Top Secrets to Shield Your Patients From Eczema and Allergies

Image credit: © Юля Шевцова - stock.adobe.com

Mark and Sarah share a deep bond strengthened by their health struggles. Mark's eczema brought isolation, bullying, and missed childhood joys. Sarah’s severe allergies turned playgrounds and food into hazards, making every outing risky. Now, as they dream of starting a family, they fear their children might inherit these conditions. They don’t want their kids to endure the same pain and stigma. This scenario for families is all too familiar.

But hope exists. By implementing proactive measures and leveraging innovative treatments, we can reduce the risk and severity of these conditions. In this article, we'll explore practical steps and the latest research to help reduce the role of eczema and allergies for our patients.

Understanding the Microbiome

At the heart of our approach to reducing the risk and severity of eczema and allergies lies a deep understanding of the human microbiome. Picture it as a vibrant, bustling city within our bodies, home to trillions of tiny residents – bacteria, viruses, fungi, and archaea – each playing a unique role in keeping us healthy. They live in neighborhoods like the gut, skin, mouth, and respiratory tract, working around the clock to keep us healthy. For new clinicians and parents, it is fundamental to know the gut is particularly important for building a strong immune system as it can aid in the prevention and severity reduction of eczema and allergies. This process begins even before the baby is born.

How Birth Influences the Microbiome

A newborn's journey into the world can significantly impact their microbiome. For example, babies born vaginally acquire beneficial bacteria like Lactobacillus and Prevotella, which establish a healthy foundation, while babies delivered by cesarean section encounter a different set of bacteria, such as Staphylococcus and Corynebacterium. This altered microbial environment has shown to influence immune development, potentially increasing the risk of conditions like eczema.¹

Breastfeeding and Gut Health

Breastfeeding acts as a nurturing gardener for the baby's gut, providing essential nutrients, beneficial bacteria, human milk oligosaccharides (HMOs), immune cells, and antibodies. Over time, this garden flourishes with Bifidobacterium and Lactobacillus, creating a vibrant ecosystem associated with a lower risk of developing eczema. The presence of these beneficial microbes supports the maturation of the immune system by promoting a balanced Th1/Th2 response and enhancing the function of regulatory T cells.²

Probiotics: A Helpful Ally

Research has shown that when an expecting mother takes oral probiotics from one month before to one month after giving birth, it can reduce the risk of eczema in her baby. In keeping with the neighborhood analogy, oral probiotics act like friendly villagers, bringing their unique skills to support overall gut health. Oral probiotics with strains like Lactobacillus rhamnosus being particularly effective when introduced during pregnancy and postpartum.³ This understanding of how probiotics impact the microbiome is a key piece of the puzzle in our mission to create a healthier future for the next generation.

The Role of Allergens and the Hygiene Hypothesis

Beyond the microbiome, the hygiene hypothesis offers valuable insights into the rising prevalence of allergies in the US. It suggests that reduced exposure to microbes during childhood can weaken the immune system's development, making individuals more prone to allergies later in life. By understanding that allergens are simply unrecognized cells, we can reframe our approach to preventing allergies and eczema.

Take, for example, the lower rates of peanut allergies in Israel compared to the UK, which are linked to the early introduction of peanut-containing foods to infants. Similarly, children raised in rural areas tend to have lower allergy rates than those in urban settings, possibly due to diverse environmental exposures like contact with farm animals, which promote immune tolerance.⁴

Food Allergies and Eczema

When it comes to food allergies and eczema, elimination diets are often touted as a solution. While some individuals might benefit, the link between food allergies and eczema is complex. Diagnosing food allergies accurately requires an oral challenge under medical supervision, as blood and scratch tests can be misleading. Treating eczema effectively can actually help prevent food allergies. So, instead of relying on elimination diets, focus on controlling eczema.⁵

In general, the consensus is to introduce allergenic foods between 4 to 6 months of age, once the child shows developmental readiness for solid foods, ensuring the baby can sit up and swallow. Introduce one allergenic food at a time in small quantities and gradually increase if no reaction occurs. Once tolerated, include the food in the child's diet regularly.⁶

Conclusion

As we navigate this path towards a brighter future for the next generation, our role as healthcare professionals is to empower parents with knowledge and guide them through proactive steps. By focusing on the microbiome, early microbial exposure, and accurate treatment, we can help reduce the burden caused by eczema and allergies.

Imagine a world where children can grow up free from the limitations and stigma associated with these conditions. A world where they can freely enjoy their childhood, explore new environments, and embrace life to the fullest. This is the future we are striving for, and it's within our reach.

By focusing on the microbiome, early microbial exposure, and accurate treatment, we can build a healthier future for our patients and reduce the burden caused by eczema and allergies. Empowering parents with this knowledge and guiding them through proactive steps will help nurture a generation of resilient, healthy children. Let's commit to this goal, armed with compassion and the latest research, to make a lasting difference in our patients' lives.

Michael Rubio, PA-C, is a dermatology physician associate (PA) at Infinity Dermatology in Brooklyn, NY. He is the co-chair of Distant Education with the Society of Dermatology Physician Associates (SDPA) and a contributor to the National Commission on Certification of Physician Associates (NCCPA) development of the Certificate of Added Qualifications (CAQ) in Dermatology. He is also a co-founder of Well Revolution (www.wellrevolution.com), a same-day care platform addressing the US health care shortage crisis.

References

1. Zhang C, Li L, Jin B, et al. The effects of delivery mode on the gut microbiota and health: state of art. Front Microbiol. 2021;12:724449. Published 2021 Dec 23. doi:10.3389/fmicb.2021.724449
2. Walker WA, Iyengar RS. Breast milk, microbiota, and intestinal immune homeostasis. Pediatr Res. 2015;77(1-2):220-228. doi:10.1038/pr.2014.160 
3. Wang F, Wu F, Chen H, Tang B. The effect of probiotics in the prevention of atopic dermatitis in children: a systematic review and meta-analysis. Transl Pediatr. 2023;12(4). doi:10.21037/tp-23-29
4. Anderson D, Wilkin R. America has high rate of peanut allergies compared to other countries. Business Insider. October 7, 2020. Accessed June 14, 2024. https://www.businessinsider.com/america-high-rate-peanut-allergies-compared-countries-2018-10
5. Lim NR, Lohman ME, Lio PA. The role of elimination diets in atopic dermatitis—a comprehensive review. Pediatr Dermatol. 2017;34(5):516-527. doi:10.1111/pde.13244
6. Gray D. How parents can help prevent food allergies in kids. Stanford Medicine Children’s Health. April 22, 2021. Accessed June 19, 2024. https://healthier.stanfordchildrens.org/en/how-parents-can-help-prevent-food-allergies-in-kids/