Seasonal Allergies

Hate allergy shots? Oral allergy drops are a pretty good option for some allergy and allergic asthma sufferers, review suggests

Seasonal Allergies | Johns Hopkins Medicine

A scientific review of 63 published studies affirms that putting small amounts of purified grasses, ragweed, dust mites, pollen and mold, in liquid drops under the tongue is a safe and effective alternative to weekly injections of those allergens or the use of other medications, in treating symptoms of allergies and allergic asthma in some people.

Results of the review, conducted by researchers at Johns Hopkins, are contained in a report to be published in the Journal of the American Medical Association online March 27.

The report is believed to be the largest synopsis of its kind, reviewing previous research comparing various therapies designed to stop the wheezing, sneezing and runny nose that accompany allergic rhinoconjunctivitis and allergic asthma, researchers say.

Specifically, the Johns Hopkins team analyzed 63 studies, involving some 5,131 participants, almost all in Europe, where allergy drops, or so-called sublingual immunotherapy, have been widely available for nearly two decades. Sublingual therapies have not been approved for use by the U.S. Food and Drug Administration, but physicians in the United States do use the drops “off-label” for some patients.

In eight of 13 studies evaluated, researchers found what they say is “strong evidence” that drop therapy produced a 40 percent or greater reduction in coughing, wheezing, and tightness in the chest compared with other treatments, including inhaled steroids.

In nine of 36 studies comparing allergy drops to other allergy treatments, including antihistamines and nasal steroid sprays, researchers found that allergy drops produced a 40 percent or greater reduction in symptoms of runny nose, sneezing and nasal congestion, results which they describe as “moderate evidence” in support of using sublingual immunotherapy.

“Our findings are clear evidence that sublingual immunotherapy in the form of allergy drops are an effective potential treatment option for millions of Americans suffering from allergic asthma and allergic rhinoconjunctivitis,” says senior study investigator Sandra Lin, M.D.

According to Lin, an associate professor of otolaryngology-head and neck surgery at the Johns Hopkins University School of Medicine, allergy drops are more convenient for many people because they can be taken at home, and allow such individuals to avoid the discomfort and travel time needed for regularly scheduled trips to the physician's office for an allergy shot. Lin says that, according to current estimates, as many as 40 percent of Americans suffer from some form of allergic rhinitis or allergic asthma.

Lin cautions that drop therapies may not be for all sufferers of allergic rhinoconjunctivitis and allergic asthma, but that many will want to weigh the risks and benefits of sublingual immunotherapy before deciding on long-term treatment options.

Study funding was provided by the U.S. Agency for Healthcare Research and Quality. The corresponding grant number is HHSA 290-2007-10061.

Other Johns Hopkins researchers involved include Jodi Segal, M.D., M.P.H.; Darcy Ward, B.A.; Yohalakshmi Chelladurai, M.B.B.S.; Catalina Suarez-Cuervo, M.D.; Murugappan Ramanathan, M.D.; Julia Kim, M.D., M.P.H.; and Nkiruka Erekosima, M.D., M.P.H.

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Materials provided by Johns Hopkins Medicine. Note: Content may be edited for style and length.


Johns Hopkins Gazette | October 9, 2006

Seasonal Allergies | Johns Hopkins Medicine
Researchers at the School of Medicine have successfully used an experimental DNA-based vaccine to protect against ragweed allergies, commonly known as hay fever, after just six injections.

Patients receiving the vaccine showed an average 60 percent reduction in allergy symptoms compared to those receiving a placebo.

The experimental therapy holds the promise of one day eliminating the need for traditional allergy medicines targeting allergy symptoms, such as nasal steroids and antihistamines, and providing a safer, faster replacement for immunotherapy regimens, which are costly and take years to work, the researchers say.

The Johns Hopkins study, conducted during two fall ragweed (“hay fever”) seasons in Baltimore, enrolled 25 volunteers, ages 23 to 60, with a demonstrated history of ragweed allergy. Fourteen people received the vaccine, administered as six weekly shots, while 11 others received placebo injections.

During the test period, allergic symptoms were monitored and recorded, right down to how many times volunteers sneezed and how often their noses ran. Compared to the placebo group, those who received the vaccine exhibited a 60 percent reduction in all their allergy symptoms, including sneezing, runny nose, watery eyes and itching.

Relief from allergic symptoms was as pronounced in the second year as in the first, even though no more vaccine was administered.

Lead investigator Peter Creticos, medical director of the Johns Hopkins Asthma and Allergy Center, explained that such prolonged relief is an important part of his team's findings because it appears that the vaccine's efficacy doesn't wear off quickly. A new study, currently under way, will further examine the drug's lasting effects in a larger group of participants.

Creticos' current findings are published in the Oct. 5 issue of the New England Journal of Medicine.

“This therapeutic intervention heralds a major advance in the treatment of allergic rhinitis,” Creticos said. “Long-lasting relief can be achieved with a concise, six-week injection regimen, as opposed to the current tedious, four-to-five-year course of treatment with allergen immunotherapy.”

Investigators at the University of California, San Diego had previously observed that a particular sequence of DNA, derived from bacteria, shuts down a T-helper cell called Th2 that is involved in the body's inflammatory response.

Creticos and his team, recognizing that allergic disease is driven by Th2 inflammation, then embarked on a series of studies to evaluate the effectiveness of using this approach to treat allergies.

The central question that they sought to answer was, What would happen if the DNA strand was linked to the most allergenic portion of the ragweed pollen protein, which is the No. 1 cause of seasonal allergies in North America?

Dynavax Technologies Corp., of Berkeley, Calif., developed the vaccine and funded several of Creticos' early safety studies; during that period, Creticos was a paid consultant of Dynavax.

The current study was sponsored by the Immune Tolerance Network, which receives its funding from the National Institute of Allergy and Infectious Diseases and the National Institute of Diabetes and Digestive and Kidney Diseases.

Creticos said that the vaccine works in two ways: by suppressing acute allergic reactions (such as sneezing) and by helping the body better regulate chronic inflammation (such as itchy eyes and a runny nose).

It is thought that the vaccine lessens the immune system's excessive reactions to inhaled allergens by stimulating protective cells that turn off the Th2 helper cells.

The Th2 helper cells send out signals for the body to create more IgE, the protein largely responsible for making allergy sufferers miserable throughout the entire ragweed season.

Someone allergic to ragweed has inherited the ability to make too much IgE antibody when exposed to inhaled allergens.

Additionally, the vaccine may activate specialized immune cells known as “dendritic cells” that serve as peacekeepers, maintaining balance by keeping inflammation in check over the long term and breaking an otherwise self-sustaining allergic cycle that Creticos calls “Th2-orchestrated allergic inflammation.”

“We are turning off an inappropriate or abnormal allergic response and returning the body to normalcy,” Creticos said. “Our hope is that we can one day provide a long-term cure for hay fever and other chronic inflammatory diseases.”


Tips to Avoid COPD Complications with Seasonal Allergies

Seasonal Allergies | Johns Hopkins Medicine

Seasonal allergies are a nuisance for most people. For people with COPD, however, any extra condition that makes breathing difficult is automatically more serious.

According to a 2012 study at the Johns Hopkins Allergy and Asthma Center, people who had COPD and seasonal allergies experienced worsened respiratory symptoms such as coughing and wheezing.

They were also significantly more ly to need medical attention for their symptoms.

Chronic obstructive pulmonary disease (COPD) is a group of lung conditions usually made up of chronic bronchitis and emphysema. COPD is commonly linked to a history of smoking cigarettes.

The condition results in airway blockages and mucus production, often causing serious breathing difficulties. Symptoms include:

  • persistent cough
  • wheezing
  • fatigue
  • shortness of breath
  • feeling winded after activities that weren’t difficult in the past
  • coughing up mucus

Seasonal allergies are very common. Millions of people deal with the itchy, watery eyes and stuffy noses that seasonal allergies cause.

These symptoms occur when your immune system reacts to allergens you’ve inhaled such as:

  • pollen
  • dust
  • mold
  • animal dander

Your immune system activates certain cells that produce substances, including histamine. These substances produce allergy symptoms.

People with COPD seem to be more sensitive to other breathing conditions. Of course, if you have COPD, you ly already have some trouble breathing.

The best thing you can do is to avoid potential allergens.

Allergens are all around us, but you already have a head start if you know your triggers. You can take steps now to reduce your contact with specific allergens that worsen your symptoms.

Read on for tips on avoiding common allergens that could make your COPD symptoms worse.

Know before you go

Check out your local pollen report before you leave the house. Many weather sites, such as AccuWeather, will provide information on the current pollen and mold levels for your area.

The Weather Channel’s Allergy Tracker also notes the levels for particular types of pollen, including:

You may wish to plan outings on days when pollen and mold levels are lower to reduce your allergy symptoms.

Stay inside

It’s best to stay inside when the air quality in your area is poor. For people with COPD, an Air Quality Index above 100 can wreak havoc on respiratory symptoms.

If you live in the United States, a good resource for checking air quality is AirNow, which measures the amount of air pollution in a given area. If you have to go outside, try wearing a mask to filter out pollutants and irritants.

Treat your symptoms

When you have allergy symptoms, such as itchy eyes or a runny nose, talk to your doctor about allergy medication. Taking an over-the-counter antihistamine may work for you.

Medications such as diphenhydramine (Benadryl) and cetirizine (Zyrtec) can stop your immune response to allergy triggers in its track, potentially lessening breathing difficulties.

Nasal steroids, decongestants, and inhalers may also be needed to decrease inflamed airways.

Allergy-proof your environment

Whenever possible, try to take measures to keep allergens your space. Here are some things you can do at home:

  • Install a good filtration system in your air conditioner.
  • Keep windows closed when pollen counts or pollutants are high.
  • Buy a cabin air filter for your car that’s specifically designed to keep allergens out.
  • Vacuum and dust regularly to get rid of any pollen or mold spores that may have gotten in from outside.

Talk to your doctor about your allergy symptoms and how seasonal allergies affect your COPD. They may suggest a variety of options, which could include:

  • trying a prescription allergy medication
  • using your inhaler more often during peak allergy season
  • getting an allergy test to see which allergens are causing your reactions
  • trying allergy shots (immunotherapy) to reduce allergy symptoms


Johns Hopkins experts gain insight into underlying cause of eczema

Seasonal Allergies | Johns Hopkins Medicine

Researchers at Johns Hopkins are reporting a discovery that explains why our skin becomes inflamed from conditions such as atopic dermatitis, more commonly known as eczema.

The bacteria Staphylococcus aureus, or S. aureus, is an important human pathogen and the most common cause of skin infections in people. In a study described online in Cell Host & Microbe, the scientists found that this common, toxin-producing bacteria sometimes induces a protein that causes our own cells to react and cause inflammation.

“We don't really know what causes atopic dermatitis, and there aren't many good treatments for it.”

Lloyd Miller

Associate professor of dermatology

“Our skin is covered with bacteria as part of our normal skin microbiome and typically serves as a barrier that protects us from infection and inflammation,” says Lloyd Miller, associate professor of dermatology at the Johns Hopkins University School of Medicine. “However, when that barrier is broken, the increased exposure to certain bacteria really causes problems,”

Twenty to 30 percent of the U.S. population have S. aureus living on their skin or in their nose, Miller adds, and over time, up to 85 percent of people come into contact with it.

Eczema is an inflammatory skin disease that affects 20 percent of children and about 5 percent of adults. Ninety percent of patients with eczema have exceedingly high numbers of S. aureus bacteria on their inflamed skin.

Untreated eczema can lead to other allergic conditions, including asthma, food allergies, seasonal allergies, and conjunctivitis. Blocking the skin inflammation in eczema has the potential to prevent these unwanted conditions.

“We don't really know what causes atopic dermatitis, and there aren't many good treatments for it,” says Miller.

His team set out to learn more about how the condition arises in hopes that other treatments can be developed.

Previous research had shown that a rare disease that causes the skin to erupt into pustules was caused by a genetic mutation that resulted in unrestrained activity of a protein normally produced in our skin. This, Miller says, was a clue that this same protein might have something to do with how bacteria on the skin surface induce inflammation.

The team tested this idea in mice by soaking a small gauze pad with S.

aureus and applying it to the back skin of both normal mice and those that had been genetically engineered to lack the receptor for the protein that triggers inflammatory responses.

Miller's team found the normal mice developed scaly and inflamed skin, and the genetically engineered mice lacking protein activity had almost no skin inflammation.

“We are very excited about these results as there is currently only a single biologic treatment targeting an inflammatory mechanism in atopic dermatitis on the market,” Miller says. “As there are patients who don't respond or have treatment failures, it would be better if there were biologics on the market that target alternative mechanisms involved in skin inflammation.”

Read more from Hopkins Medicine

Posted in Health

dermatology, eczema


Brace Yourselves: Spring Allergy Season Is Coming

Seasonal Allergies | Johns Hopkins Medicine

A swath of the Northeast and mid-Atlantic, which had been continuously pummeled by winter storms — even in April — will be graced with warm weather later this week. After a seemingly interminable winter, it’s a chance to dig out lighter clothing and head outside into the sun.

But, if you’re one of the roughly 7% of U.S. adults with seasonal allergies, you may want to stay inside a little longer. With the change in seasons comes spring allergies (followed by summer allergies).

Here’s what you need to know about the upcoming allergy forecast.

Is it going to be a bad allergy season this year?

Predictions are mixed, but it could be. Some experts have suggested that because of the Northeast’s prolonged winter, tree pollen allergy season may be shorter, but more intense. However, Dr.

Rachel Miller, director at the division of pediatric allergy, immunology and rheumatology at Columbia University Medical Center, said there are lots of factors at play – including tree species and precipitation levels (which tend to clear out airborne allergens).

“I don’t think there’s 100% certainty on this,” Miller says. “There would be a concern that because of the delay in pollination, the pollen will start to to become airborne at the same time, as opposed to being spread out over a longer period of time. So it may be shorter, but it may be more intense.” Yet that is difficult to predict, she says, because not all tree species are the same.

And while AccuWeather senior meteorologist Alan Reppert said that there might be a “rapid ramp-up” of pollen levels in the Northeast, when the temperature rises, it may not be more than usual.

“It might a little bit higher,” Reppert said, but due to expected rainfall, “it doesn’t look it’s going to be a rapid ramp-up to above average.

We’re looking at probably near-normal pollen levels for much of the Northeast into the Midwest also.”

For some parts of the country, including Florida and Georgia, allergy season arrived in mid-March and peaked at the end of the month, according to AccuWeather, while the Northeast and mid-Atlantic have been spared thus far due to snow, wet weather and lower temperatures.

“The pollen levels may take until April or even early May to really increase over parts of Pennsylvania, New York and New Jersey,” Reppert said in a report for AccuWeather.

When will allergy season be at its worst?

A chart from AccuWeather predicts when allergy season is ly to peak across the country. For parts of the South, the peak has already hit.

For other areas of the South, peak allergens are expected to hit at the end of April, and according to AccuWeather, tree pollen allergies will be followed up with grass pollen, which should tamp down at the end of June.

For the mid-Atlantic and Northeast, late May and late June will see peak allergies.

You can track the upcoming pollen forecast on AccuWeather to prepare for spring allergies.

Why do seasonal allergies happen in the first place?

Why do some people respond to specific components — tree pollen and mold during the spring, grass pollen in the summer, and weed pollen in the early fall — with allergy symptoms, including sneezing, a stuffy or runny noes, and itchy eyes?

“That is a million-dollar question,” says Marsha Wills-Karp, chair of the Department of Environmental Health and Engineering at Johns Hopkins University. “My colleagues around the world and myself have been trying to answer that question.”

Allergies occur “when an individual’s immune system reacts inappropriately to things in the environment that don’t typically cause most people to respond,” she says. The way that a person responds to an infectious agent, a virus, is how some people with allergies may respond to pollen, dust mites, mold and other allergens: developing antibodies against otherwise harmless intruders.

And researchers are still trying to figure out why some people are more susceptible to allergies than others.

Wills-Karp said a potential combination of genetics and environmental factors — especially in early stages of a person’s life – is ly to blame.

Theories include antibiotic use early in life and a “too clean” environment with reduced exposures to everyday flora and fauna, along with other potential factors.

How can I help my allergies?

First, identify whether you are suffering from a cold or allergies. While many of the symptoms overlap — sneezing, runny nose, stuffy nose — with a cold you may also have a fever, fatigue, cough, aches and pains, which ly won’t be present with allergies.

For people who are suffering from spring allergies, it may be too late to change how the body responds to allergens. But you can combat the symptoms.

“As far as what the allergic person would do to try and diminish their symptoms, there are three broad categories,” says Dr. Sandra Lin, professor of otolaryngology at Johns Hopkins Medicine.

  1. Avoidance: To avoid tree pollen, which along with mold is often responsible for spring allergies, Lin suggests staying indoors, or if you are outside, wearing a mask that can filter the pollen particles. She also suggests showering and making sure to bathe pets who have been outside. She cautions that during tree pollen season, windy sunny days may trigger symptoms because pollen will be swept up into the air. Rainy days, however, may reduce pollen levels in the air.
  2. Treatment: Lin says people can treat symptoms with over-the-counter medications, including antihistamines and nasal steroid sprays, or prescription medication from a doctor. Nasal sprays, she says, “help tamp down your immune reaction in your nose.” And though they can be effective when used as needed, they are “most effective if you consistently use them,” especially at around two weeks of consistent use. She tells her patients to start using the spray several weeks before allergy season starts until allergy season finishes.
  3. Immunotherapy: This includes either allergy shots or tablets or drops under the tongue. Allergy shots, however, aren’t an immediate fix for quelling symptoms. Once a person has been allergy tested, small controlled amounts of an allergen are administered to the person over a course of many months to “improve their symptoms and decrease their need for medication,” Lin says. There are often benefits from immunotherapy that last for years after you’ve finished the treatment, she says.

If you suffer from seasonal allergies, it’s best to see a physician to figure out how best to tackle your symptoms.

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