Immunomodulators - Twitter summary from #ACAAI 2013 meeting

This Twitter summary from the 2013 meeting of the American College of Allergy, Asthma & Immunology (#ACAAI) was based on tweets by the following allergists/immunologists:

Robert Silge, MD ‏@DrSilge

Dr. Bellanti reports there are over 30 monoclonal antibodies approved by the FDA. Emerging field, but not without complications.

Pitrakinra antagonizes IL-4Ra and therefore blocks effects of IL-4 and IL-13 which share that chain in receptor.

IL-13 is thought to induce periostin, which contributes to airway remodeling and other asthma findings.

Innate immune response in asthma

Dr. Bacharier discussed the role of innate immune response in asthma. He reminded us that only vertebrates have an adaptive immune system. The rest of nature gets by with innate. It’s kind of a big deal.

Environmental exposures early in life can change innate TLR gene expression. There is a possible role in hygiene hypothesis.

There are monoclonal antibodies and treatments for IgE-mediated conditions and the adaptive immune system. Treating innate system an important developing field in asthma.

Robert Silge, MD asks: Is asthmatologist a word? Can I be a Tweetologist?

There was increased TLR7 expression in one study of asthma, it could explain viral infection sensitivity in these patients. There may be a deficient antiviral response in asthma. Delayed and reduced type 1 IFN response. This deficient viral response would explain why stimulating TLR (such as with CpG) improves asthma control. Very interesting. A series of studies support the hypothesis of a deficient interferon responses in patients with asthma.

Probiotics and prebiotics

It also may explain why some studies show improved allergic disease with probiotics, though this is variable and not so great in asthma.

PREbiotics are nondigestible sugars, they essentially feed & nourish desirable gut flora. There are some interesting early studies on theit role in atopy.

Immunostimulants (bacterial extracts) may decrease susceptibility to viral infections. Cochrane review confirms that, but studies are “weak.”