This World Allergy Week 2018 it’s time we pick up the speed on Atopic Eczema and recognise the critical role allergy has in fuelling the itch that rashes.
A Parents Guide to Atopic Eczema
written for World Allergy Week 2018
by Dr Suzie
Childhood Eczema remains a nightmare.
Given that 25% of pre-schoolers in 2018 now have eczema, it’s time our advice about eczema went beyond soap, sand, chlorine avoidance and steroid creams to a serious consideration of how we can stop the newest driver of childhood chronic disease - allergy.
Those who have helplessly watched children tormented by endless scratching and disrupted sleep, will understand how eczema is a killjoy of parenthood.
Parents desperately search for more natural answers, yet become increasingly frustrated by money wasted on more lotions and potions for a cure that doesn’t exist yet and no answer to when their child will have normal skin, like all those other kids.
Parents battle frequent flare-ups and more staph infections - adding antibiotics to steroid creams, on their list of concerns.
This World Allergy Week, 2018, its time to let parents know about why it’s important we consider adding Allergy to Preschool Checks because when it comes to childhood eczema, allergy is likely involved and there is one thing we can confidently predict.
It may not stop there.
Atopic eczema in childhood is the new harbinger of Allergy – sadly heralding an increased risk of a life complicated by more allergic diseases such as Food Allergies, Allergic Rhinitis and Asthma.
Even more reason why we should be gearing up for a more proactive approach. Explain more soon.
First, let me introduce myself.
My name is Dr Suzie. I’m a Sydney-based GP with a special interest in teaching Primary Care Allergy (amongst other things) to GP’s and writing!
Although many pre-schoolers are lucky enough to exit the allergic path by outgrowing their Atopic eczema by adulthood, many more overcrowd this Childhood March of Allergic Diseases - we call this the Atopic March.
Which is why, I believe investing in early intervention strategies along this Childhood path is needed.
For now, consider whatever you were originally taught about Atopic Eczema as just the tip of the iceberg with the role of underlying allergy submerged. Let’s not be fooled by the subtly and chronicity of the role of Allergies in Eczema yet to surface mainstream.
Perhaps less obvious than a life-threatening Anaphylaxis but understanding the underlying role of food and environmental sensitisations in early childhood could help stop the predictable March of allergic disease we’re seeing and the escalating numbers.
In the spirit of WAO 2018, here is a synthesis of a few things, if I were a parent, I would want to know right now in 2018, particularly if I had a child with Eczema.
✔ Yes, Atopic Eczema might just be the beginning
Allergy drives the Atopic March and Atopic Eczema is often the first step.
Atopy is the cluster of allergic illnesses like asthma, allergic rhinitis, food allergies or eczema that co-exist in families. The Allergic March is the predictable pattern of illnesses that develop starting with Atopic Eczema often in the first few weeks in life and peaking in preschool years, often then followed with Food Allergy, Allergic Rhinitis and Asthma.
✔ Yes, foods can make eczema worse
Welcome to the confusing role of food allergies, non-allergic food hypersensitivity and additives to eczema.
Firstly, the relationship between food sensitization and eczema is tricky and the focus of ongoing research. Food Allergies tend to be more of a major trigger of eczema for children than adults. Commonly milk, egg, peanut, soy, and cereals are the culprit foods, fortunately these allergies are typically lost during school age.
My advice is to arrange Allergy testing for food allergies, if eczematous skin is not improving and get appropriate diagnosis and advice by an allergist before embarking on any elimination diets or restricting foods for kids.
✔ Yes, dust mite, pollen and pet allergies make eczema worse
The underestimated importance of environmental allergies in kid’s eczema.
Eczema worsens with exposure to environmental allergies like House Dust Mite, pollen or animal dander and improves after appropriate avoidance strategies have been applied.
Therefore, this is a message especially for parents whose pre-schoolers have classic eczema flare-ups during winter. Dry skin from heating and temperature changes, swimming lessons or wearing wool are not the only causes for this flare. Think Allergy.
Given there is more time indoors within enclosed heated spaces, more blankets, more wool and yet the obvious role of House Dust Mite Allergy flaring eczema is too often ignored.
In children with House Dust Mite allergy, strenuous House Dust Mite avoidance measures needs to be carried out, especially the removal of bedroom carpets. You can try Dust Mite covers, Eucalyptus sprays and BYO School Matt for Preschool to avoid old dusty carpets too.
More and more studies point to the role of House Dust Mite allergy in eczema flares, so if you want to get proactive with eczema, then step right this way for bulk billed allergy test for kids.
✔ Yes, skin barrier is genetically abnormal in eczema
Focus on creating the most natural skin barrier you can.
Fillagrin is the protein necessary to keep skin tight but mutations in the genes for filaggrin, the molecule responsible for skin hydration, have been repeatedly described in eczema.
Subsequently eczema has impaired skin barrier function which means it’s more prone to water loss giving it a dry and scaly appearance. This also makes it more susceptible to infections which we will discuss more about in a moment and foreign substances can easily pass through causing sensitization and potentially Contact Allergies.
✔ Yes, eczema increases risk of contact allergies
Here’s where we need to make some noise about the silent increase in Contact Allergies to ingredients like Fragrances and preservatives in every-day self-care products like shampoos and soaps. Contact Allergic Dermatitis may be indistinguishable to an untrained eye to eczema. I call Contact Allergic Dermatitis the poor cousin of Atopic Eczema. Contact Patch testing can diagnose a secondary contact allergic dermatitis.
Keep skin ingredients simple. Don’t be lulled into a false sense of security seeing Natural or Organic. If you ask me, unpronounceable ingredient names on self-care products is even more reason not to ignore them. Even botanical based products or essential oils can cause allergies too. Contact Patch testing can diagnose a secondary contact allergic dermatitis.
✔ Yes, contact with these things irritate eczema
As mentioned, the dry skin of eczema has lost its inherent reduced barrier function therefore, a non-specific hypersensitivity towards all kinds of irritants exists.
Known substances with irritative potential which shouldn’t be avoided include;
✔ Yes, eczema is more likely to get infected
Why the skin microbiome will be trending next.
Just as the Gut microbiome has fascinated the world, the skin microbiome is next. There are profound changes in skin flora in patients with Eczema.
Eczematous skin displays lower amounts of antimicrobial peptides thereby reducing innate immunity. This explains why the skin of almost all eczema patients is frequently colonized with Staphylococcus aureus and yeast Malassezia furfur and gets infected by viruses like Molluscum contagious and Herpes Simplex Virus.
Sadly, the truth is there is no way to prevent or stop the Allergic March, just yet.
The good news is, there is local ground root efforts (like mine) to uphold the principles of our 2015 National Allergy by making allergy testing and a more comprehensive view of eczema widely available to the public so we can slow down this Atopic March and get a better handle on Allergic diseases in our kids.
Starting with Atopic Eczema.
Download here Dr Suzie’s 7 pieces of medical advice for the treatment of Atopic Eczema.
My recommendations To Parents in 2018
1. Look for allergies if your child’s eczema is not getting better. These may be environmental, food or contact allergies.
2. Get Medical advice before eliminating gluten, dairy or eggs from the diet. The role of food is complicated.
3. Remove all known allergens and irritants. Allergen avoidance for those with documented allergies is essential. This includes foods, dust mites and animal dander’s in individuals who are allergic to them.
4. Know exactly what you are washing and moisturizing your child with. The key is to protect abnormal skin barrier and do no harm by exposing skin to further toxicities.
5. Learn how to do wet-dressings.
6. Use steroid creams as prescribed – they help!
7. Trim nails, consider night time anti-histamine to stop itch.
8. Discuss with your Doctor whether you might benefit from adding + zinc, fish oil and probiotics
My recommendations to Healthcare and Government in 2018.
1. Let’s Get Serious About Allergy Training
GP’s are best placed to manage the team of health professionals needed for the suite of allergic diseases at play when there is an atopic predisposition.
GP's and nurses are our best frontline defence for eczema and allergy and therefore we should plan now how we can upskill our GP’s and Nurses in Allergy and Nutrition.
My 2018 Wish list: Big medical groups like Primary Health Care or IPN being proactive by investing into upskilling GP’s with Special Skills training and offering Allergy services.
2. Target pre-schoolers
Let’s identify Allergies and manage the Allergic March earlier. A proactive approach and a simple solution would be to resuscitate the NSW 4 Year Healthy Kids Check by simply adding allergy, nutrition and sleep checks to the existing pre-school screen.
My 2018 Wish List: Free National Screening for all 4-year olds including entire developmental assessment and national access to allergy testing with GP’s.
Think you might be able to help our local efforts. Please feel free to reach out firstname.lastname@example.org
Cole, Christian et al. Filaggrin-stratified transcriptomic analysis of pediatric skin identifies mechanistic pathways in patients with atopic dermatitis. J Allergy Clin Immunol Volume 134; 2014;82.91.
Eczema, Atopic Eczema and Atopic Dermatitis Darsow U, Eyerich K, Ring J (Updated 2014)
Quah PL, Ling Loo EX, Li Yuan Lee GN, Kuo I, Gerez I, Villablanca Llanora G, Chan YH, Aw M, Shek LP and Lee BW. Clinical phenotype and allergen sensitization in the first 2 years as predictors of atopic disorders at age 5 years. World Allergy Organization Journal 2015; 8:82. (doi:10.1186/s40413-015-0082-z)
Full Text Samoylikov P, Gervazieva V and Kozhevnikov S. Association between autoimmune reactions and severity of atopic dermatitis in children with herpes virus infection. World Allergy Organization Journal 2013; 6:279. (doi:10.1186/1939-4551-6-8) Full Text