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Re: Re: IgE production

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Thanks for the explanations. I finally have something I can hand to my husband

to hopefully make him understand what is going on in my body. Having others

think you are not that sick when you're dragging your wheezing body around is

most frustrating, particularly the people closest to you.

Suzanne

~~~~~~~~~~~~~~~~~~~~~~~~

" Don't mess with me because I've sold cars, stolen guns and made grown men

cry... "

---------------------------------

Moody friends. Drama queens. Your life? Nope! - their life, your story.

Play Sims Stories at Games.

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Fran - let me lay this one on you. As a child, I had nasty asthma along with

" hayfever " as it was known then. Sometimes it got so bad that the doctor had to

come to the house and sit up with me to do what he could to keep me going

through the night. Eventually, they started me on desensitivation shots, which

was about the only treatment back then other than benzedrine inhalers. I was a

tennis nut back then, and played every day with a racquet in one hand and one of

six to eight handkerchiefs I carried with me in the other hand. When one was

soaked, I'd hang it on the fencing to dry so I could use it again. Sneezing

fits were always a bit of a problem when I was serving, and even more so when I

was receiving. Periodically during the season I had to go to a specialist in a

nearby city to have my impacted sinuses drained because the sinus headaches were

brutal.

I gradually outgrew the problem, and by the time I was in college, the asthma

was gone and the allergies, mostly ragweed, were fairly mild and confined to

that season. By my thirties, the whole mess had disappeared. Wonderful!!

Then, in my late forties, it came back - mildly at first but gradually

increasing until, in my sixties I had year-long allergies that weren't too bad,

but were not especially attributable to ragweed - mold and dust instead. By my

late sixties, the problem had evolved into sinusitis, among other things, and

testing indicated I was not particularly allergic to anything. After two sinus

surgeries, I finally ended up at Duke for a sinus D & C because I had contracted

MRSA up thar, along with a mold and bacterial infection. The D & C was really

nasty, and after I stopped bleeding about two or three weeks later, my condition

was greatly improved, but my asthma had returned. The dox at Duke turned me on

to flushing with eight or more ounces of saline twice a day and said I'd have to

do that the rest of my life, and I have to say it's been an enormous help. I

asked about shots, especially for mold even though I had not tested positive for

mold. The dox said forget it - there are something like a thousand varieties of

mold and I could be allergic to any one of them.

Local pulmo dude tried a flock of different drugs on me which helped some, but

didn't get rid of the snap, crackle, pop and wheezing that kept me up at night.

Finally, he said, " boy have I got a deal for you - Xolair. " My Ig

whatchadingies were 943, which I guess is fairly high. Almost immediately my

various nocturnal noises diminished, although I continue with nasacort and

pulmicort plus 8 mg per day of prednisone. I get 375 mg every two weeks of

Xolair, which is covered by Medicare and BCBS supplementary, but I have to get

it in the hospital. Everything seems to be pretty good now, I can breathe

through my nose most of the time, and can even snort ragweed.

I imagine the jury's still out on this, but I wonder if I can ever be weaned off

Xolair. It's kind of a pain in the tush to make a 28 mile round trip from the

beach to the hospital every other week. I wonder if you or anyone knows what

happens when Xolair is discontinued. Perhaps there could be a rebound to a

condition worse than before I started. An inquiring mind wants to know.

Ohldepharte

----- Original Message -----

From: tiredofsteroids

Sent: Wednesday, October 10, 2007 8:14 PM

Subject: [ ] Re: IgE production

Hi ,

You are very welcome! Your question is a great one, absolutely no

reason to be apologetic.

Allergen exposure triggers IgE exposure in an individual genetically

susceptible to producing IgE in response to that allergen. At the

time of the very first exposure to a particular allergen, there is no

pre-existing IgE and so no allergic response to the exposure. The

allergen to which an individual is allergic initially triggers the

transformation of specific immune cells into cells that can secrete

IgE but these cells do not secrete enough IgE to trigger an allergic

response at the time of first exposure.

However, subsequent allergen exposure causes the now primed immune

system to produce more IgE that can trigger the onset of the allergic

cascade with each further antigen exposure. And each time the

allergic cascade is triggered, it can self-perpetuate itself. The

degree to which that happens also has a genetic basis and differs

between individuals.

That's a very simplified summary of what is really a very complicated

process involving many different types of immune cells and immune

mediators. Any individual will have her/his own genetic propensity to

affect each step of the overall process to varying degrees. That's

why different folks allergic to the same allergens have different

degrees of allergic responses to the same level of allergen exposure.

Fran

>

> Fran,

>

> First of all thank you. Your explanations are clear,

> concise and accurate. We are so lucky to have you!

>

> Question: What determines how much IgE one produces in

> the first place? Clearly person 1 and person 2 do not

> produce the same quantity in response to the same

> allergic trigger. Genetics? What happens first? Ige

> production or is it trigger by allergen?

>

> Sorry for the innocent questions. My immunology was

> quite a long time ago...

>

> C

>

>

> Get news delivered with the All new . Enjoy RSS

feeds right on your Mail page. Start today at

http://mrd.mail./try_beta?.intl=ca

>

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Fran:

Your suggestion of Suzanne taking her husband with her to a doctor's appointment

is a great idea. Several things happened to help my husband understand what I

was going through. I woke him up in the middle of the night several times

because I couldn't breathe and we made a trip to the ER. (Of course I went to

the doctor the next day and after several trips to the ER my allergist suggested

I might as well have a Nebulizer at home.) I insisted he go with me to one of

my appointments with my allergist and asked pointed questions of the doctor with

my husband sitting right there while the doctor answered and then prescribed my

regimen of medicine. The other thing that made a believer of my husband is that

he worked in an ER for about three years on a part time basis. He was the first

person people met when they came in and he often decided who needed help right

away (sometimes it was a no-brainer). At any rate he learned that the two

cases who were taken right back and

treated were heart pains and breathing problems (asthmatics in particularly.)

So suggesting that Suzanne's husband go with her to a doctor's visit is a great

idea. Hope it works out for her and that the doctor is sensitive enough to let

her husband know how very serious asthma is and can be!

Since we have both retired, my husband has been great and in reality my asthma

has improved so much since I have been on xolair. However, I still have some

breathing problems if I try to do too much heavy housework at once, so he often

does some of the heavy stuff for me,. like vacuuming and wet-mopping the floors.

Yes, I am very blessed to have all of my family members supportive and

understanding and I do not take that for granted. I thank God for them.

Have a great day, all.

Adah

P.S. Fran, your explanations of the IgE and histamine and how they work were

very informative. I couldn't repeat what you said, but I think I have a better

understanding of what happens. Thanks so much. I always look forward to your

posts because of your wonderful knowledge and the gift of being able to

communicate that knowledge in a way we can all understand.

tiredofsteroids <sitesee@...> wrote:

Suzanne, you're very welcome. Have you been on this board long enough

to know the term " asthnostics " ? It's part of our lingo, meaning folks

who don't really believe in asthma as a serious illness. I'm sorry

you've been having to deal with some. Have you considered bringing

your husband or any of the others to a doctor's appointment with you

for confirmation of what you're dealing with? At some point, someone

on this board (Doug?) mentioned a friend, I think, who described

asthma as feeling like you're breathing through a straw. It's a great

description - maybe you could mention that to the asthnostics in your

life and offer them a straw to try it. Seriously.

Fran

>

> Thanks for the explanations. I finally have something I can hand to

my husband to hopefully make him understand what is going on in my

body. Having others think you are not that sick when you're dragging

your wheezing body around is most frustrating, particularly the

people closest to you.

>

> Suzanne

>

>

>

>

> ~~~~~~~~~~~~~~~~~~~~~~~~

>

> " Don't mess with me because I've sold cars, stolen guns and made

grown men cry... "

>

>

>

>

>

> ---------------------------------

> Moody friends. Drama queens. Your life? Nope! - their life, your

story.

> Play Sims Stories at Games.

>

>

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Thanks, Fran - I don't think this was a question of interest to most people,

but for oldfarts like myself who consider thinking about next year as optimism,

there is the consideration that in a few years, it may be too much of an

aggravation to drive to the hospital and back. On the other hand, wife/nurse

could give me the shots at home until one or the other of us croaks, but unless

Medicare changes its rules, that's out. Oh, well.

OP

----- Original Message -----

From: tiredofsteroids

Sent: Thursday, October 11, 2007 12:35 AM

Subject: [ ] Re: IgE production

Terry, in response to your question about what happens if Xolair is

discontinued, preliminary studies showed that generally IgE levels

remain elevated above the pre-Xolair level for as long as a year but

eventually do return to the pre-Xolair level (which in all of us on

Xolair was abnormally elevated), and previous symptoms do return.

This sounds confusing but remember that the measured IgE levels are

increased above the pre-Xolair level during Xolair treatment because

the widely availabe lab test is measuring both free IgE and IgE-

Xolair complexes as IgE without distinguishing the two. So what

happens after discontinuation is that free IgE production continues

as before while IgE-Xolair complexes are gradually cleared from the

blood and the lab test will show a gradual decline in total IgE even

if free IgE remains the same. In the end, you end up where you

started.

I don't really think we're going to know the full, detailed answer to

your question until a study is done of patients who have been on

Xolair for a number of years and then choose to stop treatment for

whatever reason.

Fran

> >

> > Fran,

> >

> > First of all thank you. Your explanations are clear,

> > concise and accurate. We are so lucky to have you!

> >

> > Question: What determines how much IgE one produces in

> > the first place? Clearly person 1 and person 2 do not

> > produce the same quantity in response to the same

> > allergic trigger. Genetics? What happens first? Ige

> > production or is it trigger by allergen?

> >

> > Sorry for the innocent questions. My immunology was

> > quite a long time ago...

> >

> > C

> >

> >

> > Get news delivered with the All new . Enjoy RSS

> feeds right on your Mail page. Start today at

> http://mrd.mail./try_beta?.intl=ca

> >

>

>

>

>

>

>

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