Professor Sir Stephen Holgate has called for urgent action to tackle a global rise in allergy cases. It comes amid warnings that 70 percent of people in the UK could have food allergies by 2060. Tackling the allergy epidemic Prof Holgate is MRC Clinical Professor of Immunopharmacology at the University of Southampton and a researcher at the NIHR Southampton Biomedical Research Centre. He spoke about the urgent need to tackle the problem in a keynote speech at the BSACI Global Allergy Symposium. He explained how environmental factors are fuelling a worldwide allergy epidemic. These include the loss of biodiversity, pollution, changes in diet and urbanisation. An urgent, worldwide programme of clinical trials, he said, is essential to turn the tide. He said these should focus on developing immunity in babies and young children. “Prevention is best achieved in the womb and in early life, because a developing child is very receptive to having its immune response shaped,” comments Prof Holgate. “We are talking about training an immune response similar to our learnings from the COVID-19 vaccination programme.” His speech pointed to the development of mass programmes to halt and reverse the rise in allergies. These could potentially use bacterial extracts similar to those encountered in livestock farm dust, or minimally-processed cow’s milk as treatments. Both treatments have shown promise in pilot studies. Inspired by a royal event Prof Holgate's talk was based on the findings of a recent landmark workshop. The workshop, at Dumfries House in Scotland, was hosted by the then-Prince of Wales in September 2022. The two-day event was called Understanding the Environmental Causes of Allergic Disease to Identify Effective Interventions. Sixteen world-leading allergy experts from the UK, US, Finland, Germany and Hong Kong attended. Professor Holgate led the workshop. It was organised by The Natasha Allergy Research Foundation, set up by the parents of Natasha Ednan-Laperouse. Natasha died aged 15 in 2016 from anaphylaxis, the most severe form of allergic reaction. Losing contact with animals At the symposium, Prof Holgate said studies carried out across the world show a loss of biodiversity is driving the rise in allergies. Biodiversity is the all the different kinds of life in one area, the variety of animals, plants, fungi, and even microorganisms like bacteria that make up our natural world. This includes studies in Africa, China, the United States, Germany and South East Asia. Other studies show livestock farming and other aspects of a rural environment protect against the development of allergy. He cited a study of 1,300 German children, published last summer. Those brought up on traditional farms were protected against allergy reactions. In another example from the US, two immigrant communities with common ancestry - the Hutterites and Amish - adopted different lifestyles. The Amish stuck to traditional family farming on single farms, working manually in cattle sheds. The Hutterites adopted the American communal farming lifestyle, using mechanical farming. “If we look at prevalence of asthma and allergy, you will see a huge difference. The Amish are hugely protected, the Hutterites are not,” says Professor Holgate. Similar results have been reported across the globe, where communities have chosen different and more traditional lifestyles. Professor Holgate adds: “Where humans come into close contact with animals, the farm environment can protect against the development of allergy. High exposure to environmental microbes leads to protection against the early development of allergic disease. In contrast, decreased biodiversity is a major driver in diminishing the protective immune reactions.” Stopping the 'relentless rise' in allergies One in three people in the UK now has an allergy, and the numbers continue to rise. These conditions range food and drug allergies to asthma and eczema. Between two to three million people in the UK are living with food allergies. Hospital admissions for anaphylaxis caused by food allergies have tripled over the last 20 years, according to recent research in the British Medical Journal. Prof Holgate warns that on the current trajectory, 70 per cent of the UK population could have food allergies by 2060. He is calling for global action. He says: “The support of King Charles and Natasha’s Foundation in bringing together allergy scientists has enabled us to come up with a plea, to help us stop the relentless rise of allergies across our populations. “What are needed now are large global clinical trials to determine whether modifying the lung and gut microbiome in early life through trained immunity can protect against the development of allergy.” Nadim Ednan-Laperouse OBE, co-founder of The Natasha Allergy Research Foundation, said: “It is quite clear that loss of biodiversity and the environment are key factors affecting the huge rise in the numbers of people with allergies. There is no time to lose in confronting the allergy and environment crisis. It is crucial that new landmark studies in this field are fully funded now. We, at Natasha's Foundation, intend to play our full role in delivering on the urgent actions required.” BSACI Chief Executive Fiona Rayner said: “Our understanding of the environmental factors that cause allergies and the effective interventions is a huge breakthrough. We therefore call upon our global colleagues to undertake clinical trials to protect and prevent the further development of allergies.”

A new study will develop an app to support young people with Autism Spectrum Disorders (ASD) to manage their own mental health. Around seven in 10 autistic people experience a mental health condition, according to the Mental Health Foundation. A €4.3 million grant from the European Commission's Horizon Europe programme and UK Research and Innovation (UKRI) will fund a new study. This will assess how factors in a young person’s environment affect their mental health. These factors include diet, sleep pattern, physical activity, and exposure to stress and anxiety. The study also aims to identify ways they can manage these. Developing an app to help The team will develop app known as an automated Personal Digital Nurse (PDN). This will support the individual to manage their own health. The app will also be integrated with care services, including SENCO at school and community clinics. This will allow them to access personalised, flexible services when they need it. More than 400 teenagers, aged between 11 and 14 years old, will take part for nine months in the UK, Republic of Ireland and Romania. Researchers from many different specialisms The study is known as ETHEREAL. It will bring together researchers from many different specialisms. These include medicine, computer science, psychology, biology and business. They will work with research teams and autism charities across the three countries. Prof Jonathan Swann is Professor of Biomolecular Medicine and a researcher at the NIHR Southampton Biomedical Research Centre (BRC). He will work to understand the genetic and biochemical mechanisms underlying ASDs. He aims to identify biomarkers that can predict the start and progression of mental health outcomes. His team will work with Prof Karen Lillycrop, Professor of Epigenetics and a researcher at the BRC. Her team will study the participant’s epigenetics - how a person’s environment affects their how their genes work, for example by switching them ‘on’ or ‘off’. They aim to identify epigenetic ‘signatures’ associated with ASDs and mental health status. Prof Lillycrop, said: ‘The grant will allow us, for the first time, to characterise epigenetic changes over time with mental health status and determine the drivers of such changes.” Prof Swann said: “This exciting multidisciplinary project will combine multi-omics, mathematics, and engineering expertise from across the University. It aims to understand complex gene-environment interactions, and how they contribute to autism spectrum disorders and mental health outcomes. “Our goal is to incorporate this knowledge into a mobile app. This will allow individuals living with autism to self-control the factors having a negative impact on their mental health.”

Southampton researchers have been recognised for studying the use of machine learning for inflammatory bowel disease (IBD). IBD is the name of a group conditions that cause the gut to become inflamed. The most common types of IBD are ulcerative colitis and Crohn’s disease. It affects more than half a million people in the UK. Recent research led in Southampton reviewed computer methods to help combat the disease. Results suggested progress can be made toward personalised medicine for IBD. Findings published in Inflammatory Bowel Diseases have now been named a winning paper in the journal’s annual awards. Treating complex conditions Artificial Intelligence (AI) and machine learning are increasingly being applied to complex conditions. The winning paper surveyed the use of these methods for IBD between 2001 and 2021. It found that the most common uses include diagnosis, assessing disease activity and identifying patients more likely to develop complications. The paper went further to identify how machine learning models could translate into the clinic. Sarah Ennis, Professor of Genomics at the University of Southampton, led the study. She is driving further research in this area through the NIHR Southampton Biomedical Research Centre’s Data, Health and Society theme. Prof Ennis said: “We are delighted that our work in collaboration with colleagues at Pfizer has been recognised in this way. “As always, our driving goal is to impact change for patients with IBD. “We are hopeful that machine learning applications hold promise to discover cryptic signals from complex data, such as genomics, to advance this goal in the near future.” Award-winning research The IBD Journal Awards recognised excellent research published in 2022. The shortlist consisted of ten top-performing articles: five for basic science and five for clinical research. The Associate Editors selected a winner from each category. Prof Ennis and her team won the award for basic science. The winners were announced at the 2023 Crohn's & Colitis Congress held in Denver last month.

Women who take extra vitamin D during their pregnancy are more likely to have a 'natural' delivery, according to new research. 'Natural' childbirth, or spontaneous vaginal birth, can be safer for the baby and lead to faster recoveries for the mum. Benefits also include a lower risk of medical interventions. Southampton researchers led a national study that trialled vitamin supplements in pregnancy. Their analysis found that more of the women given extra vitamin D had a natural delivery. The research has been published in the Journal of Public Health. Boosting vitamin D Researchers from the University of Southampton and University Hospital Southampton NHS Foundation Trust (UHSFT) led the study, called MAVIDOS. 965 women from Southampton, Oxford and Sheffield took part. During their pregnancy, they were randomly allocated to two groups. One group took an extra 1,000 International Units (IU) per day of vitamin D. The other group took a placebo (dummy) tablet each day. The pregnant women, doctors and midwives did not know which group they were in. The researchers followed up the women during their pregnancy and delivery, and then compared the two groups. More of the women in the extra vitamin D group had a natural delivery. This means that they delivered their baby through the birth canal without medical help. The researchers observed that the number of women in each group needing a caesarean operation to deliver their baby was similar. Fewer women from the vitamin D group had an assisted delivery, in which a suction cup or forceps are used to help deliver the baby through the birth canal. Informing public health policy The Southampton research team are based in the MRC Lifecourse Epidemiology Centre (MRC LEC) and the NIHR Southampton Biomedical Research Centre (BRC). The NIHR Southampton BRC is part of the National Institute for Health and Care Research (NIHR) and hosted by UHSFT in partnership with the University of Southampton. Dr Rebecca Moon, a Clinical Lecturer and paediatrician in Southampton, led the analysis. She said: “Most women want to have a natural delivery of their baby. Our work suggests that taking extra vitamin D during their pregnancy might help them to achieve this. “The women taking the extra vitamin D also had less blood loss after delivery, highlighting why this is so important. Further evidence is now needed to more thoroughly inform public health policy and clinical practice.” Added benefits of vitamin D These findings are part of a large project looking at the benefits of vitamin D supplementation in pregnancy. Professor Nicholas Harvey is an MRC LEC Deputy Director, Professor of Rheumatology and Clinical Epidemiology and project lead. He said: “Vitamin D deficiency is very common in the UK. We have also shown that extra vitamin D in pregnancy can improve the mother’s vitamin D level and has benefits to their child’s skeleton. Importantly, National Institute for Health and Care Excellence guidance recommends that all pregnant women take 400 IU vitamin D per day.” Professor Cyrus Cooper, MRC LEC Director, Professor of Rheumatology, and Chief Investigator of the MAVIDOS Trial, added: “These findings add further to the knowledge generated through the MAVIDOS trial. This is informing the role of vitamin D in pregnancy for offspring bone development and underlying genetic and nongenetic mechanisms. “This successful programme has clearly demonstrated the immense added value through a nationally, collaborative approach to discovery science.”

An international study co-led by Southampton’s Professor Ratko Djukanovic has shown that a common antibiotic could reduce intensive care unit (ICU) admissions caused by COVID-19. The results, published in PLOS ONE, show that hospitalised patients at risk of severe COVID-19 who took doxycycline were less likely to be admitted to ICU. Doxycycline is a safe, inexpensive, and widely available antibiotic with anti-inflammatory and anti-oxidative properties. It could, therefore, be rapidly rolled out in hospitals to save patients’ lives. The drug had very few side effects, with no patients stopping treatment because of them. The randomised, clinical, multicentre trial was carried out in India on a mini-budget of less than £10,000. It was the work of a small but agile global team during the height of the pandemic. Less likely to need intensive care Overall, 387 patients aged 40–90 years and admitted to hospital with COVID-19 took part in the trial. They were randomly allocated to receive either standard care with doxycycline or standard care alone. The researchers then recorded how many patients deteriorated to the point where they needed transfer to an intensive care unit (ICU). In total 77 of the patients developed critical disease needing ICU admission. Doxycycline reduced the need to be transferred to an ICU by 43%. Prof Djukanovic, Professor of Medicine at the University of Southampton and Respiratory Consultant at University Hospital Southampton NHS Foundation Trust, said: “The addition of doxycycline substantially reduced the progression of patients to intensive care in this trial. This suggests that this globally available, safe and inexpensive antibiotic has potential to become an effective option in the continuing global battle against COVID-19.” Anti-oxidative and anti-inflammatory properties Former Southampton colleagues Prof Stephan Gadola and Prof Djukanovic conceived the study during the first COVID-19 wave in 2020. The core study team was joined by John Kirkpatrick, a statistical scientist and former industrial colleague of Prof Gadola, and Dr Raja Dhar, a pulmonologist at Calcutta Medical Research Institute (India) and long-term colleague of Prof Djukanovic. Clinicians at six medical centres in India as well as a microbiologist and data scientists from Germany and the UK complemented the study team. Prof Gadola, Visiting Professor of Immunology at the University of Southampton and chief physician at Bethesda Hospital Basel (Switzerland), said: “The data show that the benefits for patients in this trial are not explained by doxycycline’s antimicrobial properties, indicating they are related to its anti-oxidative and anti-inflammatory properties. “This makes doxycycline a potential candidate drug for other infectious diseases that are accompanied by severe inflammatory complications.” Innovative data acquisition and processing John Kirkpatrick, joined by his colleague and data analyst, Laura Gilbert, conceived and developed a tailormade novel software application (App) for data collection. Prof Djukanovic explained: “This study was unique amongst the many COVID-19 trials conducted worldwide. Although it was conducted in particularly difficult times, unlike many COVID-19 trials, it was inexpensive and did not depend on complex and expensive research systems. “Instead of relying on expensive and complicated data collection platforms, investigators could use John’s app that was easy to use, requiring no more than a couple of minutes for each of the four pages to collect all the relevant data.” Enrolment into the trial started on in November 2020 and continued for 27 weeks. Dr Dhar said: “The trial was carried out in the midst of the deadly second COVID-19 wave in India and circumstances could not have been more challenging. This has been an excellent, pragmatic and very friendly collaboration by experts across multiple continents, and we are greatly encouraged by the findings for this well-known and widely available antibiotic.” Prof Gadola said: “The impressive results of this trial could have significant implications for both patients and health services, in particular in countries where, because of limited financial resources, ICU admission is dependent on accessibility and affordability rather than clinical indication. A similar study is now needed to seek evidence of treatment on mortality.”

Men being more active in health and nutrition can have long-lasting benefits for their partners and children, new research has shown. Southampton researchers were part of an international team that spoke to men in sub-Saharan Africa. They explored how they could be more involved in the health and nutrition of their partners and children. They found men wanted to take part more but were prevented by stigma and perceived gender roles. The results reinforce the importance of gender equality in maternal and child health. The study was funded by the National Institute for Health and Care Research (NIHR). Researchers have published their findings in BMJ Nutrition, Prevention and Health. Crucial first 1,000 days Pregnancy and early childhood are a critical period of growth and development. They can have long-lasting effects on families’ health and well-being. Researchers from the University of Southampton and University Hospital Southampton are studying these first 1,000 days after conception. This latest study interviewed men in Burkina Faso, Ghana, and South Africa. They were asked what motivated and restricted them from being involved in their family’s health. Dr Polly Hardy-Johnson, senior author for the study, said: “In sub-Saharan Africa and across the globe, gender and social norms may mean many men have little engagement with maternal and child health and nutrition. “If men are more involved, it can have a range of benefits. These include improving the neurodevelopment of medically at-risk infants and reducing the frequency of postnatal depression.” ‘Providers and advisors’ Prof Keith Godfrey, Professor of Epidemiology & Human Development and Nutrition, Lifestyle and Metabolism lead at the NIHR Southampton Biomedical Research Centre, said: “Our research revealed that men see themselves as largely providers and advisors within their families. This was common in both rural and urban settings. But they were keen to be more involved in their family’s health and nutrition. Similarly their partners said they would like men to be more involved in family life. “By challenging gender roles and gender health inequalities, we may be able to improve maternal and child health and nutrition.” Prof Shane Norris, Professor of Global Health, added: “This could be achieved by asking families to design ways to improve communication and help identify issues and solutions. This could include improving communication and decision-making between couples and increasing male support of domestic practices.” Global nutrition research The NIHR-funded research is part of the Southampton 1000 Days Plus Global Nutrition research group, led by Professor Kate Ward. This aims to address the UN’s Sustainable Development Goal to ‘achieve gender equality and empower all women and girls’. Southampton researchers in the study are involved in the NIHR Southampton Biomedical Research Centre, the MRC Lifecourse Epidemiology Centre, as well as from Medicine, Health Sciences and Social Sciences at the University of Southampton.

Southampton researchers are trialling a new combination of two COVID-19 treatments. The trial is being run by the Southampton Clinical Trials Unit (CTU). It involves researchers from the NIHR Southampton Biomedical Research Centre (BRC). Participants will take two antiviral treatments at the same time to see if this can help prevent serious infection. Increasing treatment options Professor Gareth Griffiths is the Director of Southampton CTU and an investigator in the respiratory theme of the BRC. He is part of the team launching the trial. "We have already seen successful clinical trials of single antiviral treatments for COVID-19,” says Prof Griffiths. “They reduce the risk of hospitalisation for unvaccinated patients and can shorten the duration of symptoms for those who are vaccinated. “However, there is concern that the virus may become resistant to these treatments, or they may not be effective against future variants. “We hope that this first trial to combine antiviral therapies could help to increase the options we have to combat this virus.” Combining therapies The trial is part of the AGILE drug testing platform. AGILE is a UK-wide collaboration of research partners. They aim to find new treatments for COVID-19 and fast-track them through early phase clinical trials. “This trial is the first to combine two different antiviral treatments, molnupiravir and Paxlovid,” says Dr Emma Knox, Senior Trial Manager at Southampton CTU and BRC. “Both treatments have already been shown to have some effect against COVID-19 in previous clinical trials. “This new trial will allow us to test the safety of combining the drugs. If successful, it will lead to a larger trial involving more people to test how effective it is.” Patients with confirmed COVID-19 will be invited to take part in the trial. This must be within five days of their symptoms starting. Professor Christopher Edwards is co-director of the NIHR Southampton Clinical Research Facility (CRF). Patients will come to the CRF to be seen by the research team and get their initial dose of the trial treatment. Prof Edwards said: “The CRF was involved in two previous AGILE trials, as well as other COVID-19 studies. "As the pandemic evolves, it remains important that we develop new ways to tackle COVID-19 as soon as people know they have it. This can help prevent serious infections and hospitalisation.” Working in collaboration The trial is part of a new collaboration between the CTU and BRC in respiratory clinical trials. Both research groups are experts in respiratory research. They are working together to develop future clinical trials which will benefit patients in the NHS. The NIHR Southampton BRC is part of the National Institute for Health and Care Research. It is hosted by University Hospital Southampton in partnership with the University of Southampton. Professor Mike Grocott, Director of the NIHR Southampton BRC, said: “The BRC are delighted to be involved in this latest trial in the AGILE COVID-19 platform. “We are working with the CTU to develop clinical trials in respiratory disease and critical care. “Finding new ways to tackle the COVID-19 virus is extremely important. This will help to ensure we have treatments that are robust enough to meet the global challenges of the pandemic.” This is the latest trial in the AGILE drug testing platform. It is a collaboration between Southampton CTU, University of Liverpool, Liverpool School of Tropical Medicine, the NIHR Clinical Research Facility UK Network, and other partners. Results from a previous AGILE trial were recently published in The Lancet. They showed that molnupiravir is an effective treatment for both vaccinated and unvaccinated populations, and against different variants of the disease.

Southampton researchers have discovered how bacteria that naturally live in some people’s noses may protect them against meningitis. New research led by Dr Adam Dale has revealed that Neisseria lactamica in the nose triggers an immune response that may protect against its meningitis-causing cousin, Neisseria meningitidis. The results could lead to the development of a new, cheap vaccine for places with high rates of meningococcal disease. Researchers have published their findings in The Lancet Microbe. The study was driven by the Southampton Controlled Human Infection Group (CHIG). It was conducted at the NIHR Southampton Clinical Research Facility and funded by the Wellcome Trust and the NIHR Southampton Biomedical Research Centre. Preventing meningitis in children Meningitis is an infection of the protective membranes that surround the brain and spinal cord. If not treated quickly, it can cause life-threatening infection and result in permanent damage to the brain or nerves. One bacterial species that causes meningitis, Neisseria meningitidis, commonly lives in the nose and throat without causing symptoms. It transmits through close contact and infections can be life threatening in those who do not have protective immunity. This is most common in babies and young children before their immune systems learn about the bacteria and can generate effective protection. There are vaccines that can prevent infections caused by N. meningitidis. The most effective vaccines offer protection against both disease and silent (asymptomatic) carriage in the nose and throat. Preventing silent carriage reduces transmission. If someone is not carrying the bacteria, they cannot pass the bacteria on. This is the basis of so-called ‘herd immunity’. However, not all N. meningitidis vaccines protect against silent carriage. This means they are not as effective as they could be if they were able to generate herd immunity. Dr Dale is working with other BRC colleagues in the Southampton CHIG, including Dr Jay Laver, Dr Diane Gbesemete and Professor Robert Read, to develop novel vaccine strategies. These would both protect against N. meningitidis colonisation and induce herd immunity. Uncovering the secret of natural immunity In previous work, the Southampton CHIG showed that experimental infection with the harmless N. lactamica protected against N. meningitidis. However, until now, it wasn’t clear what afforded this protection. Data from this trial suggest that immune responses made against N. lactamica are also able to target N. meningitidis. This is largely because the two bacterial species are closely related and share a lot of common features. In this trial, the researchers placed either N. lactamica or a placebo into the noses of volunteers. They then measured immune cells in their blood called plasma cells and memory B cells. In people that became colonised with N. lactamica, they detected cells that could target both bacterial species. This shows their body recognised N. meningitidis and could mount a quick defence against it, despite not having been infected with it as part of the experiment. In short, carrying N. lactamica gave them natural immunity against N. meningitidis. These data support the use of N. lactamica as a potential bacterial medicine to prevent meningococcal colonisation and induce herd immunity. Work is ongoing in the Southampton CHIG to assess whether safe genetic modification of N. lactamica can improve this protection further. They will then assess the real-world impact of this intervention on colonisation with N. meningitidis in both the UK and abroad.

Professors Keith Godfrey and Mark Hanson have co-edited a new book published by Cambridge University Press. Developmental Origins of Health and Disease (DOHaD) explores the relationship between early life experiences and adult health. It highlights scientific and clinical advances since a first edition was published in 2006. There have been important breakthroughs in areas such as epigenetics and environmental influences. There is also a new focus on the preconception period and the significance of paternal health. A new approach Southampton researchers are driving greater understanding of nutrition, lifestyle and metabolism in the NIHR Southampton Biomedical Research Centre. Their vision is to drive better health and care across the whole life course. This includes promoting the best start in life, and building resilience through childhood, adulthood and into later life. Prof Godfrey said: “Southampton is internationally renowned for its research establishing the DOHaD concept. The concept has stimulated a new approach to understanding disease trajectories, with major public health implications. “Research in the field has led to a 'lifecourse' approach that now influences international health policies. For example, it is the basis of major World Health Organisation initiatives. "The approach also has important implications that go beyond health. They are critical to tackling disparities in society and to our economic future.” Improving life chances The publishers describe the book as a 'definitive guide' on the DOHaD field. Prof Hanson added: “Southampton is at the forefront of research on the preconception period as a critical time to improve the life chances of the next generation. "This is an essential text for clinicians and scientists to improve their understanding of the developmental origins of health and disease.” The book, published this month, was co-edited by Sir Peter Gluckman (University of Auckland) and Professor Lucilla Poston (King's College London). The chapter authors come from a range of backgrounds. They include nutrition, endocrinology, developmental physiology and molecular biology.

A new study has shown the drug rituximab could help treat chronic lung disease in some people with fewer side effects. People with connective tissue diseases (CTD) can develop interstitial lung disease (ILD), a life-threatening condition that affects their ability to breathe. CTD-ILD causes inflammation and scarring of the lungs. The standard treatment is cyclophosphamide, but this often causes severe side effects. Rituximab is also often given to these patients, but until now there has been little evidence to support its use. New evidence from the RECITAL study now shows that, while both drugs improved patients’ lung function and respiratory-related quality of life, rituximab had fewer side effects. University Hospital Southampton (UHS) was the second of 11 centres in the UK to recruit patients into the study. The results are published in The Lancet Respiratory Medicine. What is connective tissue disease? CTD (Connective Tissue Disease) is a group of diseases that includes autoimmune diseases such as lupus, rheumatoid arthritis, systemic sclerosis, idiopathic inflammatory myositis, and mixed connective tissue disease. In autoimmune diseases, the immune system malfunctions and attacks the body’s own tissues, causing inflammation. In these conditions it is the connective tissues that are damaged. When this affects the lungs, it can result in ILD (Interstitial Lung Disease), causing the lungs to become scarred and inflamed. Providing another treatment option The standard treatment for CTD-ILD is cyclophosphamide. While this works, it comes with side effects. These include nausea, an upset stomach and blood in the urine. It can also stop the ovaries or testes working properly, sometimes causing infertility, and increases the risk of bladder cancer. This study compared the two drugs. Patients aged 18–80 years with severe or progressive ILD related to scleroderma, idiopathic inflammatory myositis, or mixed CTD took part. They were randomly assigned to either receive cyclophosphamide or rituximab. For 24 weeks, they did a regular test where they had to blow as hard as they could into a tube to measure their lung capacity. They also completed a questionnaire which asked about their quality of life. While both groups had improved lung capacity and a better quality of life after 24 weeks, those who took rituximab reported fewer side effects (445) than those receiving cyclophosphamide (646). They also took fewer steroids to help manage their condition. Dr Sophie Fletcher, UHS Consultant Physician and study co-author, said: “This study is immediately directly relevant to clinical practice. It provides evidence that both drugs are equally effective, but Rituximab carries less steroid related side effects.”

Southampton researchers have given new insight into the causes of bronchiectasis. The new research has revealed that an inherited condition is often underdiagnosed as a cause of the lung disease. Primary ciliary dyskinesia (PCD) is a rare disorder that gets worse over time. Researchers hope the study will encourage physicians and GPs to 'Think PCD'. This could help patients get the treatment they need more efficiently. The new study was driven by experts from the University of Southampton, University Hospital Southampton and the NIHR Southampton Biomedical Research Centre. What is bronchiectasis? Bronchiectasis is a long-term lung condition where the airways of the lungs become widened. It affects more than 200,000 people in the UK. Common symptoms include a persistent cough, shortness of breath and recurring infections. It can lead to progressive chronic lung damage. Improved social conditions and accessible health care mean infective causes of bronchiectasis are uncommon in the UK. There are many more genetic causes. These include cystic fibrosis, primary immunodeficiency and PCD. An underdiagnosed cause The study, published in the European Respiratory Journal, used data from the UK 100,000 Genomes Project. It recruited people with bronchiectasis but without clinical suspicion of PCD to find out if the condition is underdiagnosed. The researchers used whole genome sequencing. They identified variants responsible for causing the disease in motile ciliopathy genes in 12 per cent of patients (17/142). This confirmed a diagnosis of PCD. One person within the study had genetic variants in a gene that is important for the function of non-motile cilia, CEP164. The Southampton team also demonstrated that variants in CEP164 affect motile (moving) cilia found in the lungs. This was the cause of bronchiectasis in the primary study, adding to the genes known to cause PCD-like syndromes. The separate paper was published in Clinical Genetics. Jane Lucas, Professor of Paediatric Respiratory Medicine, said: “There are currently four national PCD centres in the UK – in Southampton, Leicester, Leeds and Royal Brompton London. But without a diagnosis of PCD, patients do not have access to their NHS specialist multidisciplinary teams to optimally manage their disease. She added: “Our research highlights the need for pulmonary physicians and GPs to investigate the underlying cause of bronchiectasis. In the case of PCD, the history typically includes a daily wet cough from infancy, neonatal respiratory distress, rhinitis, glue ear and rhinosinusitis. “Half of patients also have situs inversus, a rare genetic condition in which the organs in your chest and abdomen are positioned in a mirror image of normal human anatomy. “With more genetic testing we will be able to identify bronchiectasis in more patients and ensure appropriate treatment is given to those who need it.” Katie Dexter, from PCD Support UK, was diagnosed with PCD in her late teens. She commented: “This study confirms PCD Support UK’s concern that many with bronchiectasis have undiagnosed PCD. Without a diagnosis of PCD, individuals are likely to be excluded from accessing comprehensive specialised PCD care and risk experiencing poor long-term management of the condition. “As a patient without heterotaxy, I did not receive a PCD diagnosis until my late teens. However, I was tested for cystic fibrosis (CF) around age 11. If CF was considered, then why not PCD? The answer is simple: my physicians were not aware of PCD. “PCD Support UK are hopeful that this study will help raise awareness among physicians of the urgent need to 'think PCD' as a potential underlying cause of bronchiectasis.” Image credit: Ciliated airway cells. Courtesy of Jane Lucas.

Southampton researchers have developed a new website to help improve eczema in children and young people. Hundreds of families and under 25s have trialled Eczema Care Online in nationwide research, with many showing significant improvement within the study year. The website was built using LifeGuide software supported by the NIHR Southampton Biomedical Research Centre. LifeGuide allows researchers to easily create and test websites to support healthy behaviour. What is eczema? Eczema is a condition that causes the skin to become itchy, dry, cracked and sore. It is very common and can have a large impact on quality of life and costs to the NHS. However, treatments can be complex, and people often don't receive enough advice about how to use them. Miriam Santer, Professor of Primary Care Research at the University of Southampton, is lead author of the study. She said: “Eczema can be a debilitating condition for so many people, especially children and young people. "This website gives both patients and clinicians evidence-based resources that have been shown to improve symptoms.” Support for young people The website aims to help young people with eczema and parents or carers of children with eczema to manage their own condition. It explains what eczema is and how to use eczema treatments. It also provides information on how to avoid potential trigger factors and support for living well with eczema. The study, published in The BMJ, had 650 participants. Some had access to the website alongside their usual care, and others received usual care alone from a clinician. Those who accessed the website had improved symptoms after six months, compared to those who received usual care alone. The improvements continued for another six months. The study also asked for feedback on the website, which was very positive. One participant said: “It was one of the best websites I’ve ever used; it was really easy to use and provided the answers to your specific questions. I didn’t have to read through lots of stuff that wasn’t relevant to me.” Positive clinical outcomes The researchers say that empowering parents and young people to take ownership of the condition can lead to sustained positive clinical outcomes at an affordable cost. They have made the resource free to use for anyone. Professor Santer said: “Unfortunately, health professionals often don't have enough time to go into all the details about how to look after eczema. People with eczema and their families often report they have been given insufficient information about the condition and how to manage it. She added: “We hope that the website will be rapidly rolled out within the NHS to provide effective help for eczema without causing extra workload for staff.” The study was funded by the NIHR Programme Grants for Applied Research. It was a collaboration between the University of Southampton, University of Nottingham, University of Bristol, University of East Anglia and London School of Hygiene and Tropical Medicine. In Southampton, it involved researchers from the Primary Care Research Centre and Psychology.