Tag: 4/3/24

Categories : Allergies PaediatricsTags :

Sublingual Immunotherapy for Food Allergies Safe and Effective for High-risk Children

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Photo by Corleto on Unsplash

New research from the University of British Columbia reveals a safe path to overcoming food allergies for older children and others who can’t risk consuming allergens orally to build up their resistance. Sublingual immunotherapy (SLIT) involves placing smaller amounts of food allergens under the tongue.

A study conducted by UBC clinical professor and paediatric allergist Dr Edmond Chan and his team at BC Children’s Hospital Research Institute found SLIT to be as safe and effective for high-risk older children and adolescents as oral immunotherapy is for preschoolers.

The study was published in The Journal of Allergy and Clinical Immunology.

“Our work confirms the safety and effectiveness of SLIT for older children and adolescents with multiple food allergies at higher risk of severe reaction,” said Dr Chan. “These are patients for whom oral immunotherapy would typically be denied because it’s felt to be too risky, so this could be the best approach for that population.”

Previously published research from Dr Chan’s team has shown that preschool oral immunotherapy is safe and effective in the real world. The protocol involves a “build-up phase” of several months, when patients visit a clinic every two weeks to ingest a higher dose of an allergen under medical supervision before continuing the same daily dose between visits. When they reach a certain dose – usually around 300mg of protein – they enter a “maintenance phase” during which they take that target daily dose at home. After a year of maintenance doses, approximately four out of five patients are able to pass an oral challenge test in which they tolerate a much higher dose of 4000mg of protein.

However, the build-up phase is risky for older children and those with a history of severe reactions. Dr Chan’s group has been looking for a safer way to get this at-risk group of patients to the maintenance phase.

They recruited about 180 such patients between the ages of four and 18, most with multiple food allergies. The SLIT protocol (started when COVID-19 pandemic restrictions were in place) required patients to have virtually supervised appointments 3-5 times over several months to build up to a small dose – in most cases, just 2mg of protein – which is absorbed through the membranes under the tongue rather than swallowed and ingested.

The patients’ caregivers learned how to mix and administer these doses at home using novel recipes based on products you can buy at the grocery store, developed with the team’s research dietitian. A wide variety of allergens were treated, including peanut, other legumes, tree nuts, sesame, other seeds, egg, cow’s milk, fish, wheat, shrimp, and other allergens. Patients took these doses daily for 1–2 years.

“It takes up to twice as long as oral immunotherapy, but we wouldn’t have had it any other way, because we needed the superior safety of SLIT for these older kids that are felt to be more severe,” said Dr. Chan.

While most patients had mild symptoms during the build-up phase, none had severe reactions during either build-up or maintenance. Seventy per cent of those tested at the end of the protocol could tolerate 300mg of their allergen – a success rate nearly as high as that for oral immunotherapy.

The results were encouraging for a therapy that any family can undertake at home with guidance from professionals.

“Besides safety considerations in older children, allergists are often quite burdened by the oral immunotherapy build-up phase, where a patient may require 11 or more visits to the clinic. They just don’t feel they have the capacity to offer that many visits in their office,” said Dr Chan. “In our clinic, we are starting to do more home-based approaches because the demand for medical appointments that would allow supervision far outstrips the supply. We are trying to develop an approach, based on data, that matches a patient’s risk level with the appropriate amount of supervision. Our SLIT data suggests that home-based SLIT build-up is safe.”

Ultimately, the trial highlights an alternative that allergists should now consider for patients who cannot safely undertake oral immunotherapy. The trade-off for greater safety is simply a longer timeline, but it comes with the benefit of keeping clinics free for those who need them most.

Source: University of British Columbia

Categories : Ageing ExerciseTags :

Yoga Provides Unique Cognitive Benefits to Older Women at Risk of Alzheimer’s disease

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Photo by Mikhail Nilov

A new UCLA Health study found Kundalini yoga provided several benefits to cognition and memory for older women at risk of developing Alzheimer’s disease including restoring neural pathways, preventing brain matter decline and reversing aging and inflammation-associated biomarkers – improvements not seen in a group who received standard memory training exercises.

The findings, published in the journal Translational Psychiatry, are the latest in a series of studies led by UCLA Health researchers over the past 15 years into the comparative effects of yoga and traditional memory enhancement training on slowing cognitive decline and addressing other risk factors of dementia.

Led by UCLA Health psychiatrist Dr. Helen Lavretsky of the Jane and Terry Semel Institute for Neuroscience and Human Behavior, this latest study sought to determine whether Kundalini yoga could be used early on to prevent cognitive decline and trajectories of Alzheimer’s disease among postmenopausal women.

Women have about twice the risk of developing Alzheimer’s disease compared to men due to several factors including longer life expectancy, changes in oestrogen levels during menopause and genetics.

In the new study, a group of more than 60 women ages 50 and older who had self-reported memory issues and cerebrovascular risk factors were recruited from a UCLA cardiology clinic. The women were divided evenly into two groups. The first group participated in weekly Kundalini yoga sessions for 12 weeks while the other one group underwent weekly memory enhancement training during the same time period. Participants were also provided daily homework assignments.

Kundalini yoga is a method that focuses on meditation and breath work more so than physical poses. Memory enhancement training developed by the UCLA Longevity centre includes a variety of exercises, such as using stories to remember items on a list or organising items on a grocery list, to help preserve or improve long-term memory of patients.

Researchers assessed the women’s cognition, subjective memory, depression and anxiety after the first 12 weeks and again 12 weeks later to determine how stable any improvements were. Blood samples were also taken to test for gene expression of aging markers and for molecules associated with inflammation, which are contributing factors to Alzheimer’s disease. A handful of patients were also assessed with MRIs to study changes in brain matter.

Researchers found the Kundalini yoga group participants saw several improvements not experienced by the memory enhancement training group. These included significant improvement in subjective memory complaints, prevention in brain matter declines, increased connectivity in the hippocampus which manages stress-related memories, and improvement in the peripheral cytokines and gene expression of anti-inflammatory and anti-aging molecules.

“That is what yoga is good for – to reduce stress, to improve brain health, subjective memory performance and reduce inflammation and improve neuroplasticity,” Lavretsky said.

Among the memory enhancement training group, the main improvements were found to be in the participants’ long-term memory.

Neither group saw changes in anxiety, depression, stress or resilience, though Lavretsky stated this is likely because the participants were relatively healthy and were not depressed.

While the long-term effects of Kundalini yoga on preventing or delaying Alzheimer’s disease require further study, Lavretsky said the study demonstrates that using yoga and memory training in tandem could provide more comprehensive benefits to the cognition of older women.

“Ideally, people should do both because they do train different parts of the brain and have different overall health effects,” Lavretsky said. “Yoga has this anti-inflammatory, stress-reducing, anti-aging neuroplastic brain effect which would be complementary to memory training.”

Source: University of California – Los Angeles Health Sciences

Categories : Cancer New Compounds and TreatmentsTags :

Dual Immunotherapy Drugs Show Promise vs a Range of Advanced Cancers

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Squamous cancer cell being attacked by cytotoxic T cells. Image by National Cancer Institute on Unsplash

In an early phase clinical trial, a combination of antibody-based medications targeting the immune system generated promising safety data and anti-tumour activity in individuals with various types of advanced cancer. The findings appear online in CANCER, a peer-reviewed journal of the American Cancer Society.

Both medications tested in the trial are checkpoint inhibitors, and support immune responses against tumour cells. CS1002 increases the activation and proliferation of T immune cells by binding to a T cell receptor called CTLA-4. CS1003, also called nofazinlimab, blocks the programmed cell death protein 1 that is expressed on various types of immune cells and plays a role in suppressing the immune system.

In this first-in-human multicentre, open-label study conducted from April 26, 2018 to January 18, 2022 at 9 study sites in Australia and China, phase Ia involved monotherapy dose-escalation (Part 1), which was followed by phase Ib combination therapy dose escalation (Part 2) and expansion (Part 3). Various dosing schedules of CS1002 (0.3, 1, or 3mg/kg once every three weeks, or 3mg/kg once every 9 weeks) were evaluated with 200mg CS1003 once every three weeks.

Parts 1, 2, and 3 of the trial included 13, 18, and 61 patients, respectively, who had advanced/metastatic solid, relapsed, or refractory tumors. During treatment, investigators did not observe any dose-limiting toxicities or a maximum tolerated dose. Treatment-related side effects such as diarrhoea, fatigue, and rash were reported in 30.8%, 83.3%, and 75.0% of patients in Parts 1, 2, and 3, respectively. Serious side effects such as intestinal inflammation and severe skin reactions were experienced by 15.4%, 50.0%, and 18.3% of patients in each part.

Of 61 patients evaluable for treatment efficacy, 23 (37.7%) with different types of tumours experienced a positive response. Higher response rates occurred with conventional and high-dose CS1002 regimens (1mg/kg once every three weeks or 3mg/kg once every 9 weeks) compared with low-dose CS1002 (0.3mg/kg once every three weeks) in certain cancers such as melanoma and skin cancer.

“CS1002 in combination with CS1003 had manageable safety profile across a broad dosing range and showed promising anti-tumor activities across CS1002 dose levels when combined with CS1003,” the investigators wrote. They concluded that this warranted more testing of CS1002 in combination with CS1003 for the treatment of solid tumours.

Source: Wiley

Categories : UrogenitalTags :

Prolonged Screentime Associated with Increased Nocturia

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Photo by Jan Antonin Kolar on Unsplash

In a study published in Neurourology and Urodynamics, adults who spent five or more hours a day watching TV and/or videos were more likely to develop nocturia, or the need to urinate multiple times during the night.

The study drew from 2011–2016 data from the National Health and Nutrition Examination Survey. Among 13 294 US individuals aged 20 and older, 4236 (31.86%) reported experiencing nocturia, while 9058 (68.14%) did not. Participants with five or more hours of TV and/or video viewing time per day had a 48% higher risk of experiencing nocturia compared with those with less than one hour of daily TV and/or video viewing time.

“As individuals increasingly engage in screen‐based activities, a comprehensive understanding of the impact of extended TV and/or video time on patterns of nocturia is crucial for both healthcare professionals and public health practitioners,” the authors wrote. “For individuals who engage in prolonged TV and/or video time, healthcare professionals can offer behavioural intervention recommendations, encouraging appropriate screen time management.”

Source: Wiley

Categories : Mental Health Obstetrics & GynaecologyTags :

Simple Cognitive-behavioural Intervention Reduces Postpartum Depression

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Photo by Burst on Pexels

Results from a large clinical trial published in Nature Medicine show that an intervention for anxiety provided to pregnant women living in Pakistan significantly reduced the likelihood of the women developing moderate-to-severe anxiety, depression, or both six weeks after birth. The unique intervention was administered by non-specialised providers who had the equivalent of a bachelor’s degree in psychology – but no clinical experience. The results suggest this intervention could be an effective way to prevent the development of postpartum mental health challenges in women living in low-resource settings.

“In low resource settings, it can be challenging for women to access mental health care due to a global shortage of trained mental health specialists,” said Joshua A. Gordon, MD, PhD, Director of the National Institute of Mental Health, part of the National Institutes of Health.

“This study shows that non-specialists could help to fill this gap, providing care to more women during this critical period.”

Led by Pamela J. Surkan, PhD, ScD, of Johns Hopkins Bloomberg School of Public Health, Baltimore, the study was conducted in the Punjab Province of Pakistan between April 2019 and January 2022.

Pregnant women with symptoms of at least mild anxiety were randomly assigned to receive either routine pregnancy care or a cognitive behavioral therapy (CBT)-based intervention called Happy Mother-Healthy Baby. The researchers assessed the participants (380 women in the CBT group and 375 women in the routine care group) for anxiety and depression six weeks after the birth of their child.

The researchers found that 9% of women in the intervention group developed moderate-to-severe anxiety compared with 27% of women in the routine care group.

Additionally, 12% percent of women in the intervention group developed depression compared with 41% of women in the routine care group.

“Postpartum depression not only harms mothers, it is also associated with poorer physical growth and delayed cognitive development in their children,” said Dr Surkan.

“The link between maternal and child health highlights the critical importance of developing effective ways to address postpartum anxiety and depression.”

The Happy Mother-Healthy Baby intervention was created using input from pregnant women in a hospital in Rawalpindi, Pakistan.

Pregnant women took part in six intervention sessions where they learned to identify anxious thoughts and behaviors, such as thoughts about possible miscarriage, and to practice replacing them with helpful thoughts and behaviors.

The first five sessions were conducted in early to mid-pregnancy, and the sixth session occurred in the third trimester.

Prior research suggests that up to 30% of women in the Global South, which includes South America, Africa, and most of southern Asia, report experiencing anxiety during pregnancy.

Anxiety during pregnancy predicts the development of anxiety and depression after birth, making the prenatal period a prime target for intervention.

However, it can be challenging for women living in low-resource settings to access trained clinical care.

The findings from this study demonstrate that an intervention such as Happy Mother-Healthy Baby could be an effective way to help prevent the development of postpartum depression and anxiety in settings where specialist clinical care may be hard to access.

“In the future, we can build on these findings through implementation research. Having identified an intervention that works, the next step is to figure out the best ways to deliver effective treatment to the people who need it, bridging the gap between science and practice,” said Dr Surkan.

Source: NIH/National Institute of Mental Health