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Allergist in the News: Dr. Kirsi Jarvinen-Seppo

Dr. Krisi Jarvinen-Seppo
Dr. Krisi Jarvinen-Seppo

Allergist in the News: Dr. Kirsi Jarvinen-Seppo

Director of the Center for Food Allergy at UR's Golisano Children's hospital

Mt. Sinai’s loss is Rochester’s gain! Read all about our recent interview with Dr. Kirsi Jarvinen-Seppo, Director of the Center for Food Allergy at UR's Golisano Children's hospital. She brought us up to date on all the services the one-year old Center can provide, as well as the latest research she and her team are conducting.

By Suzanne Driscoll
November 13th, 2015

We had the pleasure of meeting with Dr. Kirsi Jarvinen-Seppo last week at UR Medicine, and were very excited to hear about the relatively new Food Allergy Center she helped to set up one year ago. Originally from Finland, Dr. Jarvinen-Seppo was recruited from Mt. Sinai Hospital in New York City to expand and centralize the treatment of food allergies at Golisano Children’s Hospital. Her clinical interests are focused on various types of food allergy, including immediate-type allergies, eosinophilic gastrointestinal disease, food protein-induced enterocolitis, allergic proctocolitis, atopic dermatitis, and anaphylaxis, although she also sees patients with other allergic disorders such as asthma, allergic rhinitis, urticaria and angioedema.

Her main area of research is to study whether or not breastfeeding has an effect on preventing food allergies in children, as well as asthma. “Everyone’s breast milk is different, containing different types of immune factors depending on genetics as well as the environment. We are currently studying the breast milk of Mennonite women in our area as they live in a rural environment with more exposure to farm animals. Many mothers also drink unpasteurized milk. Based on our results, we may someday be able to boost the quality of every mother’s breastmilk to help prevent allergies in their children,” says Dr. Jarvinen-Seppo.

The Food Allergy Center utilizes a team approach with dieticians and pediatric nurses on hand who have specific training in food allergies. They also work closely with gastroenterology specialists. If you live too far from the Center, they can recommend other doctors in the area whom they know are aware of all the latest diagnosis techniques and treatments available. They also offer a safe place to conduct “food challenges.” “If your child was diagnosed at age 1 with one or more food allergies, he or she may have outgrown them by age 6,” says Dr. Jarvinen-Seppo. “You may be eliminating foods such as milk, eggs and wheat from their diet when you don’t have to.”

The team will also provide written emergency plans for day care centers, babysitters and schools that describe what needs to happen if a child is exposed to an allergen.

Dr. Jarvinen-Seppo would be happy to attend parent meetings with organizations in the area to offer advice and to bring everyone up to date on all the latest research. You can contact her at the Food Allergy Center, 585-276-7190

Why Do Humans Have Allergies? Parasite Infections May Be the Trigger

Researchers at the London School of Hygiene & Tropical Medicine are trying to find out if the antibodies we all have to fight parasites might be attacking harmless triggers as well. Could the “hygiene” hypothesis, that we now have fewer parasites to fight so the immune system attacks allergens as well, be the reason there is such a large increase in allergies?

Young Girl Sneezing Among Yellow Flowers
When a walk in the park is your worst nightmare.

Protein analysis suggests that antibodies that evolved to fight parasites might be turning their focus to otherwise harmless agents.

By Brian Handwerk
October 29, 2015

Peanuts. Bees. Pets. Trees. For most people, these things are harmless parts of everyday life. But for allergy sufferers, plenty of seemingly innocuous items can be unbearably irritating and even lethal. Now scientists have uncovered a possible molecular reason why humans evolved to have allergies, and it could lead to new ways to treat the troublesome condition.

Allergies are immune reactions gone wrong that can cause problems from upset stomachs and asthma attacks to deadly anaphylactic shock. While we've gotten pretty good at understanding what triggers allergies and how to mitigate them, researchers have been unsure why we even have allergies in the first place.

A new computer-powered analysis of the proteins involved in allergic responses supports the theory that a natural immune response that evolved to fight parasites is being misdirected in allergy sufferers against otherwise harmless triggers.

Humans have likely cohabitated with parasitic worms for our entire evolutionary history. But during recent decades, such parasites have largely disappeared in parts of the developed world, while allergy rates have risen. The "hygiene" hypothesis, now several decades old, suggests that with no parasites to fight, the immune system doesn't know when to quit and ends up targeting allergens.

"It's a very aggressive response, with the idea to quickly get rid of the parasite, and it's mediated by an antibody called IgE," says Nick Furnham at the London School of Hygiene & Tropical Medicine. "This is the same branch of the immune system which is elicited when you have an allergic response."

People don't develop long-term allergies to parasites, though, which suggests that the body has some mechanism for turning off the parasite-targeting immune reaction.

"It's poorly understood just how that mechanism works, but the immune system gets kind of played down when you have a prolonged parasitic infection, so you don't get a long-term, crazy overreaction," Furnham says.

Because allergens aren't really parasites, it may be that once they are targeted, the mechanisms to ratchet down the response never kick in, leading to lasting allergies with unfortunate results. Some allergies can prove fatal, but even relatively harmless versions can be so infuriating that they lead some people to extreme behaviors—like tracking every single sneeze for five years to identify and fix a pollen allergy.

Why would parasite-fighting systems turn their attention to allergens in the first place? Furnham and colleagues put one theory to the test. "There must be some form of molecular similarity operating between the proteins that cause allergies and the proteins that your immune system is expecting to see in parasites like worms," he says.

The team looked for and found molecular similarities between the proteins in common parasites and the ones in pollen known to cause allergies. They then predicted regions of the parasite proteins that likely shared similarities with the regions of the allergens where the IgE antibody binds.

Using blood serum from parasite-infected people in Ghana, experimental studies finally revealed the first known example of a pollen-like protein present in a parasitic worm that gets targeted by IgE.

The study methods, described this week in PLOS Computational Biology, may yield new tools for more easily identifying the specific proteins in foods and the environment that cause allergies. It could also inform future ways to intervene and help allergy sufferers with techniques like microexposure. This involves giving someone very small amounts of the thing they are allergic to, in hopes of building up immunity. The method has shown some success in training away reactions like peanut allergies.

"This is … in a way mimicking having a long-term parasitic exposure," Furnham explains. "So if you knew what these particular proteins were that were causing the immune response to the parasite, you could extract them and perhaps make synthetic versions for use as a way of dosing people for immunotherapy. But there are difficulties, ethical and practical, so I think that's quite a long way off." 

New treatment may help children with peanut allergy

Could desensitization be the holy grail of treating children with peanut allergies? Pediatric allergist Dr. Billy Tao of Flinders Medical Centre in South Australia is showing promising results with a two-step desensitization process that first involves boiling peanuts for an extended length of time to make them less allergenic. If the child shows no signs of an allergic reaction, roasted peanuts are given to increase their tolerance. But don’t try it at home!

Shehan Nanayakkara Holding Plate Of Peanuts
Shehan Nanayakkara has built up a tolerance for
peanuts through the new program

New Treatment May Help Children with Peanut Allergy

by Jane Trembath
November 4, 2015

A new study is successfully helping children to overcome peanut allergies by exposing them to peanuts and desensitising them to their allergy.

For the past four years, paediatric allergist Dr. Billy Tao has been developing a novel two-step desensitisation process at Flinders Medical Centre (FMC) in South Australia.

The first step involves boiling peanuts for an extended length of time to make them less allergenic.

The boiled peanuts are given to patients to partially desensitise them, and then once the patient shows no signs of allergic reaction, roasted peanuts are given to the children to increase their tolerance in the second step of the process.

Dr. Tao said the low-cost and effective two-step process resulted in less adverse events than previously used single-step desensitisation methods – also known as oral immunotherapy.

"With traditional methods, a lot of people ingesting increasing amounts of roasted peanut flour or similar products start to react – so much so that many have to drop out and can't finish the treatment," Dr. Tao said.

The FMC trial is carried out over a year or longer and includes patients aged between 10 and 15 years. Of the 14 participants, 10 have already completed the first step and are now eating varying amounts of roasted peanuts, while four continue to eat boiled peanuts and are progressing well.

"One patient who had to be administered three adrenaline injections after consuming peanuts is now eating several roasted peanuts every day without problems," Dr. Tao said. Studies show the number of children living with peanut allergy appears to have tripled between 1997 and 2008, and as many as one in every 200 children will have severe allergy to nuts.

Allergy symptoms can vary from very mild (including tingling mouth, puffy lips and welts around the mouth) to moderate symptoms (facial swelling, body rash, runny nose and red eyes, abdominal pains and vomiting); while severe reactions include trouble breathing, looking pale and unwell, and anaphylaxis. Very occasionally death may result from a most severe reaction.

Dr. Tao's idea for hypo-allergenic (less allergenic) nuts to be consumed first was based on an observation by German researcher Professor Kirsten Beyer, who in 2001 noted that peanut allergies were less prevalent in China than the western world because the Chinese ate boiled peanuts rather than peanut butter or roasted peanuts. She found that boiling peanuts for 20 minutes made them less allergenic than roasted peanuts.

Dr. Tao said that a partnership with Dr. Tim Chataway, Head of the Flinders Proteomics Facility, and Professor Kevin Forsyth from the FMC Paediatrics Department, proved that peanuts boiled for at least two hours were less allergenic and the pair designed a study using this immunotherapy approach.

Dr. Tao hopes his research could one day be carried out in a doctor's clinic and then at home and avoid the need for hospital-based treatment. However he strongly warned people against 'do-it-yourself' desensitisation at home and stressed that patients should be seen by an allergist and individual care plans developed.

Among those who have already undergone Dr. Tao's new desensitisation method is 16-year-old Shehan Nanayakkara, who was diagnosed with a severe peanut allergy at the age of three. "We first realised Shehan had an allergy when friends gave him a peanut butter sandwich and he had to be rushed to hospital…there have been many accidents since then," father Asanka said.

"During one round of allergy testing he ended up in the Intensive Care Unit – that time I thought I'd lost him. I approached Dr. Tao to help and at first Shehan ate boiled peanuts, working his way up to consuming 13 a day, and now he eats five normal roasted peanuts daily, mixed in with his meals. It's been a big relief because children and teenagers don't care too much about what they eat and just eat whatever, and there has always been that worry that something might happen - now we can relax a bit because Shehan has some tolerance."

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