Eczema News – Food Sensitization from Eczema?

Eczema Allergic Sensitization

This is a very interesting topic because it represents a major paradigm shift to how we view allergy – it’s not just what we eat (oral path) but also what’s on our skin. It is now accepted  that what is on our skin can lead to sensitization and allergy. For instance, dermatologist Cheryl Lee MD said in this post:

When allergens come in contact with the skin, then the allergic type of inflammation is turned on.  On the other hand, it has been shown that if you can avoid letting allergens (including foods!) from coming in contact with the skin long enough, then your child’s immune system will build up tolerance to the food when it is presented to the immune system of the gut. What this tells us is that, in susceptible populations, the skin barrier needs a little help as it is maturing.

Let’s take a closer look at this article published in Aug 2014 in Journal of Allergy and Clinical Immunology by Japanese researchers.

Article title: Eczematous sensitization, a novel pathway for allergic sensitization, can occur in an early stage of eczema

This is an article that looks at the studies being conducted, and it’s not exactly recent but I like it because it reinforces the understanding of outside-in hypothesis.

Link between Food Allergy and Eczema – From the Skin

Researchers started to look at the link between our skin and food sensitization because studies (quoting this article) demonstrated that exposure to environmental peanut protein–containing household dust and use of hydrolyzed wheat protein–containing soap significantly increased the risk of allergic sensitization to peanut and wheat, respectively. In addition, filaggrin loss-of-function mutations were a significant risk factor for peanut allergy. Those findings strongly suggest that epicutaneous exposure to proteins induces allergic sensitization…

presence of eczema is a robust risk factor for allergic sensitization to food antigens and development of food allergy

It is compiled in the article that increase in skin pH, scratching and impaired filaggrin are factors that lead to food sensitization. We have talked about the importance of skin pH for the whole of December last year and in summary, skin that is too alkaline is linked to reduced ceramides, skin lipids (good for our skin) and increase in staph bacteria (bad for our skin). Foods that come into contact on our skin can certainly trigger eczema flare-ups too!

My take: Strengthen the skin barrier – moisturize, use right products of optimal skin pH and without common irritants, treat skin promptly to reduce scratching. Keeping eczema under control or moisturizing to prevent eczema onset can have a real chance of preventing allergy.

What’s your take? Do share your take in the comment so we all can hear from each other!

Eczema Research Focus Month – Food Allergy

Eczema affects food allergy, does it cause it?

Eczema affects food allergy, does it cause it?

Last week, we looked at Probiotics. For today, we’re looking at the relationship between eczema and food allergy. In this study, it was indicated that a breakdown in skin barrier and skin inflammation in eczema could lead to increased food sensitization -> food allergy. This had been covered in the outside-in hypothesis post. Main points of this study:

1. Infants with an impaired skin barrier/ eczema, are more likely than to be sensitised to a variety of foods such as egg white, cow’s milk and peanut.

2. The more severe the eczema, the stronger the correlation to food sensitivity.

3. Repair of skin barrier therefore may reduce food allergy.

My family is already moisturizing lots for our daughter, what about yours? Do you think moisturizing from young had reduced food sensitivity? Share in the comment!

DermDoc Video – What Causes Eczema?

Dr Jeff Benabio’s Video

Dr Jeff Benabio, also known as DermDoc (on twitter), regularly posts videos on health and skincare on Youtube (DermTV). Dr Jeff tweeted MarcieMom about his recent video ‘Great Hack to Help Your Kid with Eczema’ which MarcieMom shared in this post. As Dr Jeff’s video is short, sweet and simple to understand and apply, MarcieMom invited Dr Jeff for a video series, where he would help answer questions based on his videos.

More on Dr Jeff Benabio – Dr. Jeff is board certified in dermatology and is a fellow of the American Academy of Dermatology. He is also the author of numerous scientific articles, a book and quoted in notable publications such as O, The Oprah Magazine, The Wall Street JournalDermatology News, Dermatology World, CNN, Fox News and WebMD. Read more about him on TheDermBlog.

Marcie Mom: In the video, Dr Jeff explained that eczema is mainly due to an overactive immune system and damaged skin, where the damaged skin allows bacteria to penetrate, resulting in a vicious cycle of inflammation, itching, scratching and more damage to skin (more on causes of eczema here).

Here’s a question – For parents whose children are more likely to have eczema due to family history of eczema in parents or siblings, what would you recommend the parents to do before pregnancy, during pregnancy, after birth to reduce the likelihood of eczema and/or the severity of eczema in the child? 

Dr Jeff: Great questions here. Unfortunately, there’s little that parents can do to prevent it. There is some evidence that taking probiotics during pregnancy and up to 6 months post pregnancy if breast-feeding can reduce the risk of eczema in the child.

There is some evidence that some foods can make atopic dermatitis more severe if the child is allergic to that food. Common suspects include: cow’s milk, soy, nuts, eggs, and wheat.
There’s some evidence that living on a farm can help — I’m not kidding. Here are a couple of links to studies:
.
Jeffrey Benabio, MD

Physician Director of Innovation, Kaiser Permanente, San Diego, CA

Friday Feature – Reactive Mind Q&A with Dr. B

Q&A with Dr Christopher Bridgett

MarcieMom (@MarcieMom) met Dr Christopher Bridgett (@ckbridgett) through Twitter – and learnt that he had a special interest of using behavioural interventions to help people with atopic eczema. DrB trained in medicine at Corpus Christi College, Oxford and St Bartholomew’s Hospital, London, then as a psychiatrist in Oxford. He now works in private practice in London. He has co-authored several publications on The Combined Approach, that proposes using habit reversal to stop habitual scratching in atopic eczema. To find out more about behavioural dermatology, click http://www.atopicskindisease.com/articles/PeterNoren to read DrB’s interview with Peter Norén MD, the Swedish dermatologist who created The Combined Approach.

Marcie Mom: Today’s question makes me a happy mom; It is mentioned in this article a comment by Sophie Worobec MD at University of Illinois that eczema children are “very bright” as the skin and the brain develop at the same time, so “very reactive skin and very reactive mind”. What do you think of this statement?

I’ve written in this post that there’s an association between ADHD and eczema children. And have you seen more cases of ADHD for eczema patients?

Dr B: That there seems to be a close relationship between the skin and the mind is often referred to, and the development of the skin and the brain from the ectoderm of the early embryo is seen as relevant to this relationship – I sometimes say the brain can be called a specialized part of the skin!

But in reality the whole body is closely integrated. All the separate parts are interdependent through shared characteristics, and the overall function is enabled by circulating hormones and by the nervous system links between brain and body.

Both ADHD and atopic eczema are relatively common conditions. The recent reports of an association need to be treated with caution. I have no personal clinical experience of this reported association.

DrB ©Christopher Bridgett, London. All rights reserved.

4-part series on What Causes Your Child’s Eczema – Staph

Eczema on neck – Bacteria colonization?

This is a 4-part (a little more technical) series inspired by a review article “Features of childhood atopic dermatitis” by Hugo Van Bever and Genevieve Illanora. The article summarizes 4 players involved in atopic dermatitis, and I’ve tried to understand whatever I could from the article and other research papers published online and hopefully digested the information accurately for you to read.

What is Staph?

Staph is short for staphylococcus aureus, a very resilient bacteria found on the skin that can cause infection if it penetrates the skin. More than 90% of the people with eczema has staph versus less than 10% of people without eczema.

One more reason not to scratch

Scratching gives a feel-good feeling to your child as written in this post, but it’s really bad. Scratching damages the skin barrier and makes it very easy for staph to penetrate. As written in the article “Features of childhood atopic dermatitis”, staph increases IgE production, activate native T-cells by its superantigens and damage skin by its proteases.

IgE are antibodies that catalyzed the protective cells of the immune system to lock on to the antigen, see this post on immune system). Superantigens are toxins released by staph, that causes skin inflammation. Staph also results in less protein that is used to fight infection.

How do you know if your child has Staph?

Children with eczema are prone to staph bacteria, so chances are very likely there is staph on the skin but it may or may not be visible in the form of skin inflammation. If there is honey-colored crusts, pus-filled blisters, red scaly patches, swelling that is warm to the touch or fever, it’s likely that staph has already caused skin infection.

So, how to get rid of the Staph bacteria?

Marcie’s doctor Prof Hugo Van Bever recommended using chlorhexidine before applying steroid cream for Marcie. I told him during the consultation that I only use chlorhexidine (antiseptic solution) when Marcie’s rashes is persistent and red (like in the picture). However, he said that the bacteria is not visible to human eye thus it’s a good practice to clean the skin before applying steroid.

I also read that some paediatrician recommended diluted bleach bath as the bleach can remove the bacteria from the skin. Prof Hugo recommended swimming for Marcie. The idea is that people with eczema typically suffers from bacteria colonization, so remove the bacteria first and if need be, apply steroid which is more effective without the bacteria (of course, moisturizing is a must).

For previous posts in this series, see

Defective Skin Barrier

Allergy

Auto-Immunity

4-part series on What Causes Your Child’s Eczema – Auto-Immunity

How the Immune System works

This is a 4-part (a little more technical) series inspired by a review article “Features of childhood atopic dermatitis” by Hugo Van Bever and Genevieve Illanora. The article summarizes 4 players involved in atopic dermatitis, and I’ve tried to understand whatever I could from the article and other research papers published online and hopefully digested the information accurately for you to read.

Attacking the Organ to Protect

Another possible cause of eczema is that the immune system has wrongly identified the organ it is meant to protect as an enemy to attack. Here are the basic steps on how the immune system works:

1st: The foreign substance (antigen) that invades the body is detected by a group of cells known as the B lymphocytes. B cells are specialized proteins that lock onto the antigen (but cannot destroy them).

2nd: The B cells continue to exist in the body, which helps to prevent the body from being invaded by the same antigen.

3rd: T lymphocytes are also produced to destroy the antigen, that have been locked by the B cells.

Higher level of antibodies have been found where the eczema is more severe. It is possible that scratching aggravates the immune response by stimulating a greater release of proteins (specifically the IL-21 protein that regulates the T cells) which scientists have found to be present in inflamed skin. Thus, scientists are exploring whether by manipulating the IL-21 protein, the amount of T cells can be regulated so that the immune system will not attack the skin incorrectly (click here to read more).

But why is the immune system not working as it should?

There is no answer yet, though the hygiene hypothesis is that our environment being too cleaned now (with everyone using anti-bacterial wipes and cleaning much more with chemicals) has deprived our immune system of the chance to practice working on the antigens, leading it to work on harmless substance. However, if your child is already known to be allergic to say dust mites, then the accepted action is to minimize the dust mites rather than purposely not cleaning your home.

Update on 10 Dec 2016: Came across this study by the bioengineering team at Imperial College:

The team’s model showed that repeated flare-ups of AD trigger an immune system overreaction in the body, and when triggered this can’t be reversed. This creates a cycle where the threshold for triggering further AD outbreaks becomes lower, the flare-ups are more severe, and the condition progresses to becoming long-term. Severe flare-ups happen as a result of the complex interactions between the body’s immune system, the skin’s protective barrier, and environmental factors such as stress.

The press release of the study by Imperial College here.

4-part series on What Causes Your Child’s Eczema – Allergy

Role of allergens according to age and severity of AD (taken from Table 3 of article “Features of childhood atopic dermatitus”

This is a 4-part (a little more technical) series inspired by a review article “Features of childhood atopic dermatitis” by Hugo Van Bever and Genevieve Illanora. The article summarizes 4 players involved in atopic dermatitis, and I’ve tried to understand whatever I could from the article and hopefully digested the information accurately for you to read.

Does Allergy Cause Eczema?

The answer is we don’t know. If you refer to the first part of this series, allergy is hypothesized to be caused by eczema (rather than causing eczema). What has been observed is that the more severe eczema is, the higher the chances of allergies (as shown in table above). Allergies can be to food (which in the article “Features of childhood atopic dermatitis” summarized that it can be from direct eating/drinking, breast milk, placenta, inhaling and even kissing!), to house dust mites, dander and a whole lot of others (I’ve freaked myself out when researching what my baby girl Marcie could be allergic to).

Marcie’s Allergy

As it turned out, Marcie is not allergic to anything! She had a skin prick test done, something which I always recommend other parents to do because it takes a lot of guess work out. True that skin prick test is not 100% fail-proof, but it’s better than going mad worrying about everything cos if you google, you will most surely find something written or a post by someone that their child is allergic to something.

Here are some previous posts on skin prick test and eczema triggers that may interest you:

Taking the fear out of skin prick test

What triggers itch?

If your child has eczema, can you have a pet dog?

Is partially hydrolysed milk worth the money?

What and how much Detergent to Use?

Is it what you ate? How pregnancy diet affect eczema in baby

4-part series on What Causes Your Child’s Eczema – Defective Skin Barrier

Restoring Defective Skin Barrier (taken from nationaleczema.org, article by Peter Elias M.D.)

This is a 4-part (a little more technical) series inspired by a review article “Features of childhood atopic dermatitis” by Hugo Van Bever and Genevieve Illanora. The article summarizes 4 players involved in atopic dermatitis, and I’ve tried to understand whatever I could from the article and other research papers published online and hopefully digested the information accurately for you to read.

Why does my baby get eczema?

I’ve asked the same question countless times and I know it’s something to do with the genes (if you read my family tree post here); but exactly what causes eczema? Medical professionals are still trying to find the answer as finding the right answer can help them to find the right way to prevent/treat eczema. Apparently, it has all along been thought that eczema has something to do with a hyperactive immune system, which being too sensitive has wrongly thought that matters not harmful to the skin/body are harmful. Now, there’s a new outside-in hypothesis that it is the defective skin barrier that leads to more irritant and allergen penetrating the skin, inducing the immune system to increase production of IgE (that work as antibody). Too much IgE will lead to skin inflammation, asthma, hayfever and food allergy.

But why is the skin barrier defective?

This is caused by a few types of proteins, the most commonly cited one being the filaggrin (FLG), which serves to produce and protect the skin barrier. In people with eczema, there is lower level of FLG, resulting in flatter skin surface cells, disrupted protective fatty layer, reducing the moisturizing function of the skin and increasing water loss from the skin. Reduced FLG also increases the skin pH and leads to increased skin inflammation. The FLG does not explain all cases, because there are people without defective FLG but still has eczema and people with eczema, but no defective FLG. (Thus, it’s currently accepted as a few possible factors such as the gene, environment, allergy reacting together, in some way that we don’t know yet)

The Implication

In the table above, there are some current ways to restore our baby’s skin barrier mainly by moisturizing, FROM DAY ONE. This is because if the outside-in hypothesis is true, then the stronger the skin barrier, the less chances of allergen/irritant penetrating the body to cause the body to react hypersensitively. There is a chance then for us to stop the allergic march in our children, where eczema is replaced by asthma and rhinitis. Humidifier also helps to ensure that the environment is not too dry for the skin, especially during winter or if your air-con is on.

If you are interested in reading the details, click here and here.

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