關於 immune tolerance ，我們在網路上蒐集到這些相關的討論、資訊與評價

There are many issues that social media has caused with the fitness industry, but up there is the forming of camps. Having a single stance on something makes it easier to acquire "followers" - ie people who subscribe to your religious approach to science. The more extremist, the better. Socmed gurus will tell you to "pick your niche", but what that often means is "pick your viewpoint". Being argumentative also aligns with the platform's algorithms - discussion = engagement = traction in the form of comments and sends. Zealots prosper.
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I don't say this as someone who's sat on their high horse immune to it all. I bloody love a contentious debate, and it's often very hard to resist the temptation to get into a mud wrestle. There’s hypocrisy here - I’m working on it.
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Biomechanics to me is the understanding of movement relative to gravity. The RTS syllabus defines exercise as "internal force production in response to external force application". An increased knowledge of what is taking place internally and how to manipulate the external resistance allows greater exercise analysis, design and individualisation - whether that's to accommodate someone's lack of tolerance, or improve the loading of a particular muscle group throughout it’s full contractile range in a seasoned gym user. It's tools in your arsenal as a coach, that are easy to underestimate and play down. Yes, obssessing over mechanics and the optimisation process to the point where it takes you 1.5hrs to set up a machine for a set of 5 reps at RPE0.5 because your form slacks by 8% as soon as you get within 20 reps from failure is counterproductive... but no one with a brain is suggesting that. As a PT it's literally our fucking job to make sure people move AS WELL AS POSSIBLE, as intensely, as frequently and as regularly as suits their goals/priorities. The myriad of variables involved in this are completely client-specific.
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What I’ll never understand is why you can't do both. What's wrong with constantly chasing optimal resistance profiles and movement mechanics AND seeing how close you can get your client's balls to the wall? It doesn't have to be AT THE EXPENSE OF.
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[Rant continued in comments]

BioNTech這週發表了新的論文，做了新的mRNA「疫苗」，在小鼠中嘗試。我引著疫苗，是因為這次不是刺激免疫反應，反而是抑制免疫反應，以治療自體免疫疾病。在一些自體免疫疾病中，免疫系統會錯將自體的抗原認作敵人，導致自己打自己。這篇論文，就是做了「自體抗原疫苗」，用mRNA表達自體抗原，從而教免疫系統，這是自己人，不要攻擊！

那麼問題來了，為什麼打武漢病毒疫苗，會導致免疫反應(immune response)，而打自體抗原疫苗，反而會導致免疫耐受(immune tolerance，不打自己人)呢？

一般來說，免疫系統需要一些共同刺激訊號(co-stimulatory signals)，才會有免疫反應。相反，缺乏了這些刺激訊號，有可能會發展成免疫耐受（即是這篇論文的例子）。在針對病毒的疫苗，一般會加入「佐劑」(Adjuvant)，以刺激免疫反應，好等免疫系統懂得是敵人，要反應（就是經常被反疫苗群體詬病的物質...）。然而，BioNTech的武漢病毒mRNA疫苗，並沒有佐劑。

我個人猜想，分別如下：
一、攜帶病毒抗原的mRNA的脂粒載體，本身具有致炎性，所以自帶佐劑效果。而自體疫苗，可能選用了致炎性較低的脂粒載體版本。這我沒詳細看配方，要查一下。
二、病毒疫苗，是打到肌肉，可能會直接導致局部炎症。自體抗原疫苗，是打到血液，可能因此減低炎症可能。

而實際上為什麼有這個分別，是否能確保這個分別，我暫時不知道，知道的朋友可以補充。

https://science.sciencemag.org/content/371/6525/145/tab-pdf

孫女從嬰兒時期就有異位性皮膚炎，心疼他因為癢而抓出許多血絲與常常皮膚紅腫。身為婦產科醫師的我，對這個疾病不甚了解，但最近開始閱讀這個疾病的相關知識，想與大家分享。

近二十年來，台灣的異位性皮膚炎的盛行率增加將近一倍， 有些研究顯示都市化和空氣污染會增加風險，也有些研究說媽媽在懷孕期間多吃魚會降低風險。

百分之八十的異位性皮膚炎始於5歲以下，而約有一半以上得異位性皮膚炎的小朋友，長大會”自己好” 但詳細原因不明，或許和早期疾病的控制有關。

異位性皮膚炎是一種皮膚的過敏反應，許多病人因爲皮膚天然保濕因子 (filaggrin) 不足的體質，造成過敏原更容易通過乾燥龜裂的皮膚，而誘發過敏反應，所以除了擦藥與(嚴重時)吃藥，保濕乳液對於預防復發非常重要，近幾年有些免疫阻斷劑的上市，讓對付嚴重異位性皮膚炎的 ”藥品軍火庫“ 又增加一些生力軍。

有家族病史的小朋友更容易得到異位性皮膚炎，代表基因也有關聯。約有60-70% 的異位性皮膚炎的病患，會有 Filaggrin 基因上的某些位點的突變 ，目前已知有數十個 Filaggrin 基因位點的突變，有趣的是，亞洲人與歐洲人突變的位點不盡相同。而台灣本土人口 Filaggrin 基因位點的突變，仍尚未被發表。

目前各國的皮膚科醫學會，都同意早期治療，藉以降低復發的強度與頻率，所以小朋友的皮膚如果常常乾紅癢，應該及早就醫診斷與治療。至於有家族病史但沒有發病的小朋友，是否該做Flaggrin基因檢測，而提早擦保濕乳液 ，是一個值得討論的題目。

#異位性皮膚炎
#保濕因子
#提早擦乳液

參考文獻

Chu C-Y et al. Taiwanese Dermatological Association consensus for the management of atopic dermatitis. Dermatologica Sinica. 2015 Dec 1;33(4):220–30.

Romieu I, Torrent M, Garcia-Esteban R, Ferrer C, Ribas-Fitó N, Antó JM, et al. Maternal fish intake during pregnancy and atopy and asthma in infancy. Clin Exp Allergy. 2007 Apr;37(4):518–25.

Irvine AD, McLean WHI, Leung DYM. Filaggrin mutations associated with skin and allergic diseases. N Engl J Med. 2011 Oct 6;365(14):1315–27.

Nutten S. Atopic Dermatitis: Global Epidemiology and Risk Factors. ANM. 2015;66(Suppl. 1):8–16.

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My granddaughter suffers from atopic dermatitis (AD) at a young age. The constant scratching causes little spots of bleeding and roughening of her baby skin. There doesn’t seem to be a cure for this condition. Even though I am an O&G specialist by trade, I have decided to read a little bit more on this topic and share them with you.

The prevalence of AD has doubled in Taiwan in the last 20 years. Some research shows industrialisation and air pollution may be risk factors whilst fish intake during pregnancy reduces infant risks of AD.

Eighty percent of AD starts below the age of 5. And about half of the children tend to “grow out of” AD. It may be mutli-factorial but the immune tolerance may be related to early control of AD.

Atopic dermatitis is a hypersensitivity reaction of the skin, many patients are found to have defects in their skin Filaggrin, which is a naturally-occurring skin moisturiser. Therefore skin emollient is an important treatment for the prevention of AD flares. Apart from the existing immunosuppression treatments (such as topical corticosteroids and calcineurin inhibitors), there are now biological agents available for the treatment of severe AD. The therapeutic armamentarium against AD is slowly increasing as we understand more about the disease.

Many variants of mutation at the Filaggrin gene have been found in up to 70% of patients with AD. There are currently 50-60 disease-causing variants known. Interestingly, mutations found in the European population seem to be different from those found in the Asian population. The mutations specific to the Taiwanese population are yet to be found.

The consensus amongst international experts seems to agree that early treatment of AD reduces recurrence and severities. However, it would be interesting to know the utility of early moisturizer application in those testing positive for Filaggrin gene but without AD.