Sniffing Out Leukemia?

OK Ladies – here’s a question for you.   If you suffer from seasonal allergic rhinitis who do you go and see?

(a)  An allergist

(b)  An oncologist

(c)  A hematologist

If you answered (a) you’re probably feeling pretty confident right now.  After all the more common term for seasonal allergic rhinitis is hayfever and that’s something best managed by an allergist.  Right?

Not so fast! Maybe (b) or (c) would have been better choices.  You see, a team of scientists looking into the interplay of the immune system and cancer have just found a link between a history of airborne allergies – in particular those to plants, grass and trees – with risk of blood cancers in women.

Notably, the study did not find the same association in men, which suggests a possible gender-specific role in chronic stimulation of the immune system that may lead to the development of hematologic cancers.

The findings were published online last week ahead of the December print issue of the American Journal of Hematology.

“To the best of our knowledge, ours is the first study to suggest important gender differences in the association between allergies and hematologic malignancies,” says Mazyar Shadman, MD, from the Fred Hutchinson Cancer Research Center.

According to Shadman, who led the research, the immune system’s potential role in the cause of cancer is a focus of intense scientific interest. “If your immune system is over-reactive, then you have problems; if it’s under-reactive, you’re going to have problems. Increasing evidence indicates that dysregulation of the immune system, such as you find in allergic and autoimmune disorders, can affect survival of cells in developing tumors.”

The study included a large sample of men and women aged 50-76 years old from western Washington from the VITamins And Lifestyle (VITAL) cohort study. Participants answered a 24-page questionnaire that focused on: (i) health history and cancer risk factors, (ii) medication and supplement use, and (iii) diet. Participants provided information on age, race/ethnicity, education, smoking, diet (fruit and vegetable intake), and other lifestyle characteristics, self-rated health, medical history, and family history of leukemia or lymphoma.

History of asthma and allergies was also taken, including allergies to plants, grasses or trees; mold or dust; cats, dogs or other animals; insect bites or stings; foods; and medications.  Of the 79,300 VITAL participants who filled out the questionnaires, more than 66,000 individuals were selected after eliminating those who had a prior history of malignancies other than non-melanoma skin cancers and missing information on baseline cancer history.

Participants were then followed for eight years until they either withdrew from the study, moved away, had a cancer diagnosis other than hematologic malignancy or non-melanoma skin cancer, or died.

Incidence of hematologic malignancies and other cancers was identified via the Surveillance, Epidemiology and End Results (SEER) cancer registry of western Washington.

Of the participants, 681 developed a hematologic malignancy during the follow-up period. These participants were more likely to have two or more first-degree relatives with a family history of leukemia or lymphoma, to be less active and rank their health status as low.

A history of allergies to airborne antigens was associated with a higher risk of hematologic malignancies. The most statistically significant association was seen with allergies to plants, grass and trees.

There was also an increased risk of plasma-cell neoplasms for participants who reported a history of allergies to cats, dogs or other animals. Plasma-cell neoplasms are conditions, both cancerous and noncancerous, in which the body makes too many plasma cells.

When stratified by gender, the incidence of blood cancers in response to these allergens was increased in women but not in men. The reason for this is as yet unknown.

However, Shadman and colleagues warn, “Given the limited number of cases within each sub-type of hematologic cancer, the risk estimates need to be interpreted with caution … and the possibility of chance finding due to multiple testing should be recognized.”

Even so, if you’re a women with allergies, you may want to keep a close eye on your blood work.

Pine Powder Puts an End to Sneezing

According to researchers at the University of Gothenburg, the end may be in sight for allergy sufferers.  Patients plagued by the misery of seasonal allergic rhinitis, better known as hay fever, can be cured, thanks to a powder derived from pine trees.

Cellulose nasal sprays like Nasaleze and Nasal Ease, have been on the market for years, but there wasn’t scientific evidence they worked – until now.

Now in this latest study, scientists found that the pine tree powder forms a barrier on the mucous membrane when puffed into the nose, filtering out allergens such as tree and flower pollen.

“The cellulose powder has no adverse effects, and this fact makes it a particularly attractive treatment for children,” said study author Dr. Nils Aberg, Associate Professor in the Department of Pediatrics.

The double blind, placebo-controlled  study, was carried out during the birch pollen season and involved 53 children and adolescents aged 8 – 18 years with allergies to pollen. Participants puffed the pine-tree derived cellulose powder in the nose three times daily for four weeks. They also took a daily dose of an oral antihistamine.
Pollen levels were measured every day and were subsequently analyzed in relation to the symptoms reported by the children. Patients or their parents were reminded to report their symptom scores using daily SMS messages sent to their mobile phones.
Results showed a statistically significant reduction in total symptom scores from the nose.  Further data for the study, published in Pediatric Allergy and Immunology, came from past unpublished statistics of pollen levels collected for 31 years at the same location in Gothenburg, from 1979 to 2009.

Dr. Aberg added: “We showed that the nasal symptoms of the children were significantly reduced in those who used the cellulose powder. The best effect was obtained at low to moderate concentrations of pollen”.

Word on Health asked leading allergist, Dr. Bill Storms for his reaction to this study.  He told us, “It appears that the  waxy coat of the pine tree pollen might line the inside of the nose after sniffing it and  this might prevent other pollens from getting into the mucus membranes. However, I note that patients were asked to do this three times a day and I’m not sure how many will do this.  I also wonder if there are any long term effects of putting cellulose in the nose.”

As we’ve said so many times before, further studies are needed.

Synchrotron scientists suggest solution to sneezing sans sleepiness

As allergy sufferers we know all too well that although many over-the-counter antihistamines relieve symptoms, we’re are often too groggy to enjoy the respite. Now, thanks to some sleuth work by a team of international scientists, the way has been paved for antihistamines with fewer side-effects.

An international team of scientists has successfully cracked the  code for the complex 3-D structure of the human histamine H1 receptor protein. Using an X-ray beam 100 billion times stronger than normal,  at Diamond Light Source, the UK’s national synchrotron facility, researchers were able to get a 3D picture of the shape of H1 receptors.

Published this week in Nature, this discovery opens the door for the development of ‘third-generation’ antihistamines.

The H1 receptor protein is found in the cell membranes of various human tissues including airways, vascular and intestinal muscles, and the brain. It binds to histamine and has an important function in the immune system. However, in susceptible individuals it can cause allergic reactions such as hay fever, food allergies and pet allergies. Antihistamine drugs work because they prevent histamine attaching to H1 receptors.

Dr. Simone Weyand, postdoctoral scientist at Imperial College London, who conducted much of the experimental work at Diamond, said: “First-generation antihistamines are effective, but not very selective, and because of penetration across the blood-brain barrier, they can cause side-effects including sedation, dry mouth and arrhythmias.”

The team comprised of leading experts from The Scripps Research Institute in California, Kyoto University, Imperial College London and Diamond worked for 16 months on the project.

Professor So Iwata, Director of the Membrane Protein Laboratory at Diamond, said: “It took a considerable team effort but we were finally able to elucidate the molecular structure of the histamine H1 receptor protein and also see how it interacts with antihistamines. This detailed structural information is a great starting point for exploring exactly how histamine triggers allergic reactions and how drugs act to prevent this reaction.”

Word on Health’s allergy prone bloggers will be eagerly awaiting developments and will bring you news as it happens…assuming of course we can stay awake to do so!

Survey Reveals Unmet Needs Among Patients with Allergic Rhinitis

SRxA’s Word on Health team spent the last week attending the American Academy of Allergy Asthma & Immunology Annual Meeting in San Francisco. In addition to spending quality time with many of our KOL Allergy Advisors and pharmaceutical clients, we were able to catch up with some of the latest research on allergic rhinitis (AR).

Allergic rhinitis is an allergic reaction that happens when the immune system overreacts to inhaled, such as pollen. This causes release of a type of antibody, known as IgE, into the nasal passages, along with inflammatory chemicals such as histamines. The two types of allergic rhinitis are seasonal allergic rhinitis (hay fever) and perennial allergic rhinitis, which occurs year-round. Hay fever is caused by outdoor allergens. Perennial allergic rhinitis is caused by indoor allergens such as dust mites, pet dander, and mold.

Results from a recent pivotal AR satisfaction survey assessing patient and healthcare provider perspectives on AR reveal that symptoms like nasal congestion and post-nasal drip continue to impact patients’ daily activities.

Findings from the Nasal Allergy Survey Assessing Limitations (NASL) 2010, highlight the continued unmet need for more effective treatment options to help reduce symptoms and overall disease burden of AR.

The prevalence of AR in the U.S. has increased during the past three decades.  It is now estimated that 20% of the general adult population and almost 40% of children have the condition.  Of the estimated 60 million Americans affected with AR, approximately 20% have seasonal allergic rhinitis (SAR), 40% have perennial allergic rhinitis (PAR), and 40% have a combination of the two (i.e., PAR with seasonal exacerbations) depending on the allergen sensitivity.

In other words, one in 5 adults and almost half of children suffer from symptoms including:

• Stuffy, runny nose
• Sneezing
• Post-nasal drip
• Red, itchy, and watery eyes
• Swollen eyelids
• Itchy mouth, throat, ears, and face
• Sore throat
• Dry cough
• Headaches, facial pain or pressure
• Partial loss of hearing, smell, and taste
• Fatigue
• Dark circles under the eyes

According to NASL 2010, nasal congestion, post-nasal drip and repeated sneezing continue to be the most frequently reported nasal allergy symptoms among patients. Beyond physical symptoms, AR patients experience emotional burdens, like feeling tired and miserable. When assessing the impact nasal allergies have on productivity, the survey revealed that patients are less productive when their nasal allergies are at their worst, limiting them from doing well at work.

“It’s clear from the NASL 2010 findings that the estimated 60 million people living with allergic rhinitis in the U.S. are still significantly affected, both physically and emotionally, by symptoms,” said Gary Gross, M.D. FAAAAI, Dallas Allergy & Asthma Center, Dallas, Texas. “This is a continuing trend we’re seeing in patients having allergic rhinitis as these findings are similar to those released in a past survey evaluating disease burden on patients. The NASL survey results further support the need for more effective treatment options that address these specific issues for patients living with allergic rhinitis.”

Nasal allergies can make it difficult for people to take part in both indoor and outdoor activities if their symptoms are not well controlled. According to NASL 2010, less than 20% of surveyed patients felt their nasal allergies were completely controlled over a one week time period. The vast majority of allergists, otolaryngologists and primary care providers interviewed in the survey stated intranasal corticosteroid sprays as their preferred treatment of choice for adults with moderate to severe persistent nasal allergies.

Because of its prevalence and health effects, AR is associated with considerable direct and indirect costs.  Latest estimates suggest that AR alone results in a staggering  $11.2 billion in healthcare costs, 12 million physician office visits, 2 million days of school absences and 3.5 million lost work days per year. In addition, the presence of co-morbidities such as asthma and sinusitis further increase AR-related treatment costs.

Word on Health will be bringing you more from AAAAI in the coming days, including some exciting new treatment options being developed for allergic rhinitis.