Three years of immunotherapy enough for dust mite allergy

Dust mite allergies are a common trigger of eczema flares for many. Dust mites--tiny relatives of spiders--thrive in bedding because they eat flakes of skin. And with the amount of skin that flakes off when you have eczema, it's a catch-22 problem.

From what I can find out, dust mite feces is the major source of their allergens. Eww!

One solution is to get allergy shots: regular injections of allergens at low doses that cause your immune system to develop a tolerance over time. I don't know what the regimen is--how many shots, and when you have to get them--but it is undoubtedly a hassle. Certainly it goes on for years. Doctors have debated how many years, some saying that five were required. A new study concludes that three years is enough. (Not a regime you're going to start on a whim.)

I asked the study's author, Iwona Stelmach, a professor at the Medical University of Lodz in Poland, for a copy of the paper, but haven't got one yet, so all I know is what I've read in the press release and the paper's abstract. It seems that the researchers worked with a three-part study group, totaling 90 asthmatic children, 30 each of whom had either had no immunotherapy, three years of immunotherapy, or five. While immediately after therapy, the five-year group needed less steroid to control a reaction to dust mite allergen, by the time three years had passed, the three- and five-year groups were essentially the same.

If you've got a severe dust mite allergy (and congratulations on figuring that out), it must be a relief to know you only need three years of allergy shots instead of five.

Zema, the Warrior Princess

Voov has reached a new stage. Like HAL in Stanley Kubrick's 2001, she has become self-aware. Hidden B informs me that earlier today, Voov raised her arm, pointed at her wrist (which is always red and inflamed, because we can't put steroids anywhere near her hands) with the forefinger of the other hand, and, for the first time, spoke the word "Zema."

Zema, the Warrior Princess.

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Yesterday, Caroline at Fighting Eczema posted about her son's recent scratching attack and how she has begun to suspect that dust mites might be partly responsible for his eczema. (Specifically, it's the dust mite droppings that are the allergen.) I have always been aware of the dust mite issue, but because  eczema is maddeningly inconsistent and hard to connect to any causes, even though at times it seems certain that some foods or allergens trigger flares--and because it would take a lot of time, effort, and money to attempt to control dust mites in our house, I have never done anything about them.

Vacuum? Sure, we do that once in a while. But vacuuming probably stirs up dust mite droppings and blows them into the air. Read Caroline's blog for details on what you'd have to do to begin to control dust mites.

And so it occurred to me that dust mites--and grass pollen, another thing it's virtually impossible to control exposure to--are the two most important targets for immunotherapy for eczema patients.

Three papers (here, here, and here) from the current issue of JACI show that we could expect these therapies to make it to the clinic. The grass pollen treatments are tablets, taken for about 6 months, and improved symptoms in both kids and adults by about 20% on some qualitative scale of hay fever misery. The dust mite treatments may have been injections (I don't have access to the full paper right now) and were taken over 3 years (hoo boy) but the researchers found improvements of about 45% in hay fever and 80% in asthma, so they were definitely more effective.

I'd say that the NEA should consider funding some of this research (they may already be doing so) to translate these findings into FDA-approved therapies, at least in the case of dust mites. Are the scientists considering founding a company, or patenting and licensing their discovery?

* * *

It's taken a while, but I have made an appointment to speak to Martin Steinhoff, a visiting professor of dermatology at UCSF, about the German itch center model. I'll be talking to him on January 25th. (He's visiting from the University of Muenster.) In advance of our meeting, he's given me a couple references to his papers, and I'm reading one at the moment: a review of how the skin, nervous system, and brain work together to create the sensation of itch. It's eye-opening stuff and I'll share some key points with you when I understand them! Let me give you just one quote:

"...the impression that one's skin itches is nothing but a sensory illusion created by the brain."

So, you'd think, you don't necessarily have to treat itchy skin to control itch. You could take something that acts directly on the brain. Pop a tablet, instead of smearing yourself with steroids.