Tuesday, April 29, 2008

Some thoughts on allergy treatment innovation

This article by Judith Newman “Misery for All Seasons; Allergies: A Modern Epidemic” (not available on line unfortunately) made think:
1. The therapies being worked on (gene therapy specifically) might eventually lead to a breakthrough - innovations are uncertain but proceed in small steps. If it leads to a breakthrough then it has the potential to be disruptive to current treatments. No new insight here. Just thinking out loud.
2. Current treatments treat only the symptoms. Allergy shots try to build up resistance. There is not certainty that it will be successful either.
3. If we compare the income streams between a new (and successful) innovation and the current regime: The innovation would have an S-curve adoption process. Not all people can be treated with the new innovation so the income stream would gradually increase (potentially higher than the current regime) and then stabilize (again possibly at a higher level then that of the current regime but also possibly lower). The current regime would have a constant (but possibly growing as more people develop allergies) stream of income. The difference in PV of the income streams would be the gross benefit of the innovation. (I haven't considered the costs of innovation.) Again, just thinking out loud.

The article points to the interesting fact that more people are developing allergies. It must be global warming. (I am sympathetic to the changing environment as a cause.)
"Harvard researchers say that higher levels of the greenhouse gas will also boost pollen
production, causing allergy sufferers to suffer even more in the future."
Source: WebMD
"There's growing scientific evidence that global climate change is linked to the dramatic rise in allergies and asthma in the Western world."
Source: YaleGlobal

This was one highlight that I took away:
Another key culprit: environmental pollutants. Exactly what pollutants and in what quantities are a source of heated debate. One of dozens of examples: Epidemiological studies show that children who are raised near major highways and are exposed to diesel fumes from trucks have an increased sensitivity to allergens they already react to.

Ironically it's not just the pollutants that are doing us in. It may be too much cleanliness--or rather, cleanliness of a certain sort. A prevalent theory among allergists is known as the hygiene hypothesis. The theory has its complexities and contradictions, but the basic idea is this: If the Liflanders had wanted to prevent Cameron's allergies, they should have moved a cow into their living room. People who live with farm animals almost never have allergies.

"The hygiene hypothesis has been on the scene since people first started looking at allergies," says Andrew Liu, associate professor of pediatric allergy and clinical immunology at National Jewish. "John Bostock, the guy who first identified hay fever, noted that it was a condition of the educated. He couldn't report any cases among poor people."

Hygiene theorists say that while it's true that industrialization brings with it better health care and fewer serious childhood infections, it also brings an obsession with cleanliness. We are not exposed to dirt at a young enough age to give our immune systems a good workout. Also, because of the high cost of energy, more homes are built with an eye toward energy conservation, with better insulation--insulation that seals in mold and dust, enemies of allergy sufferers.

But if dirt is a good thing, why are allergies and asthma so prevalent in poor, inner-city neighborhoods? "It's not just a question of exposure to dirt that reduces allergies--it has to be the right kind of dirt," says Liu. "We're talking about exposure to endotoxin and good microbes in soil and animal waste."

Reams of research bear out the hygiene hypothesis. "There was a famous study," says National Jewish's Nelson, "where one of the protective factors for asthma was having a pig in the house."
It would be helpful if immunologists and epidemiologists were able to tease out each factor contributing to the escalation of allergies and say, J'accuse! That's probably not going to happen. Instead, researchers are attacking the problem on all fronts. Their unspoken attitude? We've made a mess of this planet, and we may not be able to fix it. The best science can do is help us fix ourselves.

Since most of us are unable to room with a pig, we have to come up with a plan. Can we avoid allergies altogether? Can we get rid of allergies we already have? Can we desensitize our immune systems?

"We still don't know exactly how to prevent allergies," says Andrew Liu. "We know the immune response is supposed to be a helpful one, that it's not supposed to be the cause of disease. We know that the immune system of someone with allergies needs to be reeducated. But how? It's not always clear."

Leung agrees, adding, "If you are exposed to endotoxin or other microbial products early in life, it may prevent allergies. But later in life the early exposure may actually make things worse." There are those who argue that to prevent allergies, we should reduce or eliminate exposure to harmful allergens at an early age. Others believe allergens should be administered in large quantities at an early age. Many believe it depends on the specific allergen. And food allergies may work on an altogether different principle. Confused? So are the allergists.

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