For some people, an allergy is a lot more serious than a runny nose; their allergies can literally kill them. Anaphylaxis is a whole-body, rapid-onset, life-threatening allergic reaction. There are approximately 1,500 deaths in the U.S. every year due to anaphylaxis. Symptoms may include breaking out in hives or a rash, a swollen tongue or throat, trouble breathing, wheezing, and even respiratory arrest.
Because of the potential consequences, St. Louis allergist Dr. Ray Davis, professor of clinical pediatrics at Washington University School of Medicine, is a member of the national Anaphylaxis Community Experts (ACE). “Food allergies in particular have become epidemic in this country. Our problem is not being able to predict if a known allergen will cause anaphylaxis,” he says. “A rash with last exposure could lead to respiratory arrest with the next one. We want families and schools to be prepared to act quickly.”
Davis says the first line of therapy is using an EpiPen, a pre-loaded automatic syringe containing epinephrine, along with prompt 911 help. Don’t try to get your child to the ER. Administer the epinephrine as soon as any symptoms occur, and have paramedics come to you. The most frequent triggers are drugs, bee stings and food allergies such as peanuts, but any food can do it in a susceptible person. ACE’s goal is to prepare parents and schools to have a response plan: know the suspect foods, let everyone else know, recognize the symptoms, and respond quickly with an EpiPen and by calling 911.
If you suspect your child has a food allergy, get him tested. Chances of dying from anaphylaxis are increased with exposure to the allergen, the presence or history of asthma symptoms, and delay in giving epinephrine. One child had an allergy to milk, resulting in a rash. A year later, his mother accidently used real milk in a muffin mix. He got a rash and she didn’t use the EpiPen. He was rushed to the ER in shock, where he was given epinephrine and fluids, but still died, Davis relates. “You have to administer it at the first sign of any allergic reaction.” Helpful websites include: aanma.org/anphylaxis, where forms can be downloaded to fill out and take to school, and acaai.org, the American College of Allergy, Asthma & Immunology.
Heart attack patients without a heartbeat do better when lay bystanders perform only chest compression rather than chest compression and rescue breathing, according to an analysis at Washington University School of Medicine. Dr. Peter Nagele, the lead investigator and chief of trauma anesthesiology at Barnes-Jewish Hospital, took data from three studies to determine the survival benefit.
The studies looked at bystanders who called 911 and were instructed by the dispatcher to do chest compression-only CPR. Their proficiency in CPR had no impact because it was relatively simple for a bystander to find the proper area on the chest and keep doing compressions until medical assistance arrived.
Nagele says that even though a well-coordinated effort of rescue breathing and chest compression is the gold standard, if EMS can respond quickly, compressions can mean the difference between life and death. “Only one-third of bystanders to an arrest do anything,” he notes. “If they call 911 and are coached to do compression-only CPR they can be a bridge to survival. It depends on the likelihood of quick EMS or defibrillator response. Ten to 15 minutes without CPR gives the person no chance of survival. Call 911 and do something. If it’s a witnessed arrest, start compressions immediately. Have someone else call 911 and send someone for an automated external defibrillator (AED) if it’s available, but keep doing compressions. When EMS can respond quickly, compression-only can bridge the gap. At some point, everyone needs oxygen.”
Arrests in children or drownings are different. Oxygen is much more critical, so rescue breathing should be included. Nagele says it is rare for kids to go into cardiac arrest from a primary heart problem. It is more likely to be secondary to a severe asthma attack, an allergic reaction or something else unrelated to the heart. Those situations call for oxygen. He strongly recommends chest compression and rescue breaths in kids, or rescue breathing alone where a pulse is present but the person isn’t breathing.
Low Testosterone & Alzheimer’s
A recent study of 153 Chinese men demonstrated that low testosterone was an independent risk factor for the development of Alzheimer’s disease in older men. When the study started, the men, who were 55 or older didn’t have dementia, but most had some mild memory loss. Within a year, 10 of those with memory loss developed probable Alzheimer’s disease. When tested, they also had low testosterone in their body tissues. Dr. John Morley, one of the study investigators and director of geriatric medicine at Saint Louis University, was excited about the finding. “Ten years ago we had a mice model with low testosterone and Alzheimer’s symptoms. When we gave them supplemental testosterone, it blocked the beta amyloid production and they got better,” Morley notes. “In the Hong Kong study, those patients with low testosterone went on to develop Alzheimer’s much faster, within a year. Low levels of this hormone seem to allow beta amyloid, the plaque found in the brains of Alzheimer’s patients, to proliferate.”
The Hong Kong findings were consistent with finding in other small studies of older Caucasian men. The next step, says Morley, is to conduct a large-scale study to investigate the use of testosterone in preventing Alzheimer’s disease. At this point, he doesn’t want people running to their doctor to get it. “They need to have symptoms of low testosterone, such as decreased libido or impotence, before we’d test for it. Then if it’s low we would prescribe it for those symptoms. We still need to do larger studies to find out if it’s logical to give testosterone supplements to prevent dementia, and to determine what the long-term effects might be.”
Neurofibromatosis 1 & ADD
One in 3,000 children are born with an inherited condition called neurofibromatosis1 (NF1), a tumor disorder caused by the malfunction of a gene on chromosome 17 responsible for cell division. That’s more than cystic fibrosis and muscular dystrophy combined. Those with the disorder can have multiple symptoms: non-cancerous lumps, scoliosis (curvature of the spine), eye problems and even epilepsy. One in five NF1 children develops brain tumors. A recent mouse study at Washington University School of Medicine discovered that NF1 can also impair development of the brain system that facilitates attention, which helps explain why ADD and learning disabilities are sometimes seen in these children.
Dr. David Gutmann, professor of neurology at Washington University and director of the NF Center, says that they were able to restore normal attention levels with Ritalin. He finds the significance of this startling. “Two-thirds of kids with NF1 have attention problems and a wide spectrum of learning problems. The majority are attention-deficit, but without hyperactivity. There has been reluctance on the part of parents to use Ritalin. This study demonstrated in a mouse model exactly how Ritalin works to help this problem, by affecting dopamine levels. In NF mice with attention deficit, dopamine levels were very low. We gave them Ritalin and improved attention by increasing dopamine. It’s a good example of how mouse models help us make sense of why certain drugs work in people.”
Parents can find useful information at nfcenter.wustl.edu/.
Older Colitis Patients
Adults diagnosed with ulcerative colitis after age 50 are more likely to achieve remission than patients diagnosed at younger ages, even with the same or similar treatments. Dr. Matthew Ciorba, assistant professor of medicine in gastroenterology at Washington University School of Medicine, was lead investigator and says that younger people diagnosed with ulcerative colitis are more likely to have a genetic component. “We think those people diagnosed after age 50 have had changes in their immune system or are reacting to environmental exposures,” he says.
Nearly 1 million Americans have ulcerative colitis, an inflammation in the lining of the large intestine leading to abdominal cramping in conjunction with chronic loose stools, frequent diarrhea and sometimes blood in the stool. Treatment starts with relatively mild maintenance drugs related to aspirin (mesalamine) that reduce inflammation in the colon. For more severe cases, immunosuppressants help control diarrhea. Extreme cases may require removal of the colon.
Ciorba says diagnosed cases peak in late teens and early twenties; then again in people over 50. Other studies have shown that after 50, the immune system tends to quiet down somewhat, so that might explain the better response to medications. The current study involved 295 people treated at W.U. School of Medicine between 2001 and 2008. After treatment, 64 percent of patients diagnosed after age 50 were in remission, compared to 49 percent of younger patients.
“Younger patients should not be distressed over this finding. The message is that when you have persistent ulcerative colitis symptoms, seek treatment early. It’s easier to treat before it becomes severe and chronic. It’s also important to know that this is an area of very active research, and new treatment indicators are emerging all the time,” Ciorba says. His team says more research is needed into the environmental and genetic factors that differentiate when the disease arises to determine at what age patients respond to different therapies. Repeat UTIs
Fifteen million cases of urinary tract infections (UTIs) annually drive women to their doctors and cost $1.6 billion to diagnose and treat. The most effective treatment currently is antibiotics, but in 10 percent of women, as soon as the antibiotics are gone, another UTI starts up. Researcher Scott Hultgren, director of the Center for Women’s Infectious Disease Research at Washington University School of Medicine, reports on what the research has shown. “Using a mouse model, we have found that when the immune system overreacts to a UTI, it tends to recur. If the initial infection hangs on long enough to cause bladder damage, then those changes in the bladder walls make later infection more likely.”
Hultgren says it’s important to know why this happens so they can intervene and come up with novel therapies, preferably not antibiotics. E. coli is the most common bacterium involved in these infections, he says, and secretes a glue that helps it gradually invade the bladder walls. “Right now the No. 1 antibiotic for bladder infections is a fluoroquinalone like Cipro, and resistance is on the rise. We’re reaching a tipping point of running out of antibiotics that will work,” he says. Their research, vitally important in dissecting the details of how these bacteria interact with the host, has led to a multi-pronged approach. One prong is a possible vaccine against adhesion of the bacteria so they get flushed out and can alert the immune system that a foreign invader is present.
Another approach is to research the glue itself. The bladder is coated with a sugar called mannose. E. coli has developed the ability to specifically recognize that sugar and bind to it. “We’re now working with chemists to design sugars that are soluble and will bind 1,000 times tighter than mannose, filling the binding space and shutting out the connections for the E. coli. We just finished a mouse study where we gave this preparation orally and it worked,” says Hultgren.
The third approach has been to address the adhesions on the tips of hair-like fibers (pili) on the E. coli. They are developing a pilacide to prevent these fibers from growing. Hultgren says all these approaches are designed to prevent the infection cycle and would initially be given to women with a history of three or more UTIs a year. Later, they may be used as therapy in lieu of antibiotics.
Soy & Asthma
A recent clinical study showed that in people with asthma, the ones who ate the least soy had the most flare-ups. Another pilot study showed patients on soy had increased lung function and decreased hyper-responsiveness to asthma triggers. Based on what we know about soy, a large clinical trial involving 19 sites will compare asthma attacks between a placebo group and a group that consumes two capsules of soy isoflavones a day. Dr. Mario Castro, a lung specialist at Barnes-Jewish Hospital and lead investigator for the W.U. study site for Soy Isoflavones in Asthma (SOYA) study, says the asthma rate in the U.S. has increased to 12 percent in recent years. One reason for that increase might be our decreased consumption of food rich in antioxidants, like soy.
Isoflavones are powerful antioxidants found in soy products like tofu and edamame, as well as in other types of beans, alfalfa sprouts and lentils. They have been linked to lowered risks of heart disease, osteoporosis and even some cancers. They have been shown to slow inflammation, a component in asthma symptoms. However, Castro says, you would have to consume a lot of these foods to get the antioxidant effect contained in two daily capsules.
Nationwide the study will enroll 380 patients 12 years and older who are taking either inhaled corticosteroids or a leukotriene modifier such as Singulair, and who still have some uncontrolled asthma symptoms.
Castro says the beauty of this trial is that the product being used with the test group is Novasoy, already on the market as 50-milligram capsules. Study participants not in the control group will take two of those capsules a day. “The product is freely available and inexpensive, a potentially great alternative to drugs,” Castro says.
Siblings of Autistic Children
Brothers and sisters of children with autism have more language delays and other subtle characteristics of autism than previously thought. A new study by researchers at Washington University School of Medicine found traits in siblings more pronounced than in the general population. Dr. John Constantino, first author and the director of child and adolescent psychiatry at Washington University, says their findings indicate that it’s possible additional children in the family are affected in some degree by the same genes that contribute to autism in their siblings.
The study found that one in five siblings thought to be unaffected actually had language delays or speech problems early in life. They also noticed that many of the girl siblings had subtle traits, but few had a diagnosis of autism. In some families, Constantino says, they saw a spectrum of symptoms across family members. “It’s hard to put a cut-off on where autism begins, but we find that symptoms occur much more frequently in affected families than in the general population. We know autism is genetic but have located only one gene that accounts for 10 percent of cases.” Constantino says they don’t know if autism is due to a single gene or multiple genetic factors. If many factors have to be present, could they target one of them early in development and derail the condition?
They also found that the genetic influences for autism cross over into other conditions like ADHD and Tourette’s syndrome. Mild symptoms in females might indicate carrier status. “Because children with full-blown autism seldom have offpsring, there are clear implications for offspring of people with these mild symptoms. If we watch them closely as babies, we can intervene quickly and early, and perhaps have better outcomes. Another question yet to answer, Constantino notes, is, If siblings have a susceptibility to autism what kept them from developing it? ¤