I Neither Refute nor Endorse…
Parasitic Infestation of the Nose.
Author(s) : Liggett, Harold
Journal article : Journal of the American Medical Association 1931 Vol.96 No.19 pp.1571-1572 pp.
HOPKINS SCIENTISTS LINK IMMUNE RESPONSE TO “GHOST” PARASITES AND SEVERELY CONGESTED SINUSES
Johns Hopkins Medicine
Media Relations and Public Affairs
Media contact: David March
410-955-1534; dmarch1@jhmi.edu
September 6, 2006
– Anti-insect enzyme in humans linked to inflammation in the nose
Although it’s unclear why it’s so, scientists at Johns Hopkins have linked a gene that allows for the chemical breakdown of the tough, protective casing that houses insects and worms to the severe congestion and polyp formation typical of chronic sinusitis.
A team of Hopkins sinus experts has found that the gene for the enzyme, acidic mammalian chitinase (AMCase), is up to 250 times more active in people with severe sinus inflammation that persists even after surgery when compared to patients in whom surgery is successful. Sinus surgery is usually the treatment of last resort for those who do not respond to drug therapy. But nearly one in 10 of those treated see symptoms return within weeks or months after surgery fails to keep open the nasal passages, scientists say.
The Hopkins report, published in the May-June issue of the American Journal of Rhinology, is believed to be the first to identify the enzyme’s presence in the nose and confirm its link to sinusitis.
“This finding does not mean that there are actually parasites in the nose causing sinusitis, but our study does lend support to the concept that really severe and persistent sinusitis may be a case of a misplaced immune response directed against parasites that are not really there,” says study lead author Andrew Lane, M.D., an associate professor at The Johns Hopkins University School of Medicine and director of its rhinology and sinus surgery center.
Previous research by other scientists had looked at the enzyme’s tie-ins to asthma, which, like nasal polyps, is an inflammatory response of the body’s immune system. The theory, Lane says, is that allergies and asthma result from genes that control the body’s defenses against parasites, but these genes are dormant in healthy people. However, when turned on by so-called ghost parasites, the potent inflammatory response is medically very difficult to control.
Researchers say that although chitin, a rigid chemical compound common to fungi, insects and roundworms, is not naturally found in the human body, the presence of its corresponding enzyme and its role in the buildup of mucus and fluids, and polyp formation makes the enzyme a legitimate target for drug therapies to block its production and action.
“If we can selectively shut down the antiparasite immune response, we could potentially have new treatments for these airway diseases of the lung and nose,” says Lane.
New therapies are needed, he says, as an alternative to long-term steroids, which block the inflammatory chemical pathway but also have debilitating side effects, including loss of bone density, cataracts in the eye and weight gain.
An estimated 32 million Americans suffer from persistent inflammation of the tissue that lines the nasal and sinus cavities, according to the United States Centers for Disease Control and Prevention.
Thirty-three men and women participated in the two-year study at Hopkins, designed to find out if any of the genetic traits already known to be common in asthmatics were as active in patients with sinusitis. Twenty-two were scheduled to have surgery for sinusitis, while the remaining 11 served as study controls, having surgery for some other ailment than sinusitis.
All those who underwent sinus surgery did so after standard therapy using antibiotics, decongestants and steroids had failed to stop their symptoms and keep their sinus inflammation from coming back. They also had nasal polyps, or tissue outgrowths resulting from the inflammation, which, Lane says, are particularly hard to treat.
In the surgery, a thin, tube-like endoscope is inserted into the nose, with a camera attached to provide a close-up view of the nasal and sinus passages. Slender surgical instruments placed alongside the endoscope allow surgeons to cut away inflamed tissue and polyps, clearing a path for the sinuses to drain normally. Lane says that if left untreated, polyps can lead to severe blockage and recurring infections.
All patients were monitored for a minimum of nine months to see if polyps and their resulting symptoms returned. Ten in the surgery group had their polyps return within six months, while 12 remained symptom free.
The Hopkins team took samples during surgery of the mucous membrane lining the nose, and using real-time polymerase chain reaction tests, analyzed the samples for any genetic differences between the groups.
When researchers initially compared all the nasal tissue samples, they found that half had the gene for AMCase turned on, or expressed, to make the chitinase protein. During follow up, they found that the 10 patients who had their polyps return had exceedingly higher levels of AMCase expression than the other sinusitis patients and controls. Gene expression of another inflammatory protein, called interleukin-13, already known to be high in asthmatics, was also found to be elevated in those with polyps, but the levels of interleukin-13 did not have the same predictive value as the elevated expression of AMCase, researchers say.
Lane adds that future research will have to determine if high genetic expression of AMCase is an underlying cause of inflammation or if AMCase is simply one of many chemicals produced by cells in the nose in response to chronic inflammation.
The next phase of their research, he says, is to look for what triggers the anti-parasite response. However, Lane cautions that this reaction against parasites may come at the expense of the nose’s ability to ward off other invaders, such as bacteria, viruses or fungi.
“The epithelial cells lining the nasal and sinus cavities play an important role as first responders of the immune system,” he says. “But when they are distracted fighting non-existent parasites, they cannot deal well with the very real microbes continuously coming into the nose.”
This, Lane notes, may promote growth of bacteria and fungi in the nose, which is a common finding in those with chronic sinusitis with polyps.
Funding for this study was provided in part by the National Institute on Deafness and Other Communication Disorders, a member of the National Institutes of Health, and by the American Rhinologic Society.
Besides Lane, other researchers involved in this research, conducted solely at Hopkins, were Murugappan Ramanathan Jr., M.D., and Won-Kyung Lee, M.S.
– JHM –
Breathe Green Mite Fighter / 2 pack set / 4 packets
Lemon Eucalyptus Citronella oil
A/15
R
Dust Mite Allergy
If you have allergies or asthma, a tiny creature living in your home could be making big problems for you. Although you can’t see them, you may be having an allergic reaction to them. They are dust mites and they live in many homes throughout the world.
Dust mites may be the most common trigger of year-round allergies and asthma. They are on every continent except Antarctica. It may not be possible to rid your home entirely of these creatures. But there are ways in which you can lessen your allergic reactions to them.
What Is a Dust Mite?
A dust mite measures only about one-quarter to one-third of a millimeter. They are too small to see with your eyes alone. Under a microscope, they look like white bugs. They have eight legs, so they are not insects, but arthropods, like spiders.
Dust mites thrive in temperatures of 68 to 77 degrees Fahrenheit (20 to 25 degrees Celsius). They also like humidity levels of 70 to 80 percent. There are at least 13 species of mites. They are all well adapted to the environment inside your home. They feed mainly on the tiny flakes of human skin that people shed each day. These flakes work their way deep into the inner layers of furniture, carpets, bedding and even stuffed toys. These are the places where mites thrive. An average adult person may shed up to 1.5 grams of skin in a day. This is enough to feed one million dust mites!
What Is a Dust Mite Allergy?
An allergen is a substance that causes an allergic reaction. Both the body parts and the waste of dust mites are allergens for many people. Most dust mites die in low humidity levels or extreme temperatures. But they leave their dead bodies and waste behind. These can continue to cause allergic reactions. In a warm, humid house, dust mites can survive all year.
What Are the Symptoms of Dust Mite Allergy?
Common dust mite allergy symptoms include:
- Sneezing
- Runny nose
- Itchy, red or watery eyes
- Stuffy nose
- Itchy nose, mouth or throat
- Itchy skin
- Postnasal drip (a flow of mucus from behind your nose into your throat)
- Cough
If your dust mite allergy triggers your asthma, you may also experience:
- Difficulty breathing
- Chest tightness or pain
- A whistling or wheezing sound when breathing out
- Trouble sleeping caused by shortness of breath, coughing or wheezing
How Does a Doctor Diagnose Dust Mite Allergy?
To diagnose a dust mite allergy, your doctor may give you a physical exam and discuss your symptoms. If your doctor thinks you have a dust mite allergy, they may suggest a skin or blood test. If you have symptoms year round, you could have a dust mite allergy.
Skin Prick Test (SPT)
In prick/scratch testing, a small drop of the possible allergen is placed on your skin. Then the nurse or doctor will lightly prick or scratch the spot with a needle through the drop. If you are allergic to the substance, you will develop redness, swelling and itching at the test site within 20 minutes. You may also see a wheal. A wheal is a raised, round area that looks like a hive. Usually, the larger the wheal, the more likely you are to be allergic to the allergen.
A positive SPT to a particular allergen does not necessarily mean you have an allergy. Health care providers must compare the skin test results with the time and place of your symptoms to see if they match.
Specific IgE Blood Test
Blood tests are helpful when people have a skin condition or are taking medicines that interfere with skin testing. They may also be used in children who may not tolerate skin testing. Your doctor will take a blood sample and send it to a laboratory. The lab adds the allergen to your blood sample. Then they measure the amount of antibodies your blood produces to attack the allergens. This test is called Specific IgE (sIgE) Blood Testing. (This was previously and commonly referred to as RAST or ImmunoCAP testing.) As with skin testing, a positive blood test to an allergen does not necessarily mean that an allergen caused your symptoms.
What Is the Treatment for Dust Mite Allergy?
The most important step is to avoid dust mites as much as possible. Limiting your exposure to dust mites will reduce your symptoms. However, it’s nearly impossible to completely get rid of dust mites in your environment. You may also need medicines to control symptoms.
Certain over-the-counter and prescription medicines may help reduce dust mite allergy symptoms.
- Antihistamines are available as pills, liquids or nose sprays. They can relieve sneezing and itching in the nose and eyes. They also reduce a runny nose and, to a lesser extent, nasal stuffiness.
- Nasal corticosteroids are a type of nose spray. They reduce swelling in your nose and block allergic reactions. They are the most effective medicine type for allergic rhinitis because they can reduce all symptoms, including nasal congestion. Nasal corticosteroids have few side effects.
- Leukotriene receptor antagonists block the action of important chemical messengers (other than histamine) involved in allergic reactions.
- Cromolyn sodium is a nose spray that blocks the release of chemicals that cause allergy symptoms, including histamine and leukotrienes. This medicine has few side effects, but you must take it four times a day.
- Decongestants are available as pills, liquids, nose sprays or drops. They help shrink the lining of the nasal passages and relieve stuffiness. Use decongestant nose drops and sprays only for a short time. Oral decongestants can cause side effects such as sleeplessness and increased blood pressure in some people. Consider checking with your doctor before using them.
Many people with a dust mite allergy do not get complete relief from medicines. This means they may consider immunotherapy (allergy shots). Immunotherapy is a long-term treatment that can help prevent or reduce the severity of allergic reactions. It can reduce the course of allergic disease by changing your body’s immune response to allergens.
Allergy Shots – Subcutaneous Immunotherapy (SCIT) is an effective treatment that has been around for more than 100 years. SCIT is a series of shots that have progressively larger amounts of allergen. An injection of the allergen goes into the fat under your skin about once a week during the initial phase of treatment. Many patients get complete relief of their allergies after being on SCIP for one to three years. Many physicians will continue SCIT for a period of five or more years. SCIT can provide long-lasting symptom relief. Many people experience benefits for at least several years after the shots stop.
Sublingual (under-the-tongue) immunotherapy (SLIT) is a way to treat dust mite allergies without injections. Patients put small doses of an allergen under the tongue. This exposure improves tolerance to the dust mites and reduces symptoms. SLIT tablets that treat dust mite allergy were approved by the FDA in 2017. Talk with your allergist if you want to learn more about SLIT.
How Can I Prevent Allergic Reactions to Dust Mites?
Remember, having dust mites doesn’t mean your house isn’t clean. In most areas of the world, these creatures live in every home, no matter how clean. But, you can reduce their effects. There are many changes you can make to your home to reduce the numbers of these unwanted “guests.”
Studies show that more dust mites live in your bedroom than anywhere else in your home. So this is the best place to start.
- Cover mattresses and pillows in zippered dust-proof covers. These covers are made of a material with pores too small to let dust mites and their waste product through. They are also called allergen-impermeable. Plastic or vinyl covers are the least expensive, but some people find them uncomfortable. You can buy other fabric allergen-impermeable covers from many regular bedding stores.
- Wash your sheets and blankets weekly in hot water. You have to wash them in water that’s at least 130 degrees Fahrenheit or more to kill dust mites.
- Get rid of all types of fabric that mites love and that you cannot easily wash regularly in hot water. Avoid wall-to-wall carpeting, curtains, blinds, upholstered furniture and down-filled covers and pillows in the bedroom. Put roll-type shades on your windows instead of curtains.
- Have someone without a dust mite allergy clean your bedroom. If this is not possible, wear a filtering mask when dusting or vacuuming. Many drug stores carry these items. Dusting and vacuuming stir up dust. So try to do these chores when you can stay out of the bedroom for a while afterward.
- Special CERTIFIED filter vacuum cleaners can help to keep mites and mite waste from getting back into the air. CERTIFIED vacuums are scientifically tested and verified as more suitable for making your home healthier.
- Vacuuming is not enough to remove all dust mites and their waste. A large amount of the dust mite population may remain because they live deep inside the stuffing of sofas, chairs, mattresses, pillows and carpeting.
Treat other rooms in your house like your bedroom. Here are more tips:
- Avoid wall-to-wall carpeting, if possible. If you do use carpeting, mites don’t like the type with a short, tight pile as much. Use washable throw rugs over regularly damp-mopped wood, linoleum or tiled floors.
- Wash rugs in hot water whenever possible. Cold water isn’t as effective. Dry cleaning kills all dust mites and is also good for removing dust mites from living in fabrics.
- Keep the humidity in your home less than 50 percent. Use a dehumidifier and/or air conditioner to do this.
- Use a CERTIFIED filter with your central furnace and air conditioning unit. This can help trap dust mites from your entire home. Freestanding air cleaners only filter air in a limited area. Avoid devices that treat air with heat, electrostatic ions or ozone.