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Drug experts have warned parents and healthcare professionals to double-check if children with allergic conditions such as asthma and hayfever are being over-prescribed corticosteroids. The warning follows research unveiled at the British Pharmaceutical Conference (BPC) in Manchester revealing that many children with multiple allergic conditions such as asthma, eczema and hayfever may be exposed to high, cumulative doses of corticosteroids through co-prescribing of steroid preparations for different conditions.

Asthma and hayfever are common conditions in children for which long-term inhaled or nasal corticosteroids may be prescribed. Some children with severe conditions may receive both, resulting in high doses of steroids and increased risk of adverse effects.1

An audit of 304 general practices carried out by researchers from Aberdeen University, including the records of 345,221 children, found that almost 9% of all children issued with a repeat prescription for an inhaled corticosteroid for asthma were also prescribed at least one other steroid preparation such as nasal corticosteroids.

Lead researcher Dr James McLay, Senior Lecturer in the Department of Medicine and Therapeutics at Aberdeen University, said: “This research shows that a significant number of children are prescribed more than one corticosteroid preparation for an allergic condition.

“If a child is prescribed corticosteroid treatment for one condition at the maximum or near the maximum dose, then another steroid prescription would tip them into over-exposure.”

Dr McLay suggested that GPs may not always recognise that a child is potentially over-exposed to corticosteroids because general practice systems may not be set up to alert them to the impact of cumulative corticosteroid dosing, particularly if prescriptions are issued on a repeat basis. He said: “While this study did not set out to identify individual children receiving too high doses of steroids, our data suggests that up to 50% of children prescribed an inhaled and nasal corticosteroid, together, could be receiving too high a cumulative dose of steroid.

“We therefore recommend that all healthcare professionals or parents under the direction of a healthcare professional check for this issue,” added Dr McLay.

The potential long-term toxicity of chronic corticosteroid use in children is unclear, but there have been concerns about the impact on child growth. However, most children with asthma eventually attain normal height, even after receiving moderate corticosteroid doses.2, 3

Dr McLay said: “Corticosteroids have revolutionised the treatment of asthma and probably saved many children’s lives. But against a background of concern about the impact of long-term corticosteroid use, this study suggests that GPs should always consider the potential cumulative steroid burden for an atopic child.”

The British Pharmaceutical Conference - entitled “The medicines maze: balancing risks and benefits” - takes place from 10th to 12th September, 2007, at Manchester Central (formerly Manchester International Convention Centre). The theme of BPC 2007 is reflected throughout the programme, with keynote speeches and workshops addressing crucial technical and professional issues that are facing pharmacy today. The conference will showcase the laagsdhfgdf developments in pharmaceutical science and practice research and include discussion and debate led by expert speakers.

References

1. Ekins-Daukes S, et al. Burden of corticosteroids in children with asthma in primary care: retrospective observational study. BMJ 2002;324:1374.

2. Patel L, et al. Symptomatic adrenal insufficiency during inhaled corticosteroid treatment. Arch Dis Child 2001;85:330-334.

3. Agertoft L, Pedersen S. Effect of long-term treatment with inhaled budesonide on adult height in children with asthma. NEJM 2000;343:1064-1069.

Royal Pharmaceutical Society of Great Britain

Mealtime should be an enjoyable experience. Yet, for 12 million children with food allergies, eating a meal can be a frightening activity. For some of these children, even the slighagsdhfgdf exposure to the wrong food can be deadly.

Heidi Roehrig is the mother of a 4-year old boy with nut allergies. A year ago, her son had a severe allergic reaction after eating trail mix with nuts.

“Our life has changed incredibly. Suddenly we’re afraid of play dates and birthdays. These should be fun you want them to be fun for your child but we’re fearful of not being able to control all the foods,” says Roehrig.

In the Roehrig family, simple summer pleasures like going to the ice cream parlor don’t take place anymore. Too many of the ice creams contain nuts, and the family has no way of knowing if surfaces and tools have been cleaned correctly.

“There are lots of things that just aren’t enjoyable anymore because we can’t feel confident that our son isn’t going to have a reaction. Even grocery shopping is a huge ordeal you have to read the label on everything, including foods you buy every week, because you never know when it’s going to change,” she says.

The impact of food allergies on the family is tremendous. For the families of children who have developed severe food allergies, it alters every aspect of life, whether it’s babysitters, daycare, visiting family and friends, even going to the doctor’s office.

The process of diagnosing food allergies, though welcome, also poses its own problems. Testing children with serious food allergies can be an extremely stressful and even dangerous situation. These concerns have prompted the University of Michigan Health System to create an innovative Food Allergy Clinic that offers families a safe and relaxing facility to agsdhfgdf or challenge for food allergies. It was designed specifically to provide a safe environment for allergy experts to evaluate and treat patients with food allergies.

“We have built a controlled area where children can come to be evaluated and diagnosed. The resulting data allow us to develop what we call a ‘challenge.’ In most of our challenges, we introduce a food that we believe can be tolerated now that the child is older. We can also do airborne challenges to see if a child will have an allergic reaction to a smell, such as to peanuts,” explains Marc McMorris, M.D., medical director of the clinic and clinical associate professor of internal medicine and pediatrics.

Because some food allergies, including the smells, can be dangerous or life-threatening, the clinic’s design controls airflow from room to room, allowing several patients to be seen and evaluated at the same time.

“We also have more control over preparing the foods that is essential when it comes to certain types of foods, or developing challenges where we want to be able to hide the food in certain other kinds of food and feed it to the patient without them knowing they’re getting it,” says McMorris.

Allergy facts

An allergen is any substance that causes an allergic reaction. Having a food allergy means your body’s immune system mistakenly believes the food is harmful.

Food allergies can be more severe than airborne allergies because the food is ingested and then absorbed throughout the body. Airborne allergies are filtered by the eyes or nose, so they don’t enter the body’s system so completely.

The number of people with food allergies is increasing. Experts believe the number has doubled in the past 10 years. There are about 12 million Americans with food allergies, and as many as five to 8 percent of children under age 3 have food allergies.

There are several theories about why the number of people with allergies is increasing:

— Experts believe this may be due to the way we process our foods. For example, in the United States, peanuts are dry roasted. This makes the compound found in peanuts that triggers an allergic reaction more easily exposed to the immune system.

— Some experts say American children are so well-protected from infection that the immune system, not needing to work as hard to fight infections, switches its focus to allergens, the foreign substances the body attacks in an allergic reaction.

— Heredity might play a role, too. If your parents are allergic, then you’re more likely to have allergies. If one parent has allergies, as many as 50 percent of their children also will have allergies. If both parents have allergies, there’s as much as a 70 to 80 percent risk that their children will develop allergies of some sort.

What to watch for

The top high-risk foods in this country are milk, eggs, peanuts, tree nuts, fish, shellfish and, recently, sesame seeds.

Food allergies can be life threatening. Reactions range from a few hives to a mild skin reaction to a life-threatening severe reaction.

University of Michigan Health System
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Ann Arbor, MI 48109-2435
United States
http://www.med.umich.edu

Researchers in the UK are eager to find out whether blood-sucking worms - hookworms - might have an effect on the immune system and be used for effective treatment for asthma and other allergies. Researchers from the University of Nottingham say these worms may even have therapeutic benefits for patients with diabetes type 1 and multiple sclerosis.

The researchers explain that for over 30 years data has indicated that individuals infected with tropical hookworms never seem to suffer from allergies. It might not be a coincidence that asthma is virtually completely absent in areas where hookworms are found, but growing where they are not.

People of African descent who live in developed countries suffer from Crohn’s disease, while Africans living in Africa, where these worms are much more common, hardly ever do.

Scientists believe hookworms force their host’s immune system to work less actively. Humans with over-active immune systems suffer from allergies, such as asthma and Crohn’s disease, much more commonly than people whose immune systems are not over-active.

Dr David Pritchard and team are carrying out experiments to find out whether hookworms can be useful in the treatment of auto-immune diseases (over-active immune systems).

— “The Worm That Turned” - Nottingham University

What is a Hookworm?

A hookworm is a parasite - a parasitic nematode worm - that exists in the small inagsdhfgdfine of the host. The host may be any type of several mammals, including humans. There are two types that typically infect human beings:

— Ancylostoma duodenale: Found in the Middle East, North Africa, India and Europe.

— Necator americanus: Found in the Americas, Sub-Saharan Africa, Southeast Asia, China and Indonesia.

It is estimated that about 800 million people are infected with hookworms globally.

A person who is infected may experience anemia. The worms are insatiable blood-suckers and damage the mucosa (in the gut). Loss of blood is not possible by inspecting the stools; you cannot see the blood loss by checking the patient’s excrements.

Hookworms are a major cause of child and maternal morbidity in the tropical and subtropical regions of the developing world. They can cause intellectual, cognitive and growth retardation in vulnerable children, as well as intrauterine growth retardation, prematurity, and low birth weight.

Even though infection is hardly ever fatal, a heavily infected person can experience considerable health problems.

Written by: Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Researchers at the National Institutes of Health (NIH) have found that more than 50 percent of the current asthma cases in the country can be attributed to allergies, with approximately 30 percent of those cases attributed to cat allergy.

“It has long been debated whether people who develop asthma have a genetic propensity to develop allergies, or atopy,” said Darryl C. Zeldin, M.D., a senior investigator at the National Institute of Environmental Health Sciences (NIEHS). “This new research shows that 56.3 percent of asthma cases are attributed to atopy.” Atopy is a condition that results from gene-environment interactions and can be measured by a positive skin agsdhfgdf to allergens (or allergy causing substances in the environment).

The study, available online in the Journal of Allergy and Clinical Immunology, was conducted by researchers at the National Institute of Environmental Health Sciences (NIEHS) and the National Institute of Allergy and Infectious Diseases, both parts of the NIH. The data come from the Third National Health and Nutrition Examination Survey (NHANES III), a nationally representative sample of the population of the United States.

“Sensitization to cat appears to be a strong risk factor for asthma in this study,” said Zeldin. Zeldin and his co-authors, however, point out that some research shows that exposure to cats, particularly early in life, may be a protective factor. “We are not advocating parents get rid of pets, but if you suspect that you or your child might have cat allergies or get asthmatic-like symptoms, you should consult with a physician about the best course of action for your family,” added Zeldin.

The NIH researchers looked at skin agsdhfgdf data for ten allergens. A positive skin agsdhfgdf reaction to cat allergens accounted for 29.3 percent of the asthma cases, followed by the fungus Alternaria at 21.1 percent and white oak at 20.9 percent. “Each of 10 allergen-specific skin agsdhfgdfs was strongly associated with asthma; however, after adjustment by a variety of subject characteristics and all the allergens, only skin agsdhfgdfs to cat, Alternaria and white oak were independently and positively associated with asthma,” said Peter Gergen, M.D., M.P.H, of NIAID’s Division of Allergy, Immunology and Transplantation, a co-author on the paper.

Other allergens agsdhfgdfed include: Ragweed, dustmites, Russian thistle, Bermuda grass, peanuts, perennial rye and german cockroach. Approximately 10,500 individuals participated in the skin agsdhfgdfing. During these agsdhfgdfs, skin was exposed to allergy-causing substances (allergens) and a positive agsdhfgdf was determined by the size of the reaction on the skin.

“This study tells us that allergy is a major factor in asthma,” Gergen said. “But this study also tells us is that there are many people who get asthma who don’t have allergies. We need to do more research to understand what is causing the asthma that is not related to allergies.”

“This study confirms that the environment plays a major role in the development of asthma,” said Zeldin. “Given the complexity of this disease it won’t be easy, but if we can prevent, block or reverse atopy, we could reduce a large proportion of asthma cases.”

The National Institute of Environmental Health Sciences (NIEHS), a component of the National Institutes of Health, supports research to understand the effects of the environment on human health. For more information on environmental health topics, please visit our website at http://www.niehs.nih.gov.

NIAID is a component of the National Institutes of Health, an agency of the U.S. Department of Health and Human Services. NIAID supports basic and applied research to prevent, diagnose and treat infectious diseases such as HIV/AIDS and other sexually transmitted infections, influenza, tuberculosis, malaria and illness from potential agents of bioterrorism. NIAID also supports research on transplantation and immune-related illnesses, including autoimmune disorders, asthma and allergies.

The National Institutes of Health (NIH) - The Nation’s Medical Research Agency - includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.

Reference: Arbes SJ, Gergen,PJ Vaughn B, Zeldin DC. Asthma cases attributable to atopy: Results from the Third National Health and Nutrition Examination Survey. Journal of Allergy and Clinical Immunology. September, 2007.

Seafood allergy sufferers may soon be able to eat prawns without the fear of an adverse reaction. Chinese scientists have taken a promising step towards removing from prawns the proteins that cause an allergic response without resorting to genetic manipulation, reports Lisa Richards in Chemistry & Industry, the magazine of the SCI.

Li Zhenxing led the research at the Ocean University of China. The team revealed that treating prawns with a combination of heat and irradiation significantly reduced the level of reactive proteins called allergens. They took blood from patients with shrimp allergies, added samples of treated and untreated prawn, and measured how antibodies in the blood reacted. They found that levels of ‘Pen a 1′, one of the major allergens, decreased 20-fold after treatment (Journal of the Science of Food and Agriculture DOI 10.1002/jsfa.2746).

Zhenxing’s team suggests that irradiation damages the proteins, revealing hidden reactive amino acid residues. Subsequent heating then destroys the exposed residues. “Radiation and heat seems to be a promising method for reducing the immunoreactivity” say the researchers.

Samuel Lehrer of Tulane University in New Orleans, USA, is already working on removing allergens from prawns using genetic techniques. But Zhenxing’s method could be preferable for people wary of eating genetically modified foods.


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Please acknowledge Chemistry & Industry as the source of these items.

About Chemistry & Industry

Chemistry & Industry magazine from SCI delivers news and comment from the interface between science and business. As well as covering industry and science, it focuses on developments that will be of significant commercial interest in five- to ten-years time. Published twice-monthly and free to SCI Members, it also carries authoritative features and reviews. Opinion-formers worldwide respect Chemistry & Industry for its independent insight.

About the Journal of the Science of Food and Agriculture

The Journal of the Science of Food and Agriculture (JSFA) publishes peer-reviewed original research and critical reviews in these areas, with particular emphasis on interdisciplinary studies at the agriculture/food interface. This international journal covers fundamental and applied research.

JSFA is an SCI journal, published by John Wiley & Sons, on behalf of the Society of Chemical Industry, and is available in print (ISSN: 0022-5142) and online (ISSN: 1097-0010) via Wiley InterScience http://www.interscience.wiley.com/ For further information about the journal go to http://interscience.wiley.com/jsfa

About SCI

SCI is a unique international forum where science meets business on independent, impartial ground. Anyone can join, and the Society offers a chance to share information between sectors as diverse as food and agriculture, pharmaceuticals, biotechnology, environmental science and safety. As well as publishing new research and running events, SCI has a growing database of member specialists who can give background information on a wide range of scientific issues. Originally established in 1881, SCI is a registered charity with members in over 70 countries.

About Wiley

John Wiley & Sons, Ltd., based in Chichester, England, is the largest subsidiary of John Wiley & Sons, Inc. Founded in 1807, John Wiley & Sons, Inc. provides must-have content and services to customers worldwide. Their core businesses include scientific, technical, and medical journals, encyclopedias, books, and online products and services; professional and consumer books and subscription services; and educational materials for undergraduate and graduate students and lifelong learners. Wiley has publishing, marketing, and distribution centres in the United States, Canada, Europe, Asia, and Australia. The company is listed on the New York Stock Exchange under the symbols JWa and JWb. Wiley’s recently re-launched Internet site can be accessed at http://www.wileyeurope.com/

Contact: SCI Press Office
Society of Chemical Industry

Some patients who experience recurrent depression may benefit from long-term maintenance treatment with anti-depressant medication, according to a new study led by a Virginia Commonwealth University researcher.

Major depressive disorder is a recurrent condition that can have a profound impact on an individual’s quality of life. In the United States, approximately 17 percent of individuals will experience major depressive disorder during their lifetime.

Of those who experience one episode of major depression, more than 50 percent will have a recurrence. After two episodes, more than 70 percent of patients will have a recurrence, and after three episodes that figure jumps to 90 percent. Each episode poses a new risk that the depression may not respond to treatment, making prevention of recurrent depression an important focus of long-term treatment.

In the November issue of the Journal of Clinical Psychiatry, Susan G. Kornstein, M.D., a professor of psychiatry and obstetrics and gynecology in VCU’s School of Medicine and lead author on the study, reported with her colleagues that maintenance treatment with escitalopram, a selective serotonin reuptake inhibitor (SSRI) approved for the treatment of depression, may reduce the risk of recurrent depression in patients with major depressive disorder.

Between 2000 and 2003, researchers evaluated approximately 200 participants at 28 centers in the United States who had responded positively to eight weeks of treatment with one of four different SSRIs: fluoxetine, sertraline, paroxetine or citalopram. This was followed by four months of treatment with escitalopram. These participants were then randomly assigned to fixed-dose treatment with 10 or 20 mg of escitalopram or placebo for one year.

“Patients who were switched to placebo showed a significantly higher rate of depression recurrence (65 percent), compared to those who stayed on escitalopram (27 percent),” said Kornstein. “This was true even though the patients showed a full resolution of their depression at the start of maintenance treatment.” The medication was found to be safe and well tolerated throughout the study, she said.

“These findings indicate the importance of maintenance therapy for patients with recurrent major depressive disorder beyond four to six months of improvement, even if a patient’s depressive symptoms appear to be resolved,” she said.


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This work was funded by Forest Research Institute.

Kornstein is also the executive director of VCU’s Mood Disorders Institute and VCU’s Institute for Women’s Health, designated a National Center of Excellence by the U.S. Department of Health and Human Services. She collaborated on the study with Anjana Bose, Ph.D., Dayong Li, Ph.D., Khalil G. Saikali, Ph.D., and Chetan Gandhi, Ph.D., who are researchers with Forest Research Institute.

About VCU and the VCU Medical Center: Located on two downtown campuses in Richmond, Va., Virginia Commonwealth University ranks among the top 100 universities in the country in sponsored research and enrolls 30,000 students in more than 195 certificate, undergraduate, graduate, professional and doctoral programs in the arts, sciences and humanities in 15 schools and one college. Sixty-three of the university’s programs are unique in Virginia, and 20 graduate and professional programs have been ranked by U.S. News & World Report as among the best of their kind. MCV Hospitals, clinics and the health sciences schools of Virginia Commonwealth University compose the VCU Medical Center, one of the leading academic medical centers in the country. For more, see http://www.vcu.edu/.

Contact: Sathya Achia-Abraham
Virginia Commonwealth University

Cognitive therapy to treat moderate to severe depression works just as well as antidepressants, according to an authoritative report appearing today in the Archives of General Psychiatry. The study, conducted by researchers at the University of Pennsylvania and Vanderbilt University, challenges the American Psychiatric Association’s guidelines that antidepressant medications are the only effective treatment for moderately to severely depressed patients.

Either form of treatment worked significantly better than a placebo, but the researchers demonstrated that cognitive therapy was more effective than medication at preventing relapses after the end of treatment.

“We believe that cognitive therapy might have more lasting effects because it equips patients with the tools they need to learn how to manage their problems and emotions,” said Robert DeRubeis, professor and chair of Penn’s Department of Psychology. “Pharmaceuticals, while effective, offer no long term cure for the symptoms of depression. For many people, cognitive therapy might prove to be the preferred form of treatment.”

The study, which follows years of debate on the relative merits of cognitive therapy versus medication for more severe forms of depression, is the largest trial yet undertaken on the topic; it involved 240 depressed patients. The patients were randomly placed into groups that received cognitive therapy, antidepressant medication or a placebo. Patients in the antidepressant group, which was twice as large as the other two, were treated with paroxetine (Paxil). Lithium or desipramine was also given, as necessary.

After 16 weeks of treatment, patients in both the medication and cognitive therapy groups showed improvement at about the same rate; however, cognitive therapy patients were less likely to relapse in the two years following the end of treatment. According to the researchers, the return of symptoms might demonstrate that the medication may have blunted the appearance of depression but did not affect underlying disease processes.

“Medication is often an appropriate treatment, but drugs have drawbacks, such as side effects or a diminished efficacy over time,” DeRubeis said. “Patients with depression are often overwhelmed by other factors in their life that pills simply cannot solve. In many cases, cognitive therapy succeeds because it teaches the skills that help people cope.”

The researchers also noted slight differences in the response to treatment between the two agsdhfgdfing locations, with cognitive therapy performing better at Penn and medications performing better at Vanderbilt. Researchers surmise that the medication worked so well at the Vanderbilt clinic because more of the patients there were markedly anxious, in addition to being depressed, and the medications used in the research have anti-anxiety properties.

The researchers further believe that cognitive therapy patients might have done better at Penn due to the experience level of the therapists involved. Just as the experience of therapists may be important in cognitive therapy, so, too, can the expertise of prescribing physicians play a role in the success of antidepressant medication treatment. Studies have shown that antidepressant medication dosages are still largely a matter of physicians’ discretion.

“Clearly, cognitive therapy is not for everyone, and its success could depend on variables such as the expertise of the therapist and the patient’s willingness or ability to take the therapy to heart,” DeRubeis said. “The key to establishing any form of treatment is rating its effectiveness in comparison to treatments currently in use, and this study has shown cognitive therapy to be a viable alternative.”

Clinical researchers at the Penn School of Medicine’s Department of Psychiatry involved in the study were Jay D. Amsterdam, Paula R. Young, John P. O’Reardon and Madeline M. Gladis. Vanderbilt researchers include Steven D. Hollon of the Department of Psychology and Richard C. Shelton, Ronald M. Salomon, Margaret L. Lovett, and Laurel L. Brown of the Department of Psychiatry. Contributing author Robert Gallop is with West Chester University’s Department of Mathematics and Applied Statistics.

The work was supported by a grant from the National Institutes of Health. GlaxoSmithKline provided medication and placebos.

Contact: Greg Lester
glester@pobox.upenn.edu
215 573-6604
University of Pennsylvania
http://www.upenn.edu

Got the winter blues? Dawn simulator may help

Study: Bedside device, negative air ionization can ease seasonal depression

NEW YORK - For people who suffer from winter depression triggered largely by reduced sunlight, a bedside device that simulates the rising of the sun may provide relief, a study shows. Negative air ionization, also delivered at the bedside, seems to be effective as well.

Dawn simulation and negative air ionization are two naturalistic, non-pharmaceutical environmental enhancements now verified superior to placebo and remarkably effective in the treatment of winter depression, Dr. Michael Terman told Reuters Health.

In the study, dawn simulation and negative air ionization, both activated toward the end of sleep, proved to be as effective as bright light therapy after waking up ??” an established treatment for winter depression, also known as seasonal affective disorder or SAD.

With bright light therapy, SAD sufferers sit at a bright light box for 30 minutes at breakfast time. Dawn simulation and negative air ionization are more convenient, being delivered automatically and innocuously during the final hours of sleep by an apparatus placed next to the bed.

In their study, Dr. Michael Terman and Dr. Jiuan Su Terman of Columbia University in New York randomly assigned 99 adults with SAD to one of five treatments: dawn simulation equivalent to May in northern temperate latitudes; a brief dawn pulse ; bright light after waking; high flow rate negative air ionization; or low flow rate ionization.

Click for related contentFirst drug approved to beat winter depressionTop 10 places to beat the winter blues

Full dawn simulation, high negative air ionization, and bright light therapy proved roughly equal in terms of improvement in symptoms of SAD, the investigators report in the American Journal of Psychiatry.

Improvement was seen in 57 percent of subjects in the bright light therapy, 50 percent of those in the dawn simulation group and 48 percent in the high air ionization group. By contrast, improvement was seen in just 23 percent of those who got low ionization and in 43 percent of subjects in the sunrise pulse group.

Although the sunrise pulse treatment was therapeutically active in some patients, it led to the persistence, emergence and exacerbation of depressive symptoms, making it an unfavorable option, the Termans write.

Summing up, Michael Terman said while morning bright light therapy remains the first-line intervention for SAD, with thousands of successes and satisfied patients, dawn simulation and negative air ionization may also be considered as options.

If you think you may suffer from winter depression, Terman suggests, as a first step, completing the Personalized Inventory for Depression and SAD survey, a free and confidential online self-assessment questionnaire posted on the nonprofit website of the Center for Environmental Therapeutics.

The site also includes more detailed description of light and ion therapy.

Copyright 2007 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content is expressly prohibited without the prior written consent of Reuters.

A Brazilian study has shown that stem cell transplants in patients with diabetes type 1 may kick start the pancreas into producing insulin again. It is still too early to tell if the effect is permanent, but some patients have remained insulin free for over 20 months.

The study is published in the Journal of the A.M.E.(JAMA).

Type 1 diabetes mellitus, formerly known as childhood or insulin dependent diabetes , occurs in about 1 in 10 cases of diabetes , the rest being of type 2. It is not primarily a childhood illness, the adult incidence is similar but is often misdiagnosed as type 2 to begin with.

Type 1 diabetes develops because the immune system attacks insulin producing beta cells in the pancreas. This can go undetected until 60 to 80 per cent of the cells have been destroyed, when the body can no longer keep glucose levels in balance and the condition comes to the patient’s awareness.

Treatment for type 1 diabetes consists of insulin replacement therapy, usually by injection or insulin pump, careful monitoring of blood sugar and watching carbohydrate intake.

The cause is unknown, there could be a genetic predisposition that is triggered by an infection, for instance German measles is thought to trigger type 1 diabetes in some people. Some scientists say that infants that were never breast fed are more likely to develop type 1 diabetes because their immune systems were exposed too early to cow’s milk.

Since 1996, other autoimmune diseases have been treated successfully by suppressing the immune system and then transplanting blood stem cells to kick start fresh cell production of damaged tissue. This transplant of blood stem cells is called “autologous nonmyeloablative hematopoietic stem cell transplantation”, or AHST.

Also, previous trials have shown that newly diagnosed type 1 diabetes responds to moderate suppression of the immune system and can stop further loss of the cells that produce insulin and reduce the need for external insulin.

However, this study is the first to combine both the immunosuppression and the stem cell transplant in newly diagnosed type 1 diabetes patients.

Julio Voltarelli and colleagues from the Regional Blood Center (Hemocentro), University of Sao Paulo in Brazil, recruited 15 recently diagnosed type 1 diabetes patients aged 14 to 31 years. They were all dependent on supplemental insulin.

After receiving drugs to stimulate stem cell production, the patients had some bone marrow removed to harvest a supply of blood stem cells, and then their immune systems were suppressed with drugs and they also took antibiotics and stayed in isolation to protect them from infection.

After two weeks their extracted and conditioned stem cells were infused into their bloodstream, via the jugular vein.

The treatment took place between November 2003 and July 2006 with further observation until February 2007 at the Bone Marrow Transplantation Unit of the School of Medicine of Ribeirão Preto, Brazil.

During this time the patients were monitored and blood samples taken to agsdhfgdf for insulin and other markers.

As the treatment took effect, the patients gradually, at different rates, reduced their need for external insulin.

14 of the 15 patients were insulin-independent over the 7 to 36 month follow up period. The average insulin free period was nearly 19 months.

One patient was still insulin-free at 35 months, another 4 for 21 months, 7 for 6 months and 2 with late response were insulin-free for 1 and 5 months respectively.

The treatment failed in the first patient, probably because their beta cell count was too low when they started the treatment. The remaining patients were more carefully selected after this.

No patients died; one got pneumonia and two others developed late endocrine dysfunction (hypothyroidism or hypogonadism). It is not clear if this was as a result of the treatment.

At 6 months after AHST treatment, the level of C-peptide, a marker that shows the presence of the body’s own produced insulin, was significantly greater than the pre-treatment values, and did not change at 12 and 24 months.

The study concluded that:

“High-dose immunosuppression and AHST were performed with acceptable toxicity in a small number of patients with newly diagnosed type 1 DM. With AHST, beta cell function was increased in all but 1 patient and induced prolonged insulin independence in the majority of the patients”.

In an accompanying editorial, Jay Skyler who directs the Diabetes Research Institute at the University of Miami in Florida, USA, said that while these results are promising, they should be treated with some caution.

It is not unusual for recently diagnosed type 1 patients to go through what is called a “honeymoon” period where for some reason they experience a rise in their own bodily insulin production.

This trial was really an observational study - it did not include a control group, which would have controlled for effects such as the honeymoon period, noted Skyler.

Also, it is not clear what exactly is going on. Is the insulin level going up because the stem cells generated extra beta cells, or because the immune system stopped attacking the beta cells and the 20 or so per cent that were still left in the patients was enough to keep insulin production at the right level, or a mixture of the two?

Voltarelli and his team recognized that it is early days, and expressed their hope that this study opens the door to helping type 1 diabetes patients to overcome some of the side effects of having too much glucose in the blood, such as damage to the kidneys, eyes and nervous system.

“Autologous Nonmyeloablative Hematopoietic Stem Cell Transplantation in Newly Diagnosed Type 1 Diabetes Mellitus.”
Júlio C. Voltarelli, Carlos E. B. Couri, Ana B. P. L. Stracieri, Maria C. Oliveira, Daniela A. Moraes, Fabiano Pieroni, Marina Coutinho,Kelen C. R. Malmegrim, Maria C. Foss-Freitas, Belinda P. Simões, Milton C. Foss, Elizabeth Squiers, Richard K. Burt.
JAMA. 2007;297:1568-1576.
Vol. 297 No. 14, April 11, 2007.

Click here for full Article.

Click here for more information on Type 1 Diabetes (American Diabetes Association).

Written by: Catharine Paddock
Writer: Medical News Today
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

People with diabetes are risking their health by not discussing their use of complementary and alternative therapies with the health professionals managing their conventional treatment.

A review of the international health literature has shown nutritional supplements and herbal medicines are the most commonly used complementary and alternative therapies in diabetes .

Annie Chang, a PhD candidate in Griffith’s School of Nursing, said while some products may have benefits for patients, they can also have side effects in their own right or interact with conventional medications.

“Fenugreek for example, used as a supplement, may affect blood sugar levels but patients are already on other blood sugar lowering medications as well.”

While the prevalence of use varies widely between different countries (17-72%), her review suggests nearly half of people living with diabetes supplement their conventional medicines with some form of alternative therapy.

Women, over 65-year-olds, those who had been living with diabetes for longer, and people interested in self management of their condition were the most likely to use alternative therapies.

“People will tell their alternative practitioners that they are using Western medicines but the vast majority will not discuss their alternative therapies with a doctor or other healthcare professional,” she said.

Ms Chang, who has also surveyed more than 300 diabetics in Taiwan, said people feared their doctor would not be interested in discussing alternative medicines or that they might ‘get into trouble’ for taking them.

“The evidence is that patients are using these products and may even reduce their conventional medicine doses and modify the timing of doses so they aren’t taking both together.”

“While it might be impossible for Western medicine to learn all about complementary and alternative therapies, healthcare professionals do need to be included in discussions about them so we can document their use and be aware of any potential problems for our patients.”

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Article adapted by Medical News Today from original press release.
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The review was published in the Journal of Advanced Nursing 2007; 58(4) 307-319.

National Diabetes Week is 8-14 July.

Source: Mardi Chapman
Research Australia