Precision Medicine in Allergy-Asthma

Allergy-asthma is an enormous burden on healthcare systems and its health impact is substantial. This article describes scientific information on what allergy is, how allergy responses occur, what are the symptoms, how to diagnose it and a word about medications.

Jaykumar Mehta, Pulmonologist, Zydus Hospitals According to the World Health Organisation (WHO), more than 20 per cent of the world population suffers from IgE (Immunoglobulin E) mediated allergic diseases such as allergic asthma, allergic rhino-sinusitis, allergic conjunctivitis, eczema/atopic dermatitis and anaphylaxis. The recent Global Burden

of Disease (GBD, 1990-2019) estimated total burden of asthma in India at 34.3 million, accounting for 13.09 per cent of the global burden. The health impact of allergy-asthma is substantial and the burden is increasing owing to climate change and adverse environmental factors.

Asthma is a Greek word meaning “panting”. The Global Initiative for Asthma (GINA) defines it as a heterogeneous disease usually characterised by chronic airway inflammation. Elaborating it, the presenting symptoms as well as treatment responses differ person-to-person and hence it is important not to adopt “one size fits all” or blanket solutions for all asthmatics. These patients require proper understanding of their household as well as work environments and personalised care plans to achieve maximum symptom control. In short, the need of the hour is to practice precision medicine to answer most common questions encountered in clinical scenario:

1. What am I allergic to? 2.Can my allergy be cured?

The following description will help understanding allergy-asthma scientifically. It will also provide information on latest technologies to find out precise culprits and shed lights on hope for allergy cure.

What is allergy?

The term “Allergy” was coined by von Pirquet in the year 1906. With it he wanted to describe a change in reactivity. In general, allergy occurs when a person reacts to substances known as allergens, which are harmless, non-infectious and in abundance in the surrounding environment. A person’s inherent tendency of being hypersensitive to particular substance is known as atopy. According to Gell and Coomb, the hypersensitivity reactions are classified into four types based on involvement of different cells and mediators.

Allergic reactions are most commonly attributed to Immunoglobulin E (IgE) mediated or Type 1 hypersensitivity reaction. IgE is part of the human body’s immune system. Its level rises in serum on allergen exposure which ultimately is responsible for symptoms of allergy.

Pollen

Peanut

Apple

Allergen source Allergen extract

Specific allergen components Cross-reactive allergen components

SYMPTOMS OF ALLERGY

When a predisposed or atopic individual is exposed to an allergen, the body reacts in a way to eliminate the offending substance out of the body with different behavioural responses like itching, rashes, running nose, sneezing, coughing and watering of eyes. However, in some persons it can lead to inflammation/ swelling and narrowing of airways which causes wheezing and difficulty in breathing — the main attributes of asthma. In some cases it can lead to life threatening anaphylaxis, where the body goes into complete shock.

These symptoms can be seasonal or perennial (year round). Most often it is found that symptoms increase due to triggers. Exposure to smoke, heavy perfumes or pungent smell, air pollution, difference in temperature or humidity as well as emotional stress can trigger allergy-asthma symptoms. As allergic tendencies run in families, positive family history contributes significantly in diagnosis of allergy.

Allergic March

Though allergies most commonly manifest as rhinitis/dermatitis, according to a school of thought, it can progress to asthma or life threatening allergies if not addressed in time. The phenomenon is called “allergic march”. It is observed many times that a person first has upper respiratory tract allergies and limited symptoms but it slowly progresses to chest congestion and wheezing with increase in severity and frequency over time. There are no tests yet which can predict development of allergy-asthma or its progression. In that scenario, the best way is to keep regular follow up check up.

Diagnosis

Traditionally, skin prick testing (SPT) was considered as gold standard of allergy diagnosis. In this, a drop of crude allergen extract is placed over the forearm/back and it is pricked with a lancet. The positive response is noted by development of wheel and flare. This roughly hundred years old technique suffers the drawback of purity of allergen extracts as well as issues of cross-reactivity. Due to poor cooperation this technique is not suitable for diagnosis in children.

The other alternative is called in-vitro tests where the blood is tested for presence of IgE against particular

allergen. IgE assays based on ELISA/ EIA are sensitive but not specific. The capture assays are slightly more specific. However, these in-vitro tests S. IgE against carbohydrate, lipid and protein: all three components of allergen. As only the protein component is responsible to mediate allergenic responses, IgE measured against other two may lead to false positive reports. The issue of crossreactivity still persists and for the same reason, these tests detect ‘sensitivity’ and not true allergy. Hence there is a dire need of precision diagnostic testing to identify the culprit allergens.

Precision diagnosis with CRD allergy profile

Component resolved diagnosis (CRD) allergy profile is an in-vitro method, where the patients’ serum is tested for specific IgE levels against approximately 300 known allergens. In this method, IgE level against only protein moieties of purified and filtered allergenic extract, the specific components responsible for allergic responses, is measured. In addiction, cross-reactive carbohydrate determinant (CCD) inhibitors makes it possible to cancel noise. Presence of IgE in substantial levels against major allergen components is considered a hallmark of allergy diagnosis. The test is reasonably sensitive and specific. However Indian studies are still awaited as the test is available only in few centres across India.

For example, a person suffering from apple allergy, the reactions can be prevented if the apple is given after peel removal as suggested by CRD allergy profile. Cockroach allergies can be controlled with robust pest control measures. Pollen and Mould allergies can be controlled with appropriate environmental intervention. Most importantly, dust mite sensitisation can potentially be cured.

Allergy cure: Is it possible?

Allergen immunotherapy (AIT), a scientific method where the offending AIT administered in build up and maintenance phase can slowly lead to reduction of allergen-specific IgE levels and convert it to an IgG mediated response, which will no longer produce the symptoms. Though it may sounds simple, it is best carried out only under professional guidance and at an experienced centre.

The recent Global Burden of Disease (GBD, 1990-2019) estimated total burden of asthma in India at 34.3 million, accounting for 13.09 per cent of the global burden.

allergen is administered, mostly via subcutaneous route, to develop immune tolerance, has potential to allow a symptom- and medication-free life. Known as allergy shots, these can lead to long-term benefits provided the treatment is based on sound knowledge of presence of IgE against major allergen component, mainly dust mites, and administered after thorough evaluation like spirometry and detailed physical examination at an experienced centre and for appropriate duration.

After careful selection, in a person suffering from dust mite allergy,

Medications

The goal of an allergy-asthma treatment plan is to reduce the risk and symptoms. The subset of patients deemed unfit for successful administration of AIT have medications and allergen avoidance as mainstay of treatment plan. The medications can be divided according to their role: preventer/controller medications and reliever medications. Reliever medications are used after the symptoms have appeared and mainly tame the aggravated symptoms. While preventer/controller medications need to be taken on regular basis, irrespective of symptoms, to be adjusted after re-assessment at scheduled interval, which is usually around 6-12 weeks. Rapid withdrawal of preventer/controller medications or poor adherence to same are major risk factors for frequent flareups as well as asthma with fixed airway obstruction.

References are available at www.asianhhm.com

AUTHOR BIO

Jaykumar Mehta is awarded as “Best interventional Pulmonologist - 2021”. With motto ‘ensuring compassionate care to make people breathe better’, he provides his services full-time at Zydus Hospitals, Ahmedabad, Gujarat.

First Glove’s Manufacturing Providing a High-Quality, Nitrile Exam Glove for Hospitals

This article awards a new brand of Nitrile Examination Gloves the Best Glove for Medical Professionals in 2022. Nitrile Gloves are used during medical examinations and procedures to help prevent cross-contamination between caregivers and patients.

When a company stands up for its clients on multiple levels that can only result in becoming a leading manufacturer & distributor in that market. First Glove – the fastest growing glove manufacturer in South East Asia and distributor in North America – has done exactly that. Providing a vertically integrated end to end solution. Resulting in increasing quarterly market share. Right now their team efforts focus their own Hospital procurement, providing high-quality gloves with additional services that are convincing GPO’s and small hospitals they are the new alternative to the Medline’s & Cardinal Health’s of the world.

Providing a better solution for hospitals means getting right in there with those who use gloves. Nurses, Doctors and other important staff members finding out the needs that haven’t been met yet in the industry, applying creativity and logistics, and solving their problems. That intensive groundwork has been proven key to developing better gloves, packaging and ordering systems.

“After speaking with front line healthcare workers we were shocked to hear of the quality of gloves that they were receiving from some of the biggest healthcare suppliers in the world. It seems these companies and their purchasing offices have chosen greater profit margins but forgoing quality for their staff. Staff members often complained about sticky gloves and gloves that easily ripped.” We came in and were able to offer a better glove at a more competitive price and this has led to a significant shift in hospital systems moving away from the large monopolies in the industry and in-trusting First Glove in one of the most important supplies in the Healthcare industry.

First Glove’s Blue Exam glove was the result of building relationships with hundreds of health professionals in hospitals. Their goal was to exceed the performance specs that the medical industry required.

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Why Nitrile Gloves? What are the advantages?

Nitrile gloves are ones that offer several different benefits. With these gloves that are comfortable when wearing for long periods of time, you can easily see any type of damage or tear, and easily replace them. This allows you to keep up the protective barrier of a high-quality glove. They can be molded to your hands and are also puncture-resistant and the materials resist degradation by chemicals. Nitrile gloves are also a known barrier for oils, solvents, hydrocarbons, and some acids and bases. And they are a good substitute for those who have known latex glove allergies.

One of the types of FDA-approved medical gloves manufactured by First Glove is the ASTM D6319 glove, a core exam glove that resists chemicals, viruses, and oils. This glove has a length of greater than or equal to 230 mm, fitting nicely over the wrist, a palm thickness of 0.07 mm ± 0.02 mm, and a finger thickness of 0.10 mm ± 0.02 mm. Even after aging of the glove, the tensile strength remains strong and the glove retains its elongation and elasticity properties.

Helping hospitals with their bottom line was the next goal

For hospitals, their concern isn’t only providing high quality gloves. It’s helping hospitals make positive changes in their processes and purchasing procedures to result in short and long-term cost savings and process improvement.

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The success of First Glove’s Core Nitrile Exam Glove is in the process of changing the industry by making several other transformations within their competitive glove procurement industry: • high-efficiency manufacturing production of highquality, reliable gloves • conservation of energy during the glove-making process • consistently solid prices that don’t involve a middle man, thus no mark-ups • focus on building strong customer relationships • distributor partnerships around the world, with 30-60 per cent margins • the creation of personalised gloves according to customers’ needs • adaptation of resources that have minimal impact on the environment

Regulatory compliance followed explicitly

First Glove is also developing their own line of biodegradable gloves as well, which will be released soon. And with over 16 different certifications by international governing bodies, First Glove’s quality standards meet regulatory compliance and FDA standards. The details on the standards may be found on their website, https://firstglove.com

Best Nitrile Exam Glove 2022

Through First Glove’s market research and design development we have awarded their Gloves the Best Nitrile Exam Glove for 2022. We believe that many other healthcare professionals will be switching their glove of choice to First Glove.

A company that cares

First Glove is a community-minded company as well. “With First Glove Cares, our people will give their time and donations locally in ways that are personally meaningful to them – because no one knows a community better than the employees who serve it.” We have partnered with the Bowery Mission donating 50,000 plus gloves to date. Find out more at https://firstglove.com

With two master's degrees and over 25 years of experience, Donna Schwontkowski has an Extensive medical background knowledge on stem cells, diabetes, spinal care, disease treatments, mesothelioma, hyperbaric oxygen, PEMF, Permaculture, high blood pressure, and more. Working as the Health & Fitness Magazine Editor-in-Chief since 1996.