Allegy & Immunology News

Local administration of glucocorticoids decrease synovial citrullination in rheumatoid arthritis
Protein citrullination is present in the rheumatoid synovium, presumably contributing to the perpetuation of chronic inflammation in the presence of specific autoimmunity. As a result, the present study examined and found that effective anti rheumatic treatment will decrease the level of synovial citrullination with glucocorticoids which decrease synovial inflammation by decreasing the level of citrullination.

Long-Term Biologic Use in RA Cuts MI, Cancer Risk
Long-term treatment with the biologic agent etanercept (Enbrel) reduces a rheumatoid arthritis patient's risk of heart attack and malignancy, and may also reduce the risk of death, when compared with therapy using disease-modifying anti-rheumatic drugs, researchers suggested here. Over a five-year period, malignancy rates were lower for patients on etanercept – 13.6 per 1,000 patient-years – than for the other drugs, at 23 per 1,000 patient-years (P=0.023), Duncan Porter, MD, of the University of Glasgow in Scotland, determined.

Most nocturnal asthma symptoms occur outside of exacerbations and associate with morbidity
Although nocturnal awakenings help categorize asthma severity and control, their clinical significance has not been thoroughly studied. This article sought to determine the clinical consequences of nocturnal asthma symptoms requiring albuterol (NASRAs) in children with mild-to-moderate persistent asthma outside of periods when oral corticosteroids were used for worsening asthma symptoms. Overall it was shown that nocturnal symptoms requiring albuterol in children with mild-to-moderate persistent asthma receiving controller therapy occurred predominantly outside of exacerbation periods. Despite being poor predictors of exacerbations, they were associated with increases in albuterol use, school absences, and doctor contacts the day after nocturnal symptom occurrences.

Lack of evidence for a protective effect of prolonged breastfeeding on childhood eczema
Exclusive breastfeeding for at least 4 months is recommended by many governments and allergy organizations to prevent allergic disease. This article attempted to investigate whether exclusive breastfeeding protects against childhood eczema. Although there was a protective effect of ever having been breastfed on more severe disease, we found no evidence thatexclusive breastfeeding for 4 months or longer protects against eczema. Our results are consistent with findings from a recent systematic review of prospective studies. The U.K. breastfeeding guidelines with regard to eczema should be reviewed. Intervention studies are now required to explore how and when solids should be introduced alongside breastfeeding to aid protection against eczema and other allergic diseases.

Propranolol vs Corticosteroids for Infantile Hemangiomas
The authors of this article sought to determine whether propranolol therapy is safe and effective and superior to oral corticosteroids for treating infantile hemangiomas (IHs). They found that Propranolol therapy was more clinically effective and more cost-effective than oral corticosteroids in treating IHs. It also resulted in fewer surgical interventions and demonstrated better tolerance, with minimal adverse effects, compared with oral corticosteroids. Therefore, propranolol should be considered a first-line agent given its safety and efficacy in the treatment of IHs.

Rheumatoid Arthritis Drugs May Help Curb Diabetes Development, Study Finds
Drugs for rheumatoid arthritis and psoriasis, led by Johnson & Johnson (JNJ)’s Remicade and Abbott Laboratories (ABT)’ Humira, may stave off diabetes, a study suggests. Patients using Remicade, Humira or Amgen Inc. (AMGN)’s Enbrel had a 38 percent lower risk of developing diabetes, according to the report in the Journal of the American Medical Association. Those on hydroxychloroquine, a generic drug for rheumatoid arthritis and malaria, had a 46 percent lower risk, the study found. Rheumatoid arthritis, which damages joints, and psoriasis, marked by thick, itchy skin patches, are inflammatory ailments. Their treatments may fight diabetes by suppressing the immune system or slowing the body’s metabolism of insulin, said Daniel Solomon, a researcher at Brigham and Women’s Hospital in Boston. The results provide added information on diabetes and may one day help prevent and control it, the investigators said.

First new lupus drug approved in more than a half-century
Benlysta (belimumab) has received FDA approval for the treatment of patients with active, autoantibody-positive lupus (systemic lupus erythematosus) who are receiving standard therapy, including corticosteroids, antimalarials, immunosuppressives, and NSAIDs, the agency announced. This is the first new lupus drug approval in the past 56 years. Previously, the FDA gave approval for hydroxychloroquine(Drug information on hydroxychloroquine) and corticosteroids (in 1955) andaspirin(Drug information on aspirin) (in 1948) to be used for lupus.

Benlysta is delivered via intravenous infusion, the FDA noted. The agent is the first inhibitor designed to target B-lymphocyte stimulator protein, which may reduce the number of abnormal B cells thought to be a problem in lupus. Benlysta was developed by Rockville, Maryland–based Human Genome Sciences Inc, which will comarket the drug in the United States with GlaxoSmithKline of Philadelphia.

Canakinumab Tames Gout Flares
The monoclonal antibody canakinumab (Ilaris) provided rapid pain relief in acute flares of gout in patients with difficult-to-treat disease, according to results of a randomized trial reported here.

In the month-long trial of 200 gout patients, 78% of those receiving the highest dose of canakinumab achieved 75% or more reduction in pain by 72 hours, and 96% had at least a 50% reduction in pain, according to Alexander So, MD, of the University of Lausanne in Switzerland, and colleagues.

In contrast, only 45% of those assigned to triamcinolone acetonide had a 75% reduction in gout pain by 72 hours and 61% had a 50% reduction, So reported during an oral presentation at the annual meeting of the British Society for Rheumatology here.

Acetaminophen use linked to risk for wheeze in young children
The use of acetaminophen (paracetamol) in early life is associated with an increased risk for wheeze in young children, study results suggest.

Writing in the American Journal of Respiratory and Critical Care Medicine, Alemayehu Amberbir (Addis Ababa University, Ethiopia) and team explain: "Acetaminophen has been hypothesized to increase the risk of asthma and allergic disease… but evidence from longitudinal cohort studies is lacking."

Salmonella and Campylobacter infection not linked to increased IBD risk
Infection with enteric Salmonella or Campylobacter is unlikely to increase the risk for inflammatory bowel disease (IBD), say researchers who suggest that any observed association is due to detection bias as a result of increased stool testing of these patients. As reported in the journal Gut, Morten Frisch (Statens Serum Institut, Copenhagen, Denmark) and colleagues evaluated claims that enteric pathogens such as Salmonella or Campylobacter could be implicated in the development of IBD.

High levels of Crohn's disease-associated anti-microbial antibodies are present and independent of colitis in chronic granulomatous disease
Chronic granulomatous disease (CGD) and inflammatory bowel disease (IBD) have overlapping gastrointestinal manifestations. Serum antibodies to intestinal microbial antigens in IBD are thought to reflect a loss of tolerance in the setting of genetically encoded innate immune defects. CGD subjects studied here, with or without colitis, had considerably higher levels of ASCA IgA, ASCA IgG, anti-OmpC, anti-I2, and anti-CBir1, but absent to low pANCA, compared to IBD-predictive cutoffs. Higher antibody levels were not associated with a history of colitis. Except for higher ASCA IgG in subjects < 18 years, antibody levels were not age-dependent. In comparison, 7 HIES subjects expressed negative to low antibody levels to all of these antigens; none had colitis. Our results suggest that markedly elevated levels of antimicrobial antibodies in CGD do not correlate with a history of colitis but may reflect a specific defect in innate immunity in the face of chronic antigenic stimulation.

Factors predicting inhaled corticosteroid responsiveness in African American patients with asthma
African American patients disproportionately experience uncontrolled asthma. Treatment with an inhaled corticosteroid (ICS) is considered first-line therapy for persistent asthma. We sought to determine the degree to which African American patients respond to ICS medication and whether the level of response is influenced by other factors, including genetic ancestry. Among 147 participating African American patients with asthma, average improvement in FEV1 after 6 weeks of ICS treatment was 11.6%. The mean proportion of African ancestry in this group was 78.4%. The degree of baseline bronchodilator reversibility was the only factor consistently associated with ICS responsiveness, as measured by both an improvement in FEV1 and patient-reported asthma control. Although baseline pulmonary function parameters appear to be associated with the likelihood to respond to ICS treatment, the proportion of genetic African ancestry does not. This study suggests that genetic ancestry might not contribute to differences in ICS controller response among African American patients with asthma.

Mild Asthma Often Over-Treated
Many people with seemingly mild asthma may be over-treated -- at a higher cost without any noticeable clinical benefit, according to a retrospective analysis reported here. The analysis, based on medical and pharmacy claims for almost 8,500 asthma patients, showed that about two thirds of the patients were prescribed a combination of inhaled corticosteroids and long-acting beta-agonists, adding more than $1,00 to their drugstore bill, said Thomas Manley, BSPharm, of Medco Health Solutions in Franklin Lakes, NJ. Only 34% of the patients were prescribed less expensive inhaled corticosteroids alone -- the recommended therapy for mild asthma, Manley reported at the annual meeting of the American College of Allergy, Asthma, and Immunology.

Erectile Dysfunction Drug Potent in Raynaud's
A drug developed to help men overcome erectile dysfunction appears to successfully heal finger ulcers associated with Raynaud's phenomenon -- mainly among women. Of the 18 patients in the study assigned to receive tadalafil (Cialis) who were observed with finger ulcers at the start of the trial, 14 exhibited healed lesions within eight weeks, compared with five healed ulcers among 13 patients who were on placebo (P=0.026), according to Vikas Agarwal, MD, associate professor of clinical immunology at the Sanjay Gandhi Postgraduate Institute of Medical Services, Lucknow, India.

Azithromycin induces anti-viral responses in bronchial epithelial cells
The majority of asthma exacerbations are caused by rhinovirus. Currently the treatment of asthma exacerbations is inadequate. Previous evidence suggests that macrolide antibiotics have anti-inflammatory and antiviral effects; however, the mechanism is unknown. This article investigated the anti-rhinoviral potential of macrolides through the induction of antiviral gene mRNA and protein. Azithromycin, but not erythromycin or telithromycin, significantly increased rhinovirus 1B- and rhinovirus 16-induced interferons and interferon-stimulated gene mRNA expression and protein production. Furthermore, azithromycin significantly reduced rhinovirus replication and release. Rhinovirus induced IL-6 and IL-8 protein and mRNA expression were not significantly reduced by azithromycin pre-treatment. In conclusion, the results demonstrate that azithromycin has anti-rhinoviral activity in bronchial epithelial cells and, during rhinovirus infection, increases the production of interferon-stimulated genes.

Johns Hopkins Researchers Turn Off Severe Food Allergies In Mice
Johns Hopkins scientists have discovered a way to turn off the immune system's allergic reaction to certain food proteins in mice, a discovery that could have implications for the millions of people who suffer severe reactions to foods, such as peanuts and milk. The findings, published online in the journal Nature Medicine, provide hope that the body could be trained to tolerate food allergies that lead to roughly 300,000 emergency room visits and 100 to 200 deaths each year.

New treatment for severe vasculitis?
A new strategy for treating patients who have antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, a severe form of vasculitis, provides the same benefits as the current standard of care used for more than 40 years but requires less frequent treatments. Early results of an NIH-sponsored study suggested that patients with disease relapses—typically recurrences of fever, fatigue, kidney damage, or bleeding in the lungs—respond better to the new regimen.

The current standard of care for ANCA-associated vasculitis combines a 3- to 6-month course of daily cyclophosphamide plus corticosteroids, followed by long-term daily azathioprine (AZA) plus corticosteroids. Before this treatment regimen became available, about 80% of patients died as a result of kidney failure or bleeding in the lungs within 2 years of disease onset, it was noted. Now more than 90% of patients experience remission after they receive cyclophosphamide-based therapy, but a high rate of relapse and a need for re-treatment remain, according to researchers.

Acute transverse myelitis and antiphospholipid antibodies in lupus. No evidence for anticoagulation
Current views suggest that prothrombotic properties of antiphospholipid antibodies (aPL) have a role in the development of acute transverse myelitis (ATM) in patients with systemic lupus erythematosus (SLE). Consequently, empiric anticoagulation may be included in these patients’ treatment. This article performed a systemic review of the literature to explore the clinical value of the presence of aPL in patients with lupus myelitis and the possible effectiveness of anticoagulation. Overall the detection of circulating aPL at ATM onset appears unreliable to suggest a thrombotic cause and perhaps not enough to dictate therapeutic anticoagulation. Registry creation of ATM in patients with SLE is needed to obtain more definite answers on the role of aPL in this condition.

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