Faecal Microbiota Transplant

November 12th, 2016

This involves taking stool specimens from healthy individuals and transplanting it into the gut of people who suffer with bowel problems that relate to faulty or pathogenic organisms in the gut. This may be a factor in certain chronic conditions that are difficult to treat with conventional medication and antibiotics. These include Inflammatory Bowel Disease (Crohns and Ulcerative Colitis), Irritable bowel syndrome and Clostridium Difficile infections, as well as non-specific colitis and chronic constipation. It has also been shown to have a beneficial effect on conditions such as Parkinson’s Disease, Diabetes and even obesity by altering bowel flora. There doesn’t seem to be any application to use this treatment for food allergies to foods and other allergic conditions. The healthy persons faecal material is transplanted by enema, oro-gastric tube via the mouth or swallowing freeze dried faecal capsules.

Reference: https://en.wikipedia.org/wiki/Fecal_microbiota_transplant

 

Local IgE Production

November 10th, 2016

A new  concept in allergology is that of “local” IgE production on respiratory and ocular membranes  causing allergy and also called Local Allergic Rhinits. The allergic reaction in this case is very localised to the nasal membranes and conjunctiva and not identified on routine allergy skin prick testing or RAST blood testing.  However these patients respond to allergy treatment although testing negative for allergies. Many will develop symptoms if exposed to an allergen (Provocation Testing). In the past they would have probably been told they had no allergies at all!

Local IgE production can be triggered by pollens and house dust mites and checking a nasal mucus sample will show allergy cells called Eosinophils.

Diagnostic approach in patients with LAR. J Allergy Clin Immune 2012 Jun;129(6): 1460-7

Autoimmune Progesterone Dermatitis

July 1st, 2016

Autoimmune Progesterone Dermatitis is a rare condition related to a hypersensitivity to endogenous overproduction or sensitivity to progesterone the sex hormone in fertile (ovulating) and pregnant women. Those affected develop dermatitis during the luteal phase of their menstrual cycle (7 days before the period commences). The skin lesions can include eczema, folliculitis, hives, Urticaria, small blistering lesions on the skin and mouth and even target like lesions. Confirmation involves a positive intradermal skin test when injected with a small amount of progesterone hormone.

Treatment involves avoiding progesterone containing contraceptives, and suppressing ovulation with Danazole before the period or using Tamoxiifen.

Alzheimer’s Disease and antihistamines

June 6th, 2016

Some recent medical studies have suggested that overuse of antihistamine medication may result in Alzheimer’s disease. Only some of the older non-sedating antihistamines were mentioned in the study.

Some older (sedating) antihistamines such as chlorphenamine and diphenhydramine cross into the brain and can cause drowsiness and are even used as OTC “sleeping pills”.  Newer once-daily non-sedating antihistamines do not cross this blood/brain barrier and thus have no anticholinergic effects and are unlikely to be implicated in Alzheimer’s disease.

Vocal cord dysfunction

November 1st, 2015

Vocal cord dysfunction is a curious condition where the vocal cords go into paradoxical spasm whilst breathing (especially breathing in). This can mimic asthma with sudden onset intermittent breathlessness, wheeze and exercise related symptoms mainly in the throat with noisy breathing. Patients who fail to respond to conventional asthma treatment should have this diagnosis considered. The confirmatory tests include a “flattened” inspiratory lung function flow loop test and directly visualising the vocal cords during an episode. Symptoms are often intermittent and so difficult to diagnose and may respond to speech therapy and Botox injected into one vocal cord to reduce spasm.

Ref: Vocal cord dysfunction: asking the right questions. Bardin PG et al Clinical and Experimental Allergy 2015 45;1374-1375

Give lactose a break!

September 16th, 2015

Lactose in milk has been implicated in infant colic and feeding problems, with a migration to lactose-free formulas.

However, Lactose is very important in the infants diet as it adds flavour to milk, aids absorption of calcium and promotes the growth of probiotics. Growing infants need lactose as a carbohydrate source. Did you know there is more lactose in breast milk than cow’s milk (but no one suggests stopping breast feeding as a treatment for lactose intolerance). Lactose intolerance is actually very rare in infants and only develops in older children and adults of Afro-Asian descent. Infants can develop a temporary lactose intolerance if they get viral gastroenteritis, but this rapidly settles in a week or two.

Source: British Society for Allergy and Clinical Immunology Congress. Telford UK, Sept 2015

Local Allergic Rhinitis

May 18th, 2015

Nasal, eye and respiratory allergies have traditionally been diagnosed by doing blood and skin tests for specific allergy to pollens, dust mites and pets.  These test include Skin Prick Testing (SPTs) using allergens applied directly to the skin or RAST blood tests testing for systemic IgE antibodies travelling around the body in the blood stream.  If these “systemic” allergy tests returned negative results, then one would diagnose these patients as being “non-allergic”, implying that an allergic cause for their condition was not present.  However, up to 50% of people previously diagnosed as being non-allergic with negative tests have now been found to be allergic.  The allergic reaction in these cases remained localised in the eye, nose and lower airways and the reaction did not spill over into the circulation, hence their blood tests and skin test remained negative.  Recent research has shown localised IgE antibody production actually occurs on the surface of the eye conjunctiva, nasal membranes and airway bronchioles after exposure to pollens, dust mites and pet danders.  It is more common in younger people with a family history of allergy (atopy).  In the nose, Local Allergic Rhinitis (LAR) can only be diagnosed by measuring IgE antibodies in nasal mucus or by sniffing in the allergen and provoking a reaction, which causes measurable airway narrowing with swelling.  These tests are not readily available outside medical research institutions and so are not yet accessible to general medical practice.  So in the interim, we remain at a loss to confirm this type of localised allergic response, but do know it exists!

Reference:  Campo R, Rondon C et al.  Local IgE in non-allergic rhinitis. Clinical and Experimental Allergy: May 2015 (45) 872-881

Improving the barrier effect of the skin.

March 13th, 2015

Allergic eczema is a genetically predisposed disease (atopy). The atopic skin is a poor barrier to the outside environment, lacking an essential “protective glue” called Filaggrin. Casual contact with traces of foods and aero allergens from handling the infant, then leads to allergen sensitisation, followed by increased natural colonisation with Staphylococcus aureus skin bacteria which release endotoxins that further damage to the skins natural protective barrier mechanism.

Reducing Staphylococcal colonisation and improving the protective barrier effect of the skin is essential to guarding against eczema and allergies, and this needs to be done in the first year of life.

Clinical and Experimental Allergy: March 2015; 567-574. (Pathogenesis of atopic dermatitis – Peng and Novak)

Bronchial Thermoplasty

January 6th, 2015

Bronchial Thermoplasty is a new invasive treatment in severe asthma. The thickened airway bronchial smooth muscle that develops over years, makes the asthma difficult to control with conventional medication (inhalers and steroids).  The procedure results in the airway muscle being destroyed by heat using a bronchoscope (lung probe) under general anaesthetic to relieve airway spasm. It usually involves a series of treatments and preliminary results show considerable improvement in control of severe asthma. Ref: www.nhs.uk/Conditions/Asthma/Pages/Treatment.aspx

Food Protein-induced enterocolitis syndrome – 10 years down

December 14th, 2014

A recent international study has highlighted this condition Food Protein-Induced Enterocolitis Syndrome (or FPIES) related to a delayed allergic hypersensitivity to food that results in infants developing severe colic, feeding difficulties, vomiting and diarrhoea all occurring within 4 hours of feeding. Of the 180 different foods investigated, cow’s milk, soy, rice and oats were most often implicated. Of those affected, 65% reacted to one food (most commonly milk) 26% reacted to 2 foods and 9% reacted to 3 different foods. 40% of Milk FPIES went on to develop IgE mediated milk allergy as well. But thankfully most FPIES will resolve by 5 years of age.

Jean Christoph Caubet et al . Journal Allergy and Clinical Immunology 2014 134; 382-389