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Crohn's Disease Forum » Parents of Kids with IBD » Immune system when ill


04-21-2014, 08:50 AM   #1
Firecaptain2009
 
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Immune system when ill

Ok, so here is a question I can't seem to get an answer for:

When my son is beginning to come down with a cold, do I try to boost his immune system?

In the past, and currently with all the family except C'b, we use products such as "Airborne" or extra vitamins during times of illness. But, Crohns is the immune system ramped up, right? So he is on Remicade to suppress it…so do I want to rev it up when he is getting sick?

I hate trying to distinguish Crohns symptoms and illness!
04-21-2014, 09:13 AM   #2
Tesscorm
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I'll be interested in what others have to say about this too. I know when my son started on remicade, the specialty pharmacist called with some basic info, she specifically mentioned to avoid immune boosters such as ginseng, Cold FX, etc. for the exact reason you mentioned. She did say that a rule of thumb would be that supplements of things found in typical foods would be okay (ie vitamin C = oranges), however, I haven't given my son any extra supplements when he's caught a cold/flu.

My son has had a couple of colds since being on remicade but has used only tylenol if he had a bit of a fever or headache. I'm not sure how young your son is but mine is 19 so he does understand the need to, perhaps, grin and just work through some of the effects of a cold/flu.

I find lemon tea with honey is quite helpful at alleviating some of the general 'sick' feeling that comes with a cold... but, again, not ginseng tea.
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Diagnosed May 2011

Treatment:
May-July 2011 - 6 wks Exclusive EN via NG tube - 2000 ml/night, 1 wk IV Flagyl
July 2011-July 2013 - Supplemental EN via NG, 1000 ml/night, 5 nites/wk, Nexium, 40 mg
Feb. 2013-present - Remicade, 5 mg/kg every 6 wks
Supplements: 1-2 Boost shakes, D3 - 2000 IUs, Krill Oil
04-21-2014, 09:14 AM   #3
Clash
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Hi my son has been on remicade as well. I have no advice about boosting immune but I'm going to tag Tesscorm because I do believe this question came up for her and she had a discussion with her doc about. I know there are some things those on remicade may need to steer of.
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C age 19
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Dx May 2014: JSpA
8/2014 ileocecectomy
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04-21-2014, 09:14 AM   #4
Clash
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Haha Tesscorm you were too quick for me!
04-21-2014, 09:30 AM   #5
Mehita
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My son is on Remicade too and I've been told not to do or give anything that boosts the immune system. I don't even do vitamin C, but I won't stop him from eating a ton of oranges if that what his body is craving.

About a month ago my son had his first cold on Remi. He came home from school and was all stuffy and runny. Little bit of a cough, sneezing. Typical cold symptoms. Being a Friday night I thought it would be silly to call the on all GI, but I had no idea what I could give him, so I told him to just drink tons of water. He took it to heart and drank several gallons over two days, but by day three the cold was complelty gone. The water flushed it out. I was very surprised, though very happy too!

I'd check with your doctor, but I wouldn't encourage anything that boosts the immune system. If you're into homeopathic meds or essential oils, be careful there too. There is a one essential oil in particular (sorry, the name escapes me) that should never be used while on Remicade.

Hope he feels better soon.
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Mom of DS, age 17, dx Crohn's and Celiac Oct 2008
- Remicade, started Nov 2013, added Solumedrol June 2015
- added Methotrexate/Folate March 2016
- Multivitamins, Probiotics, Vit D
- Small bowel resection, Jan 2013
04-21-2014, 11:31 AM   #6
kiny
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But, Crohns is the immune system ramped up, right?
I don't believe so. There is a considerable amount of immunodeficiency in crohn's disease, crohn's disease involves innate immunodeficiencies. I don't know if it helps, I always wanted to test myself by writing it all down.

The immune system has 2 tasks. Immunological recognition (detection) and immune effector function (containment and elimination).

*Our first line of defense to invasion is the physical barrier and the release of certain types of proteins that are secreted, especially in the intestine.

If the invader actually manages to bypass those defenses, the innate and adaptive immune system come into play.

-The innate immune system , a very old type of defense, almost all animals have a form of this immune system. It's an extremely fast response that happens within hours after infection. The main weapon of the innate immune system are white blood cells called phagocytes, particularly macrophages and neutrophils. They will literally ingest the invader and eliminate it. The macrophages and dendritic cells also produce signaling molecules, they come up a lot, they're called cytokine (one of them is TNF-alpha). They signal other immune cells, and they can signal the brain to induce a fever to help kill bacteria, they help immune cells talk to each other. Macrophages are present all over the body, especially the intestine is lined up from top to bottom with inactive macrophages, ready to defend it. They live quite long compared to other white blood cells, they are matured monocytes. They are one of the key elements in crohn's disease.

--dendritic cells--

-The adaptive immune system, this is an extremely specific immune system that tends to take days to respond. Dendritic cells from the innate immune are the main link to the adaptive immune system. Dendritic cells (and to a much lesser degree, macrophages) set off the adaptive immune system. Dendritic perform what they call "antigen presentation", they are antigen presenting cells, APC, they present the invader to the adaptive immune system, and they do this by travelling to lymph nodes. The cells present this antigen to, extremely important cells, lymphocytes. Specifically T cells. T cells constantly travel in lymphoid organs, they are called "naive T cells" when they're not active. Once they are activated, the effector T cells start travelling quickly to the tissue where the initial bacteria or infection is taking place, "lymphocte migration". CD4+ T cells help macrophages of the innate immune system kill microbes by activating them, and CD8+ T cells kill infected cells themselves.
There is another part of the adaptive immune response, and that's the humoral response, consisting of B lymphoctes. B lymphocytes recognise antigen and are most active against certain microbes and toxins. Helper T Cells can activate them and they expand extremely quickly, thousands per second. Many of those B cells then start to secrete "antibodies", those antibodies can "tag" certain microbes "opsonize" for phagocytosis.
Certain immune systems also have a "memory", the second time they encounter those invaders, they will respond much quicker than the days it took to activate the adaptive immune system. Vaccinations exploit this by letting the body recognise certain types of infections.

I posted a picture of an APC in the Wiki forum once.




In crohn's disease, the innate immune response seems to have issues correctly recognising and eliminating those bacteria. NOD2 and ATG16L1 and many other gene mutations result in issues when macrophages try to eliminate these bacteria. Autophagy has been recently recongised to be very important to eliminate those bacteria. What people assume happens in crohn's disease is that the innate immune system is not capable of eliminating those bacteria, the adaptive immune system is activated by an APC, antigen presenting cell, T Cells are activated, those T Cells try to activate more macrophages, those same macrophages can not eliminate the macrobe, more APC arive in the lymph nodes, activating more T Cells, and you get a viscious circle of continuous immune activation. So the treatment in crohn's disease revolves around, controlling that immune response by immunosupression, and elimination of bacteria through antibiotics.

Another way is simply stimulating the innate immune system and autophagy...this would be the preferred solution...and people with crohn's disease actually already do this...this is why we take vitamin D or make sure out vitamin D is optimal, it appears that vitamin D stimulates autophagy through NOD2 and ATG16L1 and thereby helps us eliminate bacteria, partly correcting the innate immunodeficiencies. And studies looked at this, and I have linked this, and for example, vitamin D helps clear AIEC in crohn's disease, invasive E coli specific to crohn's disease.

So our immunse system is not "ramped up", it is more that we are "immunodeficient", specifically, we have innate immunodeficiencies, and our adaptive immune system is likely chronically stimulated.


Once you have that part down, you can easily start to understand crohn's disease studies that start to talk about those innate immunodeficiencies, it is often more specific, it is often called autophagy deficiency, or macrophage deficiency, commonly it is just referred to as innate immunodeficiency in crohn's disease. A lot more studies that seem very complex will start to make sense rather quickly, it only takes very limited knowledge about how the immune system works to start to understand what most studies trying to unravel the cause talk about.

It also becomes easy to understand why people are interested in bacteria like AIEC and MAP now...those bacteria are bacteria that are capable of exploiting those innate immunodeficiencies, in fact AIEC's main forte is exploiting autophagy weaknesses.

It's also easy now to understand why many researchers, much more so than GI, talk about diseases that have at first glance, little to do with crohn's disease. Diseases like HIV and chronic granulomatous disease. These diseases are important, because they involve specific immunodeficiencies, and they can teach us about crohn's disease, and what happens when an immune system is compromised. In HIV the immunodeficiency revolves around those T cells I mentioned, same thing with lymphopenia. In fact many people with crohn's disease have lymphopenia.



-

Last edited by kiny; 04-21-2014 at 11:55 AM.
04-21-2014, 12:10 PM   #7
Tesscorm
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Kiny- Thanks so much for that explanation!!
04-21-2014, 12:14 PM   #8
kiny
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In regards to the vitamin. There is no issue using vtamin C or E in crohn's disease. In fact I would like to think this would be helpful if anything. Much of the actual physical tissue damage in crohn's disease is from oxidative stress.

While antioxidants in the media get overhyped a lot, they serve a real function in crohn's disease. People with crhon's disese tend to have chronically stressed tissue, and vitamin C and E will help. In fact there are studies about this for crohn's disese, I have linked them in the past, they know people wtih crohn's disease are often under oxidative stress, by measuring peroxide, and vitamin C and E should help.

Regarding "boosting off immune system" of those vitamin, that would first require we have a "boosted immune system", some GI who haven't studies the immune system keep wrongly repeating this, it doesn't make it true. And these vitamins probably help us combat oxidative stress. There is no reason why people with crohn's disease couldn't take vitamin C or E.

study: http://www.ncbi.nlm.nih.gov/pubmed/12591053
04-21-2014, 02:25 PM   #9
Crohn2357
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Kiny, thanks.
04-21-2014, 03:36 PM   #10
Jmrogers4
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Thanks Kiny, best and easiest to understand immune description.
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Mom to Jack (18) dx Crohn's 2/2010
Vitamin D -2000mg
Remicade - started 1/9/14; 7.5ml/kg every 6 weeks
Centrum for Him teen multivitamin
Past meds: Imuran/Azathioprine; allopurinol; methotrexate; LDN; Prednisone; Apriso; Pentasa; EEN

Husband dx Crohn's 3/1993
currently none due to liver issues
04-21-2014, 09:38 PM   #11
Firecaptain2009
 
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Wow. Thank you. That is a great explanation of the immune system, Kiny. Makes me want to read up on that more! Maybe we can optimize our son's treatment a bit more.
04-22-2014, 03:47 PM   #12
DustyKat
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I am on the fence about this and so do nothing in particular to boost the immune system.

There is another train of thought to the long established one of IBD being a result of an overactive immune system. It is the one that Kiny has so eloquently laid out. That being that it is actually an under response to attack.

Vitamin D regulates the immune system. Magnesium increases the activity of the immune system. Zinc plays a vital role in fighting infection by preventing the immune system from becoming overwhelmed. This being the least each these vitamins and minerals play in supporting a normal immune system and response and there certainly appears to be a co dependency on each other. Add to that the fact that many people with Crohn’s are deficient in these three things I personally don’t find it difficult to take the under response theory as being credible.

*When I say deficient I am also saying that what are deemed normal reference ranges for the general population, and so low ranges within this standard are acceptable, that isn’t the case for those with Crohn’s. I must add here that this is my opinion.

Dusty. xxx
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04-24-2014, 12:50 PM   #13
CrohnsKidMom
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I just had my kids in to see our GP yesterday to get (or at least talk about) the new Bexsero vaccine for Meningitis B. I happened to ask if my son should take some kind of immune booster. Other than regular vitamins and minerals, which my son already takes, she said he shouldn't take anything else and she wasn't even sure they really do anything for anyone anyway.

Having said that, she also didn't know much about the Bexsero vaccine, and had to google it with me there. That gave me loads of confidence! She didn't think it was approved for use in Canada yet, so I should wait a month or 2 before getting my prescription filled. But it is approved. (Sigh.) May be time for a new GP...
04-24-2014, 02:22 PM   #14
Tesscorm
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Scary, isn't it!!! When my son was going to Dominican Republic last year, it was only months after he'd started remicade, so I sent an email to his GI asking if there were any precautions we should take. His answer was to go see a travel doctor for his recommendations but to let him (GI) know before I gave S anything. Travel doctor, who gets paid per vaccine , had a whole bloody list of vaccines he thought S should have and, when I said I had to check with GI, he actually got mad at me! Anyway, sent GI an email with recommendations and my reasons for questioning them. At the same time, did some of my own checking and S had been vaccinated for a number things that the travel dr had recommended (even though I had given him S's vaccination record). However, this was the doctor who did test S for MMR which came back showing S did not have immunity to mumps.

So, since I thought the travel dr was full of and still waiting for the GI to reply, we went to see an Infectious Diseases specialist who my mom knew - she agreed that S did not need all the vaccines travel dr had recommended but felt strongly that S should have protection for malaria. Unrelated to the travel but, in conversation, it came up that S had reacted to Cipro at one time - she suggested he try again and that I could just try to give it to him at home (didn't do it!!! ! was afraid of a more serious reaction!!!) and suggested he have the MMR vaccine even though he was on remicade! (This was an ID specialist who was, at one time, apparently, head of an ID dept at a local hospital and was on CNN during the SARS outbreak! ) She also prescribed doxycyclin(??) as a prevention for malaria. Doxy.. has been linked to crohns onset! (Guess the 'onset' risk was gone but still!!)

So, while waiting for the GI to reply, sent him another email with these new recommendations! (It's no wonder if he thinks I'm a pain in the ass!) GI agreed with all my 'disagreements' of the other doctors' recommendations! In the end, S had NO vaccines and only took a prescription from the GI for antibiotics in case he should develop some sort of GI infection/bleeding while away!

It's no wonder we all become neurotic!!!
04-24-2014, 02:55 PM   #15
Tesscorm
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Oh, and the kick-you-in-the-butt moral of the story... after all my attempts at precaution and advice - what to eat, wear sunscreen, etc., etc., S still ended up in the hospital in Dominican Republic! He slipped, dislocated his shoulder, ended up having x-rays, needing general anesthesia to pop shoulder back in, being wrapped up like a mummy and being pulled aside by customs/security officials in DR because they thought he might have hidden something in all his wrapping!

So, no matter how much you think you prepare...
04-24-2014, 04:29 PM   #16
CrohnsKidMom
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Thanks Tess, I actually thought of your MMR story while at the GP's yesterday. I mentioned that once my son(s) is vaccinated for Men B, I would like his immunity tested for all diseases he's been vaccinated for. She said, "oh, once they're vaccinated you can be pretty sure they're immune." Right.

Hope you're son's shoulder healed ok and he's doing well now. And you gotta love Customs. I have stories there too...But that's for another thread...
04-25-2014, 08:07 AM   #17
Mehita
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She said, "oh, once they're vaccinated you can be pretty sure they're immune." Right.
Ha! No Hep B immunity for DS. He had a big fat zero when they checked his antibodies. We did a booster. Still zero. Apparently 10% of the population falls into this category which I find somewhat alarming. Pretty sure? I'd like to know FOR SURE, thankyouverymuch.

Mini rant over.
04-25-2014, 09:45 AM   #18
Tesscorm
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Mehita - Was he already on an immunosuppressant? The ID specialist did tell me that if you are on an immunosuppressant, the regular vaccine dosage may not be enough as your suppressed immune system does not react as it normally would. She did recommend that S have immunity levels after all vaccines while on remicade and have boosters if necessary. (And, of course, then there are the other 10% who just don't develop antibodies to the vaccines. )
04-25-2014, 10:45 AM   #19
Mehita
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The first time around he wasn't, but for the booster he was on Azathioprine. Hmmm, interesting. Thanks, Tess.
04-25-2014, 11:31 AM   #20
DanceMom
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Mehita - Maybe I've asked this before, but have his Immunoglobulin levels been checked? How soon after the booster did they check antibody levels?
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04-25-2014, 04:20 PM   #21
DustyKat
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Tess is right about vaccine response and immunosuppressives.

As to seroconverting, well yeah, some people will not respond to a vaccine at all and still others will only have a partial response. It is another reason for the herd theory.

I didn’t seroconvert to Hep B after two attempts and after three BCG (TB) vaccines they couldn’t get a positive mantoux test from me so just rolled their eyes and said…you must be immune by now!

Dusty. xxx
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