By Henry Ehrlich
Three abstracts from AAAAI in San Diego by our contributors :
47 Allergic Sensitization and Environmental Exposures In Amish and Hutterite Children Dr. Mark Holbreich, MD et al
RATIONALE: In separate studies of two US farming populations of central European ancestry, we found marked differences in the prevalence of allergic sensitization between Indiana Amish and South Dakota Hutterite children (7% vs. 40%). Here, we directly compared the prevalence of allergic sensitization and exposure to major inhaled allergens in these children.
METHODS: 30 age- and sex-matched school children each were studied in Nov. (Amish) and Dec. (Hutterite) 2012. Serum IgE (ImmunoCap; Phadia) to mite, cat, cockroach, mold, mouse urine protein and epithelium, mixed tree, and mixed grass allergens were measured. Atopy was defined as IgE more than 3.5KU/L to more than 1 allergen. Eight allergens (3 mite, cat, dog, cockroach, rat, mouse) were measured by multiplex immunoassay in airborne dust sampled from electrostatic dust collectors one month after their placement in 10 homes from each population.
RESULTS: We confirmed atopy prevalence is 7% (2/30) among Amish and 30% (9/30) among Hutterite children (P50.042). Common allergens were essentially undetectable in house dust from both groups, except for Musm1, which was found more frequently (9 of 10 vs. 2 of 10 homes, P50.0054) and at higher levels (median5210 vs. 15 ng/m2) in Amish compared to Hutterite homes. However, Amish children had no IgE to mouse allergens.
Conclusions: Differential exposure to common allergens per se does not explain the lower prevalence of allergic sensitization among Amish compared to Hutterite children. However, the combination of high mouse allergen exposure and lack of sensitization to these allergens may reflect a microbial environment that promotes protection from atopy among the Amish.
72 Prospective Study To Determine Risk Factors and Severity Of Food-Induced Allergic Reactions In Children Dr. Anna H. Nowak-Wegrzyn, MD, et al
RATIONALE: To determine risk factors, severity, and treatment of food-induced allergic reactions in children in the outpatient setting from prospective data.
METHODS: Children with diagnosis of food allergy were followed over 24 months. 126 patients were contacted to document food exposures and reactions.
RESULTS: Thirty eight percent of patients reported an allergic reaction. The majority of reactions were caused by milk (39%), followed by peanut (16.3%), egg (8.2%) and tree nuts (6.1%). Exposure to milk (OR 40.4, CI 5.2-316.4, p<0.0001) or peanut (OR 7.3, CI 1.5-36.1, p50.014) was shown to be associated with increased odds of having a reaction. Furthermore, milk and peanut were linked to more severe reactions (44.4%). 83% of reactions were caused by ingestion. There was no difference in odds of having a reaction whether one took a tiny bite versus full serving. 33% of patients with more severe reactions had recently exercised. The amount and form of food had no association with severity of reaction. 4 out of the 48 reactions used epinephrine, and were all given by patient/parent, at the scene or at home.
3 out of 4 had just previously exercised. Mean anaphylaxis score was 2.3 for those that used epinephrine, versus 1.3 for those that did not (p50.003). 75% of parents reported feeling comfortable using the epinephrine auto-injector.
CONCLUSIONS: Milk or peanut allergy is associated with increased odds of having an allergic reaction and caused more severe reactions. The amount and form of food was not associated with severity of reaction.
103 Pharmacokinetics Of Berberine, a Bioactive Compound In Butanol Purified Food Allergy Herbal Formula-2 Dr. Xiu-Min Li, MD et al
RATIONALE: Food Allergy Herbal Formula 2 (FAHF-2) prevents peanut-induced anaphylaxis in a murine peanut allergy model. Butanol extracted FAHF-2 named B-FAHF-2 is equally effective at only 20% of the FAHF-2 dose. We found previously that berberine isolated from these formulas inhibit IgE production and basophil activation. The aim of this study was to determine the pharmacokinetics of berberine.
RATIONALE: Food Allergy Herbal Formula 2 (FAHF-2) prevents peanut-induced anaphylaxis in a murine peanut allergy model. Butanol extracted FAHF-2 named B-FAHF-2 is equally effective at only 20% of the FAHF-2 dose. We found previously that berberine isolated from these formulas inhibit IgE production and basophil activation. The aim of this study was to determine the pharmacokinetics of berberine.
METHODS: Berberine standard and B-FAHF-2 were dissolved in acetonitrile and several concentrations were analyzed by liquid-chromatography-mass-spectrometry (LC-MS). Calibration curves were generated by plotting the chromatographic peak area as a function of berberine concentrations. C3H/HeJ mice were randomly separated into three groups and 12 mg of B-FAHF-2, 2mg of berberine, and water were orally administered. Blood samples were collected at several time points after feeding. In addition, the presence of berberine in sera from subjects in a controlled phase 1 FAHF-2 study was also analyzed. All serum samples were protein-precipitated with acetonitrile and berberine was detected by LC-MS.
RESULTS: The percentage of berberine present in B-FAHF-2 was calculated to be 9.161 + or -8%. Serum concentration-time curves of berberine were plotted. Tmax was determined to be 60 minutes and the Cmax was 172.5 + or- 27.6 ng/mL. Berberine alone was absorbed at a lower rate than was berberine in B-FAHF-2. Berberine was also detected in sera from patients receiving FAHF-2, but not placebo, in a phase I study
CONCLUSIONS: Berberine is a bioactive compound in B-FAHF-2 and other components composed in B-FAHF-2 many enhance berberine bio-availability.
Re:
“CONCLUSIONS: Berberine is a bioactive compound in B-FAHF-2 and other components composed in B-FAHF-2 many enhance berberine bio-availability.”
Pardon my ignorance, but is enhancing the bio-availability of berberine a good thing or a bad thing?
Dear Selena,
Thanks for writing. As a food allergy mom who follows the research closely, you know it’s not easy to find out the effectiveness of treatments while they are in process. A food challenge is the only sure thing, but you can’t do them all the time. Patients who are being treated by Dr. Xiu-Min Li for eczema and/or asthma can track their progress because of improvements in these highly symptomatic conditions. With food allergies it’s harder because the most common measure of allergy, allergen specific IgE floating in the blood, is not really an indicator of the effectiveness of treatment, so the scientists are always on the lookout for biomarkers that can be associated with progress. As it says in the rationale, berberine, an active compound in FAHF-2, inhibits IgE production and basophil activation, which are both part of the allergic response. If other compounds make berberine even more effective, it may account for the effectiveness of B-FAHF-2, the refined form of FAHF-2. In time, it may be feasible to measure the effectiveness of treatment using a basophil activation test, which can be done with a blood draw. If basophils are not activated when exposed to an allergen in a laboratory setting, it will show progress.
Henry Ehrlich