Using human and guinea pig tissue samples, the research team discovered that by combining an asthma reliever drug – the short-acting beta-agonist isoproterenol – with certain components of ginger, relaxation of the airway smooth muscle was three to five times greater than when treating with the reliever medication alone.

“We have shown that these naturally derived chemicals use similar pathways to known asthma therapies and augment beta-agonists, the most widely used asthma medication during an emergency,” said Elizabeth Townsend, lead study author and post-doctoral research fellow at the Columbia University Medical Center.

Three ginger components appeared to have more than one role in providing airway relaxation. They enhanced the relaxation achieved from beta-agonists, reduced the amount of medication required to achieve the same outcome, suppressed the activation of molecules that lead to inflammation and inhibited an enzyme that also brings on inflammation.

Townsend told Allergic Living that this study, which was presented at May’s annual meeting of the American Thoracic Society, helps to explain patients’ reports of herbal remedies such as ginger being effective. She hopes that this research will lead to new asthma drugs that involve ginger.

Research published last year by the Columbia group and British colleagues found that certain purified components of ginger had a relaxing effect on airway muscles in guinea pig and human tissue. The components deemed to be useful were [6]-gingerol, [8]-gingerol and [6]-shogaol. (Another component of ginger, [10]-gingerol, had little beneficial effect.)

In the current study, combining the beta-agonist medication with [6]-gingerol or [8]-gingerol was shown to relax the airway three times more than using the medication alone. One component, [6]-shogaol, had an even stronger effect: using it with the medication resulted in five times more smooth muscle relaxation.

The study notes that as many as 40 percent of asthmatics use herbal remedies to self-treat their symptoms. These results give some credence to the use of herbal remedies, and suggest that asthma medications can be made to be more effective.

Townsend says the next step for this research is studies with mice to see how the treatment works in a living creature, as opposed to tissue samples. If that goes well, her team will be one step closer to finding a novel treatment.

The findings of this continuing study, which so far includes 170 parent and child groups, were presented at the annual meeting of the American Thoracic Society in May 2013.

By examining symptom diaries, speaking to teachers and measuring air flow rates of the kids with asthma, researchers found that children with poorly controlled asthma produced lower-quality schoolwork when compared to kids with better asthma control. The more severe the symptoms, the more negatively the school work was affected.

The poorly controlled children were also found to be more careless with school work, which the researchers associated with poorer sleep quality because of asthma flare-ups at night. Teacher reports of students struggling to stay awake during class were tied to difficulty falling asleep at bedtime – the kids who could fall asleep quickly tended to be more alert in class, which led in turn to higher quality school work.

These results suggest that asthma symptoms can have an impact on both sleep quality and school performance in children. Researchers hope these results will contribute to family- and school-based initiatives to help improve asthma control, sleep quality and school performance in kids with asthma living in urban areas.

In May, the Asthma and Allergy Foundation of America (AAFA) released its annual Asthma Capitals list – which ranks the 100 largest U.S. cities by how problematic they are for people living with asthma.

Richmond ranked at No. 1, shooting up from spot No. 23 last year. Chattanooga came in second, worsening from last year’s fifth place position. Memphis, last year’s most challenging city in the U.S. to live with asthma, marginally improved, dropping to the third spot.

Tennessee was the only state to have three cities within the top 10, including two out of the top three, suggesting the state has much room for improvement for those living with asthma.

For two years running, San Francisco was ranked at No. 100, meaning it remains the least problematic of the 100 largest metro areas in the U.S. for people living with asthma.

In order to determine the ranking of the cities, 14 factors were examined. These included asthma prevalence, asthma death rate, pollen and air quality scores, ER visits for asthma, number of asthma specialists, and asthma medicine use.

Here are Top 10 2013 Asthma Capitals:

1. Richmond, VA

2. Chattanooga, TN

3. Memphis, TN

4. Philadelphia, PA

5. Oklahoma City, OK

6. Detroit, MI

7. Dayton, OH

8. McAllen, TX

9. Atlanta, GA

10. Knoxville, TN

Not surprisingly, there was some overlap between this list and the AAFA’s Spring Allergy Capitals list released in April. All but four of the top 10 asthma capitals were also found in the top 10 spring allergy capitals list. Chattanooga ranked in the top 3 for each list, suggesting it may be a very difficult place to live for people with asthma, environmental allergies, or other respiratory issues.

See AAFA’s Asthma Capitals List

With strong evidence that schools close to highways are setting off asthma attacks in kids, this 2011

Does the air around your child’s school trigger asthma attacks? George Thurston, an environmental health science professor at New York University, wanted to know, so a few years ago he enlisted a bunch of 5th grade students in the South Bronx to help. The kids lived in a neighborhood where 13 percent of children suffer from asthma and where the hospitalization rate for asthma was dramatically higher than in other areas of the city.

In some of the schools, the children and their teachers could see diesel trucks and buses rumble by all day long, spewing out dark, sooty vapors on their way to massive garbage dumps. Was there a connection between all that pollution and the kids’ frequent breathing troubles?

To answer the question, Thurston found 40 children with asthma in four schools in the South Bronx. He gave each child a rolling backpack with air-monitoring equipment. Thurston’s team carefully tracked their symptoms, and later, a local TV crew spoke to participants.

“It feels like somebody’s not letting me breathe,” ponytailed Aldores Lopez said shyly on camera. “My mum gets nervous. I don’t like it when my mum gets nervous.”

The results were striking. All the children’s asthma symptoms – wheezing, coughing and shortness of breath – increased on high traffic days. What’s more, the kids’ breathing troubles were exacerbated by a key pollution ingredient – soot, the carbon particles that look like black smoke spewing out of diesel trucks and buses. They become part of the tiny particulates that get trapped deep in the lungs.

Thurston’s study bolsters a body of research which makes a powerful case that highway-related pollution is a key trigger of asthma attacks in kids. A 2007 review of the research put it this way: “The health studies show elevated risk for development of asthma and reduced lung function in children who live near major highways.” That’s a serious warning when you consider that, according to the same research review, 11 percent of U.S. households are located within 325 feet of a four-lane freeway.

A 2011 study in the shantytowns near Lima, Peru, drives home the point: Teenagers who lived within 800 feet of a congested roadway were twice as likely to wheeze or to use medications for asthma as those who lived four blocks away. Pulmonologist William Checkley, the senior researcher from Johns Hopkins University, sums it up: “The closer to the road, the more disease.”

Many of the studies of the effects of vehicle exhaust have focused on where children live. But a new wave of research, like the South Bronx study, is targeting the air near and at school, where kids spend one-third of their waking hours.

At the University of Southern California, researchers looked at the highway effect both at school and at home by following nearly 2,500 kindergarten and Grade 1 students, none of whom had asthma at the outset. After three years, 120 of the children had developed the lung disease. “Children exposed to higher levels of traffic-related air pollution at school and at home are at increased risk of developing asthma,” the researchers concluded.

Yet it’s still not clear whether exposure to high volumes of traffic-related pollution causes asthma, says Jim Gauderman, an associate professor of preventive medicine at USC and the study’s lead author. It may instead trigger the symptoms of a disease that’s already there. Or, if it does cause the disease, it may be doing so at an earlier age, says Michael Brauer, a professor at the University of British Columbia’s school of environmental health. His research for Canada’s AllerGen research network suggests that children born to mothers who lived beside busy highways during pregnancy are more likely to develop asthma by age 4.

What’s not in dispute among the researchers is this: kids who live or learn near a highway are more likely to cough and wheeze. When you consider that asthma is the most common chronic disease in childhood, this is a major public health issue. Over seven million children in the United States live with asthma. Across North America, it’s the No. 1 cause of missed school days. Now consider this: one-third of U.S. schools sit within 1,300 feet of a major highway, in what the media has dubbed the “air pollution danger zone.”

Researchers have discovered that most adults with asthma who are sensitive to Aspirin also get mild to severe respiratory symptoms when drinking alcohol.

Dr. Tanya Laidlaw, of the allergic disease research center at Boston’s Brigham and Women’s Hospital, explained that Aspirin Exacerbated Respiratory Disease, or AERD, is a condition that involves three things: asthma, nasal polyps and a sensitivity to Aspirin (and other non-steroidal anti-inflammatory drugs or NSAIDS). AERD affects 10 to 20 percent of those with adult asthma.

She says her research team has now found that “three-quarters of all AERD patients do have respiratory reactions when they drink alcohol. For many of them, it’s within several sips of a single glass.”

Seventy-four percent were found to react to alcohol with an upper respiratory reaction, such as a runny nose or congestion, compared to 34 percent of a group with asthma who tolerate Aspirin.

Lower respiratory reactions, such as sometimes severe wheezing and shortness of breath, occurred in 51 percent of AERD patients after drinking alcohol, compared to 24 percent of the Aspirin-tolerant asthmatics.

What Causes Your Reaction to Alcohol?

The alcohol association arose initially from patients themselves. Laidlaw says patients at the AERD clinic at Brigham and Women’s Hospital were often mentioning symptoms like wheezing and coughing, signs of an asthma attack, when they drank alcohol. “They began asking: ‘Did we know why it was that when they had a glass of wine or a couple of beers, they would also have a very similar and often very severe respiratory reaction to the alcohol,’” she told a news conference.

She and her colleagues didn’t know, but were intrigued and decided this warranted study. The Brigham and Women’s center collaborated with the Scripps respiratory clinic in San Diego to send out a survey study to four groups: diagnosed AERD patients, patients who had asthma but are aspirin tolerant, patients with chronic sinusitis who don’t have asthma and to healthy patients with no asthma or sinus issues.

Among the patients reacting to alcohol, red wine emerged as the most likely to provoke symptoms (29 percent of patients), followed by beer (9 percent) and white wine or liquor (6 percent). However, for half of the patients, any kind of alcohol triggered symptoms.

This study of AERD patients and alcohol is continuing. So far, 132 patients have been recruited into the study, but researchers hope to expand this number to 320 before they finish.

Laidlaw notes that many AERD patients have had to stop drinking alcohol. The next step will be to examine what the mechanisms through which alcohol triggers such symptoms. Laidlaw says the relationship should also be useful in the diagnosis of AERD, which is not always obvious, as the sensitivity to Aspirin can be mild and is often overlooked.

See more news from the AAAAI 2013 conference here.

Read more about wine reactions here.

“We’ve shown that the gene being changed is directly associated with asthma and severity of the asthma,” Dr. Kari Nadeau of Stanford University, the senior study author, told a press conference at the 2013 meeting of the AAAAI in San Antonio, Texas.

The new study shows that exposure to polycyclic aromatic hydrocarbons (PAHs) in the air directly led to a change in a gene known as FOXP3. This gene exists inside regulatory T-cells, whose job is to suppress inappropriate immune responses, such as the airway inflammation associated with asthma. This alteration in the gene makes it harder for the T-regulatory cells to do their job, leading to worsened asthma symptoms.

The study also associated PAH exposure with higher overall levels of IgE antibodies, which play a major role in any allergic response.

For the study, researchers observed a group of children and teens at two sites in California: Fresno, which is known for heavy air pollution and a high rate of asthma (about 22 percent), while Stanford, a lower-pollution area, was used as a control group. Measurements were taken of PAH levels in the air, the children were given lung function tests, and also gave blood and urine samples.

The children who had been exposed to PAHs for three months before the testing were more likely to have altered FOXP3 genes, decreased T-regulatory cell function and high levels of IgE antibodies. All three differences make asthma more likely, and its impact more severe.

“Exposure to high PAH quantities may be having an effect at the molecular level, possibly leading to new cases of asthma,” said Nadeau in a press release. This altered version of FOXP3 was even found in individuals from the area who didn’t have asthma – and it is unknown whether this change is reversible.

More than 100 chemicals are classified as PAHs, which form when an organic substance is burned incompletely. Sources include oil, gas, coal, tobacco, or even meat from a barbecue (when drippings fall onto the flames, PAHs are formed which then adhere to the meat). Man-made PAHs can also be found – in tars as well as some plastics, dyes and pesticides.

See Allergic Living‘s full coverage of the 2013 AAAAI allergists conference.

NEW YORK (March 1, 2013) — Researchers at the Columbia Center for Children’s Environmental Health at the Mailman School of Public Health are the first to report an association between early childhood exposure to the chemical bisphenol A (BPA) and an elevated risk for asthma in young children. BPA is a component of some plastics and is found in food can liners and store receipts.

Results appear in the March edition of the Journal of Allergy and Clinical Immunology.

“Asthma prevalence has increased dramatically over the past 30 years, which suggests that some as-yet-undiscovered environmental exposures may be implicated. Our study indicates that one such exposure may be BPA,” says lead author Kathleen Donohue, MD, an assistant professor of Medicine at Columbia University College of Physicians and Surgeons and an investigator at the Center for Children’s Environmental Health.

Dr. Donohue and her co-investigators followed 568 women enrolled in the Mothers & Newborns study of environmental exposures. BPA exposure was determined by measuring levels of a BPA metabolite in urine samples taken during the third trimester of pregnancy and in the children at ages 3, 5, and 7. Physicians diagnosed asthma at ages 5 to 12 based on asthma symptoms, a pulmonary function test, and medical history. A validated questionnaire was used to evaluate wheeze.

After adjusting for secondhand smoke and other factors known to be associated with asthma, the researchers found that post-natal exposure to BPA was associated with increased risk of wheeze and asthma. BPA exposure during the third trimester of pregnancy was inversely associated with risk of wheeze at age 5. This unexpected finding is in contrast to the results of a previous study, which found that BPA exposure during the second trimester, a critical period for the development of airways and the immune system, was positively linked with risk for asthma.

Increased risk for wheeze and asthma was seen at “fairly routine, low doses of exposure to BPA,” says Dr. Donohue. “Like most other scientists studying BPA, we do not see a straightforward linear dose-response relationship.”

At all three time points, more than 90% of the children in the study had detectable levels of BPA metabolite in their bodies, a finding that is in line with previous research. This does not mean that they will all develop asthma, cautions Dr. Donohue. “Just as smoking increases the risk of lung cancer but not everyone who smokes gets lung cancer, not every child exposed to BPA will develop asthma.”

The biological mechanism behind the BPA-asthma connection is unclear. The current study found no evidence that exposure to BPA increased the risk that the immune system would develop more antibodies to common airborne allergens. “Other possible pathways may include changes to the innate immune system, but this remains an open question,” says Dr. Donohue.

The new study builds on existing evidence linking BPA exposure to respiratory symptoms, as well as to obesity, impaired glucose tolerance, and behavioral issues, among a range of health problems. In July, the Food and Drug Administration banned BPA in baby bottles and sippy cups.

Read more at http://ccceh.org/news/bpa-raise-risk-for-childhood-asthma

Up to 1,200 patients are enrolling in an international study to evaluate a new form of allergy immunotherapy which, if successful, will require as few as four allergy shots, given monthly, to rid a patient of an allergy to cat dander.

Current immunotherapy for cats takes about three years and often more than a hundred shots to complete.

“Use of immunotherapy has always been limited by the long treatment required,” said allergist Dr. Harold Nelson of National Jewish Health in Denver, who is heading the project. “If the current study confirms earlier findings, it could be a major step forward for allergy treatment,” he said in a news release.

With traditional allergy immunotherapy, multiple injections of protein triggers like cat dander or pollen are given in small then increasing amounts over a long period of time. The idea is to gradually build tolerance and, ultimately, to desensitize the patient to the allergen. While this type of vaccination is currently the only way to treat the underlying allergic disease (rather than just allergy symptoms), it is a fairly invasive, costly and time-consuming, since patients must make numerous visits to the doctor.

Cat allergy is one of the most common allergic disorders, and a frequent trigger for asthma. The protein in cat dander that causes almost all symptoms is “fel d 1”, and the new vaccination therapy, called ToleroMune, works by injecting seven tiny protein fragments or “peptides” of this cat protein, as opposed to the whole protein.

By using the fragments, which aren’t large enough to provoke an allergic reaction, studies to date show that patients can become desensitized to cat much more rapidly and with far few side effects. Unlike the proteins used in traditional immunotherapy, as the protein fragments are not large enough to cause a reaction.

The study is expected to involve about 1,200 participants at National Jewish Health as well as at more than 100 centers in the United States, Canada, and Europe. Researchers hope to confirm earlier findings which showed that after four shots of ToleroMune, which has been developed by the British firm Circassia Ltd., many patients became desensitized and remained so a year later.

Asthma can be tricky for a doctor to diagnose, especially in young kids. Symptoms can mimic other diseases and spirometry, the breathing test to diagnose asthma, requires the patient be able to breathe into a tube, which isn’t possible for most small children.

“The hypothesis has been that people with airway disease will have different metabolism compared to those without disease,” says Dr. Darryl Adamko, head of pediatric pulmonary medicine for the Saskatoon Health Region.

That is, the chemicals in their urine will have a unique compound that could be tested for. His team, based at the University of Alberta where he used to work, is using a technology called nuclear magnetic resonance (NMR) and they believe they have pinpointed what the metabolism of an asthmatic looks like in urine.

They are now working with groups in the United Kingdom and Canada to see how well testing urine for this compound predicts asthma. (Adamko is also testing the theory with COPD, bronchiolitis and allergic rhinitis.)

The researchers are still trying to recruit groups large enough for a robust study, but based on the early results, “it does look like it can differentiate asthma versus COPD or asthma versus no asthma,” says Adamko.

The pediatric respirologist hopes this test will do more than just diagnose. “As you get sicker, your metabolism changes,” he says. That means if someone comes into a clinic or hospital with asthma symptoms, a urine test could tell doctors whether the symptoms will get worse. While Adamko is optimistic his team will be successful, he says it’s at least five years before such a test is used in common practice.

First published in Allergic Living magazine.
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But a new study could change that. Researchers at Monash University in Australia are working on a dust-mite vaccine that, if successful, would have the potential to cure sufferers in just two to three doses. Professor Els Meeusen is applying her experience in infectious disease vaccines to the world of allergy. She believes the addition of a new ingredient into the vaccine could be the magic bullet allergy sufferers have been waiting for.

Allergic Living’s Kim Shiffman spoke with Els Meeusen to find out what that ingredient is, and when the vaccine might be available.

Why focus on immunotherapy as a treatment for dust mite allergy?

It’s the only treatment that could be a cure. All the others are just to keep allergic symptoms under control, but they don’t cure anything.

How would your vaccine be different than the one that’s been available for years?

The current house dust mite allergy vaccine is given at continuously increasing doses over a period of years. You have to be very careful giving it – it can be a little bit dangerous to use because it’s not well known how it works, and if you don’t use it properly, it could cause a serious reaction. It’s also not quite clear if or when it’s going to start working, and there are no clear markers to actually assess if it’s working.

What our work will do is try to speed up the vaccine effect, a bit like in the work I do with infectious diseases, where you only have to give two or three injections before you get good immunity. If we can achieve the same immune deviation – changing the immune system by vaccination using the same principles as infectious diseases – then we may be able to have a more effective and quicker vaccination regime for house dust mite allergy.

Next Page: More questions on the vaccine