How do you know if your child is potentially susceptible to allergies later in life? It turns out that developing atopic dermatitis – often referred to as eczema – during infancy could be an indication, say experts.
The phenomenon is known as atopic or allergic march, and it refers to the genetic tendency to develop other allergic diseases such as asthma, allergic rhinitis and food allergies over time, according to Asthma and Allergy Foundation of America (AAFA). The course of disease progression tends to take on the following pathway, according to the website:
Atopic dermatitis or eczema is the most common chronic inflammatory skin disorder affecting more than 20 per cent of children in industrialised countries. (Photo: iStock/naumoid)
According to this research, which analysed 66 studies, atopic dermatitis is the most common chronic inflammatory skin disorder, affecting more than 20 per cent of children in industrialised countries. While two thirds of these patients with early-onset atopic dermatitis do not show sensitivity to environmental and food allergens, around one third do progress to other allergies through atopic march.
In another study on 94 children with atopic dermatitis, who were followed up to age seven, even though 82 improved their skin condition, 43 per cent developed asthma and 45 per cent allergic rhinitis.
The severity of your child’s atopic dermatitis appears to have an impact on the progression pathway as well. For instance, the prevalence of asthma in children with mild atopic dermatitis is about 20 per cent but this risk increases to more than 60 per cent in those with severe atopic dermatitis as reported in this study.
What about the situation in Singapore? Atopic dermatitis affects about one in five children, said Dr Sue-Ann Ho Ju Ee, a consultant dermatologist with Medical & Surgical Dermatology at Novena Medical Center. “A review has reported that children with atopic dermatitis can be as much as six times more likely to develop a food allergy compared to their healthy peers.”
She continued: “The prevalence of food allergies is wide, depending on the age groups, and can be up to 20 per cent to 40 per cent in children who have atopic dermatitis and a family history of food allergies.”
Research shows that children with atopic dermatitis can be as much as six times more likely to develop a food allergy compared to their healthy peers. (Photo: iStock/Kwangmoozaa)
WHAT’S THE LINK BETWEEN A SKIN CONDITION AND OTHER ALLERGIES?
Atopic march typically begins in infancy when babies born with dry skin tend to develop atopic dermatitis. But how does a dry skin condition lead to nasal or food allergies?
Think of skin as a protective barrier. When this protection becomes dry and develops cracks as it does when you have atopic dermatitis, it allows substances to get past the outer layer of skin.
“It is hypothesised that an impaired skin barrier in atopic dermatitis facilitates allergen penetration, sensitisation and development of allergic diseases such as food allergy, allergic asthma and allergic rhinitis,” said Dr Chong Yi Rui Tricia, a consultant with National Skin Centre.
“Scientists think this may be what leads some children to develop food allergies. When a baby’s cracked skin touches food such as peanut, egg or cow’s milk, their immune cells may respond and overreact to the food,” said Dr Ho.
The result is the immune system’s production of antibodies known as immunoglobulin E (IgE). These antibodies travel to cells that release chemicals and typically tend to create symptoms in the nose, lungs, throat or on the skin, according to American Academy of Allergy Asthma & Immunology.
Interestingly, IgE responses to inhalant allergens tend to develop later in childhood than food-specific IgE, which probably explains the delayed onset of asthma and allergic rhinitis.
Antibody responses to inhalant allergens tend to develop later in childhood than food-specific antibody responses. (Photo: iStock/Mikumi)
WHAT IF YOU DEVELOP ATOPIC DERMATITIS AS AN ADULT?
If you did, would you be vulnerable to the same atopic march and subsequently develop asthma or food allergies as an adult?
“Some postulate that people who develop atopic dermatitis in adulthood may have been predisposed by underlying genetic and immunological factors from an early age,” said Dr Chong. “But they are only exposed to particular environmental triggers in adulthood.”
On the other hand, the mechanisms behind adult-onset atopic dermatitis may be different, said Dr Ho. “Certain genetic findings and immunological features were more common in childhood-onset atopic dermatitis as opposed to adult-onset atopic dermatitis.
“A study showed that persons with adult-onset atopic dermatitis were less likely to have a history of asthma compared to atopic dermatitis in childhood. However, there are limitations to the study such as recall bias or misclassification of subtype of eczema,” said Dr Ho.
The good news is, “a personal history of atopy was less common in adult-onset atopic dermatitis patients compared with childhood-onset atopic dermatitis patients”, said Dr Chong.
Individuals with adult-onset atopic dermatitis may be less likely to have a history of asthma compared to atopic dermatitis in childhood. (Photo: iStock/primeimages)
DOES FAMILY HISTORY PLAY A PART?
Yes, the prevalence of atopic dermatitis, asthma or allergic rhinitis among your immediate family members is an indication of your child’s situation.
In a study on 16,336 participants from Malaysia and Singapore, atopic dermatitis was found to be more frequent in participants who had one parent (more prevalent if it’s the father) with the skin condition than participants whose parents didn’t. Your child’s chances of hitting the atopic dermatitis jackpot are at their highest if you, your partner as well as your other children have the skin condition.
Similar findings were also shown when the study evaluated the association between family history of asthma and allergic rhinitis to atopic dermatitis.
Atopic dermatitis or eczema was found to be more frequent in those who had one parent (more prevalent if it’s the father) with the skin condition than participants whose parents didn’t. (Photo: iStock/Kikujiarm)
CAN YOU STOP ATOPIC MARCH?
“Atopic march begins in childhood and is often evident by five years of age,” said Dr Ho. “Although it has become clearer that allergen exposure occurs via the impaired skin barrier, more studies are needed to understand the mechanisms behind atopic march.”
On the upside, said Dr Ho, “there is some evidence that managing atopic dermatitis early and well may prevent the ‘march’” and this can be done by:
There is some evidence that managing atopic dermatitis or eczema early and well may prevent atopic march. (Photo: iStock/panida wijitpanya)
You can also try to prevent the progression of atopic dermatitis to food allergies. If your baby has mild atopic dermatitis, introduce egg and peanut (two common food allergens) one food at a time once he or she is able to tolerate solids but no earlier than four months of age, according to Dr Chong.
Best to consult the paediatrician prior to introducing any new food to your little one, especially foods that are known to be allergens.
Infants with moderate to severe atopic dermatitis may already have a pre-existing food allergy, so it is a good idea to consider allergy testing. A skin prick test will assess the specific IgE that your baby is sensitive to, said Dr Chong. If the results are negative, you can introduce egg and peanut into your baby’s diet. Avoid egg and peanut if the test results are positive, and test again after at least six months.
There are also other ways to protect your child, according to AAFA:
The key is to stay vigilant, according to this study. Although many affected patients grow out of mild childhood atopic dermatitis as they get older, atopic dermatitis can reoccur at any point in their life after a prolonged environmental trigger.
Continue reading...
The phenomenon is known as atopic or allergic march, and it refers to the genetic tendency to develop other allergic diseases such as asthma, allergic rhinitis and food allergies over time, according to Asthma and Allergy Foundation of America (AAFA). The course of disease progression tends to take on the following pathway, according to the website:
- Dry skin: Begins at birth
- Atopic dermatitis: First few weeks or months of life
- Food allergies: First few months or years of life
- Rhinitis (or nasal allergies): After age three
- Asthma: First few months to years of life
Atopic dermatitis or eczema is the most common chronic inflammatory skin disorder affecting more than 20 per cent of children in industrialised countries. (Photo: iStock/naumoid)
According to this research, which analysed 66 studies, atopic dermatitis is the most common chronic inflammatory skin disorder, affecting more than 20 per cent of children in industrialised countries. While two thirds of these patients with early-onset atopic dermatitis do not show sensitivity to environmental and food allergens, around one third do progress to other allergies through atopic march.
In another study on 94 children with atopic dermatitis, who were followed up to age seven, even though 82 improved their skin condition, 43 per cent developed asthma and 45 per cent allergic rhinitis.
Related:
The severity of your child’s atopic dermatitis appears to have an impact on the progression pathway as well. For instance, the prevalence of asthma in children with mild atopic dermatitis is about 20 per cent but this risk increases to more than 60 per cent in those with severe atopic dermatitis as reported in this study.
What about the situation in Singapore? Atopic dermatitis affects about one in five children, said Dr Sue-Ann Ho Ju Ee, a consultant dermatologist with Medical & Surgical Dermatology at Novena Medical Center. “A review has reported that children with atopic dermatitis can be as much as six times more likely to develop a food allergy compared to their healthy peers.”
She continued: “The prevalence of food allergies is wide, depending on the age groups, and can be up to 20 per cent to 40 per cent in children who have atopic dermatitis and a family history of food allergies.”
Research shows that children with atopic dermatitis can be as much as six times more likely to develop a food allergy compared to their healthy peers. (Photo: iStock/Kwangmoozaa)
WHAT’S THE LINK BETWEEN A SKIN CONDITION AND OTHER ALLERGIES?
Atopic march typically begins in infancy when babies born with dry skin tend to develop atopic dermatitis. But how does a dry skin condition lead to nasal or food allergies?
Think of skin as a protective barrier. When this protection becomes dry and develops cracks as it does when you have atopic dermatitis, it allows substances to get past the outer layer of skin.
“It is hypothesised that an impaired skin barrier in atopic dermatitis facilitates allergen penetration, sensitisation and development of allergic diseases such as food allergy, allergic asthma and allergic rhinitis,” said Dr Chong Yi Rui Tricia, a consultant with National Skin Centre.
Related:
“Scientists think this may be what leads some children to develop food allergies. When a baby’s cracked skin touches food such as peanut, egg or cow’s milk, their immune cells may respond and overreact to the food,” said Dr Ho.
The result is the immune system’s production of antibodies known as immunoglobulin E (IgE). These antibodies travel to cells that release chemicals and typically tend to create symptoms in the nose, lungs, throat or on the skin, according to American Academy of Allergy Asthma & Immunology.
Interestingly, IgE responses to inhalant allergens tend to develop later in childhood than food-specific IgE, which probably explains the delayed onset of asthma and allergic rhinitis.
Antibody responses to inhalant allergens tend to develop later in childhood than food-specific antibody responses. (Photo: iStock/Mikumi)
WHAT IF YOU DEVELOP ATOPIC DERMATITIS AS AN ADULT?
If you did, would you be vulnerable to the same atopic march and subsequently develop asthma or food allergies as an adult?
“Some postulate that people who develop atopic dermatitis in adulthood may have been predisposed by underlying genetic and immunological factors from an early age,” said Dr Chong. “But they are only exposed to particular environmental triggers in adulthood.”
Related:
On the other hand, the mechanisms behind adult-onset atopic dermatitis may be different, said Dr Ho. “Certain genetic findings and immunological features were more common in childhood-onset atopic dermatitis as opposed to adult-onset atopic dermatitis.
“A study showed that persons with adult-onset atopic dermatitis were less likely to have a history of asthma compared to atopic dermatitis in childhood. However, there are limitations to the study such as recall bias or misclassification of subtype of eczema,” said Dr Ho.
The good news is, “a personal history of atopy was less common in adult-onset atopic dermatitis patients compared with childhood-onset atopic dermatitis patients”, said Dr Chong.
Individuals with adult-onset atopic dermatitis may be less likely to have a history of asthma compared to atopic dermatitis in childhood. (Photo: iStock/primeimages)
DOES FAMILY HISTORY PLAY A PART?
Yes, the prevalence of atopic dermatitis, asthma or allergic rhinitis among your immediate family members is an indication of your child’s situation.
In a study on 16,336 participants from Malaysia and Singapore, atopic dermatitis was found to be more frequent in participants who had one parent (more prevalent if it’s the father) with the skin condition than participants whose parents didn’t. Your child’s chances of hitting the atopic dermatitis jackpot are at their highest if you, your partner as well as your other children have the skin condition.
Similar findings were also shown when the study evaluated the association between family history of asthma and allergic rhinitis to atopic dermatitis.
Atopic dermatitis or eczema was found to be more frequent in those who had one parent (more prevalent if it’s the father) with the skin condition than participants whose parents didn’t. (Photo: iStock/Kikujiarm)
CAN YOU STOP ATOPIC MARCH?
“Atopic march begins in childhood and is often evident by five years of age,” said Dr Ho. “Although it has become clearer that allergen exposure occurs via the impaired skin barrier, more studies are needed to understand the mechanisms behind atopic march.”
On the upside, said Dr Ho, “there is some evidence that managing atopic dermatitis early and well may prevent the ‘march’” and this can be done by:
- Protecting skin with a regular moisturiser and gently washing with lukewarm water.
- Avoiding triggers or irritants, for example, scratching, fragrances, extremes of temperature, house dust mites and stress.
- Treating atopic dermatitis flares early and adequately.
- Treating accompanying or associated infections.
- Seeking help from a dermatologist early to get the right diagnosis and learn how best to manage atopic dermatitis.
There is some evidence that managing atopic dermatitis or eczema early and well may prevent atopic march. (Photo: iStock/panida wijitpanya)
You can also try to prevent the progression of atopic dermatitis to food allergies. If your baby has mild atopic dermatitis, introduce egg and peanut (two common food allergens) one food at a time once he or she is able to tolerate solids but no earlier than four months of age, according to Dr Chong.
Best to consult the paediatrician prior to introducing any new food to your little one, especially foods that are known to be allergens.
Infants with moderate to severe atopic dermatitis may already have a pre-existing food allergy, so it is a good idea to consider allergy testing. A skin prick test will assess the specific IgE that your baby is sensitive to, said Dr Chong. If the results are negative, you can introduce egg and peanut into your baby’s diet. Avoid egg and peanut if the test results are positive, and test again after at least six months.
Related:
There are also other ways to protect your child, according to AAFA:
- Avoid cigarette smoke, pollution and certain viruses (such as RSV). This may help prevent asthma.
- Breastfeed your baby to support lung growth and reduce respiratory infections. There is some evidence this may be one way to cut asthma risk for young children.
- Eliminate dust mites from your home. This may prevent dust mite allergy, which then may help prevent asthma or atopic dermatitis.
The key is to stay vigilant, according to this study. Although many affected patients grow out of mild childhood atopic dermatitis as they get older, atopic dermatitis can reoccur at any point in their life after a prolonged environmental trigger.
Continue reading...