Trends in Allergic Disease
Although important discoveries in the diagnosis and treatment of allergic disorders have been made over the years, 50 million Americans still suffer from asthma, rhinitis, sinusitis and other allergic/immunologic disorders and the prevalence continues to rise. Following are three trends in research stimulating much discussion and excitement among the medical community.
Genetics of Asthma and Allergy
Researchers and clinicians are trying to find the genes that predispose to allergic reactions and asthma in certain people-a difficult task as there are no universally accepted definitions of asthma or allergy, genetic criteria or defined indicators as to why allergies and asthma occur in certain people. Without this important knowledge, there is no way to scientifically identify inherited disorders or predict their response to therapy.
Researchers use three major approaches to study the genetics of allergies and asthma:
- Forward genetics-when you already have or know the protein produced by the gene causing the condition;
- Positional genetics-the opposite of forward approach, when you do not have a gene product to work with;
- Candidate gene approach-when you look at genes already known and propose which might be a good match for the condition in question.
Using Anti-IgE to Treat Allergies and Asthma
Researchers are making efforts to modify the activity of IgE-the key antibody responsible for all allergic reactions. Scientists are using special techniques to create antibodies against IgE which remove the IgE from circulation by dislodging it from the surface of mast cells. This essentially disarms the cells and, theoretically, should prevent allergic reactions from occurring. In other words, by removing the IgE, people should be able to encounter allergens to which they are sensitive without fear of experiencing an allergic response. The newly created antibodies would "turn off" the allergic reaction. Preliminary research has also demonstrated the effectiveness of anti-IgE to lessen the severity of asthma.
Linking Asthma with Allergies
Allergic rhinitis was recently proven to have a strong link to other respiratory diseases including chronic sinusitis, middle ear infections, nasal polyps and bronchial asthma. The connection to bronchial asthma has caused great concern among allergists/immunologists. A recent analysis of asthmatics showed that those who had both rhinitis and asthma were much more likely to have nighttime awakening due to asthma, miss work because of asthma and require more potent medications to control their symptoms.
Researchers are investigating ways to determine which patients with allergic rhinitis are at highest risk for developing asthma and why the relationship exists. Although research is still being conducted, there are several theories as to why asthma and allergies go hand in hand:
- Similar anatomy-The idea that the anatomy of the tissues in the nose and lungs are almost identical. Both are exposed to the same allergens and irritants and both respond similarly;
- The nasal-bronchial reflex-The idea that there are nerve fibers originating in the upper airway which connect to the lungs, allowing allergic reactions in the nose to cause a reflex in the lungs;
- Nasal blockage results in increased mouth breathing-The idea that the nasal blockage caused by allergic rhinitis may result in a shift from the normal pattern of nasal breathing to mouth breathing;
- Postnasal drip of inflammatory material-The idea that severe postnasal drip triggers episodes of asthma. Researchers have found that inflammatory chemicals commonly found in the noses of people with allergic rhinitis drip into the lungs while they sleep, thus causing asthma to worsen.
Journal of Allergy and Clinical Immunology
Research on these and other areas of allergic disease is published in the AAAAI's official peer-reviewed, scientific monthly publication, the Journal of Allergy and Clinical Immunology (JACI). The JACI features the latest clinical/laboratory research on a variety of allergic, dermatologic and immunologic issues and is the most-read journal by allergists. All submissions undergo intensive review before acceptance into the JACI, and truly represent the finest and most recent findings available.
Selected journal articles are chosen each month and released to the media. The consumer-friendly highlights are disseminated via the AAAAI executive office and are also available on the AAAAI Web site, www.aaaai.org.
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