A quick post on the latest study published in the above New England Journal of Medicine on the effectiveness of chlorhexidine soap on the decolonization of MRSA in hospitals.
1. Investigating if targeted decolonization or universal decolonization are more effective in hospitals.
Why hospitals? Hospitals is one of the common areas where staph bacteria S. aureus strive, due to it being a confined area with patients with infection. Read Dr Clay’s Q&A #2 to avoid hospitals if your child has eczema.
What’s the big deal of MRSA decolonization?
MRSA is a big deal, because it is a particular strain of staph bacteria that is resistant to commonly prescribed antibiotics such as methicillin, floxacillin, lactamase-resistant pencillin and amoxicillin. This puts the patient at a high risk of complications from MRSA infection that cannot be promptly treated. Read this post to understand MRSA. It is a big deal for eczema patients because staph bacteria colonization is common on eczema skin, and thus poses the risk of MRSA infection.
The study from 3 hospitals (including 74 ICUs and 74,256 patients) showed that universal decolonization is more effective than targeted. Which means – eliminate the need to screen patients for MRSA, but instead have all ICU patients use chlorhexidine soap and mupirocin ointment. What’s chlorhexidine? A chemical that can kill stap bacteria – implications for eczema?
3. Implications for Eczema?
I think it reinforces the active washing with chlorhexidine reduces bacteria infection. I always wipe my child’s eczema skin with chlorhexidine, to remove staph. Staph promotes skin inflammation, read more here, and here on how resistant Staph is.
This is a quick update on the study just published on evening primrose oil and borage oil. A quick summary of the study:
Study Objective: To assess the effects of oral evening primrose oil or borage oil for treating the symptoms of atopic eczema.
Scale: This is a review article, meaning it reviewed studies done by others according to certain criteria and methodologies. There are 27 studies, 1596 participants (up to August 2012) and 19 studies covered evening primrose oil and 8 covered borage oil.
Results: For oral evening primrose oil and borage oil, there was no significant improvement over placebos used in trial. There were also “fairly common, mild, transient adverse effects, which are mainly gastrointestinal”.
It was mentioned that there was a warning in a case report that if evening primrose oil was to be taken for a prolonged period of time (more than one year), there is a “potential risk of inflammation, thrombosis, and immunosuppression”. No long-term effects included in the studies.
Do refer to my Eczema and Diet post if interested to find out effect on certain supplements on eczema.
This post is just what it is – The investigative bug has caught up with me and given that there are (i) more studies on impact of diet on eczema, and (ii) more people (experts or not) claiming that their diet is ‘proven’, I’m setting out in this post to POUR THROUGH ALL THE ECZEMA and DIET studies I can find and make sense of it for you here; Let’s see my investigation report!
Studies on Pregnancy Diets
Impact on Preventing or Reducing Severity of Eczema in Newborn
Antigen Avoidance Diet during Pregnancy
In a trial conducted with 952 participants, there was no evidence of protective effect of maternal dietary antigen avoidance during pregnancy on the incidence of atopic eczema during the first 18 months of life. Another two trials that had 523 participants similarly did not see benefit of avoidance of antigen during pregnancy for babies up till 18 months nor on their skin prick test results up to 7 year old.
In a review article of 21 trials from 1997 to 2007, there was evidence that probiotics prevented the onset of pediatric atopic dermatitis. In another article covering up to 2011, there was evidence of probiotics for the prevention of atopic dermatitis in infants, and this benefit was seen both for mother and child, and whether taken during pregnancy or early life of child.
Studies on Children Diets
Impact on Preventing or Reducing Severity of Eczema in Young Children
Timing of Introduction of Solids
In a consensus document, the conclusion from reviewing 52 studies from 1998 to 2006 was that early introduction of solids can increase food allergy. The recommendation was to introduce at 6 months, dairy products 12 months, hen’s egg 24 months, and peanut, tree nuts, fish, and seafood at least 36 months for those with higher risk of food allergy. An update on a study on early introduction of eggs done in August 2015 showed that the elevated immune responses to egg were established prior to egg ingestion at 4 months and were not affected by whether eggs were introduced early.
Using Hydrolyzed Milk Formula
In a review article of 12 studies up to 2006, there was (i) no evidence to support hydrolyzed formula to replace exclusive breastfeeding, and (2) limited evidence that supported hydrolyzed formula for high risk infants who could not be 100% breastfed. One article that provided such evidence concluded that partially hydrolyzed formula is more effective than standard formula for high risk infants.
In a trial of close to 14,000 mothers, there was no evidence of protective effect of prolonged and exclusive breast feeding on asthma or allergy.
Using Soy Formula
In a review article of 3 studies up to 2006, there was no evidence of reduction in allergies for children fed with soy formula.
Adding Prebiotics to Infant Formula
In a review article covering 13 studies up to 2012, there was limited evidence of prebiotics added to infant formula can prevent eczema, but the authors cautioned that further research is needed prebiotics can be routinely prescribed.
Adding Probiotics to Infant Formula
In two review articles (one of 12 studies up to 2007, the other up to 2008), there was insufficient evidence to recommend adding probiotics to infant feed.
Consumption of Omega 3 and 6
In another review article covering 10 studies up to 2009, there was no evidence for reduced risk of allergic sensitization or a favourable immunological profile.
Impact on Minimizing Eczema Flare-ups for Children already diagnosed with Eczema
In a review article, the conclusion from reviewing 9 studies (up to 2006) was that there was (1) no evidence of benefit to an egg and milk free diet, (2) no evidence of benefit to an elemental or few-foods diet, (3) some benefit to egg-free diet for infants with positive IgE to eggs, with improved eczema.
In a review article covering 11 studies up to 2011, there was no evidence of benefits of supplements in the treatment of eczema. The background of this study was that many patients turned to supplement to avoid steroid treatment, fearing long-term effects. However, there was no evidence for supplements like fish oil, olive oil, corn oil placebo, zinc sulphate, selenium, selenium plus vitamin E, vitamin D, pyridoxine, sea buckthorn seed oil, sea buckthorn pulp oil, hempseed oil, sunflower oil (linoleic acid) and DHA.
1st, I’ve made it a point to look at the studies themselves, rather than articles that refer to studies (so that I minimize the lost in translation effect). I also urge parents who are taking the leap to try a specific diet to ask your doctor and read up on studies, instead of relying on fad posts or personal testimonies.
2nd, I must make it clear that I’m no expert in reading studies, the review articles mentioned were all written by medical professionals. Should any medical professional coming across this post and see any misinterpretation, do point it out to the rest of me.
3rd, after this investigation, the following seem to be actionable take-away that we parents can ask our doctors on and decide if we should apply them:
1. Consider Probiotics
2. Not to introduce solids before 6 months’ old, and check with doc on timing for other more common food allergens
3. If you can’t breastfeed exclusively, consider partially hydrolysed milk formula
Readers of this blog will know that I’m 100 percent focused on eczema, so why this post on Allergy and to tackle Myths! I came across an article ‘Eight Myths from the Food Allergy Clinic’ written by St Thomas Hospital and Kings College Hospital, London, UK and got very interested because I do think these myths are very common! My detective side got the better of me and I did a research and found many more – but I’m just highlighting to you those more applicable for parents with eczema children, so here you go!
MarcieMom Allergy Myth Number 1 – During the skin prick test, if the wheal is larger, it means that the allergen can cause a more severe allergic reaction
In reality: Should the wheal exceeds a certain size (usually 3-4 millimeter), then it can be considered as a positive reaction to the allergen. BUT a larger size wheal does not mean in reality, the child will show a more severe reaction versus another with a smaller wheal.
MarcieMom Allergy Myth Number 2 – Previous allergic reactions predicts the severity of future ones
In reality: As the conditions that were present in a previous allergic reaction would defer from the future one, parents should not assume that a child will react in the same way to the allergen every time. Factors include the amount, state (raw versus cooked), existing health conditions at the time of allergic reaction. Parents should however note that should a child had a previous anaphylactic reaction, the likelihood of the same allergen triggering a severe allergic reaction is more likely.
MarcieMom Allergy Myth Number 3 – A mom should avoid high risk foods during pregnancy and breastfeeding
In reality: No conclusive study on this, and the American Academy of Pediatrics had withdrawn its advice on avoidance of peanuts, eggs, cow’s milk and fish during pregnancy and lactation.
MarcieMom Allergy Myth Number 4 – Children with allergy to eggs cannot be administered with MMR vaccines
In reality: MMR vaccine is safe for children with egg allergy, see below from a previous Dr Q&ADr Liew: Vaccines are the one of the proven public health measures to reduce mortality from infectious diseases. Vaccines are produced for significant infectious diseases. There is no link between vaccination and allergies.Traces of egg proteins can be found in influenza vaccines and specialised vaccines like yellow fever. Egg allergic patients should discuss the risk benefit ratios of receiving these vaccines. MMR vaccines are safe for egg allergic patients.
MarcieMom Allergy Myth Number 5 – Cooking a food removes the allergy
In reality: Some proteins that trigger an allergic reaction are not destroyed by cooking, AAAAI’s recommendation on this: Most food allergens can cause reactions even after they are cooked or have undergone digestion in the intestines. There are some exceptions. For example, some allergens (usually fruits and vegetables) cause allergic reactions only if eaten in their raw form.
I actually thought of including a 6th myth, which is children with parents who have allergy are more likely to develop the same allergy to that specific allergen. Generally, children are more likely to have allergies if their parents have, but whether the allergy to a specific food is inherited is still pretty controversial. Found a study that showed male teens were more likely to be sensitized to dog if their fathers are, so this myth may not be a myth after all. Anyone has any thoughts?
The short answer is we don’t know, but get your kids away from fast food.
Apart from the risk of obesity, a recent study of more than 500,000 children in over 50 countries showed a linkage between fast food and chronic illnesses, namely severe asthma, hay fever and eczema. For kids who eat fast food 3 times or more a week, there’s a 30 percent increased risk in severity of the above conditions. There’s no causal relationship, but signal a link between fast food and eczema. This study was widely reported because it covered a large number of participants and across countries, however, there are limitations which NHS (UK) pointed out. Professor Hywel Williams, one of the co-authors of the study, mentioned in an NIH interview that three or more weekly servings of fruit reduced the severity of symptoms in 11 percent among teens and 14 percent among children. Fast foods is defined as burgers, while eczema is an itchy rash in the past 12 months with symptoms defined as severe if sleep disturbance was reported at least once per week.
I also come across other interesting reports relating to trans fat (abundant in fast food) and coke, and eczema.
Dr David L Katz replied to a Q&A on Oprah.com to reduce intake of saturated or trans fat, as well as foods related to inflammation. He also suggested increasing omega-3s that can help increase anti-inflammatory hormones in the body. He pointed out flaxseed oil, which I’ve been giving my toddler Marcie. For those of us who are celebrating Chinese New Year, you’d be aware (and beware) as many of these commercial cookies have been prepared with partially hydrogenated vegetable oil and one piece of bak-kwa is 300 calories!
Dr Jeff Benabio in his video said that people severely allergic to formaldehyde can also be allergic to diet soda, as diet soda contained aspartame which after ingestion, created formaldehyde. Specifically, aspartame is hydrolysed to methanol, which is metabolized to formaldehyde then to formate.
For readers of this blog, you’d know I’ve been blogging about eating anti-inflammation food and staying away from inflammatory sugar and trans fat, in the link below:
Interview series with nutritionist Toby Amidor on eczema kids’ nutrition & inflammatory foods.
So, in conclusion, there’s no doubt that fast food, which are high in trans fat and mostly fried, are to be avoided. I’ve been cooking healthy food for my family daily, and you’d be amazed at how fast you can whip out a meal once you’re used to it, faster than fast food!