I for one am tired how my health score is tied to my existence as a person rather than who I really am. “How to keep up your credit score, what income bracket I’m in, what’s my IQ” are nagging reminders that I may not be anything more than just a number and not a unique person on this planet. Health care is fast approaching this same pigeonhole similar to banks and retailers, but it’s not all bad. Ever heard of personalized medicine?
#Personalized medicine has some pretty awesome benefits on the horizon, but “what’s the catch?” My cholesterol has to be below 120, cigarettes at zero, and my daily cups of coffee can’t be over 5 if I have any hope of living past 80;you just can’t get away from numbers.
According to Wikipedia, Personalized medicine, also termed precision medicine, is a medical procedure that separates patients into different groups—with medical decisions, practices, interventions and/or products being tailored to the individual patient based on their predicted response or risk of disease. So if numbers and health are an integral part of the future of health care, is there such a thing as an allergy or asthma number? Wouldn’t it be nice to find out which asthma inhaler is best for you based on “personalized medicine?” Or what if you suffer from chronic hives and can’t find the cause? Personalized medicine involves many more diseases that just asthma and allergy–just look at the link below, but I have a list as well.
- Xolair–Fifteen years ago, I prescribed my first dose of Xolair for asthma. I watched in awe as patients felt better with less medication. One patient I’ll call Joe (not his real name), could never attend his grandkids’ ball games because of his asthma. Was I surprised with his follow-up report–not only does he regularly attend their games, but it’s baseball, folks, outside. And guess who volunteers as the first base coach? Besides working very well, I knew that the age of treating every asthmatic the same was over. So where does personalized medicine fit in here? If you have asthma or allergies, you will produce more IgE than normal. #IgE is a molecule that “causes” asthma. So if we can block IgE, we should be able to get a better handle on asthma and that’s exactly what happens with Xolair.
- Blocking IL-5–Where does the time go? Just 3 years ago, we had #Xolair as a biological medication, but now you can add #Nucala, #Cinquair, #Fasenra to the list. All three of these medications block the production/function of IL-5 and help with asthma control. (I’ll devote an entire post to this topic at a later date) You begin to see a pattern, with new medications blocking the molecules that are responsible for causing asthma and allergy. The cartoon below illustrates how the lungs use these molecules to communicate with one another, in this case, it’s detrimental to the airways causing asthma. In the bottom left corner of the slide, you see IL-5 which makes eosinophils grow and reproduce and wallah…..there’s your asthma. By blocking growth of eosinophils, the asthma has nowhere to go!
- Inhaled #corticosteroids–treatment of asthma has evolved from strychnine (yes, believe it) to epinephrine (treating your asthma every 4 hours) to bronchodilators such as Ventolin or Proventil to #inhaled corticosteroids that actually prevent asthma from developing. I couldn’t imagine any medication more effective for asthma than inhaled steroids, but nothing could be further from the truth. Now, don’t go run and trash your asthma inhalers! Inhaled steroids are still the first line treatment for asthma. (ie, they work better at a lower cost which is exactly what our health system needs!) If inhaled steroids don’t work, however, we now have choices listed in this article besides oral steroids that tend to make you fat & ugly. Is there one brand or type of inhaled steroid better than all the rest? Probably not, but it all comes down to your genes…everyone is different and responds to treatment based on those genes.
- Genetics–sooner or later, everything comes down to genetics. Whether it’s your hair color, your ability to fight infection, or your tendency to develop asthma, your genetic make-up will determine much more about your health than either your environment or your diet. Researchers have found that if you have the genetics for allergy (IL-4, IL-31, IL-33, TLSP) you will react much stronger to dust mite and mugwort (common weed) when you become exposed.
- See below for proof–> Immunotherapy. 2017 Mar;9(4):331-337. doi: 10.2217/imt-2016-0131.The significance of the levels of IL-4, IL-31 and TLSP in patients with asthma and/or rhinitis. Chai R(1), Liu B(1), Qi F(1). (1)Department of immunology, China Medical University, Shenyang 110010, China.AIM: To investigate the clinical significance of the levels of IL-4, IL-33 and thymic stromal lymphopoietin (TLSP) in patients with asthma and/or rhinitis, then do the simple verification in animals. METHODS: Levels of IL-4 IL-31, IL-33 and TLSP were detected by ELISA and real-time PCR in 64 asthma patients (sIgE[+]: 32 cases, sIgE[-]: 32 cases), 64rhinitis patients (sIgE[+]: 32 cases, sIgE[-]: 32 cases), 64 asthma complicatedwith allergic rhinitis patients (sIgE[+]: 32 cases, sIgE[-]: 32 cases) and 32 healthy controls. Then we detected the IL-4, IL-31, IL-33 and TLSP in the sensitized mice.RESULTS: Results showed that levels of IL-4, IL-31, IL-33 and TSLP in asthma and rhinitis patients, and those complicated with allergic rhinitis, had significant differences compared with the control group (p < 0.05). It was found that the indicators of mugwort and dust mite allergic patients were significantly higher than that of other allergic patients (p < 0.05). We got the same tendency in in vivo experiments. CONCLUSION: IL-4, IL-31, IL-33 and TSLP may be involved in the pathogenesis of asthma and rhinitis; dust mite and mugwort allergy could increase them significantly. 6. Blocking IL-4 and IL-13–one more molecule to discuss and I promise I’ll stop. #Dupilumab blocks two molecules that are responsible for asthma. How can one molecule block 2 messengers at the same time? Through ingenious research, it was discovered that the IL-4 and IL-13 receptors share a common link–if you block this link you block both receptors like this: (shared component in yellow)
At the present time, Dupilumab or Dupixent is approved only for #atopic dermatitis, but studies are in progress to obtain approval for asthma.
So the next time you hear, “I can’t use that for my asthma”, they might just be right.