Oral Immunotherapy For Peanut Allergy Shows Promise For Very Young Children

Oral Immunotherapy For Peanut Allergy Shows Promise For Very Young Children

A new study addresses peanut allergy, which affects 2 percent of children in the U.S. and has potentially fatal consequences. (National Institute of Allergy and Infectious Diseases)

By Martin M Barillas

Allergic reactions to peanuts can be fatal, but a new trial dubbed IMPACT showed that a majority of peanut-allergic children under the age of four achieved desensitization after receiving experimental immunotherapy, and one in five achieved remission.

Around 2 percent of children in the United States have peanut allergy and most remain allergic throughout life. Advised to avoid peanuts to avoid a dangerous anaphylactic reaction, the danger of accidental exposure nevertheless remains. A life-saving epinephrine injection can help.

The trial recruited 146 peanut-allergic children ages 1 to 3 to participate. Some were given small amounts of peanut protein powder that gradually increased to 2,000 milligrams daily (roughly equal to six peanuts) under supervised conditions for 30 weeks. Some were randomly assigned to be given a placebo powder.

For the next two years, the children were given a daily dose of the peanut or placebo powder. After that, the children underwent an oral food challenge in which they received gradually increasing doses of peanut protein up to a cumulative maximum of 5 grams., equivalent to about 16 peanuts.

They then stopped treatment and avoided peanut for six months.

The children then underwent a second food challenge with 5 grams of peanut protein powder. Those who did not have an allergic reaction were given about two tablespoons of peanut butter on a different day to confirm remission.

At the end of the treatment period, 71 percent of children who received the peanut protein were desensitized to peanut, meaning they could consume 5 grams of peanut powder during the first food challenge without having a reaction. After six months of avoidance 21 percent of the children were able to do the second food challenge without having a reaction, which the researchers define as remission.

That one out of five children achieved remission is a major breakthrough, according to the authors of the study, published in The Lancet, but results are even better among those who started the trial at younger ages.

Children who were younger at the start of the trial were more like to achieve remission. Among those who started at age 1, 71 percent achieved remission, while 35 percent of 2-year-olds and 19 percent of 3-year-olds achieved remission.

EpiPen, which dispenses epinephrine through an injection mechanism for people with severe allergies. People with severe peanut allergies can go into anaphylactic shock after accidental exposure, and must quickly be given life-saving epinephrine. (Joe Raedle/Getty Images)

Previous studies had been done on school-age children and young adults, also involving gradually increasing doses of the allergen in order to reduce reactions.

“It has been suggested that intervening in early life when the immune system is still developing may prove more effective than intervening in later life,” said study author Dr. Stacie Jones of the University of Arkansas.

“As the first large study in a preschool age group to test earlier interventions, we found that the treatment induced desensitization in a majority of peanut-allergic children and around one in five achieved remission. We also saw an additional one in five children whose peanut tolerability did not reach our threshold for remission but still increased significantly after treatment,” Jones said.

For the most part, parents dosed the peanut powder at home. But when dosing was increased, it was under observation at one of the five academic medical facilities involved.

Any reactions were recorded throughout the trial, while the children were also tested to measure immunologic biomarkers corresponding with peanut allergy.

Nearly all the children who consumed the peanut flour had at least one mild or moderate dose-related reaction during treatment. Of the children in the study, 21 were administered the rescue drug epinephrine for 35 moderate reactions to peanut flour during the treatment period.

Dr. Wesley Burks of the University of North Carolina-Chapel Hill said that peanut allergies “can restrict peanut-allergic children’s freedoms” in schools and daycare facilities where food may not always be safe.

“Although peanut oral immunotherapy at any age is not without some risk of an allergic reaction, this is a reasonable treatment consideration for very young children with peanut allergy, guided by an allergy specialist, in the context of shared decision-making,” said Dr. Matthew Greenhawt of the University of Colorado School of Medicine, who was not involved in the study. “Oral immunotherapy has the potential to help manage disease through treatment, not fear and avoidance.”

Edited by Kristen Butler

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Antifreeze Cream Could Help Prevent Frostbite

Antifreeze Cream Could Help Prevent Frostbite

New Zealand climber Mark Inglis shows his badly frostbitten fingers as he arrives at Auckland International airport after returning from Kathmandu May 25, 2006, in Auckland, New Zealand. Inglis became the first double-amputee to conquer Mt. Everest, the world's highest mountain. (Sandra Mu/Getty Images)

By Martin M Barillas

Exposure of unprotected skin to extreme cold can lead to frostbite, the painful and often dangerous formation of ice crystals in the skin. Apart from covering up with adequate clothing, a preventative measure has been elusive until now.

Scientists have developed an ointment that prevented frostbite in lab mice when applied to the skin 15 minutes before exposure to cold. They reported their findings in ACS Applied Biomaterials, a journal of the American Chemical Society.

Frostbite can lead to severe injuries and limb amputations, especially in cold, remote regions far from the necessary medical services. But skiers, hikers, soldiers and others can also experience milder frostbite on exposed noses, cheeks or ears, which may result in scarring.

Frostbite kills skin cells, as well as muscle and bone tissue, and can result in permanent nerve damage. While rapid rewarming of an affected limb can reverse tissue freezing, the effort may come too late if many cells have already died.

A herdsman whose toes were injured by frostbite in a hospital on Jan. 9, 2006, in Fuyun County of Altay Prefecture, Xinjiang Uygur Autonomous Region, northwest China. A blizzard that swept in from Siberia and temperatures plunged to as low as minus 45 degrees (minus 43 degrees C). (China Photos/Getty Images)

Trying to stay warm has been a priority throughout recorded history, from the use of animal skins to the advent of woolen clothing. Nowadays, technology offers solutions such as heated clothing or even transgenic antifreeze proteins, but these strategies are often impractical, expensive and raise safety issues.

Lead researcher Munia Ganguli, a biotechnologist with Genomics and Integrative Biology in India, has worked on a system for delivering a nanometer-sized peptide carrying plasmid DNA to the skin without harm. For the study, Ganguli’s team tested a combination of synthetic molecules used to cryopreserve cells for lab use: dimethyl sulfoxide (DMSO), which prevents the formation of ice crystals inside cells, and polyvinyl alcohol (PVA) to prevent cell crystallization, which can damage membranes between cells.

The researchers managed to preserve cells in a dish despite exposure to freezing. A combination of 2 percent DMSO and 1.6 mg/ml PVA yielded an 80 percent cell survival rate. The method also protected cell membranes and cytoskeletons, the network of proteins in a cell’s cytoplasm that helps give it structure.

The research team dubbed this combination SynAFP and mixed it with commercially available aloe vera cream. They applied the mixture to lab mice 15 minutes before exposure to cold, and found it reduced tissue damage and inflammation, while lessening frostbite wound size and speeding healing.

However, applying the cream 30 minutes before exposure did not prevent frostbite during the cold challenge. It remains to be seen whether the antifreeze cream may be effective for people, the researchers said.

Proper gear for staying warm is important for skiers and hikers in cold conditions, because even mild frostbite on exposed noses or ears can lead to scarring. (George Frey/Getty Images)

Signs and symptoms of frostbite include redness or pain of any area of the skin, which may be a first sign of harm. More advanced frostbite may result in white or grayish skin areas, unusually firm or waxy skin and numbness.

Frostbite and hypothermia are related conditions. Hypothermia results when the body’s core temperature drops because of exposure to cold. Symptoms include shivering, exhaustion and delirium. According to the CDC, frostbite and hypothermia victims should seek immediate medical attention and a warm shelter. Any wet clothing should be removed. Also, they should be warmed beneath layers of dry blankets and clothing.

The CDC noted that the affected skin of frostbite victims may be insensitive to pain. Therefore, the agency warns they should not walk on frostbitten toes and feet unless absolutely necessary. Also, they should not use sources of dry heat such as a fireplace, heat lamp, radiator or stove for warming or an electric heating pad or blanket.

According to Nemours Children’s Health, blisters on frostbite victims should not be broken. Warm (not hot) water can be applied for about 30 minutes. Clean cotton balls should be placed between frostbitten fingers and toes after warming, and warmed areas should be wrapped with clean bandages to prevent refreezing. Acetaminophen or ibuprofen can be administered for pain.

Both the CDC and Nemours recommend preventative measures such as wearing adequate clothing and face coverings when exposed to freezing temperatures.

Edited by Richard Pretorius and Kristen Butler

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Pig-To-Human Kidney Transplant Is Another Step Closer After Trial

Pig-To-Human Kidney Transplant Is Another Step Closer After Trial

The kidneys of a genetically modified pig were transplanted into a brain-dead human recipient for the first time. The trial is expected to help perfect the xenotransplantation process for future trials. Doctors say xenotransplantation could help address the shortage of human organs available for transplants. (Joern Pollex/Getty Images)

By Martin M Barillas

Surgeons at the University of Alabama at Birmingham (UAB) published a paper about their successful transplant of genetically modified pig kidneys into a “brain-dead,” or severely brain-damaged recipient.

Xenotransplantation, when non-human organs are put into a human being, can address a global shortage of human organs, the doctors said. Trials on other patients are expected by next year.

The study was published in the American Journal of Transplantation. Dr. Selwyn Vickers, dean of the UAB Heersink School of Medicine and CEO of the UAB Health System and UAB/Ascension St. Vincent’s Alliance, said the procedure was a “remarkable achievement for humanity” that will advance xenotransplantation into the clinical realm.

Pig organs are about the same size as human organs. Brought from a pathogen-free environment, the humanized pig kidneys had 10 key gene edits making them more compatible with human beings. The xenotransplanted pig kidneys filtered blood, produced urine and were not immediately rejected by the recipient’s body. They remained viable for more than 70 hours.

Calling it a “paradigm shift,” Dr. Jayme Locke, the lead surgeon for the study, said the transplant represents a “milestone in the field of xenotransplantation, which is arguably the best solution to the organ shortage crisis.”

Jayme Locke MD is a professor at the Marnix E. Heersink School of Medicine Department of Surgery Division of Transplantation and holds the Arnold G. Diethelm Endowed Chair in Transplantation Surgery at the University of Alabama-Birmingham (UAB). She is also director of the UAB Comprehensive Transplant Institute. (University of Alabama-Birmingham)

“We have bridged critical knowledge gaps and obtained the safety and feasibility data necessary to begin a clinical trial in living humans with end-stage kidney failure disease,” she said.

“This study provides knowledge that could not be generated in animal models and moves us closer to a future where organ supply meets the tremendous need,” Locke said.

While the recipient was not an ideal environment for kidney function, the experiment identified where more research is needed before xenotransplantation can be used clinically. The experiment also sought to find any life-threatening complications. Due to the biological differences between humans and pigs, previous xenoplantations into non-human primates left gaps in knowledge about how to treat humans.

“By actually doing this transplant,” said Locke, “we were able to show that you could take a kidney from a pig that had been genetically modified, put that into an adult brain-dead human and actually have it hold its integrity.”

Locke said the team watched “with bated breath” when it restored the kidneys’ blood flow but saw that they soon “turned beautiful and pink, and within 23 minutes … started making urine.”

Just as when transplanting organs from human donors to human recipients, rejection is a problem when transplanting pig organs into humans. While gene editing of pigs has reduced immune rejection, according to the team, only human xenotransplantion trials can reveal whether a humanized pig kidney can avoid rejection.

As in cases of a transplant from a living human donor to an end-stage kidney disease recipient, the team did a cross-match for the pig kidney xenotransplantation to reveal whether the donor organ was compatible with the recipient’s immune system. To do so, they did a novel test to screen stored human recipient serum to establish positive and negative controls, the first time this has been accomplished.

“Now we have evidence that this cross-match we developed is very accurate and can predict compatibility between the pig [kidney] and the human recipient,” Locke said.

The team thanked Jim Parsons, 57, the recipient of the pig organs, and his family for participating in the experiment. While he was a registered organ donor, his organs were not suitable for donation. He was kept on a ventilator at UAB during the experiment until natural death. Parsons’ ex-wife, children and mother allowed the study to go forward after being approached by Locke and the Legacy of Hope organ donation network.

“Brain death,” according to Johns Hopkins Medicine, is defined as “Irreversible cessation of all functions of the entire brain, including the brain stem.” Controversy has swirled over this definition and the ethics of removing organs from living persons with severe brain injury to be transplanted into recipients.

Edited by Richard Pretorius and Kristen Butler

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Study Shows Green Med Diet Slows Age-Related Brain Atrophy

Study Shows Green Med Diet Slows Age-Related Brain Atrophy

Duckweed is high in polyphenols and regular consumption is linked to reduced signs of brain atrophy.  (Leon Neal/Getty Images)

By Nicky Blackburn

A green Mediterranean diet, high in polyphenols and low in red and processed meat, appears to slow age-related brain atrophy, according to a new international study led by Ben-Gurion University of the Negev.

The 18-month long randomized control trial among 300 participants from the Nuclear Research Center in Dimona, is one of the longest and largest brain MRI trials in the world.

Participants were chosen based on abdominal girth, and high cholesterol levels, and divided into three groups according to diet, and whole brain MRI measurements were taken before, and after the trial.

Prof. Iris Shai. (Dani Machlis, Ben Gurion University)

One group ate a regular healthy diet, another the Mediterranean diet, and the last a green Mediterranean diet — which included high polyphenol green components: 3-4 daily cups of green tea and a daily green shake of Mankai duckweed, as a substitute for dinner, with minimal consumption of red and processed meat. Walnuts, which are high in polyphenols, were also provided to the Med-diet participants.

All three groups were given free gym memberships and participated in physical activity programs based on aerobic exercise.

The trial, which was published in The American Journal of Clinical Nutrition, was led by Dr. Alon Kaplan and Prof. Iris Shai, professor at Ben-Gurion University and adjunct professor at Harvard University, together with several international teams of brain experts.

Researchers measured hippocampal-occupancy (HOC) and lateral-ventricle-volume (LVV) as indicators of brain atrophy and predictors of future dementia.

Brain MRI-derived data were quantified and segmented using NeuroQuant, an FDA (Food and Drug Administration) authorized fully automated tool.

This is the first time scientists have explored the effect of diet on age-related brain atrophy, and they were surprised to discover a dramatic reduction in brain atrophy over the 18 months in those who adhered to both Mediterranean diets; with greater magnitude in the green-MED group, specifically among participants over age 50.

In addition, they noticed that an improvement in insulin sensitivity was independently associated with attenuated brain atrophy.

Greater Mankai, green tea, and walnuts consumption and less red and processed meat consumption were significantly associated with lower hippocampal occupancy decline.

“The beneficial association between the green Mediterranean diet and age-related neurodegeneration might be partially explained by the abundance of polyphenols in plant-based food sources which have antioxidant and anti-inflammatory metabolites,” said Shai, the lead author.

“Polyphenols can cross the blood-brain barrier (BBB), reduce neuroinflammation, and induce cell proliferation and adult-onset neurogenesis in the hippocampus.”

“Our findings might suggest a simple, safe, and promising avenue to slow age-related neurodegeneration by adhering to a green-Mediterranean diet,” adds Kaplan.

This study was funded by grants from the German Research Foundation (DFG), the Israel Ministry of Health; the Israel Ministry of Science and Technology; and the California Walnuts Commission.

This is not the first time employees at Dimona have taken part in large diet-related studies. Employees at the remote workplace do not leave the premises during the day, and lunch is provided on site.

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Sweet Dreams: Teens Eat More Sugar When They Don’t Get Enough Sleep, Says Study

Sweet Dreams: Teens Eat More Sugar When They Don’t Get Enough Sleep, Says Study

New research from Brigham Young University conducted at Cincinnati Children's Hospital Medical Center says lack of sleep increases the risk of weight gain and other cardio-metabolic diseases among teenagers because they have worse dietary habits when they sleep less. (Brigham Young University)

By Martin M Barillas

Getting a good night’s sleep is important for everybody but especially so for adolescents, with a new study showing how insufficient sleep leads growing teens to eat more sugar and carbohydrates.

In the era of smartphones, social media and endless online streaming services, a larger number of teenagers are not getting enough pillow time. According to the American Academy of Pediatrics, 73 percent of high school students get less than the recommended eight to 10 hours of nightly sleep. Lack of sleep has long been linked to obesity, behavioral problems and poor mental health as well as inadequate performance at school.

A new study by Brigham Young University in cooperation with Cincinnati Children’s Hospital Medical Center in Ohio concluded that when teens don’t get enough sleep, they are at risk of weight gain and other cardio-metabolic conditions.

“Shortened sleep increases the risk for teens to eat more carbs and added sugars and drink more sugar-sweetened beverages than when they are getting a healthy amount of sleep,” Dr. Kara Duraccio of Brigham Young University said.

Teens who sleep less than recommended end up consuming more carbohydrates and sugary drinks, according to new research. (Justin Sullivan/Getty Images)

Researchers examined the eating and sleeping habits of 93 teenagers during short sleep, or spending six and a half hours each night in bed for one week, and what is considered healthy sleep, spending nine and a half hours each night in bed for another week. The study also measured the types, calories, macronutrients and glycemic load (the rise in blood sugar levels) of the foods the teens ate.

During the short sleep session, the teens had consumed more sugary and carbohydrate-rich foods and drinks than they did when they got healthy sleep. This usually happened after 9 p.m. Teenagers ate fewer vegetables and fruits throughout the day after short sleep sessions when compared to healthy sleep.

“What’s interesting is that getting less sleep didn’t cause teens to eat more than their peers getting healthy sleep; both groups consumed roughly the same amounts of calories of food. But getting less sleep caused teens to eat more junk,” Duraccio said.

She and her fellow researchers believe that when teenagers are tired, they seek quick energy to keep them going until bedtime, therefore the preference for sugary and carbohydrate-rich foods. During short-sleep sessions, teenagers took in 12 extra grams of sugar every day. Because most don’t get enough sleep during the estimated 180 nights in an academic year, 12 extra grams of sugar can result in 4.5 pounds of added sugar each year.

The results were published in the medical journal SLEEP.

“We know that pediatric obesity is an epidemic, and we’ve focused on a lot of interventions to try and address it, but sleep is not one of the things that researchers tend to focus on,” Duraccio said.

“If we are really trying to discover preventative strategies or interventions to increase optimal weight in teens, getting enough and well-timed sleep should be at the forefront of our efforts,” she added.

The issue is complicated by early start times for classes in many school systems, resulting in habitually short and ill-timed sleeping patterns. Duraccio said it is common for many busy people to skimp on sleep when posed with multiple tasks.

“We don’t recognize that getting enough sleep helps you accomplish your to-do list better. Sleep health should be incorporated into all prevention and intervention modules for child obesity,” she said.

In a study published in Sleep Medicine in 2017, American teens were found to trade sleep for time on their electronic devices. Researchers analyzed data from the activities of hundreds of thousands of teenagers and showed that the number who were logging more screen time and losing more sleep rose dramatically between 2009 and 2015. In 2015, more than four of every 10 teens slept less than seven hours each night, an increase of about 17 percent compared to 2009.

Edited by Richard Pretorius and Kristen Butler

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A Book-Filled Childhood Prevents Later Cognitive Decline

A Book-Filled Childhood Prevents Later Cognitive Decline

Growing up in a book-filled home seems to improve memory in those 65 years old and older as well as preserve against cognitive decline, according to a recent study. (Josh Applegate/Unsplash)

By Abigail Klein Leichman

Books intrigue and delight children, and now we know they may also help those children preserve cognitive functioning into old age.

Growing up in a book-filled home seems to improve memory in those 65 years old and older as well as preserve against cognitive decline, according to a study by Galit Weinstein of the University of Haifa, Ella Cohn-Schwartz of Ben-Gurion University of the Negev, and Noam Damri of the Israel Gerontological Data Center.

The researchers drew their conclusions from an analysis of results from two waves of the Survey of Health, Ageing and Retirement in Europe (SHARE). In 2011 and 2013, the survey was completed by the same 8,239 individuals aged 65 or over who did not suffer from neurodegenerative disease.

Their analysis concluded that a book-filled childhood home — defined modestly as containing 11 to 25 books — correlated significantly with improved immediate memory, delayed memory, verbal fluency, and less global cognitive decline.

“If we can identify early life factors that affect brain aging and give an advantage to people in late life, then we can preserve cognitive function in older age,” explained Cohn-Schwartz, from BGU’s Department of Public Health.

The team’s findings were published recently in the journal Dementia and Geriatric Cognitive Disorders.

“This study contributes to our understanding of the importance of our childhood environments for brain health in old age. More studies are needed to determine the long-term effects on the brain of the transition from reading printed books to using digital media,” said Weinstein.

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