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Guest Interview

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

Celia Imrey is an architect and co-founder of SpaceKit; she 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 has taught architecture and art courses at Yale, Brown, Columbia/Barnard and NYU.

This was originally a two-part series combined into one informative post.

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!). Whilst most of us think about our bed sheets, our laundry and carpets, we may not think about the layout and materials of our homes.

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 – Eczema Trigger for Children

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):

Reducing Dust Mite through Home Design

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.

The natural lanolin in wool repels dust mites. 

How Home Design Affect Humidity & Dust Mite Growth

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.

Humid conditions can be countered using air conditioning and ensuring that windows are fully sealed when closed.

Designing a Home to be Cool without Drying Child’s Skin

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.

Sunlight and Ventilation in Child’s Room Design

MarcieMom: Sunning and ventilation helps to remove dust mites.

What factors should we consider so that our bedroom can have sufficient sunlight and ventilation?

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.

Mold, Another Common Eczema Trigger

Mold is another common indoor allergen and more of it can be read from CDC. Like house dust mite, they thrive in room temperature and humid environment. Their feeds include materials like wood, leather, dead skin and cotton and wool fibres. Mold spores are airborne and trigger symptoms and conditions such as watery eyes, sore throat, respiratory issues, nasal congestion, eczema and even asthma. Minimizing mold growth can be via control of temperature, control of humidity and reducing their food.

Choice of Home Materials on Mold

MarcieMom: As I’m preparing for this, I’m surprised to learn that many building materials are food sources for mold, including wallpaper glue, greases, paper, textiles and wood. 

Do you have suggested common materials to use for our walls and floors, and in our bathroom, so that there is less food for the mold?

Celia: Solutions that resist mold are a fundamental part of Space Kit’s designs. There are many design considerations to make with regard to moisture. Good designs don’t leak, cause condensation, or trap moisture. Some options include using good quality door seals and gaskets for shower doors. Usage of moisture and mold resistant backer boards and vapour barriers.

Are there other areas in our home that traps moisture easily and what can we do about them (both during renovation and on maintenance basis)? 

I’ve read that certain paints, leaks, damp basements, poor drainage or plumping traps moisture, and also condensation on cool surfaces can increase mold.

Celia: Basically mold feeds on untreated, natural surfaces. Space Kit promotes the use of natural materials, like stone, ceramics, plaster and wood and we advocate finishing them properly. For example, wood is a beautiful home material, especially for floors, but it needs to be finished properly, so use varnishes, stains, paints, and fill all the cracks. In using any natural material, make sure all the surfaces are coated and maintained.  Wool carpets are dyed and the dye is bound with a sealer. If you keep carpets clean and off any floors that have moisture issues like concrete floors in a basement, they should not feed mold. Space Kit’s window treatments use materials that hinder mold, like synthetic materials. For bathrooms, we recommend tiling the full walls.

Note: be vigilant about spotting mold: undersides of tables, on ceilings, etc. and treat immediately before it spreads.

What about the selection of cabinets, walls, wall coverings, bookshelves and also the positioning of furniture? Do these affect mold growth?

Celia: None of these affect mold growth if there if proper air circulation.

Bathroom Design on Mold Growth

MarcieMom: My guess on the common area in our homes where mold thrive is the bathroom where it is often damp. 

What are your recommendations to minimize mold in bathroom?

Celia: Our designs are intended to minimize moisture retention, for example, we like glass shower doors (with systematic wipe-down after showering) instead of curtains. Proper ventilation for bathrooms and dryers is critical.

Cockroach – The Yucky Eczema Trigger

Cockroach, more precisely the allergens found in their droppings, saliva and bodies, is another common indoor allergen. From the AAFA website, it is mentioned that When one roach is seen in the basement or kitchen, it is safe to assume that at least 800 roaches are hidden under the kitchen sink, in closets and the like’.

Cockroaches thrive in warm and humid environment, and they feed on our food (thrash, scraps, starch) and water. The particle sizes of cockroach allergen are large and tend to settle on surfaces. They not only worsen allergic conditions, but carry bacteria.  Symptoms or conditions of allergy to cockroach may be itchy eyes, itchy skin, eczema rashes, nasal congestion, asthma and allergic rhinitis. Minimizing the growth of cockroach can be done by observing hygiene and minimizing their food source, water and shelter.

Prevalence of Cockroach Allergen in Dust

In a study published in the New England Journal of Medicine, of the children in the study, “36.8 percent were allergic to cockroach allergen, 34.9 percent to dust-mite allergen, and 22.7 percent to cat allergen. Among the children’s bedrooms, 50.2 percent had high levels of cockroach allergen in dust, 9.7 percent had high levels of dust-mite allergen, and 12.6 percent had high levels of cat allergen”.

I understand that cockroaches hide outside the home, what are the possible areas in our home to ‘seal off’ cockroaches?

Celia: Sealing the hole around the steam pipe and sealing the hole around all plumbing and electrical pipes. Also, you can utilize drain covers to prevent critters from entering up into your home through showers and sinks.

MarcieMom: Chemicals may trigger irritation either in airway or skin for young children. It is best, therefore, to use cockroach trap. This may sound strange, but is there a need to plan ahead where cockroach traps should be placed?

Celia: If proper preventive measures are appropriately taken such as sealing of holes and cracks, then there is no need to plan for precautions.

Safe Chemicals at Home for Children

MarcieMom: While we’re on the topic of chemicals, which are the materials you would commonly recommend that are safe for young children, and for how long would ‘airing’ be required before the family moves into the home?

Celia: Materials with zero or low VOC content are recommended for children and adults. It is best to move in after all the fumes from the paint have disappeared (i.e. that are no off gassing smells) and the home is dust free.

MarcieMom: Thank you so much Celia for helping us improve our homes and minimize the indoor allergens, right from the renovation stage!

Categories
Living with Eczema

SOMEONE Managed Allergic March for Son with Eczema

Sarah, with her 3 children, shares on managing allergic march
Sarah, with her 3 children, shares on managing allergic march

This is a series focused on personal journey with eczema while managing a certain aspect of life. Today, we have Sarah Chapman, whose third son has eczema since three-month old. Today, she shares how she managed her son’s Allergic March. Sarah is a volunteer with AllergyUK and had shared her allergy knowledge nationwide.

Marcie Mom: Hi Sarah thanks so much for taking part in my Friday blog series ‘Someone has Eczema’! Let’s start with you sharing a little of your family’s eczema and allergy history, and when did eczema or allergy start and what’s the severity?

Sarah: I had eczema soon after birth, and throughout my childhood. I still get it every now and then. My maternal grandfather had it all his life. I can remember him scratching! My mother and her brothers had eczema as well. There is also a lot of asthma in my family and nickel allergies.

My husband has asthma with links to environmental allergies.

Marcie Mom: I understand that your son, now 17 year old, experienced the Allergic March, progressing from eczema to allergies.  What was his condition from birth to a young child?

Sarah: Our 3rd son had eczema day 10 after birth, and as time went by he had a poor sleep pattern (by that I mean an  inability to sleep for longer than 2 separate hours a night, and 20 min cat naps a day) He also had very slow and poor weight gain, even though breastfeeding was going well. These are the early signs of food allergy in a breast fed infant before three months old.

As he grew his eczema was very hard to control, his daily treatment was 5- 8 all body emollients and twice daily low dose steroid cream. Just before we were about to start wet wrapping treatment we discovered that he had an egg allergy and then peanut at 13 months old. I had also started to suspect that environmental allergies, like pollen, dog and cat were a problem.  At 18 months old immunologist confirmed allergies to, dust mite, cat, dog, tree pollen, hay fever, egg, tree nut, peanut.

As we paid a great deal to lessen dust mite exposure and pollen in our home, and controlled diet and his skin improved. When I stopped breastfeeding him, his skin got instantly better, but he began to catch every infection going, and skin became infected and so on.

Treatment added to original eczema plan, change of emollients, eye drops, nasal sprays, antihistamine during hay fever and tree pollen season.   Age 2 epi pens, and emergency plan for anaphylaxis.

Like many allergic children he physically shows signs of being an allergic child. He has a ‘captains salute’ a small dry crease on top of nose from rhinitis, from using hand to push up nose from constant nose drip. He is a mouth breather child, again a sign of poorly controlled rhinitis.

He has dark rings, and an extra dry crease under his eyes. He also has derma- graphism (am not sure about the spelling of that btw!) which means that if he is slightly scratched a wheal will form within minutes. He also snored as a child which isn’t normal and is a sign of rhinitis.

Rhinitis has a major impact on sleep quality, and babies and young children require sleep to grow. Concentration at school when you have a totally blocked nose 24/7 is very difficult and so has impact on education.

Marcie Mom: How did the eczema progress when he started elementary school?

Sarah: As he neared 5 his eczema improved, this is typical of an allergic march child, and at the same time his rhinitis and environmental allergies were making more of an impact. We had discovered more food allergies to add to list.  Eczema treatment 3 full body emollient a day, and no steroid cream required. Except after food reaction in which eczema would appear as hives and other IgE response symptoms disappeared.

Age 5   allergies, Dust mite, Tree Pollen, hay fever, dog , cat , egg, peanut, legumes, tree nut, kiwi fruit.

Age 7   Dog allergy considered life threatening, change to emergency treatment plan, oral steroids and asthma inhaler (has asthma response during allergic reaction, but not asthmatic) yeast extract new food allergy.

Food challenge in allergy clinic confirmed outgrown cooked egg allergy = increase in  food  choice with higher calories.(still underweight.)

Age 10 Outgrown raw egg allergy in food challenge. Dog allergy lessened and quality of life improved, for instance sleep overs with friends who have dog, controlled with antihistamine.

Eczema,dry skin only.

Marcie Mom: What was his condition as a preteen and teenager? Did puberty change his condition? And how is your son now, as a young adult?

Sarah: By 12 redeveloped raw egg allergy, and by 13 possibly cooked egg, now at 17 prefers to avoid himself.  Food allergies: Egg, Peanut, some Legumes, Brazil nut, Yeast Extract, Kiwi Fruit, Hay Fever, Mold, Tree Pollen, Dust Mite.

Skin very dry, but otherwise OK!

We have used epi pen 3 times so far, but despite this is gaining confidence in his ability to buy food independently and going out with his friends.

Marcie Mom: Thanks Sarah for taking time to share your son’s allergic march, it is useful for parents to know but hopefully, won’t go through the full allergic march!

Categories
Living with Eczema

SOMEONE Managed Diet for Child with Eczema

Judy Converse, nutritionist and a registered dietitian, shares about managing diet for her son.
Judy Converse, nutritionist and a registered dietitian, shares about managing diet for her son.

This is a series focused on personal journey with eczema while managing a certain aspect of life. Today, we have Judy Converse, founder of Nutrition Care for Children LLC, whose son showed signs of eczema in his first two months. Today, she shares how she managed her son’s diet. Judy is a licensed nutritionist and a registered dietitian for more than 20 years, and had shared on Eczema Kids Nutrition here.

Marcie Mom: Hi Judy, thanks so much for returning to take part in my Friday blog series ‘Someone has Eczema’! Let’s start with you sharing a little of your son’s eczema history – when did eczema start and what’s the severity?

Judy: My son’s rashes became visible just after birth. It was confusing – he was breast fed; I had received no medications or interventions during delivery. There seemed to be nothing, as far as I knew, that he could have reacted to. Within the next few weeks, it was bad enough that he might bleed from scratching at it, unless we covered his hands for sleep. I know this is controversial, but we came to strongly suspect this was part of an adverse reaction to his newborn dose of hepatitis B vaccine, which had been given without our knowledge.

Marcie Mom: I understand that you got into your current field to understand more about helping your son.

Share with us: What perplexed you so much when you were managing his diet that spurred you to be a nutritionist and dietitian?

Judy: I became a dietitian years before my son was born, and had already worked in this field. But I had not been involved with pediatric nutrition up to that point, other than some work in the WIC program in my training. My son’s circumstances are what triggered me into this niche. What perplexed me – or I should say – stunned me – was that even though he was having rashes and many other concerning symptoms, we were repeatedly told it was “normal”. He had projectile vomiting, terrible hard screaming (one nurse said to me “he’s too young to have colic” when he was just a few days old and screaming until he was blue), seizure like events, and runny liquid stools – at 8 or 12 months old, he would have 10 liquid runny mucousy stools a day, that ran up to his neck and down his legs. Even my father, then about 70 years old, brought it up to me. Five kids plus three other grandkids and he’d never seen poop like that. But the doctors insisted it was normal. It isn’t normal. It’s clearly a sign of a problem with digestion, absorption, inflammation or all three.

My son was born full term weighing 7 lbs 8 oz, but slid down the growth chart so that by age 2 months, he was hovering at the 5th percentile. This was the wrong direction. Obviously, his digestion was not working normally. But I could not get any of my son’s pediatric providers to see that. I found this quite disturbing, to see that a baby’s nutrition, growth, feeding and eliminating were not a priority to them.  My training had given me thorough evidence based information about how crucial these are for normal brain development and learning. It was a shocker to me that no one was concerned. No one seemed to realize this can impact a baby’s brain.

Marcie Mom: Was it easy to figure out his allergies or did the allergy testing not corroborate with your observations?

Judy: Though I had excellent training in my undergrad and graduate nutrition studies, allergies in infants was new territory for me. I had no guidance from my son’s health care providers. I reached out to La Leche League, which I knew about because one of my graduate advisors had been involved with them. They gave me helpful information about breastfeeding an allergic baby. This was in 1996-1997. No internet to speak of. I opened my text books and dove into learning as much as I could. I requested allergy testing when my son was 8 months old. This is young for this testing, but he had dramatic allergic responses to several foods he had never eaten. The doctor apologized, saying my son would probably have asthma and eczema for the rest of his life. Neither came true – I was determined to redirect that.

I later learned that these reactions were only part of the story. These were IgE allergy reactions. When my son was about two years old, we checked IgG food sensitivity reactions. There were several reactions there as well. They didn’t correspond to the IgE. It filled out the rest of the story, and confirmed he had other foods we had to prioritize. This is something I have seen often in my practice since. There is plenty of debate about IgG food allergy testing, especially in children as young as 2 years old. But once we mapped both the IgG and IgE reactions, we could make a more effective plan. My son was eczema free and has been his whole life since. His stools and growth normalized. He was happier. Over the years, he has had a few asthma episodes. Every time we are offered an inhaler, he seems to use it once or twice, then it sits in a drawer and expires before he needs it again.

Marcie Mom: One final question – now that your son is an adult, did that shared experience managing his diet give him fond memories of your care and love for him?

Judy: My son is in high school – not always the moment when parents feel appreciated by their kids! But he understands all the effort made on his behalf. We as a family have learned to enjoy many foods that we never would have discovered if it weren’t for his needs. He is sort of a foodie. He loves good food, is interested in cooking, and has an adventurous palate, because at a very young age, we had to have other options for him. He has taught me a lot.

Marcie Mom: Thanks Judy for taking time to share your journey on managing your son’s diet – am sure many moms like me are inspired to study to help our children!

Categories
Living with Eczema

SOMEONE manages TWO kids!

Jennifer shares on managing a second child when the first has eczema
Jennifer shares on managing a second child when the first has eczema

This is a new series focused on personal journey with eczema while managing a certain aspect of life. Today, we have Jennifer Roberge, whose eldest son Tristan has had eczema from three-month old and shares how she manages taking care of him while having another child. Jennifer is a blogger at It’s an Itchy Little World and a mompreneur who started her own company and online store The Eczema Company – she’s a return guest on my blog and you can read her first interview on her mompreneur journey here. Marcie Mom: Hi Jennifer, thanks for taking part in my 2013 blog series ‘Someone has Eczema’! Share with us a little on the severity of Tristan’s eczema when you were pregnant with your second child; was it tiring even before the second one was born?

Jennifer: During my pregnancy, Tristan (just shy of two years) had severe eczema behind his knees, around his midsection, around his ankles, wrists, and hands. It was dry, flaky, inflamed, and extremely itchy. My husband and I would lie awake with him at night trying to help him settle back down to sleep and try to forget the incredible, over powering urge to itch. So, we weren’t sleeping well to begin with – add to that the end of my pregnancy where sleep tends to evade mothers to be. They weren’t the easiest of times, that’s for sure. The eczema worsened after the baby was born, and continued to cover his body. Around three he was 90% covered, head-to-toe in eczema and resembled a burn victim. It was a difficult balancing act, trying to prevent my son from tearing up his fragile skin and managing an infant.

Marcie Mom: I know that Tristan has allergies too. Did you manage to figure out what’s triggering the majority of his eczema flares and his allergies before the birth of your second child? And did being able to manage somewhat his eczema helped in your decision to have a second child?

Jennifer: To be completely honest, when we decided to have a second child, Tristan’s skin was much less severe, so his condition didn’t really play much of a part in our decision. When things started to worsen during the pregnancy, my goal was to determine all of Tristan’s triggers and to get control over his eczema before the baby was born, but it didn’t happen that way. We hit rock bottom after the baby was born and when Tristan head-to-toe, severe eczema. No one in the house was sleeping, so we went for extreme methods and did a full elimination diet and saw results within days. It was nothing short of a miracle for our family.

Marcie Mom: Do share with us how you manage the breast-feeding, taking care of a new born, when Tristan I suppose do still need attention to his eczema and allergies? What was the toughest part?

Jennifer: Tristan needed constant supervision back then, not because he was only two, but because he’d scratch his skin raw if we left him alone for a minute. So, breast-feeding was extremely difficult. Tristan was very jealous and wasn’t a fan of my alone time with the baby during nursing, so when I was alone with the children, I’d cover Tristan’s hands with ScratchMeNot mittens and distract him with a book during nursing. Yes, I managed to learn how to read to him breast feeding! I also remember I relied on an infant wrap a lot during the first few months. I’d have my baby safely attached to me and I’d have free hands to help Tristan when he needed me. The wrap was essential back then. What was the hardest part of it all? When no one was sleeping – not the baby, not Tristan, not my husband or I. It’s one thing getting up to nurse throughout the night, but add to that frequent wakings and hours spent with an uncomfortable toddler that will do anything in his power to scratch until he draws blood.

Marcie Mom: One final question – what word of encouragement would you give to someone who just found out she is pregnant with a second child while the eldest has eczema?

Jennifer: Buy a good infant wrap or sling. Try to work on determining your child’s eczema triggers before the baby arrives – we waited too late. If your child wakes a lot during the night, try rotating nights with your partner. One night you take all the shifts with your restless child, the next time it’s your partner. And nap as often as you can to catch up on lack of sleep.

Marcie Mom: Thanks Jennifer for sharing your personal journey, it definitely strikes a chord with many moms out there!

Categories
News & Research

Eczema and Diet Studies

Eczema and Diet on EczemaBlues
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.

Probiotics

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.

Prolonging Breastfeeding

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

Elimination Diets

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.

Dietary Supplements

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.

The Conclusion

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

References (from PubMedHealth and The Cochrane Library)
1.    Food allergy and the introduction of solid foods to infants: a consensus document
2.    Meta-analysis of clinical trials of probiotics for prevention and treatment of pediatric atopic dermatitis
3.    Probiotics for treating eczema
4.    Dietary supplements for established atopic eczema in adults and children
5.    Effect of prolonged and exclusive breast feeding on risk of allergy and asthma: cluster randomised trial
6.    Omega 3 and 6 oils for primary prevention of allergic disease: systematic review and meta-analysis
7.    Meta-analysis of the evidence for a partially hydrolyzed 100% whey formula for the prevention of allergic diseases
8.    Probiotics supplementation during pregnancy or infancy for the prevention of atopic dermatitis: a meta-analysis
9.    Dietary exclusions for established atopic eczema
10.  Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child
11.  Formulas containing hydrolysed protein for prevention of allergy and food intolerance in infants
12.  Prebiotics in infants for prevention of allergy
13.  Probiotics in infants for prevention of allergic disease and food hypersensitivity
14.  Soy formula for prevention of allergy and food intolerance in infants
Categories
News & Research

Top Allergy Myths as compiled by Mom of Eczema Child

allergy myths eczema bluesReaders 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&A Dr 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?

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Living with Eczema

SOMEONE manages Eating Out with Child

Lisa shares on managing her son’s eczema when eating out
Lisa shares on managing her son’s eczema when eating out

This is a new series focused on personal journey with eczema while managing a certain aspect of life. Today, we have Lisa, who is sharing on managing her son’s eczema when eating out. Lisa blogs at mybabyhaseczema.com and also LifeofaHappyMom

Marcie Mom: Hi Lisa, thanks for taking part in my new blog series ‘Someone has Eczema’! Let’s start with you sharing a little of your son’s eczema, what’s the severity and his triggers?

Lisa: My older son’s eczema was quite severe as a baby, covering over 90% of his body. It is relatively mild now, but it still shows on his face and behind his knees, and he still itches other places.

There is no question that foods trigger his eczema. His gut is irritated, allowing food to pass through undigested, which the body attacks, causing inflammation, similar to how it attacks pollen in people who have environmental allergies. Once when he refused to eat for two days straight, his eczema almost disappeared. Eczema is not the only reaction he has, however; certain foods like milk can cause hives almost instantly, and some foods cause mild asthma-like symptoms which only last a few minutes.

Marcie Mom: Since your son’s eczema is triggered by food, can you share how his eczema flared when in contact with various types of food?

Lisa: He is more or less sensitive to most foods, but he doesn’t react to most of them instantly; they have to be absorbed and then he will show some reaction over time, in the form of more itchy red patches, usually on his face, neck, and behind his knees. It used to be all over. Eczema is not the only reaction he has, however; certain foods like milk can cause hives almost instantly, and some foods cause mild asthma-like symptoms which only last a few minutes. Recently he was playing in some white flour (I have some for science experiments, and his sister, who has no allergies, was digging for “dinosaur” bones in it on a rainy day for a school science project); he was fine until he rubbed his face, and then his eyelids began to swell and his face to feel hot and puffy. I rushed him to the bathroom and rinsed his face and washed his hands, and the reaction eventually subsided. He also has been known to throw up when he ingests certain foods; he used to throw up apples in all forms (even juice), but now he does okay as long as he eats only organic apples, and even those not every day.

Marcie Mom: Since we never really know what goes into outside food, how did you manage eating out? Do you take precautions (like epipen) or is there a tried and trusted way you identify where to eat to be safe?

Lisa: Because my son is not noticeably reactive to trace elements in food (if he were, I’d need two blenders!), and because of his tendency to throw up when he ingests too much of most high allergens, I have never gotten an epipen. However, since the list of things he cannot have is so extensive (including not just all the common allergens, but potatoes, corn, and other staples of many allergic and GF eaters), for most of his life I simply packed him a lunch. I would inform the server that he had allergies and so we had brought his lunch, and we never had a problem. Even in buffets, I would just tell them that he was allergic to everything (and when he was in the “I hate vegetables” stage, there was nothing he could and would eat), and they didn’t charge me for his meal. At 2 or 3, he didn’t care that he was eating something different from the family–that was the story of his life anyhow.

I once learned the hard way that you cannot assume a food will be safe. Once I found myself at the Olive Garden without his lunch. I had taken the bus, and we were too hungry to wait to go home. I ordered the GF pasta just olive oil and salt instead of the sauce, and double grapes, since he couldn’t have any of the juices they had. That night he had a rough time, wheezing and waking frequently. I wrote them and asked what was in the pasta (thinking back, I remembered it being a little yellow, as though it had corn). Not only did it indeed have corn, but also cheese and some other things that he is allergic to. So I learned to ask more questions about anything that wasn’t in it’s natural form.

Last month I once again forgot to pack his lunch, but this time we were eating at a buffet that had a huge salad bar. Since he has decided he likes veggies, though, it turned out okay. He ate lettuce, cauliflower, broccoli, cabbage, cucumbers, olives, kidney beans for protein, and jello for dessert. If I had planned better, I would have had a little something with more carbs in it, like bread or pancakes, but at least he ate enough. He did seem to react a bit more to that meal than he does at home, but I figure it is because we eat most produce organic, and he does do better on organic foods. But once in a while is okay for us.

Marcie Mom: One final question – do you have a fave restaurant or chef that dishes yummy food for your child and you have complete trust in?

Lisa: Yes! That buffet I just shared about is Sweet Tomatoes. There are several of them here in the Portland, OR area, as well as in other places. Besides salad, they have baked potatoes, several varieties of soups, muffins, faccocia bread, and pasta, as well as several dessert options. My husband is mildly sensitive to gluten, and I’m avoiding it while breastfeeding our youngest (who also has eczema, mostly in reaction to gluten and food colors, though I know there are some other triggers, just not strong enough to identify yet), and we both are able to eat as much as we want there. This last time I had two servings of salads, and he had a salad and a baked potato. They have a list of items on a card on the table that are gluten-free, and you can ask to see the ingredient list for any item available. Of course, if all you eat is salad, you know exactly what goes into it, and they have vinegar and oil available in bottles next to the dressings so that you can use those if you aren’t sure about the dressings, or are worried about contamination. Join their Veg Club and you’ll get coupons every week and never have to pay full price–they’ll even let you show the email on your smart phone so you don’t have to print it!

We have also found that in a pinch, my son will fill up on white rice, so Chinese and Thai food are also an option–but we usually try to at least bring some veggies and protein. But since we became concerned about GMOs, we have been leery of tofu and soy sauce unless we can read the label, so most of those places are not options for us now.

In summary, my advice to anyone would be to know your triggers, talk to managers if you are unsure about anything, and don’t be afraid to bring food if you or your child has allergies, especially if they can lead to life-threatening reactions when exposed to trace bits.

Marcie Mom: Thanks Lisa for sharing your journey with eating out with your son; it does take a lot of care and I’m wishing all moms and dads out there to have happy meals despite!

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Living with Eczema

SOMEONE has Eczema and managed Allergies, Asthma and Make-up

Tristan Joseph shares on managing eczema, with asthma, allergies and make-up
Tristan Joseph shares on managing eczema, with asthma, allergies and make-up

This is a new series focused on personal journey with eczema while managing a certain aspect of life. Today, we have Tristan Joseph, who has eczema since her childhood and shares how she manages her make-up. Tristan is a support volunteer with The Eczema Society of Canada and also blogs at AtopicGirl on allergies, asthma and eczema.

Marcie Mom: Hi Tristan, thanks for taking part in my 2013 blog series ‘Someone has Eczema’! How long have you had eczema, and did your allergies and asthma come at about the same time?

Tristan: I have pretty much always had eczema. A few days after my birth, my mom used a baby shampoo on me and my entire body broke out in rashes. My asthma, food and environmental allergies came about nine years later. To make it even more complicated my food allergies took a full eight years to really develop and some of the foods I was told that I was allergic to…well, I may not be allergic to them at all. I know I’m allergic to dairy, eggs, cashews, pistachios and I have a severe intolerance to shrimp. My environmental allergies also developed as I grew up. Spring is not my favourite season and I have pet allergies.

Marcie Mom: What are the triggers for your eczema? And are those triggers same as that for your allergies and asthma?

Tristan: Complicated answer again. My eczema is not triggered by my food allergies. I can have an anaphylactic reaction and my skin is just fine. Of course, if an allergen comes into contact with my skin, I break out in that specific area. I am extremely allergic to petroleum and its derivatives which are in a lot of dermatological products; so, that’s hard to avoid, but I manage. However, my asthma can be triggered by environmental allergens, like pet dander and pollen. Second- and third-hand cigarette smoke are major triggers for my asthma.

Marcie Mom: Is there any ingredient in makeup or skincare that triggers your eczema? And have you taken a patch test? For more information on allergy testing, do refer to interview with Dr Verallo-Rowell and Q&A with Dr Liew.

Tristan: I have to be very careful to stay away from petroleum. It’s in a lot of skin care and make-up products. However, I’ve found a make-up line that doesn’t use petroleum or mineral oil. I also have to make sure to avoid dairy, eggs and nuts in skin care and make-up. I’m always on the lookout for words like “lecithin” and “albumen”. Sometimes lecithin can be from soy, but it’s derived from egg as well.

As for patch testing, I always patch test new products and never use anything new if I have a big event coming up right away. I have recurring eye eczema; so, I’m careful about eye shadows, eye liners and mascaras. I also make sure to wash my make-up brushes weekly. The last thing I need is to apply make-up with a bacteria-ridden brush. As is the case for everyone, I throw out old make-up.

Marcie Mom: One final question – on bad days when you’ve allergies, asthma and eczema flares at the same time, what would be the top three actions you would take to calm the conditions

Tristan: All three? Yipes. It has happened and I basically go into my Plan Bs. What that means is that from day-to-day, I use Plan A – whatever I need to do on a daily basis to maintain my health. However, when Plan A doesn’t cut it for some reason – exposure to an allergy trigger – then I go to Plan B. That could mean taking more anti-histamines, increasing the dose of my maintenance inhaler (both as advised by my immunologist) and taking more time to get my skin under control – a bath, heavier moisturizers and cold compresses for inflammation. My Plan B is something I’ve developed through trial and error and with the advice of medical professionals.

Marcie Mom: Thanks Tristan for sharing your personal journey, on eczema, asthma, allergy and makeup. I love how systematic and in-control you are 🙂

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Living with Eczema

SOMEONE has Eczema and managed Beach Holidays

Selena shares on beach holidays with her child with eczema!
Selena shares on beach holidays with her child with eczema!

This is a new series focused on personal journey with eczema while managing a certain aspect of life. Today, we have Selena Bluntzer, whose 4-year-old daughter has had eczema since she was 3 months old and share how she manages beach holidays with her family. Selena blogs at AmazingandAtopic.com on her daughter’s multiple food allergies, asthma and eczema.

Marcie Mom: Hi Selena, thanks for taking part in my new blog series ‘Someone has Eczema’! Can you share with us the severity of your daughter’s eczema and what are her triggers?

Selena: I would characterize my daughter’s eczema as mild to moderate.  It’s contained to mostly her hands, yet it flares on her legs, arms and torso, when she ingests an aggravating trigger (food or medication).  In the past, she has had some more severe bouts with staph infections, but things are better, now.  It has definitely improved with age and/or the fact that we’ve learned to control her triggers.  Her biggest triggers are her multiple food allergies.  She is also affected by the weather and I also believe stress affects her, as well.

Marcie Mom: Let’s talk holidays! Is a beach holiday something your family does often? And did you have any worries about how your daughter’s eczema and asthma would change on a beach holiday?

Selena: We live about 3 hours from the beach.  We’ve taken our daughter to the beach 3 times and she is 4 years old.  The first time we took her, we didn’t know about her food allergies, and didn’t know very much about managing her eczema.  We were certainly wondering how the change in environment would affect things.  After learning of her food allergies and asthma, we also needed to figure out how to pack for such a trip.

Marcie Mom: Share with us the preparations that you need to take, from planning the length of car drive, how often to stop and moisturize (or just do so in the car), what to pack – for her skin, and change of clothes? (I always pack three sets of clothes for a day holiday, to keep my daughter fresh and not trigger eczema flare.)

Selena: I guess I will cover our latest trip, for which we were probably the best prepared.  We typically plan to leave very early in the morning, stay one night and leave the following afternoon.  Since we’re dealing with food allergies, eczema and asthma, we always have to pack for all 3 conditions.

For the food allergy issue, we had to pack enough food to feed her for the duration of the trip.  She has multiple food allergies and we cannot count on being able to find safe foods when we travel, nor do we take the risk of letting her eat at restaurants.  We packed her favorite shelf-stable goodies and some perishable items in a large cooler, packed with plenty of ice.  (One time, we stopped for gas and were stranded for a couple of hours when our car battery died.  Most tow trucks do NOT have a place for a child car seat, and it took a while before someone could get our battery “jumped”, so we could get to the shop for a replacement.  It’s always good to have extra allergy-safe snacks on hand, because we can’t just pick up anything at the convenience store, with my daughter’s multiple food allergies.)  We had to pack her antihistamines and epinephrine auto-injectors (EAIs).  We took multiple sets of EAIs with us, because we did not know how far away emergency help would be, should it be needed.  I bought a waterproof carrier so we could take them down to the waterfront.

For her asthma, we packed her rescue inhaler (she was not on a daily medication, at the time), her nebulizer and medications.  We also had a power inverter so we could run the nebulizer inside the car, in case we needed to stop for any unexpected, sudden asthma attacks and were not near an electrical outlet (http://www.amazingandatopic.com/2012/01/reactive-airwayasthma-gear.html).

For her eczema, we packed her ointments, lotions, allergy-safe sunblock, SunSmarties UPF clothing, including water shoes to protect her feet from the hot sand and a hat to protect her scalp ( http://www.amazingandatopic.com/2012/06/upf-50-clothing-great-for-eczematic.html), and hydrocortisone and steroid ointments, for any serious outbreaks/spots.  For the car trip, I dressed her in thin, light clothing, and did the moisturizing before getting in the car.  The drive is just under 3 hours, so we only needed to do so once.  We changed clothes after every activity, and I basically packed two outfits for every activity/part of the day, in case she needed a fresh set.

For our next trip, I plan to take a freshly washed set of sheets with us, for lining the hotel bed.  She didn’t seem irritated by the sheets, or anything, but it just seems like a good idea, since you never know about bed bugs and such.

Marcie Mom: One final question – how did your daughter like the beach and did she swim in the beach water and play with the sand?

Selena: She loved it!  She loved playing in the water and didn’t want to get out, when it was time to go inside.  She really enjoyed digging in the sand and making sand castles.  I was worried, at first, about how that would affect her skin, but it turned out that it was like having a sea salt scrub spa treatment!  Her skin looked amazing at the end of our trip!  I thought she might have been troubled by the high salt content in her open splits on her fingers, but she was having too much fun to even care and never said a thing about it!  I was really impressed.  Now, I will say that I had to prep her skin with lots of Aquaphor ointment, beforehand, to protect it, because we went out once without it and it did get irritated, but as long as I remembered to do that each time, her skin came out looking renewed and fresh.  My husband and I have discussed taking more frequent trips to the beach, just based on the wonderful effect the beach had on her skin, aside from the enormous amount of fun she had!

Marcie Mom: Thanks Selena for taking time to share your journey on your daughter’s eczema and beach holiday. There are many beaches in Malaysia and Singaporean and Malaysian parents reading this may be motivated to take up your tips and head down to a beach!

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Guest Interview

Eczema Kids Nutrition with Judy Converse: Newborn – Just Milk but Complicated

Newborn Eczema Kids Nutrition with Judy Converse Dietitian Nutritionist EczemaBlues

Judy Converse, MPH RD LDN is the founder of Nutrition Care, a licensed nutritionist, a registered dietitian who has a master’s degree in public health nutrition and a bachelor’s degree in food science and human nutrition. She has also testified for safer vaccines and consulted with industry partners on specialized formulas for infants and children with inflammatory conditions. Her books include:

This is a 4-topic series focused on nutrition for babies and toddlers with eczema. It was originally spanning 7 posts, and combined to 3 longer informative posts.

MarcieMom: Judy, thank you so much for helping us. My questions will be based on my (thankfully, past!) experience and what I know other moms of eczema children face. We know that the American Academy of Pediatrics recommend breastfeeding for 6 months, but in reality, it’s not always possible in every family. In my case, I just can’t generate sufficient milk supply even after consulting with lactation consultant, taking their recommended supplements and a harrowing ordeal with tricking my baby to latch despite my lack of milk (using the supplemental nursing system).

Selection of Milk Formula for Eczema Babies

For parents of eczema child who are choosing formula milk, would you recommend that they go for fully hydrolyzed or partially hydrolyzed formula from the onset?

Or should they wait and see if the child is allergic to cow’s milk before switching to alternatives? Since allergy testing is not accurate for a new born, how can a parent know if it is cow milk allergy?

Judy: First we should understand “hydrolyzed”. That means the formula uses an in-tact, whole protein source – casein or whey or soy – which is treated with enzymes to partly break it up or hydrolyze it. The idea is that this will make it easier for the baby to absorb. It’s a reasonable place to start. If it works, it should work in a week or so, to settle eczema down. But many babies do just as poorly on this as they do on whole protein formulas (this was my son). Then what?

But many babies do just as poorly on this as they do on whole protein formulas (this was my son)

Probiotics in Formula Mix

There are a couple of options. The baby may do better on any formula, if gut biome is replenished with probiotics. I work these into care plans for many infants and children. There are many different types and potencies. Some probiotics are not appropriate for babies. More experience and data are emerging to show that beneficial bacteria are critical to mitigating inflammation in a newborn’s gut. What grows in a newborn’s gut appears to be predictive of whether or not they have allergies or asthma years later. So, no matter what, if a baby is having signs of inflammation, I would be keen on getting a probiotic in the mix.

Elemental Formula for Babies

If trouble persists, the next step is elemental formula. These are different from hydrolyzed formulas because they are not made from naturally occurring protein. Instead, individual amino acids are blended in a specific ratio known to be essential for human newborns. These are ready to absorb. A healthy human gut will break protein down into these constituent amino acids during digestion. So this formula simply provides the protein in that form, ready to absorb, and it can’t trigger inflammation. What surprises me is how often this option is not offered to families whose infants are really uncomfortable with eczema and colic. Many pediatricians may not know about elemental formulas. Brand names are Elecare or Neocate. The caveat with using formulas is that they change the baby’s gut biome. That is, they change the profile of bacteria in the baby’s gut. Breast milk sets up the healthiest gut biome, which humans need to develop normal, healthy immune signaling and avoid allergy. Formulas, especially the elemental ones, make it easier for nasty species like Clostridia difficile or fungal strains to grow.

Breast milk sets up the healthiest gut biome, which humans need to develop normal, healthy immune signaling and avoid allergy.

To have a win win, use a probiotic for your baby. My book Special Needs Kids Go Pharm-Free guides parents on how to pick these, and what to do for colicky babies with eczema.

Is it Cow’s Milk Allergy for your Eczema Baby?

Second – how do you know it’s cow’s milk allergy? Easy. Do an elimination trial. Newborns eat one protein source (breast milk, or formula). Change it and observe. Note that soy protein is triggering often as well. My preference, if breast feeding is truly out, is to trial homemade goat milk formula (I provide recipe and steps to do this safely in my books) first. This often goes very nicely, and it may support a healthier biome than commercial formulas. If eczema is still persisting, then I suggest hydrolyzed casein or whey formulas, then elemental. If you must use soy protein, which I hesitate to do since it has other impacts as a phytogen and is usually genetically modified, then be sure you use an organic source.

Which Cow’s Milk Formula to Choose?

MarcieMom: Let’s talk about the scenario where the child has no cow’s milk allergy and parents can decide among the many brands of formula cow milk. I’ve read about the toxins in formula milk – the antibiotics given to the cows and the cows eating a diet of genetically modified corn. I’ve also seen babies who drank lots of formula milk growing very big, exceeding far more than 100% on the growth chart.

Is there (i) any conclusive study done on formula milk and its impact on the child’s health, (ii) does formula milk contain toxins and is it inflammatory? (if yes, which ingredient makes it so?) and (iii) how soon should parents attempt to replace formula milk with solid food that are rich in protein, calcium, vitamins and other minerals?

Quality of Breast Milk

Judy: Breast milk is best, hands down. We’ve all heard that, and it is still true. There are so many immune modulating components in human milk that formula will never be able to emulate. It is so powerful in this regard, that it may outperform vaccinations in protecting the baby. Its impact on gut biome and long term immune function is just emerging in the literature. Unfortunately there are toxins in breast milk too, simply because we now live in a toxin filled world. These concentrate in breast milk. Rather than not breast feed, I would like to see women become conscious prior to pregnancy about eliminating toxins from their diets. Begin early to eat very healthfully, avoid pesticides, poor air quality, heavy metals, and other toxins. Consider working with providers who can help you detoxify prior to conception.

Quality of Commercial Milk Formula – Corn Syrup & GMO

Meanwhile, yes, it is often easier for babies to gain and grow on commercial formula, as long as they are not allergic/sensitive to it. Bottle-feeding can offer faster delivery, so more is taken per feeding. But “more and faster” is not necessarily better. The carbohydrate source is often corn syrup, which is troubling for weight gain in older children. And yes all these ingredients – unless you have an organic formula – may come from genetically modified sources. I think there are enough data implying that GMO foods may be more allergenic to consider avoiding these entirely for a newborn, or during pregnancy. This is a big debate. For more info, parents can visit ResponsibleTechnology.org. Click on the link for health professionals, then on the “state of the science” link.

Solids for Your Baby

Solids can be introduced once your baby is able to sit well unassisted, can hold his head up, and is able to move soft foods to back of tongue and swallow them safely with a little practice.This can be around six months, but later is okay too. This might also depend on your baby’s growth pattern. Some will want solids sooner than others.

Cow’s Milk Alternative

MarcieMom: Let’s talk about the scenario where the child has cow’s milk allergy. What would be the cow’s milk alternative? Fully hydrolyzed formula or goat’s milk (which I understand to be similar to cow’s protein, so may not help cow milk allergy?) or soy milk or rice milk?

Judy: We covered that in the previous section, except for rice milk. Rice milk should not be used for infant formula, period. It is devoid of protein and healthy fats that are essential for brain development. Please do not use rice milk! Same goes for oat milk, hemp milk, or almond milk. None of these are safe or appropriate for babies as a substitute for breast milk or formula.

Rice milk should not be used for infant formula, period. 

Goat milk has casein, as does cow or human milk. But it is in a gentler configuration, slightly different than the cow casein, and is often quite tolerable for babies who can’t take cow’s milk. Again think in terms of two parts to this puzzle – the protein source, and the baby’s gut biome. Both may need changing to successfully arrest inflammation.

Advice for New Moms – Choosing Cow’s Milk Formula Alternative & Reading Product Label

MarcieMom: I remembered the first six months when my baby was too young to take allergy test, we were advised to switch to partially hydrolyzed milk (our girl turned out not to have any allergy). When her rashes didn’t go away with the partially hydrolyzed milk, we switched to goat’s milk then soy milk (her rashes were still there all the time). It was a stressful experience copying all the ingredients across formula brands and different types of milk, and comparing which brand had higher carbohydrates, protein, calcium, DHA and more than 20 nutrition elements listed. What would be your advice when choosing formula milk – I assume first decide on the type of milk and once that’s decided, how to see which brand is better formulated?

Judy: This is too much stress for a new mom! I went through that and then some myself. This is how I became so interested in this niche of practice. I could not fathom that my pediatricians didn’t have good answers for me, or why it was so hard. I would have added an elemental option to those you were told to try, plus probiotics. As I mentioned earlier, this is commonly overlooked.

Worth Looking Into – Why a Baby’s Gut Could be Inflamed

I would also want to know what set your daughter’s gut up to be inflamed. Did she need antibiotics, C-section delivery (another early antibiotic exposure), time in NICU? All these things disrupt optimal colonization of the newborn gut with healthy bacteria. If this is found to have been the case, sometimes babies need herbs or medications to treat fungal species dominating the gut biome. I give this topic a lot of ink in both my books.

Milk Protein Sensitivity

Your daughter may have had a milk protein sensitivity and a soy protein sensitivity, without allergic to either. These are mediated by different classes of immunoglobulins, one is IgE (allergy) and the other is IgG (sensitivity). Both can cause skin changes, feeding problems, and eczema.
A negative IgE test does not mean that a food protein is safe. Most allergists do not test for IgG reactions, because they think the testing is unreliable. This is not my experience in practice. The tests are not perfect, but they are useful, when interpreted in the context of food intake, signs, and symptoms.

MarcieMom: Thanks so much Judy, honestly, I feel like bursting into tears now, just thinking how difficult the first 9 months are, sorting through the milk formula, breast feeding, solid feeding – if only I’ve known you earlier! I’m sure many parents reading this will feel the same, and start to ask their docs of other alternatives.

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Doctor Q&A

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

Dr Liew is a pediatrician who practices at the SBCC Baby & Child Clinic, Gleneagles Hospital Singapore and is also a visiting consultant to KK Hospital. He subspecialises in allergy, immunology and rheumatology. He was also awarded several research grants to pursue clinical research in paediatric anaphylaxis, drug allergy, primary immunodeficiencies and Kawasaki disease.

Managing Allergy for Eczema Kids Dr Liew Woei Kang

This was an original four posts of Friday Q&A, combined into one more informative post. MarcieMom contacted Dr Liew on setting up an eczema fund in Singapore and subsequently collaborated on this Q&A.

Childcare for Allergy Kids

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 share with the childcare?

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.

Food Allergy in Childcare

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? 

For instance, is 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.

Non-Food Allergens

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.

Allergic Reactions in Kids

How can a parent recognize an allergic reaction and more importantly, which are the symptoms that are signs of serious reaction such as anaphylaxis?

Mild to moderate allergic reaction include:

• Swelling of lips, face, eyes

• Hives or welts

• Tingling mouth

• Abdominal pain, vomiting

Antihistamines usually suffice.

Severe allergic reaction (anaphylaxis) include:

• Difficult/noisy breathing

• Swelling of tongue

• Swelling/tightness in throat

• Difficulty talking and/or hoarse voice

• Wheeze or persistent cough

• Persistent dizziness or collapse

• Pale and floppy (young children)

Epi-pens at Childcare

When should a parent prepare an epi-pen and how can the parent teach the child and the alternative care-giver on when an epi-pen is to be used?

Epipen should be administered for severe reactions. A written anaphylaxis plan should be provided with pictorial reminders on how to administer an epipen.

Outdoor Allergens

What are some common outdoor allergens in Singapore?

For instance, to certain type of trees or to certain pollen? Pollen counts are usually higher in the morning and on a warm, windy day versus just after a rain. Many places in Singapore are air-conditioned, is this better or worse off for a child with dust mite, pollen or certain allergy?

Dr Liew: Outdoor aeroallergens include tree pollen (Oil palm tree pollen is commonest), grass pollen are common in temperate countries with seasons, but is uncommon in Singapore. Air-conditioning is better tolerated for eczema patients but can worsen an allergic rhinitis. The impact on specific allergens are not great except moulds, as they may grow in poorly maintained air-conditioning units.

Air-conditioning is better tolerated for eczema patients but can worsen an allergic rhinitis.

Mold & Indoor Allergens

MarcieMom: Mold is another allergen and lots seem to be growing in my home!

If a child is allergic to mold, what steps should a parent take?

Also, for allergies like cockroach droppings, does it mean that the parent must diligently hunt for all droppings in corners of the home and remove them?

Dr Liew: Steps to reduce mould in the environment include a well-ventilated room, and if air-conditioning is used, frequent maintenance of the AC unit. Pest control measures are best for cockcroach sensitisation, as cockroaches often “roam” around and leave traces of protein.

Vaccines and Allergy

MarcieMom: On vaccines, there is so much discussion out there where even doctors are coming out to say that vaccines are unnecessary and pharmaceutical companies are coming up with more and more vaccines that are unnecessary and even harmful for our children. Some parents may be opting their child out of vaccines due to egg protein included in some of the vaccines.

What’s your recommendation on this and when should a parent seriously questions a vaccine before letting his/her child have it?

Dr 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.

Antibiotics

MarcieMom: On antibiotics, I’ve read online that antibiotics are mostly unnecessary since they are only effective against bacteria yet it is so common for general practitioners to prescribe antibiotics! (in fact, I always have to refuse the prescription because it’s just a common flu!) Antibiotics are also known to cause allergic reaction, what would be your recommendation?

Dr Liew: Antibiotics should only be prescribed for bacterial infections.

Cross-Reactions

MarcieMom: On cross-reaction, it’s commonly heard of when a child is allergic to birch pollen, he/she is also allergic to apple. Or a child who is allergic to latex is also allergic to kiwi.

Can such allergy be identified by allergy tests?

Also, what are some of the common allergies that you can point our parents to, so that they are aware if their child is allergic to one thing, they should probably avoid something else.

Dr Liew: Cross-reactive allergens occur due to the similarity of one protein to another, usually within the same botany taxonomy. They can be easily tested by skin prick test or blood IgE testing. A good example would be most cow’s milk allergic patients are allergic to goat’s milk as there is an approximately 95% similarity between the two.

MarcieMom: Thank you Dr Liew, it’s such a great pleasure to have you explaining all these allergy questions that many parents have, we are all so grateful!

Categories
Doctor Q&A

Friday Dr Q&A with Dr Liew – Allergy Tests

Dr Liew is a pediatrician who practices at the SBCC Baby & Child Clinic, Gleneagles Hospital Singapore and is also a visiting consultant to KK Hospital. He subspecialises in allergy, immunology and rheumatology. He was also awarded several research grants to pursue clinical research in paediatric anaphylaxis, drug allergy, primary immunodeficiencies and Kawasaki disease.

This was an original 4 week Friday Q&A, combined into a single more informative post.

Children’s Allergy Basics

Thank you Dr Liew for taking time to help answer these questions, we’ll start with the basic information on allergy.

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.

Allergy vs Intolerance

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.

Skin Prick Test for Kids

Common questions on allergy tests: There are a few allergy tests available – skin prick test, blood IgE test and patch test.

Can you explain a little more about these tests, how it is done on a child and how can a parent decide which to bring their child for?

Dr Liew: The type of allergy test recommended is based on the allergy symptom of the patient. As eczema is a mixed IgE/non-IgE driven disease process, tests for IgE like SPT and blood tests may be useful if positive, as targeted elimination may be attempted. If the tests are negative, empiric elimination of 2-3 weeks duration may still be considered if there appears to be a consistent food trigger.

Prolonged food avoidance however is not necessary and may result in malnutrition.

A skin prick test (SPT) is probably commonest and simplest allergy test performed in outpatient clinics. Essentially it is a scratch test with either a needle or plastic device, thus introducing a tiny amount of allergen protein under the skin surface. The test is completed within 15 minutes and measurement taken. A positive reaction appears as a small hive-like wheal and surrounding redness. It is good for identification of IgE mediated allergic reactions, and also for trending allergy sensitisation over time. Antihistamines would need to be ceased for 5-7 days, and there must be an area of clear skin (preferably the back in young children) for the test to be done. This is my preferred allergy test as there is minimal pain (especially with plastic devices), and results immediate. SPT also correlate better with allergic reactions if properly performed, as it takes into account the blocking antibody responses when the body is “outgrowing” an allergy.

Blood IgE Test

Allergen specific IgE test can also be easily performed for IgE mediated reactions. This is sometimes preferable if the patient has severe eczema and unable to tolerate cessation of antihistamines, or has minimal normal skin to perform the SPT. Blood tests are generally more expensive, as each allergen protein tested cost around $30. Results are usually known within a week.

Patch Testing

Patch tests are designed to test for delayed allergic reactions, rather than acute IgE reactions as the above 2 tests. Patch tests involved placing small area of allergen protein coated on wells or filter paper, and leaving them as a skin patch for 48 to 72 hours. A reading is then performed to look for delayed hypersensitivity reactions and the skin reaction graded. As there are several confounding factors for a successful test, patch tests are currently not recommended for clinical use but confined to research studies.

What to do after Your Child is Tested Positive for Allergens?

Given that allergy tests are not 100% accurate, parents may start to rely on an elimination diet strategy. 

Can you explain how much you would rely on each allergy test and whether they serve a different purpose in your diagnosis?

Dr Liew: Standard allergy tests are accurate, but have their limitations. Unvalidated tests for food allergy include blood IgG testing, intradermal skin testing, applied kinesiology, electrodermal testing, hair mineral testing, and iridology, and should not be performed. Eczema is a chronic medical condition with no curative treatment currently, and some patient would undertake extreme measures to look for the “elusive trigger”.

I would remind your readers that eczema is a skin disease, and not an allergic disease. Removing triggers can reduce the eczema, but will not cure it.

Food Elimination for Kids

Empiric food elimination may be considered for 2-3 weeks if a consistent food trigger is suspected. An objective assessment should be made if food elimination has resulted in any change. Food triggered eczema would improve significantly with elimination. If there is no improvement, as in the majority of cases, the food should be introduced and assessment made if there is a change. I would caution regarding multiple food elimination as I have seen really malnourished and stressed out patient and families.

Young Children’s Developing Allergy Profile

MarcieMom: I understand that it’s good to send the child for a re-test, to check if he or she has outgrown any allergy or developed new ones. 

What’s the reason for the change in the allergy profile of the child? Also, how often do you recommend a re-test and would your recommendation differ for a child who has different type of allergies and/or differ for a child who has different level of severity in eczema?

Dr Liew: Retesting is sometimes required in food allergies, but generally not necessary for eczema. The allergic profile of an individual changes according to his/her immunity and exposure to environmental proteins. We often see food allergens being “outgrown”, but a gain of house dust mite sensitisation with time. Retesting is usually considered if there is a new allergic disease eg. Allergic rhinitis, rather than based on fluctuation in eczema severity.

Common Pediatric Allergens

Based on your experience and knowledge of research studies, what are the common allergens in children? 

Dr Liew: The most common allergens depend on the allergic conditions. For eczema, older patients tend to be sensitised to house dust mites, but not food allergens. Some young infants with eczema has food sensitisation and trigger. The most common food allergens in eczema children include egg, cow’s milk, wheat, peanuts and soy. Some forms of food allergy eg, allergic enteropathy presents with isolated intestinal symptoms without skin involvement.

If a parent suspect a food is causing an allergy, should the parent insist on it being an item to be included in allergy test? 

As a pediatrician, would you test the child on what the parent suspect?

Dr Liew: A detailed history would be obtained prior to allergy testing. If there is a suspected food trigger, I would usually test it. I would usually encourage targeted testing, whereby only the relevant food items are tested. For eg, should the child be tolerating cow’s milk formula for the past 3 years, and eczema commenced after 3 years old, cow’s milk protein is unlikely to be a food trigger, and should not be tested.

Gluten and Eczema

MarcieMom: Gluten has been gaining more awareness and with many food packaging labeling gluten-free, some parents may think it’s gluten that’s causing the eczema. 

Again, how can a parent identify if it’s gluten (is it even a common trigger?) that’s triggering the eczema?

How can this be differentiated from celiac disease?

Dr Liew: There should be a close temporal relationship between food ingestion and eczema flare. If there is inconsistent relationship, it is unlikely a food allergy. Celiac disease is an immune-mediated reaction to glutens, resulting in malabsorption in the gut, and resultant bloatedness, diarrhea and weight loss.

Categories
Guest Interview

Honestly…on Baby Diapers

MarcieMom received an email from The Honest Company, a company founded by Jessica Alba and Christopher Gavigan, and learned that it’s a company created ‘to help moms and to give all children a better, safer start’. Their products are natural and non-toxic which interests MarcieMom and she contacted Janelle Sorensen, Communications Manager from The Honest Company to find out more on what’s going on inside their baby diapers.

Marcie Mom: Thank you Janelle for taking time to help answer my questions, which other parents who have children with eczema or sensitive skin may likewise also have. I’ve checked out your lovely website and noted that ‘100% Natural’, ‘all-natural’ are used for your products. From an interview that I’ve done, I learnt that the term Natural is not regulated for skincare products. Does the same go for diapers?

Is ‘Natural’ regulated for Baby Diapers?

Janelle Sorensen: Currently, there aren’t any standards or certification for “natural” or “organic” as they may apply to disposable diapers. And, just to clarify, while some of our products are 100% natural, our diapers are not (but, they’re very, very close!) We use a chlorine-free, wood-pulp fluff (from certified sustainably managed forests), a wheat and corn starch BIO-core (which significantly reduces the need for SAP), and a plant-based PLA for the outer layer, inner layer, and moisture barrier layer. You can learn about all the details and ingredients on our website. https://www.honest.com/product/honestdiapers Unlike most other diaper companies, we are completely transparent about what’s inside our products.

Note (by Marcie Mom): SAP/ Super Absorbent Polymer such as sodium polyacrylate is a polymer that can absorb 200-300 times its mass in water.

PLA/ Polylactic acid is derived from renewable resources, such as corn starch.

What’s Non-Toxic for Diapers?

Marcie Mom: Relating non-toxic, it’s really great to know that your products are chlorine-free, no petrochemical, no PVC, no phthalates and fragrance-free. Moms like me who are always on the lookout for hypoallergenic products truly appreciate this. Do you actively track how many of the allergens that are currently on the list compiled by American Contact Dermatitis Society are in your products? Also, is your product registered with The Contact Allergen Replacement Database (CARD) (a database for patients in USA to find out which skincare products are safe for them based on their allergy/patch test results)?

Janelle Sorensen: Just to clarify again, most of our products are 100% petrochemical-free, but the diapers are not – just very, very close. We’re making changes to the website that will better describe everything, so we don’t unintentionally mislead anyone. (We’re committed to constantly improving every facet of our work!) In regards to your questions, we’ve just started tracking allergens because we’ve heard from so many families living with allergies. So, it’s a growing priority for us in regards to future products, reformulations, and even website updates. If we are using common allergens, we want it to be easy for consumers to know – it’s a part of our company ethos to make life a little easier for parents! We are not registered with CARD, but I’ll put it on our internal to-do list. Thanks for the recommendation!

Why the Manufacturing process of Diapers is Important

Marcie Mom: When choosing products, moms have to take note that not only the ingredients but also the manufacturing process can introduce allergens. For instance, the case against the use of polypropylene was because acrylic acid was used in the process.

Do you manufacture your diapers in USA? Also, how do you monitor your production sites (cradle to cradle certified)?

Janelle Sorensen: Currently, all of our products are manufactured in the USA, but the diapers are made just across the border in Mexico (it was the nearest facility we could find with the technology to make our innovative diapers). We’re hoping to see development of similar facilities in the USA soon. Still, we are very scrutinizing about the manufacturers we work with and our Co-Founder and Chief Products Officer, Christopher Gavigan, is very hands-on with the facilities to ensure the highest quality end products. We aren’t Cradle-to-Cradle certified yet, but it’s a goal we look forward to reaching.

Sustainability for Baby Diapers

Marcie Mom: I’ve also read from your website that you’re in process of getting sustainability certified. That’s a complex systems involving minimizing waste and maximizing reuse in your office, your products, including making your products flushable and biodegradable! Personally, I can’t imagine flushing diapers or wipes down the toilet because my toilet choked just on the amount of toilet paper I used!

Tell us more about how flushable your products are and how long it takes to biodegrade.

Janelle Sorensen: The wipes are flushable, but the diapers are not. And, it’s hard to know how long it would take anything to biodegrade – it totally depends on the environment and landfill conditions. Still, given the right conditions, (which it’s true – most landfills can’t guarantee) our diapers will indeed biodegrade faster than others on the marketplace today. As with everything else, we’ll do everything we can to constantly improve – to be as safe, affordable, and eco-friendly as possible.

Marcie Mom: Coming to our environment – I read with delight that chlorine is not used in your diapers. I understand that chlorine is used in the process of the woodpulp that is in diapers and it’s not so much the chlorine itself but the chlorinated toxins that are released into the environment during processing. The dioxin created when the wood pulp is bleached has been linked to cancer but has also been studied to be in such small amounts that it’s safe. Can you explain to us why you do not use chlorine?

Janelle Sorensen: Dioxins are the most potent cancer-causing chemicals known to man. Even if there’s little left lingering on the final product, we’d rather not be a part of releasing any of it into the environment. Our children and the generations to come deserve a cleaner, healthier environment.

Marcie Mom: Thanks Janelle for helping parents to understand more of what’s going on inside baby’s diapers; this will surely add comfort to those with children with sensitive skin. p.s. to readers of eczemablues.com, I didn’t receive any money from The Honest Company for this interview.

Categories
Guest Interview

Dr SEARS L.E.A.N. Series: Raising Healthy Kids

This original 9-part series published every fortnight has been condensed to one longer informative post. This series examine the DrSearsLEAN (Lifestyle-Exercise-Attitude-Nutrition) tips and privileged to have DrSears’ team to help with the tips for parents with eczema children.

Healthy Kid’s Diet

Tip #1: Pick Your Salad

It is a fun way to learn about fruits and vegetables in a farm, by picking them and making your own salad. Most of the farms listed on pickyourown.org are in the US, but you can also find vegetable farms in Singapore! Parents of eczema children may think that their child is allergic or hypersensitive to certain foods, particularly when there’s an eczema flare after consumption of a new food. But is the food really a trigger?

How do Parents know if it’s the Food that’s Triggering an Itch?

There are certain foods that are more common in triggering an allergic reaction, but food in itself is not a common eczema trigger. The nature of eczema is that it comes and goes and it’s best to have the suspected food be confirmed in a skin prick test or if need to, an oral food challenge before excluding it. Should food be a trigger, usually it’s a few food rather than many foods. Even food that shows up positive in a skin prick test may not trigger itch and thus need not be excluded from your child’s diet.

You may start suspecting a food allergy when:

1.             Your child shows immediate rashes or swelling around the mouth (oral allergy syndrome). This is less common in young children but some foods such as banana, kiwi, avocado, and potato have triggered such reactions. Other reactions could be itchy bumps or abdominal pain, vomiting, itchy eyes, sneezing or wheezing.

2.             Your child shows delayed reactions, more than 24 hours, after consuming the food. However, such foods are harder to detect through skin prick test or by observation as abdominal pain, itchiness or diarrhea could also be due to other reasons.

For a start, you can keep a food diary for your child, logging everything he/she eats for 4 to 6 weeks. I actually recorded from my baby’s first bite all the way to 9 month old but there’s no discernible pattern because my baby turned out to be not allergic to anything! I was a paranoid mom for so long until the negative results from the skin prick test, which is why I recommend it to every parent to save themselves the agony of second-guessing.

DrSearsLEAN’s recommendation

Eczema is a condition caused by two factors: first, a genetic tendency toward dry, irritated skin; and second, skin allergies to a variety of irritants and foods. The cause is mainly genetic – an inborn tendency toward dry skin and allergies. There is no way to change this genetics. The important issue is not what causes eczema in the first place, but what allergies and skin irritants is your child exposed to that is triggering the flare-ups.

If your child has any food allergies, then they will play a major role in causing eczema. The problem is, you may not know if your child has any food allergies, and if he does, which foods is he allergic to? Thankfully, there are six common foods that make up nearly 90% of possible allergic foods. These are milk, egg, soy, peanuts, fish and wheat.

What Foods for Eczema Child?

Before we discuss the common food allergens that may trigger your child’s eczema, let’s have some fun looking at DrSearsLEAN  – Traffic Light Eating for healthy diet:

GREEN Light foods are “Go” foods. They are all high in nutrients and are all fruits & vegetables.

Yellow Light foods are “Slowdown” foods. These are foods that are ok to eat every day, but you need to use portion control. Examples of yellow light foods include whole grain bread, pasta, eggs, lean meat, fish, and olive oil.

Red Light foods are “Stop and Think!” about making a better choice. These are foods that are highly processed and contain high amounts of sugar and trans-fat. Red Light foods are foods such as cookies, candies, fast food, doughnuts, etc.

What are the Common Food Allergens?

Food is not a common eczema trigger, but certain foods that children are more commonly allergic to include cow’s milk, eggs, soya, wheat, fish, nuts and gluten (this is different from celiac disease). Cow’s milk should not be excluded unless it’s proven intolerant or to trigger a reaction. Salicylates, usually present in concentrated juice/sauce, unripe fruits and areas around the skin, can also trigger itchiness and redness. Salicylates increase the release of histamine but cooking the food can reduce the chance of allergy.

Should Elimination Diets be carried out?

Food should not be excluded until proven allergic to. A dietian should always be consulted and advice followed. Parents need to be educated in nutrition and be able to read food labels. A restricted diet, usually consisting of meat, vegetables, fruits, water and rice milk, should not be continued if there is no improvement after 6 weeks. There are cases when food removed from a diet added back later in childhood causes a more severe allergic reaction than before.

AskDrSears also has an article on eczema, which shares allergic triggers such as milk, egg, soy, peanuts, fish and wheat. The advice was to eliminate all six foods for 2 to 3 weeks, then re-introduce each food one at a time to determine which is causing the allergy.

DrSearsLEAN’s recommendation

As mentioned last week, there are six common foods (milk, egg, soy, peanuts, fish and wheat) that make up nearly 90% of possible allergic foods. Eliminate all 6 foods for 2 to 3 weeks. If you see dramatic improvement, then re-introduce each food one at a time to determine which is causing the allergy. It is important to note that fruits and vegetables are not common allergens and are very important in boosting your child’s immune system and the phytonutrients and antioxidants they contain are powerful anti-inflammatories. Try incorporating fruits and vegetables into every meal – even breakfast!

Healthy Kid’s Lifestyle

Tip #2: Make a Rule – Less TV, More Exercise!

Make a rule’ – which is no TV or video games on weekdays or before 30 minutes of play outside. Ideally, instead of watching TV, children can spend time exercising and do a range of activities from inviting their friends over to play to playing sports as a family. TV (and IPad) is becoming a ‘baby-sitter’, offering some relief for parents to finish up the chores or tidy the house (my own favorite phrase is ‘Order Has Been Restored!’). I have to confess that I let my baby watch TV since 3 month old, but only baby sign language dvd which has distracted her from scratching. As parents of eczema child would appreciate, it’s immensely stressful and difficult to keep the child from scratching and if TV can help, is that ok?

TV and Eczema and ADHD

The American Academy of Pediatrics recommends no TV for children below two years old. A study by Dr. Dimitri Christakis, Director of Child Health Institute at Children’s Hospital and Regional Medical Center (Seattle, Washington) showed that for every hour of TV watched, the toddler has a 10% higher chance of developing attention problems by age 7. The study is not without its limitations, which include data collected based on parents’ recollection, no data on content of TV programs and attention problems do not necessarily equal ADHD (‘Attention Deficit Hyperactivity Disorder’). Another study done by Carl Landhuis of University of Otago in Dunedin similarly concluded that children aged 5 to 7 who watched more than two hours of TV are more likely to develop symptoms of ADHD. Common reasons why TV is not good for children are that the fast-paced screens are not natural and replaces other activities like reading that require attention development. The noise of the TV also interferes with the brain’s ‘inner speech’, especially if TV is left on all the time when no one’s watching.

The bad news for parents with eczema children is that study has suggested an association between eczema and ADHD in children. 5.2% of 1,436 children with eczema also have ADHD versus 3.4% of children without eczema. Also the younger the child has eczema, the increased likelihood of ADHD. Thus, it would appear that even though TV may help distract a child from scratching, it is even more critical not to let eczema children watch TV given the higher correlation with ADHD.

DrSearsLEAN’s recommendation

Television plays a big role in childhood obesity because watching TV is a non-active activity that often leads to boredom (believe it or not!) and a tendency to over consume junky foods. Be a role model for your children and don’t eat while watching TV. Encourage them to participate in another activity such as reading or imaginative play. Your children will imitate your actions so always remember that how much time you spend watching TV and what other behaviors you practice while watching TV is a choice. Taking the time to invest in your child by playing with them is always a worthwhile investment for both your and their health!

Tip #3: ‘Set an Example’ – It’s easier to Exercise as a family

Exercise as a family such as ‘develop a routine’, ‘play sports together as a family’ and ‘have each person pick a different family exercise or activity to learn together’. It’s even more important to encourage each family member to keep fit because obesity is contagious! As written in the ‘The New England Journal of Medicine recently published a study that showed that if one spouse is obese, the other is 37 percent more likely to become obese, too’. For families with children with eczema, it is even more important because there appears to be a link between obesity and eczema.

Obesity is Contagious

Obesity and Eczema

In a study conducted by Dr. Jonathan Silverberg, dermatologist at St Luke’s Roosevelt Hospital (New York), there’s increased risk of developing severe eczema for children who are obese. Particularly, for children who became obese between age 2 to 5, the risk is three times higher than non-obese children. A later study focusing on adults gave similar results but the good thing is in both studies, eczema symptoms improved when weight is reduced.

Another study in Sweden also showed that hand eczema co-relates with individuals who are obese, have higher stress and smokes. The reason for obesity affecting eczema could be due to obesity resulting in inflammation in fat tissue, which overtime, can affect the skin.

DrSearsLEAN’s recommendation

Moving around and being active is one habit kids can learn easily, especially if their parents set a good example. Rather than thinking of movement as “exercise”, think of it as “play”! Running, hopping, skipping, jumping, riding a bike, etc, – These are all things kids (and parent) naturally enjoy. Movement does far more than just help control obesity. Moving more improves mood, helps you to feel better, improves sleep, helps digestion, encourages self-confidence, and more! Take some time to play with your child everyday. It will benefit both of you immensely!

Tip #4: ‘Reduce Stress in Your Life’ – Laugh More and Be Grateful

Leading a healthier and happier life comes from having the right attitude to life, and that includes taking steps to reduce stress, increase laughter and be grateful. There are many practical tips to follow but as parents of eczema children, it may be hard to do so; for instance, it’s hard to think positively when the eczema flares yet again for no reason. Or it can be difficult to enjoy a dvd when your child keeps scratching during the movie. Worse, repeated failed attempts to keep the eczema under control could demoralize the parent so much that it’s hard to appreciate the good even in our spouse, not to mention someone we don’t like.  The stress that families with eczema faces is considerable and a study has shown that stress levels in mothers caring for young children with eczema are equivalent to those mothers of children with severe disabilities.

Stress Triggers Eczema

While it may be more difficult to keep the stress level low in families with eczema children, it is important to do so should stress be one of the triggers of the eczema. As stated in Adnan Nasir’s book Eczema Free for Life, stress is the number three trigger and can worsen eczema by:

(i)         Stimulating hormones to be released which result in an increase in inflammatory substances the skin is allergic to

(ii)        Suppressing the immune system which results in a decrease in defense proteins to protect the skin

(iii)       Weakening the lipid skin barrier which results in dry skin that is vulnerable to irritants

Museums, Factory Tours, Animal Farms but Swimming?

Swimming is a fun activity such as having fun with balls and slides in water parks or leisure pools.  But many parents are worried about bringing their child with eczema to the pool, fearing that the chlorine in the swimming pool water may worsen the eczema. On the contrary, my baby’s doctor actually advised swimming three times a week but not more than 10 minutes each time. Be sure to shower them immediately and apply generous amount of moisturizer.

According to a factsheet from the National Eczema Society, chlorine is generally the least likely to cause skin irritation. In another of their fact sheet, it is suggested that re-creating chlorinated swimming pool with a bleach bath can have positive anti-septic effects on the skin. In particular, eczema skin is susceptible to colonization of staphylococcus aureus bacteria that can cause infection if it penetrates the skin. More than 90% of the people with eczema have staph versus less than 10% of people without eczema. Swimming is therefore a fun way to reduce this bacteria and applying steroid will then be more effective.

DrSearsLEAN’s recommendation

Chlorine and other chemicals in water can sometimes be the cause of skin irritation and contribute to eczema in a small percentage of kids. Always bathe your child in clean fresh water after swimming and avoid using regular soap. Most regular soap, whether liquid or bar soap can cause dryness. A natural soap mixed with moisturizing lotion and free of perfumes will enhance skin moisture. These can be found in any drugstore or supermarket. Also avoid scented lotions and use PABA-free suntan lotion to protect their skin. Be sure to use a generous amount of moisturizer after bathing your child.The lotion helps seal in all the moisture gained from the bath to help control your child’s eczema.

Overall, swimming is a fun way to get your kids moving more! Plus, they are learning a life-long tool. It’s much easier to learn to swim when your child is young. Getting them used to the water helps them overcome fears and could be a life-saving tool  someday!

Indoors Fun versus Sweating it Outdoors

There are many fun activities to do indoors and some are ‘put together a PLAY basket’ and ‘get a pedometer’. One of the tips is ‘plan your family vacation around an outdoor activity’, such as camping which is an opportunity to get away from technology and instead, do some biking and hiking. However, outdoor exercise inadvertently comes with sun and sweat. Heat and perspiration is the number one trigger for eczema and is also the only trigger I’ve identified for my baby. The combination of heat and perspiration may set off a ‘heat rash’ as an eczema child’s skin is more vulnerable to chemicals in sweat which may irritate the skin.

Sunlight – To Block or Not?

According to a factsheet from the National Eczema Society, sun exposure is drying to the skin and may aggravate eczema for some people. Ron Sweren, M.D., a dermatologist and director of the photo-medicine unit at Johns Hopkins also said that sunlight can serve as a trigger that worsens eczema. To prevent sunburn, sunscreen lotion is a must but again, you can read here that some of the ingredients may also irritate your child’s skin. Moreover, according to Sewon Kang, M.D., director of department of dermatology at John Hopkins, increased sweating will lead to more showers taken, which again could worsen the eczema. In less common cases, there may be sunlight allergy or photosensitive eczema which further restricts exposure to sun.


However, there are also cases of eczema that improve with sunlight exposure and there’s a treatment known as phototherapy that exposes the skin to UVA1 rays that can soothe the skin without causing sunburn. Moreover, vitamin D that comes from sunlight has been shown to increase the production of skin proteins (cathelicidin) which protects against skin infection.

Dr Sears L.E.A.N.’s recommendation

Eczema results from the combination of a genetic tendency toward dry, sensitive skin and a susceptibility to allergies. Although most children aren’t bothered by the day-to-day wear and tear of soaps, dirt, sweat, heat, clothing, and everything else we come into contact with, the skin of a child with eczema is hypersensitive to everyday life. It is important for you to monitor your child and identify the main trigger for developing eczema flare-ups. For some it could be heat and sweat, others are triggered by what they eat (or what mom eats if they are breastfeeding), grass, dirt, or chemicals in the environment around them. Although there is nothing you can do to change your child’s genetic susceptibility to dry, sensitive skin, there are many steps you can take to improve skin health, reduce exposure to irritants, track own allergic triggers, and minimize the impact the eczema has on your child’s day-to-day life

Healthy Kid’s Nutrition

Boosting our immune system is important, particularly for both parents and children with eczema because the lack of sleep can lower our immunity. As recommended on DrSearsLean.com, we should choose healthy food that contain the following eight immune system boosters, namely vitamin C, vitamin E, carotenoids, bioflavonoids, zinc, garlic, selenium and omega-3 fatty acids. Out of these eight immunity boosters, parents may find that zinc and essential fatty acids are often recommended for children with eczema.

Tip #5: Get Healthy Eating Food, not Supplement

There’s some research that points to zinc and omega-3 fatty acids can help to reduce skin rashes in adults and also that eczema children appear to be deficient in essential fatty acids which results in a lower production of anti-inflammatory prostaglandins that can help fight skin infection. However, research is not conclusive as clinical trials have also been conducted with no significant impact on eczema. Parents should incorporate the immune system booster food into the child’s diet rather than in supplement as excessive intake of say, zinc can inhibit immune function. The RNI (reference nutrient intake) for zinc is 4mg per day for a six month-old and 5mg for a toddler. Zinc-rich foods include beans, chickpeas, beef, turkey and spinach while omega-3 rich foods are salmon, tuna and sardines.


DrSearsLEAN’s recommendation

To improve your child’s skin from the inside out, add these nutrients to his or her diet:

  • Fruits and vegetables can help improve allergic and inflammatory diseases like eczema. If you have a picky eater who avoids fruits and veggies, you may consider giving them a whole food supplement to help boost their immune system.
  • An omega-3 supplement provides beneficial fats to help the skin stay healthy. Good sources of Omega-3s are avocados, salmon, tuna, flax seeds, pumpkin seeds.
  • Probiotics taken in liquid, powder, or pill form can help decrease food allergies.

Choosing A Healthy Drink for Kids

Parents beware that not all drinks packaged for children and have ‘vitamins’ listed on the packaging are healthy. As stated on DrSearsLean.com, drinks with the main ingredient ‘high fructose corn syrup’ may result in overeating because it does not trigger a hormone, leptin, that creates fullness. Moreover, children who drink more than 12 ounces per day of concentrated juice are more likely to be overweight. For eczema children, it’s also best to avoid sugary drinks which contain caffeine (may trigger eczema), increase tooth decay while artificially flavored drinks have been linked to ADHD. For a healthy choice, plain water with lots of fruits and vegetables is best

Does Softening Water Help?

Water makes up 60% of our body and is useful for flushing out waste and toxins. There are some observations that eczema is more prevalent in areas where water is hard as the higher calcium and magnesium content may be a skin irritant. However, from a clinical trial conducted by Professor Hywel Williams and Dr Kim Thomas of the Centre of Evidence Based Dermatology at University of Nottingham, there is no impact of using softened water on eczema. However for parents who have found water softeners to improve their children’s eczema, they certainly can continue to do so. Skincare routine like moisturizing, showering without using harsh soap and appropriate treatment is still required.

DrSearsLEAN’s recommendation

Water is an essential nutrient. Water is to our body what oil is to a car; we can’t function without it. Like growing plants, growing kids need lots of water. Our bodies are 50 to 70 percent water, and much of that water has to be replaced every day. Water helps prevent constipation, eliminate toxins from the body, hydrate the brain, and keeps breathing passages moist and clear of mucus. As a general rule, children need around one ounce of fluid per pound of body weight per day. The majority of your fluids should be from plain water, but a small amount of fluids can also be from milk or 100% fruit juice. Drinking soda should be discouraged. Many juice drinks and all sodas are high in calories, provide no nutrients, and are usually sweetened with high fructose corn syrup (HFCS), which you should always avoid.

MarcieMom: Thank you Dr. Sears for being with us throughout the whole series. I’ve been so glad and delighted to hear your advice which definitely gives me the confidence to raise a healthy child, despite her eczema.

Categories
Doctor Q&A Eczema Tips

Sensitive Skin Product Series – What Ingredient to Avoid

I ‘met’ Laura Verallo Rowell Bertotto, the CEO of VMVGroup, on twitter and learnt that her company is the only hypoallergenic brand that validates its hypoallergenicity.

VMV Hypoallergenics is founded in 1979 by Dr. Vermén Verallo-Rowell who is a world renowned dermatologist, dermatopathologist and dermatology/laser surgeon, also an author, esteemed researcher and speaker. 

Sensitive Skin Skincare Product Interview series with Dr Vermen Verallo Rowell VMV Hypoallergenics
  1. Sensitive Skin Product Series – What is Hypoallergenic?
  2. What does Natural Skincare Product mean?
  3. What is considered Organic and Non-Comedogenic?
  4. What does Suitable for Eczema Children mean?
  5. What is Patch Testing (for skincare product ingredients?)
  6. How do you read ingredients on skincare product label?
  7. What does Irritant-Free mean?
  8. What ingredients in skincare product to avoid?
  9. How is Coconut Oil used in skincare?
  10. What is product cross-reactivity?
  11. How many ingredients in a skincare product?
  12. How to use skincare products on Sensitive Skin?
  13. How to manage the diaper area?
List of Ingredients that could Irritate in skincare product
List of Ingredients that could Irritate Skin

How to Choose Moisturizer

Marcie Mom: For a parent on a tight budget (also considering long term and frequent use of moisturizers), should he/she start the child on the cheapest lotion/cream available? If not, is there certain baseline to start with, for instance, it must state ‘suitable for infant with eczema’ or not contain ‘perfume’?

Dr. Verallo-Rowell: The answer is no. Many cheap products are strongly/nicely scented to cover up for the natural scent of less-pure cosmetic ingredients versus, for example, pharmaceutical-grade or higher-quality or purer ingredients, which are frequently more expensive. Some cheaper products are dyed with relatively cheap ingredients to add attractiveness in children’s eyes. Cheap or expensive, preservation is also problem, as are added antibiotics. All these are allergens and break down the skin’s natural barrier.

Many cheap products are strongly/nicely scented to cover up for the natural scent of less-pure cosmetic ingredients

Make function be the basis for your choice. Remember that in different forms of eczemas you pay attention to the skin’s outermost barrier layer: genetic innate barrier dysfunction initiates atopic; allergic or irritant reaction breaks down the barrier in contact; food around the mouth area can physically act on the barrier, and secondarily, bacteria cross damaged barrier in all types of eczemas. Hence to keep the barrier as intact as possible:

Place the least irritating, partially occluding product you can find without any of the above: scents, preservatives, antibiotics, dyes.

Mineral oil and pertroleum jelly are long time favorites of us dermatologists. They are cheap and excellent barriers, but they are petrochemical derived. Consider non-preserved, non-adulterated oils. For this my favorite is virgin coconut oil because it needs no preservation and is broken down by lipases of friendly skin bacteria into monoglycerides with antiseptic properties. I have a published paper on VCO vs. Olive oil in Atopic Dermatitis that includes comparison on Staph. Aureus action by both oils.

Can you list for us some common irritants and list them on a scale of 1-10 (1 being the most likely to cause allergy)?

It’ll also be great if you can let us know if there are other common names for these irritants.

Perfume, Fragrance

Benzyl alcohol (Phenylmethanol / Phenylcarbinol), also
named as Natural grape aromatic preserves & scents in
“fragrance-free products
Carvone (d-carvone, d-1-Methyl-4-isopropenyl-6-cyclohexen-2-one, essential oils from dill, caraway seeds, spearmint, orange peel
Cananga odorata(Ylang ylang, Cananga distillates)
Cinnamic aldehyde (Cinnamaldehyde),
from bark camphor, cassia cinnamon trees
Colophonium Rosin (Abietic acid, alcohol, Abitol), a resin
from pine tree
Extracts of common plants of the (Astraceae/ Compositae
family: yarrow, mountain arnica, German chamomile,  
feverfew, tansy) – Botanic addictives

Preservatives

Bacitracin  (An Antibiotic )
p-Chloro-M-Xylenol (Chlroxylenol, PCMX)
Clioquinol
Formaldehyde (Formalin, Methaldehyde, Methanal)
Diazolidinyl urea (Germall II) and    Imidazolidinyl urea
(Germal 115, Eukyl K 200)
Dimethylol dihydroxy ethyleneurea (DMDHEU)
DMDM Hydantoin (Glydant)
Quarternium 15 (Dowicil 200)
Methyldibromo glutaronitrile + 2 phenoxyethanol
(Eukyl K 400)
Methylchloroisothiazolinone/methylisothiazolinone
(MCI/MI Eukyl K100, Kathon CG)

Parabens

Methyl, Ethyl , Propyl, Butyl Paraben.  Please see also above in Preservatives

Propylene Glycol

1,2 Propanediol

Lanolin

Lanolin alcohol, Wool Alcohol

Colorant/Dye

Disperse blue 124/106  Mix (Thiazol-azoyl-p-phenylene
diamine derivative dyes)
p-Phenylenediamine

Conventional emulsifiers

Stearamidopropyl dimethylamine  (Amidoamine)
Dimethylaminopropylamine (DMAPA)
Cocamide DEA (Coconut Diethanolamide)
Cocamidopropyl betaine
Oleamidopropyl dimethylamine
Decyl glucoside  from glucose (corn starch) & decanol fatty acid from coconut
Ethylenediamine dihydrochloride (Chlorethamine)

Mineral oils – actually quite skin safe. A favorite among dermatologists.

Paraffin – same as mineral oil.

Sodium Lauryl Sulphate – An Irritant especially when present in higher concentrations. Not too common as an Allergen.

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Guest Interview

Sensitive Skin Product Series – Understanding Irritant-Free

I ‘met’ Laura Verallo Rowell Bertotto, the CEO of VMVGroup, on twitter and learnt that her company is the only hypoallergenic brand that validates its hypoallergenicity.

VMV Hypoallergenics is founded in 1979 by Dr. Vermén Verallo-Rowell who is a world renowned dermatologist, dermatopathologist and dermatology/laser surgeon, also an author, esteemed researcher and speaker. 

Sensitive Skin Skincare Product Interview series with Dr Vermen Verallo Rowell VMV Hypoallergenics
  1. Sensitive Skin Product Series – What is Hypoallergenic?
  2. What does Natural Skincare Product mean?
  3. What is considered Organic and Non-Comedogenic?
  4. What does Suitable for Eczema Children mean?
  5. What is Patch Testing (for skincare product ingredients?)
  6. How do you read ingredients on skincare product label?
  7. What does Irritant-Free mean?
  8. What ingredients in skincare product to avoid?
  9. How is Coconut Oil used in skincare?
  10. What is product cross-reactivity?
  11. How many ingredients in a skincare product?
  12. How to use skincare products on Sensitive Skin?
  13. How to manage the diaper area?
Contact allergens irritants in skincare products
Allergens to Avoid

‘Perfume Free’, ‘Propylene Glycol Free’, ‘Paraben Free’, ‘Lanolin Free’, ‘Preservatives Free’, ‘Colorant Free’ – So Many ‘Frees’! Is this too much or too little?

In this post, I’ve consolidated a list of irritants to avoid which include the above and also sodium lauryl sulphate, mineral oils, conventional emulsifiers and paraffin. I’ve also realized that it’s difficult to find a product that excludes all potential irritants so for this interview, we catch up with Laura to understand which are the more allergenic ingredients and how to assess what our child can use.

Marcie Mom: I understand that VMV recommends its customers to perform a patch test, i.e. applying on a small area and observe for few hours to up to 72 hours before gradually increasing usage. Can a child also take a patch test?

Laura: Wow you do your research 🙂 Ok, for ANY cosmetic, doing a provisional patch test before purchasing and/or sampling is always a good idea prior to making a purchase.

Patch Testing

The best tool is really a proper patch test done by your dermatologist, but this cannot be done on children. If you have a child with very sensitive skin, allergies and/or eczema, etc., however, as soon as he is old enough to get a full patch test, he should. This is really the best way to determine what, in particular he needs to avoid. And if you’re sensitive, as allergies are often hereditary, your own patch test results may give you a possible idea of what your child might be allergic to as well (this is not a sure thing, however; your child would still benefit from his/her own patch test at the appropriate age).

Making Sense of Irritant-Free

Marcie Mom: Should parents use a product that markets ‘XXX-Free’?

Laura: Yes, a good guide is to look out for what irritant the product is free of. The big problem, however, is that a lot of marketing-speak says “free this” and “free that”, and, unless you’ve really done your homework and have a deep understanding of ingredients and allergens, you may not be able to accurately judge if the ingredient that is absent is even harmful. What I’m trying to say is that “XXX-FREE!” is a powerful marketing phrase on its own, whether or not it has objective merit (e.g. whether or not a product is better for not having a particular ingredient in it).

SLS – FREE

Lots of shampoos now, for example, are touting “SLS-free” heavily. The thing is there are two ingredients with these initials: Sodium LauRYL Sulfate and Sodium LaurETH Sulfate. While the former is a well-known irritant, the latter is actually rather harmless, particularly in lower concentrations. So if a product says SLS-Free, you’d need to check which of the two is absent. And, neither is on the allergen lists (again, these lists are compiled from patch tests done on over 20,000 people). Much of the hooplah surrounding SLS/SLES has to do with their environmental impact — which is a valid concern but may not be as relevant as for skin safety.

‘Cancer-Causing’

One more thing to consider. When you read a lot of the posts about “causes cancer”, it’s natural to worry. These claims are serious and you don’t want to take them lightly. However, it is important to remember that many (but not all) of these reports are skewed to be sensational — they may not be balanced. For example, much of the evidence of the carcinogenicity of certain ingredients is determined in laboratory experiments with animals fed the ingredient in very high doses (sometimes the equivalent of the animal’s body weight and the equivalent of a lifetime of consumption at these doses). Many of the same ingredients used in cosmetics are used in minuscule amounts and in molecular sizes that are too large to penetrate to the dermis, much less get to the bloodstream. An example would be parabens: we stopped using them because they are allergens, not because of the cancer panic, because there simply is not enough to go on.

Mineral Oil

Mineral oil is another great example: NOT an allergen. Ask any dermatologist and they’ll tell you mineral oil is a go-to, reliable hydrator even for extremely sensitive skin (there are some reports of comedogenicity but it is otherwise a go-to moisturizer) and for extremely sensitive areas (even the genitalia). Again, most of the concern with this (as well as petroleum jelly, another big dermatologist favorite) is environmental. And again this is a valid argument for the planet, but strictly speaking for skin safety, these ingredients are not allergens and are relied upon regularly by dermatologists for very dry, sensitive skin conditions.

Hypoallergenic

“Hypoallergenic” is not regulated. Many ingredients touted for sensitive skin are actually highly allergenic. Some natural and/or organic ingredients are allergens, too. Yes, definitely, “fragrance-free” is key…but then again, are you confident that you know all the chemical names of all products that are fragrances and masking fragrances or that cross react with/are related to them (e.g. cinnamic alcohol)?

The best guide is really allergen-free. But you have to make sure that the “allergens” to which the brand is referring are those that are proven allergens. The NACDG and ESSCA patch test on over 20,000 people in multiple countries to compile their lists of allergens, and crucially, they update these lists every few years. These lists are, therefore, statistically relevant, consistently updated, and put together by two of the most respected groups of doctors in the world who concentrate on allergens and contact dermatitis — and they are regularly published in peer-reviewed medical journals. This allergen list is what the VH-Rating System uses and, considering we’ve had less than 0.1% reported reactions in 30 years, it’s quite reliable.

Marcie Mom: Thanks! It’s great to understand a little more about some of the ingredients, so that parents can assess if they truly need a product that excludes them. For the next interview, we’ll continue to learn more about choosing products for sensitive skin.

2015 update: Selection of moisturizer – try to see how to put a few basic principles of moisturizer selection in practice

2016 update: Surfactant skincare series that covers ingredients that have been studied to irritate eczema skin, such as CAPB

2018 update: The current list of prohibited ingredients by FDA are 1,4-dioxane, and 10 other ingredients: Bithionol, Chlorofluorocarbon propellants, Chloroform, Halogenated salicylanilides (di-, tri-, metabromsalan and tetrachlorosalicylanilide), Hexachlorophene (HCP concentration in a cosmetic may not exceed 0.1 percent, and it may not be used in cosmetics that are applied to mucous membranes, such as the lips), mercury compounds, methylene chloride, prohibited cattle materials, Vinyl chloride and Zirconium-containing complexes.

Categories
Support Group

Will daycare help protect your eczema child from allergy and asthma?

Allergic March – Starting with Eczema

I believe all parents with eczema children struggled with sending their children to daycare. I know I did, when I sent my baby girl Marcie to daycare when she’s 11 months old. Apart from worrying that daycare teachers can’t take care of her, given the constant scratching and attention required, I also worry that she will fall sick more often, resulting in asthma. Are these worries valid?

There is no conclusive research on daycare’s protection against nor causing allergy and asthma. As far as I gather, various studies’ conclusion are mixed as below:

1. A German study reviewed 3,097 children from birth to 6 years old and noted that children who attended daycare in the first two years also had more chances of eczema. This was from tracking children in East versus West Germany, as 52% of children attended daycare in the East versus only 6% in the West.

2. Another study showed that children who attended daycare early (between 6 to 12 months) had lower allergy antibodies, meaning less likely to develop food or nasal allergy. However, there was a higher incidence of respiratory tract infection, i.e. more wheezing.

3. Another study showed that children who attended daycare early were 75% less likely to develop asthma by 5 years old. However, if daycare was started after the child turned 2 years old, there were 3 times more allergy problems.

4. Another study showed that by 8 years old, daycare or no daycare had no impact on allergy/asthma.

How do we decide on daycare’s impact on allergic march when we still don’t know the cause? Based on the 4-part series, you’ll see that there is no one clear cause of eczema. If it’s the skin barrier, then you may decide to take care of your child yourself to make 100% sure that her skin is protected by moisturizing. If it’s the immune system, you may hope that sending your child to daycare will strengthen her immunity (though as you see above, there’s no conclusion). Moreover, eczema is a skin condition with multiple factors influencing the outcome, so it is hard to isolate a single cause to focus on.

So what do you base the daycare decision on? Personally, I don’t base it on impact on allergy/asthma. I base it on other factors, like whether she’s taken care of at the daycare, whether they pay attention to moisturizing and disinfecting her skin, whether I want or need to go back to work. The allergic march, which is the progression from eczema, to allergy and asthma, is also dependent on the severity of eczema (the more severe, the more likely to have allergy/asthma) and the whether the child has both eczema and allergy (then more likely to have asthma).

I know.. tough letting someone else take care of our eczema children, wondering if she scratches more, stresses more (which trigger more scratching) because someone else is taking care of them.

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Eczema Facts

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

Categories
Eczema Facts

Is your Eczema Child (Wrongly) Avoiding a Tested-Positive Food in SPT?

Skin Prick Test (SPT)

If your child has eczema and has been avoiding a food that he/she has been tested positive in the Skin Prick Test (SPT), it may be time to review if there is indeed a true food allergy. Research indicates, as I understand from various online articles, that the skin prick test is a test of sensitization, and not clinical relevance. Below are some points on the accuracy of skin prick test:

1.      Skin Prick Test is more accurate for non-food allergen, such as dust mite and pollen, than for food allergen.

2.      Skin Prick Test is More Accurate in predicting when there is NO food allergy and Less Accurate in predicting a Positive food allergy. The implication of this is that children who have been avoiding food (for example more than 50% of those tested positive for milk and eggs, and more than 70% of those tested positive for peanuts) actually didn’t have an allergic reaction to these foods. (There is only a 0.5-10% chance that a child who is allergic to a food will test negative for it.)

3.      Follow-up tests are required for skin prick test for children at different age, sometimes about 1-2 years later. The results can be different as children may ‘outgrow’ some allergy or develop new ones? (hopefully not…)

4.      An oral food challenge is the most accurate (less than 5% incorrect).

5.      For children with eczema, there is an 80% possibility that food that the child is avoiding turn out not to be one he/she is allergic to. Refer to this article for detailed research.

Despite above, Skin Prick Test still remains the most recommended first test for allergy, as it is by comparison simpler, lower cost, faster results, more tolerated (children won’t feel much pain, you can read this post on my baby Marcie’s experience) and more accurate than blood test. If anyone has an experience to share on skin prick test for your child, do comment below this post.