Bring on the Bugs?

Think that keeping your children’s hands and mouths clean is helping them stay healthy?  Think again!  New research from Johns Hopkins Children’s Center reveals that exposure to common antibacterials found in soap, toothpaste, mouthwash and other personal-care products may make children more prone to a wide range of food and environmental allergies.

Using existing data from a national health survey of 860 children aged 6-18, the researchers examined the relationship between the children’s urinary levels of antibacterials and preservatives found in many personal-hygiene products and the presence of IgE antibodies in the child’s blood. IgE are markedly elevated in people with allergies.

We saw a link between level of exposure, measured by the amount of antimicrobial agents in the urine, and allergy risk, indicated by circulating antibodies to specific allergens,” said lead investigator Jessica Savage, M.D., M.H.S., an allergy and immunology fellow at Hopkins.

While antibacterials and preservatives themselves don’t cause allergies, that these agents appear to play a role in immune system development.

The link between allergy risk and antimicrobial exposure suggests that these agents may disrupt the delicate balance between beneficial and bad bacteria in the body and lead to immune system dysregulation, which in turn raises the risk of allergies,” Savage added.

In the study, those with the highest urine levels of triclosan – an antibacterial agent used in soaps, mouthwash and toothpaste – had the highest levels of IgE antibodies and their risk for food allergy risk was twice that of children with the lowest triclosan levels. Similarly, children with the highest urinary levels of parabens – preservatives with antimicrobial properties used in cosmetics, food and medications – were more likely to have detectable levels of IgE antibodies and twice the risk of environmental allergens such as pollen and pet dander.

These findings are consistent with the so-called hygiene hypothesis, which has recently gained traction as one possible explanation behind the growing rates of food and environmental allergies in the developed world. The hypothesis suggests that early childhood exposure to common pathogens is essential in building healthy immune responses. Lack of such exposure, can lead to an overactive immune system that misfires against harmless substances such as food proteins, pollen or pet dander.

Just  this week, other new research from the University of California, San Francisco has provided some answers to why children who grow up in homes with pets are less likely to develop allergies.

All of which suggests that parents should put away the hand sanitizer and let their kids play in the dirt with a dog!

Fighting Flu

Last night I participated in my annual healthcare lottery. Fortunately for my finances, this didn’t involve scratch cards, ticket stubs or wheel spinning of any kind, nor will it bring me great riches, a new car or a timeshare condo. Instead, if my gamble pays off, I might be spared the flu this winter season.

However, this may be one of the last years that I have to keep my fingers crossed that the vaccine might work.  In future years getting a flu shot may become a safe bet.

In a significant step against the disease that affects billions of people each year, scientists at Oxford University in the UK, just announced that they have successfully tested a universal flu vaccine that could work against all known strains of the illness.

This new vaccine targets a different part of the flu virus to traditional vaccines, meaning it does not need expensive reformulation and guess work  every year to try and match the most prevalent strains of the virus that are circulating the world.

The team, led by Dr Sarah Gilbert at the Jenner Institute, developed a vaccine that targets proteins inside the flu virus that are common across all strains, instead of those that sit on the virus’s external coat, which are liable to mutate.

If used widely, a universal flu vaccine could prevent pandemics, such as the swine flu outbreaks of recent years, and could even end the need for a seasonal flu jab.

A universal vaccine would save the time and money now needed to create vaccines to fight whatever particular virus has emerged in any given year.  The process of developing a seasonal vaccine takes at least four months and if the flu strain is highly pathogenic the delay means people get sick and die before the vaccine is ready.

If we were using the same vaccine year in, year out, it would be more like vaccinating against other diseases like tetanus,” said Gilbert. “It would become a routine vaccination that would be manufactured and used all the time at a steady level. We wouldn’t have these sudden demands or shortages – all that would stop.”

While traditional vaccines prompt the body to create antibodies, Gilbert’s vaccine boosts the number of the body’s T-cells, another key part of the immune system which can identify and destroy cells that have been infected by a virus.

In her trial, Gilbert vaccinated 11 healthy volunteers and then infected them, along with 11 non-vaccinated volunteers, with a strain of flu virus.  She then monitored the volunteers’ symptoms twice a day.  Her results showed that the vaccine worked as planned.

Fewer of the people who were vaccinated got flu than the people who weren’t vaccinated,” said Gilbert. “We did get an indication that the vaccine was protecting people, not only from the numbers of people who got flu but also from looking at their T-cells before we gave them flu. The people we vaccinated had T-cells that were more activated. The people we hadn’t vaccinated had T-cells as well but they were in a resting state so they would probably have taken longer to do anything. The volunteers we vaccinated had T-cells that were activated, primed and ready to kill. There were more T-cells in people we vaccinated and they were more activated.”

The trial proved two important things about the vaccine: First, it showed that it was safe; and second it proved that giving people flu virus in the presence of lots of T-cells induced by the vaccine was absolutely fine.

What we’ll probably do is take the existing flu vaccine and mix in the new virus-vector vaccine, so you get both good antibodies and good T-cells. As well as giving you the antibodies for this season’s strain of flu, we’ll give you some T-cells that will cover this season, next year, and thereafter. It may not be 100% effective against all strains, but at least if there were a pandemic coming around, it would cover you for any strain.”

It is also believed that the vaccine could provide better protection against flu for older people. Traditional flu vaccines are effective in about 70-80% of young people, but only 30-40% of older people, because the older people’s immune systems are less efficient at making new antibodies.

The next step for the new vaccine is a larger scale trial comparing several thousand people who are given and not given the vaccine.

Although that means a commercial product is still some years away, this study represents some potentially very exciting findings not only for flu but possibly for other infectious diseases.

SRxA’s Word on Health looks forward to bringing you this news as it happens.

Hope for hard-to-match kidney patients

The first (unsuccessful) human-to-human kidney transplant took place 75 years ago.  Some 16 years later, the first successful human transplant took place. Now, according to the United Network for Organ Sharing (UNOS), there are currently 111,714 people in the US awaiting organ transplantation.  Approximately 20,000 of these are so called “hard-to-match” kidney transplant patients.

In other words, their immune systems will reject most kidneys because of antibodies circulating in their blood that react to proteins known as human leukocyte antigens (HLA). These proteins are found on most cells and are used by the immune system to recognize what is foreign to the body.

In HLA-sensitized patients, the body has been exposed to foreign HLA in the past, either through pregnancy, blood transfusion or previous kidney transplant. As such, it immediately recognizes most donor organs as unfamiliar. And, unless these antibodies can be removed, they will result in severe antibody mediated rejection (AMR) and early loss of the transplanted organ.

Apart from the scarcity of donor kidneys, the biggest barrier to kidney transplant is the percentage (nearly 1:3) of patients on the waiting list whose immune systems make them likely to reject most kidneys available to them. Highly HLA-sensitized patients are very difficult to match with less than 7% receiving transplants each year.

SRxA’s Word on Health was therefore interested to hear of a new study from Johns Hopkins which showed that desensitizing such patients with a combination of therapeutic plasmapheresis and intravenous immunoglobulin (IVIG) doubled their chance of survival eight years after transplant surgery, as compared with those who stay on dialysis awaiting compatible organs.

Additionally, the protocol enabled a dramatic 98% transplant rate rather than the traditional 7%.

The results of this study should be a game changer for health care decision makers, including insurance companies, Medicare and transplant centers,” said lead investigator Robert A. Montgomery, M.D., D. Phil. “There’s a dramatic survival benefit, so people should take note. If this were a cancer drug that doubled chances of survival, people would be lined up out the door to get it. It’s really extraordinary to go from 30 percent survival to 80 percent survival after eight years.”

Widespread use of the pre-surgery protocol developed at Johns Hopkins could potentially lead to 3,000 more kidney transplants from living donors each year. The protocol uses plasmapheresis to remove the HLA from the blood before the transplant, then the patient receives low-dose intravenous immune globulin (a human plasma protein) to replace the problematic antibodies and prevent their return. This process is performed every other day for several days before transplant and then for up to 10 days following the surgery.

Although the protocol has great benefit in living donor transplants, it cannot be used in patients receiving cadaver organs – where time is of the essence,  because several days of plasmapheresis and IVIG are needed before surgery can take place.

Additionally, the patient will still to take the same anti-rejection drugs as all other organ transplantation patients.

The desensitization protocol also makes kidney transplants more expensive, However, the cost savings when compared to remaining on dialysis are enormous. Better still, the patient no longer has to endure the difficulties of dialysis, a process that takes about five hours a day, three days a week, and which often makes the tasks of daily life from working to caring for children nearly impossible.

“This treatment increases survival, ensures a better lifestyle and saves the health care system money,” says Montgomery. “There aren’t many things like that.”

Let’s hope healthcare insurers are reading this and taking note.