Medical bulletin 27/ February / 2024

A study published on Feb. 25 2024, in the New England Journal of Medicine, suggests that regular use of the drug, omalizumab, could protect people from severe allergic responses, such as difficulty breathing if they accidentally eat a small amount of food they are allergic to.

Food allergies occur when the body's immune system mistakenly identifies certain proteins in food as harmful invaders. Upon encountering these proteins, the immune system launches an attack, leading to various symptoms such as hives, difficulty breathing, or digestive issues. A drug can make life safer for children with food allergies by preventing dangerous allergic responses to small quantities of allergy-triggering foods

"I'm excited that we have a promising new treatment for multifood allergic patients. This new approach showed really great responses for many of the foods that trigger their allergies," said the study's senior author, Sharon Chinthrajah, MD, associate professor of medicine and of pediatrics, and the acting director of the Sean N. Parker Center for Allergy and Asthma Research at Stanford Medicine.

Originally approved by the Food and Drug Administration (FDA) to treat conditions like allergic asthma and chronic hives, Omalizumab works by binding to and neutralizing the antibodies responsible for various allergic reactions. It's an injected antibody that targets and deactivates all forms of immunoglobin E (IgE), the molecule central to allergic responses in the bloodstream and on immune cells throughout the body. Current evidence suggests that Omalizumab may offer relief from multiple food allergies simultaneously.

For the study, 177 children were involved with three or more food allergies, spanning different age groups. Participants underwent omalizumab injections or received a placebo over 16 weeks, with dosages tailored to weight and IgE levels. After testing, 79 patients (66.9%) on omalizumab tolerated at least 600 mg of peanut protein, compared to only four patients (6.8%) on the placebo. Similar improvements were observed with other allergenic foods. Approximately 80% of omalizumab-treated patients could consume small amounts of one allergenic food without a reaction, with percentages decreasing for multiple allergens.

The findings indicated that Omalizumab was generally safe, with no significant side effects observed except for occasional minor reactions at the injection site. This research represents the first evaluation of its safety in children as young as 1 year old.

“Food allergies have significant social and psychological impacts, including the threat of allergic reactions upon accidental exposures, some of which can be life-threatening,” Chinthrajah said. “There is a real need for treatment that goes beyond vigilance and offers choices for our food allergic patients,”

“The drug could be especially helpful for young children with severe food allergies because they tend to put things in their mouths and may not understand the dangers their allergies pose” she concluded.

Reference: Terri Brown-Whitehorn, Amanda K. Rudman Spergel, Maria Veri, Sanaz Daneshfar Hamrah, Erica Brittain, Julian Poyser, Lisa M. Wheatley, R. Sharon Chinthrajah. Omalizumab for the Treatment of Multiple Food Allergies. New England Journal of Medicine, 2024; DOI: 10.1056/NEJMoa2312382

Study finds new RNA nanomedicine lowers HIV replication by 73%

University of Waterloo researchers in Canada have devised a method to combat HIV using gene therapy with ribonucleic acid (RNA).

The findings were published in the Journal of Controlled Release.

HIV is a virus that targets the body's immune system and white blood cells, leaving individuals susceptible to various infections and illnesses. Presently, there is no cure for HIV. While antiretroviral therapy (ART) can assist in disease management, it does not eradicate the virus. Without treatment, HIV can progress to AIDS (acquired immunodeficiency syndrome) within a decade or longer.

For the study, the researchers created a new nanomedicine filled with genetic materials called small interfering RNAs (siRNA)Trusted Source.

“siRNA was selected as a potential therapy because they can be designed to regulate the expression of specific genes in the body,” said lead study author Dr. Emmanuel Ho, associate professor in the School of Pharmacy at the University of Waterloo. “Benefits of this include lower chance of side effects in comparison to conventional small molecule drugs.”

By utilizing siRNAs to modulate gene expression, researchers achieved a 73% reduction in HIV replication. Furthermore, the novel nanomedicine addressed challenges associated with HIV-related autophagy, the body's cellular recycling process for eliminating viruses and bacteria.

"Autophagy is a natural cellular mechanism for recycling proteins and removing pathogens. However, HIV can hinder autophagy through the production of the protein Nef." explained Dr. Ho.

The study also employed a dual preventive approach, targeting both the host gene CCR5 and the viral gene Nef.

“By developing a combination nanomedicine that can deliver siRNA specific for Nef and CCR5, we hope to one, reduce the expression of CCR5 on cells to reduce HIV binding and infection two, if unfortunately, HIV is still able to infect cells, then by reducing the expression of Nef, we can re-activate autophagy in these cells so that they can digest HIV. This is the first study demonstrating this two-pronged approach for preventing HIV infection.” said Dr. Ho.

Reference: Sidi Yang, Yufei Chen, Jijin Gu, Angela Harris, Ruey-Chyi Su, Emmanuel A. Ho; https://doi.org/10.1016/j.jconrel.2023.12.043

Doctors report that 90% of young women in India experience iron deficiency

Doctors highlighted on February 25, that iron deficiency is prevalent among young women in India, affecting approximately 90% of them and emphasized the importance of timely detection of this condition.

Iron deficiency, a common nutritional deficit, is often overlooked by many women who may attribute symptoms like fatigue and weakness to other causes. This essential mineral is vital for oxygen transport, sustaining healthy red blood cells, and maintaining energy levels. Insufficient iron can result in fatigue, weakness, shortness of breath, and impaired cognitive function.

"Iron deficiency among young women is a growing concern that is often overlooked. Despite efforts to promote healthy eating and supplementation, 90 per cent of young women still struggle with insufficient iron levels," said Dr Rajesh Bendre, National Technical Head and Chief Pathologist Apollo Diagnostics. He emphasized that factors like menstrual blood loss, restrictive diets, and excessive processed food intake are behind rising iron deficiency in women.

Many pregnant women also suffer from iron deficiency, leading to low hemoglobin, anaemia, and its associated symptoms such as weakness, shortness of breath, and pale skin, the expert said.

“Iron deficiency in many pregnant women is a pressing concern that can have far-reaching consequences. Beyond the immediate health risks to the mother, such as anemia and fatigue, iron deficiency during pregnancy can also hinder foetal development. Inadequate iron levels in expecting mothers may increase the risk of preterm birth and low birth weight, which can impact a child's long-term health and cognitive development, " said Dr. Bendre.

Beyond iron supplementation, experts should educate pregnant women on the significance of regular prenatal check-ups to monitor iron levels and intervene promptly in case of deficiencies.

"Anaemia is one of the most widespread public health problems and has important health and welfare, social, and economic consequences. These include reduced hours at work, poor concentration and low self-esteem causing impaired development and in severe cases increased risk of death in pregnant patients, especially around the time of delivery. About 50 to 60 percent of pregnant women are found to be deficient in iron," said Dr Abhya Bhave, Haematologist, Lilavati Hospital.

Anaemia is prevalent in our population, particularly among students and those of marriageable age. Iron deficiency, stemming from factors like inadequate nutrition, worm infestation, intestinal bleeding, and menstrual blood loss, is the primary cause.

Fatigue and general weakness are often the first signs of iron deficiency, according to Dr. Kekin Gala, Gynecologist, Apollo Spectra Mumbai. “Monitoring your menstrual cycle is crucial for diagnosis, as heavy periods can result in iron loss and deficiency. Screening for iron deficiency involves a complete blood count (CBC), along with tests like serum ferritin and transferrin saturation for detailed iron level assessment. Regular monitoring using these tests not only reveals current iron status but also aids in preventing severe complications linked to untreated deficiency.”

In addition to supplements, Dr. Gala emphasised the need to incorporate iron-rich foods like spinach, and lentils into daily diet to help replenish iron levels naturally while also improving overall nutrition.

Reference: IANS