Damned if you do, Damned if you don’t 

Damned if you do, Damned if you don’t 

By; Sasha Klemawesch, MD  Here’s a doozy of a “Would-You-Rather”: Would you prefer continuing to deal with chronic unremitting knee pain, or would you rather have several days of unrelenting hiccups?  Those may seem totally unrelated, but actually, a little known (though not altogether uncommon) side effect of steroid injections is intractable hiccupping!  This was news to me too, but one of my colleague’s fell victim to it recently and was absolutely miserable for days. His knee was great! To…

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Dear Dr. K; 

Dear Dr. K; 

I heard on the news that there is a new nasal EpiPen, can it really work for anaphylaxis?  The short, simple and sweet answer is “yes”.  But if you’ve read this newsletter previously you know how I like to elaborate on simple answers.     The FDA did recently approve “Neffy” a single dose nasal spray containing epinephrine.  It can be used in adults and children who weigh 66 pounds or more.  There is a pediatric spray for smaller children that is…

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Protein Degraders 

Protein Degraders 

Inflammation is the causative common denominator for most of the allergic and autoimmune conditions that plague humans.  Inflammation is mediated at a cellular level by inflammatory proteins.  Many current therapies work by inhibiting the function of inflammatory proteins.  But a new evolving strategy is to develop protein degraders to remove these inflammatory proteins completely.  Targeted protein degradation is a process using a new class of medicines that may revolutionize the treatment of inflammatory diseases.  These medicines are designed to selectively…

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Lucky 13 

Lucky 13 

13% of Americans have not been infected with Covid-19.  Roughly the same number is true in other developed countries where epidemiologic studies have been done.  Is it simply good luck or is some other force at work?    As it turns out a recent bit of research published in the journal Nature points toward genetics.  Scientists in the UK placed infecting doses of Corona virus in the nostrils of study volunteers.  The small minority who did not become ill had high…

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TIL:  Tumor Infiltrating Lymphocyte Therapy 

TIL:  Tumor Infiltrating Lymphocyte Therapy 

TIL is a recently FDA approved therapy for treating certain types of metastatic cancer.  It has been referred to as a “living drug” as it is made up of the individual patients T lymphocytes.  It does so by taking cancer-targeting T cells from the patient’s own tumor and then growing them into billions more of the same cells in the lab and then re-infusing them into the patient.   This massive influx of warrior T cells can destroy the tumor whereas…

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HANE (HAE) 

HANE (HAE) 

A recent New England Journal of Medicine had three articles and an editorial about hereditary angioedema previously called hereditary angioneurotic edema.    By way of reminder, HAE causes recurrent episodes of swelling that can affect various parts of the body:  face, tongue, throat, abdomen, extremities.  It is caused by a gene mutation in SERPING 1 which controls the production of C1-inhibitor.  In type 1 HAE there is a deficiency of the inhibitor, in type 2 the inhibitor protein is present but…

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Chronic Pruritis 

Chronic Pruritis 

A recent issue of JAMA the Journal of the American Medical Association had a review article of this condition.    Chronic pruritis is defined as an itch that lasts 6 weeks or longer.  It occurs in 22% of people during their lifetime and it accounts for 1% of doctor visits in the US.  Chronic pruritis can be classified as either inflammatory or neuropathic.    The inflammatory causes are myriad.  Believe it or not a very common cause of inflammatory itch is dry…

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Dear Dr. K; 

Dear Dr. K; 

I’ve modified my diet to include lots of anti-oxidants and I take vitamin E, vitamin A and beta carotene supplements.  Now I’ve recently heard they don’t reduce inflammation.  What’s the truth and, oh by the way, why can’t scientists get things straight?  Well, first of all, scientists are people and therefore fallible.  But, science itself can be thought of as a ratchet to the truth moving forward one cog at a time.  And the complete truth/understanding may not become apparent…

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Immune Memory Cells 

Immune Memory Cells 

Scientists at McMaster University in Canada and at Mount Sanai in the US have co-discovered the cells that remember an allergy.  The Canadians call it MBC2 while the Americans call it a type 2 Memory B cell.    B cell refers to a type of lymphocyte critical to immune function.  B cells are the factory for producing immune proteins called immunoglobulins (Ig’s).  Ig’s have a finite life span, but the B cells are much longer lived.  This is important in terms…

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Islet Cell Transplant 

Islet Cell Transplant 

The FDA has recently approved the first pancreatic islet cell transplant for some type I diabetics.  By way of clarification, type I diabetes is due to loss of the pancreatic islet cells and therefore a lack of insulin.  Whereas; type II diabetes is due to insulin resistance because the islet cells are over producing insulin due to obesity.    Most type I diabetics can be treated with insulin, either by injection or continuous infusion.  But in a small minority safe control…

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