The University of Chicago Medicine - Comer Children's Hospital

Department of Pediatrics 2017 Annual Report

Cancer & Host Defense Allergy, Immunology, Pulmonology & Sleep Medicine

Ivan Guzman and son Adrian with Raoul Wolf, M.D

Citizen scientists can help drive research forward

A food allergy can severely limit a child’s life—and make meals extremely challenging for the entire family. Christina Ciaccio, MD, MS, clinical director of the Food Allergy Program, can’t yet offer patients a cure for their food allergies. But she can offer them an opportunity to participate in a new biorepository that will expedite research on food allergies and asthma. Patients, their siblings, and their parents are invited to donate samples of blood, stool, and DNA from buccal swabs, which will be stored in the University of Chicago Allergy and Asthma Repository.

Patient Mikaela J.L. Ewing with Steve Handoyo, MD

“Instead of prospectively enrolling patients in a research project, we can query the biorepository and immediately find patients with a particular food allergy and phenotype that we want to analyze, which is a much more efficient way to conduct translational research,” says Ciaccio. Having ready access to biological samples will advance the research of basic scientists such as Carole Ober, PhD, who studies the genetic variants of asthma, and Cathryn Nagler, PhD, who created a mouse model of food allergies using stool samples from children and has developed a microbiome-modulating drug to prevent or treat food allergies that is on the verge of trials in humans.

Ciaccio also maintains a registry of individuals interested in participating in clinical trials at the University of Chicago Medicine. “People often contact us, even if they aren’t patients here, wanting to participate in our very active clinical trials program,” she says. “The registry is another way we connect people with our research.” Among the current trials are an oral immunotherapy study to desensitize children with peanut allergy and a phase 1 randomized controlled trial to evaluate a vaccine for peanut allergy.    

For information about clinical trials for food allergies:

To enroll in the University of Chicago Allergy and Asthma Research Registry:

To participate in the University of Chicago Allergy and Asthma Repository, call the research coordinator at 773-702-8137

We should feel outrage when a child dies from asthma

B. Louise Giles, MD, with patient Daniel McCloud

Approximately 20 percent of children—and up to 45 percent in some neighborhoods—in the University of Chicago’s service area suffer from asthma, compared with 10 percent in Illinois and 12 percent nationally. Chicago’s South Side children are hospitalized for asthma at twice the rate of the rest of Chicago and four times the rate of Illinois and the nation.

Yet not all children with asthma are diagnosed or receive the care needed to prevent death or near-fatal events that result in neurological damage, says B. Louise Giles, MD, a leader in the field of pediatric pulmonary medicine. “Today no child should die or suffer long-term consequences as a result of asthma.”

To identify children with this chronic disease and to provide high-quality, accessible care, the University of Chicago Medicine’s Urban Health Initiative and Department of Pediatrics are leading the development of the South Side Pediatric Asthma Center. Community partners in this “one-stop shop” for asthma care and education include La Rabida Children’s Hospital, St. Bernard Hospital and the Friend Family Health Center.

With funding from the Coleman Foundation and two anonymous donors, the South Side Pediatric Asthma Center is hiring nurses and community health workers to provide culturally appropriate educational materials and training to asthma patients, their parents, school nurses, teachers and others. The community health workers will provide care in clinics and emergency rooms, as well as follow patients in their homes. They also will serve as advocates for families, helping them negotiate the health care system to get the best results for their children.

B. Louise Giles, MD, right, with patient Daniel McCloud and family

Today no child should die or suffer long-term consequences as a result of asthma.

~ B. Louise Giles, MD

“The center’s goal is to provide a comprehensive and collaborative approach to treating children with asthma, resulting in fewer deaths, emergency department visits, hospital admissions and missed days of school,” says Giles.

As part of a National Institutes of Health multicenter study, University of Chicago researchers led by Carole Ober, PhD, are investigating whether African Americans—the predominant population on the South Side—are more genetically predisposed to asthma. Pollution, higher smoking rates and lower socioeconomic factors are other risk factors increasing the vulnerability of Chicago’s children for asthma.

We may be able to protect children from asthma by re-creating the Amish experience

Carole Ober, PhD

Geneticist Carole Ober, PhD, professor and chair of the Department of Human Genetics at the University of Chicago, studies the Hutterites of South Dakota and the Amish of northern Indiana, two groups with nearly identical genetic ancestry but strikingly divergent childhood asthma rates. About 5 percent of Amish schoolchildren ages six to 14 have asthma. This is about half of the U.S. average (10.3 percent) for children and one-fourth of the prevalence (21.3 percent) among Hutterite children.

In recent research published in the New England Journal of Medicine, Ober and colleagues found that the microbe-rich dust from Amish homes engages and shapes the innate immune system in young Amish children and may suppress pathologic responses leading to allergic asthma. Exposure to these microbes is a byproduct of the Amish community’s traditional farming practices, which require close contact between families and their animals, such as Amish children working in barns at an early age. The Hutterites have replaced these methods with modern, industrialized farm machinery, and young children are not exposed to the animals or barns.

Ober and her collaborators studied 30 Amish children seven to 14 years old and 30 age- and sex-matched Hutterite children, examining their environmental exposures, genetic ancestry and immune profiles. The Amish children had more and less-mature neutrophils to fight infections and fewer eosinophils, which promote allergic inflammation. Gene expression profiles in blood cells also revealed enhanced activation of key innate immunity genes in Amish children. The prevalence of asthma and allergic sensitization was four to six times lower in the Amish, but median endotoxin levels in Amish house dust was 6.8 times higher than in Hutterite homes.

A better understanding of how the environment influences our immune system is the first step to the development of novel strategies to both treat and prevent chronic, non-infectious inflammatory diseases, such as asthma, that start in childhood but may last a lifetime.

~ Christina Ciaccio, MD, MSc

The researchers also exposed mice to house dust extracts and found the airways of mice that received Amish dust were protected from asthma-like responses to allergens. In contrast, mice exposed to Hutterite house dust were not protected.

“There’s no obvious dirt in the Amish homes, no lapse of cleanliness,” says Ober. “The protective Amish environment is in the air and in the dust. Early and chronic exposure to the Amish environment likely patterns the child’s immune system toward one that is protective against asthma and possibly other immune-mediated diseases.”

Adds Christina Ciaccio, MD, MSc, interim section chief of Allergy and Immunology: “A better understanding of how the environment influences our immune system is the first step to the development of novel strategies to both treat and prevent chronic, non-infectious inflammatory diseases, such as asthma, that start in childhood but may last a lifetime.”

This year, Ober’s study was chosen as one of the three best clinical research papers published in 2016 by the Clinical Research Forum, a national organization of senior researchers and thought leaders from the nation’s leading academic health centers.

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