Eczema News – Child car seats – Home for House Dust Mites

House dust mites in child car seatsHouse dust mites is one of the most common allergen triggering eczema in older children. We often think of house dust mites residing on the bed sheets, pillows and mattresses. One often overlooked area is the child car seat. This team of researchers from Ireland studied the type and amount of allergens in the child car seats and (oops, add one more thing to your to-do chores) it turned out child car seats are quite loaded with dust mites and allergens. Here’s a quick look at the study.

Sample: Dust samples collected from 106 child car seats and driver seats

Results: 12 species of mites, of which nine are known to produce harmful allergens, were recorded from 212 dust samples. Over 80% of drivers’ seats and over 77% of child car seats had house dust mites and its allergens. Over 12% of driver seats and 15% of child car seats contained house dust mite levels sufficient to be risk factors for sensitization and allergic reactions. From the samples examined, the house dust mites were breeding (not dead).

What it means: For those with eczema, asthma and rhinitis, you’d have to add car seats to your list of items to clean. Especially if you spend long hours in the car, even more critical to vacuum your car seats regularly. Plus it is compulsory for your child to be in a child car seat for safety.

Why dust mites love car seats: The researchers pointed out that the materials of the car seats, being made of polyester and/or cotton, trap shed human skin and other organic matter (like food) that are the food sources of house dust mites.

Read also these posts for more on:

Eczema Research Focus Month – House Dust Mite

Removing House Dust Mite even when there's no sensitization improves eczema

Removing House Dust Mite even when there’s no sensitization improves eczema

The above is a cartoon from Life of Eczema Girl. In the cartoon, I shared that there is no need to do crazy cleaning if the child does not have an allergy to house dust mite. Now, I’m not sure if I have to take back my words as I’ve come across this study that concluded that higher indoor house dust mite worsens the skin of eczema children, whether or not they are sensitized to house dust mite. The main points of the study are:

1. 95 patients of average 23 month old

2. Indoor house dust mite levels associated with the severity of skin symptoms, especially in eczema children who are not sensitized to dust mite

3. Possibly due to house dust mite being an irritant instead of an allergen

4. Practical implication to reduce house dust mite levels

How often is your cleaning? Did more measures to reduce house dust mite improve your child’s eczema? Do comment!

Improving our Homes for Eczema Children – Minimizing Indoor Allergens (House Dust Mites)

Celia Imrey, Architect and Co-Founder of SpaceKit

Celia Imrey, Architect and Co-Founder of SpaceKit

For parents with eczema children, it is very likely you’ve ‘scanned’ your homes looking for possible triggers of eczema flare-ups (I know I did!). While most of us think about our bed sheets, our laundry and carpets, we may not think about the layout and materials of our homes. For this series, I’m pleased to have Celia Imrey, architect and co-founder of SpaceKit, to share her knowledge from more than 20 years of experience in designs for homes, museums, libraries and hospitals.

More on Celia – Celia graduated from Yale University (Masters of Architecture) and Brown University (Bachelor of Art and Semiotics, Magna Cum Laude). She is an Associate at the American Institute of Architects and is a LEED (Leadership in Energy and Environmental Design Accredited Professional) Accredited Professional. She founded her own practices since 1996 and has taught architecture and art courses at Yale, Brown, Columbia/Barnard and NYU.

MarcieMom: Hi Celia, it’s so good to have you share with us on improving our homes. It’s also the first time I’ve an architect as featured guest, so I’m excited for the fresh perspective your interview will give to readers of this blog.

Common Indoor Allergens

The common indoor allergens are dust mites, mold, pet dander and cockroaches (droppings). We will consider how we can improve our home environment to minimize indoor allergen. Let’s start with the dreaded, all pervasive dust mites!

Dust Mites

Dust mite is a very common trigger of eczema for children, and more of it can be read in this post. They thrive in room temperature, humid environment and feeds on our dead skin. There are different allergens within the dust mite dropping, and they vary in particle size which renders some airborne while others tend to stay on surfaces. It may trigger different allergic conditions and symptoms for different ones in your family, depending in part, whether their airways or their skin is sensitized to the allergen.

Measures to reduce house dust mites are listed here, and they include removing carpets and stuff toys, washing in above 60 degC water and getting dust mite covers.

MarcieMom: Let’s suppose we are not changing where we live, but able to change our room layout and materials we use (ie major renovation):

Do the materials which we use for our floor, and for our walls, make a difference? For instance, will certain wall materials or paint or finishing increase the surfaces for dust mites to live while others make it more difficult for them to thrive?

Celia: At Space Kit, we recommend using natural materials where possible, especially for carpets. Dust mites take refuge in carpets but can’t live on hard surfaces like wood floors or plastic. Wherever you have carpets or rugs, use wool. The natural lanolin in wool repels dust mites.  Paint does not affect dust mites that we know.

MarcieMom: Is there a way to manage the humidity of our home? Both in the overall sense, meaning to reduce trapping moisture in our home; and also particular to the child’s bedroom, should it be say further away from the bathroom or have windows positioned a certain area (or if windows can’t be moved, for the bed to be positioned differently)?

Celia: Proper natural and mechanical ventilation are essential for healthy living, especially in bathrooms, kitchens and laundry areas. A well designed home takes air circulation (and thus temperature and humidity) into account; there is directionality to air circulation, and Mechanical Spaces (where air handling equipment are) are designed in relation to the spaces they serve in order to maximize air circulation and minimize dead air pockets. Humid conditions can be countered using air conditioning and ensuring that windows are fully sealed when closed. Furniture placement near humid areas will encourage mites.

MarcieMom: For a child with eczema, like mine, needs to be kept cool and so sleeps in air-conditioned room. As the air-con dries the air, I actually have a humidifier on. The risk of a humidifier is of course it promotes the growth of dust mites and mold. Do you have a solution to keeping the room cool, without making it dry or too moist?

Celia: You could cool the air before having your child sleep in the room. This will minimize the amount of time the child sleeps in dry air.  You could use the smaller, directional humidifiers to provide humid air only to the pillow area and then remove and treat the linens each day. It’s a lot of changing sheets but very hot water kills mites immediately, so regular laundering should be part of your solution if you use a humidifier.

MarcieMom: Sunning and ventilation helps to remove dust mites. What factors should we consider so that our bedroom can have sufficient sunlight and ventilation? (just thinking aloud -do different color walls make a difference? Does the type of window make a difference too?)

Celia: We love sunning and ventilation at Space Kit too! Light materials and paint colors help bounce light around. For bedrooms, use window treatment that provides sufficient privacy when open.  If you like sleeping in a dark space but have a privacy issue, you will need two kinds of window treatment, one for darkening the room and one for providing privacy while letting light (and some air) in.  Quality window treatment that is easy to use is critical.  You need to be able to operate it or pull back the curtains with a simple hook or tie.  Ease of use encourages you to use your windows to live in a healthier manner.

Thanks Celia, I’ve learnt much from your sharing! Next week, we will tackle other indoor allergens.

Sharing Treatment for Eczema Children

Elomet ointment

Last Friday’s lunch sharing session with Dr Lynn Chiam was a fruitful one – the topic was Treatment for Kids’ Eczema and we had pizza and chicken wings for lunch at the NSC!

The few notes shared:

1. Moisturizing within 3 Minutes After Shower

This is inline with Dr Jennifer Shu’s tip here, so it appears that it’s an international recommended practice. Dr Lynn shared that should it be difficult to do so, or if skin is still dry, wet wrap can be implemented. For practical purpose, should the child not be able to tolerate wet wrap overnight, instead implement at least an hour, 5 times a week. Even a dry wrap will retain moisturizer better for the skin.

2. Removing House Dust Mite (if it is an allergen for your child)

Dust mite can be killed either by extreme cold or heat – so wash bedsheet in at least 60 deg C water (read this post) and for stuff toys, freezing them may help decrease the amount of dust mite as they are affected by extremes of temperature. Dr Lynn recommended sunning mattresses and changing mattress once per year, i.e. don’t get a thick and very expensive one. Remove carpets.

3. Use of Topical Steroid – Don’t be Steroid-Phobia

I shared that there is a lot of fear out there among parents on using even the mildest steroid cream, and I’ve heard of increasing number of children hospitalized for infections due to fear of using steroid. Read more here on ‘Is Steroid Cream Safe?’. Dr Lynn explained 4 side effects of topical steroid (i) skin thinning (ii) easy bruising, (iii) fragile blood vessels and (iv) excessive hair growth. However, these can be avoided if patients ensure they use (1) the right steroid (2) at the right part of skin and (3) for the right amount of time. 

For anyone who emailed me (and we’re talking many!) who ask if steroid cream is safe because they’ve read about the side effects (which further reinforces FEAR spread like FIRE), you know my reply is the side effects of MISUSE should not be confused with Right Use. There are also many who have an agenda for propagating fear – to sell a steroid-alternative. Again, there is no need to use one and not the other. You can use steroid safely to treat flare-ups and skin inflammation, while at the same time, moisturize, wet wrap, have healthy diet, healthy lifestyle, distract your child, protect their skin, covering their fingers..

Dr Lynn shared that steroid treatment should be used pro-actively, to treat skin inflammation even after the rash disappear, and this is also consistent with what Dr Bridgett shared in this post. Protopic can be used for maintenance, and I’ve clarified with Dr Lynn that the stinging sensation that some experienced with Protopic will not be manifest as rashes. For more on Protopic, see here.

4. On Oral Steroid

This is usually a treatment for severe active cases, not lightly prescribed due to its side effects of osteoporosis, stunting growth and increased vulnerability to infection. Tomorrow’s post is on prednisolone, and you can also refer to previous post on cyclosporine.

5. This is my afterthought – Don’t Jump from Fear to Fire

I’ve shared earlier that Fears spreads like Fire, and I like to remind parents not to jump from fear into fire – for instance:

Is someone telling you not to use steroid but something natural? If so, do ask them and search Pubmed for studies. I’m not against natural and I’m not against any parent wanting to try something natural. Do check 1. It’s safe to consume/apply, 2. Keep up the standard treatment.

Is someone telling you that a steroid cream is not working and that the flare is caused by it? Think back – did your child have rashes before the steroid? and Dr Lynn shared that each steroid cream has its own molecular structure, suited for different purpose. You may wish to work with your doctor on another cream.

Is someone telling you their skin recovers after doing a,b,c and d? Ask them, did they do a,b,c and d while applying the steroid?

Is your doctor (I really hope not) telling you that established clinically trialed cream is no good and their own concoction is better? I do not know if it is/not, how would anyone know if it’s kept a secret, even without a medical name. If it doesn’t work for your child, it’d be impossible for the next doctor to understand what your child has been prescribed and how the skin reacted.

This is a very long summary of the discussion. But as you can see, I’m really AGAINST people who spread fear of steroid – again, I’m not saying steroid is the only way, I’m saying it has its place and fear shouldn’t be propagated for personal means.

Friday Dr Q&A with Dr Liew – Managing Allergy & Eczema at Childcare

Dr Liew Woei Kang

Marcie, who inspired MarcieMom to start this blog, doesn’t have any allergy and thus, this blog has been focused on eczema. Recognizing that there are many parents whose child also have allergy, MarcieMom invites Dr Liew Woei Kang, Paediatrician with special interest in Allergy, Immunology & Rheumatology to share more about managing allergy for eczema children.

More about Dr Liew: Dr. Liew practices at the SBCC Baby & Child Clinic and is also a visiting consultant to KK Hospital. He was also awarded several research grants from the National Medical Research Council, Singhealth Foundation and KKH Research centre to pursue clinical research in paediatric anaphylaxis, drug allergy, primary immunodeficiencies and Kawasaki disease. He is also the President of Singapore’s Asthma & Allergy Association which is currently administering the very first eczema fund (initiated by MarcieMom’s donation) for low income patients in Singapore.

MarcieMom: Suppose a child who has an allergy has to have alternative care-giver, say at child care centre. What would you recommend a parent to do and is there any initiative already taken in Singapore to increase awareness of allergy?

Dr Liew: Your allergist should be able to advice what the caregivers be taught. Written action plans for eczema are useful for daily skin care instructions, whilst food allergy/anaphylaxis action plans provide information on treatment in emergencies. There is continued public education regarding allergic conditions via hospitals and societies like AAA.

MarcieMom: For Food Allergy – How should a parent besides obviously telling the teachers/ care-givers of the allergy, help to make it easier for the school to prevent contact with the food? In there a need to warrant 0% contact, for instance, the whole school shouldn’t even bring the food in?

Dr Liew: After a diagnosis of food allergy, it would be important to relay the importance of food avoidance and emergency care plans with the care-givers. Written food allergy/anaphylaxis plans are useful. The degree of strict avoidance varies accordingly to the food allergen and severity of allergic reaction. It would be better to discuss specific advice with your allergist.

MarcieMom: For Non-Food Allergy – What are the common non-food allergens? And if it’s dust mite, how can a parent tell the school to keep the dust mite level low since house dust mite is something that can’t be totally eliminated? And if it’s dog droppings allergy, should a parent not even sign up a child care centre where teachers or even classmates have dogs at home? For common skin allergen like soaps and detergents, should a parent go as far as to monitor what detergent the child care centre or caregiver is using? (And the bigger question is – how can a child care centre with 70+ kids cope with so ‘many requests’ of a parent?)

Dr Liew: The most common environmental allergen is house dust mites in Singapore. House dust mite avoidance measures are useful to reduce the levels of protein, but results variable. I would not recommend schools to implement house dust mite avoidance measures as they are time-consuming and difficult to implement in the long term. Dog sensitisation is usually to the hair epithelia, rather than poo, and is not common in Singapore. Irritants like harsh soaps and detergents should be avoided in children with eczema and dry skin. It may be helpful to provide the school with your child’s soap substitute and moisturisers, and get the teachers assistance for application.

MarcieMom: Thank you Dr Liew! Next friday, we’ll learn more on recognizing allergic reactions.

Friday Dr Q&A with Dr Liew – Kids’ Allergy Basics

Dr Liew Woei Kang

Marcie, who inspired MarcieMom to start this blog, doesn’t have any allergy and thus, this blog has been focused on eczema. Recognizing that there are many parents whose child also have allergy, MarcieMom invites Dr Liew Woei Kang, Paediatrician with special interest in Allergy, Immunology & Rheumatology to share more about managing allergy for eczema children.

More about Dr Liew: Dr. Liew practices at the SBCC Baby & Child Clinic and is also a visiting consultant to KK Hospital. He was also awarded several research grants from the National Medical Research Council, Singhealth Foundation and KKH Research centre to pursue clinical research in paediatric anaphylaxis, drug allergy, primary immunodeficiencies and Kawasaki disease. He is also the President of Singapore’s Asthma & Allergy Association which is currently administering the very first eczema fund (initiated by MarcieMom’s donation) for low income patients in Singapore.

MarcieMom: Thank you Dr Liew for taking time to help answer these questions, we’ll start with the basic information on allergy as this blog hasn’t covered this topic before.

Question: What is an allergy? For children with eczema, should parents send their children to allergy tests or should only those with eczema of a certain severity do so?

Dr Liew: An allergy is simply an abnormal immune reaction to a common protein. Symptoms are varied depending on trigger and organ involvement. The most common reaction is on the skin, resulting in itchy rashes like urticaria (hives) or eczema flares.

Atopic eczema starts essentially as a skin barrier defect, with resultant dryness, itch and allergen sensitisation later. It is not a pure allergic disease. Skin tests for eczema patients are generally not necessary, as the most common allergen is house dust mites. Food triggers are more commonly in young infants with significant eczema despite good skin therapy.

MarcieMom: Allergy and intolerance are often mixed up; can you explain the difference between the two, specifically, how a parent can correctly identify if the child is allergic or intolerant and what follow-up action they should take in each case?

Dr Liew: Allergy and intolerance result in adverse reactions, but the key difference is that the former involves the immune system, whilst the latter do not. If the immune system is involved, there is a potential for severe allergic reaction called anaphylaxis with continued exposure due to immune memory. There is no risk of anaphylaxis in intolerance. Eg. Cow’s milk allergy can result in hives, vomiting and wheezing; in contrast, cow’s milk intolerance presents with diarrhea in lactose deficient individuals.

MarcieMom: Thanks Dr Liew for your very clear explanation; now, we know the meanings of allergy, eczema and intolerance. Next week, we’ll chat more on different allergy tests.

Friday Dr Q&A with Prof Hugo – Vacuum Cleaner

Prof Hugo Van Bever

Prof. Hugo Van Bever is the Head of National University Hospital’s Pediatric Allergy, Immunology & Rheumatology Department. He is also an active member of the board APAPARI (Asian Pacific Association of Paediatric Allergy, Respirology and Immunology) and has published more than 250 papers in national and international journals. His main research interest areas are paediatric allergy and paediatric respiratory infections.

Marcie Mom: Good day, Prof Hugo! Today, I’m doing some spring-cleaning and just got me thinking – There are many expensive vacuum cleaners out there.

Do you think the expensive vacuum cleaners are worth investing in? What should a parent look out for when buying a vacuum cleaner?

Prof Hugo: In case of house dust mite-allergy, a decent vacuum cleaner is recommended. However, most companies have no research data on their vacuum cleaner. Don’t spend too much money!

Marcie Mom: Thanks! For parents who want to know more about house dust mites, see this post 🙂 (quote below, my advice on vacuuming, and btw, I clean my whole small apartment with wet kitchen towel..I know, my hubby complaining about that too!)

If vacuuming, get a vacuum cleaner with a good filter that does not release small particle in the exhaust; I borrow my friend’s $3000 vacuum cleaner twice a year to vacuum mattress; but if your child has asthma, then the mattress needs to be vacuum weekly. (Dust mite can burrow deep into the mattress and will be hard to vacuum away if the mattress is thick.)

Friday Feature – Co-Sleeping 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: Good morning Dr B; today’s question is one related to attachment parenting. There’s much discussion about co-sleeping, some of the pros and cons in this post. Do you think co-sleeping is positive emotionally for the baby? Is it positive for the parent? I’ve read that co-sleeping reduces scratching by eczema child as they feel more comforted, is it true?

Dr B: Yes, co-sleeping is being promoted isn’t it? I am cautious about it: remember, for those with atopic eczema one of the hazards of the bed-room can be the house dust mite. They feed on discarded skin cells, and their droppings are everywhere, and especially in bedding.

Picture of dust mite, contributed by Dr. B

It is easier to keep a cot clean & relatively free from the house dust mite – with special bedding, and use of a urine-proof under-sheet – it is difficult achieving the same with a big bed shared with Mum and Dad! DrB

Should you be Worried about House Dust Mite (HDM) for your Eczema Child?

House Dust Mite (picture from dust-mite.net)

House dust mites are tiny insects, about 0.03mm long, look scary under a microscope but too small to be seen by us. They are definitely in our homes as house dust mites, or HDM, love room temperature (18 deg C to 26 deg C/65 to 80 deg F), humid (above 55%) homes where there are plenty of shed human skin for food. HDM feed on our dead skin, fingernails, hair, animal fur, bacteria, fungi and pollen. In your home, they are likely to be on the bed, mattress, carpets, upholstered furniture and curtains. There is no way to have zero dust mite in your home, but you can reduce their quantity by making the environment less favourable for them. It takes a lot of effort to keep the dust mites away, so we should understand a little bit more before killing ourselves with the cleaning.

How does house dust mite affect your eczema child?

First things first, get your child tested. A skin prick test will show if your child is allergic to the droppings of the house dust mite. It’s the protein in the droppings that is the allergen, and not every eczema child will be allergic to HDM (my baby Marcie isn’t) though patients with eczema could be more susceptible to dust mite allergy (taken from “Specific profiles of house dust mite sensitization in children with asthma and in children with eczema” article in Pediatric Allergy and Immunology 2010). It was also written in the same article that those with eczema by 3 months old is more likely to be sensitized to aeroallergen by 5 years old. Also, the more severe the eczema, the greater the sensitization to HDM. In the article, it is noted that the major HDM allergen for eczema patients is Der p1 of D.pteronyssinus, which is a large particle that don’t stay airborne but quickly land on surface, including on the skin. For eczema children with defective skin barrier, the allergen can penetrate the skin more easily to trigger itchiness.

How to reduce house dust mite?

If your child is tested allergic or get asthma attack from inhaling the HDM allergen, then there’s little choice but to get rid of as much dust (and the dust mite dropping trapped in the dust) as possible. Here’re a few ways to keep the dust mites away:

1.      Remove carpets, thick curtains, thick mattress, upholstered furniture (think plastic, wood, leather, vinyl).

2.      Get dust mite proof covers for the pillows and mattresses.

3.      Wash bed sheet, pillow cases weekly at temperature of above 60 deg C (you can see my washing machine here, I steam wash everything).

4.      Wipe your home with wet cloth, instead of dry dusting from one area to the air (finally, there’s some support for what I love to do, using a wet kitchen towel to clean everything).

5.      If vacuuming, get a vacuum cleaner with a good filter that does not release small particle in the exhaust; I borrow my friend’s $3000 vacuum cleaner twice a year to vacuum mattress; but if your child has asthma, then the mattress needs to be vacuum weekly. (Dust mite can burrow deep into the mattress and will be hard to vacuum away if the mattress is thick.)

6.      Ventilate room; this will reduce stale humid air trapped in the room, and let the sun in (think less cosy for the dust mite).

7.      No soft toys; if your child absolutely can’t do without them, try freezing the soft toys in plastic bag for 24 hours in the freezer to kill the dust mite, followed by washing away the dead mites and droppings in the washing machine.

8.      Reduce humidity, but too dry environment is bad for eczema, read this post on humidifier and air-con.

9.      Reduce ornaments, dried flowers, books, textured wallpapers; the less surface for dust to land on, the better.

Save your money on these:

1.      Don’t buy mite killing sprays which may be an irritant; likewise, for ionizers.

2.      Don’t buy air filters because the air filter may stir up air, making it longer for the dust to settle (which increases risk for asthma children as the HDM allergen stays airborne). Or air filter may end up filtering only the air near to the filter.

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