome. The allergens can be either food allergies or airborne. It may sound weird, but part of the self-cleaning process of our sinuses is to filter allergens, wrap them in mucus and then send them out of the body via swallowing them. As these aero allergens pass through the esophagus they can elicit the eosinophil response.
Treatment consists of two main approaches. First is to identify and then avoid food and airborne allergens. Second is topical corticosteroids. These can be administered either by swallowing the spray from a steroid asthma inhaler, or by viscous preparation of a liquid asthma steroidal normally used in a nebulizer.
Dear Dr. K: What can you tell me about the new asthma drug, Nucala?
It is just newly released by the FDA, seems very promising; unfortunately, it is not for you.
Because I’ve helped you with your asthma for several years, I am aware that you don’t have eosinophilic asthma, and thus, would not be a candidate for this new drug.
Nucala’s pharmacologic name is mepolizumab is a monoclonal antibody whose target is interleukin–5 (IL\-5). It is delivered in a subcutaneous injection that is given once a month in a doctor’s office. It is designed for severe asthmatics aged 12 years or older, who have the eosinophilic type of asthma.
IL-5 is the main cytokine responsible for growth, recruitment, activation and survival of eosinophils – one form of white blood cell that causes airway inflammation in a large number of asthmatics. By inhibiting IL-5, you prevent the eosinophils from getting into the lungs to create their mischief.
One criterion for being a candidate for Nucala is having a blood eosinophil count of 300 cells/mcl.
The drug trials revealed excellent improvement in target patients who received the drug, including better control of their asthma with fewer exacerbations. Also, a large percentage of asthmatics on oral steroids were able to reduce their steroid dose or go off oral steroids while receiving Nucala.
Several patients on Nucala had shingles during the trial, so a shingles vaccine is recommended prior to starting treatment.
Asthma worse? Being female and a list of other factors might be the cause — based on Columbia University’s recently published data on research about women and asthma. They found that a number of factors led to greater difficulty with asthma including: hormones, obesity, stress, depression and PTSD (Post Traumatic Stress Disorder).
The researchers note that hormone levels (especially estrogen) impact the Th-2/ Th-1 balance that has been previously discussed in this newsletter. High estrogen leads to Th-2 predominance, which promotes allergy. Increased estrogen can come from the normal wax and wane of the menstrual cycle, pregnancy, hormone replacement or oral contraceptives.
Obesity is also pro-inflammatory via the Th-2 mechanism. Columbia found that as little as a 15pound weight loss by obese women asthmatics resulted in 20 percent improvement in their asthma.
The issue of stress and depression is a double bind. In general, women experience depression more frequently than men. The asthmatic condition itself can cause life stress and depression, but the opposite is also true: stress and depression cause worsening of asthma. The Columbia group found that upwards of 15 percent of women with poorly controlled asthma had unresolved issues from childhood sexual trauma. They consider this a form of PTSD.
Interestingly, they found strong correlation of PTSD and worsening asthma in military women who had service-related traumas. Stress, depression and PTSD all lead to a number of stress hormone changes by way of the adrenal glands, along with production of inflammatory molecules such as interleukins, substance-P, and natural killer-cell function.
African-American women seemed more prone to depression and PTSD than their Caucasian, Asian and Hispanic sisters. In yet another fallout from racial discrimination, Columbia found a strong correlation between African-American asthmatics who had experienced significant racial bias versus women who had not, in terms of severity of asthma and frequency of exacerbation.
The researchers’ take-home message is that both patients and doctors should be aware of the interplay and dynamic force of stress/depression and asthma.
The Journal of Allergy and Asthma Proceedings contained a study survey of more than 6,000 schools and the occurrence of anaphylaxis. The numbers reflect how frequently this scary condition threatens lives, and which forms of treatment were most effective.
There were 919 reported events over a one-year period. Ninety percent of the events were in students and 10 percent were in teachers and/or staff.
Sixty percent of the events were due to food allergy; twenty percent to an unknown cause; ten percent were due to insect stings.
Seven percent were caused by a drug allergy or environmental exposure and 2 percent were caused by latex allergy. Eighty percent of the cases were treated with injected epinephrine. Twenty percent were treated with antihistamines and of these, most were transferred to an emergency room. There were no deaths reported in the study.
The study’s researchers editorialized that it makes good sense that all school offices have adrenalin injections available, such as epinephrine pens. This strengthens a law signed by President Barack Obama two years ago (The School Access to Emergency Epinephrine Act) to encourage schools to prepare for these emergencies.