Allergic Reactions A semiannual publication of Volume 1, Number 1 Spring/Summer 200 An Interview With the New Allergy Division Director W hen Dr. Bruce S. Bochner was being considered in 2002 to head the Johns Hopkins Division of Allergy & Clinical Immunology, other centers around the country were trying to recruit him. But, Dr. Bochner says, when Hopkins made the offer, it really was a no-brainer: This being the largest, most successful and, humbly put, best allergy group in the country, when the opportunity came along, I took it. We caught up with this clinician scientist to hear his thoughts about the future of the division. First, what do you see as the division s strengths? We re an internationally recognized program, one of the few in the country with an National Institutes of Health (NIH) grant for training academic allergists. One of our greatest strengths is having 30 faculty who see patients, teach and/or do research, collabo- rating to study all aspects of allergic diseases. While our expertise is diverse, we need to recruit new young faculty, but it s not like building from scratch. It may be a while before the division has my influence and flavor. But I d rather take over as commander of the best ship in the fleet than build the next big ship in the fleet. New clinical challenges? I take great pride in the quality of care provided by our faculty, fellows, and staff. In a university setting, we can take the time to practice medicine the right way, without worrying about the profit motive. In academics, we can really make a difference. However, one goal is to provide more efficient clinical care. At certain times of the year, patients have to wait too long to get an appointment. Because complicated patients are often referred to us, clinics do not always run on time, and patients may wait too long before being seen. Finally, I would like to expand some of our more unique services, like testing for food, drug, and latex allergies and challenging and desensitizing for drugs such as aspirin. Your research goals? Because there are no perfect animal models for asthma and allergic diseases, it s really critical to move new therapies into humans as efficiently as possible. Our group is really good at developing research ideas in the laboratory that can be safely tried in humans. There s still plenty of that? The battle against asthma? The take-home message? We have good medicines to control asthma, but not a cure. We re involved in developing and testing new therapies because they may provide new treatments for those with asthma, including our sickest patients. Any new technologies? We re using gene chips, which allow you to measure the presence of thousands of genes from cells or a tissue sample. For example, we can now compare normal and asthmatic lung specimens, and determine what genes are over- and under-expressed. Then what? Then the job is to figure out which of those genes actually cause or perpetuate the disease. The approach yields broad, unbiased snapshots of what s going on. This may suggest new and unanticipated targets for future therapeutic research. Yes, the good news is that the NIH has doubled its budget. We used to have a 10 to 1 percent chance of getting a grant funded, which was a deterrent for the junior person considering an academic career. Now there s a 20 to 2 percent chance of funding. Bigger salaries can be found in private practice and in the pharmaceutical industry. We chose academic medicine because it allows us to help many patients, as well as to engage in the intellectual challenges of teaching and doing research. We all enjoy interacting with colleagues and presenting our work at meetings around the world. In academics, we can really make a difference. Inside this issue Stop and Smell the Roses 2 Allergen Season Calendar 3 Medication Update New Website Launched Our Mission Our Clinical Practice
Q & A Go Ahead: Stop and Smell the Roses What are rosefever and hayfever? Rosefever is really a folk name for allergic symptoms that occur during the peak season for grass pollen allergies in late spring to early summer, when roses are in bloom. Hayfever is a common name for symptoms that occur during the peak season for ragweed pollen allergies in late summer to early fall, when hay is harvested. Neither is associated with a fever. Why does smelling a rose sometimes make me sneeze, even if I am not allergic to it? Some people with allergies can be particularly sensitive to strong scents especially during their allergy seasons, when they are already experiencing symptoms. This sensitivity is not a true allergic response, but more like an irritation. Other examples of such irritants include cigarette smoke and strong perfumes. Rarely, florists, professional rose growers and avid rose gardening hobbyists may develop true allergic responses to rose pollens while handling the roses, since they may shake the heavy pollen grains directly into contact with the nose or eyes. E ye-catching, heavenscented blooms should be enjoyed, not avoided even by most allergy sufferers. If you have kept a wary distance for years, you may have trouble approaching that red, red rose. But this kind of red is not an alert to danger, because ornamental plants generally do not produce aeroallergens. Aeroallergens are tiny, airborne particles that can trigger allergic reactions when they come in contact with a membrane lining the nose or throat or covering the eye. While sneezing, coughing, and red-rimmed eyes can be caused by pollutants, irritants, and infections, true allergic symptoms only can be caused by an aeroallergen if a person is allergic to it, if enough particles are present to produce an allergic reaction in that person, and if the particles are small enough to interact with the human immune system. When an aeroallergen floats onto a membrane, it initiates a microscopic chain reaction, which results in the release of substances like histamine and leukotrienes with the consequent allergic symptoms. Allergic symptoms may include sneezing and/or a runny, clogged nose, coughing, post-nasal drip, itchy eyes, nose and throat, and watery, redrimmed, swollen eyes. Showy, fragrant flowering plants typically do not produce allergic reactions, because their pollens are not airborne, are small in number, and are large in size. Their big, sticky, heavy pollen grains are carried by insects like butter- flies and bees, instead of by the wind. In contrast, plainer-looking plants like trees, grasses, and weeds, as well as some molds, produce microscopically small, lightweight pollens or spores in great number, that are easily carried by the wind. One major exception is ragweed. This weed agressively invades the landscape, filling large fields, and is showy in its production of enormous clusters of tiny pollen grains. A single plant can produce a million pollen grains, and it takes as few as ten grains to produce symptoms in allergic individuals. The yellow of ragweed is a warning signal to ragweed allergy sufferers that they should be taking allergy medication. Because ragweed s pollen grains are numerous and windborne, victims will suffer allergic symptoms whether they are blocks away from a ragweed plant or up close and personal. For more information about allergy medications, talk to your doctor or visit us at www.hopkins-allergy.org. 2
Clinical Care Unit: (10) 0-2300 ALLERGENS TREE POLLENS Juniper Willow Elm Maple Birch Alder Poplar Beech Sycamore Ash Oak Hickory Walnut GRASS POLLENS Timothy Orchard Bermuda WEED POLLENS Sorrel Plantain Lambsquarters Pigweed Sage Ragweed MOLD SPORES Aspergillus Penicillium Alternaria Fusarium Cladosporium Helminthosporium Botrytis DUST PARTICLES Dust mites Roaches ANIMALS Cats Dogs Allergy Season Calendar* Courtesy of JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC *For the mid-atlantic region Season Peak of season 3
R Xolair Offers Relief Asthma Medication Update Xolair (Omalizumab) has been approved by the U.S. FDA (Food and Drug Administration) for treatment of patients with moderate to severe persistent asthma. It is recognized that a significant number of asthmatic patients have an allergic basis to their disease because they produce too much of a certain protein in the body, called IgE antibody. Xolair binds to this allergic antibody in the blood stream and hence neutralizes (blocks) its actions. Xolair is indicated for adults and adolescents ( 12 years age) who have moderate to severe asthma that is Support Our Mission not currently controlled with inhaled corticosteroids, and are sensitive (allergic) to year-round, aeroallergens (for example: dust mites, household pets, cockroaches, and certain molds). Xolair has been shown to decrease the number of asthma attacks in patients with moderate to severe asthma, and in some patients it allows a reduction, and perhaps complete elimination, of other asthma medications. For more information, go to our website at www.hopkins-allergy.org. Financial support from concerned individuals is essential for high quality patient care and sponsorship of innovative medical research. If you are interested in supporting the work of the Johns Hopkins, contact: No More CFC Propellants In 1987, the United States signed an international treaty, the Montreal Protocol, agreeing to stop using chlorofluorocarbons (CFCs) as refrigerants and aerosol propellents. CFCs are the chemical propellants that have been used in metered-dose inhalers, devices that effectively deliver medicine to the lungs of people who suffer from asthma and other lung diseases like emphysema. Pharmaceutical companies have developed metereddosed inhalers based on other propellants as well as dry powder inhalers, but it will be a few years before CFCs will be completely phased out. www. Visit us on the Web Now you can check out our division s new website at www.hopkins-allergy.org to access more information about patient care services, our faculty, or allergic and immunologic diseases and their treatments. You also will find campus maps, contact information, and links to other helpful sites at the Johns Hopkins Medical Institutions. Bruce S. Bochner, M.D. Director, Johns Hopkins Asthma & Allergy Center 01 Hopkins Bayview Circle, Room 2B.71 Baltimore, MD 2122 (10) 0-2101
Our Mission Director: Bruce S. Bochner, MD Clinical Director: Peter S. Creticos, MD The mission of the at Johns Hopkins is to promote the treatment and understanding of allergic and immunologic diseases, including asthma, in order to provide optimal patient health by providing compassionate, state-of-the-art diagnostic and therapeutic care of adults with allergic and immunologic diseases fostering basic, clinical, and translational allergy and immunology research training physicians and scientists for academic careers in allergy and immunology Our ClinicalPractice Faculty: N. Franklin Adkinson, Jr., MD Bruce S. Bochner, MD Peter S. Creticos, MD Philip S. Norman, MD Sarbjit Saini, MD Alvin Sanico, MD Glenn M. Silber, MD Alkis Togias, MD All of our faculty have expertise in the diagnosis and treatment of asthma, allergic rhinitis, sinusitis, anaphylaxis, urticaria, angioedema, adverse reactions to foods, drugs, latex, and insect stings, and non-aids-related deficiencies of the immune system. Some faculty have additional interests and expertise in specialized areas. Evaluations include: allergen skin testing, methacholine challenge, spirometry, and food and drug challenges. The Dermatology, Allergy and Clinical Immunology (DACI) Reference Laboratory is a full service laboratory that provides specialized diagnostic measurements to allergists, dermatologists, and clinical immunologists. Contact us at (10) 0-2300 for appointments and referrals.