Are We Killing Ourselves with Cleanliness? As Number of Allergy Sufferers Soar, Potential Cures Are More Radical
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In a Boston hospital, people are eating whipworm eggs.
Too small to see, they're swigged in cups of tasteless, odorless clear liquid. Once swallowed, they lodge in the gut and produce larvae. They're parasites, known clinically as Trichuris suis . Are they the next big thing in allergy relief?
Pathologist Marie-Helene Jouvin, who launched this study at Beth Israel Deaconess Medical Center with allergist/immunologist Mariana Castells, hopes they are -- and the sooner the better, as America's allergy rate is soaring. According to the Centers for Disease Control and Prevention, the number of young Americans with food allergies soared nearly 20 percent in the last decade. Eight percent of children under six now have food allergies. The number of adults with allergies has risen too.
The Boston worm study stems from a scientific hot potato called the hygiene hypothesis, which holds that growing up in developed nations enfeebles our immune systems. When it's not constantly battling dangerous bacteria, "the immune system doesn't know what to fight against," Jouvin says, "so it fights against stuff that isn't supposed to be dangerous, like food.
"As the human immune system matures, normally it learns how to differentiate what is not dangerous from what is dangerous. If you raise children in too clean of an environment, this distinction is missing."
In other words, we're killing ourselves with cleanliness.
Allergies are far more common in rich nations than in poor ones. Hygiene hypothesists believe that's because people in poor countries are riddled with parasites.
Studies in Africa and South America have tested groups of parasite-infected people and found them to have few or no allergies. These people were then treated with vermifuges. Once they became parasite-free, they developed allergies, Jouvin says.
"We don't know precisely how it works, but parasites have developed this very fine mechanism that allows them to survive in a host's body without killing the host and without the host killing them. The presence of parasites in the body acts on the immune system and somehow avoids an allergic reaction."
Because Trichuris suis flourishes in pigs' bodies but not human ones, the larvae that hatch after the eggs are ingested never fully mature in human subjects, who thus never become infected. The Boston study won't be completed for another few years; if it succeeds, FDA approval would be sought for Trichuris suis ova , aka TSO.
"The eggs are the medicine," Jouvin says. "It's very easy, a clear liquid. You just drink it."
"This idea that you can infect yourself with these things so that your immune system gets too tied up with parasites to worry about allergens" is gaining traction, "but it's very radical," says allergist Andrew Engler, director of the Allergy and Asthma Clinic in San Mateo, California.
It's not as radical as the remedy that integrative-medicine guru Andrew Weil aired at the Psychedelic Science in the 21st Century conference in San Jose last April. Having been terribly allergic to cats all his life, Weil took LSD one day at age 28. While he was tripping, a cat jumped into his lap. For a split second, Weil froze. Just being near cats had always made his eyes itch and his nose run. If cats licked him, he'd always broken out in painful hives. But not this time: "I started petting the cat. I began playing with the cat. The cat licked me. I had no reaction to the cat. I have never had a reaction to a cat since -- and that was almost 40 years ago. Now, that's pretty special. As a physician, I would love to know what happened there, and I would love to know how to make that happen for other people."
The medical community isn't investing tons of time or money in the wider applications of LSD. Nor does it consider acid -- or anything else -- an allergy cure. Symptom-soothers flood the market. Desensitization studies involving peanuts and insect venom offer hope, but nothing has yet been clinically proven to render once-allergic human bodies no longer allergic.
One day, one of Andrew Engler's patients told him she was considering injecting herself with hookworms. It was the first Engler had heard of it, and he was horrified. She showed him the Web site that had given her the idea. It was one of many that promote the self-administered use of worms and worm eggs, aka TSO therapy or helminthic therapy, to treat a wide range of conditions including autism, colitis, HIV --and allergies.
UK-based AutoimmuneTherapies.com sells an admittedly experimental worm "therapy" for $3,050. Its Web site declares: "Helminthic therapy, nature's most powerful probiotic, harnesses nature to heal, restoring the helper organisms we co-evolved with and that our immune systems depend on to function correctly. … It involves deliberate infection with beneficial microorganisms, a lot like buying live or natural yoghurts for the microorganisms they contain. But in this case it is helminths, hookworm or whipworm, not bacteria that are the beneficial microorganisms. … Contact us to arrange delivery of therapy to you, anywhere outside the US and Mexico."
Thailand-based Biomonde.com sells a 2,500-egg bottle of TSO for 300 Euros.
"There's no concrete medical evidence" that worm therapy is safe, warns Engler, who argues that standard allergy treatments are now better than ever.
And more necessary than ever, apparently. Given their startling increase, allergies might turn out to be the 21st century's rickets. Because of this increase, many schools are now going peanut-free. The U.S. Department of Transportation proposed legislation in June that would have banned peanuts from airplanes, but canceled the proposal weeks later upon learning of 2000 legislation requiring the agency to obtain scientific proof (which it did not have) that peanuts on planes cause harm. Nonetheless, the proposal sparked a still-surging wave of support. Other increasingly common allergens are eggs, wheat, milk and shellfish.
"We don't know with 100-percent certainty why this is happening," Engler says. He doesn't discount the hygiene theory.
"Our ancestors lived in swamps. They had to fight off parasitic infections. When we moved into modern societies, our immune systems got misdirected."
That's compounded by the fact that we moved out of the swamps and into sealed buildings, where in otherwise clean rooms, highly allergenic dust mites accumulate. Outdoors, diesel-polluted air raises the risk of allergies -- and of asthma, whose effects are often triggered by allergies.
"When vehicles, machines, and factories are spewing out diesel fumes, the incidence of asthma and allergies are sky-high," Engler says. Industrial seaports and agricultural regions are allergy and asthma hotspots.
And is there any health problem that isn't linked to obesity?
"As body mass index gets higher, the risk of allergy gets higher. Overweight people are more likely than others to develop allergies," Engler says. This might explain the stratospheric rise in adult-onset allergies and allergies among the elderly. More and more Americans now grow up displaying no allergy symptoms at all until one day, one bee sting or Snickers bar after a lifetime of bee stings and Snickers bars, and boom . Anaphylaxis throws the body into crisis mode: Blotchy skin, plummeting blood pressure, organ failure, swollen face and tongue, swollen airways.
Ten minutes later, it might be too late.
While raking a backyard 30 miles south of London one day last month, Doug Garrett disturbed a wasp nest. Stung three times, he reached the kitchen before dying of cardiac arrest. Six months earlier in another English garden, Alison Piercy -- who had adopted beekeeping in hopes of restoring the waning global bee population -- was stung once while tending her hives. She too died almost instantly.
Both had venom allergies.
Food allergies kill some 200 Americans every year, venom allergies kill 100, and latex allergies kill 10, according to the Asthma and Allergy Foundation of America. Allergist-immunologist Robert Wood of the Johns Hopkins Children's Center says the actual figures are probably much higher, "because the cause of death on so many death certificates is listed as heart failure or respiratory failure" without specifying that those conditions, which are aspects of anaphylaxis, were triggered by allergic reactions.
When anaphylaxis starts, "there's only one medicine that matters," Wood declares, "and that's epinephrine." Otherwise known as adrenaline, it's prescribed to allergy patients in the form of ballpoint-pen-like auto-injectors whose needled tips, sharp enough to penetrate clothing, are jabbed into the thigh. Within five or six seconds, the strong neurotransmitter dilates airways and contracts blood vessels, restoring breathing, saving lives.
It's one of those rare treatments that's 100-percent effective, Wood says.
Once a patient has been prescribed an adrenaline auto-injector -- the most popular brand is the EpiPen -- the person must carry it at all times,"not back home or locked in a car," Wood warns. "If you have an allergy, you need to assume that on any given day you will have an allergic reaction."
In Boston, the TSO flows. Have we really created such a shiny sudsy scrub-a-dub-dub civilization that we now must eat worms to teach our bodies normalcy? Marie-Helene Jouvin thinks so. Love your bottled water, bacteria-free flush toilets, boiled food, and Band-Aids?
"In a lot of things, moderation is a key word," she says. Cleanliness is good, but "too much of a good thing is usually not a good thing."