How Allergic Reactions Occur

Dr. Joshua “Josh” Este is a board-certified MD from Newport, Oregon. He serves as an internal medicine physician who provides care within a critical access setting. Possessing a wide knowledge of general medicine, Josh Este, MD, has assisted patients with issues such as allergic reactions.

Allergic reactions typically take place when the immune system is overly sensitive to substances that are usually harmless. These substances are known as allergens and range from nuts to pet dander. Allergies impact as much as 40 percent of people worldwide.

There are several ways in which allergens may enter the body, including inhalation, eating or drinking, injection, and skin contact. Skin contact is known as contact dermatitis and involves touching something repeatedly to which one has an allergy. Rashes typically appear between 24 and 48 hours after this contact. It is important to note that an allergy-related rash is not necessarily contact dermatitis. An allergen that has entered the body (through eating peanut butter, for example) may also trigger inflammation and a skin rash.

Sweet Creek Falls in Oregon’s Coastal

Practicing in Newport, Oregon, Dr. Joshua “Josh” Este leverages his MD as a member of the Samaritan Pacific Communities Hospital team, where he manages patient care. An outdoors enthusiast, Josh Este, MD, enjoys backpacking and has explored various wilderness trails. One scenic area about 40 miles south of Newport is Sweet Creek Falls.

Inhabiting a lush Coast Range valley, the trail is located Siuslaw National Forest and spans four sections totaling three miles. The verdant forest is characteristic of the coastal region and includes big leaf maple, alder, and Douglas fir. The 11 waterfalls encountered along this route all feature ferns and moss-grown rocks. The highlight is a tiered series of cascading waterfalls in the 10- to 30-foot range that together offer a haunting “multiple waterfall” effect.

One word of caution is that the stream can have fast-moving currents in the rainy season and there are many slippery stones in the vicinity. For this reason, an abundance of caution, rain gear, and a hiking partner are recommended for this trek.

American Board of Internal Medicine

The American Board of Internal Medicine (ABIM) is a nonprofit membership organization that establishes standards for internal medicine specialists. Founded in 1936, ABIM has certified more than 200,000 physicians, including 25 percent of all physicians in the United States.

In 1989, ABIM created the ABIM Foundation, which functions as a charity organization to support and implement initiatives that advance the quality of medical care. The ABIM Foundation has launched a special initiative called Building Trust.

Building Trust focuses on trust as a crucial tenet of healthcare quality. The program highlights the importance of trust through the promotion of leadership skills, best practices, and research projects. Multiple organizations participate in the initiative. For example, AcademyHealth is collaborating with the ABIM Foundation to launch research studies that explore trust topics in health care.

According to the program, trust is characterized by four key dimensions: competency, caring, communication, and comfort. Healthcare organizations and physicians can improve these four C’s to boost patient trust.

Patient trust depends on competent services that align with expectations and result in positive outcomes. Physicians need to behave in a caring manner to show their empathetic attitude. Additionally, they must respectfully communicate with patients. Comfort and safety also nurture patient trust.

Building Trust also champions diversity and inclusion in medical education. Alongside the ABIM Foundation, the Academic Alliance for Internal Medicine and the American College of Physicians are cooperating to reform internal medicine education as an inclusive and equitable experience for all.

To create a more trustworthy healthcare environment, Building Trust organizes events and webinars to investigate trust-building activities. The Trusting Conversations webinar series showcases experts and their approach to building trust in their organizations. Topics include the effect of COVID-19 on trust in the patient-physician relationship and between the public and healthcare institutions.

In 2019, the ABIM Foundation held its inaugural Trust Practice Challenge to create a compendium of trust-building measures that can be implemented in healthcare settings. The challenge’s eight winners included Mayo Clinic’s Leader Index and Hawaii Pacific Health’s Getting Rid of Stupid Stuff. While the former identified positive leadership skills, the latter helped clinical staff members refine the electronic health record system.

The Building Trust initiative brings together many collaborators, including patient advocacy organizations and professional associations. In June 2021, the ABIM Foundation selected WorkWell as a collaborator on Building Trust. An American Physical Therapy Association practice, WorkWell provides various industries with evidence-based education and training services to reduce workplace injuries.

Designed by certified physical therapists, WorkWell’s safety programs address workplace risks and create interventions to protect employees from musculoskeletal injury. By promoting workplace safety, WorkWell builds and restores trust in organizations. Further, WorkWell’s therapists manage onsite clinics to promptly treat employee complaints and boost productivity.

Employer services include post-injury testing for employees returning to work. This service ensures a safe transition from home to the workplace through assessments such as functional capacity evaluations and fit-for-duty screenings.

WorkWell’s onsite services exemplify the principles behind Building Trust. Therapists help employees receive the medical care they need, and thus, foster a trustworthy relationship between patients and physicians, and between employees and employers.

An Overview of Prion Disease

Neurodegenerative diseases affect the nerve cells of the body. These conditions result in the damage and death of nerve cells, which leads to movement and/or mental dysfunction. Prion diseases, also called transmissible spongiform encephalopathies, are neurodegenerative conditions characterized by an accumulation of abnormal prion proteins (PrPs).

PrPs are found in normal brain cells. When PrPs fold abnormally, they clump and accumulate in the brain. Abnormal PrPs lead to brain damage that manifests as movement difficulties, behavior changes, and memory problems.

Prion diseases, categorized as infectious diseases, can affect humans and animals. The diseases can be acquired through contaminated meat or medical equipment or inherited as a result of genetic mutations. Some cases of prion disease are sporadic and have no known cause. Although they are rare, prion diseases are considered fatal due to the lack of an effective treatment.

Prion diseases are divided into human and animal subtypes. The most common human prion disease is Creutzfeldt-Jakob disease (CJD). Other human subtypes include variant Gerstmann-Sträussler-Scheinker disease, fatal familial insomnia, and kuru. Animal prion diseases include bovine spongiform encephalopathy, chronic wasting disease, and scrapie.

Symptom onset may take many years, but once symptoms develop, they follow a rapid course. Patients with prion diseases experience physical symptoms such as muscle stiffness, slurred speech, and loss of coordination. Mentally, patients develop dementia accompanied by personality changes and confusion.

Diagnosing prion disease can be difficult. To conclusively confirm the diagnosis, physicians typically examine a biopsy sample from the patient’s brain, often after death. Nevertheless, various tests can facilitate the diagnosis. For example, a lumbar puncture obtains a sample of cerebrospinal fluid (CSF). CSF testing can identify specific biomarkers associated with prion disease. Additionally, brain changes can be seen with magnetic resonance imaging (MRI) tests.

Since there is no cure for prion disease, most patients receive supportive treatment. Physicians may prescribe medications to manage pain and muscle spasms. Unfortunately, the disease progresses into a debilitating condition; patients eventually require assistance with daily activities.

Recent research has demonstrated key points about the development and possible treatment of prion disease. In 2017, the Journal of Immunology published a study that identified complement regulatory protein factor H (fH) as a prion receptor that contributes to the accumulation of abnormal PrP in the brains of infected mice. The study offered insight into the interaction of PrP with the immune system.

Scientists are still working on a treatment for prion disease. A research team at the University of Texas Mitchell Center for Alzheimer’s Disease and Related Brain Disorders published a study proposing a potential therapy for prion disease in 2017. Named anti-prion, the treatment comprises a designed PrP similar in form to the abnormal PrP. The anti-prion competes with the disease-causing PrP, reducing the replication of the disease-causing PrP and overall disease development.

In 2021, researchers at Imperial College London and the University of Zurich conducted a study that detected a critical location on mutant PrP where the abnormal folding process begins. They targeted this spot with antibodies that halted the abnormal folding, providing a potential treatment for prion disease.