ALLERGY TESTS ARE NO MAGIC BULLETS FOR DIAGNOSIS

from Medical News Today

An advisory from two leading allergists, Robert Wood of the Johns Hopkins Children’s Center and Scott Sicherer of Mt. Sinai Hospital in New York, urges clinicians to use caution when ordering allergy tests and to avoid making a diagnosis based solely on test results.

In an article, published in the January 2012 issue of Pediatrics, two leading allergists warn that blood tests, an increasingly popular diagnostic tool in recent years, and skin-prick testing, an older weapon in the allergist’s arsenal, should never be used as standalone diagnostic strategies. These tests, researchers say, should be used only to confirm suspicion and never to look for allergies in an asymptomatic patient.

Test results should be interpreted in the context of a patient’s symptoms and medical history. If a food allergy is suspected, the patient should undergo a food challenge – the gold standard for diagnosis which involves consuming small doses of the suspected allergen under medical supervision.

Unlike food challenges, which directly measure an actual allergic reaction, skin tests and blood tests are proxies that detect the presence of IgE antibodies, immune-system chemicals released in response to allergens. Skin testing involves pricking the skin with small amounts of an allergen and observing if and how the skin reacts. A large hive-like wheal at the injection site signals that the patient’s immune system has created antibodies to the allergen. Blood tests, on the other hand, measure the levels of specific IgE antibodies circulating in the blood.

These tests can tell whether someone is sensitive to a particular substance but cannot reliably predict if a patient will have an actual allergic reaction, nor can they foretell how severe the reaction might be, the scientists say. Many people who have positive skin tests or measurably elevated IgE antibodies do not have allergies. For example, past research has found that up to 8 percent of children have a positive skin or blood test for peanut allergies, but only 1 percent of them have clinical symptoms.

Undiagnosed allergies can be dangerous, even fatal, but over-reliance on blood and skin tests can lead to a misdiagnosis, ill-advised food restrictions or unnecessary avoidance of environmental exposures, such as pets

In addition, the researchers caution, physicians should be careful when comparing results from different tests and laboratories because commercial tests vary in sensitivity. Also, laboratories may interpret tests results differently making an apples-to-apples comparison challenging.

In their report, the scientists say, skin and blood tests can and should be used to:

– Confirm a suspected allergic trigger after observing clinical reactions suggestive of an allergy. For example, children with moderate to severe asthma should be tested for allergies to common household or environmental triggers including pollen, molds, pet dander, cockroach, mice or dust mites.

– Monitor the course of established food allergies via periodic testing. Levels of antibodies can help determine whether someone is still allergic, and progressively decreasing levels of antibodies can signify allergy resolution or outgrowing the allergy.

– Confirm an allergy to insect venom following a sting that causes anaphylaxis, a life-threatening allergic reaction marked by difficulty breathing, lightheadedness, dizziness and hives.

– Determine vaccine allergies (skin tests only).

Conversely, skin and blood tests should NOT be used:

– As general screens to look for allergies in symptom-free children.

– In children with history of allergic reactions to specific foods. In this case, the test will add no diagnostic value, the experts say.

– To test for drug allergies. Generally, blood and skin tests do not detect antibodies to medications.

Nearly 3 percent of Americans (7.5 million) and at least 6 percent of young children have at least one food allergy, according to the latest estimates from the National Institutes of Health.

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In A Few Short Weeks, Cedar Allergy Season in Texas Will Begin

From KENS5 News

SAN ANTONIO — In just four to six short weeks, cedar allergy season will be upon us. This month, local doctors are looking for volunteers to test new medications for sneezing and watery eyes.
Up to 20 percent of the people who live in South Texas have some degree of cedar allergy. There’s now a way to get tested and treated and get paid to do it.

Juan Carlos Amer, 25, has noticed a pattern. Every winter he gets the same nagging symptoms.

“I sneeze a lot,” Amer explained. “My throat itches and my eyes get really watery.”

The Texas Hill Country is home to millions of cedar trees releasing billions of grains of pollen, creating misery when the north wind blows.

“Cedar allergy is one of the most intense allergies known,” said lung specialist Dr. Charles Andrews.

Diagnostics Research Group in San Antonio is looking for hundreds of volunteers who have had cedar allergy symptoms for at least two years. They’ll be tested with skin pricks on the forearm for 20 different allergies, including cedar. Then they’ll help test one of three new medications, either nasal sprays or pills, to see if there is a better way to control the symptoms.

“It takes a large number of volunteers,” Andrews said. “And it takes volunteers who will follow the rules, who will keep their diaries and let us know what kind of symptoms they’re having.”

Patients have to make four to eight visits and can earn up to $575 for their trouble.

The cedar usually starts blowing into our area in late December or early January.

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Vaccines: Looking Back, Looking Ahead

Guest Editorial:

By Robin A. Weiss and Peter Hale | June 1, 2011| The Scientist

[NOTE: From time to time we come across an interesting piece that adds perspective to the topic at hand. The June 1, 2011 issue of the publication The Scientist features the topic of vaccines and we wanted to bring some of their content to your attention. We hope that you find it interesting and informative.]

The Scientist magazine recently focused on novel approaches to vaccines. Vaccines are “miracles” that have saved millions of human lives—more than any other medical intervention—by activating the body’s natural defenses to prevent infection. Likewise, veterinary vaccines protect our livestock and pets. Vaccines were originally produced to prevent infectious diseases, and this goal continues to be important. Today, however, there are also interesting developments in the use of vaccines to control noninfectious conditions, such as some types of cancer and Alzheimer’s disease, or, as discussed in this issue, cocaine addiction.

Humankind has benefited from more than 200 years of successful vaccine use. (See time line.) One hundred years ago, parents worried most about their children contracting diphtheria, and 50 years ago they worried about polio; today, the most serious childhood infections have largely disappeared from the developed world. Moreover, the World Health Organization officially declared the global eradication of smallpox in 1980. In addition, vaccines are now available to combat adult diseases such as cervical cancer and shingles. Yet there are three major 21st century scourges that still cry out for efficacious vaccines: HIV/AIDS, tuberculosis, and malaria.

Prevention is better than cure

Since ancient times, people have realized that you could only catch certain diseases once. If you recovered, you became immune for the rest of your life. In the 17th century, variolation—scratching a small amount of a patient’s smallpox scab into the skin of uninfected individuals, inducing a mild form of the disease followed by protective immunity—was introduced to Europe from China by way of Turkey. Although around 1-2 percent of variolated people contracted the disease and died, the odds were still favorable during a raging epidemic. In 1796, Edward Jenner took note of the folk observation that milkmaids had smooth complexions: they did not get smallpox. (In the nursery rhyme that begins “Where are you going, my pretty maid?/ I’m going a-milking, sir, she said,” the girl claimed that “My face is my fortune” because it was free of pockmarks.) Jenner successfully used the relatively harmless cowpox as a vaccine (from the Latin vacca, “cow”) in place of smallpox.

Vaccines: Some Key Developments & Pioneers

 

 

Although we understand the immune system better today, we still do not have sufficient insight into the reasons why certain vaccines work poorly or not at all, or why some of the most successful ones (e.g., the vaccine against yellow fever) protect for a lifetime. Rather than targeting the pathogen itself, some vaccines protect against the byproducts of infection, such as the toxins produced by diphtheria and tetanus bacteria. In the 90 years since the Bacillus Calmette-Guérin (BCG) vaccine—made from bovine TB—was developed to fight the Mycobacterium that causes human tuberculosis, there has unfortunately been little progress in developing a new vaccine. But promising results are beginning to emerge for a vaccine that may offer partial protection against the malaria parasite. HIV has managed to evade researchers’ best efforts towards an efficacious vaccine: the virus rapidly changes its outer coat, and protects itself with a “glycan shield” or sugary carapace. Moreover, HIV invades and subverts the immune system itself. Gene Shearer and Adriano Basso resurrect an approach to HIV immunization based on using human antigens in addition to viral antigens. But a pathogen’s immune-evasion strategy is not always the biggest barrier to vaccine development. As Brad Spellberg discusses, investment in the development of fungal vaccines has been hindered by the lack of demand in the developed world and by a perceived lack of profitability.

Therapeutic vaccines

Although vaccines were originally designed as a method of preventing disease, we now realize that stimulating the immune system after diseases have taken hold may also help patients. Therapeutic (rather than prophylactic) vaccines have been designed to make cancer cells look more foreign so that immune cells will destroy them. But because cancer cells originate from our own cells, there is danger that such an approach could backfire, with the body rejecting its own tissues in an autoimmune reaction. Paradoxically, the very immune reaction responsible for transplant and graft rejection may help to spawn a new kind of vaccine, as Shearer and Basso explain in their article. Therapeutic vaccines are also being attempted for conditions like addiction. Although molecules of nicotine and cocaine are too small to elicit immune reactions by themselves, Thomas Kosten writes about the development of a vaccine against cocaine that couples an immune-stimulating protein to the small addictive molecule.

The future of vaccines

Despite the enormous number of lives saved by immunization, a vocal minority holds the view that these measures are harmful. Parents who withhold vaccination from their children usually see no ill effect, because they benefit from the vast majority of vaccinated children providing “herd immunity,” making the disease agents much rarer. Sadly, though, because of the unjustified scare about a vaccine-autism link—a claim which is not evidence-based and which has been rejected by public-health authorities—we have witnessed a rise in measles infections, which can have debilitating complications. One of the greatest challenges of the modern era is to convince parents in Western countries of the essential benefits of vaccines. With the exception of a few brave individuals, the scientific community as a whole has not risen to this challenge.

If only this vocal minority could appreciate the enormous impact vaccines have had in the past and their untapped potential for the future. For example, there is the challenge of developing an efficacious multivalent influenza vaccine that would avert pandemic influenza. Rino Rappuoli outlines the extraordinary challenges inherent in developing “universal” vaccines, protective against all strains of rapidly replicating viruses such as influenza and HIV. These viruses mutate key proteins at a furious rate, reconfigure their shapes, and recombine with each other, constantly evolving to make it harder for the immune system and vaccinologists to find a highly conserved Achilles’ heel. Further problems concern the huge cost of manufacturing, the growing complexity of vaccine design, the fear of liability on the part of pharmaceutical companies, and the funding and logistics of rollout in countries where vaccines are most needed. Yet given determination, these challenges can be surmounted.

Robin A. Weiss is a professor of viral oncology at University College London. Peter Hale is the founder of the Foundation for Vaccine Research, Washington, DC.

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The Last Vaccine Frontier… Fungal Infections

Successful vaccines have been created to protect against pathogenic bacteria and viruses. Why aren’t there any for combating fungal infections?

When fungal spores touch a moist patch of earth, they germinate and push hair-like hyphae deep into the soil, sucking up enough nutrients to feed the growing cells of the filaments. When a pathogenic fungal spore lands on human tissue under the right conditions, it too germinates and burrows deep into susceptible organs or multiplies like yeast, coating a tissue’s surface as it buds new offspring, colonizing and devouring the tissue beneath it.

Read more of this article in The Scientist.

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An AIDS Vaccine?…Recognizing The Human Potential

It may be time to reconsider an AIDS vaccine which is more human than viral, triggering the immune system in a way that no other vaccine does.

At the beginning of 1991—almost ten years after the cause of AIDS had been identified—researchers thought they might have a vaccine. Evidence from several laboratories suggested that it was possible to develop a vaccine against HIV by inoculating individuals with a crippled version of the virus that could not replicate—a time-tested strategy similar to that used to produce effective measles, mumps, and polio vaccines. In animal experiments, researchers used an HIV-like virus called simian immunodeficiency virus (SIV) which infects rhesus macaque monkeys. Over time, infected monkeys developed AIDS-like symptoms, much like humans. Researchers inactivated SIV, injected it into monkeys, and tested whether the animals were protected against live SIV infection. Most vaccinated monkeys were indeed protected, encouraging AIDS researchers to believe that an effective human AIDS vaccine would soon follow. However, in October 1991, a brief article was published that sent AIDS vaccine research into a tailspin. For the complete article, see The Scientist.

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Growing Number Of Adults in Britain Are Developing Hayfever

A surprising surge in late-onset allergies is baffling the scientific community as over 500,000 additional middle-aged Britians will develop hay fever over the next decade.

Experts say more and more adults are suddenly finding themselves with the allergy that causes sneezing, itchy eyes and a runny nose throughout the summer.

Industry market researcher Datamonitor reports that in 2010, 12.5 million people in Britain – over the age of 20 suffer from allergic rhinitis —projected to rise to 13.1 million by the end of the decade.  Allergic rhinitis represents a range of conditions including reactions to grass and tree pollens.

Climate change, the introduction of new species of exotic plants into the country, new infections and the tendency to live in more sterile internal environments are four theories offered to explain the rise. Of the current 12.5 million, 2.5 million are aged between 20 and 34 but the vast majority, some 9.5 million, are middle-aged. By contrast, market researcher Datamonitor estimated there were 3.7 million children allergic to pollen or dust in 2010, but that this will fall slightly to 3.5 million by 2020.

Among the possible causes, which might include the changing global environment, are an increase in the number of plants that release larger amounts of pollen into the air and trees and flowers blooming for longer in a warmer climate.

Dr. Glenis Scadding, President of the British Society for Allergy and Clinical Immunology (BSACI) said: “Immunotherapy is vastly underutilized despite epidemic proportions of allergic disease which significantly impair quality of life, work and school performance.”

Effective treatments for hay fever remain expensive and most sufferers simply take tablets to control their symptoms. Among newer treatments are pollen barrier balms, which are applied to the nostrils to prevent irritation, and do not have the drowsy side-effects that antihistamine tablets can cause.

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America’s Most Ragweed Allergy-Prone Cities

Quest Diagnostics recently analyzed 14 million test results from more than 2 million patient visits during a four-year period (2005 – 2008) and found that while sensitivity to ragweed, a common culprit of seasonal allergies, is on the rise, allergies can indeed be more problematic in some cities than others. While Quest has yet to complete a thorough analysis of this phenomenon state by state, the company says its preliminary findings show that climate change has something to do with it.

According to Quest “….the cities on top typically have dryer climates; places with warm, dry climates have longer allergy seasons. Many of the cities on the bottom of the list are coastal or tend to be wetter.”

Past studies show that cities with high levels of new construction or increased vegetation can also lead to prolonged and intense allergy seasons for its dwellers.

The Methodology

To determine which cities have the most allergy-afflicted residents, Quest’s testing center took the most populous metropolitan areas, as defined by the United States Office of Management and Budget, and then ranked the largest cities by their rate of allergen sensitization, or the percentage of patients who tested positive for ragweed allergies.

According to the Asthma and Allergy Foundation of America, ragweed allergies, or hay fever, are caused by weeds that grow throughout the United States that produce up to 1 billion pollen grains each year. They are more common in Eastern states and the Midwest. Hay fever is most common during the late summer months and continues almost until frost kills the plants that cause it.

Ragweed allergies are characterized by sneezing, stuffy or runny nose, itchy eyes, nose and throat and trouble sleeping. There is no direct cure for these types of allergies, but they can be controlled by avoiding contact with pollen or taking an antihistamine. You can find more information about ragweed allergies on the AAFA’s website.

The Top Ten

Most Alergy Prone

US Cities

City % testing ragweed positive
10th Most Allergy-Prone Minneapolis and Washington, D.C. 21.7%
9th Most Allergy-Prone Denver 22.3%
8th Most Allergy-Prone Philadelphia 22.6%
7th Most Allergy-Prone Sacramento 22.9%
6th Most Allergy-Prone Chicago 23.1%
5th Most Allergy-Prone Dallas 23.6%
4th Most Allergy-Prone Riverside-San Bernadino, Calif. 23.9%
3rd Most Allergy-Prone Kansas City, Mo. 24.1%
2nd Most Allergy-Prone Las Vegas 25.7%
Most Allergy-Prone City Phoenix 29.3%
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Allergy-sniffing dogs help kids with peanut allergies

An article in the The Washington Post – Lifestyle Section of Sunday, May 29, 2011 titled “The nose knows: Allergy-sniffing dogs helping children with peanut allergies avoid exposures” makes a few interesting points about how pervasive allergies have become in everyday American life and how serious peanut allergy is to many families.

The article presents a series of stories from around the nation about dogs that have been trained to sniff out any number of things that their child owners are seriously allergic to and that these youngsters would never have been able to identify on their own… until it was too late.

The article talks about how such dogs are trained, much like police dogs and military dogs. The article also describes various ways people deal with issues of these ‘sort of’ service dogs regarding access to establishments that normally prohibit dogs.  The bottom line is that ITI’s peanut allergy LAMP-vax vaccine currently in development will be welcomed when it has successfully completed clinical trial.

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2011 The Worst Year For Allergy Sufferers On Record

If you are sneezing and itching your eyes this spring allergy season, you are not alone. 2011 is shaping up to be the worst year for allergy sufferers on record. More than 35 million American suffer from pollen allergies, according to the FDA . Every year, the United States spends $21 billion on health costs related to allergies. A study published today in the Proceedings of the National Academy of Sciences of the USA searched for the cause of a trend towards longer allergy seasons. Researchers found that a delayed first frost of the fall season and a lengthening of the frost-free season combined with increasing levels of carbon dioxide in the atmosphere have contributed to a longer allergy season. Longer pollen seasons increase human exposure, the duration of symptoms and severity of symptoms. “Studies have found that not only do [plants] create more pollen, it’s more potent,” said Dr. Stanley Fineman, president-elect of the American College of Allergy, Asthma and Immunology and a practicing physician in Atlanta. So what can you do if you are one of the millions of Americans who suffer from pollen allergies every year? 5 TIPS.

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TEXAS MOUNTAIN CEDAR (aka ‘RED MENACE’) – IS COUSIN TO JAPANESE RED CEDAR

Texas Mountain Cedar is the US analog to Japanese Red Cedar sharing the key CryJ1 allergen. JRC LAMP-vax is the Company’s first allergy vaccine targeting Japanese red cedar which is an allergenic pollen in Japan with over 25 million severely affected.  This vaccine has been designed and validated and  ITI is seeking a Japanese corporate partner to develop this vaccine in Japan.

In Texas, antigens of Japanese red cedar (Cry J1) are cross-reactive with the potent allergen mountain cedar (known as the “red menace”) and are recognized as a major regional health problem in the United States.  The San Antonio News has reported on the regional health problem that Texas Mountain Cedar pollen represents.

New Year’s Day 2011 arrived with something not so happy for many Texans — lots and lots of mountain cedar pollen. Jan. 1 brought not only the highest pollen count of the season so far, at 22,300 grains per cubic meter of air, but also the highest single-day count measured here since 2003. And given the generous rainfall through September last year, some observers are predicting an unpleasant few weeks ahead.  Read more….

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