Category Archives: Allergy

Allergen Immuntherapie

Spam Email

Science Spam nimmt immer mehr zu. Die Abbildung zeigt eine Spam-Email, die ich letzte Woche bekommen habe. Fake Konferenzen. Predatory Journals. Nonsense Papers. Es wird immer schwieriger, den Überblick zu behalten.

Schauen wir uns also auf Wunsch der Firma Stallergenes einen Artikel an: Allergy 2018 Jan;73(1):165-177. Sublingual immunotherapy provides long-term relief in allergic rhinitis and reduces the risk of asthma: A retrospective, real-world database analysis. Zielen S, Devillier P, Heinrich J, Richter H, Wahn U. Continue reading Allergen Immuntherapie

 

CC-BY-NC Science Surf , accessed 29.08.2026

Eosinophils in asthma

There is an update of our eosinophil SNP paper now in the Lancet with 27 new asthma CpG associations. The authors claim 3 overlaps to Cookson’s 36 IgE loci while I see only cpg0177040, maybe there are two more conicidental findings in the supplement? At least the paper says

eosinophil counts were not significantly different between patients with asthma and controls in our discovery cohorts, suggesting that our results reflect the presence of a different subset or activation state of eosinophils, rather than a change in eosinophil counts per se. Although eosinophils are linked to sub-phenotypes of asthma such as the T helper 2-type subset, our study provides unequivocal data supporting their involvement at the epigenetic level in mild-to-moderate asthma in children.

maybe, maybe not – this could be just residual confounding…

Additionally, CpG methylation patterns identified an early-life shift from naive T cell populations towards effector and memory CD8 and natural killer cell subsets, indicating a potentially crucial role for host virus interactions

maybe, maybe not – this could be vaccine effects, some other antigens, allergens or vitamin D

 

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Allergy risk by baby food

A new analysis of the GINI-LISA study published this month in has an interesting plot showing the eczema incidence in the first 15 years of life. Eczema is a major allergy symptom.

On the right side (FIG1C), we find the untreated group, and on the left (FIG1A) we find the intervention group. Overlying both figures with Photoshop gives an interesting perspective.

When we use the lower opaque double line as reference, all types of baby feeding give an increased eczema risk. To be more comparable, the opaque upper two lines should be used, which will result in zero effect size.

The question is: Why is breast feeding / breast milk (BF) a risk factor in the interventional (left figure) but not in the observational arm (right figure)?

  1. In accordance with national and international guidelines full BF was recommended for 4 months in the interventional group. “Only in case of insufficient BF, children were randomized to one of the baby foods”. “Insufficient BF” is not clearly defined and the reasons seem to be complex.
  2. The general pediatric recommendation at the time of the study was that BF is allergy-preventive and that allergic children should be BF as long as possible.
  3. BF in the interventional arm therefore is a self-selected biased group primarily by allergic mothers and children with unclear criteria. The authors acknowledge in the discussion “Even adjustment for the potential confounders does not eliminate the phenomenon of reverse causality. Particular early eczema occurring in the first months of life may influence the mother's decision regarding full breastfeeding versus formula supplementation.”
  4. BF is a complex chemical mixture that even varies over time – there is is a long-standing controversy on the effect of BF on allergy with many negative, null and positive associations to allergy. From this discussion we can assume, that there is probably no direct effect of BF on allergy development. More likely BF is a proxy for something else – setting up a further biological argument that the interventional BF group should NOT be used as a reference.

Children who receive “antiallergic” formula food will not have any benefit which is in accordance with a recent review in the BMJ. Nevertheless Nestlé Beba Pro HA is further advertising as “reducing allergy risk to milk protein”, Hipp HA Combobiotik as “reducing allergy risk by strong protein cleavage”, Nutramigen 1 LGG as “extensively hydrolysed, hypoallergenic formula … suitable for babies with … allergy”.

 

Postscriptum

The revised blog entry has been published as a letter to PAI. Unfortunately it turned out only after submission that there are also some major issues with the number of individuals included when comparing the 2003 with the 2013 and 2018 report.

 

 

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Vitamin D trials in newborns never done

Vitamin D was introduced into clinical medicine in 2 large waves basically in the 1930ies and 1960ies without any clinical study.

Although I am interested in the relationship twith allergy since 1999 none of our proposed four vitamin D trials were funded.

2005: “Vitamin D and Induction of Allergies”
2013: “Vitamin D and allergy (VIT-AL)”
2017: “Biomarker Screening of Vitamin D response in Newborns (VITAPRIME)”
2017: “Immunological effects of vitamin D supplementation in newborns in Ghana (IMVITAD-GHA)”

Unfortunately the published clinical studies so far missed the point as they were looking only at pregnancy and not at newborn supplements (VDAART, COPSAC and Grant/NZ).

But there are good news now, as studies are going on in Australia and Finland that are sufficiently powered and examining exposure in the newborn period: VIDI and VITALITY. The only problem there will be the inevitable co-exposure by vitamin D supplemented baby food.

 

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Was ist die Leitlinie zur Immuntherapie von Allergien wert?

Leitlinien sollten nicht von eigenen Interessen gesteuert sein. Das gilt alle Leitlinien genauso wie Leitlinie “Allergen-spezifische Immuntherapie bei IgE - vermittelten allergischen Erkrankungen”.

Der Markt ist hier allerdings – wohl durch die Therapieallergene-Verordnung (TAV) – stark in Bewegung, da die Hersteller kostenintensiven Zulassungsverfahren durchführen müssen.
Allergenhersteller sind dabei traditionell schon immer stark als Sponsoren auf Allergiekongressen vertreten, einer Randsparte der klinischen Medizin, wo es kaum pharma-unabhängige Experten gibt.

Zu diesem Schluss kommt auch leitlinienwatch.de, eine Initiative, die vor zwei Wochen im deutschen Ärzteblatt vorgestellt wurde.

Das Portal wertet den Umgang mit Interessenkonflikten bei der Leitlinienerstellung kontinuierlich aus und bewertet die Ergebnisse. Ziel der Initiative ist es, den Einfluss von Interessenkonflikten auf medizinische Behandlungsleitlinien zu reduzieren. Leitlinienwatch.de will Best-Practice-Beispiele identifizieren und den Fachgesellschaften ein konstruktives Feedback mit Verbesserungsvorschlägen für anstehende Revisionen geben.

Die Initiative ist eine Gemeinschaftsaktion von Mezis ("Mein Essen zahl' ich selbst - Initiative unbestechlicher Ärztinnen und Ärzte"), Neurology First und Transparency International, alles Organisationen, die sich gegen die Einflussnahme der Pharmaindustrie auf das Handeln von Ärztinnen und Ärzten wenden.

Diese unabhängige Einschätzung der Leitlinie zur Immuntherapie ist gelinde gesagt verheerend mit nur 4 von 18 möglichen Punkten. Im Detail finden die Autoren

Das Statement, dass “keine Interessenkonflikte festgestellt wurden, die die fachliche Unabhängigkeit der Autoren im Hinblick auf die Erstellung der Leitlinie beeinträchtigen könnten” überzeugt angesichts der zahlreichen Beraterverträge mit den Herstellern der bewerteten Medikamente nicht.

Die Leitlinie beruht dabei zu einem nicht unbeträchtlichen Teil auf Studien und Reviews der derselben Autoren. Honi soit qui mal y pense.

 

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München Flughafen Spengstoffkontrolle

Der neue SZ Bericht über die Beschwerden der Angestellten am Münchner Flughafen ist technisch nicht sehr ergiebig. Alles nur Sick Building Syndrom? Auch wenn von anderen Flughäfen keine solchen Symptome bekannt sind, kann es unter spezifischen Umgebungsbedingungen anders aussehen: andere Substrate, Gerätedefekte, Fehlbedienung. Im Prinzip wird eine Wischprobe genommen.

der Streifen wird anschließend in einem Analysegerät untersucht. Zwei Hochgeschwindigkeits-Gaschromatographen lösen die Sprengstoffe aus der Probe. Die Geräte erkennen so in 15 bis 18 Sekunden kleinste Mengen Sprengstoff und zwar schon ab der Menge von 100 Piktogramm.

Nach Presseberichten kommen zwei Arten von Gaschromatographen zur Anwendung: Itemizer 4DX und Quantum Sniffer QS-B220. Falls es dabei zu einer Luftionisation kommt, könnte man Ozon messen oder auch das Trockenmittel auf allergene Potenz untersuchen. Oder ganz einfach mal alle Geräte zwischen Frankfurt und München tauschen.

 

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Vitamin D buffering

Response to oral vitamin D seems to be different in humans . How do we buffer (artificial) vitamin D intake?

Vitamin binding protein or group specific component GC is a good candidate. GC regulates the bioavailability of 25(OH)D3, acting as the main transporterint he blood stream from liver to kidney. As described earlier GC binds with high affinity to 25(OH)D3, leaving less than 1% of circulating 25(OH)D3 free. In contrast to 25(OH)D3, which has a half-life of several weeks, GC has a short half-life of 3 days only, suggesting that the protein and its ligand are independently regulated. Also the free binding capacity of GC is variable. In addition there are GC variants that have different binding characteristics. Depending on these isoforms, serum levels increased between 97% and 307% after receiving 600 or 4000 IU/d vitamin D3 for one year. Taken together GC is assumed to be a buffer of vitamin D effects (and side effects) whenever transport in the blood stream is being involved.

The most recent GWAS study now shows again skyrocking p-values of GC variants and serum 25(OH)D3.

It is long known, that two missense variants of GC locate in exon 11. rs7041 encodes Asp432Glu pr D432E and rs4588 encodes Thr436Lys or T436K. These amino acid exchanges are leading to electrophoretically distinguishable proteins Gc1F/Gc1S and Gc2 respectively. We are moving the following gene plot bottom up to match the orientation.

Unfortunately LD is extremely high at GC. The GWAS peaks are therefore in the first intron, at exon 11 and intron 12. Lets’ s get closer to exon 11 where the two most important SNPs reside.

Although both variants are listed at many SNP chips I can find only results for rs7041 with p=10^-222 in the new dataset.

rs7041 is listed as a A->C SNP there but according to Fu 2009 it is definitely a G->T variant. Also SNPedia has numerous articles for rs7041 being a G->T exchange, for example Suaini 2014

This is also confirmed by dbsnp. The GAT -> GAG exchange is equivalent to D -> E, so the online results report a wrong strand orientation. Unfortunately we are stuck here, as one of the main effect SNP seems to have an unclear allele assignment and the second most important SNP is missing from the meta-analysis.

What would be nice is a conditional analysis based on rs7041/rs4588 haplotypes. I predict there are further unknown functional variants in GC. Maybe in intron 1 that often contains regulatory elements at the 5'-site of the intron. As the strongest signal is in the last intron and even beyond the 3′- end, further studies of 3′-UTR would be interesting, looking for binding sites of regulatory proteins, some miRNA or AU rich elements that affect the stability or decay rate of the transcript.

 

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Timeline asthma / allergy genetics

First Genetic Study
1923 AF. Coca.J Immunol 8:163-171

First Linkage Study (AB0 blood group)
1936. I. Zieve, Ann Hum Gen 7:4074, 163-178

First Molecular Study (HLA)
1973 D. Marsh, Science 179:4074, 691-3

Second Linkage Study (SLC14A1)
1985, H. Eiberg, Cytogenet Cell Genet 40: 622 -journal discontinued, no online archive-

Third Linkage Study (11q31) – questionable results
1989 W. Cookson, Lancet 1:8650, 1292-5

First Modern Family Study
1992 S. Dold, Arch Dis Child 67:8, 1018-22

First gene (Fc∈RI-β)
1993 A.J.Sandford, The Lancet 341:8, 332-334

First true gene (IL4)
1994 D. Marsh, Science 264:5162, 1152-6

First Genomewide Linkage Scan
1996 S. Daniels, Nature 383:6597, 247-50

Transatlantic Airway Conference Key Biscayne FL
1997 N. Zamel (only reported later by Thompson 2003 and Duffy 2019)

Second Genomewide Linkage Scan
1997 CSGA Nature Genetics 15:389-392

Third Genomewide Linkage Scan
1999 M. Wjst, Genomics 58:1-8

First GWAS
2007 M. Moffatt, Nat Genet 15:389-392

Second GWAS
2008 C. Ober, NEJM 358: 1682-91

then it is getting confusing

 

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An update of IL2 function

More than 7 years ago, I wrote a blog post that there is nothing new under the sun predicting the next asthma genetics study for 2020 to include 100K asthmatics.

Ok, I am wrong the paper appeared already a week ago with 360K asthmatics while basically doubling the number to 136 independent risk variants. It’s not an asthma only study as the authors had a rather loose definition of asthma or rhinitis or eczema – is is more about the allergy/atopy complex.

It will be a long time reading and replicating the data while my first interest was to examine the affected gene list as shown in table ST15. Using the online Enrichr database I get the following result from the GO ontology

This is basically the same result as the authors see in their table ST20.

 

The highest combined score is with a negative regulation of IL-2. What does that mean? A genetically disturbed pathway predicted by a gene ontology network?

IL2 was discovered in 1976 by Robert Gallo by growing T-cells in culture for more than nine months by stimulating lymphocytes with phytohemagglutinin. ((IL1 was described back in 1972 by Charles Dinarello). Gallo identified T-cell growth factor (TCFG), now known as interleukin-2 (IL-2) as being absolutely important for a protective immune responses (Science 1976).

The next important paper was also published in Science 1984 showing the following figure

 

So we have in allergy 2 hits on IL2: by genetics (as show in the new study) and by early vitamin D supplementation (as I reviewed earlier). Maybe we need more clinical studies like the Zhang 2016 study:

In a general population-derived birth cohort, we found that in infants who developed food allergy, cord blood displayed a higher monocyte to CD4(+) T cell ratio and a lower proportion of natural regulatory T cell (nT(reg)) in relation to duration of labor. CD14(+) monocytes of food-allergic infants secreted higher amounts of inflammatory cytokines (IL-1β, IL-6, and tumor necrosis factor-α) in response to lipopolysaccharide. In the presence of the mucosal cytokine transforming growth factor-β, these inflammatory cytokines suppressed IL-2 expression by CD4(+) T cells. In the absence of IL-2, inflammatory cytokines decreased the number of activated nT(reg) and diverted the differentiation of both nT(reg) and naïve CD4(+) T cells toward an IL-4-expressing nonclassical TH2 phenotype.

Suppressed IL2 is a key for allergy development shown also in experiments by Bonnet 2016:

We previously demonstrated that Tregs can be selectively expanded and activated by low doses of IL-2 (ld-IL-2) inducing immunoregulation without immunosuppression and established its protective effect in autoimmune diseases. In this study, we evaluated the ability of ld-IL-2 to control allergy in an experimental model of food allergy. Ld-IL-2 induced Treg expansion and activation that elicited protection against clinical manifestations of food allergy in two mouse models with OVA and peanut. This clinical effect was lost in Treg-depleted mice, demonstrating the major contribution of Tregs in ld-IL-2 efficacy. Mechanistic studies further indicated that protection from allergy could be explained by a Treg-dependent local modification of the Th1/Th2 balance and an inhibition of mast cell recruitment and activation. Preventive and therapeutic effects of ld-IL-2 were observed over a 7-mo-period, highlighting its long-term efficacy. This study demonstrated that ld-IL-2 is efficient to prevent and to treat allergic immune responses, and thus represents a promising therapeutic strategy for managing allergic diseases.

What we do need now for allergy prevention is a trials of newborns with low dose IL2 and also more trials refining the IL2 antagonist application of vitamin D.

 

CC-BY-NC Science Surf , accessed 29.08.2026

Whats’ wrong with the Hutterities and Amish in the NEJM paper?

Following a recent discussion, I looked into more details of the Stein et al. 2016 NEJM paper. It claims that

Despite the similar genetic ancestries and lifestyles of Amish and Hutterite children, the prevalence of asthma and allergic sensitization was 4 and 6 times as low in the Amish.

The first sentence is correct. There is a similar genetic ancestry. Although that doesn’t mean anything as overlapping principal component plots are derived only by frequent SNP alleles that have no major disease impact. Continue reading Whats’ wrong with the Hutterities and Amish in the NEJM paper?

 

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Vitamin D responder: Check CD14 methylation

A clinical study in 2015 already showed, how to recognize vitamin D responders using a preselected gene set based on VDR chip seq data.

Vitamin D3 is a pleiotropic signaling molecule that has via activation of the transcription factor vitamin D receptor (VDR) a direct effect on the expression of more than 100 genes. The aim of this study was to find transcriptomic and clinical biomarkers that are most suited to identify vitamin D3 responders within 71 pre-diabetic subjects during a 5-month intervention study (VitDmet). In hematopoietic cells, the genes ASAP2, CAMP, CD14, CD97, DUSP10, G0S2, IL8, LRRC8A, NINJ1, NRIP1, SLC37A2 and THBD are known as primary vitamin D targets […] only 39-44 (55-62%) of the study subjects showed a highly significant response to vitamin D3, i.e., we considered them as "responders" … genes were expressed but in a wide range that differed up to 327-fold between the most prominently (CD14) and the lowest expressed candidate (CAMP)

y-axis end/start CD15 serum, x-axis end/start 25-OH-D3

In new editorial, the same authors argue that the vitamin D response index is an epigenetic property of an individual that may not change at all. Indeed, changes in the epigenome, such as methylation of genomic DNA is an essential prerequisite for initiating gene transcription. The concept of an individual vitamin D response therefore has a lot of merits and is able to resolve a long controversy which serum vitamin D levels are sufficient.

CD14 is a particular interesting gene. As we have learned in allergy research, however, methylation status is not stable over time, it increases slightly over the first decade, possibly as vitamin D sensitivity decreases??

The average increase in CD14 methylation from 2 to 10 yr (n = 153) was 1.3% (from 5.5% to 6.8%, p = 0.001)

This difference isn’t really huge while also the time spent outdoors seem to be relevant. CD 14 methylation may even influence SNP association results

rs2569191, rs5744455, and rs2569190 were associated with sCD14 levels at birth and 2 years, but only rs5744455 was associated with sCD14 levels at 10 years. CD14 methylation increased significantly from age 2 to 10 years.

So CD14 methylation looks like an interesting indicator and may even have biological relevance itself as CD14+ monocytes can differentiate into a host of different cells.

 

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SMAD3, Vitamin D and asthma

A new JACI paper claims

in three independent birth cohorts (N=60, N=30, N=28) DNA methylation at the SMAD3 promoter was selectively increased in asthmatic children of asthmatic mothers and was associated with risk of childhood asthma.

and argues

although associations between SMAD3 variants rs17228058, rs744910, rs17294280 and asthma have been reported in GWAS, asthma-related SMAD3 methylation differences were unlikely to be influenced by SMAD3 genotype

while I am not convinced as it is common wisdom that

If a SNP interferes with or alters a TF binding site, it could potentially affect both DNA methylation and gene expression independently.

So this possibility needs to be excluded before drawing any conclusions. BTW, SMAD3 is a well know vitamin D target…

1,25-dihydroxyvitamin D3-bound [1,25(OH)2D3-bound] vitamin D receptor (VDR) specifically inhibits TGF-β-SMAD signal transduction through direct interaction with SMAD3.

while so far only IL2 methylation was linked to asthma (another super Vitamin D target).

 

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