Research into IMMUNOTHERAPY

AdminCM · September 13, 2011, 12:25:38 PM

Posted: 06/01/11 at 10:23 am
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Some of these are pretty heavy-weight immunology, but the information is pretty interesting and generally, it will apply to ANY IgE-mediated process and efforts to 'tweak' the immune system. So it applies to notions of what "outgrowing" means, what to look for in terms of markers for that, what immunotherapy causes in terms of changes to the immune modulators, etc.

from 2008:

http://iji.sums.ac.ir/march2008/1stiji_vol5_no1_2008.pdf

This one is a bit older (2001) but has some pretty clear explanations (it's much more readable than most):

http://www.greerlabs.com/files/Library/Clinical-Resources/Allergen-Immunotherapy-Curr-AA-Rep-2001.pdf

http://www.allergy-clinic.co.uk/more-about-allergy/desensitization-immunotherapy/

That one is from an individual physician in the UK-- but it seems current and, from what I can tell, accurate--

Quote
How does immunotherapy work at a cellular level?
The exact immuno-modulatory mechanism by which desensitization immunotherapy switches off allergies is uncertain. It was hypothesised that specific "IgE blocking" antibodies were produced, as during successful immunotherapy an initial increase in specific IgE was followed by an IgE fall and compensatory rise in IgG (a blocking antibody). Researchers then postulated that specific IgG4 antibodies where induced towards the offending allergen. An associated reduction in mucosal mast cell numbers and a decrease in antigen-induced eosinophil migration to the site of inflammation are noted during immunotherapy. The latest "hot" hypothesis is that immunotherapy modulates the T-helper cells, causing switching from predominantly TH2 (IgE inducing) to predominantly TH1 (IgG inducing) subsets and as a result of this, allergen-specific IgE falls with successful immunotherapy.

Emphasis mine. This is the exact pattern that members have noted in their kids' IgE levels as they proceed through an immunotherapy protocol for a food allergen. It's unfortunate that Dr. Morris doesn't provide citations here, because I think those would be good ones.

This is just about as current as it gets:

"Immunological Mechanisms of Allergen-specific Immunotherapy" Allergy 66, 6, pp725–732, June 2011

I haven't had a chance to read tht one yet.

Oh, wow. This is a fascinating look at food allergy immunotherapy study cohorts/recruitment:

http://pediatrics.aappublications.org/content/124/3/e503.full

A little scary, though.

http://www.pediatricsconsultantlive.com/food-allergies/content/article/1145425/1403856

Author of the above is Dr. J. Stokes of Creighton's Medical School.

Here are a couple about peptide immunotherapy:

http://www.aacijournal.com/content/3/2/53

http://onlinelibrary.wiley.com/doi/10.1111/j.1398-9995.2011.02610.x/abstract

Fascinating stuff, to be sure... but somehow, that one in particular gives me pause as a parent. This one seems promising-- but also potentially with a LOT of unknown, very long-term side effects if the protein fragment happens to be something common and shared with other antigens. Then again, it does reduce risk during immunotherapy... so...

Posted: 06/01/11 at 10:44 am

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Oh, this is a FANTASTIC blog written by Dr. Leickly of Indianapolis' Riley Hospital for Children:

http://www.pediatricallergyindy.com/2011/03/03/notable-articles-on-skin-food-drug-insect-allergy-jaci-2010/

Awesome plain-English summaries of a lot of big ticket research in that post.

VERY recent, and food-specific:

http://www.jacionline.org/article/PIIS0091674911006749/abstract?rss=yes Milk allergy-- baked milk and tolerance. (still 'in press' at this point, but now available on-line)

epicutaneous allergen administration: the future of immunotherapy?

(I'll add more as I find them.)

Posted: 06/10/11 at 05:14 pm

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From the blog:

You have been busy today, good stuff.

From the blog:

"Prolonged avoidance of certain foods to infants at risk of developing food allergy has been the standard advice, however two studies were published that shake this concept, at least for milk and egg allergy. When milk exposure was delayed beyond the 15th day of life, the odds ratio for milk allergy was 19.3. (Odds ratios are the odds that an event will occur compared to the odds that it will not occur). The OR gives an idea of how strongly a variable is associated with an outcome. In this example the odds of milk allergy was 19.3 times more likely to have milk allergy."

Didn't happen to work out this way in my own family.

DD had formula in the hospital and I nursed her for 2 months with a dairy diet=ana to milk

DS had zero milk products until age 2=no allergies

Posted: 06/10/11 at 08:34 pm

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Yeah-- I think that there is a subset of highly atopic kids (mine is another one like that-- we basically DID do what the evidence now suggests is the right stuff) for whom the 'new trends' in atopy during childhood....

do not hold true.

Our kids have MORE allergies, they develop them earlier, they have lower thresholds (even if we don't 'over-avoid' allergens) and they last longer... much longer... than they are supposed to.

So there are kids that shouldn't have developed FA at all a generation ago (and maybe haven't NOW, either-- aside from increased vigilance concerning what counts as "reaction history" to an allergen and is therefore worth testing for)...

those that should have outgrown all their FA's by school age and never been at real risk of anaphyalaxis (but potentially seem to be now)...

and then there are the kids that *would* probably have been pretty atopic anyway, genetically, would have needed epinephrine prescribed, would probably have had MFA anyway... and those kids are the ones that are probably over-represented by our community here at FAS.

The SUPER-atopic kids. The ones who were born with hives and eczema. The kids who were FTT and an atopic mess from day one.

I'm not sure that most studies accurately capture information about THAT group, and it seems different from the other two, anecdotally speaking.

My DH and I weren't surprised by our DD's food allergies. It was on our radar from day one. The sheer ferocity and number of them, on the other hand... that came as a rude awakening, for sure.

Anyway. I have to wonder about that statisic, Socks. I am glad that you mentioned it again, because even when I read it the first time, I thought, "Huh. Well, THERE's an example of conflating correlation with causation in a big way." Because it seems to me that if children are deliberately NOT exposed to milk proteins... maybe there is a REASON. Parents of super-atopic kids probably DO try to avoid sensitization to soy or milk, particularly if they have experience managing an allergy to either one. <shudders>

My DD's odds of being food allergic were probably (from what we've deduced since) about 10 to 1 already. I'd imagine that most of the parents who deliberately avoid food allergens like that are in a similar situation, where they KNOW already that they have a high risk infant. Makes the comparison start to look like mixed fruit to-- well, kumquats or something, doesn't it?

Posted: 06/12/11 at 10:53 pm

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At the FAAN conference yesterday Dr. James (He's at Colorado Allergy and Asthma Centers)presented a slide that just about made me fall off my chair.

Early exposure to cow's milk is protective against IgE-mediated cow's milk protein allergy.
Feeding histories of more than 13,000 babies in Israel were investigated.
Incidence of cow's milk allergy was determined
.5% of infants dx with IgE mediated cow's milk allergy
Babies who were not routinely given cow milk until 4-6 months of age were at higher risk of IgE mediated cow's milk allergy
Supplementing breastfed babies with cow's milk could help promote tolerance to cow's milk.
JACI 2010;126:77-82.e1

Does this shock you as much as it did me? Doesn't practically the entire medical community say that breast feeding is one of the best things you can do to prevent food allergies? It seems so unnatural and bizarre to me!

Posted: 06/13/11 at 07:16 am

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Yes, that DOES seem bizarre to me, because IMO what the bulk of evidence seems to support is instead having breastfeeding mothers not limit their own diets.

Enough of the proteins pass through breastmilk for there to be oral tolerance established-- if it can be, that is.

Posted: 06/13/11 at 09:21 am

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LOL, This is trending right now on yahoo news -

http://www.news.com.au/breaking-news/infant-formula-linked-to-childhood-diabetes-study-shows/story-e6frfku0-1226073069866

This is a good thread to CONTINUE adding research finds to over time. Let's put together a clearinghouse of immunotherapy resources! This is very helpful for parents considering desensitization or introducing baked egg/milk.

Macabre · January 29, 2013, 06:54:45 PM

We just tweeted this.
Egg oral immunotherapy Presented by Suparat Sirivimonpan, MD. on Jan25, 2013.
www.slideshare.net/AllergyChula/egg-oral-it #foodallergy #eggallergy