Thinking about allergy challenges…our 100 day research project.
Eat Allergy Safe at the Allergy and Free From Show North 2015
Nina here (founder of Eat Allergy Safe). I have been thinking a lot about the future of Eat Allergy Safe. I believe it should be a company dedicated to serving the needs of allergy sufferers.
Over the next 100 days, I have set myself the mission to find out how we can start serving you better and addressing your allergy challenges.
Please help me in my research by reading this short post.
There are a couple questions at the end (takes less than 2 minutes to answer!)
Do you or a family member have allergies/intolerances/coeliac disease/special dietary restrictions?
I do. I have anaphylaxis to tree nuts and peanuts, and I am gluten intolerant. My nut allergy was discovered when I was 9 months old when I had a reaction to peanut butter – pretty scary for my Mum.
Living with anaphylaxis has many challenges day to day. Not to mention big problems when I’ve had a reaction.
Over my life, I have learned how to deal with them and adapt. My parents protected me as a child, raised me and taught me how to look after myself and own my allergy. Helping others learn about their allergies is one of my passions.
Sadly, allergies are on the rise. For new allergy sufferers, many are being diagnosed with multiple extreme allergies and intolerances. Some of these can be quite surprising and shocking. How do you deal with these multiple allergies and the difficulties that arise?
100 Days Research Project
We’re doing research into the topic: What allergy challenges do YOU face and what solutions can we find?
Why 100 days? Because in truth we need a deadline to work to. We want to be able to present our findings to you, and without a deadline, we won’t know when to start showing you what we’ve found.
Want updates? Every 10 days I will be sending out an email with how we’re getting on, the challenges we’re facing on our journey and how we’re overcoming them. If you would like to receive updates, please sign up to our newsletter below.
Allergies don’t have cures yet, that’s why we rely on each other, the allergy community. Most wisdom has come through trial and error and sharing stories.
With YOUR help, myself and the Eat Allergy Safe team are going to start a project addressing your biggest allergy challenges. Please help us start our 100 day research project; there is just ONE question I need you to answer…
What is your BIGGEST hair pulling frustration and challenge you have living with allergies?
Thank you for stopping by! Have you go anything you’d like to share? Leave a note in the comments section below
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What’s the difference between food allergies, intolerances and coeliac disease?
Over the last 20 years food allergies, intolerances and coeliac disease have become more and more common. Many children are now being diagnosed with multiple severe allergies. The BBC reported Coeliac disease is on the rise with a rate of 19.1 per 100,000 diagnosed in 2011, compared with 5.2 per 100,000 in 1990. Food intolerances are more common than allergies and coeliac disease state the NHS.
If intolerances are common, and allergies and coeliac disease are becoming more common, it might be thought they should all be lumped into one category.
However, allergies, intolerances and coeliac disease have fundamental differences which set them apart from each other. These differences also have ramifications for food production and the risks taken or not taken when deciding what to eat.
So, allergies, intolerances and coeliac disease: what are they? how are they different? are those differences important?
An allergy is an immune response the body has to a particular foreign substance causing an allergic reaction. For those with allergies, even the smallest amount could prove fatal.
An allergic reaction is an over-reaction the body has to an allergen. An allergen is a substance which can cause an allergic reaction. Allergens such as peanuts, fish, dairy and eggs do not cause problems for everybody, however for some it could be life threatening.
Reactions can happen immediately or can take a few hours. A reaction is caused because the body produces Immunoglobulin E, an antibody designed to respond to this allergen. IgE’s purpose is to destroy disease cells, however in the case of an allergic reaction, the body believes the protein of the allergen is a disease. The IgE destroys the white blood cell it is attached to. The destruction of these white blood cells leads to the release of histamine, a chemical produced by the body, into the surrounding blood and tissue.
The release of histamine can cause a variety of symptoms such as itching of the body, eyes and nose, hives, faintness and stomach pain, sneezing, wheezing, nausea and vomiting. An allergic reaction can be widespread throughout the body depending on the exposure to the allergen. Anti-histamines can also be used to reduce inflammation.
If a reaction progresses to a more severe stage, this reaction is known as anaphylaxis, which is life threatening. The risk is that the air ways can become swollen causing difficulty in breathing. Those diagnosed with anaphylaxis will be prescribed adrenaline auto-injector pens to be carried at all times incase of an anaphylactic attack.
Some children can grow out of their allergies, but many have theirs for life. There is no cure for allergies. The best and safest course of action that is advised by medical professionals is to avoid all known allergens.
If you do have an allergy, make sure you avoid known allergens, keep medication with you, read the ingredients labels and ask about allergens if you’re eating out. Remember to speak also speak to your doctor if you have concerns.
A food intolerance is when the body has trouble digesting a certain food product.
The difference between food allergies and intolerances is that intolerance is not an immune response.
The reasons for food intolerances can vary. Some people do not have the correct enzyme to digest a certain protein, such as with lactose intolerance. People with lactose intolerance do not have the enzyme lactase to give them the ability to digest lactose containing products. If you have Irritable Bowel Syndrome symptoms can be exacerbated or eleviated by certain foods. Food poisoning may cause an intolerance, or a sensitivity to food additives.
Symptoms experienced have some similarities to those with allergies: intestinal gas, abdominal pain and diarrhoea can all be experienced. However these symptoms are not caused by IgE antibodies, intolerances are to do with the digestive system.
Unlike allergies, those with intolerances can eat small amounts the offending food. Sometimes it takes a build up to cause symptoms. Some symptoms can have a delayed onset and last anywhere between a few hours or a day. Symptoms can be incredibly uncomfortable.
To avoid any uncomfortable or unpleasant symptoms, it is suggested to avoid the offending food.
If you are concerned, speak to your doctor or nutritionist for more information.
Coeliac disease is an auto-immune disease. An auto-immune disease is when the body attacks itself. In coeliac disease, the body’s immune system attacks itself when gluten gets into the body.
The body of coeliac disease sufferers mistakes the gluten protein as a foreign invader and provokes an auto-immune response in the small intestine. This means that the gut starts to attack itself. This destroys the tiny hairs which line your small intestine, called villi. It perforates the gut, this is also known as “leaky gut” syndrome, and stops your intestine from absorbing nutrients from food.
Some coeliacs can also develop Dermatitis Herpetiformis, a type of red rash. Although this may seem similar to allergies, it is not caused by IgE.
Symptoms can vary in severity from person to person with different symptoms affecting different people. The affects of eating gluten, or being “glutened” can last for a few hours to a few days.
Those suffering from Coeliac Disease can suffer a variety of symptoms that range from mild to severe, including; bloating, diarrhoea, passing wind, stomach pains, weight loss, malnutrition, depression, fatigue, repeated miscarriages, anaemia, hair loss and, in children, not growing at the expected rate.
Like the variety and severity of symptoms, the onset of symptoms varies from person to person. Some may have symptoms immediately, others it may take a few hours. [Click here to read a discussion of symptoms.]
Some symptoms suffered by coeliacs are similar to those suffered by those with intolerances. This causes some cases of coeliac disease to be mistaken as Irritable Bowel Syndrome or wheat intolerance.
Coeliac disease symptoms occur because the gut is attacking itself. Long term exposure can have long term damage. Coeliac disease sufferers, if they continue to eat gluten, are at greater risk of osteoporosis, certain kinds of gut cancer, and a greater risk of other auto-immune diseases such as type 1 diabetes and thyroid disease.
There is no cure for Coeliac Disease. It is a life long condition that can be managed through a gluten free diet. A gluten free diet relieves symptoms and lets the gut act normally. In cases of dermatitis herpeformis, medicines can be prescribed to relieve symptoms while the gluten free diet is taking affect.
So how are allergies, intolerances and coeliac disease different?
Let’s summarise our findings:
Allergies, intolerances and coeliac disease have similarities between their symptoms however they are produced by different responses in the body. Allergies are an immune response produces the antibody IgE. Intolerances are due to trouble digesting certain foods, they are not to do with the immune system. Coeliac disease is an auto-immune disease where the body attacks itself when specifically gluten is consumed.
Allergies can be life threatening in the case of anaphylaxis. Coeliac disease can have long term damage with prolonged exposure. Intolerances can have uncomfortable symptoms, but they are not life threatening.
Symptoms for allergies, intolerances and coeliac disease can all vary in their onset and variety from person to person.
Is it important that we distinguish between allergies, intolerance and coeliac disease?
The importance of distinguishing between allergies, intolerance and coeliac disease relates to food production. More specifically it relates to cross contamination. Take a look at this scenario below:
Lets look at the allergen wheat as an example: person A has a wheat allergy, person B has a wheat intolerance and person C has coeliac disease.
Cross contamination scenario: Knife is used to cut bread containing wheat flour and then used to cut vegetables.
Person A can be affected by a minute about of wheat causing swelling, hives, vomiting and other symptoms. The reaction can take place all over their body depending on their exposure to the wheat. If person A eats the vegetables thinking that no cross-contamination has happened but then has an allergic reaction to the ‘little bit’ of crumb on the vegetables, Their reaction can happen immediately or within a few hours. Their body produces IgE to attack the wheat protein. In the worst case, a reaction could develop to an anaphylactic attack needing adrenaline and immediate hospitalisation with the risk of death.
Person A, however, could probably eat rye and barley because these grains do not contain wheat, so long as there has been no cross contamination.
Person A would most likely avoid food products which would have a “May contain wheat” warning.
Person B in the same situation will most likely not be affected at all by the cross contamination. They would probably have to eat more than a trace amount to have some symptoms such as bloating, stomach pains or intestinal gas. The symptoms will clear up within a few hours or a day usually. Person B, like person A, may also be able to eat rye and barley because they do not contain wheat. Though the difference to person A is that cross contamination doesn’t matter so much.
Person B would not need to pay attention to may contain warnings, because the risk of the product containing wheat is not that great.
Person C would be affected by the cross contamination and have symptoms such as bloating, stomach pains, diarrhoea, depression and others from immediately ingesting the bread crumb to a few hours later. Some people experience symptoms for a few hours or a few days. The difference between coeliac disease, wheat allergy and wheat intolerance, is that person C would not be able to eat rye or barley because these grains, like wheat, contain the protein gluten. It is the gluten in these grains that case coeliac disease sufferers the problem. So whether these grains were cross-contamination with wheat, person C wouldn’t be able to eat them anyway.
Person C would be very wary of a “may contain warning” because of the severity of symptoms and the possible long ramifications.
So, is there a point in distinguishing between allergies, intolerance and coeliac disease? I would say yes, there is a point. But why?
In the case of allergies and cross-contamination, we can see from the scenario above, “a little bit” is a big problem. For coeliac disease sufferers, “a little bit” leads to many problems, some of which can have long term affect. For those with intolerances it could maybe lead to problems.
On the backs of food packets there are allergy advice warnings. These warnings are directed and vetted on the “do I risk it?” basis. Cross-contamination can lead to a world of hurt and pain in the case of allergies and coeliac disease.
Chefs and restaurant staff need to know when it is really important to avoid cross-contamination. If everyone says “I’m allergic” or “I’m coeliac” when they’re not, it is going to be like the boy who cried wolf. Except it’s not the boy who cried wolf whose going to suffer, it will be the people who arrive later who actually have a problem.
Your body distinguishes between allergies, intolerance and coeliac disease. It is important because that distinction is how your body reacts to an allergen. In some cases, it can be fatal.
Got any questions or comments, leave a comment below .
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It seems from the research that children with eczema are more susceptible to becoming sensitised to allergens. It was also found that a family history of allergies made it more likely that a child could develop allergic sensitisations. Please click for the full article of Eczema, Asthma & Allergies Part 1: Why Does My Child Have All Three.
In Part 2, we will be sharing the stories of our interviewees. We will be sharing their experiences managing and preventing eczema, asthma and allergies. From what you’ve learned from Part 1, can you see an correlation with the research?
Donna and Theo
Donna is Mum to 3 year old Theo. Theo is allergic to peanuts, almonds, baked beans, locust beans, green peas and lentils. Theo has also suffered with eczema as a baby; a red, sore, bumpy looking rash on his face. There was no history of allergies in the family. The doctors said that the rash was baby acne or milia.
It wasn’t until Theo was 7 months old that Donna discovered why her baby had a rash face. At 7 months, Theo was given some peanut butter, but when given it as finger food his lips and eyes swelled. Donna called the doctors and took him there where they prescribed piriton (anti-histimine brand in the UK). “In hindsight I should probably have called an ambulance or at least gone to A&E due to the type of reaction, but I knew little about it back then” said Donna.
Theo was referred to a paediatrician who did blood tests that day which confirmed a peanut allergy. At an appointment 3 months later, Theo was prescribed epipens (epinephrine adrenaline auto-injector pens).
“When I stopped breastfeeding when he was 18 months old more allergies to other legumes appeared (things he’d been fine with before) – the beans and peas, and particularly locust bean which is in hamster food (reacted just being in the same room while eating!) and used as a thickening gum in Philadelphia cheese… These cause hives, sickness and Diarrhoea. It can be tricky avoiding all these things but you do get used to it!
Theo has been prescribed epipens and piriton for allergic reactions. Donna says “A good skincare regime and allergen avoidance has helped keep the eczema at bay.” Theo also has emollient bathes every other day or so as an eczema preventative and uses Aveeno cream on prescription.
“Managing the allergies is an interesting one and we’ve learned so much. I’m sure there’ll be more challenges but for now we keep ourselves informed and educate all those around him, and are vigilant. Nursery are fantastic too. Even though he is very young he already understands there are things he can’t have, and is quite accepting of it. When I feel worried I tell myself we have the tools we need in case of the worst case scenario which is anaphylaxis; if we didn’t know and didn’t carry epipens it would be more dangerous so at least we found out early on.”
Donna is an allergy mum and blogger, you can check out her blog Nut Allergy Mum at http://nutallergymum.blogspot.co.uk/
Anna, William and Felicity
Anna is Mum to 5 year old William and 2 1/2 year old Felicity. William is allergic to dairy, eggs, nuts and lentils. Felicity is allergic to egg and dairy intolerant.
Williams allergies are very severe with symptoms from birth. He would wheeze; he was sick and puffy after every feed, Anna was breast feeding at this time. Williams eczema started appearing when Anna started weaning him. “We saw several gps with my son and formal diagnosis was given on referral to dermatology department of local children’s hospital after skin prick testing. We didn’t know what was wrong until 5 or 6 months in. A very stressful time!”
His eczema became so bad that he was admitted into hospital after a referral appointment for infected eczema and required treatment over a weekend. Anna says “ when my son was born he showed symptoms of CMPA (Cow’s Milk Protein Allergy) straight away, although he wasn’t diagnosed until skin prick testing at 6 months when he was admitted on referral to hospital for his infected eczema.”
William has had several trips to A&E “one was when we were on holiday in Spain and he had egg pasta, he suffered anaphylaxis and we had to call an ambulance and spent the night in hospital, very scary!”
With Felicity, Anna noticed the signs as soon as the eczema appeared. Felicity developed eczema when she’s was weaned onto formula. Anna requested a referral to the children’s hospital and steroid treatment was prescribed and both children were moved onto Neonate Formula.
“I’m not sure what you can do to prevent it. We don’t have a history of allergies in our family on either side so I don’t know where it came from. I think the key is getting a diagnosis quickly which we didn’t get. No one seemed to know what was wrong although looking back at pictures it seems so obvious! Management is all about getting the right treatment plan and access to help, advice and resources which there is more of now. So many alternative foods are available if you just know where to look.”
Anna is an allergy Mum and blogger, you can find her on her twitter @mychildsallergy.
Dana and her daughter
Dana has a 7 year old daughter who is allergic to “Peanut, tree nut, and about every environmental allergy you can have. Her nut allergy is anaphylactic. Animals make her face swell, eyes burn and rashes. She also has a sensitivity to wheat/gluten but that one is improving where the other allergies are getting worse.”
Dana’s daughter has had eczema and bad skin from birth. Dana breastfed and ate nuts throughout. Her daughter’s rash was very difficult to get under control. At 9 months Dana and her family went to the zoo and fed the animals with peanuts, her daughter swelled up. They saw a doctor after the first reaction to nuts and were referred to an allergy doctor 2 weeks later. They received a formal diagnosis and a prescription of epipens.
After the formal diagnosis all peanuts and nuts were removed from Dana’s house and her daughter’s skin began to get much better.
At 10 months old Dana’s daughter got RSV (Respiratory Syncytial Virus – a common virus that can lead to mild cold-like symptoms in adults and older children but more severe in infants) and this is when she first had asthma.
It wasn’t until 2 years old that the animal and environmental reactions started. On her blood work and skin tests, Dana’s daughter’s nut and environmental allergies get worse every year.
Dana’s daughter has been prescribed epipens, steroid cream for eczema, inhalers for daily use as well as rescue inhalers and breathing equipment for her asthma. She also has nose sprays and eye drops for environmental allergens.
Flair ups for eczema still happen in winter and spring but it was nothing like when Dana’s daughter was a baby. Her asthma is exercise induced so inhalers before PE or any outside activity or exercise is used. Dana makes sure steroid ointment is applied for any and all eczema outbreaks. “We we strictly avoid all peanut and tree nut products even the ones that…may contain. Always have meds on hand [and we] never leave without epipens.”
Kathy and her daughter
Kathy has a 2 year old daughter who has eczema, allergic to peanuts and tree nuts, avoiding shellfish and is allergic to cats and dogs. They suspect asthma and have a nebuliser and rescue inhaler, but not able to officially diagnose due to age.
Kathy’s daughter started to show symptoms around 2 months old. The eczema was from head to toe and so horrible. Kathy said her daughter “looked like a burn victim, her eczema was beyond severe.” The eczema started to clear up a bit around her first birthday, but at about 20 months old, Kathy’s daughter tried peanut butter and went into anaphylactic shock.
Upon seeing an allergist after this reaction, a skin and blood test were done which confirmed allergies to peanuts, tree nuts, fish, shellfish, cats and dogs. Kathy’s daughter has been prescribed epipens, anti-histamines and inhalers along with strict avoidance of all allergens.
“What I’ve learned is how serious allergies are and how careful we have to be with reading labels. Since we avoid shared equipment and facilities her eczema has been gone for quite sometime and we have things under control with that. But anytime she has a cold she requires albuterol and budesonide treatments via nebulizer as her airways close up” Kathy says.
Kathy’s daughter has now been cleared for fish but they continue to avoid shellfish. Kathy’s daughter’s tree nut numbers have fallen so they are hoping to do a hazelnut challenge soon.
Good luck to Kathy and her daughter, we hope for the best!
Carly and Oliver
Carly is Mum to 6 year old Oliver. Oliver has an allergy to tomatoes which triggered his eczema. His eczema was also, unknown to Carly, exacerbated by fabric softener and white soft paraffin creams.
Oliver’s symptoms started when he was about 18 months old. His initial eczema covered his body and was so sore that it hurt him to be picked up. Carly saw a doctor and was suggested that it might be a tomato allergy. Carly tried cutting out tomatoes and then tried a tomato based meal two weeks later. During the couple weeks of tomato elimination, Oliver’s eczema was still sore but after tomato was re-introduced his eczema became bright red and very sore again.
After Carly discovered that fabric softener and white soft paraffin creams made Oliver’s eczema worse, they were cut out along with tomatoes. Oliver’s eczema only really comes back in the winter now, but clears up with cream.
Oliver has been prescribed Aveno cream. Carly also uses coconut oil which helps Olivers skin.
“You have to be very aware of school meals, kids parties and visits to friends houses. You are constantly checking ingredients. Tomatoes are in meals etc that you wouldn’t expect them to be in. Schools need better practices to deal with allergens, they need to educate the other children in the class about allergens and how to prevent them. As do the general public, people who have no experience do not understand allergies, they ask the same questions-
Isn’t that hard?
What do you eat?
Will they grow out of it?
You can do everything possible to eliminate and prevent allergens but ‘slip ups’ happen, an unknown food, eating at a kids party, cross contamination from other children. Allergies are stressful!”
Ali and Molly Lee
Ali is mother to Molly Lee. Both Ali and Molly Lee have severe multiple allergies.
Ali is allergic to milk, eggs, wheat, soya, penicillin, dust, fur feathers, tree pollen, grass and Tocopheryl acetate (a form of Vitamin E). Molly Lee has been diagnosed with reflux as well as delayed allergic reactions to milk and egg. She is also affected by pollen and has hay fever. Both suffer from eczema and were covered in eczema as babies. They also are affected by asthma.
“I was the typical allergic child with clear and easy to understand reactions. Traditional allergic testing methods (skin prick tests) work a treat on me. I swell up nicely and that gave everyone something to work with…Molly was a different case altogether. Her reactions are delayed and it took years to find out the triggers. She was born covered in eczema but we think that was triggered by me eating a lot of tomatoes during my pregnancy. Molly hates tomatoes so we do wonder if she’s allergic but haven’t had that tested yet. Once her skin cleared up as a baby we started to moisturise two to three times a day and her skin is now pretty good. She does have a prescription for cortisone but we get through maybe a tube a year at most.
Molly vomited daily until the age of 7. She, and we, never had a nights’ sleep due to vomiting and stomach pain. Finally, at age 4 she was admitted to Chelsea and Westminster hospital and the gastric team diagnosed reflux. I will never forget her last cry of ‘mummy’ as she went under the anaesthetic. Truly heart rending. Stomach and nasal tubes were inserted and she was hooked up to a mini computer to assess the level of acid in her stomach and throat. It didn’t take long for the diagnosis to be confirmed.
She was put on high doses of omeprazole and ranitidine which calmed things down but didn’t stop the vomiting. We were repeatedly told she wasn’t allergic until a consultant from Great Ormond Street got involved and diagnosed delayed allergic reactions. Once the elimination diet showed eggs and milk to be an issue Molly recovered and stopped vomiting constantly.
She is now off medication (unless she eats too much sugar!) and on a no dairy, no egg diet. She vomits rarely now, although still gets a bit of heart burn now and then.
I am grateful that the one consultant believed she was allergic; without her I think Molly would have continued to live a life of pain, sleep deprivation and constant vomiting. Molly is now, finally, at age 11 a healthy bmi of 18.”
In her experience, Ali believes that it is best to “jump on a reaction the minute it starts. Most GP’s seem to start with the lowest dose of everything, which in my experience, just prolongs the problem and allows it to ‘get a grip’. Best to go strong and short with medicines.”
Ali is an allergy sufferer, allergy mum and blogger. You can follow her on twitter @allergymumscouk and visit her blog at www.allergymums.co.uk.
We would like to say a huge thank you to all the parents who shared their experiences. Those stories described in this article are not the only responses we received from parents. Thank you to everyone who contributed and those who allowed us to share your stories.
Through sharing stories we can help those who are struggling in the allergy journey and provide support, because we’ve been there. Don’t suffer in silence!
Have these stories resonated with you? Please leave a comment below.
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Recipe of the Week
Have you got any leftovers from Easter lunch still lying about in the fridge? Are you having another roast dinner this weekend? Don’t let any of the beautiful roasted meat, veggies and juices go to waste.
Make this amazing Roast Lamb Leftovers Risotto!
(Honestly! Best recipe we’ve created in the last couple months. Even Mum said so!)
Click on the recipe now, you won’t regret it.
Roast Lamb Leftovers Risotto: so quick, easy and absolutely scrummy!
If you haven’t read our latest blog article yet, make sure you click it today. We have been investigating the link between Eczema, Asthma and Allergies. In Part 1, which is already up on the blog, we focused on what scientific research has found and why many children have eczema, asthma and allergies.
In the next couple weeks we will post Part 2 looking at your experiences of Eczema, Asthma and Allergies. We will be sharing your stories and what you have learned about prevention and management.
If you or a family member are affected by any of these atopic diseases, these articles include recent research and personal stories to help answer “why?!” and “how do I cope?!”
Interesting Reads This Week
Want to know what’s going on in the allergy world this week? Have a look at out top 3 interesting reads of the week.
By Josh L Davis for IFLScience.com
By Olga Osman for The Guardian
Press Release by the University of Southampton for EurekaAlert.org
Got any articles you’ve read recently you want to share? Or have you got an idea for an article, we’d love to hear from you. Email us via the contact page here.
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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?
Doctors and researchers have noted the rapid increase of eczema, asthma and allergies over the last couple decades.  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.
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. 
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.  It is an atopic disease because the 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. 
Why the Rise in Atopic Diseases?
Scientists have attributed the rise in atopic diseases to three primary causes:
- genetic pre-disposition, and
- 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.  Countries which had these types of diets were Ethiopia, Morocco, Indonesia and Georgia to name a few.  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. 
Modern western lifestyle is also theorised to stop children developing a strong immune system in early life because we are ‘too clean.’  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.” 
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.  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.  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%.  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.  This, they concluded further shows the relationship between eczema, early sensitisation and the subsequent development of asthma. 
Gene mutations have also been suggested to have caused the rise in atopic diseases. The skin is a key factor in protecting our bodies from infection, allergens and other environmental compounds.  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.  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.  It is also suggested that this skin barrier defect can lead to sensitisation to environment allergens and other atopic diseases.
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. 
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].”  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].” 
“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].” 
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.
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.  Kobletzki et al. found that a period of breastfeeding shorter than 6 months increased the risk of developing asthma by 57%.  However, Eugene Weinberg states a mother’s diet should be hypoallergenic when an infant has already shown signs of allergic symptoms. 
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.  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.  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.
 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
 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
 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
 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
 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
 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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