Archive for the ‘Allergy’ Category

Welcome to Istanbul, and 100 years of immunotherapy, a price to a 99 year old allergist   Leave a comment

It is with huge pleasure that I can welcome all readers to the 30th EAACI congress in Istanbul, and the opening ceremony today on the 11th June 2011. Today it is 100 years + one day since Leonard Noon published his historic paper on Immunotherapy “PROPHYLACTIC INOCULATION AGAINST HAY FEVER” in the Lancet. EAACI is celebrating this in many ways, one being the handing over of the “once only” Leonard Noon award, to the investigator that first published a controlled trial in immunotherapy, William Frankland. Bill was also a Secretary General and a President of EAACI, around 50 years ago, and still energetic and ambitious on his 99th year. The 2011 EAACI congress promises to be a fantastic event, with the best scientific programme possible, in the exciting surrounding of Istanbul. Thank you to Ömer Kalayci, the Congress President, as well as Lars Paulsen and Christian Virchow, who have coordinated the Scientific programme committee to produce this excellent programme. And also huge thanks to Cezmi Akdis, the current vice President of Congresses, Susanne Rothschild, the congress manager of EAACI, as well as the Congrex team, that have all contributed to create this exceptional event. I look forward to seeing you in Istanbul in the next few days.

Jan Lötvall

EAACI President for another two days.

Posted June 11, 2011 by Jan Lötvall in Allergy, asthma, EAACI

The core of science and politics, wise words by Bertrand Russel   Leave a comment

There is a lot of politics in science, and arguing about this that and the other. We scientists see it all the time, and perhaps we sometimes forget the core of science: Finding the Truth. And only the Truth… And when we find the truth, there is not much to argue about… As long as we agree with it…

And in politics, there is one core principle that is important. Live in peace!

These two core principles of humanity were well described by Bertrand Russel in this old interview, when asked “what advice would you like to give to future generations”:

Thank you Maneck for directing me to this video.

In the exosome field we are searching for consensus to be able to establish the truth. By using crowdsourcing. Are we trying to bridge science and politics, to avoid conflict. Maybe. And to find the truth and provide opportunities to communicate that truth.
From my previous blogpostings:
http://bit.ly/kOLMAv
http://bit.ly/kSn7lM

asthma in athletes needs to be treated correctly   3 comments

http://www.expressen.se is writing that WADA is planning to possibly take away the classification of formoterol as restricted drugs for athletes. That is probably a wise approach. EAACI will still pursue its plan to discuss such decisions, since asthmatics may have risk of taking long-acting beta-2-agonists only without concomitant use of inhaled glucocorticoids (http://bit.ly/gLBxAL ). The question is thus not so simple. Asthma must be treated correctly, otherwise athletes may be at risk.

Expressens current comments:

http://www.expressen.se/sport/2.701/langdskidor/1.2346078/bjorgens-medicin-bort-fran-dopinglista

Posted February 27, 2011 by Jan Lötvall in Allergy, asthma, EAACI, medicine, science, Treatment, Uncategorized

Bjorgen is not taking doping   Leave a comment

http://www.expressen.se

An article is mentioning that the world champion cross-country skier Marit Björgen is taking formoterol-containing asthma medication. Björgen has asthma, and has been properly diagnosed. It is absolutely appropriate to take such medication if you have asthma, and there is in fact NO evidence that formoterol is helping performance, and in fact this pharmacological entity should be taken off the doping list.

The EAACI  Executive Committee has today approved to rapidly do a task force to discuss the doping classing of formoterol and other asthma drugs, and will soon come with feedback on how such drugs should be classed and dosed in athletes with asthma.

http://www.expressen.se/sport/2.701/langdskidor/1.2345554/jag-har-papper-och-allting-pa-min-sida

Posted February 26, 2011 by Jan Lötvall in Allergy, asthma, EAACI

Exercise, asthma and allergy – why medicines are crucial   Leave a comment

In today’s Expressen and Aftonbladet, Swedish tabloids, it is discussed about Marit Björgen’s asthma and her medication for it. Some asthma medication is unfortunately classed as “doping”, even though they are NOT shown to increase exercise performance. For a simple emotional reason, the International Olympic Committee 2008 decided to remain strict control of asthma medication, the only argument being: “Because of the widespread use and potential for misuse of inhaled beta-2 agonists by athletes, there was consensus to continue the strict control of the use of this class of drugs in sport.”

http://multimedia.olympic.org/pdf/en_report_1301.pdf

Personally, I am sure that Björgen’s asthma medication use has no performance-enhancing effects, beyond controlling the disease.

Also in 2008, the European Academy of Allergy and Clinical Immunology (EAACI) and the American Academy of Allergy, Asthma and Immunology (AAAAI) published a task force discussing the different aspects of allergic reactions in sports, not only restricted to asthma, as exercise may cause symptoms of rhinitis, urticaria (hives) or even anaphylaxis (allergic chock). It was published in the journal Allergy, and took a very practical view on these aspects:

Exercise-induced hypersensitivity syndromes in recreational and competitive athletes: a PRACTALL consensus report (what the general practitioner should know about sports and allergy). Schwartz LB, Delgado L, Craig T, Bonini S, Carlsen KH, Casale TB, Del Giacco S, Drobnic F, van Wijk RG, Ferrer M, Haahtela T, Henderson WR, Israel E, Lötvall J, Moreira A, Papadopoulos NG, Randolph CC, Romano A, Weiler JM.

This is the abstract of that publication: http://bit.ly/g1MpWM

Asthma in athletes needs to be treated efficiently. Extreme exhaustion can cause very severe airflow obstruction also in those with very mild disease, and every measure to avoid such attacks should be taken, including chronic medication with appropriate doses of asthma medications such as inhaled corticosteroids and sometimes LABAs. It does happen that asthmatics die from an attack during exercise http://www.aftonbladet.se/sportbladet/innebandy/article95942.ab and http://www.highbeam.com/doc/1G1-79032563.html. With appropriate preventive medications, such sad effects of asthma are exceedingly rare.

http://www.expressen.se/sport/vintersport/1.2328157/bjorgen-berattar-om-sin-hemliga-medicin

http://www.aftonbladet.se/sportbladet/vintersport/skidor/article8561792.ab

http://www.aftonbladet.se/sportbladet/vintersport/skidor/article8561792.ab

Posted February 14, 2011 by Jan Lötvall in Allergy, asthma, behaviour, EAACI, health care

Cat allergic, but no immediate response to cat exposure?   1 comment

Cat allergic, but no immediate response to cat exposure?

I have been arguing in earlier blogs that exposure to your pet may not cause you immediate responses, but can explain chronic disease in the nose and in the lung. It can explain those daily symptoms of asthma, and even exercise induced asthma. Now there is more scientific evidence that this can be true. Very late responses to allergen exposure have been described, and a recent publication in Annals of Allergy Asthma & Immunology emerging from the Netherlands discusses this phenomenon.

Recent paper: http://bit.ly/hGLUeN

Paper 6 months ago: http://bit.ly/eoqnGs

Briefly, individuals with allergy and asthma were exposed to an allergen, and responded with bronchoconstriction starting at 26 to 32 hours after exposure. The asthmatic response reached a maximum at 32 to 48 hours, and was associated with dyspnea, wheezing, tiredness, increased peripheral blood leukocyte count, lymphocytosis and neutrophilia, but was not related to eosinophilia. The response was resolved after three days. The investigators call this type of response Delayed-type asthmatic response delayed asthmatic response (DYAR). Commonly, allergen exposure otherwise is related to an immediate response, occurring within a few minutes of exposure and resolving within an hour, and a late asthmatic response starting at 4-7 hours after exposure. The existence of “DYAR” further argues that exposure to your pet may not cause immediate allergic symptoms, but can certainly explain chronic disease.

This is an extension of my blogs last week related to the “expressen dilemma” published in http://www.expressen.se in Swedish. Here is the resolution:

http://www.expressen.se/nyheter/dilemmat/1.2325640/dilemmat-kattallergi-avslutning

My GOD, I am allergic to my cat, or “the dilemma of pet allergy” – thoughts and reflections from an allergy doctor   Leave a comment

Today the Swedish newspaper Expressen is posting articles about the “cat allergy dilemma”.

today: http://www.expressen.se/nyheter/dilemmat/1.2321744/dilemmat-del-2-kattallergi

yesterday: http://www.expressen.se/nyheter/dilemmat/1.2320390/dilemmat-del1-kattallergi#comments

Scenario:

What happened? My eyes are red and itchy, my nose is blocked, I sneeze all the time, and sometimes I get wheezy and have difficulty to breathe. My doctor tells me I am allergic to my cat. ARGH! What does this mean? What can I do? How do I deal with this? I love my cat, I don’t want to get rid of my cat! STOP THIS, I AM ANGRY. I DON’T WANT TO BE ALLERGIC, CURE ME NOW, I LOVE MY PET!!

This is a very common problem, and a perfectly normal psychological reaction, occurring every day in every country of the world. People that have a furred pet suddenly develop symptoms of allergies, and the doctor coldly and bluntly state “you have to get rid of your cat or dog”.

This is clearly not an easy situation to deal with as a patient and as a doctor, and involves complicated issues such as allergy diagnosis, complications of allergies, psychology of the individual becoming allergic, and the welfare of the animal.

Research is unequivocal. If you are truly allergic to a pet, and maintain exposure to that pet, chronic allergic symptoms develop. The nasal mucosa is more swollen than normal, eyes are red and inflamed, and some individuals develop symptoms of asthma. The allergic symptoms become chronic, influencing everyday life and quality of life, and can make you more tired. The risk of developing difficult asthma is obvious.

The tricky detail is that many patients say “I am NOT allergic to my own pet, only other people’s pets”. This is not so strange actually, but the fact is that the cat at home is hugely responsible for chronic symptoms, but not for the immediate symptoms. What happens is that long-term exposure to an allergic stimulus, such as cat, reduce immediate reactions, but the chronic inflammation becomes more enhanced, causing chronic daily symptoms also away from the pet. Scientifically, this has been shown by repeated low dose allergen exposure increasing allergic inflammation (http://bit.ly/fW9WTl), but reducing allergen responses (http://bit.ly/fkxXza). That chronic blocked nose and itchy eye, and that chronic asthma, is still caused by the cat at home.

Can I take medicines to remove my allergy? Medicines such as inhaled and nasal glucocorticoids can reduce the inflammation. But they are seldom sufficient to remove symptoms totally, except in those with really mild allergy. But in the end, if this allergy is perpetuated, the efficacy of medication is often inefficient to eliminate the allergic symptoms. And the medication is fairly short term, and if you forget a dose the effect is more or less gone (http://bit.ly/glA0qJ )

What is the general advice if you have a furred pet allergy in a skin-prick test, but do not have or have ever experienced any symptoms? Well, there is no or very little evidence to say what is best. If the sign of allergy on the test is strong, it is likely that symptoms will develop, but it is not universal.

Can I be vaccinated against cat? If you have a cat, it is not recommended that cat allergy immunotherapy should be performed. This treatment is usually reserved for those exposed to cat allergens indirectly, for example teachers at school exposed to cat dander from the clothes of children.

Can I have another type of pet if I am allergic to another? Thus, can I get a dog, if I am not allergic to dogs, but to cats. Clinicians avoid giving advice on matters like these. It is possible that a new allergy will be developed, but the likelihood that it will not happen is probably greater.

Are there some pets that spread less allergens? The answer is yes, but the importance is really nothing. Allergy is usually an “all or nothing” response, and small reductions in exposures are seldom sufficient. Elimination is required to achieve significant effects on symptoms. There is one company that has claimed to have developed a “hypoallergentic cat”, which they sell at very high prices, but there is controversy how true and effective this is for allergic individuals http://abcn.ws/ezDySP .

If I am allergic to pollen, and the prick test says I am allergic to pet, should I avoid getting a pet, even though I have never felt any symptoms? There is no real reason to argue either way. If you have one allergy, you have a greater risk of developing a new allergy.

How about the psychology and thoughts when dealing with this dilemma? It is easy to understand the emotional distress and even anger when the doctor’s advice is to “get rid of your pet”. Health is important, allergy is difficult, allergy makes the sufferer more tired and less productive, and increases the risk of asthma.

I sometimes ask “what do you think your pet would advice you, had he or she understood the dilemma”.

Posted February 8, 2011 by Jan Lötvall in Allergy, asthma, behaviour, EAACI, medicine

Having a cat at home – risk of mutual love and risk of mutual allergy   2 comments

Expressen, the Swedish newspaper, today published a “dilemma”. It is one person in the family wishing to have a cat, and the others not being so keen.

http://www.expressen.se/nyheter/dilemmat/1.2320390/dilemmat-del1-kattallergi

Having a cat at home during the first years of life does not increase the risk of developing allergy http://bit.ly/gAT61L. By contrast, it might even reduce the risk of allergy over time. However, if you are allergic, cat allergy can certainly cause a lot of problems and may induce severe asthma attacks http://bit.ly/hXZCXA .

A few days ago, a very popular blog-posting appeared on wordpress, that very nicely describes the positive relationship between pets and their ownders:

http://analyfe.wordpress.com/2011/02/04/the-pet-effect/

But also cats can have asthma http://www.ncbi.nlm.nih.gov/pubmed/20800209

So is it good or bad to have a cat or a dog in your home? Well, it probably depends on personal preference and family health status, including pet allergies…

Posted February 7, 2011 by Jan Lötvall in Allergy, asthma, EAACI, health care, Uncategorized

What is “asthma endotype” – asthma is a syndrome encompassing several disease entities, “asthma endotypes”   Leave a comment

What is “asthma endotypes”?

Asthma is a syndrome encompassing several distinct diseases – asthma endotypes

I placed a blogposting here last week with the abstract included http://bit.ly/h6B2ff

In a recent publication in Journal of Allergy and Clinical Immunology, EAACI together with AAAAI publish a PRACTALL paper discussing the issue of understanding the subgroups of asthma http://bit.ly/e0Trz5. The terminology “asthma phenotype” has received extensive attention over the last years, but the term “phenotype” relates only to “observable characteristics”, and does not take into account which core molecular mechanism is causing the disease in each individual. This publication attempts to encompass those thoughts into a series of examples, and is arguing that a fundamentally different approach to studying clinical mechanisms of asthma. Please read it and comment, the debate is crucial to move forward.

www.theallergynews.com

http://www.jacionline.org/article/S0091-6749(10)01858-0/abstract

Salt rooms for treating asthma – not sure it will work   Leave a comment

A while back, http://www.expressen.se wrote that sitting in a room with salt on floors wall and ceiling could affect the asthma in a positive way

http://www.expressen.se/1.2086485 (in swedish)

I am not so sure that will work. Breathing clean air is always good for an asthmatic person, but there is no evidence that it is the salt that is helping…

Posted February 6, 2011 by Jan Lötvall in Allergy, asthma, EAACI, Uncategorized