FeaturesAug/Sep 2012 Issue

Fishing for a Cure

Diary of a Worm

Helminth therapy is based on what was originally termed the “hygiene hypothesis,” now sometimes called the “biome depletion theory.” Estimates of the number of cells in the adult body range from 10 to 100 trillion—and there are at least 10 times that many bacterial cells living within each of us. For every gene in our genome, there are 100 bacterial ones. This is our microbiome—and researchers are just beginning to examine how its composition can impact our health.

The biome depletion theory says that, as a result of better hygiene—afforded by post-industrial advances, such as toilets and water treatment facilities—people in developed countries are no longer exposed to, and therefore no longer harbor, some of the microscopic bacteria with which humans have historically had a symbiotic relationship. As a result, people in developed countries are missing some of the key microbes that keep the immune system in balance.

Normally, the immune system’s white blood cells help protect the body from harmful germs. To destroy these germs, the immune system produces antibodies, also known as immunoglobulins (Ig), to identify and neutralize the germs. It’s a complicated system, and not without misfires. In the case of food allergy, the immune system mistakenly decides that a food is harmful and creates antibodies in the attempt to render it harmless. In autoimmune disorders, the immune system makes antibodies when it mistakenly decides that the body’s own healthy tissue is harmful.

The biome depletion theory holds that reintroducing some long-lost little friends back into the body—in small numbers so as not to cause illness—will dampen inflammation. Exactly how helminths do this is not yet fully understood but they seem to activate immune regulatory mechanisms, as well as enhance mucosal barrier function.

The scientific research thus far is extremely encouraging. In 2005, Joel Weinstock, MD—now chief of the division of gastroenterology/hepatology at Tufts New England Medical Center—published a paper showing that in a randomized, double-blind, placebo-controlled trial (the gold standard in research), Trichuris suis ova (pronounced try-kyuriss soo-iss oh-vah) (TSO), which are microscopic pig whipworm eggs, was safe and effective in the treatment of ulcerative colitis, an inflammatory bowel disease.

Since then, evidence has been accumulating that helminths have the potential to treat other immune-mediated conditions, such as Crohn’s disease. One study has shown that, in patients with celiac disease, hookworm infection suppressed the inflammatory immune response after a gluten challenge, although it didn’t result in a clinically significant suppression of pathology. Studies are now underway to see if TSO can help conditions like multiple sclerosis and autism, both of which may involve an underlying immune dysfunction.


Next: Type of Treatment

Comments (5)

We need to know if the person having helminthology therapy can pass on those little worms to anyone else. Has that been tracked? Since we do not want to go back to having widespread hookworm causing disease, there is good reason for importation of the worms to be banned until this piece is known. And now we have people carryng the worm around again and being possible sources if infection unbeknownst to the rest of us.
We need the follow up story to be done please.

Posted by: Canada comments | November 18, 2014 10:16 AM    Report this comment

I am someone without IgA reactions but lots of IgG reactions. My food reactions have been getting more severe (in particular, extreme asthma attacks) & involves more foods every year. My naturopathic doctor believes my adrenal system is shot. Any idea if helminth therapy would work for me?

Posted by: Unknown | March 6, 2013 6:44 PM    Report this comment

I am the writer of the article and I would point out that Dr. Sidney Baker, who is quoted in the article, has had a very similar experience using helminths to treat EE. He uses TSO, which is legal to bring into the country.

I would also highlight the last several paragraphs of the article (added below), which emphasize that helminth therapy is in the beginning stages of being researched as a treatment for EE.

The article does not endorse helminth therapy but does point out that some people have had success using it, and that physicians in the EE field find it an intriguing area for further study.

Here is an excerpt from the article: A great deal more research is needed before the medical community considers helminth therapy a safe and effective treatment for food allergy. Yet in a field where options are extremely limited, it is cause for hope.

"Helminth therapy is an intriguing therapy for treatment of eosinophilic esophagitis and other allergic diseases. It has shown promise in inflammatory bowel disease and is being studied as a possible treatment of classic peanut allergies," says John Lee, MD, co-director of the Eosinophilic Gastrointestinal Diseases Program at Children's Hospital Boston. "Treatment options for EoE are currently limited to either diet restriction or steroid therapy. If helminth therapy proves to be effective, it will open an exciting new avenue of treatment for this challenging condition."

Posted by: kdscott | July 22, 2012 8:07 AM    Report this comment

This article does not indicate if the child has been scoped again to confirm whether or not the internal damage is still being done by the disease and he only has no noticeable symptoms due to whatever affects the worms are having on his GI tract (if it's just masking the symptoms). The mom is anonymous (no last name), there is no interview with the child's Drs to confirm the information, etc.

If the damage is still being done by the food that he's eating, then is the therapy actually helpful? If a patient winds up with food impactions due to the damage and has to have his esophagus dilated, is it actually helpful?

If it led to a clear scope and will not cause any other damage, then it should be studied. However, if it is just masking the symptoms and he is still sustaining damage from the eosinophilic disorder, then that is not sufficient. This article leads you to believe that it is an effective treatment, but it might not be.

The disease can be managed well by many people, just by food elimination. For many, eliminating some or all of the top allergens are sufficient, and then they can trial those that they eliminated to determine which are the actual culprits. For some (like my son), it can be difficult to pinpoint the trigger foods. My son DID need elemental formula while he did food trials, but it resulted in determining which foods were safe and which were not. He can manage his disease for the rest of his life, just by avoiding his trigger foods (wheat, dairy, egg, soy, citrus fruits, melons, oats, barley and banana). His list is not the norm either. Wheat and dairy are the most common food triggers. Some people react to other foods as well (we are all individuals, so the triggers vary from person to person). He is now a teenager and while he can manage his disease well on his safe diet, he has chosen to use swallowed Flovent to treat it for the time being. He can now eat everything while he is taking the medication, but we know what foods to avoid when he wants/needs to take a break from the medication, or if it ever becomes less effective.

I noted that the article stated bringing the worms into this country is illegal, and I am sure it is illegal for a reason.

Posted by: EosMom | July 9, 2012 8:58 AM    Report this comment

This article is missing the first paragraph...

Posted by: Ligea R | July 7, 2012 10:26 AM    Report this comment

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