Aug
31
2013

Peanut Allergies Are Deadly

In the US 1.5 million suffer from peanut allergies (Ref.1). People who have peanut allergies have to avoid peanuts and foods that contain even traces of peanuts lifelong. Here is a recent example of a 13-year old girl who died at a camp when she tried food contaminated with peanuts. Before we discuss peanut allergies in detail, we need to review first how the immune system is functioning.

How the immune system is primed to develop an allergy

Our immune system knows the difference between our own body components and substances that come from the outside. Scientists call this tolerance to our own surface proteins; and scientists call it an immune reaction that is mounting as a reaction to anything different from the surface antigens. There are different cells that make up the immune system. One of the main working cells of the immune system are the lymphocytes, with B cells originating from the bone marrow producing antibodies when an immune reaction occurs. Antibodies fit like a lock and key to the surface of an antigen, in this case the peanut protein. T helper cells are T lymphocytes (thymus derived lymphocytes) that help the B cells to recognize the difference between the own protein components and the outside components. There are also T killer cells, which get activated when parasites or viruses enter the body. With regard to peanut allergies it is the B cells and T helper cells that interact and the B cells produce a powerful, very specific IgE antibody directed against peanut protein. There are memory B cells, which continue to produce these specific anti-peanut protein antibodies and cause severe allergic reactions when future exposure to peanuts (even traces) occurs. So, the more often a person who is allergic to peanuts encounters even traces of peanuts, the immune system will get boosted and produce even more antibodies of the IgE type through reactivated B memory cells (Ref. 2). 98% of the population does not react to peanut exposure with allergies, but the other 2% who may have genetic susceptibility factors that predispose them to this often develop life-threatening reactions (an anaphylactic reaction).

What is an anaphylactic reaction to peanuts?

The most extreme form of allergies involving IgE antibodies can cause anaphylaxis. In the beginning stages of a peanut allergy there may only mild symptoms such as hives on the skin, itching and tingling around the mouth, a runny nose, a scratchy throat, wheezing, stomach cramps, vomiting or diarrhea. However, with a more severe allergy an asthma attack can develop, blood pressure drops leading to fainting or shock and severe airway obstruction in the throat or lungs can cause suffocation.

I vividly remember an 11-year-old boy who was brought in by ambulance to the emergency room of the hospital where I was working as the on-call physician. He had a hard time talking as his throat was swelling up as part of his anaphylactic reaction, within minutes he passed out completely (shock). Fortunately an anesthetist was in the department and could intubate him very quickly. However, despite adrenaline treatment, oxygen  by artificial ventilation and high doses of corticosteroid drugs he did not wake up until 10 hours later. In retrospect it turned out that he had eaten some crackers of a familiar brand that he knew as being free of peanut flour. However, he had seen an ad that the same brand of crackers was available as cheese crackers and he tried one of these, which prompted his admission to the hospital. The parents read the ingredients later: the label on the cheese crackers noted in small print that the flour of the cheese crackers contained peanut flour! Always read labels, even if it is a familiar brand! Fortunately for this boy he did not have brain damage from the time of his unconsciousness. He has been extremely careful since and is reading labels and avoiding unknown food items.

Peanut Allergies Are Deadly

Peanut Allergies Are Deadly

Cross-reactions between peanuts and other allergens

Allergies can be made worse when a person has inhalant allergies from pollens of trees or grasses that can share protein components from protein found in foods. The latest findings are that there are cross allergies between Fenugreek and lupine, which are both legumes, as are peanuts, so there are common antigens present in their proteins. A mouse-testing model has shed more light on this. Fenugreek has been shown to control mild diabetes by improving insulin resistance, but it cannot be consumed by persons who are highly allergic to peanuts because of the cross allergy mentioned.

There are other possible cross allergies to legumes like lentils, soy and chickpeas.

Other factors that can cause allergies to get worse

In the past the RAST test was often used.  This is a blood test for common food allergies that can cause severe allergic reactions like egg, milk, peanut, tree nuts, wheat, crustacean shellfish and soy. However, since about 2010 this has been replaced by the more sensitive ImmunoCAP Specific IgE test. Children who have food allergies to egg, milk, wheat, nuts, peanuts and soy often outgrow these allergies when they age, in other words their immune system can develop tolerance to many of these foods. Not so with peanut allergies ! They tend to be very persistent.

The immune responses to food allergies are complicated as there are immediate type immune reactions and delayed type immune reactions. The immediate immune responses are investigated with the above mentioned ImmunoCAP Specific IgE test. The delayed immune responses can be measured using the ELISA test. Positive IgE antibody tests for peanut protein are a marker that the person affected likely has more other allergies and they should be investigated by a knowledgeable allergist in that regard (Ref. 2).

What complicates the allergy sufferers’ lives even more is the fact that new wheat varieties since the 1970’s, called Clearfield wheat have a much higher gliadin (gluten) and lectin content than the old wheat varieties. As a result of exposure to this new type of wheat gluten intolerance and leaky gut syndrome have increased substantially in the world population (Ref.3). In addition, genetically modified foods like soy, corn, sugar beets, canola and others have challenged the immune system of sensitive humans even more. We do know that some people can develop autoimmune diseases from GMO foods and modern wheat, and this may be the reason that a host of diseases that belong into this disease category (MS, rheumatoid arthritis, Hashimoto’s thyroiditis, ankylosing spondylitis etc.) are much more common now than in the past. The geneticists who developed GMO foods seemed to be unaware how sensitive the immune system is, which will detect a few different amino acid sequences in a protein mounting a strong immune response to it.

Treatment for peanut allergies

The key for sufferers from peanut allergies is to avoid exposure to it. Read labels and use common sense. If something is not labeled, do not be tempted to eat it. Peanut flour is often mixed into the dough of crackers, not being labeled properly or only in fine print. With peanuts the antibodies usually circulate in the blood life long as the B memory cells do not diminish and get reactivated very quickly on repeat exposure producing antibodies again. As exposure to peanuts can cause severe asthma or anaphylactic shock, it is important to carry an EpiPen with you and to know how to use it.

In Europe attempts have been made to develop an oral desensitization method for food allergies including peanut allergies, but it has not produced concrete results yet. Recently, however, research from Texas, USA showed that it is possible to desensitize patients with peanut allergy by oral desensitization. In Australia where food allergies are more prevalent than in the US, tolerance to peanut, nut and shellfish allergies is being pursued by oral immunotherapy. Another group in Australia has developed a vaccination method using peptides, which are a sequence of amino acids, but shorter than the full peanut protein. It appears that this is the future direction of  treatment for peanut and other IgE mediated allergies: a kind of vaccination treatment to induce competing antibodies, which will neutralize the allergic IgE antibodies.

Conclusion

Peanut allergies have become more troublesome as the food industry has mixed peanut flour into Thai sauces, drinks, cookies, crackers and such. The person allergic to peanuts must read food labels and eat as much single-ingredient natural food as possible. This goes against the tendency of food processors who produce foods with a long rat tale of ingredients. If you see a label “may contain nuts or peanuts”, stay away from this product, as it is safer. Always carry an EpiPen or Twinject with you, just in case you develop an anaphylactic reaction (you only have a few minutes to stop the allergic reaction with adrenaline). In the future vaccination with a peanut protein specific peptide vaccine as mentioned regarding the Australian research, will probably become the treatment of choice.

More information on status asthmaticus (an acute asthma attack): http://nethealthbook.com/lung-disease/asthma-introduction/asthma-treatment/

References

1. Adkinson: Middleton’s Allergy: Principles and Practice, 7th ed. Chapter: Food Allergy. © 2008 Mosby.

2. Mandell: Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 7th ed.© 2009 Churchill Livingstone.

3. William Davis, MD: “Wheat Belly Cookbook. 150 Recipes to Help You Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2012.

Last edited Nov. 7, 2014

Feb
27
2013

Joint Replacement For Osteoarthritis Of The Knee Will Become Obsolete

Osteoarthritis of the knee joints is one of the most common forms of arthritis of the aging person. Often the patient starts feeling pain when walking for a long time or when climbing stairs, more so when walking down. Eventually there is swelling of the knees, pain and inflammation (the affected knee feels hot). When the condition deteriorates over a period of 5 to 10 years, the patient notices a decrease in range of motion in the joint and it may affect the gait as the patient favors one knee. The physician or physical therapist may suggest the use of a cane. Later the patient may need a walker to get around.

In the following I will describe two possible ways of treating this condition in the end stage followed by unconventional ways of treating osteoarthritis to hopefully prevent disabilities.

The conventional treatment of osteoarthritis (total knee replacement)

The typical way of treating knee osteoarthritis in an early case is to order physical therapy treatments and to give anti-inflammatory medication to treat the swelling and pain. Anti-inflammatory medicine with NSAIDs is not harmless as it can lead to severe gastric bleeding from gastric erosions. On the longer term it can cause kidney damage with kidney failure, possibly requiring dialysis. In a moderate case an orthopedic surgeon may inject hyaluronic acid and steroids, which may give relief for up to 6 or 9 months. Eventually the pain and the restriction with regard to the range of motion become so severe that the orthopedic surgeon recommends a total knee replacement. This can be quite successful with respect to relieving most of the pain, but often it is less than 100% satisfactory with regard of regaining range of motion.

Osteoarthritis Of Knee With Degenerative Joint Changes

Osteoarthritis Of Knee With Narrowed Cartilage

The new way of treating osteoarthritis (mesenchymal stem cell transplant):

In a case publication from Korea an alternative new treatment for osteoarthritis has been published with two typical cases described, both Korean women, one aged 70, the other  one aged 79. Both were assessed by orthopedic surgeons and found to be severe enough to qualify for total knee replacements. However,  both declined, as they were afraid of the risks associated with surgery. Instead both patients received mesenchymal stem cells transplants derived from their abdominal fat by liposuction.  The transplant was done by injections into their knees using a small needle on several occasions weeks apart. This is known as a transplant with autologous adipose-tissue-derived stem cells. Within only 12 weeks from the date of the stem cell treatment the patients noticed a 90% improvement of the pain, and similar progress with regard to increase in range of motion was noted. MRI scans were done just before the stem cell treatment and again 12 weeks after the treatment. Here is the MRI image of the 79 year-old woman’s knee before and 12 weeks after her procedure.

According to the authors of this publication these cases were new reports on human subjects compared to previously successful reports with animal experiments. They felt that more human trials would be required, to show on a larger scale that end stage osteoarthritis can be treated successfully with tissue stem cells taken from the patient’s own abdominal fat.

Alternative treatment for osteoarthritis

In Europe there was a lot of interest in the 1980’s in the use of glycosaminoglycan polysulfate (which was sold as “Arteparon”). It was derived from hyaline cartilage of calf knee joints.

It was available as an injectable medicine and produced by the Luitpold Pharmaceutical company. Only a two or three injections into an affected joint would be needed to cure about 70% to 80% of patients with osteoarthritis. Later it was shown that simple intramuscular injection rather than specific joint injection had the identical cuarative effect for osteoarthritis. One injection was only about 3$ to 5$. However, in 1991 the Munich company in Germany was sold to a Japanese pharmaceutical firm and Arteparon was no longer produced, so it was only known in Europe, as it never made it to the US market. Since then Synvisc came onto the market in the US in the early 2000’s. Now one injection was 150$ (!). However, a randomized study showed that Synvisc is only about 15 to 20% more effective than placebo after three to five injections (450$ to 750$).

However, the word was out that there are non-toxic substances that are part of the natural cartilage which would be useful in treating osteoarthritis. Glucosamine and chondroitin are often combined in supplements for osteoarthritis and you can get this in the health food store. The American Family Physician reported about non-conventional supplements for osteoarthritis in its January 2008 edition.

Perhaps equally important to this is to approach osteoarthritis from the nutritional angle, namely in terms of cutting out refined sugar and starches. It has been observed that osteoarthritis develops mostly in the industrialized countries where sugar consumption is the highest. Not so on the islands of Okinawa. Recently a study showed that sugar from soft drink consumption contributes to worsening osteoarthritis, especially in men. It follows from this that your food intake should be modified to provide optimal nutrients for healthy joint maintenance. Read this article, which describes in detail what you should eat to reverse osteoarthritis.

Omega-3 fatty acids are also useful, but higher doses are required for arthritis reversal than are required for healthy heart maintenance.  About 2.7 Grams of Omega-3 fatty acids per day are required, such as two to three capsules of high quality molecularly distilled fish oil capsules three times per day. This will help  balance the overload from omega-6 fatty acids in processed foods.

Another approach to help with joint pains from osteoarthritis is through chicken cartilage. It appears that with the initial degenerative changes of joint cartilage with osteoarthritis, collagen is exposed to the immune system, which responds with the production of T killer cells, which attack the joint cartilage. Research has shown that a tolerance state of the immune system is created when you take chicken cartilage (either fikzol type II or UC-II) for only 90 days. The body tolerates the chicken cartilage supplement and the joint surfaces recover from the prior degenerative changes.

Finally, studies regarding DMSO and MSM(methylsulfonylmethane) are not very conclusive, except perhaps for one study on knee osteoarthritis as this link shows.

By nutritional intervention (cutting out refined sugar and refined carbohydrates) and following what was summarized under point 3 above, many people with minor osteoarthritis may not progress further to the end stage where either procedure 1 or 2 above would have to be done.

This is an example of how medicine is moving forward. The technique has been developed for osteoarthritis and also for osteonecrosis of the hip joint as described in the same publication. In the past laparoscopic procedures have replaced older, more invasive surgical procedures with better results and less complications. In a similar vein these newer stem cell transfer procedures can replace, at least partially the more invasive total joint replacements with less dangers to the patient. Should a mesenchymal stem cell transplant not be successful, the patient can still return to a conventional total knee or total hip joint replacement.

More information on osteoarthritis: http://nethealthbook.com/arthritis/osteoarthritis/

Here is a limited selection regarding  regenerative or restorative centers in the US (I have no financial interest or other bias with respect to any of these treatment centers):

http://www.regenexx.com/about-regenexx/doctor-christopher-j-centeno-md/

http://www.the-stem-cell-center.com/

http://www.stemcellrevolution.com/

http://tulane.edu/som/regenmed/

Last updated Nov. 6, 2014

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