A recent article in The New England Journal of Medicine points out that the human GI tract contains up to 10-million different microbial species. This review of the human intestinal microbiome found bacteria, fungi (yeast), viruses, archaea (specialized bacteria with a resistant cell wall) and algae. More than a billion years of co-evolution of mammals and their gut flora has led to a complex interdependency of the mammal and the microbes, and the microbes with one another. Humans today are dependent on their gut flora for important biologic functions including: development of normal immunity, protection against pathogens, elimination of various toxins, regulation of intestinal function, neurologic signaling, bone-density maintenance, synthesis of essential vitamins and neurotransmitters, plus providing 10% of our daily energy requirements. Studies of abnormal gut flora in humans and mouse models have shown a correlation with a variety of Alist serious health issues: cancer, diabetes, asthma, atherosclerosis and autism. The studies also cited improvement through use of specific probiotics. Two bacteria with long names (Christensenellaceae and methanogenic orchaea) are found in lean people with healthy metabolism, but are absent in obese persons with Type II diabetes and insulin resistance. In a study of genetically predisposed infants for Type I diabetes, the introduction of probiotics in their first month of life reduced their risk of developing diabetes by 60%. In studies of people with atherosclerosis, they were found to have a gut flora that broke down the protein in their diet to a chemical that speeds up plaque deposits in arteries. Research in children of asthmatic parents found that early introduction of probiotics in infancy reduced the risk for developing childhood asthma by 30%. In a mouse model of autism it was found that abnormal gut flora led to an increased production of 4ethylphenylsulfate (4EPS). Improving gut flora with a countering bacteria reduced the 4EPS by 50% and led to a marked improvement in the mouse behavior. Finally, in human cancer studies it was found that taking a probiotic with bifidobacterium improved the response to chemotherapy for melanoma. Also, the probiotic Lactobacillus casei was shown to inhibit progression of colon cancer.
Having elevated levels of the heavy metals lead and cadmium does result in an increased incidence of asthma, as demonstrated in recently published research from Brown University.
Elevated lead levels can be seen in children living in homes with old-fashioned lead paint, and in adults with workplace-exposure to lead fumes.
Elevated cadmium levels are typically only seen due to industrial workplace exposure.
The heavy metals cause a shift in TH1/TH1 response, thus leading to much greater production of IgE, the allergic antibody that causes asthma.
The next phase of the research at Brown University if to see if reduction in the heave metals in the blood stream leads to amelioration of the asthma.
Dermatology researchers at the University of Oregon recently published two Phase 3 trials of Dupilumab in eczema. Phase 3 trials are the ones that can lead to FDA approval of a new drug. These trials were very successful.
Dupilumab is a human monoclonal antibody against interleukin-4 receptor alpha. Interleukin-4 is a cytokine (inflammatory molecule) that is an important cause of allergic eczema. The studies were done on 1,500 patients with moderate-to-severe eczema that was not responding to topical medications. In one of the trials, patients received injections of Dupilumab weekly, and in the other trial the injections were every two weeks. Both groups showed more than a 75% improvement in their rash compared to placebo. Not only did the rash improve, but there also was great reduction in itching and anxiety/ depression. Finally, quality of life assessments showed marked improvement. In people with moderate-to severe eczema skin rash can cover large parts of the body’s surface. This rash is accompanied by intense, persistent itching which leads to sleep deprivation and symptoms of anxiety and depression. For many people with this measure of eczema, topical therapies just don’t work. The available systemic treatments are often associated with significant toxicity or side effects. Hence, there is a great need for a safe and effective long-term therapy. Dupilumab seems to fit this need. The two main side effects were injection site swelling (8 to 19%) and conjunctivitis (2 to 5%).
Dear Dr. K: My friend and I, who have both been on allergy shots for four years, went off them. My friend remains allergy-free, but my allergies are coming back again. What gives? That is a simple question to ask, but a more difficult one to answer. Let’s start with how allergy shots work. Actually, we should call them allergy vaccines because all vaccines lead to the production of protective antibodies (called IgG). For example: in the case of tetanus vaccine, it leads to antitetanus antibodies. Similarly, an allergy vaccine against ragweed leads to protective IgG antibodies against ragweed. These IgG antibodies interfere with the allergic antibody (IgE) from interacting with ragweed and hence, prevent the allergy symptoms. The longer a person receives an allergy vaccine, the greater the level of protective antibodies. Everyone who receives allergy shots experiences this response. A second benefit of allergy shots is to gradually turn off IgE production. Unfortunately, this doesn’t happen in everyone. It’s the diminution of IgE that leads to long-term remission from the allergies. Your friend undoubtedly has had this benefit. A few other issues are worth mentioning. People living in southern climes tend to need allergy shots longer than their northern neighbors. The absence of winter freezes leads to higher levels of both indoor and outdoor allergens year-round. Outdoors is obviously more challenging as there is a year-round growing season. Indoors, both mold and dust mites persist through the winter. This is because of persistent indoor humidity. Up north, the months of dry heating kills indoor mold and dust mites. Finally, there is the issue of animal allergy. People with dog and cat allergy tend to need these allergy shots for a longer period — especially for cat allergy.
which leads to sleep deprivation and symptoms of anxiety and depression. For many people with this measure of eczema, topical therapies just don’t work. The available systemic treatments are often associated with significant toxicity or side effects. Hence, there is a great need for a safe and effective long-term therapy. Dupilumab seems to fit this need. The two main side effects were injection site swelling (8 to 19%) and conjunctivitis (2 to 5%).