Dr. Summit Shah

Dr. Summit Shah

Friday, 23 February 2018 07:00

Can You Be Allergic to the Cold?

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. 

 

Friday, 15 December 2017 07:00

How Cats Can Protect Newborns Against Asthma

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.

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.  

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