Dr. Summit Shah

Dr. Summit Shah

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.

Though children with asthma are usually advised to avoid allergens that could exacerbate their symptoms, new research published in the Journal of Allergy and Clinical Immunology suggests that exposure to allergens associated with pets - and even pests - can actually prevent the development of asthma. 

Dr. James Gern from the University of Wisconsin-Madison led this new study as part of an ongoing Urban Environment and Childhood Asthma study. For this particular study, Dr. Gern and his team studied 560 children living in New York City, Boston, St. Louis, and Baltimore, beginning in 2005. The children who were studied were considered at risk for developing asthma because each child had at least one parent with asthma or allergies

When the children were aged 3 months, 2 years, and 3 years, researchers sampled allergens from their homes. They also tracked the children to determine their incidence of asthma over the first 7 years of the children's lives. They found that the higher the concentration of cockroach, mouse, and cat allergens present in these children's homes, the lower the children's risk of developing asthma by the age of 7. 

Though dog allergens alone did not seem to confer any preventative benefit, when dog allergens were combined with these other allergens, the risk for developing asthma was even lower than when just cockroach, mouse, and cat allergens were present. Cockroaches appeared to be the most powerful in staving off the development of asthma. 

These findings are consistent with other data suggesting that exposure to allergens can prevent the development of asthma and allergies by training the immune system to recognize these substances as harmless. These results also point to the possibility of new preventative measures for asthma. For instance, if specific allergens or bacteria can be clearly and repeatedly shown to reduce asthma risk, this knowledge can be used in the development of interventions to reduce the chances that children get the disease. 

A new study, published by an Australian team in Lancet Child & Adolescent Health, has shown that an immune-based therapy has successfully allowed children who are allergic to peanuts eat peanuts for four years without experiencing reactions. The rationale for immune-based therapies is to expose children to small doses of peanut to treat their immune systems to learn that the foreign substance is not harmful and therefore to stop reacting to it as if it were threatening.

The children studied in the new research report had been enrolled in a previous study where they received a combination of probiotics and small peanut doses. Probiotics were used as a way to enable the gut to have a higher tolerance for peanuts. In this initial study, 82% of the children who received this combination therapy experienced a significant reduction in their allergic reactions to peanuts.

The new study is a follow-up study that tracks the children from the initial study four years later. According to the researchers, 67% of the children who had received the combination therapy are still comfortable eating peanuts. When tested for peanut allergy, fewer children who had received the combination therapy demonstrated allergic symptoms compared to the children who did not receive this therapy.

One criticism of this set of studies is that the scientists only compared the outcome of the allergen/probiotic combination therapy to the outcomes associated with no therapy at all. The limitation of this design is that it limits the researchers’ ability to evaluate the impact of the probiotics.

While a number of studies have shown that exposing children to allergens can improve their tolerance for that allergen. However, the evidence for the impact of probiotics on allergies is not nearly as robust. Had the researchers compared the effects of the combination therapy to those from the immune therapy alone, it would be clearer whether probiotics are beneficial in peanut allergies. Treating one group with only probiotics may make the relationship between probiotics and peanut allergies even more clear. Future research can help to clarify the importance of probiotics in fighting peanut allergies and how and why combining probiotics with immune-based therapies may enhance the benefits of immune-based therapies.

Friday, 08 September 2017 07:00

What It’s Like to Age With Asthma

A new review published in The Lancet has revealed that older people who suffer from asthma are five times more likely to die from the condition than their younger counterparts. Unfortunately, the rate of asthma in older adults is climbing. Though the specific prevalence is debated, up to 9% of all older adults may suffer from the condition.

Why can asthma be tougher on older adults than younger adults?

For one, breathing becomes more difficult with age, even in the absence of asthma. The elasticity of the lungs diminishes as we get older, and the muscles of our respiratory systems weaken. These changes exacerbate the breathing problems that normally occur with asthma.

Another issue is that the strength of our immunes systems can decrease with age. The relevant impact is that older adults can be more likely to suffer infections that can trigger asthma attacks. Similarly, the body’s response to inflammation changes with age, so steroids that may have worked for someone with asthma in the past may stop working as they age.

According to the authors of the review, about half of older adults with asthma are not properly diagnosed, which complicates treatment and the prevention of complications. Both physicians and the patients themselves are apparently likely to blame symptoms of asthma on other conditions. For instance, people often blame their shortness of breath on being overweight or out of shape rather than considering that the symptoms represent an asthmatic condition.

Changes in cognition and motor skills are also major contributors to the heightened effects of asthma in older adults. Managing asthma requires patients to remember to take medications regularly and to deploy those medications correctly. Asthma inhalers are notoriously misused, with patients failing to get the intended doses. As patients get older and their understanding of how to use inhalers diminishes – along with their physical ability to coordinate the different aspects of using the inhalers – the chances increase that they are not getting enough medicine.

In addition to bringing more awareness to the realities of growing older with asthma and how to avoid unnecessary complications, researchers will likely aim to develop strategies to help overcome some of the challenges older adults face when dealing with asthma. Therapies that are aimed at circumventing the specific risks associated with treating asthma in the elderly could help to minimize the additional burden that asthma brings to older adults.  

Friday, 25 August 2017 15:22

New Data on Penicillin Allergies

Though penicillin allergy is the most commonly diagnosed drug allergy, there has been mounting evidence in recent years that many people who believe they are allergic to penicillin are in fact not allergic to it. True penicillin allergy is actually quite rare.

A study that was just published in the journal Pediatrics investigated a potential penicillin allergy in 100 children between the ages of 4 and 18. The parents of all 100 children reported that their child had a penicillin allergy, but each child was deemed “low-risk” because the symptoms that led to a diagnosis were common symptoms seen in children, such as a rash.  The researchers tested all 100 children for a penicillin allergy, and all 100 children tested negative.

Why are so many children who are not allergic to penicillin diagnosed as such? The answer is that penicillin allergies are often diagnosed based on clinical symptoms rather than through allergy tests. In other words, physicians will often stop a course of penicillin if a rash, itching, or vomiting occurs because these symptoms could indicate an allergy.

Because subsequent exposures to penicillin in the case of allergy can be more dangerous, the physicians will often then avoid using these antibiotics. The children (and their parents) therefore continue assuming they have a penicillin allergy without being tested.  

The biggest problem with thinking that you’re allergic to penicillin when you’re not is that you will not be given penicillin or other widely used antibiotics like amoxicillin. If you get sick with an infection that would normally be treated with these antibiotics, you will instead be given something that is more likely to have adverse side effects and is also more likely to be much more expensive.

As it becomes clearer that penicillin allergy has been over-diagnosed, some physicians and researchers are recommending that penicillin allergy tests be conducted to confirm a penicillin allergy. Confirmation may be especially important in the low-risk cases, where the clinical symptoms that led to diagnosis are relatively harmless symptoms that are likely to arise from common viruses.

A study, recently published in European Respiratory Journal, investigated the potential link between pregnant women’s consumption of certain types of sugars and the development of allergy and asthma in their children.  Specifically, the scientists were interested in “free sugars,” which do not include sugars found in whole fruits and vegetables.

The researchers evaluated families with children born in 1991 and 1992 and did not find any correlation between sugar intake and eczema or hay fever. They also failed to find a significant relationship between sugar consumption and asthma generally.

The researchers did, however, find that higher sugar consumption was significantly associated with allergy and the allergic form of asthma. Specifically, the 20% of mothers who ate the most sugar during pregnancy were 38% more likely to have children who developed allergies or allergic asthma than the 20% of mothers who ate the least sugar. The highest sugar intake was 82-345 grams per day, which is equivalent to 16-69 teaspoons per day. In contrast, the lowest sugar intake was less than 34 grams (or 7 teaspoons) per day.

The identified correlation between sugar intake and allergy and allergic asthma does not mean that eating more sugar during pregnancy causes allergies or allergic asthma in children. Further research needs to be conducted to determine if these findings can be replicated.

If the findings appear robust, the next step will be to determine whether sugar can actually increase the risk for allergic conditions, or if some other factor may impact both sugar intake and allergy development. Interestingly, sugar intake in children has not been shown to impact the chance of developing allergies or allergic asthma.

Researchers hypothesizing any mechanisms that could explain a causal link have pointed to lung development and suggested that high levels of fructose could cause inflammation in the developing lungs. However, this idea has not yet been tested so there are no data to confirm or deny this concept.

Doctors and scientists have long suspected a connection between asthma and diabetes, as it has appeared that people with one of these conditions tend to be at higher risk for the other. What researchers have not been clear on is the strength of the relationship and whether asthma makes it more likely to develop diabetes or vice versa.

Scientists at the National Institute for Health and Welfare in Finland have now helped to clarify the relationship between type-1 diabetes and asthma. Rather than a simple link where the presence of one condition increases the likelihood of the other, the link between diabetes and asthma is apparently more complicated. Whereas having asthma increased the risk for type-1 diabetes by about 41% in the subjects studied, having type-1 diabetes actually decreased the risk of developing asthma. The magnitude of the reduced risk for asthma was about 18%.

The researchers investigated health records from 171,138 children who were born between 1981 and 2008. From this sample, which represented 10% of the Finnish population born in that time frame, the researchers identified 80,871 children who were diagnosed with asthma and 8,939 with type-1diabetes by the age of 16. Both conditions were present in 602 of these children.

The purchase of insulin and anti-asthmatic drugs helped researchers determine children’s diagnoses. To perform their analysis, the researchers divided children into groups based on their birth years and looked at 4 age groups: 0-3, 4-7 8-11, and 12-16. The relationships between diabetes and asthma were revealed in all age groups.

While the study provided novel insights into the link between diabetes and asthma, it also contained some limitations. For one, not all the diagnoses were confirmed. Second, there was limited information on any other conditions that the patients may have had. Similarly, the researchers did not have information on when the patients developed their conditions.

The lead author of the study, Dr. Johanna Metsala, recently presented these findings at the European Academy of Allergy and Clinical Immunology Congress. The discussion at the meeting provided more insights into how scientists can further clarify the link between diabetes and asthma in the future. Researchers are particularly interested in determining whether food allergies may also be linked to diabetes.

 

When most people think of food allergies, they think of things like nuts, eggs, or shellfish. However, red meat has been causing more allergic reactions in recent years, and the culprit is a sugar molecule found in red meat called galactose-alpha-1,3-galactose, or alpha-gal. The picture is complicated by the fact that people do not tend to be naturally allergic to the sugar molecule found in red meat but instead become allergic to it after experiencing a tick bite.

The tick that leads to the red meat allergy has been linked to the lone star tick, which has a white spot in the shape of Texas on its back and is generally found in the southeastern United States. Dr. Thomas Platts-Mills, a lead allergy research from the University of Virginia helped to identify this critical link after he himself developed the meat allergy.

When Platts-Mills heard that an effective cancer drug, called cetuximab, was causing allergy-like side effects in 10x more people living in the southeastern United States than those living elsewhere, he decided to partner with Bristol-Myers Squibb, the drug’s distributor, to conduct blood tests. He found that all the cancer patients experiencing this reaction had pre-existing antibodies to the alpha-gal sugar. The sugar was indeed found in abundance in cetuximab.

What was causing people living in the southeastern United States to develop this sensitivity to alpha-gal sugar? The area where these cancer patients lived mapped on to the same geographical area where Rocky Mountain spotted fever, a disease carried by the lone star tick, occurs. With this clue, Platts-Mils screened more patients with meat allergies, and his studies revealed that 80% of these patients had reported tick bites. The tick bites resulted in 20x more antibodies to the alpha-gal sugar.

While Platts-Mills’ work helped to reveal the role of tick bites in red meat allergies and the allergic reaction to cetuximab, the mechanism by which the bite confers this sensitivity to the alpha-gal sugar is not yet understood. Some researchers have suggested that a virus or bacteria carried in the tick’s saliva may cause the change in the immune system of those who have been bitten.

A former member of Platts-Mills’ team at the University of Virginia is now conducted research on mice at the University of North Carolina to improve our understanding of how ticks cause these allergies. Now that more red meat allergies are being reported outside the southeastern United States – namely in Duluth, Minnesota, the eastern tip of Long Island, and Hanover, New Hampshire, one important question researchers are interested in is whether the lone star tick has traveled to new parts of the country, or if instead ticks of other species now cause the red meat allergies. Research that improves our understanding of how exactly ticks enable these allergies will hopefully enable us to develop effective interventions to reduce the suffering that accompanies these allergies.

Wednesday, 19 December 2012 00:00

‘Tis the Season For Allergy Testing

asthma-inhaler-300x199Runny noses and sniffles aren’t exactly rare this time of year; colds and the flu run rampant among adults and children alike. After the twentieth sneeze or so, chances are you’ll pop a sinus pill, load up on Kleenex, and plop yourself in front of the fire to watch another holiday-themed movie. Sometimes this works, but sometimes there’s something a bit more complicated going on that might require allergy testing. Ohio has an allergen-friendly climate, and often people go years without realizing they have seasonal allergies. If a cold and sinus medication hasn’t been doing the trick, and symptoms seem to drag on for days or weeks, you may be suffering from allergies.  

Cabot Rea: If you have allergies, the worst season could be on our doorstep.

Colleen Marshall: Central Ohio is a hotspot for seasonal allergies. In For Your Health tonight, Ellie Merritt is going to tell us what to expect. Ellie, I hear it’s going to be a bad one.

Ellie: Yes, allergy season comes on fast and furious and while it is chilly outside today, doctors are expecting seasonal allergies to be earlier this year. And you’re right, Colleen, much more intense. Blame the weather. Get ready for the sneezing.

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