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The Immune System
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LifestyleTranscript
00:00Your immune system is mercilessly efficient, with certain cells dedicated to devouring
00:11pathogens and others that seek out and destroy anything in the body that doesn't belong.
00:17But sometimes your defenses get confused, sounding the emergency alarm even with harmless
00:22intruders like dust or pollen, or they attack your own organs like the skin or thyroid.
00:29Felice's immune response was so extreme that he almost suffocated to his mother's horror.
00:35I was thinking, we're not going to make it.
00:39Could the mystery allergy be stopped?
00:41That and more on In Good Shape.
00:44Felice Portelli has always loved speeding along on his motocross bike, up, down and around
01:04dirt racetracks.
01:05He lived in Italy until the age of 12 and continued to spend his holidays there after
01:12his family moved to Germany.
01:14But after one summer, something wasn't quite right.
01:18Easy, give me the bike and hold on to me.
01:26After the vacation in Italy, he said, Mom, I don't feel good.
01:31He couldn't breathe properly.
01:36It feels like your lungs are contracting and you quickly get out of breath.
01:41Felice had already been to see a doctor while still in Italy, who diagnosed him with allergic
01:46asthma.
01:47But once back in Germany, his condition deteriorated further.
01:51It got worse by the week.
01:55He didn't want to go riding on his motorbike anymore, or do anything in fact.
02:09His concerned mother called the family doctor, who didn't consider things to be dramatic.
02:16He advised her to increase the dosage of Felice's asthma medication.
02:21But he didn't get better.
02:23On the contrary.
02:25He started coming home early more often, or not going to school at all, because it was
02:32too much.
02:33Eventually, he grew so short of breath, he couldn't even walk up or down the stairs.
02:40Still one fateful night.
02:42His father was out at work, while his mother Mandy was already in bed.
02:47Felice collapsed in the bathroom.
02:50He couldn't breathe at all, and was just gasping for air.
02:59That's when I really panicked, and I called an ambulance.
03:02Felice's blood oxygen saturation level was just 86%, way below the normal level of 98.
03:14He was rushed into hospital due to a suspected asthma attack.
03:18Asthma causes the mucous membranes in the airways to swell and constrict, letting very little
03:23air pass through, and that in turn can mean not enough oxygen reaching the bloodstream.
03:30This can take a dramatic turn, to a point where children and teenagers end up in intensive
03:35care, and every year we still have asthma-related deaths in Germany.
03:40Dr. Maren Dietrich prescribed cortisone, hoping to stop the allergic reaction in Felice's
03:47airways and relax the bronchial muscles.
03:51Once the immediate danger was averted, the doctor switched the young man to a more effective
03:56asthma medication, then monitored him to ensure his oxygen levels rose back above 95%.
04:06A week later, Felice had recovered.
04:08His oxygen saturation was back up to 97%.
04:12In addition to his asthma spray, the 15-year-old now also had emergency medication, in case he
04:17had another attack.
04:21But he and his parents hoped he wouldn't need it.
04:25I thought, OK, it's over.
04:31Things are looking up again.
04:33But just a week after Felice came out of hospital, the nightmare resumed.
04:40One morning, his mother found him in bed, gasping for air.
04:44She immediately gave him the emergency spray.
04:48I started crying, it's my son we're talking about.
04:57That same morning, she took Felice to see a lung specialist.
05:01But he couldn't even manage the few steps up to the entrance of the practice.
05:08His mother declined help from a stranger, but internally was starting to panic.
05:16That was the worst part, thinking, we're not going to make it.
05:23Stay tuned to find out what happened next and what was causing the serious attacks.
05:28Typical suspects are pollen, animal hairs, and dust mites.
05:33When the immune system targets the airways, symptoms range from an itchy nose and watery
05:37eyes to respiratory problems and fatigue.
05:42Allergies and similar disorders are on the rise worldwide thanks to climate change and
05:46air pollution.
05:48And treating allergies takes lots of patience.
05:54Getting a shot containing allergens was a last resort for Erma Bornhoeft.
06:00Before being given the treatment by her ear, nose and throat doctor, the symptoms from
06:03her allergy to dust mites had grown pretty severe.
06:09I had this constant runny nose.
06:11Right after getting up, it would be completely blocked and I had difficulty breathing.
06:17The idea now is to fool her body with a three-year desensitisation therapy.
06:25Basically we're reprogramming the immune system.
06:29In patients with allergies, the immune system has taken a wrong turn somewhere.
06:34It's only supposed to react to bacteria, fungi and viruses, not to things like pollen we
06:39inhale or detritus from house dust mites.
06:45Many allergy sufferers struggle with pollen year round.
06:48Due to climate change, plants in many places are now blooming earlier and longer, exacerbating
06:53the symptoms.
06:55In people with hay fever, the immune system mistakenly identifies pollen as a threat and
07:00reacts as if it were a virus, bacteria or other pathogen.
07:05Nasal sprays and allergy tablets can provide some relief from symptoms.
07:10And one promising treatment, already being used in some countries, is a medication containing
07:15antibodies.
07:22This is an antibody therapy that works very well in patients with uncontrolled asthma.
07:29It blocks the protein molecules in the body that are also present in allergy sufferers.
07:35It certainly can help.
07:37But ultimately it's a very expensive therapy.
07:43A single injection that can potentially relieve symptoms for an entire hay fever season.
07:48And another medication with a similar effectiveness is expected to hit the market soon too.
07:55Patients who discover through testing that they have hay fever are advised to try to keep
07:59pollen out of their homes, which might mean using air purifiers.
08:03And when they do venture outdoors, wear a mask.
08:10Another thing we learned during the Covid pandemic was that a lot of pollen allergy sufferers had
08:15fewer symptoms because they were constantly wearing masks, which also prevented pollen from
08:20getting through as easily.
08:22Diet is also important.
08:25Certain foods can worsen symptoms and increase the risk of cross-allergies.
08:29Emma, for example, avoids kiwis, but now hopes to be symptom-free once she's completed her
08:35desensitization therapy.
08:38Plenty of people have food allergies.
08:41The most common culprits are milk, eggs, peanuts and other legumes, wheat, fish and seafood,
08:49and sesame.
08:51Sufferers just have to give those foods a wide berth.
08:54A misfiring immune system can start viewing parts of the body, like the hair, as hostile
09:00and attack.
09:01When it turns on the thyroid, it causes what's known as Hashimoto's disease.
09:06With symptoms like fatigue, depression, weight gain and dry skin.
09:15The thyroid is a relatively small organ that produces T3 and T4 hormones.
09:21They regulate a range of processes in the body, influencing your heartbeat, metabolic rate
09:26and mental health.
09:28If the thyroid fails to produce enough of the hormones, it can throw off the body's balance
09:32in a big way.
09:35Medicine expert Saskia Momberger is familiar with the full range of potential symptoms
09:39caused by the autoimmune disease Hashimoto's thyroiditis.
09:43It triggers a kind of inflammatory reaction that impairs the thyroid's function and leads
09:50to reduced hormone production.
09:52And thyroid hormones are needed throughout the body.
09:56autoimmune diseases involve malfunctions in the body's natural defense system.
10:03In the case of Hashimoto's disease, it mistakenly identifies thyroid cells as a danger and attacks
10:09them.
10:10That causes the organ to grow chronically inflamed and produce fewer hormones.
10:18thyroid values can reveal whether the thyroid is still functioning, and if so, how well.
10:25The concentration of freely circulating T3 and T4 hormones is a key indicator.
10:31In the case of Hashimoto's disease, it is a key indicator.
10:42This is very important for diagnosis, because if antibody levels are higher, I know why, it's
10:47in black and white.
10:50And the specific antibodies connected to Hashimoto's have a greater impact on the body than previously
10:55thought, says endocrine surgeon Volker Fendrich.
11:03Recent studies are increasingly showing that these TPO antibodies don't just target the thyroid.
11:09They can also be found in many other organs and bodily fluids, such as the synovial fluid
11:15in joints.
11:19There are no specific drugs for treating Hashimoto's disease.
11:22To compensate for the insufficient hormone production and provide symptom relief, patients are prescribed
11:28tablets containing synthetic T4 hormone.
11:32The problem is, while blood values, thanks to the tablets, then appear normal, many patients,
11:38like Johanna Olenska, still don't feel any better.
11:44They say the blood values are fine and within the normal range.
11:50And then my doctor says there's nothing more he can do for me.
11:56For years now, a range of supplementary therapies have been under consideration for treating Hashimoto's.
12:02One is the trace element selenium, taken as a dietary supplement.
12:06Selenium was recommended a few years ago because it was thought to have a generally positive
12:14effect on inflammation, especially with Hashimoto's.
12:17But those initial studies haven't really been replicable and we no longer recommend it in
12:22our department.
12:24For a long time, it was thought the trace element iodine might aggravate Hashimoto's or even
12:30trigger it.
12:33That was based on a study from Asia, where it appeared that high iodine intake led to
12:38a greater prevalence of Hashimoto's.
12:42But this hasn't really been confirmed over here in Western Europe, at least.
12:49Physiologists now agree that consuming iodine via a reasonable amount of table salt is fine,
12:55but not as an extra dietary supplement.
13:00What's also clear is that the thyroid changes over the course of the disease, growing smaller
13:05and more fragile, and in many cases developing dark spots.
13:09But it doesn't waste away completely.
13:11A few cells can be enough to sustain the autoimmune process, and 100% of the thyroid is never completely
13:17dead and providing no stimuli for the body.
13:22As is also shown by a study in Norway, Hashimoto's patients who had their thyroids removed felt
13:29better than those only on medication.
13:33Especially when it came to symptoms like fatigue and exhaustion.
13:40The researchers concluded that removing the thyroid stops the autoimmune process, because
13:45the body no longer receives the stimulus to continue producing these antibodies.
13:55Surgery, however, is still more the exception than the rule.
13:58Medication in the organ is only recommended in very severe cases where medication simply
14:03doesn't help.
14:05We're waiting to hear from you.
14:09Are you always stressed and worried it's damaging your heart?
14:15Thinking about quitting smoking, but not sure how?
14:19Maybe you just want to eat healthier.
14:23Or you're looking for the right workout to ease back pain.
14:28If you've got a health question, In Good Shape has the answer.
14:32Just drop us an email.
14:37Our skin cells usually regenerate around every four weeks, but in people who suffer from psoriasis,
14:43they renew in just six or seven days, leaving the skin red and covered in scaly patches.
14:49Another case of the immune system going haywire.
14:52And the itching isn't the only thing patients stress out about.
14:56Many also feel embarrassed and worry about social stigma, raising their stress levels and lowering
15:02their self-confidence even further.
15:08Going out in a short-sleeved shirt used to be anything but a walk in the park for Inken Junge.
15:15She felt insecure because it seemed like people were staring at her.
15:20Since childhood she's had psoriasis, a skin condition that took her years to get under control.
15:26It really hurts your self-esteem, people wondering what it is.
15:35You try to cover up the plaques so you don't give them a reason to make fun of you or say
15:40you look like a fish or whatever.
15:42That feeling of being ostracised made Inken Junge develop a hostile attitude toward her own
15:48body, a phenomenon known as self-stigmatisation, with consequences affecting her to this day.
15:54I definitely became very sensitive and anxious and I still struggle to really trust people
16:06and to believe that someone might find me beautiful or that my partner accepts me as I am.
16:14A psychological impact that is common among people with visible skin conditions.
16:20Some develop anxiety disorders, even depression.
16:23In response, dermatologists and psychologists in Hamburg have teamed up with patients to
16:28develop the Skin Compass programme, a kind of online self-therapy aimed at improving mental
16:33health.
16:34We have a lot of patients affected by social phobias, so for them, starting with a more anonymous,
16:42low-threshold programme is especially appealing.
16:47Three hundred patients with conditions ranging from psoriasis and eczema to alopecia areata
16:52or spot baldness were invited to test the programme.
16:56One of them was Inken Junge.
16:59The Skin Compass provides information and poses questions a therapist might ask.
17:04Practical exercises help participants develop a more positive view of themselves.
17:09The questions are mainly about identifying the triggers of critical thoughts, how it feels
17:18when I have those negative or self-critical thoughts, and how to cope with them better.
17:26When Inken's feeling down, she turns to an exercise from the programme.
17:30It helps me reconnect with myself and with reality, and to move forward feeling stronger.
17:48Taking effective medication has made Inken's skin mostly plaque-free, except for a few patches
17:53on her scalp.
17:54And her mental health has also improved a lot, thanks to therapy and also the Skin Compass.
18:01In a large nationwide study, we're seeing less self-stigmatisation among patients who participated
18:06in the programme.
18:08Their acceptance of the condition has improved, as has their attitude toward their own body.
18:14And we're seeing a decrease in depression rates.
18:17A further study will take a more in-depth look at the programme's impact.
18:23For Inken Junge, it's already made a difference.
18:26There's a newfound confidence in her stride.
18:28And most importantly, she's happier.
18:32Psoriasis is still a part of her life, but no longer the defining one.
18:39The idea why some people have overreactive immune systems is still unclear, which stands
18:44in the way of developing cures.
18:48Cortisone can reduce inflammation while other drugs suppress the immune response.
18:52If there's a specific known trigger, obviously it helps to avoid it.
18:56But what if the cause is unknown?
19:00Back to Felice, whose severe asthma attacks left him gasping for air, his life on the line,
19:06his parents beside themselves, and the doctors running out of ideas.
19:14Mandy Portelli had rushed her son to the doctors after he suffered another asthma attack.
19:19His oxygen saturation was measured at just 48%.
19:23Lung specialist Hazan Bali was shocked, as an adult with that level wouldn't even be able
19:28to stand.
19:29Plus, the blood gas analysis was clearly abnormal, pathological.
19:35He had severe oxygen deficiency, unusual for his age.
19:41But was it really being caused by an asthma attack?
19:44Dr. Bali was skeptical.
19:47After listening to Felice's lungs, he sent the patient for an x-ray to clear up the mystery.
19:54And after viewing the resulting images, his doubts were confirmed.
19:57There was a shadow on the lung.
20:00It was looking like something worse than asthma.
20:05The doctor sent Felice straight to hospital.
20:08The specialists there were surprised to see the young man back so soon with another asthma
20:12attack.
20:13But when pediatrician Maren Dietrich checked the x-rays and examined the young patient,
20:18she too realized that something was not adding up.
20:25This time there was also a diminished breathing sound and now he had audible crackles, which
20:30doesn't correspond to bronchial asthma.
20:34So, what was it?
20:37Maren Dietrich presented the case at the team's daily conference the next morning.
20:42And as she and her colleagues pondered the possible cause, it dawned on them that it could
20:47be direct damage to the lung tissue.
20:50A type of what's called interstitial lung disease, or ILD, where the delicate tissue of the tiny
20:58air sacs gradually become stiff and scarred.
21:02This leads to less and less inhaled oxygen reaching the bloodstream.
21:05If the scarring process is not stopped and it spreads, it can become too late to save the
21:11lung tissue.
21:16One of the most interesting matters was the fact that ILD can have over 100 different origins,
21:21ranging from undetected bacterial infections to autoimmune diseases where the body's defenses
21:27attack the lungs.
21:32To narrow down the list of suspects, the doctor first performed a bronchoscopy, looking inside
21:38the tiny passageways of the lungs.
21:41She also flushed them with a fluid that was then sent to the lab for analysis.
21:45And finally, a breakthrough for the young patient, as the paediatric pulmonologist found something
21:50suspicious.
21:54We looked at the cell composition and found a pronounced lymphocytic inflammation.
22:01In other words, an allergic inflammation of the lungs that often arises from external sources,
22:07such as inhaled dust or mold spores.
22:09Maren Dietrich finally had a lead.
22:12But which substance exactly was triggering the response?
22:19We wanted to know about any potential sources that could be triggers, whether he had been
22:26in contact with certain noxious chemicals, from inhaling glue, for example.
22:31It was pretty clear that Felice had not been inhaling glue, whether in Germany or while he was alone
22:40on holiday in Italy.
22:42But what about contact with other chemicals, like solvents in paints and varnishes, or wood
22:48dust?
22:49Every clue now could be crucial.
22:51I also asked his parents what they'd do for a living.
22:58Because if one of them were, say, a carpenter, that could definitely be relevant.
23:06And I also asked about any pets.
23:10He's crazy about animals.
23:13He loves dogs, birds, animals in general.
23:17He even wanted to become a vet.
23:20And Felice was particularly fond of a specific species of parrot.
23:28I had cockatiels in my bedroom.
23:30I had a lot of fun playing and singing with them.
23:36But as the cute-looking birds move around or fly, they shed dust and tiny feather particles.
23:42If anyone nearby inhales them, they're drawn into the fine air sacs, or alveoli, in their
23:47lungs.
23:48In some people, those particles trigger a reaction.
23:51And the resulting inflammation can spread through the alveoli across the entire lung.
23:59All that was missing was definitive proof.
24:02So Maren Dietrich took a blood sample and sent it to a specialized lab to check for markers
24:07indicating the disease.
24:11He had significantly elevated levels of immunoglobulin G for budgerigar feathers, canaries and parrots,
24:18which absolutely matched our findings.
24:26And the timing matched too.
24:29Felice had only had the birds in his room since the end of the summer holidays, which
24:33was when the whole nightmare had begun.
24:38The diagnosis was now clear.
24:41The dust from the cockatiel's feathers had triggered a severe inflammation in the alveoli.
24:46Felice was suffering from extrinsic allergic alveolitis, also known as bird fancier's lung.
24:56Fortunately, that's a disease that responds well to high-dose treatment with cortisone.
25:02While Felice could now look forward to recovering, the bad news was that he would have to give
25:07up his beloved pets.
25:10I loved my cockatiels.
25:16I actually wanted to keep them, but that just wasn't an option.
25:23Felice could at least look forward to riding his bike again.
25:29He was able to breathe almost as well as before.
25:32But the long journey wasn't quite over, with six more cortisone treatments scheduled.
25:37Each one a hospital visit.
25:39But now he's gotten the all clear.
25:43I'm so happy to have him back.
25:47The family gave the cockatiels to a bird park, where Felice can visit whenever he wants, should
25:53he manage to find the time.
26:07All's well that ends well.
26:09See you next time.
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