We have launched our new Mobile Check In app. You may download it by clicking the download on the right side of this page, or by scanning the QR Code in the office. You can check in from the parking lot. If you are going to be waiting for your shot in the car just click the box that says “yes, in car” and in the comment section please add the color and make of your car.
Of course, you can still check in from the IPad in the lobby.
The Journal of Allergy and Clinical Immunology recently published research on an experimental H4-antihistamine investigated at the University of Hanover. The research is part of a global effort to find more effective therapies for atopic dermatitis (eczema). The prevalence of atopic dermatitis has doubled in the past 30 years with occurrence in between 15% to 30% of children and 2% to 10% of adults. It is characterized by chronic relapsing itching of the skin which develops bumps and scaling, and can weep fluid in its severe form. The itch is very problematic often disrupting life activities and sleep.
Current therapies include improving skin barrier function through moisturizers and wet wraps, dilute bleach baths to reduce skin bacteria overgrowth, topical and systemic steroids, topical calcineurin inhibitors, topical phosphodiesterase inhibitor, phototherapy, and for very severe cases injectable monoclonal antibodies. To date, the available antihistamines have proven to be of very modest value. The traditional antihistamines block either H1: Benadryl, Claritin, Allegra, Zyrtec, Xyzal or H2: Zantac, Pepcid, Tagamet, and Axid. These are of modest benefit because the skin cells have only a small number of H1 and H2 receptors. But as it turns out, there are many H4 receptors on skin cells, hence research to find an effective and safe H4 antihistamine.
The drug ZPL-3893787 just might fit the bill. Recently developed by German scientists it proved to be extremely effective in a large-scale clinical trial. It led to a very remarkable lessening of itch but also to healing of the skin. The H4 receptors in the skin mediate both pruritis and inflammation. By blocking the H4 receptor “ZPL” seems to both stop the itch and heal the skin. If further studies give similar results it will prove to be a “God-send” for atopic dermatitis patients.
All three of my children have food allergies. My two daughters have minor symptoms but my son has eosinophilic esophagitis and has had to have his esophagus dilated twice. Why the difference?
The short and sweet answer is gender. First off, all food allergy is quite common, affecting up to 15% of Americans at some time during their lives. The resultant symptoms can vary from trivial to life threatening anaphylaxis (such as severe peanut allergy). Also, the “target organ” of the food allergy can vary from the skin, to the sinuses, to the lungs, to the GI tract. Eosinophil esophagitis (EOE) tends to be one of the more troublesome manifestations. The allergy leads to inflammation in the esophagus causing heart burn, reflux, and sometimes strictures, with resultant sticking of food. If mild the lodged food can be vomited out, but sometimes it has to be removed via endoscopy.
As it turns out, EOE is four times more common in males than in females. It also tends to be more severe in males than in females with more frequent development of strictures. The gender difference turns out to be due to a protective effect of estrogen, specifically 17-Beta-Estradiol. Estrogen can affect physiologic processes beyond reproductive function by its effect on the immune system. Estrogen receptors have been found on T and B lymphocytes, other white blood cells and on natural killer cells, all of which can mediate allergic inflammation. By downregulating the inflammatory response, estrogen protects the esophagus from the severe inflammation that can occur in males.
Researchers at the University of Michigan and the University of Cincinnati have recently found estrogen receptors in esophageal tissue of both sexes. Based on these findings they plan to investigate the plausibility of using a dilute estrogen solution to swallow as part of a healing therapy. They hope
that very dilute concentrations would work in males, but not adversely affect their hormonal balance.
A recent article in the Journal of Allergy and Clinical Immunology discussed current research into why asthma patients cough.
The answer, as it seems to be to many complex questions, is multifactorial. The human brain is the source of a myriad of protective reflexes from blinking to coughing. Protecting the airway compels a complex and delicate neural network. Think about the high degree of neurologic coordination required for swallowing without aspirating, even though the esophagus and trachea lie against one another. There is no question that asthmatics have a more delicate (“hair trigger”) cough reflex. What makes their cough-nerves more sensitive?
It seems to be a function of both structural issues and functional issues. The main structural issue is airway narrowing, which is why asthmatics wheeze and have shortness of breath. The narrowing of the airway “tugs” on the cough-nerves and by stretching them makes them more sensitive. One example of this heightened sensitivity is coughing due to laughing. When we laugh, we move a greater volume of air in and out of our lungs and this in turn leads to very slight cooling of the airway. This slight cooling is perceived as an airway threat and hence the coughing.
The functional issue is inflammation. You can think of this as “burning” the cough-nerve fibers. Because protecting our airway is so important the cough-nerve fibers are unmyelinated; that is, they don’t have the protective myelin coating that most nerves in the human body have. This makes them very vulnerable just as a bare copper wire would more easily spark.
Treating the cough of asthma boils down to expanding the narrowed airways and reducing inflammation.
By: Sasha Klemawesch, MD
Do you get misty-eyed every time you’re standing in RayJay, waiting for kickoff, listening to the National Anthem? Or do other drivers give you the side-eye when they catch you singing R-e-S-p-E-c-T into your air mic while sitting at a red light? No matter what genre you prefer, everyone has been moved by music at some point.
Cultures throughout history have recognized and made use of this, specifically, sound’s healing power. For example, aboriginal healers used the low frequency tones of the Yidaki instrument during their treatment of sick tribal members. Ancient Egyptians believed vowels to have held sacred power, so priests chanted them for healing prayers. Priestesses meanwhile played Ras (rattles) and harps during therapeutic rituals, both of them typically doing so in reverberant chambers which augmented the ultrasonic vibrations they were creating.
This latter phenomenon is the basis for modern science’s foray into sound therapy. Vibroacoustic treatment as we know it today started in Scandinavia in the 70’s; where early reports cited reduction in muscle tension, pain and anxiety after exposure. Since then, there have been a variety of research studies done in the area of sound and music therapy, including (more recently):
- Just 2 weeks of vibroacoustic treatment using classical music, done 30 min a day for 5 days a week, led to statistically significant reduction in depression among nursing home residents.
- NIH observed a group of patients with issues ranging from cancer to cardiovascular and infectious diseases to mood disorders, who underwent vibroacoustic sound treatment, and found a 53% “cumulative reduction in pain and symptoms” including tension, nausea, and fatigue.
- Yet another study found that vibroacoustic therapy helped decrease maladaptive behaviors and acting-out among children on the Autism spectrum.
One of the theories behind its effectiveness is the idea that our bodies are constantly using energy (at the cellular level seen as persistent micro-vibrations), and injury, stress or other sicknesses sap the speed and intensity of these micro-vibrations, further compounding fatigue, immunologic dysfunction, and overall chronic illness. It may seem a little new-agey to those with more western allopathic mindsets, but the goal of vibroacoustic therapy is to replenish this cellular energy and “get us vibrating at the optimal frequency”. And when you add music to the equation you are accessing a whole additional set of benefits with how much music affects the brain. Now the eastern vs western, alternative vs allopathic medicine debate is for another time, but it’s hard to argue with the results to date in the vibroacoustic therapy arena. In fact, you could say, it’s a pretty sound option for treatment!