Hookworms and allergies, natural fallacy or good idea?

Hookworm_LifeCycleThere has been a surge of press recently on hookworms. But the press has not been covering any sort of First World outbreak of this Third World affliction. They have made little mention of the dangers to children and pregnant women who are infected with hookworms including anemia, protein deficiency, abdominal pain, and diarrhea. Nope, instead the press is covering a recent interest in using hookworm to suppress allergies.

The idea, based on research by David Pritchard, an immunologist-biologist at the University of Nottingham, is that parasites like Necator americanus, or hookworm, that live inside other animals have to have some serious weaponry to battle the host’s immune system. One tool in their arsenal may be to release agents that simply suppress the immune response of the host. This idea occurred to Pritchard while thinking about the prevalence of allergies and other auto-immune disorders in the First World compared to the Third World. Now immunology is really not my forte, but here is my elementary-level understanding of how our immune system works: White blood cells and the histamines and antibodies they produce are terrific at attacking foreign crud in our bodies, be they viruses, bacteria, parasites, pollen, or whatever. Additionally, our immune system also has the onerous task of not only specifically identifying what they should kill, but also what they should not kill, i.e. our own tissues. Auto-immune disorders are usually an indication that there is a problem in the immune system such that the line between Self=Good, NonSelf=Bad becomes blurred and murky. For instance, alopecia areata, a type of hair-loss that is not due to male pattern baldness, is thought to occur when a person’s immune system begins to attack their own hair, obviously erroneously. The flip side is that the histamines that are produced by our immune system as it fights foreign invaders like pollen can cause the watery eyes and mucus associated with allergies.

So, get yourself infected with hookworms that pump out immune suppressants and goodbye allergies and auto-immune disorders, right? That is what Pritchard and others who have prematurely jumped on this panacea band-wagon are saying. Aside from infecting himself, I believe that Pritchard is following the normal chain of basic research and clinical trials necessary to uncovering how hookworms handle their hosts’ immune system. But others, like Jasper Lawrence who was featured on This American Life this week, are bypassing these steps. Check out his slick website that does not mention hookworms anywhere on the front page  or the story of his escapades stomping barefoot through latrines in African villages until he was infected with hookworm. Oh, did I fail to mention that hookworm bores up through the soles of your feet until it settles in your gut to thrive, be pooped out, and spread to anyone who comes in contact with your pooh? Yeah, neither does he on his website.

The trick here is that Pritchard and Lawrence are probably right, an infestation of hookworm may well diminish your allergies because they are suppressing your immune response.* However, we have many, non-parasite options that do the same thing! We currently treat allergies and auto-immune disorders with drugs that suppress our immune system. Histamine blockers like Claritin and Benadryl do this, as do steroids like corticosteroids which we tend to apply as creams to rashes and such. Aside from the ick factor of worm infestation, the necessity for such a drastic and possibly dangerous treatment  when we have a large variety of drugs that do the same thing utterly escapes me. (Have you already guessed from where Lawrence harvests the hookworms that he sells? Yes, his own feces.) I can only chalk it up to a sort of demented natural fallacy: infestation with parasites is more natural, and therefore better, than non-infestation with parasites.

I am not one to shy away from a conversation about poop. In fact, my dissertation is largely based on poop. So if you can make an argument for why infecting yourself with a parasite that is transmitted via feces would be a better treatment for seasonal allergies than a Benadryl and a tissue, please enlighten me.

*Recent research on the powers of hookworm:

David I. Pritchard, Doreen S. W. Hooi, Alan Brown*, Moses J. Bockarie, Rebecca Caddick, and Rupert J. Quinnell (2007). Basophil Competence during Hookworm (Necator americanus) Infection. Am. J. Trop. Med. Hyg., 77(5), pp. 860-865

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11 comments to Hookworms + allergies, natural fallacy or good idea?

  • I bet hookworm helps you lose weight

  • Anna

    You over-estimate the effectiveness of current allergy medication. I’ve suffered from severe allergies and asthma since childhood. After seeing an allergist and trying every available mainstream treatment (inhalers, pills, allergy shots, topical steroid creams for eczema, etc.), I am intrigued by this hookworm idea. Ideally, scientists would find out exactly how the hookworm interacts with our immune system to prevent allergic reactions, and that information could lead to new, and better, medications.

    It’s important to remember, though, that all medicines have side effects. Although having too many hookworms in your system can be harmful, so can mainstream allergy meds. Because hookworms can’t reproduce inside your body (and the likelihood of anyone stepping in your poo in the US is pretty small), doctors could easily control the amount of hookworms used for treatment. (It’s also very easy to terminate treatment.)

    It sounds like you find the idea of parasites just icky, and of course, it makes us squeamish – we’ve been trying to eradicate them for the last hundred years. But for almost all of human history, people have lived with little critters inside them. Understanding exactly how they interact with our bodies holds enormous potential, for both science and medicine.

    • Laura

      I so agree with Anna. My son is twenty-two years old and has suffered horribly with allergies and asthma since he was two. He’s such a trooper and doesn’t complain when an allergen causes him to sneeze one hundred times in a row, disrupting classrooms and his life. He’d had allergy shots up until he started college. In addition to this he took long-term allergy medication. When he had frequent “break-through” allergy attacks, he took benadryl which would make him fall asleep in class. He uses Advair and other inhalers ad nauseum. I’ll be quite honest, if I had the finances, I’d send for hookworks and apply them myself. I would love to see him get relief and normalcy.

      • I want to stress here that, while I am sympathetic to allergy sufferers (I too have a family member that suffers from severe allergies), the point of this post is to call attention to a theory that has not been replicated or rigorously tested. There have been NO sanctioned and supervised clinical trials using hookworm to treat the symptoms of allergies. In addition, the dangers and health risks that hookworm pose are well understood and documented. As I pointed out in this post, researchers are actively testing theories about the relationship between hookworm and allergies and the evidence may show that the benefits of their use outweigh the risks, but it is important to be able to make an informed decision once that evidence has been collected. Certainly there are cases where current treatments are not sufficiently handling the ailment, but the purpose of this blog is to encourage folks to think critically and seek out scientific evidence before jumping on the next health fad.

  • Lisa

    I agree with Anna. This would not be used to treat seasonal allergies. There are people out there who can’t live normal lives because of life threatening allergic reactions. No amount of medications currently on the market can treat allergies this bad. For some people this really may be an option.

    My allergies are not severe enough to consider worm therapy but I’m very interested in whatever drug comes out of this research. Usually the side effects of taking allergy medication is just as bad as the allergies themselves. Any new meds that actually work will be welcome news.

  • For a similar example, you may want to google ‘maggot therapy’.
    Each therapy involves a certain degree of risk. The risk of a parasite therapy is not only the harm the parasite can do to the patient but also the perpetual spread of infectious agents that might harm other people. Maybe sometimes we will come up with a genetically engineered worm that can reproduce only under laboratory conditions and easily rinsed from the bowel as maggots from a wound.

  • Christian

    You have to bear in mind that drugs against allergies are very ineffective and some even dangerous. I use histamin blockers and I can assure you that they are not strong enough to really suppress your immune response. Corticosteroids taken in large doses have serious side-effects as they destroy your bones, muscles and kidneys. If it was possible to obtain these worms, I would have little hesitation to use them. (I am sorry for my poor English, but I am German).

  • Page, how about an article about windbags with blogs who pontificate without doing any research?

    Take Claritin, the research that lead to its approval showed it only about ten points more effective than a sugar pill at controlling symptoms of allergy. On the basis of this we have a multi billion dollar branded and generics market in that one drug. I think the scientific orthodoxy you like so much came up with that, and VIOXX, and Phen-Phen, and Thalidomide, etc.

    In the meantime there is a growing epidemic of diseases like allergy that have quite obviously been created by modern medicine and science, most of which are related to excessive hygiene. Meanwhile there are no answers from, and precious little understanding by, the mainstream scientific and medical community, about what caused this epidemic of chronic progressive and unresponsive diseases involving immune dysregulation or autoimmunity, and certainly no therapies that are not dangerous and expensive. Far more so than hookworm, not even close.

    Nor is allergy only about sniffles that can be handled with Benadryl and a tissue, which makes one sleepy and dopey besides. If that were all it was I would not have gone to Africa.

    I suggest you read a parasitology text and perhaps the CDC website, where if you are resourceful enough, you will find a diagnosis and treatment algorithm for US doctors for hookworm infection. Lower left under light infection you will see that the recommendation is to not treat.

    Your skepticism, so called, looks to me like a knee jerk defence of mainstream scientific views, although in this case you are woefully ignorant even of those. You express opinions forcefully but did no research for this post that I can discern. Grabbing a graphic off the CDC website for the lifecycle of hookworm infection doesn’t count, no.

    Lets see, doesn’t proliferate in the host, causes no symptoms even in moderate infections after the initial immune response to first exposure, does not cause pathology except in very large numbers or in conjunction with malnutrition, problems caused all relate to anaemia a slow to develop condition that is only lethal to the world’s poor. No evidence it can act as a vector for other pathogens, does not mismigrate, easy to eliminate within 24 hours with a pill off-patent for forty-odd years, dosing interval of once every five years on average. Has been studied since being identified in the mid 19th Century.

    Not my opinions, but scientific orthodoxy regarding hookworm infection in man.

    Oh, and it works. Gosh, almost forgot that.

    Is “slick website” meant as a perjorative?

    I got this email from a client who had Relapsing Remitting MS today, we provided him with hookworm on the basis of good research I am happy to provide, in 2008, summer of:

    I just recently had a brain MRI and I wanted to share the great results with you. This is the letter from my neurologist:

    “Just a short note to let you know about the results of your recent MRI of the brain done 5/30/10. We were finally able to get it compared to your previous MRI done 6/22/07 done at Kaiser Woodland Hills.
    Here’s a copy of the report:
    “Comparison exam dated 6/22/07 from outside institution is now available for review. Compared to this study, a lesion in the lateral aspect of the right thalamus has significantly decreased in size. A previous lesion in the right brachium pontis is not seen. Other white matter lesions are without significant change. Hyperintensity in the left optic nerve was not definitely seen on the prior but this area was not seen clearly given technique. No new lesion has developed.”
    So things are actually improved and no new lesions are seen! This is great news! I think we can safely reduce your Copaxone to every other day provided you have an annual MRI. What are your thoughts?”

    This is about far more than allergy, and you owe it to your readers to do the subject justice instead of sneering at me or Pritchard on the basis of profound ignorance.

    • One other thing that grabbed my attention when rereading your post.

      The introduction and use of toilets is sufficient to break the life cycle of hookworm or whipworm in any society. Even a tropical or subtropical one where they are endemic.

      Meaning in the US the risk of accidental infection is zero, unless you live in the South East, are in the habit of defecating outdoors and your friends or neighbours are in the habit of then coming into bare skin contact with faeces contaminated soil about two weeks later.

      You can come into direct contact, or ingest, the faeces of an infected individual for a week or more after they defecate without risk of infection with hookworm.

      Pathology related to hookworm given this, and the low cost of elimination, is more correctly associated with poverty. The kind that means you don’t have shoes or access to a toilet. Or, that you cannot afford a pill that costs perhaps $3 in the tropics.

  • Mathilda

    Firstly; becoming infected with hookworms requires that the poop be left in a very warm place to incubate for a prolonged period of time. Even the most basic hygene measures (using a lavatory) make transmission extremely unlikely.

    Secondly; low level infestations with hookworms have minimal to nil symptoms.

    Thirdly; antihistamines do not have a sufficient efffect for many allergy sufferers. The only alternative is steroids- not something for long term use. Allergies kill a lot of people. Anything that reduces them is a life saver.

    Fourth: hookwork and other parasites sbdue the autoimmune response that causes untreatable illnesses like MS and Crohns disease. I have MS, I’d like to be able to walk and see in ten years time.

  • Raina

    Have any of you long time allergy sufferers had an immunoglobulin E, G or A test for common food allergies? My tests just came back extremely positive for reactions to eggs, wheat, dairy, beans – all of which give me hives and other nasty reactions – and, I also tested positive for hookworms. I have not had hookworms my whole life, and since my infection, my reactions became so terrible my doc and I were suspecting cancer or worse.

    The therapy may have merit… but before randomly infecting yourself with hookworm, realize that it could also make your allergies more severe.

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