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Breast Feeding and Eczema

New York Times August 29, 2011
Nutrition: Breast-Feeding Does Not Prevent Eczema
By NICHOLAS BAKALAR

   Prolonged breast-feeding is widely believed to protect infants against developing eczema and other allergic diseases. But a new study has found no evidence for the belief.
   Researchers in Britain gathered data on more than 50,000 children ages 8 to 12 in 21 countries, assessing the prevalence and severity of eczema with skin examinations of the children, family medical histories and questionnaires about past symptoms. The children also received skin-prick tests for common allergens.
   Even among children who had been breast-fed for six months or longer, there was no evidence that breast-feeding prevented eczema or limited its severity. The results were the same for children whose mothers had a history of allergy and for those who had a positive reaction to the allergens used in the skin-prick test.
   In more affluent countries, breast-feeding actually was associated with a slight increase in the risk for eczema. The researchers suspect that this is because mothers who see an allergic reaction in an infant may try to breast-feed longer, not because breast-feeding causes the allergy.
“We’re not questioning the benefits of breast-feeding,” said Carsten Flohr, the lead author and a senior lecturer in pediatrics at Kings College London. “But when it comes to prevention of eczema, neither breast-feeding itself nor prolonged breast-feeding seems to be protective.”
   The study appears online in The British Journal of Dermatology.  See: 

Br J Dermatol. 2009 Aug;161(2):373-83. Epub 2009 Feb 23.
Exclusive breastfeeding and incident atopic dermatitis in childhood: a systematic review and meta-analysis of prospective cohort studies.
Yang YW, Tsai CL, Lu CY.
Conclusion: There is no strong evidence of a protective effect of exclusive breastfeeding for at least 3 months against AD, even among children with a positive family history.

Allergy to Natural and Organic Products

While most skincare and hair care is filled with potential allergy triggers, it turns out that organic versions are, to green proponents’ dismay, among the worst offenders.  Allergies Can Be Natural, Too is a good article on this topic that appeared in the Thursday, April 28, 2011 NY Times.  It should be particularly useful to parents of kids with atopic dermatitis.

Food Allergies Take a Toll on Families and Finances

Yet another article on Food Allergies in the NY Times.  The focus is different from the previous article which dealt with overdiagnosis of the problem.  This one has helpful information for people who have kids with documented food allergies.  See: Food Allergies Toll on Families and Finances.

Food Allergies Overdiagnosed

"Many who think they have food allergies actually do not.

A new report, commissioned by the federal government, finds the field is rife with poorly done studies, misdiagnoses and tests that can give misleading results."

Gina Kolata's article in the May 12th NY Times summarizes this topic well. See:  Doubt is Cast on Reports of Many Food Allergies.

Peanut Allergy: Oral Desensitization

"A medically supervised daily dose of peanuts may help children with peanut allergies greatly increase their tolerance to the food, according to two new studies that raise the possibility of a cure for this potentially life-threatening condition.

The findings, presented on Sunday at a meeting of the American Academy of Allergy, Asthma and Immunology in Washington, suggest that a treatment for peanut allergy may be developed in two or three years, said Dr. Wesley Burks, the chief of the division of pediatric allergy and immunology at Duke University Medical Center, who helped conduct the research."  From NY Times article, March 16, 2009 -- see Full Article. 

This is an interesting article, but is really "old wine in new bottles."  Sulzberger experimented with oral desensitization over 50 years ago.  It is likely that American Indians have done this for hundreds if not thousands of years (see Wayne Winterrowd's fine piece:  "The Baleful Weed.") There is a fascination with Peanut Allergy.  It is far rarer than one thinks but has a strangely compelling aura. See Extraordinary Nutty Delusions.

Here is the abstract of a recent review of oral desensitization from PubMed:

Beyer K, Wahn U. Oral immunotherapy for food allergy in children. Curr Opin Allergy Clin Immunol. 2008 Dec;8(6):553-6.
Children's Hospital Charité, Humboldt University, Berlin, Germany.
kirsten.beyer@charite.de

PURPOSE OF REVIEW: Food allergy is a common disease in childhood. Natural tolerance development is frequent, but some children with cow's milk or hen's egg allergy and the majority of children with peanut allergy will remain allergic until adulthood. Within the last several years, the usefulness of oral immunotherapy has been investigated in food allergic patients. This review covers the most recent findings. RECENT FINDINGS: In cow's milk and hen's egg allergy, controlled trials have been conducted in children, showing that oral immunotherapy, in general, has been successful and safe. Moreover, rush protocols have been developed allowing desensitization in a short period of time. Although side effects are frequent, allergic reactions seem to be controllable by antihistamines, steroids, or epinephrine. For peanut allergy, the first results look promising and detailed data will be available shortly. SUMMARY: Several studies have shown that oral immunotherapy is a promising approach, especially in patients with severe and persistent food allergy. Side effects are frequent but seem controllable. So far, treatment protocols have been performed in highly supervised research settings. Until more experience is gained from larger long-term studies, oral immunotherapy should not be tried in clinical practice settings.

Telling Food Allergies From False Alarms

 "Doctors say that misdiagnosed food allergies appear to be on the rise, and countless families are needlessly avoiding certain foods and spending hundreds of dollars on costly nonallergenic supplements. In extreme cases, misdiagnosed allergies have put children at risk for malnutrition."

This is an important article that you should read if you are afraid you or your child has food allergies.  It's old news.  Hugh Sampson has been saying this for > 15 years, but many docs were not listening.  The simple answer is that in many cases RAST testing is overused. Be warned.

Full article.

Nuts!

An important comment piece was published in the British Medical Journal of December 10, 2008.

BMJ 2008;337:a2880

This allergies hysteria is just nuts

Nicholas A Christakis, professor of medical sociology, Harvard Medical School, and attending physician, Mt Auburn Hospital, Cambridge, Massachusetts

The issue is not whether nut allergies exist or whether they can occasionally be serious. Nor is the issue whether reasonable accommodation should be made for the few children who have documented serious allergies. The issue is what accounts for the extreme responses to nut allergies and what to do about the responses and the allergies themselves.

The responses bear many of the hallmarks of mass psychogenic illness (MPI), previously and quaintly known as "epidemic hysteria." MPI is a social network phenomenon involving otherwise healthy people in a cascade of anxiety. Outbreaks typically occur in small towns and in schools, factories, and other institutions, and they are most often prompted by fears of contamination. It does indeed provoke anxiety to imagine a hidden, deadly danger in so innocent a thing as having a snack in kindergarten. And being around others who are anxious heightens one’s own anxiety. 

Read in full: Download Nut Allergy Nuts

Breast Eczemas

Toronto dermatologist, Benjamin Barankin and M. Shirley Gross wrote an important article on nipple and areolar dermatitis in breast feeding women in 2004.  This is of great import.

Abstract.  Eczema of the nipple and areola can occasionally develop in the breastfeeding patient and is associated with sore, burning, and painful areolae and nipples. Management includes elimination of any precipitating allergens and irritant and the judicious use of appropriate topical corticosteroid preparations. Patients must also be offered effective pain control and support. The proper diagnosis and management of eczema of the nipple and areola in breastfeeding patients will prevent premature and iatrogenic weaning.

This is an important area for pregnant and breast feeding women.  Often, eczema is the underlying cause, compounded by secondary infection and/or contact dermatitis. It may be that the immune dysregulation of pregnancy contributes to this subset of eczema.  DJE

The pdf is here for those who need more information see:  Download Nipple and Areolar Eczema i

Food Allergy Research

There was a good article in the December 9 2008, NY Times on Food Allergies.

(Picture from Times article: A DAILY STRUGGLE Sean Batson, 5, who is allergic to soy, eggs and milk, is participating in a large food allergy study.)

Excerpt: "Indeed, with recent data showing a marked increase in the number of food allergies, which cannot be explained by a lack of detection in years past, the national institutes have begun an initiative to address food allergies as an emerging health challenge.

Although it is possible to be allergic to any food, eight foods account for 90 percent of all reactions — milk, eggs, peanuts, fish, shellfish, soy, wheat, and tree nuts like cashews and almonds."

If you have an interest in this subject, this is a good place to begin.  Researchers Put a Microscope on Food Allergies

Brian Maurer, a pediatric physician's assistant in Enfield Connecticut has these comments about this article and food allergies:

"In today’s New York Times we read about the latest emerging healthcare challenge: 4 percent of the general population suffers from food allergies.  Fifteen years ago, clinicians paid little attention to food allergies; they were thought to be relatively rare.  Nowadays, more and more children are being diagnosed with allergic disease triggered by milk, soy, egg, wheat, peanut, tree nuts, fish and shellfish.  The question is: how many of these are bona fide allergies?
 
Certainly, if a child demonstrates clinical signs of an allergic reaction when challenged with a particular food substance—hives, wheezing, dysphagia, angioedema—there is little doubt of the diagnosis.  The clinical waters become murkier when we attempt to arrive at a diagnosis through screening tests.  Many patients who show significant reactions to skin-prick testing demonstrate no problem when challenged with the actual foodstuff in the diet.  As the article points out: “[i]n China…skin-prick testing found that large percentages of one rural population were sensitive to shellfish (16.7 percent) and peanuts (12.3 percent). Yet actual food allergies in that population, as diagnosed by physicians, were all but unheard of: less than 1 percent.”  How reliable is skin-prick testing?
 
Anecdotally, I have had one pediatric allergist—an internationally recognized researcher and clinician—tell me that blanket screening tests are basically useless.  His recommendation is to measure quantitative IgE levels for those substances to which the patient has demonstrated a past sensitivity in order to assess the degree of allergy over time.
 

Infantile Eczema

 The NY Times, on October 29, 2008, had a fine article:  Learning to Cope With, if Not Cure, Infant Eczema.  Their reporter interviewed some of the key U.S. pediatric dermatologists in this area.  You can access this from the Times website or through Permalink.