Dr. Summit Shah
A new experimental treatment for children with peanut allergies, called AR101, has given way to promising Phase 3 clinical trial results. A biopharmaceutical company from California, called Aimmune Therapeutics, led the study into how safe and effective this new treatment is. They collected data from 554 patients, aged 4 to 17, who suffer from peanut allergies. The study was conducted across 69 sites within the United States.
The researchers split participants into a control group and an experimental group, with the former group receiving a placebo treatment, and the latter grouping receiving AR101 The investigation was performed as a double-blind study, meaning that neither the participants nor their health care providers were aware of whether the participant had received peanut powder or placebo. The logic for using this double-blind approach is to ensure that there is no bias in evaluating peanut tolerance at the end of the trial.
By the end of the yearlong clinical trial, more than two thirds of the group that received AR101 could tolerate the equivalent of about two peanuts, or 600 mg of peanut protein powder, without experiencing an allergic reaction. By comparison, only 4% of those who had received only the placebo intervention could tolerate a 600 mg dose of peanut protein powder a year after the trial began.
The majority of those from the experimental group that could handle a 600 mg dose of peanut protein after a year of treatment could also handle a 1000 mg dose. Whereas only 2.4% of the placebo group could tolerate 1000-mg of peanut protein at the end of the trial, 50.3% of the experimental group could handle this larger dose without incident.
In addition to the promising results of AR101, with respect to the treatment’s ability to protect children against severe allergic reactions to relatively small doses of peanut protein, the study also showed promising results in terms of safety. Only a small proportion of study participants experienced serious adverse side effects.
Some interventions for peanut allergies aim to aggressively reverse allergies or allergic reactions so that patients can safely eat peanuts like those without allergies. The rationale behind AR101, however, was to simply protect children from accidental peanut exposures. Given that 2.5% of children are now allergic to peanuts, up 21% since 2010, treatments like AR101 that may help prevent severe reactions including anaphylaxis in the unfortunate event of peanut exposure are critical for protecting children and for providing peace of mind to those with peanut allergies, as well as their loved ones.
The Centers for Disease Control and Prevention (CDC) has just published results of a study into the prevalence of asthma amongst children in the United States. According to their findings, asthma attack rates have improved a bit in recent years, and fewer children are being admitted to the hospital for asthma attacks. In addition, children have missed fewer days of school in recent years due to asthma attacks.
According to the CDC, that 61.7% of children with asthma experienced attacks in 2001, where only 53.7% of asthmatic children experienced these attacks in 2016. Perhaps more impressive is the drop in hospital admissions. In 2003, 10% of children with asthma were admitted to the hospital, but in 2013, this figure had dropped to only 5%.
The overall rate of asthma amongst children has not gone down in recent years, so there has been some speculation as to the reduction in attacks and hospital admissions. Experts have pointed to the fact that more children now follow an asthma action plan, meaning that more children are now trained to recognize symptoms of asthma and respond to them in a timely way. These action plans can prevent full-blown asthma attacks and the need for hospitalization.
In addition to the improvement in asthma attacks and hospitalization, the CDC report also provided other data on childhood asthma in the United States. For instance, in 2016, asthma attacks were most common among children who were 4 years old or younger. Additionally, asthma among children of Mexican heritage increased from 5.1% in 2001 to 6.5% in 2016.
Based on the results of the study, it is important to ensure that asthmatic children understand asthma and their own triggers and symptoms. Having an action plan in place can be helpful not only in preventing major asthma attacks and visits to the hospital, but it can also reduce anxiety about these types of events. With the flu being particularly severe this year, it is also critical to remember that the flu can exacerbate asthma symptoms. Being prepared to deal with the sudden onset of asthma symptoms can protect children from the physical and emotional stress of an attack.
Researchers at Aarhus University have made a serendipitous discovery that could help an enormous amount of patients who suffer from allergies. Though they were searching for a way to improve existing allergy treatments, their data pointed to a new way to approach allergy treatment. Their results, published in Nature Communications, demonstrate how an antibody can be used to block the immune reaction that leads to allergy symptoms.
Normally, when patients with allergies are exposed to allergens, they produce large amounts of IgE molecules. These molecules travel through the blood and attach to immune system cells called effector cells. When this attachment occurs, histamine production is triggered, which leads to the allergic reaction that the patient experiences.
What scientists have found is that there is an antibody that can interfere with this binding of IgE to two types of effector cells (called CD23 and FceRI). Not only does the antibody block the IgE molecules from attaching to these effector cells, but it can also remove IgE molecules from effectors cells after they have become bound to them.
Certain features of this new antibody make it interesting to researchers and clinicians. For instance, it is much smaller than other antibodies that are currently used in allergy medications. It is also very stable and may be able to be inhaled or swallowed rather than injected into patients. In addition to being more convenient and less painful, this feature of the antibody may also make it less expensive than it otherwise could be.
While the research is still in the preclinical stages, the results are promising. If this antibody can prevent IgE-effector cell attachment, then the amount of IgE the body produces will not be indicative of the subsequent allergic reaction. More research will have to be conducted to determine if and how this antibody can be used to prevent allergic reactions in patients.
Many of us tend to get sick during the cold months, but if allergy symptoms arise, we are likely to blame a cold. Though rare, some people are actually allergic to the cold itself, suffering from what is known as cold urticaria. For comparison, about 1 out of every 10 people is allergic to pets, while only about 1 in 100,000 are allergic to the cold.
Cold allergies have been reported in children as young as 5 years old, but the age of onset tends to be during the adolescent years. The allergies to the cold can arise out of nowhere or may be triggered after an infection or illness. An allergy to the cold can be inherited, but inheriting this allergy is extremely rare, occurring in about 1 out of every 1 million cases of cold allergy. Many of those with cold allergies suffer from their allergies for about 5 years and then the allergy disappears.
As with many other allergies, cold allergies are diagnosed through a skin test. The patient will have an ice cube set on his or her forearm to see if changing the temperature of the skin causes an allergic reaction. The course of a cold allergy is much like that of other allergies and includes swelling, hives, and itchiness. The treatment is also the same. Patients avoid the allergen, use antihistamines, and in severe cases, deploy an EpiPen.
In extreme cases, cold can induce anaphylaxis in those who are allergic to it. Luckily for those who are allergic to the cold, allergy onset usually requires that the temperature of skin drop dramatically. By bundling up, those with cold allergies can therefore still enjoy the outdoors on cold days.
What is more dangerous for those with cold allergies than going outdoors in cold weather is swimming in cold water or eating cold foods. While swimming in cold water, cold allergy sufferers may become covered in hives –or, in severe cases, suffer from anaphylactic shock. It is particularly dangerous to suffer a severe cold allergy reaction in the water because it increases the chances of drowning. Similarly, those who have an extreme reaction eaten frozen foods or drinks may end up choking.
While cold allergies are rare, it is important to recognize when the allergy exists so that precautions can be taken to prevent symptoms or serious reactions. Those who suffer from cold allergies can generally follow the same advice as other allergy sufferers do and even rely on the same medications.
Stress adversely affects our health in a number of ways. Research has long shown that there is some relationship between stress and asthma. Much of the scientific thinking has focused on the idea that stress likely exacerbates asthma symptoms.
However, a $2.5 million long-term study at the University of Wisconsin-Madison, lead by Dr. William Busse, is exploring the idea that asthma may also exacerbate stress. As their researchers have noted, it is indeed stressful to feel as though you cannot breathe. To gain a better understanding of the association between asthma and stress, the scientists are looking both at how asthma affects the brain and at how stress affects the lungs.
First, they are inducing asthmatic events in patients and then analyzing the communication from the lungs to the brain using magnetic resonance imaging (MRI) technology. By investigating which parts of the brain are activated in response to asthma symptoms, the researchers may be able to tell whether the experience of asthma leads to a stress response.
Observing how stress may impact asthma is a more challenging task. To do so, Dr. Busse and his colleagues are placing people under stress, then inducing an asthma attack and monitoring the details of that attack.
While the study has not been completed yet, Dr. Busse suspects that what the data will show is that there is two-way communication between the lungs and the brain and that there is therefore a feedback loop that can lead to both more stress and more asthma symptoms. In other words, increased stress may exacerbate asthma symptoms, which may in turn enhance stress, and the cycle continues.
An interesting idea that Dr. Busse has is that the negative nature of the feedback between the lungs and the brain could be combatted through both medication and non-medication strategies. For instance, understanding the specific pathways and molecules involved in lung-brain communication can help with the development of medications that block problematic signaling. However, he also suggests that techniques like mindfulness and meditation may offer promising ways to modify the circuits involved in this communication.
Regardless of the specific findings of this large study, it is likely that the insights will help us better understand the link between asthma and stress. They should also inform the way we approach this link so that people under stress are less likely to experience worsening asthma symptoms and those with bad asthma are able to mitigate any potential stress responses.
A study published in Nature Communications at the end of 2017 has identified 6 genes involved with children’s allergic reactions to peanuts. Unlike many other studies, which compare the physiology of those with allergies to those without allergies, this investigation involved comparisons between when an individual was experiencing an allergic reaction and when that individual was not experiencing such a reaction. The advantage of this strategy was that the researchers, located at Mount Sinai in New York, could observe specific changes in gene expression that occurred during allergic reactions to peanuts.
The experiment was performed on 19 children with peanut allergies. On one day, the children ingested incremental amounts of peanuts every 20 minutes until they ingested 1.044 grams of peanuts or until an allergic reaction occurred. On another day, children did the same thing but ingested oat powder, which should not cause an allergic reaction. During the process, children were unaware of whether they were eating peanuts or oat powder.
To monitor changes in gene expression, the researchers drew blood samples from the children before they ingested each product, during their ingestion, and again afterwards. They then performed a technique known as RNA sequencing that allowed them to see which genes and which cells became selectively activated during allergic reactions. They found that certain genes because active only during allergic reactions and could potentially explain the inflammation that occurs during allergic reactions. The findings from the 19 children were consistent with data from another 21 subjects.
This important study not only helps to reveal how peanut allergies work but could also lead to target candidates for therapeutics. It is unclear whether other food allergies – and allergies to other types of substances – may involve similar genes and mechanisms, but future research should help clarify these issues. With more knowledge of the details of different allergies, treatment options should improve.
It is not news that diet during pregnancy is important for the health of the growing fetus. Asthma is one condition that has been shown to occur more frequently in the offspring of those who do not eat well during pregnancy or are obese. It is perhaps therefore not surprising that a new study, performed by researchers at Harvard University and published in the Annals of American Thoracic Society, has found that the amount of sugar ingested during pregnancy could be predictive of a child’s likelihood of developing asthma.
To evaluate the impact of maternal sugar intake on a child’s risk for asthma, the researchers investigated data from 1068 Massachusetts mothers and then collected information on the diets and asthma status of their children when they were 3 and 7 years old. The researchers controlled for several non-dietary factors that could potentially lead to differences in the health of offspring, including the sex of the child, the mother’s education level, age, and smoking habits, and the body mass index and race of the mother and child.
When researchers focused on the impact of sugar, they found that the mothers who consumed the highest amounts of fructose or sugary beverages during the 1st and 2nd trimesters of their pregnancy were more likely to have children who developed asthma by the age of 7 than those who consumed the lowest amounts of sugar. They also found that children who ingested higher amounts of fructose or sugary beverages early in life were also more likely to develop asthma than those who consumed less of these sugary substances.
While these new data implicate sugar in the development of asthma, they do not provide evidence that sugar intake causes asthma. They also do not provide information on the mechanism by which sugar may lead to asthma. However, given that sugar has increasingly been shown to lead to health problems, including obesity, cardiovascular disease, and diabetes, lowering sugar intake may be a good idea, regardless of its effects on the development of asthma or other allergic conditions. Many juice and soda beverages have large quantities of sugar, and so cutting these drinks can go a long way in reducing sugar consumption.
Cluster immunotherapy is a strategy for treating allergies and allergic diseases. Like other types of immunotherapy, it is generally performed after skin tests have shown what allergies a patient has and involves a series of shots.
What makes cluster immunotherapy different from conventional therapies is the speed with which the shots are given - and how quickly a patient gets to what is known as their maintenance dose. The maintenance dose is the dose that proves most effective for treating the individual patient's allergy. Because patients get to the maintenance dose faster with cluster immunotherapy, they also often feel better faster with this approach.
While conventional immunotherapy tends to involve months of shots before the maintenance dose is reached, cluster immunotherapy can be done in a matter of hours. Some patients worry that getting several injections in a single day can increase their risk of allergic reactions. As with all immunotherapies, it is important to monitor your reaction to the therapy and to have access to the right medicine or care when undergoing cluster immunotherapy. However, it is also important to note that several studies have shown that cluster immunotherapy is a safe way to treat populations of allergy patients.
A study performed earlier this year in patients with allergic rhinitis demonstrated that cluster immunotherapy reduced the time it took for patients to get to their maintenance dose by more than 60%. The patients, who were studied over a 6 week period, experienced significant improvement in their symptoms. Critically, they did not suffer any worse systemic adverse reactions than patients who underwent conventional immunotherapy. The researchers therefore concluded that cluster immunotherapy is both safe and effective for treating certain patients.
There is ongoing research to help us understand all the advantages of cluster immunotherapy and any potential disadvantages. The research should also help to clarify which patients can benefit the most from cluster immunotherapy.
A new study conducted by scientists at the Copenhagen Studies on Asthma in Childhood Research Center in Denmark has revealed a way that cats may help protect newborns from developing asthma. According to the investigation, cats may also prevent babies from developing bronchitis and pneumonia. The researchers did not find, however, that dogs have the same impact.
Research on how pets affect the likelihood of developing allergies and asthma has produced mixed data. Some disorders appear to be more likely for those who grow up with certain pets, whereas others appear to be less likely.
A specific gene, called TT, has been implicated in the relationship between pets and the development of allergies. People with a certain genetic variant of TT have been shown to be twice as likely to develop conditions referred to as atopy conditions, which include asthma.
In this recent Danish study, the scientists studied 377 children from Denmark whose mothers had a history of asthma. The researchers analyzed the children's genes, as well as allergens collected from their beds. About 1/3 of the children carried the TT genetic variant that should have increased their risk for developing asthma.
Of these children who were genetically more susceptible to asthma, those who had a cat at home were less likely to actually develop asthma. The study did not clarify why having a cat reduces the likelihood of developing asthma, but scientists speculate that something about exposure to the cat prevents the TT gene in these children from becoming activated. Future research will likely help us understand the circumstances in which pets can protect children against allergic diseases and how exactly those pets confer their health benefits.
Adults with asthma are at increased risk for pneumococcal diseases, which are caused by the bacteria Streptococcus pneumoniae. These diseases include things like pneumonia, meningitis, and sepsis. Luckily, there are pneumococcal vaccines that can be delivered via simple injections under the skin or into the muscle that can potentially prevent these diseases.
The Centers for Disease Control and Prevention (CDC) recommends that all adults between the ages of 19 and 64 who suffer from asthma get the pneumococcal vaccine and that those older than 65 get 2 such vaccines. Nonetheless, according to a new study published in the American Journal of Preventative Medicine at the end of September, only about 50% of those with work-related asthma get the vaccine.
The study aimed to determine what percentage of people with different types of asthma actually get the pneumococcal vaccine as recommended. They were particularly interested in the difference between those with work-related asthma and those whose asthma occur independent of their work. The researchers analyzed national data from the years 2012 and 2013 and found that while overall, adults with asthma got the vaccine at a rate of about 50%. However, the likelihood of getting the vaccine varied depending on various factors. For instance, compared to those with work-related asthma, patients with asthma that was not work-related were less likely to get the pneumococcal vaccine. About 35% of those with asthma that was not work-related got the vaccine in 2012-2013.
The lowest rate of pneumococcal vaccination in work-related asthma patients was amongst Hispanics. Only about 36% of Hispanics with work-related asthma had gotten the vaccine. Uninsured patients and younger adults (ages 18-44) with work-related asthma also had low rates of vaccination, with only about 39% and 42% getting vaccinated, respectively.
Physicians and researchers are eager to get those with asthma to get the pneumococcal vaccine. The vaccination is important not only because pneumococcal diseases can be fatal (about 5-7% of the 900,000 Americans who get pneumococcal pneumonia each year die from it), but also because pneumococcal pneumonia can exacerbate asthma. Those with asthma are also at a higher risk for other complications related to pneumococcal disease.
Research like the current study that helps to reveal the actual uptake of the pneumococcal vaccine can be used to help physicians recognize the need to educate their asthma patients on the importance of the vaccine. Future studies may also be able to help clarify the best ways to increase compliance with the vaccine recommendation.