Tag Archives: asthma

Infants, young children finally get relief from eczema’s terrible itch, scratching

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· More than half of children treated had at least a 75% reduction in signs of eczema and itch
· Kids sleep through night for first time instead of scratching
· Parents see children’s personalities change as they are able to lead a normal life.

Eczema, also known as atopic dermatitis, is a chronic inflammatory skin disorder characterized by red, dry, often oozing skin and itch that can profoundly affect the lives of affected patients and their families.

An estimated 19% or more of all children under 6 years of age have eczema and 85 to 90% of individuals affected overall with eczema have the onset of disease during the first five years of life.

The children’s debilitating itch leads to sleep disturbance, poor neurocognitive development and, on average, a full night of sleep lost per week.

CHICAGO — The first study to treat moderate-to-severe eczema in infants and children 6 months to 5 years old with a biologic drug (monoclonal antibody) rather than immune-suppressing medications shows the drug was highly effective in reducing the signs and symptoms of moderate-to-severe eczema, report researchers involved in a new multi-site international phase III study led by Northwestern Medicine.

A 16-week course of dupilumab, a medication that targets a key immune pathway in allergies, resulted in more than half the children having at least a 75% reduction in signs of eczema and highly significant reductions in itch with improved sleep.

This is the first large-scale, randomized, placebo-controlled trial of a monoclonal antibody in any skin disease, including eczema, in children as young as 6 months. The study, which included 31 sites in Europe and North America, will be published Sept. 15 in The Lancet.

“Preschoolers who are constantly scratching, awake multiple times a night with their parents, irritable and markedly curtailed in their ability to do what other children their ages can do improved to the extent that they sleep through the night, change their personalities and have a normal life — as babies and children should,” said lead study author Dr. Amy Paller, chair of dermatology at Northwestern University Feinberg School of Medicine and an attending physician at Ann & Robert H. Lurie Children’s Hospital of Chicago.

“The ability to take this drug will significantly improve the quality of life for infants and young children who suffer tremendously with this disease,” Paller said. “Atopic dermatitis or eczema is so much more than just itchy skin. It is a devastating disease. The quality of life of severe eczema — not only for the child but also parents — is equivalent to many life-threatening diseases.”

As a result of this study, this medication is now available to infants and preschoolers as young as 6 months of age. It has “an outstanding safety profile” and does not even require any laboratory tests before starting the medication, Paller said.

Although one-half to two-thirds of young children with eczema have mild symptoms, which can be handled with steroid ointment and moisturizers, the other one-third or more have moderate-to-severe disease and require more aggressive management.

“Up to now, all we have had to treat more severe eczema is immune-suppressing medications, such as oral steroids, which we try to avoid in children, because they are associated with so many side effects and thus are not a preferred treatment for a chronic skin disease,” Paller said. “The potential long-term impact on the development of the immune system in young children is also of concern with these immunosuppressants.”

During the past few years, a new medication has become available called dupilumab, which is the first “biologic” drug to treat eczema in a targeted manner, meaning a narrow attack on just what scientists have found is causing the manifestations of the disease in skin. This medication was found to be effective and safe in studies with adults, then adolescents, then other school-aged children. 

“But the group in whom we worry the most about safety — those under 5 — had not been tested and were unable to get this medication,” Paller said.

The parent or a health care provider gives the child a monthly shot to administer the medication.

“The effect for most of these younger children is dramatic and at least as good as we’ve seen with the risky immunosuppressant medications,” Paller said.

Potential added benefit by treating associated allergies

This medication has also been shown to be effective for treating asthma, gastrointestinal manifestations of allergy and other allergy-mediated problems but is not yet approved for these indications in infants and young children.

In fact, 66% of children in this trial had developed their eczema during the first six months of life and, by the time of initiating the dupilumab, more than 80% had already developed at least one allergic disorder, such as asthma or food allergy.

“By treating more aggressively to calm the immune system activation in these young children with early, severe eczema, we may also reduce the risk of their developing a range of allergic problems, changing their life beyond improving eczema,” Paller said. “These associated allergic issues most often begin after the eczema starts.”

Children were randomized to receive either a placebo injection or the dupilumab (weight-based dosing) every four weeks for 16 weeks. Only children who were not responding adequately to topical medications were allowed to enroll, and they had to be of a high severity, even with the topical medications.

As a result of the study, Paller said, scientists and physicians can start to better understand the relationships between eczema and a variety of allergic disorders and can consider the possibility of using this medication for other disorders that affect these very young children.

The trial was sponsored by Regeneron Pharmaceuticals, Inc. and Sanofi, who jointly developed dupilumab.

Exposure to air pollution in infancy alters gut microorganisms, may boost disease risk [Preventive Steps]

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Exposure to air pollution in the first six months of life impacts a child’s inner world of gut bacteria, or microbiome, in ways that could increase risk of allergies, obesity and diabetes, and even influence brain development, suggests new CU Boulder research.

“This study adds to the growing body of literature showing that air pollution exposure, even during infancy, may alter the gut microbiome, with important implications for growth and development,” said senior author Tanya Alderete, assistant professor of Integrative Physiology at CU Boulder.

At birth, an infant hosts little resident bacteria. Over the first two to three years of life, exposure to mother’s milk, solid food, antibiotics and other environmental influences shape which microorganisms take hold. Those microbes, and the metabolites, or byproducts, they produce when they break down food or chemicals in the gut, influence a host of bodily systems that shape appetite, insulin sensitivity, immunity, mood and cognition. While many are beneficial, some microbiome compositions have been associated with Chrohn’s disease, asthma, type 2 diabetes, and other chronic illnesses.

Air pollution/photo:en.wikipedia.org

“The microbiome plays a role in nearly every physiological process in the body, and the environment that develops in those first few years of life sticks with you,” said first author Maximilian Bailey, who graduated in May with a master’s in Integrative Physiology and is now a medical student at Stanford University.

Boosting inflammation

For the study, the researchers obtained fecal samples from 103 healthy, primarily breast-fed Latino infants enrolled in the Southern California Mother’s Milk Study and used genetic sequencing to analyze them.

Using their street addresses and data from the U.S. Environmental Protection Agency’s Air Quality System, which records hourly data from monitoring systems, they estimated exposure to PM2.5 and PM10 (fine inhalable particles from things like factories, wildfires and construction sites) and Nitrogen Dioxide (NO2), a gas largely emitted from cars.

“Overall, we saw that ambient air pollution exposure was associated with a more inflammatory gut-microbial profile, which may contribute to a whole host of future adverse health outcomes,” said Alderete.

For instance, infants with the highest exposure to PM2.5 had 60% less Phascolarctobacterium, a beneficial bacterium known to decrease inflammation, support gastrointestinal health and aid in neurodevelopment. Those with the highest exposure to PM10 had 85% more of the microorganism Dialister, which is associated with inflammation.

infant-small child/photo:en.wikipedia.org

Infants are particularly vulnerable to the health hazards of air pollution because they breathe faster and their gut microbiome is just taking shape.

“This makes early life a critical window where exposure to air pollution may have disproportionately deleterious health effects,” they write.

Meantime, Alderete advises everyone to take these steps to reduce their exposure to both indoor and outdoor pollutants:

  • Avoid walking outdoors in high-traffic zones
  • Consider a low-cost air-filtration system, particularly for rooms children spend a lot of time in
  • If you are cooking, open the windows
  • And for new moms, breastfeed for as long as possible

“Breast milk is a fantastic way to develop a healthy microbiome and may help offset some of the adverse effects from environmental exposures,” Alderete said.

Fish oil, vitamin D supplements during pregnancy lower risk of croup in babies

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Babies and children under three years old are less likely to develop croup if their mothers took fish oil and vitamin D supplements during pregnancy, according to new results from a clinical trial.

Croup is a viral chest infection that affects young children. It causes a characteristic ‘barking’ cough, a hoarse voice and difficulty breathing. Croup is common and usually mild, but some children will need hospital treatment and breathing support.

The study was presented by Dr Nicklas Brustad, a clinician and postdoctoral researcher working on the Copenhagen Prospective Studies on Asthma in Childhood (COPSAC) at Copenhagen University Hospital, Denmark.

He told the Congress: “There is currently no vaccine against the pathogen that causes this disease. Therefore, other preventive strategies are needed, and measures initiated during pregnancy might be important since croup occurs in babies and young children. For such purpose, there is evidence that both vitamin D and fish oil could have an influence on the immune system.”

croup-chest infection/photo:en.wikipedia.org

The study included 736 pregnant women being cared for by COPSAC from 2010. The women were divided up into four groups. One group were given a high-dose vitamin D supplement (2800 international units per day) and fish oil containing long-chain n-3-polyunsaturated fatty acids (2.4 grams), the second group were given high-dose vitamin D and olive oil, the third group were given standard-dose vitamin D (400 international units per day) and fish oil, and the final group were given standard-dose vitamin D and olive oil. All the women took the supplements daily from their 24th week of pregnancy until one week after their babies were born. Neither the women nor the researchers knew which supplements they were taking until the end of the study.

Researchers monitored the children until they were three years old and any who were suspected of suffering from croup were diagnosed by a doctor or via their medical records. There was a total of 97 cases of croup amongst the children.

Vitamins-Fish oil supplements/photo:en.wikipedia.org

Overall, children whose mothers took the fish oil had an 11% risk of croup, compared to 17% in the children whose mothers took olive oil (a 38% decrease). Children whose mothers took high-dose vitamin D had an 11% risk of croup, compared to an 18% risk in those whose mothers took the standard-dose vitamin D (a 40% decrease).

Dr Brustad said: “Our findings suggest that vitamin D and fish oil could be beneficial against childhood croup in sufficiently high doses. These are relatively cheap supplements meaning that this could be a very cost-effective approach to improving young children’s health.

Vitamin D and fish oil can stimulate the immune system to help babies and young children clear infections more effectively.”

The research team working at COPSAC have already investigated other potential benefits of vitamin D and fish oil during pregnancy, including its effects on bone development, the central nervous system, body composition and asthma. They will continue to follow the children in the study and plan to investigate why some children are more prone to infections in childhood than others.

Professor Rory Morty from the University of Heidelberg is chair of European Respiratory Society’s lung and airway developmental biology group and was not involved in the research. He said: “We know that lung health in babies and young children can be influenced during pregnancy. For example, babies whose mothers smoke tend to have worse lung health. We are increasingly seeing that elements of a mother’s diet can also help or hinder a baby’s lung development.

“This research suggests that taking vitamin D and fish oil supplements during pregnancy could have benefits for babies and young children. We would like to see further research in this area to support these findings as this could lead to new recommendations for supplementation during pregnancy. Pregnant women should always speak to their doctor before taking supplements.”

 

 

Air pollution is more dangerous for women than men: Study

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The impact of breathing diesel exhaust fumes may be more severe for females than males, according to new research that will be presented at the European Respiratory Society International Congress in Barcelona, Spain [1].

Researchers looked for changes in people’s blood brought about by exposure to diesel exhaust. In both females and males, they found changes in components of the blood related to inflammation, infection and cardiovascular disease, but they found more changes in females than males.

The research was presented by Dr Hemshekhar Mahadevappa, from the University of Manitoba, Winnipeg, Canada and was a collaboration between two research groups led by Professor Neeloffer Mookherjee at the University of Manitoba and Professor Chris Carlsten at the University of British Columbia, Vancouver, Canada. Dr Mahadevappa told the Congress: “We already know that there are sex differences in lung diseases such as asthma and respiratory infections.

Air pollution/Photo:en.wikipedia.org

Research showed that breathing diesel exhaust creates inflammation in the lungs and has an impact on how the body deals with respiratory infections. In this study, we wanted to look for any effects in the blood and how these differ in females and males.”

The study involved ten volunteers, five female and five male, who were all healthy non-smokers. Each volunteer spent four hours breathing filtered air and four hours breathing air containing diesel exhaust fumes at three different concentrations – 20, 50 and 150 micrograms of fine particulate matter (PM2.5) per cubic metre – with a four-week break in between each exposure.

Volunteers donated blood samples 24 hours after each exposure and the researchers made detailed examinations of the volunteers’ blood plasma. Plasma is the liquid component of the blood that carries blood cells as well as hundreds of proteins and other molecules around the body. Using a well-established analysis technology called liquid chromatography–mass spectrometry, the researchers looked for changes in the levels of different proteins following exposure to diesel exhaust and compared the changes in females and males.

Airpollution/Photo:en.wikipedia.org

Comparing the plasma samples, the researchers found levels of 90 proteins that were distinctly different between female and male volunteers following exposure to diesel exhaust. Among the proteins that differed between females and males, were some that are known to play a role in inflammation, damage repair, blood clotting, cardiovascular disease and the immune system. Some of these differences became clearer when volunteers were exposed to the higher levels of diesel exhaust.

Professor Mookherjee explained: “These are preliminary findings, however they show that exposure to diesel exhaust has different effects in female bodies compared to male and that could indicate that air pollution is more dangerous for females than males.

“This is important as respiratory diseases such as asthma are known to effect females and males differently, with females more likely to suffer severe asthma that does not respond to treatments. Therefore, we need to know a lot more about how females and males respond to air pollution and what this means for preventing, diagnosing and treating their respiratory disease.”

Air pollution/photo:en.wikipedia.org

Professor Zorana Andersen from the University of Copenhagen, Denmark, is Chair of the European Respiratory Society Environment and Health Committee and was not involved in the research. She said: “We know that exposure to air pollution, especially diesel exhaust, is a major risk factor in diseases such as asthma and chronic obstructive pulmonary disease. There is very little we can do as individuals to avoid beathing polluted air, so we need governments to set and enforce limits on air pollutants.