Oral Immunotherapy for Food Allergies

Some people have food allergies so severe that even the slightest contact with the food can lead to a life-threatening allergic response. A rare but potentially fatal allergic response to peanuts, for example, is why most airlines no longer serve peanuts on their flights. Other sufferers are equally allergic to milk or to eggs, commonly used as ingredients in many food products and recipes. Is there anything that can be done for people with life-threatening food allergies aside from having them try to avoid the food?

Current research efforts are focused on oral immunotherapy (OIT). OIT consists of exposing the patient to miniscule quantities of the allergen in a supervised research setting (under close medical supervision), and then if an allergic reaction fails to occur or remains mild, slowly increasing the dose over days or months to “desensitize” the patient.

Researchers caution that the technique is not yet ready for widespread clinical use, however. The risk of an adverse reaction to the first dose is fairly high, and little is known about the safety of OIT when done at home under a variety of conditions. In addition, it is not known how long desensitization lasts if/when regular desensitizing dosing is ended. There is a danger that desensitized patients might develop a false sense of security once they become partially desensitized or quit their therapy altogether.

Nevertheless, OIT might become a useful therapy for severe food allergies in the future, once we better understand how to perform it safely. For sufferers of truly severe food allergies, the risks associated with desensitization would have to be balanced against the risk of accidental exposure to the allergen and perhaps even death.

Kidney Disease and African Sleeping Sickness

Natural selection can actually favor an otherwise harmful allele of a gene, if that allele somehow confers a survival advantage in some individuals and populations. The one textbook example of this phenomenon has always been sickle cell disease, a genetically inherited disease that results in deformed red blood cells and can lead to early death. Sickle cell disease is prevalent in persons of African ancestry because the allele that causes sickle cell disease also protects the person with that allele from malaria, a disease which is widespread in Africa.

Now there’s a second example of this phenomenon. Researchers have found that two different alleles for a gene involved in the production of a blood protein can; a) lead to kidney disease, and b) protect against the parasite that causes African sleeping sickness. Not surprisingly, the two abnormal alleles and the kidney diseases they cause are four to five times more common in African Americans than in persons of European descent.

Researchers are wondering how many other genetic diseases we’ll find that also confer protective advantages against certain infectious diseases. Researchers are also hoping to develop new treatments for African sleeping sickness that are based on the proteins these abnormal alleles produce.

Maximum Heart Rate for Women

Many serious exercisers pay close attention to their heart rates while exercising. That’s because they generally are advised to keep their heart rates within 65-85% of their maximum heart rate for a safe but relatively strenuous workout designed to improve aerobic capacity and endurance.

According to a formula for maximum heart rate that is now 40 years old (it was developed in the 17970s), your maximum heart rate should be around 220 beats per minute (bpm) minus your age. The formula is a population average, of course, and shouldn’t be taken as an absolute number for each individual. More importantly, the old formula was based solely on men subjects. Now a new study of over 5,000 healthy women indicates that a better population-based formula for women is:

Maximum Heart Rate for Women = 206 – (0.88 x age)

Admittedly the new formula has the disadvantage that it can’t be calculated in your head, but it’s easy enough to do with a calculator. And the difference may be significant: By the old formula, a 40-year-old’s 65-85% target range would have been 117-153 bpm. By the new formula, the target range for a 40-yr-old woman would be 111-145 bpm. Six to eight beats per minute might not sound like much, but over an hour’s workout it could make the difference between pushing yourself too far and getting discouraged, and just getting a good healthy workout.

The new study focused only on women subjects. Perhaps someone ought to confirm or revise the old formula for men, too!

Reference: Gulati, M. et al., Heart Rate Response to Exercise Stress Testing in Asymptomatic Women: The St. James Women Take Heart Project. Circulation 122:130-137, 2010.

Rapid Eye Movement (REM) Sleep

Humans go through several stages of sleep during a typical night. One of them is the period during which we have complex dreams, called rapid eye movement (REM) sleep. During REM sleep our eyes move about rapidly beneath closed eyelids, even though our bodies typically remain completely motionless.

The explanation for rapid eye movement during REM sleep has always remained somewhat of a mystery - until now. In the June issue of Brain, researchers report that the most likely explanation is that our eyes are trying to follow the action in our dreams. They came to this conclusion after studying the direction of eye movements in a group of subjects who have a particular sleep disorder in which they physically act out their dreams while sleeping. The patients’ eye movements tracked their physical actions with a consistency of nearly 90%. The eye movements in these patients were no different than in normal subjects who did not move physically during sleep, leading the authors to suggest that the “follow-the-dream-action” explanation for REM activity may hold for normal subjects as well.

Dietary Supplements Deceptive Sales Practices

Dietary supplements are regulated as food products, not as drugs. Manufacturers are free to make vague claims of effectiveness, such as “improves heart health” or “boosts brain function”, but they cannot make medical claims such as “lowers high blood pressure” or “prevents Alzheimer’s”. And although their products are supposed to be safe, they’re not required to submit any data to prove it.

Now a Senate document reveals that even though the products may be labelled correctly, in sales conversations (“off-label”, so to speak) retail sales representatives of dietary supplements products are openly engaging in “deceptive and questionable sales tactics” – in other words, they’re lying to make a sale.

In testimony before a U.S. Senate committee, the General Accounting Office (GAO) reported that it had staff members ask questions of sales representatives such as: Is ginkgo biloba safe to take with aspirin? Can ginseng cure cancer? Is it okay to replace my blood pressure medication with garlic supplements? All too often they got “yes” answers when the correct answers are “no”. These answers are not just harmless sales advice – they are potentially dangerous advice and they are against the law. Action may be taken against some sellers as a result of the investigation. But for all practical purposes, it’s still “buyer beware” when it comes to the safety and efficacy of dietary supplements.

You can hear clips of some of the undercover calls at http://www.gao.gov/products/GAO-10-662T.

First Human Stem Cell Therapy Trial

The first clinical trial of a therapy based on human stem cells has received final approval from the Food and Drug Administration (FDA) and will get underway shortly, according to a press release from Geron Corporation, the company sponsoring the research. During the first phase of the trial, researchers will inject precursor cells to neural support cells called oligodendrocytes into the spinal cords of patients who have suffered recent spinal cord injuries and who have almost no chance of recovery of function otherwise. The hope is that the precursor cells will differentiate into mature oligodendrocytes (the cells that produce myelin) and that the myelin will form new sheaths around damaged nerves.

The trial was planned several years ago but held up by the FDA over concerns that the therapy could increase the risk of tumors forming in the spinal cord if the injected cells were not free of embryonic stem cells. The first phase of the trial is designed to test the safety of the procedure. It will be years before the technique becomes widely available for the repair of spinal cord injuries, even if it does eventually prove to be both safe and effective.

Stem cell researchers will be holding their breath. A failure in this first approved trial could set back the whole field of stem cell therapy research for years.

Familial DNA Searches

DNA testing is a modern way to positively match DNA left at a crime scene to a suspect. But what if police have DNA from a crime scene but no suspect? Most states have DNA banks only of convicted felons already in prison, so a criminal with no prior record would almost certainly go undetected.

One method being used in California is to look for partial matches between DNA from a crime scene and the state’s database of DNA from convicted criminals. A partial match, while not implicating the criminal himself, would suggest that a close relative might have carried out the crime. California used the method this month to identify a person previously convicted on a weapons charge as “probably related” to a long-sought-after Los Angeles serial killer known as the Grim Sleeper. The person’s father eventually was arrested and charged with ten murders.

This is new ethical ground for us all. As a society we need to understand the costs vs. benefits of these types of searches. The benefits are obvious – another killer identified. But the costs will be freedom lost – the freedom, for example, not to be put under suspicion and investigated for a crime unless there is reason to suspect you of an offense. Suspicion of relatives based on partial DNA matches is likely to fall disproportionately on African Americans, since they already represent a disproportionate fraction of the prison population.

Because of these concerns, California wisely put some safeguards in place for familial DNA searches. Currently, such searches require that all other investigative leads have been exhausted, that the crime is murder or rape, and that the criminal is still committing crimes – i.e. is still a threat to society. Other states considering familial DNA searches should consider similar safeguards.