Question about Antibiotics

[bgbarnes]

I am trying to wrap my head around antibiotic use if the exacerbation was flared by allergies or a virus- which we all know can happen once the BB has opened. What does the antibiotic do to help since it is not from strep?

Thanks

Brandy

[Fixit]

I am trying to wrap my head around antibiotic use if the exacerbation was flared by allergies or a virus- which we all know can happen once the BB has opened. What does the antibiotic do to help since it is not from strep?

Thanks

Brandy

 

that is the problem....the goal is to get the bb to close and keep away allergens, which is virtually impossbile unless you only have food allergies...

i think the problem becomes autoimmune, where even if the infection is cleared...the body is in such a fight mode, it is still fighting itself and remaining inflammed on its own accord...you've somehow got to get the body to slow down.....

[bgbarnes]

I am trying to wrap my head around antibiotic use if the exacerbation was flared by allergies or a virus- which we all know can happen once the BB has opened. What does the antibiotic do to help since it is not from strep?

Thanks

Brandy

 

that is the problem....the goal is to get the bb to close and keep away allergens, which is virtually impossbile unless you only have food allergies...

i think the problem becomes autoimmune, where even if the infection is cleared...the body is in such a fight mode, it is still fighting itself and remaining inflammed on its own accord...you've somehow got to get the body to slow down.....

that makes sense as to why IVIG is an effective treatment-rebooting the immune system to work properly...still waiting for our Cunningham results to see if we go to IVIG.....I can guarantee my son is greatly affected by allergies even if his skin test does not show it!

BRandy

[Buster]

Hi Brandy,

 

I am trying to wrap my head around antibiotic use if the exacerbation was flared by allergies or a virus- which we all know can happen once the BB has opened. What does the antibiotic do to help since it is not from strep?

 

PANDAS is thought to be caused by three things:

1. a genetic predisposition to an abnormal immune reaction
   
2. the creation of antineuronal antibodies as a response to an antigen (i.e. GABHS)
   
3. ability of the antineuronal antibodies to cross the BBB (e.g., due to inflammation or high blood pressure or ...)
   

The exact mechanism in #3 is not known, but inflammation seems the most likely culprit. Abnormal levels of eosinophils are common in those with allergies (and asthma) and these cells degranulate to release an array of cytotoxic granuals and inflammatory cytokines ( IL-1, IL-2, IL-4, IL-5, IL-6, IL-8, IL-13, and TNF alpha). If the anti-neuronal antibodies are still in the blood stream (they seem to have a half-life of 28 days), then eosiniophils and other diseases that increase inflammation of the endothelial cells can allow these to cross the BBB. This is why symptom exacerbation could be due to other sources of BBB inflammation -- not because they produce the antineuronal antibodies (i.e., not #2), but rather because they allow the antineuronal antibodies to cross the BBB.

 

So to your question about antibiotics. Some antibiotics (such as macrolides) are anti-inflammatory and immunomodulating. They tend to shift the immune reaction from Th2 to Th1 response reducing inflammation (i.e., address #2 above). Azithromycin falls in this camp. There have been reports on this forum that high-dose augmentin is also anti-inflammatory but I don't have a good reference study there. What might be happening (just a guess) is that augmentin is acting to stop residual spread of a GABHS infection, reduce the superantigens that creates significant inflammation, and by treating this underlying trigger, reduces the antineuronal antibody production such that there isn't anything in the blood to cross the BBB. It is important to remember that antibiotics don't kill GABHS, they essentially prevent rapid spread of bacteria so that the bodies immune system can eradicate the bacteria.

 

If your child's exacerbations don't seem to correlate with GABHS/mycoplamsa infections/exposures then probably other treatments might work better. For those who do have correlation with GABHS exposure/infection, antibiotics seem to keep the severity of symptoms in check. More research is needed to know for sure, but that's what we think at this point.

 

Buster

Edited May 23, 2010 by Buster

[melanie]

Ok so Buster do you or dont you need antibiotics? I need help Im not using the antibiotics right now anf dr has put dan on nystatin,Hes ticcing alot more maybe its the nystatin maybe its the no antibiotics.Maybe its just what it is .

 

Melanie

[dee45]

Hello,

Anthony is ticcing a little more this week--he was on Augmentin but was switched to Zithromaz and has been on that for the last 40 days. I am not sure why the flare up,so frustrating. Do we switch back, keep things the same--ughhhhh wish this was easier.

 

Deanna

[smartyjones]

PANDAS is thought to be caused by three things:

1. a genetic predisposition to an abnormal immune reaction
   
2. the creation of antineuronal antibodies as a response to an antigen (i.e. GABHS)
   
3. ability of the antineuronal antibodies to cross the BBB (e.g., due to inflammation or high blood pressure or ...)
   

 

so - do you think, in addition or instead of (1), could it be another big infection such as lyme that is involved instead of and/or with of a genetic predisposition?

 

buster - if i may ask your personal thoughts - do you believe it's a particular strain of strep or any strain can cause the reaction?

 

so we have a perfect storm set of circumstances that really doesn't appear to be so rare!

[bgbarnes]

Hi Brandy,

 

I am trying to wrap my head around antibiotic use if the exacerbation was flared by allergies or a virus- which we all know can happen once the BB has opened. What does the antibiotic do to help since it is not from strep?

 

PANDAS is thought to be caused by three things:

1. a genetic predisposition to an abnormal immune reaction
   
2. the creation of antineuronal antibodies as a response to an antigen (i.e. GABHS)
   
3. ability of the antineuronal antibodies to cross the BBB (e.g., due to inflammation or high blood pressure or ...)
   

The exact mechanism in #3 is not known, but inflammation seems the most likely culprit. Abnormal levels of eosinophils are common in those with allergies (and asthma) and these cells degranulate to release an array of cytotoxic granuals and inflammatory cytokines ( IL-1, IL-2, IL-4, IL-5, IL-6, IL-8, IL-13, and TNF alpha). If the anti-neuronal antibodies are still in the blood stream (they seem to have a half-life of 28 days), then eosiniophils and other diseases that increase inflammation of the endothelial cells can allow these to cross the BBB. This is why symptom exacerbation could be due to other sources of BBB inflammation -- not because they produce the antineuronal antibodies (i.e., not #2), but rather because they allow the antineuronal antibodies to cross the BBB.

 

So to your question about antibiotics. Some antibiotics (such as macrolides) are anti-inflammatory and immunomodulating. They tend to shift the immune reaction from Th2 to Th1 response reducing inflammation (i.e., address #2 above). Azithromycin falls in this camp. There have been reports on this forum that high-dose augmentin is also anti-inflammatory but I don't have a good reference study there. What might be happening (just a guess) is that augmentin is acting to stop residual spread of a GABHS infection, reduce the superantigens that creates significant inflammation, and by treating this underlying trigger, reduces the antineuronal antibody production such that there isn't anything in the blood to cross the BBB. It is important to remember that antibiotics don't kill GABHS, they essentially prevent rapid spread of bacteria so that the bodies immune system can eradicate the bacteria.

 

If your child's exacerbations don't seem to correlate with GABHS/mycoplamsa infections/exposures then probably other treatments might work better. For those who do have correlation with GABHS exposure/infection, antibiotics seem to keep the severity of symptoms in check. More research is needed to know for sure, but that's what we think at this point.

 

Buster

Thanks Buster!

I know my son definitely gets exacerbation from Strep- no doubt there- its just I know every Spring he changes and the allergy test did not really show up any serious allergy even though his ige is elevated- knowing that allergies are not bacteria- trying to figure out how to treat that side of it!

Thanks

Brandy