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Researchers identify irregularities that may cause itching
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ThinkstockIn a small study of patients who have chronic itching with no known cause, researchers from the Center for the Study of Itch at Washington University School of Medicine in St. Louis identified immune system irregularities that may prompt the urge to scratch.
People who suffer itching with no clear cause may have previously unrecognized immune system defects. In a small study of such patients, researchers from the Center for the Study of Itch at Washington University School of Medicine in St. Louis identified immune system irregularities that may prompt the urge to scratch.
The findings are reported in the May issue of The Journal of the American Academy of Dermatology.
“As doctors, we throw things like antihistamines, ointments and lotions at patients who suffer chronic itching, but if there is something profoundly abnormal about the immune system — as it appears there is — then we can’t solve the itching until we address those underlying causes,” said principal investigator Brian S. Kim, MD, an assistant professor of medicine in the Division of Dermatology. “The immune system needs to be in balance, and we hope to find ways to restore that balance in patients with this very debilitating condition.”
The researchers took blood samples and skin biopsies from a small sample of patients — only four are reported in the study — to look for immune problems. They found “an incredible amount of dysfunction,” Kim said, adding that he has seen similar defects in numerous additional patients not included in the current study.
The four patients researchers zeroed in on were ages 75 to 90. In blood samples, three of those four had high levels of the protein IgE — an immunoglobulin that is a marker of inflammation. Immunoglobulins are antibodies deployed by the immune system to fight infections. Elevated levels of IgE often are seen in patients with allergies.
Dig to the stars mac os. The researchers also noted very low levels of an immunoglobulin known as IgG; abnormally low counts of a type of immune cell called a CD8 T-cell; and an elevated number of immune cells called eosinophils, which are markers of allergic inflammation.
“Curiously, none of these patients had any history of allergic disorders,” Kim said. “We often see similarly high counts of eosinophils in patients with eczema, but the patients we studied didn’t have eczema. They didn’t even have a rash. Only itching.”
Kim explained that dermatologists frequently take skin biopsies when a patient has a rash, but with chronic itching of unknown origin, which doctors call chronic idiopathic pruritis, there is nothing evident to biopsy.
The study’s first author, Amy Xu, a medical student in Kim’s lab, said most patients with this type of unexplained, chronic itching tend to be older and develop itching problems later in life.
“It may be caused by some sort of wear and tear on the immune system,” Xu said.
Because of the small number of patients in the study, it’s too soon to draw firm conclusions, but the itching may be an indication that something else in the body is going wrong, Kim said.
“We have begun working on a mouse model in which the animals have similar defects,” he said. “We want to learn whether these changes in the immune system create only itching or whether they could be signs that some other problem is present.”
PROGRAM OVERVIEW
Although moderate-to-severe atopic dermatitis (AD) manifests on the skin’s surface, it’s far from superficial. It’s a disease that originates from the deepest interior of the immune system to profoundly destabilize all psychophysical aspects of health-related quality of life. As we have begun to unravel the mystery of the pathophysiology of AD, it is becoming clear that to be effective, treatment needs to target the proinflammatory pathways and cytokines that are the pruritogenic core of this disease. This program will review current and emerging Janus kinase (JAK) inhibitors for the treatment of atopic dermatitis.
FACULTY
Seemal R. Desai, MD
Clinical Assistant Professor of Dermatology
University of Texas Southwestern
Plano, Texas
FACULTY REVIEWER
Jonathan I. Silverberg, MD, PhD, MPH
Associate Professor of Dermatology
Director, Clinical Research & Contact Dermatitis
School of Medicine and Health Sciences
The George Washington University
Washington, District of Columbia
Release date: September 16, 2020
Expiration date: September 16, 2021
Estimated time to complete activity: 0.25 hour(s)
SUPPORTER ACKNOWLEDGEMENT
Supported by an educational grant from Pfizer, Inc.
TARGET AUDIENCE
This program is intended for allergists, immunologists, dermatologists, specialty advanced practice providers, and other healthcare professionals involved in the management and treatment of patients with moderate-to-severe AD.
LEARNING OBJECTIVES
Upon completion of this educational activity, participants should be able to:
- Devise a strategy to incorporate emerging biologic monoclonal antibodies (mAbs) and JAK inhibitors into treatment plans as they become available to appropriately selected patients with moderate-to-severe AD
- Interpret endpoint results from phase 3 clinical trials comparing the biologic dupilumab with JAK inhibitors
DIRECTIONS TO LEARNER
There are no fees for participating and receiving CME credit for this activity. During the period of September 16, 2020 through September 16, 2021, participants must:
- Read the CME information (this page)
- Complete the pretest
- Study the educational Tweetorial/activity
- Complete the posttest and the evaluation form
A statement of credit will be available for immediate download upon completion of the activity evaluation form and a completed post-test with a score of 100%
MEDIA
Internet
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Integrity Continuing Education, Inc. https://papa-free.mystrikingly.com/blog/asus-vs238h-p-driver-for-mac. is accredited with commendation by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
CREDIT DESIGNATION
Integrity Continuing Education, Inc. designates this other activity Twitter-based Tweetorial for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
CONTACT INFORMATION
For information about ACCME accreditation of this activity, please contact Integrity Continuing Education, Inc. https://truejload386.weebly.com/resume-lab-1-2-pages-templates-download.html. at (855) 835-4004 or info@integrityce.com.
DISCLOSURE OF CONFLICTS OF INTEREST
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Integrity Continuing Education, Inc. requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Integrity Continuing Education for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.
The following faculty/planners reported the financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of these CME activities:
Seemal R. Desai, MD does not have any conflicts of interest to disclose.
Jonathan I. Silverberg, MD, PhD, MPH
Consulting Fees: AbbVie, Arena, Asana, Bluefin, Boehringer Ingelheim, Celgene, Dermavant, Dermira, Eli Lilly, Kiniksa, Leo, Luna, Medimmune, Menlo, Novartis, Pfizer Inc., Regeneron, Sanofi Genzyme
Speakers’ Bureaus: Regeneron, Sanofi Genzyme
Contracted Research: Galderma, GlaxoSmithKline
The Integrity Continuing Education, Inc. planners and managers have nothing to disclose.
DISCLOSURE OF UNLABELED USE
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Integrity Continuing Education, Inc. does not recommend the use of any agent outside of the labeled indications.
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The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
PRIVACY POLICY
When you participate in an online educational activity sponsored by Integrity Continuing Education, Inc., you will be asked for your name, degree(s), affiliation(s), street address, telephone number, fax number, and…(continued)
MINIMUM SYSTEM REQUIREMENTS
Windows 98, 2000, XP, 2003, Vista, and 7
Internet Explorer 6/7
Firefox 2
Mozilla 1.7 or higher
Netscape 8.1 or higher
Flash Player 10
Mac OS X 10.3, 10.4
Safari 1.3 (Mac OS 10.3)
Safari 2.0 or higher (Mac OS 10.4)
Firefox 2
Flash Player 10
Use of Internet Explorer browser is not recommended.
DISCLAIMER
The information provided at this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.
PROVIDER STATEMENT
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Provided by Integrity Continuing Education, Inc.