Allergy Statistics — Accurate Testing and New Ideas in treatment.

Allergies have plagued the population for thousands for thousands of years. The most common irritants have been Pollens, Molds and Spores, Dust and Dust mites, Foods, cockroach, and a wide range of natural and man made chemicals. Over 50 million people in this country suffer from allergies, and more than 50% of us test positive to one or more substances. Allergies are the 6th leading cause of disease in the US.

The most common treatments for Allergy involve using medications to change or try to prevent symptoms. In most cases this is not fruitful, because these substances only work with continued use, and all carry side effects that are unwanted. Also, these medications don't change the cause of allergy; they only temporarily change how we view the symptoms. With a better understanding of how the immune system works, we can better understand the entire mechanism and do a great deal more to change the outcome.

In short, the immune system must respond to foreign substances entering the body. When an irritant is presented, a variety of immune cells gathers and determines how to react to the "invader". Bacteria, viruses, and cancers will stimulate different responses, but allergens typically stimulate antibodies IGE and IGG. With the repetition of exposure, more antibodies are recruited and the immune system has a great deal more to have to do. The stimulus can create symptoms anywhere in the body and can show in a variety of ways. Some of the latest studies have linked allergy history and risk of cancers. It is probable that when the immune system is working diligently at producing response to allergens, it is not able to create as significant a response to abnormal cells. So, the overall strength of the response is diluted by the ever-growing and potentially large allergen exposure. One of the attached articles describes this. This is also supported by the fact that those with allergy history also have a more difficult time fighting colds, whether bacterial or viral. Frequency of infection and severity are much higher in allergic patients.With this in mind we need to do a better job at stopping the problem at the base, or beginning, rather than allowing the immune system to get caught up in such a mess. The idea, as I see it, is to actually decrease binding to allergens and free up the immune response to a better and possibly more important job.

The most accurate type of allergy testing, (proven by years of research) is something called Skin Endpoint Titration or Serial Dilution Titration. This involves an intradermal or skin test to evaluate response to allergen. It is more accurate than scratch or prick testing because it places the allergen into a better area in the skin for antibodies to respond to it. It does not have the false positive profile that the other techniques have. It is also more accurate than blood testing. With this technique different strengths of solution can be tested to further clarify a response. Testing is done with different dilutions to find the dose that first creates a response. This is the best dose to start treatment with. The results here are the most rewarding. I have used this technique for over 18 years in my practice.

Treatment can be done in different ways but the best techniques have evolved into using a sublingual dose. Here, the patient can take 2 drops of the allergen under the tongue daily and see better safer results sooner.Another useful tool in testing is the Multitest kit. This is primarily used on children, because it doesn't involve the use of needles. A plastic device presses the allergens onto the skin, and results appear within minutes. It can also be used on adults. Proof of the efficacy of the treatment can be seen with quick symptom regression as well as change in results on recheck skin testing. Free up your immune response, and change the cause of your symptoms.

Stay tuned,

Dr. Chris Calapai

Blending skin endpoint titration and in vitro methods in clinical practice.

The definitive diagnosis of allergy involves proving the presence of allergen-specific IgE. This had traditionally been done by skin testing, the most precise method being skin endpoint titration. In vitro diagnostic methods offer advantages over skin tests and have become increasingly popular with both patients and physicians. However, thorough knowledge of skin testing techniques and interpretation of results is necessary for the physician using in vitro test methods and also allows moving back and forth between the two modalities in the preparation of antigen treatment sets and adjustment of immunotherapy dosage. 

Multitest CMI for standardized measurement of delayed cutaneous hypersensitivity and cell-mediated immunity. Normal values and proposed scoring system for healthy adults in the U.S.A.

The Multitest CMI system, a disposable device that simultaneously applies seven standardized preloaded antigens and diluent control, is a major advance for measurement of delayed type hypersensitivity (DTH) in assessment of cell-mediated immunity (CMI). The system was tested in 402 healthy adults, aged 17 to 92 years, to determine normal values for incidence and size of DTH responses. Incidence of positive responses to individual antigens varied from 85% to 46%, with great variability related to age and sex. To better assess CMI, a two-part score based on 48-hour readings was employed. The mean number of positive antigens ranged between four and five, and the mean sum of their mm induration ranged between 18 and 25, with both scores increasing with advancing age. A statistical zone of reduced DTH scores (hypoergy) was identified. The Multitest CMI system appears to be a practical means of reproducibly assessing CMI in subjects with immunologic, metabolic, infectious, or neoplastic disorders. The scores in our population may serve as reference values to which results from any tested adult can be compared. 

Sublingual swallow immunotherapy (SLIT) with a standardized five grass pollen extract (drops and sublingual tablets) versus placebo in seasonal rhinitis.

Background: Recent studies have demonstrated the efficacy of sublingual swallow immunotherapy (SLIT) in seasonal and perennial rhinitis. Sublingual administration of solutions is not convenient for all patients. The aim of the study was to evaluate the efficacy and safety of immunotherapy administered sublingually, initially as drops, and then as tablets during maintenance therapy.

Methods: A total of 126 patients with grass pollen seasonal rhinitis were included in this double blind, randomized, placebo controlled trial. During the progression of doses phase, the five grass extract was given as sublingual drops from 1 to 100 IR/ml. Once the 100 IR dose was reached, the drops were replaced by a single 100 IR sublingual tablet per day.

Results: Throughout the grass pollen season, patients in the active treatment group had significantly lower (P<0.05) total conjunctivitis and ocular redness scores. Rhinitis symptoms were not significantly different between the two groups. Patients given the active treatment were significantly (P<0.02) less likely to have asthma symptoms. The global medication score showed no significant difference between the two groups. A highly significant difference in favor of the active treatment group was seen in inhaled salbutamol use (P<0.01).

Conclusions: Clinical benefits achieved during the present study included significant improvements in conjunctivitis symptoms and prevention of asthma symptoms. The overall safety profile of the active treatment (drops or tablets) was good. 

Prior History of Allergies and Pancreatic Cancer in the San Francisco Bay Area

Data from a large population-based case-control study conducted in the San Francisco Bay Area between 1994 and 2001 were analyzed to examine the association between pancreatic cancer and history of allergic conditions. Pancreatic cancer cases (n = 532) had to be 21–85 years of age and were identified using rapid case ascertainment. Random digit dialing and Health Care Financing Administration lists (age, 65 years) were used to obtain 1,701 controls who were frequency-matched to cases by sex and age within 5 years. In-person interviews were conducted and detailed allergy history data were obtained for all participants.

Prior history of any allergy was associated with a reduced risk estimate for pancreatic cancer (odds ratio (OR) = 0.77, 95% confidence interval (CI): 0.63, 0.95). Inverse associations were observed for common allergens, including house dust (OR = 0.72, 95% CI: 0.54, 0.94), cats (OR = 0.59, 95% CI: 0.41, 0.85), plants (OR = 0.77, 95% CI: 0.62, 0.96), and mold (OR = 0.49, 95% CI: 0.32, 0.75), and for all allergic symptoms, although some confidence intervals included unity. Trends were observed for decreased risks associated with increasing number of allergies (p = 0.0006) and severity of allergic symptoms (p = 0.003). These results provide support for the plausibility that immune function in relation to allergies may play a role in the etiology of pancreatic cancer.