Search Results for "eczema"
I hate to bore you with another “probiotics are good for you” blog post, but I’m going to anyway. I’ve said it before and I’ll say it again: Destruction of the normal bacteria flora in an infant or toddler’s body is one of the worst things that can be done to his or her long term health.
Although research has shown that probiotics seemingly help with almost everything (obesity, anxiety, diarrhea, constipation, ulcers, ear infections, etc..), I think the most important feature is how well they balance out a delicate, developing immune system. The first two years are critical. Lose this windown and your little one may be fighting immune imbalances for the rest of his or her life.
This particular study highlights the benefits yet again. Researchers looked at how well a specific probiotic (Lactobacillus rhamnosus HN001; Bifidobacterium animalis subsp lactis HN019, at 6 and 9 billion CFU / day respectively) could benefit eczema and allergic sensitization at age 6 when given within the first 2 years of life. Here’s the details:
- Maternal supplementation from 35 weeks until 6 months post-partum if breastfeeding, and then infant supplementation from birth (or at cessation of nursing) until 2 years.
- The HN019 didn’t have an impact, while HN001 made a pretty large difference as seen below.
- 44% lower rates of eczema.
- 31% lower rates of skin-prick-testing reactions.
Keep in mind that this is a single intervention with probiotics and takes no other lifestyle changes or supplements into account (pets in household, vitamin D, trans fat intake, omega 3 fatty acid intake, etc..). This is a powerful statement.
And one that still is not getting across to pediatricians.
One final comment. This particular study looked at how effective a single probiotic was at lowering the rates of eczema. But this does not mean that we should drop everything and try to find the one or two “miracle” probiotics. Rather, research is headed towards patterns of probiotic species present that represent disease or health. In other words, there may be 4 or 5 principle bacteria that are more likely to be found in someone who is obese. Lean people, on the other hand, may have a different blend of 4-5 bacteria. While this story and the research has a long way to go, suffice it to say that, from what we know right now, a good quality broad spectrum probiotic supplement (around 20 billion / day) coupled with a good quality diet will be your best approach.
Hygiene levels associated with wheezing, eczema in preschool infants
If you follow the concept of Th1/Th2 balance of the immune system (search prior Updates on the website for additional information on this topic) then a certain level of exposure to antigens (primarily bacterial) are required for healthy development of the Th1 system. This article supports this hypothesis. There is also ample additional evidence to suggest that a normal bacterial flora is also essential for this process, and that antibiotic use will disrupt this. I realize the above article comes to a different conclusion, but with research you always need to step back and look at the totality of the evidence–this is usually where the more real truth lies.
ADC — Abstracts: Sherriff et al. 87 (1): 26
Starvation reduces skin wheals, plasma substance P, vasoactive intestinal peptide in patients with atopic eczema/dermatitis syndrome
While I don’t usually recommend starvation for patients with eczema (although most people would do well with a good fast…), this article does show the impact that the food we put into our mouths can have a direct effect on our skin. Too many times in dermatology we look only at the skin, when, in reality, the dermatologist should be talking to the gastroenterology to best aid the patient. I am firmly convinced that most atopic/eczema cases are related to food allergies. Now these may be difficult to identify and after a long history the pattern of altered physiology may be strongly ingrained, but it is possible.
Food allergy and atopic dermatitis in infancy: an epidemiologic study
The connection between the gut and the skin is not well accepted, despite quite a bit of research actually supporting this link.
This study further supports the relationship with food allergy (which would be mediated via the GI tract) and eczema. My personal opinion is that, if you can address it very early, food allergies and eczema can be easily handled. As that baby gets older, the pathways of inflammation and allergy get “burned in” and resolution becomes more difficult. In addition to identifying food allergies, research also suggests the use of probiotics to add an additional protective barrier between our environment and the interior of our body.
Food allergy and atopic dermatitis in infancy: an epidemiologic study – Pediatric Allergy Immunology, Vol 15, Issue 5, pp. 421-427 -
Our immune system starts out delicate. The first 2 years are critical. Luckily, natural remedies for eczema in infants, toddlers and children are safe and effective.
The phrase to understand here is “immune tolerance.” The immune system is supposed to attack things it is supposed to (like bacteria and viruses) and not attack things it is not supposed to (like our skin, thyroid or gut). This is called tolerance. And it develops very early. Like, “in the womb” early.
A few things are well known to increase the risk of asthma and eczema very early in life.
- Paracetamol (Tylenol) use in pregnancy increases risk of asthma in children
- While nursing is best, if formula is used, hydrolyzed formulas like Nutramagen or Alimentum may lower the risk of eczema and asthma
- Vitamin D intake during pregnancy may lower the risk of wheezing up to 3 years of age
- C-section babies are at increased risk of allergies and asthma
Hold on…C-sections can increase the risk of immune system problems? “How does that happen?” you may ask.
One of the most powerful factors helping newborns, infants and toddlers develop a healthy immune system and good immune tolerance is the presence of a healthy bacterial flora. I would have to venture to say that, based on the evidence, this may be THE most important factor for a healthy immune system. And not just in our younger years, but for the rest of our lives.
Back to the C-section dilemma.
In the womb, a developing baby’s gut is sterile. Nothing is growing in it, although it is a warm and very hospitable environment for bacteria to grow. So, as the baby passes through the vaginal canal, that baby’s first exposure should be Lactobacillus from healthy bacterial flora in the vaginal vault. Now, if mom’s had antibiotics this might not occur.
So think of the C-section baby. Rather than Lactobacillus, the first bacteria to hit that nice warm growing environment is kind of up for grabs. And sure enough, we see differences in the bacterial flora of the gut in infants born vaginally vs C-section. But can the C-section baby be spared the increased risk?
That leads us to this particular study. Researchers found that giving a Lactobacillus supplementation for the first 2 years of a high risk newborn’s life had some pretty amazing effects.
- Risk of having eczema at 4 years was cut 43%
- Rhinoconjunctivitis (think runny nose and watery eyes) at 4 years was a whopping 62% lower
- There were also smaller reductions in the risk of atopic dermatitis (26%)
- Risk of wheeze was down 21%
- Allergic sensitization down 28%
Interestingly, the probiotic Bifidobacterium animalis did not affect the risk of any of these.
These are some pretty massive impacts from such a simple and safe natural remedy for eczema in our infants, toddlers and children. And keep in mind that these effects are likely lifelong–those first 2 years are so critical that they can set up a lifetime of protection or problems.
Looking at the flip side, it becomes clear that antibiotics can be a major contributor to the development of these same problems by killing off the good bacteria.
Given that some 90% of kids are given antibiotics by the time they are 2, did your child’s pediatrician explain some of the problems that might occur with destruction of the normal flora? Better yet, did they recommend probiotics after antibiotics? Feel free to share!
IF YOU’RE NOT NURSING, WHAT’S BETTER–COW’S MILK OR SOY? Actually…neither. Mother’s milk is superior to anything and every single attempt needs to be made to nurse before moving on to formula. That being said, it is not always possible. Regardless of what type of formula you use, the newborn’s GI tract is not ready to be bombarded with one type of protein again and again and again.
I really feel that hydrolyzed formulas (Nutramagen, Alimentum) are the best choice for formula feeding if nursing is not an option. This gives that developing GI tract and immune system less intact proteins to react to and develop an atopic profile with allergies and asthma. Couple this with no antibiotics, use of probiotics and Vit D and you’ve got a nick recipe for a healthy immune response.
Early Behavior May Point to Later Atopic Disease in High-Risk Infants
The authors to this article make a wonderful hypothesis at the conclusion by suggesting that gut microflora may play a role in this relationship. It makes much sense to think that an imbalance of intestinal flora (most likely following antibiotic therapy) could lead to symptoms of colic. These gut alterations could unquestionably set the stages for abnormal responses to allergens; i.e. atopy and allergy.
Arch Dis Child 2001;84:349-350 Much “fussing” and crying in certain infants may predict subsequent development of atopic disease, Finnish researchers report. Dr. Marko Kalliomaki of Turku University Hospital, and colleagues note that it is important to detect atopic disease in infants because it may lead to “impaired growth and subsequent development of more permanent manifestations such as allergic rhinitis and asthma.” To determine whether behavior patterns in infants indicate impending atopic disease, the researchers studied 116 newborn infants who were considered at high risk for atopic disease. The subjects all had at least one close relative with atopic eczema, allergic rhinitis or asthma, and more than half (55%) had two or more such relatives. During two 7-day periods in the 7th and 12th weeks, parents recorded their child’s behavior using a 24-hour chart and diaries. Items covered included whether the infant was awake and content, fussing or crying. Evaluation at the age of 2 years indicated that the 44 infants (38%) who developed atopic disease, showed “significantly more fussing during the 7th, and colic-type cry during the 12th week than those who remained healthy.” Given these findings, Dr. Kalliomaki suggests that “excessive fussing and prolonged colic-type crying at an early age may predict manifestation of atopic disease later in early childhood.” The investigators speculate that gut microflora could be involved and suggest that its modulation “might help prevent allergy” and reduce such fussing and crying during the first 3 months of life.
Food allergy/intolerance: associations with other manifestations of atopy
This is another wonderful article packed full of interesting concepts. First is finding out just how common food allergy is in the general population. This article also gives some common food allergens found which includes certain nuts, milk and fruits. Another common theme arises here as well–systemic manifestation of food allergy resulting in reactions in the GI tract, skin and oral cavity. Skin reactions were found in 28.7% of the allergic patients. This brings to mind one of my patients with eczema whose PCP told her that food does not have any relation to her symptoms. According to this study that’s just plain not true. Any patient with dermatological problems should be put on an elimination diet to see if food allergies has any contribution to symptoms. What does the patient have to lose?? Maybe the skin lesions…. Synergy : Allergy 56 (12), 1172-1179
Childhood Atopy Predicts Asthma Severity in Adulthood
Many problems in childhood that many people would consider “minor” or “normal” such as allergies and constipation, concern me a great deal with regards to long term health. This research supports this concern and strengthens the need to truly address allergies in children, not just medicate them, to maintain health in adulthood. This would mean addressing healthy intestinal flora, identifying and removing food allergies, avoidance of food preservatives and colors and adherence to healthy eating habits.
Am J Respir Crit Care Med 2000;162:2177-2181 Atopy in children with asthma appears to increase the risk of having more severe disease later in life, Australian researchers report in the December issue of the American Journal of Respiratory and Critical Care Medicine. Dr. Rory Wolfe, of Monash Medical School, Prahran, Victoria, and colleagues sought to examine a number of relationships including whether “the presence of allergic features in childhood is a predictor of the subsequent course of asthma.” The researchers followed a cohort of 378 asthmatic children from the age of 7 to 35 years at intervals of 7 years. Among items recorded were the presence of eczema or hay fever and sensitivity to rye grass or house dust mite. Having an atopic condition in childhood was associated with a higher risk of severe asthma in later life. For eczema, the odds ratio increased to 1.66, for hay fever, it was 1.39. A positive skin test result increased the odds ratio of severe asthma to 2.25. Conversely, greater severity of asthma in childhood was related to increased odds of having eczema and hay fever later in life. These findings, the researchers conclude, may “improve the clinician’s ability to predict probable long-term outcomes in children with asthmatic symptoms.”
Role of Intestinal Flora in the Development of Allergy
I’m really getting to the point where I will not include any more info on probiotics and allergies–there is enough research and anecdotal evidence in the medical literature to pretty much solidify the concept. No more groundshaking news in this department. Unfortunately, the “coming soon to a doctor’s office near you” commercial may still be several decades off.
Current Opinion in Allergy and Clinical Immunology Posted 02/10/2003 Marko Kalliomaki, Erika Isolauri Abstract and Introduction Purpose of Review: The frequency of allergic diseases is increasing worldwide. Experimental and clinical studies have linked a reduced number of early infections to this trend. The gastrointestinal system, which comprises the largest lymphoid tissue and microbial reservoir of the body, has received more attention during the last few years as a potential determiner in the development of atopic disease. Recent Findings: Alterations in intestinal microbiota have been detected both in infants suffering from allergic disease and in those later developing the disorder. Delay in the compositional development of Bifidobacterium and Lactobacillus in gut microflora was a general finding in allergic children. In a subsequent study, perinatal administration of lactobacilli halved the later development of atopic eczema during the first 2 years of life. Specific strains of the healthy gut microbiota have been shown to induce the production of IL-10 and transforming growth factor-beta, which possess an important regulative role in the development of allergic type immune response. Probiotics also strengthen gut defence barrier mechanisms and reduce antigen load in the gut. Pattern recognition receptors in intestinal epithelial and antigen-presenting cells have been demonstrated to mediate a continuing dialogue between host and gut microbiota. Summary: Despite several promising findings, the exact role of gut normal microbiota in the development of allergy remains to be elucidated. For successful interventions, more data concerning a communication between host and specific microbial species are needed.