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eczema asthma allergies atopic march triangle triad

Part 1 of this topic: In this article we will be looking at eczema, asthma and allergies to investigate whether there is a relationship between the three.

In Part 2 will hear from you. We will focus on your experiences and what methods you use to manage/cope/prevent.


You may have/or have been the little prince or princess in your parents eye, but was your crown a little itchy?

Did Granny knit you a jumper and mittens? But rather than to keep your hands warm, these mittens were to stop you from scratching?

Then all of a sudden, perhaps you were rushed to the hospital, only a tiny little thing but so very uncomfortable. Your parents in a panic because your skin was red, you were crying and vomiting…?

If any of these situations are familiar, you or your child were probably diagnosed with eczema, asthma, and allergies? But why have so many children got all three?

Introduction

Doctors and researchers have noted the rapid increase of eczema, asthma and allergies over the last couple decades. [1][3][4][5] Many allergy sufferers have experienced all three with varying severity of symptoms throughout their childhood and or lifetime. Recent studies have found that there could be a link between eczema, asthma and allergies and that the increase could be attributed to urbanisation, inherited predisposition, and genetic mutations.

Definitions:

Eczema, asthma and allergies are all atopic diseases. ‘Atopy’ comes from the Greek word atopia  meaning ‘out of place,’ it refers to the tendency to produce immunoglobulin E (IgE) antibodies which are produced when the body has an allergic reaction to proteins (allergens) found in the environment such as pollen, animal dander, dust, and foods. [1]

Eczema, medical name atopic dermatitis, is the red and itchy inflamed rash that appears on the skin. It is an atopic disease because the inflammation of the skin is an IgE mediated reaction. This means the body has produced IgE antibodies specific to the allergen the skin has reacted to.

Asthma is a disease of the airways which is characterised by wheezing, shortness of breath, chest tightness
and coughing. [1] It is an atopic disease because the asthma blue inhaler ventolin salbutamol characteristics of asthma are caused by airway inflammation and hypersensitivity. These inflammation and hypersensitivity are caused by IgE specific antibodies reacting to an allergen.

Allergies, such as food allergies and hay fever (allergic rhinitis), are caused because the body is hypersensitive to an allergen. The body produces a specific IgE antibody to attack the allergen protein which releases histamine which cause inflammation making it an atopic disease.

Researchers have found that these atopic diseases often happen sequentially. They refer to this as the “atopic march” or “allergy march.” The atopic march usually starts in infancy and develops with a sequence of symptoms and diseases appearing throughout a child’s life and continuing for a number of years. [2][3][6]

Why the Rise in Atopic Diseases?

Scientists have attributed the rise in atopic diseases to three primary causes:

  1. urbanisation,
  2. genetic pre-disposition, and
  3. gene mutations.

Urbanisation has changed our environment and the way we eat. Ellwood et al. state that “Westernisation” has moved us away from eating locally grown produce. There is an increased supply and consumption of processed foods, the use of fertilisers and pesticides. Through their research they found that diets containing fewer calories but higher intake of protein from cereals and rice, nuts, seafood, fish and olive oil had a lower instance of asthma, hay fever and eczema. [5] Countries which had these types of diets were Ethiopia, Morocco, Indonesia and Georgia to name a few. [5] Ellwood et al. stated also that fish oil supplements did not have the same reductive effect on asthma as the actual consumption of oily fish. [5]

Modern western lifestyle is also theorised to stop children developing a strong immune system in early life because we are ‘too clean.’ [3] This hypothesis is referred to as the “Hygiene Hypothesis.” This means that when we are children our immune system may be under-stimulated, which could have contributed to an increased risk of hypersensitivity and so the “allergic march.” [1][3]

A genetic pre-disposition can be defined as traits inherited from one’s parents. Laura B von Kobyletzki et al. found that if there was a perennial history of  of allergic diseases, the odds of developing asthma and hay fever were increased 2-fold. [4] It was also found that boys were more likely to develop hay fever than girls, although no differences were found between gender regarding the development of eczema. [4] A study conducted by Rhodes et al. found that 69% infants who had developed eczema by 3 months were sensitised to aero allergens by 5 years old and in high risk children (parental history of atopy), this percentage rose to 77%. [6] Of children who had developed eczema early in life, 50% had developed asthma by the age of 5 years old. These figures are shocking when compared with the 12% of children without eczema or a family history of atopic diseases who had develop asthma by 5 years old. [6] This, they concluded further shows the relationship between eczema, early sensitisation and the subsequent development of asthma. [6]

Gene mutations have also been suggested to have caused the rise in atopic diseases. The skin is a key factor gene mutations in skin barrier disfunction in protecting our bodies from infection, allergens and other environmental compounds. [1][2] Recent studies have lead scientists to believe that gene mutations in the skin play crucial roles in the development of allergen sensation and the atopic march. [2] It has been found that these mutations cause a dysfunctional skin barrier. A dysfunctional skin barrier can lead to the skin not being able hydrate or stay together properly. This, researchers have seen, has lead not just to inflammation but the development of eczema. [1] It is also suggested that this skin barrier defect can lead to sensitisation to environment allergens and other atopic diseases.[2][4][6]

Further evidence to this hypothesis was seen through an experimental atopic march mouse model. In this experiment, mice were treated with a protein allergen on their skin. It was found that mice with barrier-impaired skin developed a sensitisation to the protein. This evidence was seen through responses including  specific immunoglobulins which they stated to be allergen specific, the mice exhibited asthmatic symptoms and their airways were hypersensitive. [1]

What can be concluded from this research is that eczema, asthma and allergies seem to be inter-related. Having eczema points to dysfunctional skin. If a child has dysfunctional skin barrier, they are more likely to be sensitised to other allergens in the their environment. It also seems that our environment and lifestyle in the West is against us. We are too clean, which may have affected our ability to fully build our immune systems. If our parents are predisposed to allergen sensitisation, it is more likely that their children will be. If a child has eczema, they are more likely to develop asthma or other sensitisations, or vice versa. It is a vicious cycle, or “atopic march.”

Suggestions from the Scientists

We are unable to control the rate of change in western lifestyle and our parents DNA, however understanding our skin has lead to theories about preventing or halting of the atopic march.

Maja-Lisa Clausen et al. state that “repairing and restoring the skin barrier is fundamental to the management of AD [atopic dermatitis/eczema].” [1] it is further suggested that “repairing the skin barrier and preventing AD possibly will minimise the risk of allergic immunisation and the development of asthma and allergic rhinitis [hay fever].” [1]

 

“repairing the skin barrier and preventing AD [atopic dermatitis] possibly will minimise the risk of allergic immunisation and the development of asthma and allergic rhinitis [hay fever].” [1]

 

Having identified that skin barrier disfunction is key to allergen sensitisation, scientists have suggested possible theories to preventing or halting the atopic march: these include skin care regimens, changes in the length of breastfeeding and the avoidance of allergenic substances.

1. Use of moisturisers

Clinical guidelines now include as standard the use daily use of moisturisers and intermittent use of topical anti-inflammatory treatments for eczema. These work to repair the skin and studies have show that this systematic skin care can be an easy, cheap and effective prevention of eczema.[1]

2. Breast feeding

It is suggested that breast feeding appears to delay or prevent the occurrence of cow’s milk allergy even though allergenic proteins might be consumed through breast milk and that breastfeeding. [3] Kobletzki et al. found that a period of breastfeeding shorter than 6 months increased the risk of developing asthma by 57%. [4] However, Eugene Weinberg states a mother’s diet should be hypoallergenic when an infant has already shown signs of allergic symptoms. [3]

3. Avoidance of allergens

An allergy might subside at puberty, or it might begin at puberty. Once a child has developed an allergy, there is no cure. Weinberg states that the primary prevention of atopic diseases involves avoidance of early exposure to certain foods. [3] When an allergy is diagnosed, medical advice tells allergy sufferers to avoid known allergens and carry their prescribed medication incase of unintended ingestion. If a person has been diagnosed with asthma, they are advised to carry their inhalers incase of wheezing. If a person has hay fever, anti-histamines can be taken and it is advisable to stay from pollenated areas. If anaphylaxis has been diagnosed, Epinephrine auto-injector pens should be carried at all times.

What Conclusions Can be Drawn?

If you or your child has allergies, unfortunately, not a lot can be done. From the research presented in this article, it leads one to conclude that we didn’t really have a chance. The circumstances in which we are born into have been determined. Our genetics are the sum of our parents, our parent’s parents, and their parents before them.

If you have eczema, asthma and allergies, it is mostly likely due to a combination of factors.

Primarily, it could be concluded that your skin is not functioning as it should. Some of the genes which are key to helping your skin protect you from allergens are dysfunctional meaning that your skin cannot do its job properly and you will be more susceptible to allergen sensitisation. As seen through the atopic march mouse model, the atopic march can follow the ‘traditional’ course. However it does not always present this way. It has been seen that our skin barrier is the gateway, if it is not working as it should, it is more likely that a child can develop eczema, which can further damage the skin barrier, develop asthma and allergies.

What has become clear, however, is that modern medicine and research is doing it’s best to find effective prevention methods. Protecting and repairing skin seems to be the most effective and thankfully, cost efficient method to keep yourself from being sensitised to allergens.

If you or your child has eczema, speak to your doctor to find out about moisturisers.

Eating healthily also seems to be an easy way to repair and keep skin healthy. Meals with oily fish, is better than supplements one study suggests. [5] Speak to a nutritionist about what is right for you.

There is still a long way to go in understanding the development of allergies and the atopic march. All scientists call for more research on the subject, however what has been revealed does show that we might be able to take some small measures in care and prevention. Our skin is what keeps us safe from our environment, so what we can do now is take care of our skin.

 


We hope you’ve found the article informative, but now we need your help.  The allergy community is all about sharing and helping each other. We need you to share how have you managed them? What advice would you give to the newly diagnosed?

Please leave a comment with your thoughts.

 

To read Eczema, Asthma and Allergies Part 2: You Stories, please click here.

 

Sources:

[1] Maja-Lisa Clausen , Tove Agner, Simon Francis Thomsen, “Skin Barrier Dysfunction and the Atopic March,” published in Pediatric Allergy (Am Giménez-Arnau, Section Editor), 28 May 2015. https://link.springer.com/article/10.1007%2Fs40521-015-0056-y

[2] Mei Li, “Current evidence of epidermal barrier dysfunction and thymic stromal lymphopoietin in the atopic march,” published in European Respiratory Review, 1 September 2014. http://err.ersjournals.com/content/23/133/292

[3] Eugene G Weinberg, “The Allergic March,” published in CME, February 2010, Vol. 28 No.2. https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0ahUKEwiwl8GQ08fLAhWH6g4KHRPfBL0QFggdMAA&url=http%3A%2F%2Fwww.ajol.info%2Findex.php%2Fcme%2Farticle%2Fdownload%2F55237%2F43705&usg=AFQjCNEzemYKlAU19md4sCH1eQ9EnF9jtw&sig2=hEHxEqdHUcp-UPz2vjv2eQ

[4] Laura B von Kobyletzki, Carl-Gustaf Bornehag, Mikael Hasselgren, Malin Larsson, Cecilia Boman Lindström and Åke Svensson, “Eczema in early childhood is strongly associated with the development of asthma and rhinitis in a prospective cohort,” published  on BioMed Central Dermatology, 2012. http://bmcdermatol.biomedcentral.com/articles/10.1186/1471-5945-12-11

[5] P. Ellwood, M.I. Asher, B. Björkstén, M. Burr, N. Pearce, C.F Robertson, “Diet and asthma, allergic rhinoconjunctivitis and atopic eczema symptom prevalence: an ecological analysis of the International Study of Asthma and Allergies in Childhood (ISAAC) data,” published in European Respiratory Journal., March 2001. http://erj.ersjournals.com/content/17/3/436

[6] Jonathan M Spergel, MD, PhD1, Amy S Paller, “Atopic dermatitis and the atopic march,” published in The Journal of Allergy and Clinical Immunology, December 2003, Volume 112, Issue 6, Supplement, Pages S118–S127. http://www.jacionline.org/article/S0091-6749(03)02370-4/abstract

 

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