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Allergies and autoimmune diseases: how the body and mind suffer — and what really helps. Patients, experts and tips on In Good Shape.
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00:06Your 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? That and more on In Good Shape.
00:58Felice Portelli has always loved speeding along on his motocross bike, up, down and around
01:04dirt racetracks. He lived in Italy until the age of 12 and continued to spend his holidays
01:11there after his family moved to Germany. But after one summer, something wasn't quite right.
01:20Easy. Give me the bike and hold on to me. After the vacation in Italy, he said, Mom, I don't
01:28feel good. He couldn't breathe properly. It feels like your lungs are contracting and you quickly
01:39get out of breath. Felice had already been to see a doctor while still in Italy, who diagnosed
01:45him with allergic asthma. But once back in Germany, his condition deteriorated further.
01:53It got worse by the week. He didn't want to go riding on his motorbike anymore, or do anything
02:00in fact.
02:08His concerned mother called the family doctor, who didn't consider things to be dramatic.
02:15He advised her to increase the dosage of Felice's asthma medication. But he didn't get better.
02:23On the contrary. He started coming home early more often, or not going to school at all,
02:31because it was too much. Eventually he grew so short of breath, he couldn't even walk up
02:36or down the stairs. Until one fateful night. His father was out at work, while his mother
02:44Mandy was already in bed. Felice collapsed in the bathroom. He couldn't breathe at all,
02:55and was just gasping for air. That's when I really panicked, and I called an ambulance.
03:06Felice's blood oxygen saturation level was just 86%, way below the normal level of 98. He was
03:14rushed into hospital due to a suspected asthma attack. Asthma causes the mucous membranes in
03:20the airways to swell and constrict, letting very little air pass through, and that in
03:24turn can mean not enough oxygen reaching the bloodstream.
03:30Things 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.
03:42Dr. Maren Dietrich prescribed cortisone, hoping to stop the allergic reaction in Felice's
03:47airways and relax the bronchial muscles. Once the immediate danger was averted, the doctor
03:54switched the young man to a more effective asthma medication. Then monitored him to ensure
03:59his oxygen levels rose back above 95%. A week later, Felice had recovered. His oxygen saturation
04:09was back up to 97%. In addition to his asthma spray, the 15-year-old now also had emergency
04:16medication, in case he had another attack. But he and his parents hoped he wouldn't need it.
04:28I thought, OK, it's over. Things are looking up again.
04:33Felice!
04:34But just a week after Felice came out of hospital, the nightmare resumed. One morning his mother
04:41found him in bed, gasping for air. She immediately gave him the emergency spray.
04:51I started crying. It's my son we're talking about. That same morning, she took Felice to see
05:00a lung specialist. But he couldn't even manage the few steps up to the entrance of the practice.
05:07His mother declined help from a stranger, but internally was starting to panic.
05:14That was the worst part, thinking, we're not going to make it.
05:22Stay tuned to find out what happened next and what was causing the serious attacks. Typical suspects are
05:29for pollen, animal hairs and dust mites. When the immune system targets the airways, symptoms range from an itchy nose
05:37and watery eyes to respiratory problems and fatigue.
05:41Allergies and similar disorders are on the rise worldwide thanks to climate change and air pollution.
05:47And treating allergies takes lots of patience.
05:53Getting a shot containing allergens was a last resort for Elmer Bornhoeft.
05:59Before being given the treatment by her ear, nose and throat doctor,
06:03the symptoms from her allergy to dust mites had grown pretty severe.
06:08I had this constant runny nose.
06:11Right after getting up, it would be completely blocked
06:13and I had difficulty breathing.
06:16The idea now is to fool her body with a three-year desensitisation therapy.
06:25Basically, we're reprogramming the immune system.
06:28In patients with allergies, the immune system has taken a wrong turn somewhere.
06:33It's only supposed to react to bacteria, fungi and viruses,
06:38not to things like pollen we inhale or detritus from house dust mites.
06:44Many allergy sufferers struggle with pollen year round.
06:48Due to climate change, plants in many places are now blooming earlier and longer,
06:52exacerbating the symptoms.
06:55In people with hay fever, the immune system mistakenly identifies pollen as a threat
06:59and reacts as if it were a virus, bacteria or other pathogen.
07:05Nasal sprays and allergy tablets can provide some relief from symptoms.
07:09And one promising treatment, already being used in some countries,
07:13is a medication containing antibodies.
07:21This is an antibody therapy that works very well in patients with uncontrolled asthma.
07:28It blocks the protein molecules in the body that are also present in allergy sufferers.
07:34It certainly can help.
07:36But ultimately, it's a very expensive therapy.
07:42A 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 pollen out of their
08:00homes,
08:01which 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 fewer symptoms
08:15because they were constantly wearing masks, which also prevented pollen from getting through as easily.
08:22Diet is also important.
08:24Certain foods can worsen symptoms and increase the risk of cross allergies.
08:29Elma, for example, avoids kiwis, but now hopes to be symptom-free once she's completed her desensitization therapy.
08:38Plenty of people have food allergies.
08:41The most common culprits are milk, eggs, peanuts and other legumes, wheat, fish and seafood, and sesame.
08:50Sufferers just have to give those foods a wide berth.
08:53A misfiring immune system can start viewing parts of the body, like the hair, as hostile and 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.
09:14The thyroid is a relatively small organ that produces T3 and T4 hormones.
09:20They regulate a range of processes in the body, influencing your heartbeat, metabolic rate and mental health.
09:27If the thyroid fails to produce enough of the hormones, it can throw off the body's balance in a big
09:32way.
09:34Hormone 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 to reduced hormone production.
09:51And thyroid hormones are needed throughout the body.
09:58Autoimmune diseases involve malfunctions in the body's natural defense system.
10:02In the case of Hashimoto's disease, it mistakenly identifies thyroid cells as a danger and attacks them.
10:09That causes the organ to grow chronically inflamed and produce fewer hormones.
10:17Blood values can reveal whether the thyroid is still functioning, and if so, how well.
10:24The concentration of freely circulating T3 and T4 hormones is a key indicator.
10:30Special antibodies are also analyzed, such as thyroid peroxidase antibodies, or TPOs.
10:41This is very important for diagnosis, because if antibody levels are higher, I know why.
10:46It's in black and white.
10:49And the specific antibodies connected to Hashimoto's have a greater impact on the body than previously thought,
10:55says endocrine surgeon Volker Fendrich.
11:02Recent studies are increasingly showing that these TPO antibodies don't just target the thyroid.
11:08They can also be found in many other organs and bodily fluids, such as the synovial fluid in joints.
11:18There are no specific drugs for treating Hashimoto's disease.
11:22To compensate for the insufficient hormone production and provide symptom relief,
11:27patients are prescribed tablets containing synthetic T4 hormone.
11:32The problem is, while blood values, thanks to the tablets, then appear normal,
11:37many patients, like Johanna Orlenska, still don't feel any better.
11:45They say the blood values are fine and within the normal range,
11:49and then my doctor says there's nothing more he can do for me.
11:55For years now, a range of supplementary therapies have been under consideration for treating Hashimoto's.
12:01One is the trace element selenium, taken as a dietary supplement.
12:09Selenium was recommended a few years ago because it was thought to have a generally positive effect on inflammation,
12:15especially with Hashimoto's.
12:17But those initial studies haven't really been replicable, and we no longer recommend it in our department.
12:25For a long time, it was thought the trace element iodine might aggravate Hashimoto's, or even trigger it.
12:33That was based on a study from Asia, where it appeared that high iodine intake led to a greater prevalence
12:39of Hashimoto's.
12:41But this hasn't really been confirmed over here in Western Europe, at least.
12:49Experts now agree that consuming iodine via a reasonable amount of table salt is fine, but not as an extra
12:56dietary supplement.
12:59What's also clear is that the thyroid changes over the course of the disease, growing smaller and more fragile,
13:05and in many cases developing dark spots.
13:08But it doesn't waste away completely.
13:11A few cells can be enough to sustain the autoimmune process,
13:14and 100% of the thyroid is never completely dead and providing no stimuli for the body.
13:22As is also shown by a study in Norway,
13:26Hashimoto's patients who had their thyroids removed felt better than those only on medication.
13:32Especially when it came to symptoms like fatigue and exhaustion.
13:40The researchers concluded that removing the thyroid stops the autoimmune process,
13:45because the body no longer receives the stimulus to continue producing these antibodies.
13:54Surgery, however, is still more the exception than the rule.
13:58Removing the organ is only recommended in very severe cases where medication simply doesn't help.
14:07We'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.
14:22Or you're looking for the right workout to ease back pain.
14:27If you've got a health question, In Good Shape has the answer.
14:31Just drop us an email.
14:36Our skin cells usually regenerate around every four weeks.
14:40But in people who suffer from psoriasis, they renew in just six or seven days,
14:45leaving 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.
14:55Many also feel embarrassed and worry about social stigma,
15:00raising their stress levels and lowering their self-confidence even further.
15:08Going out in a short-sleeved shirt used to be anything but a walk in the park for Inken Yunger.
15:14She 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.
15:30It 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
15:39or say you look like a fish or whatever.
15:43That feeling of being ostracised made Inken Yunger develop a hostile attitude toward her own body,
15:49a phenomenon known as self-stigmatisation, with consequences affecting her to this day.
15:57I definitely became very sensitive and anxious.
16:03And I still struggle to really trust people and to believe that someone might find me beautiful
16:09or that my partner accepts me as I am.
16:14A psychological impact that is common among people with visible skin conditions.
16:19Some develop anxiety disorders, even depression.
16:22In response, dermatologists and psychologists in Hamburg have teamed up with patients to develop the Skin Compass Programme,
16:30a kind of online self-therapy aimed at improving mental health.
16:34We have a lot of patients affected by social phobias.
16:39So for them, starting with a more anonymous low-threshold programme is especially appealing.
16:47300 patients with conditions ranging from psoriasis and eczema to alopecia areata or spot boldness were invited to test the
16:55programme.
16:56One of them was Inken Yunger.
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.
17:12The questions are mainly about identifying the triggers of critical thoughts,
17:17how it feels when I have those negative or self-critical thoughts,
17:20and how to cope with them better.
17:26When Inken's feeling down, she turns to an exercise from the programme.
17:38It helps me reconnect with myself and with reality, and to move forward feeling stronger.
17:47Taking effective medication has made Inken's skin mostly plaque-free, except for a few patches on her scalp.
17:54And her mental health has also improved a lot, thanks to therapy and also the Skin Compass.
17:59In a large nationwide study, we're seeing less self-stigmatisation among patients who participated in the programme.
18:07Their acceptance of the condition has improved, as has their attitude toward their own body.
18:13And we're seeing a decrease in depression rates.
18:18A further study will take a more in-depth look at the programme's impact.
18:22For Inken Yunger, it's already made a difference.
18:26There's a new-found confidence in her stride.
18:28And most importantly, she's happier.
18:31Psoriasis is still a part of her life, but no longer the defining one.
18:38Exactly why some people have overreactive immune systems is still unclear, which stands in the way of developing cures.
18:47Cortisone 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?
18:59Back to Felice, whose severe asthma attacks left him gasping for air, his life on the line, his parents beside
19:07themselves, and the doctors running out of ideas.
19:13Mandy 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 to stand.
19:31Plus, the blood gas analysis was clearly abnormal, pathological.
19:35He had severe oxygen deficiency, unusual for his age.
19:40But was it really being caused by an asthma attack?
19:44Dr Bali was sceptical.
19:46After listening to Felice's lungs, he sent the patient for an x-ray to clear up the mystery.
19:53And after viewing the resulting images, his doubts were confirmed.
19:57There was a shadow on the lung.
19:59It was looking like something worse than asthma.
20:04The doctor sent Felice straight to hospital.
20:07The specialists there were surprised to see the young man back so soon with another asthma attack.
20:13But when pediatrician Maren Dietrich checked the x-rays and examined the young patient,
20:18she too realised that something was not adding up.
20:24This time there was also a diminished breathing sound and now he had audible crackles,
20:30which doesn'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,
20:45it dawned on them that it could be direct damage to the lung tissue.
20:51A type of what's called interstitial lung disease or ILD,
20:56where the delicate tissue of the tiny air sacs gradually become stiff and scarred.
21:01This leads to less and less inhaled oxygen reaching the bloodstream.
21:05If the scarring process is not stopped and it spreads,
21:08it can become too late to save the lung tissue.
21:16Complicating matters was the fact that ILD can have over a hundred different origins,
21:21ranging from undetected bacterial infections to autoimmune diseases,
21:25where the body's defences attack the lungs.
21:31To narrow down the list of suspects, the doctor first performed a bronchoscopy,
21:36looking inside the tiny passageways of the lungs.
21:40She also flushed them with a fluid that was then sent to the lab for analysis.
21:45And finally a breakthrough for the young patient,
21:48as the pediatric pulmonologist found something suspicious.
21:53We 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,
22:06such as inhaled dust or mould spores.
22:10Maren 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.
22:25Whether he had been in contact with certain noxious chemicals,
22:29from inhaling glue for example.
22:34It was pretty clear that Felice had not been inhaling glue,
22:38whether in Germany or while he was alone on holiday in Italy.
22:42But what about contact with other chemicals, like solvents in paints and varnishes,
22:47or wood dust?
22:48Every clue now could be crucial.
22:55I 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.
23:05And I also asked about any pets.
23:11He's crazy about animals. He loves dogs, birds, animals in general.
23:16He even wanted to become a vet.
23:20And Felice was particularly fond of a specific species of parrot.
23:27I had cockatiels in my bedroom. I had a lot of fun playing and singing with them.
23:32I had really fun with them.
23:35But as the cute-looking birds move around or fly, they shed dust and tiny feather particles.
23:41If anyone nearby inhales them, they're drawn into the fine air sacs, or alveoli, in their lungs.
23:48In some people, those particles trigger a reaction.
23:51And the resulting inflammation can spread through the alveoli across the entire lung.
23:58All that was missing was definitive proof.
24:02So, Maren Dietrich took a blood sample and sent it to a specialized lab
24:05to check for markers indicating the disease.
24:11He had significantly elevated levels of immunoglobulin G
24:15for budgerigar feathers, canaries and parrots, which absolutely matched our findings.
24:25And the timing matched too.
24:28Felice had only had the birds in his room since the end of the summer holidays,
24:32which was when the whole nightmare had begun.
24:37The diagnosis was now clear.
24:40The 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.
24:55Fortunately, that's a disease that responds well to high-dose treatment with cortisone.
25:01While Felice could now look forward to recovering,
25:05the bad news was that he would have to give up his beloved pets.
25:13I loved my cockatiels.
25:16I actually wanted to keep them.
25:18But 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.
25:31But the long journey wasn't quite over, with six more cortisone treatments scheduled.
25:36Each 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,
25:50where Felice can visit whenever he wants,
25:53should he manage to find the time.
26:00All's well that ends well.
26:02See you next time.
26:07Switch.
26:08Switch.