Eczema in the media

[EczemaVoice]

E NUMBERS: TAME YOUR TEARAWAY

IT'S official - food additives can turn even the most well-behaved child into a tantrum-throwing terror.

New research has proved what parents have long suspected. E numbers found in many children's foods, snacks and drinks can lead to hyperactivity and, in some cases, severe behavioural problems.

A group of 277 three-year-olds on the Isle of Wight were tested for sensitivity to food additives over a period of months by researchers from Southampton University.

Some weeks they were given a daily drink containing additives while others they had a fruit drink, which looked and tasted exactly the same. Their parents, who didn't know which drink their children had been given, were then asked to monitor their behaviour.

They reported more disruptive and inattentive behaviour on those weeks their children were given the additive-packed drinks.

WHAT E NUMBERS REALLY DO

"Manufacturers include additives and E numbers to make foods more attractive to kids," says nutritionist Patrick Holford. "Either they make them look better or taste better. "One of the worst offenders is tatrazine, which gives squash and other foods their orange colour. It also makes a significant proportion of children hyperactive. "Tatrazine is also an 'anti-nutrient' which means it depletes the body of zinc, an essential mineral for children because it boosts the immune system and reduces the risk of allergy. "In one study, four out of 10 children developed eczema or asthma within 45 minutes of being fed it." Two other main offenders are monosodium glutamate (MSG) found in some potato crisps and caffeine. Both can cause hyperactivity and behavioural problems - and some kids are more badly affected than others. "These children may already have a tendency towards hyperactivity, difficulty concentrating and problems regulating their blood sugar," says Patrick. "And serious problems arise because these brain stimulants tip them over the edge. "It's a fact that certain chemicals in foods are acting like drugs in children and should be avoided at all costs."

DIET NOT DRUGS

The top 10 additives to avoid...

E102 (Tatrazine): Colouring which causes hyperactivity in children and may lead to asthma attacks and allergic reactions. FOUND IN: Orange squash, orange/yellow-coloured sweets and medicines.

E129: Colouring which can exacerbate asthma and rhinitis. FOUND IN: Red-coloured sweets such as wine gums, red drinks and red toothpaste.

E951 (Aspartane): Commonly used sweetener which can cause headaches, blindness and seizures. FOUND IN: Squash drinks, diet drinks, bubble and chewing gum and in some reduced sugar products such as baked beans.

E210/E213: Preservative which can affect digestion and trigger allergies. FOUND IN: Squashes, flavoured waters and syrups.

E151: Black food colouring can trigger asthma and allergies. FOUND IN: Drinks such as cola, and black sweets.

E320: Preservative which can cause hyperactivity and is possibly carcinogenic (a cancer trigger). FOUND IN: Cakes and biscuits.

E226 Preservative which can cause bronchial problems, low blood pressure and anaphylactic shock and is banned in US. FOUND IN: Burgers and biscuits and other products with a shelf-life.

E621(MSG): Widely-used flavour enhancer which can lead to hyperactivity, chest pain, headaches and nausea. FOUND IN: Flavoured crisps, Chinese food and stock cubes.

E512: Colouring agent which can cause vomiting, diarrhoea and headaches. FOUND IN: Fruit juices, canned and bottled foods.

E220: Common preservative which can lead to bronchial problems and anaphylactic shock. FOUND IN: Fruit cereal bars and dried fruit to prevent it losing colour.

SOME Es ARE GOOD

Not all E numbers are bad - the following represent certain vitamins and minerals which are actually good for your kids.

Colours: E101 (Vitamin B2), E160 (Carotene, Vitamin A)

Anti-oxidants: E300-304 (Vitamin C), E306-309 (Tocopherols, like Vitamin E)

Emulsifiers: E322 (Lecithin)

Stabilisers: E375 (Niacin), E440 (Pectin)

WHAT NOT TO EAT

Most fizzy drinks, most squashes and cordials, most tap water (drink filtered or bottled)

Flavoured crisps and snacks containing flavour enhancer (Monosodium Glutamate 621)

Products containing artificial sweeteners, diet products claiming "No added sugar" or "Sugar free"

Most sweets, chocolate, chewing gum, packet mixes, gravies and stock cubes

Sugary/corn/chocolate cereals

[EczemaVoice]

Be careful about 'Wonder Cures'

Parents risk harming their children because of misinformation about the best treatments for eczema, experts said today.

While some parents turn to herbal lotions of unknown quality to treat their youngsters’ skin, others are shunning prescribed steroid creams because of misconceptions about the side effects, a meeting of dermatologists was told.

Dr Sue Lewis-Jones, a specialist in paediatric dermatology from Dundee, said a network of nurses focusing on the management of childhood eczema and other skin problems was urgently needed.

She said that a lack of money and focus on the speciality was to blame for the small number of nurses working in this area.

“These nurses can help parents manage their children’s condition, keep an eye on their progress and lead to fewer admissions to hospital.

“But there is no money for it.

“It is an obvious thing to do and it would ultimately save the NHS money,” Dr Lewis-Jones said.

The consultant dermatologist, speaking at the British Skin Foundation meeting in central London, also highlighted concerns about parents opting for herbal Chinese remedies to treat their children.

She said there were examples of companies springing up promising “wonder cures” for eczema and psoriasis.

“There are lots of reputable companies and there is no reason why some remedies shouldn’t work because most medicines originally came from plants.

“But the problem is that we don’t know what part of the plant is having the effect and there is less known about the side effects.

“With modern medicines much more is known about the side effects.

“Some people out there just want to make money and will dishonestly promote small pots of cream that cost £30 each,” Dr Lewis-Jones said.

She said that these creams often contained hidden steroids which produced the desired effect and led patients to believe the treatments were working.

Dr Lewis-Jones said she knew of a case where a parent had used a very strong steroid called Dermovate which was bought from Hong Kong to treat her 12-year-old’s psoriasis.

Although the product was clearly labelled, the mother used the cream on her child for 18 months without knowing the dangers of such heavy steroid use.

The girl went on to develop the serious condition Cushing’s Syndrome which leads to weight gain, thinning of the bones and blood pressure problems and is caused by too many steroids.

But Dr Lewis-Jones said under-treatment was a much more serious concern for children with skin conditions.

She said research had shown that three-quarters of parents were worried about using steroid creams on their children and a quarter stopped using them all together.

They were apparently concerned about products would thinning the skin with some even believing they would lead to muscle development such as that seen in bodybuilders who abuse steroids.

“The thing about eczema is that we can get it under control and are not going to have to use steroids for very long.

“There is also widespread ignorance of the public and health professionals about the use of steroids but they are a life-saver for people with eczema,” Dr Lewis Jones said.

One in three-children under the age of three-and-a-half suffers from eczema.

Psoriasis is also very common, affecting 1.2 million people in the UK.

[EczemaVoice]

As the teenage Bruce Banner in The Hulk, Mike Erwin had to deal with being trapped in a body he could not control. In real life, Erwin faces a similar problem when it comes to his potentially life-threatening food allergies.
"I can't eat raw fruits or vegetables because I'm highly allergic," says Erwin. "The first inclination people have is that I made it up as a kid to get out of eating my vegetables. But it's really true. My family is part Native American. We have a history of food allergies and mine are really serious."

In fact, Erwin is so allergic to the cellulose in fruits and vegetables he could die from anaphylactic shock, a severe and quick, systemic allergic reaction that can overwhelm the respiratory and cardiovascular systems – sometimes within minutes.
Erwin says he's had several anaphylactic reactions to fruits or vegetables he did not know he was eating.

"My throat starts closing up and I have massive chest pain," he explains. "I guess the closest thing I could think of would be a heart attack. It feels like my heart cramps and I can't breathe. I've had to go to the emergency room three times. It was really serious."

According to the American Academy of Allergy, Asthma & Immunology (AAAAI) and the Food Allergy & Anaphylaxis Network (FAAN), food allergies affect about 11 million Americans. While many are familiar with peanut allergies, shellfish allergies are more than twice as common. About 6.5 million people are allergic to shellfish compared to 3 million allergic to peanuts and tree nuts.

Food allergies differ from food intolerances that occur when the food consumed is not fully digested. Symptoms of food intolerance include bloating, gas, intestinal cramping and diarrhea.

"True food allergies are an immunologic response caused when the body identifies the food as a foreign invader and attacks," explains Michael Hirt, a Harvard-trained internist and board-certified clinical nutrition specialist. "The body releases histamine which can give people the classic runny nose, itchy-scratchy throat, hives, and/or eczema. In some cases, this reaction can progress to anaphylactic shock where the person can't breathe because of swelling in the airways or lungs."

People who have a family history of food allergy, anaphylaxis or who have general environmental allergies like hay fever, eczema and asthma are generally more at risk for food allergies.

The most common food allergens include:

• Shellfish

• Fish

• Peanut

• Tree nuts

• Milk

• Egg

• Soy

• Wheat

Hirt, who is also an assistant clinical professor at UCLA and the founder of the Center for Integrative Medicine in Tarzana, Calif., said some people are allergic to food temperatures.

"Allergic reactions to something too cold are more common than something too warm," he said. " Some people are allergic to cold water – so much so that a cold shower can cause hives to break out on their skin."


Experts advise persons with severe allergies to learn how to use EpiPens.

"You need the people around you to know how to use it and when it's appropriate to use it," Hirt says. "Carrying some Benadryl or one of the other prescription antihistamines is also a good idea. If you notice something happening and can still swallow, the antihistamine and the EpiPen can buy you more time."

[EczemaVoice]

Allergy – the unmet need: a blueprint for better patient care.

Summary and recommendations of a new report from the Royal College of Physicians.

There has been a dramatic increase in allergy in recent years, including severe life-threatening and multi-system allergies. There is, however, a growing gulf between the need for effective advice and treatment and the availability of professional services. In particular, there is an urgent need (a) for specialist-led allergy centres where the more complex cases can be treated and which can provide the necessary training for other specialties dealing with allergy patients (many of whom are children), and (b) for GPs to acquire the necessary knowledge and training so that they can provide an effective primary care led allergy service in which patients can have confidence.

The recommendations of the report have been designed to form the basis for the development of a coordinated service.

Why is allergy an increasing problem?

-- INCREASED INCIDENCE The incidence of allergy has increased dramatically in the UK in recent years and is still rising. Recent studies put the rise as approximately three-fold in the last 20 years, giving the UK one of the highest rates of allergic disease in the world.

-- INCREASED SEVERITY The nature of allergic disease has also changed, so a number of severe and potentially life-threatening disorders, which were previously rare, are now common. As part of the increase in incidence, more children are now affected, particularly by previously little-known food allergies, such as peanut allergy. These are also among the most serious allergies, so accurate diagnosis, advice and treatment are vital.

-- INCREASED COMPLEXITY Patients now usually have disorders affecting several systems. For example, a child with peanut allergy often also has eczema, rhinitis and asthma – so-called ‘multi-system allergic disease’. Poorly controlled asthma in a patient with nut allergy is a risk factor for life-threatening or fatal reactions.

What is the scale of the allergy problem?

-- The latest estimates suggest that one-third of the total UK population – approximately 18 million people – will develop allergy at some time in their lives.

-- Asthma, rhinitis and eczema have increased in incidence two- to three-fold in the last 20 years.

-- Anaphylaxis, a severe and potentially life-threatening reaction, occurs in over one in 3,500 of the population each year as a result of exposure to substances to which the sufferer is allergic. Hospital admissions due to anaphylaxis have increased seven-fold over the last decade and doubled over four years.

-- Food allergy is increasingly widespread and is the most common cause of anaphylaxis in children. Peanut allergy, the most common food allergy to cause fatal or near-fatal reactions, has trebled in incidence over four years and now affects one in 70 children in the UK. Yet only 10 years ago this was a rare disorder.

-- Drug allergy is also increasingly common. Adverse drug reactions account for 5% of all hospital admissions in the UK. Up to 15% of inpatients have a hospital stay prolonged as a result of drug allergy. These figures do not include the majority of drug allergies, which occur in primary care and remain undiagnosed and unrecorded.

-- Some 8% of healthcare workers now have an allergy to latex rubber, which in some cases can lead to anaphylaxis. Yet until 1979 only two cases of latex allergy had been reported.

-- Allergic disease currently accounts for 6% of general practice consultations, 0.6% of hospital admissions, and 10% of the GP prescribing budget. The cost (in primary care, excluding hospital services) to the NHS is £900 million per annum.

Why are current services now inadequate to meet the need?

-- Across the whole country, only six major centres staffed by consultant allergists offer a full-time service with expertise in all types of allergic problems. A further nine centres staffed by allergists offer a part-time service.

[EczemaVoice]

Vaccinations
NEW YORK (Reuters Health) - Allergic diseases have risen over the past few decades in developed countries, and some people have blamed this on the increase in mass immunizations that has occurred. However, that notion seems to be unfounded.

UK researchers have shown that routine childhood vaccinations are not associated with an increased risk of asthma or eczema.

Dr. Tricia M. McKeever at the University of Nottingham and colleagues examined data on a birth cohort of 29238 children who had been followed for up to 11 years.
As reported in the American Journal of Public Health, the researchers did find a certain association between overall population rates of diphtheria, polio, pertussis and tetanus (DPPT) immunization and measles, mumps and rubella (MMR) vaccination and the incidence of asthma and eczema.
However, this affected only "a minority of children who rarely seek care" from a general practitioner, meaning they were less likely than the average child to have been given routine vaccinations. So, if anything, this suggests the opposite conclusion, that lack of immunization is tied to greater odds of allergic disease.


Thus the investigators conclude that these and other findings indicate that "current vaccination practices do not have an adverse effect on the incidence of allergic diseases."


They comment that this important, "because a perception that vaccination is harmful may have an adverse impact of the effectiveness of immunization programs."
SOURCE: American Journal of Public Health. June 2004.

[EczemaVoice]

Doctors Need Training


Doctors are not properly trained to deal with the growing spate of allergies in the UK, a committee of MPs was told today.

The health select committee, chaired by Labour MP for Wakefield David Hinchliffe, was hearing evidence on the first day of its inquiry into the provision of allergy services.

Dr Shuaib Nasser, a consultant allergist at Addenbrooke’s Hospital in Cambridge, said there was a severe shortage of allergy specialists, and called for better training for doctors.

“What we need is education, starting from medical school upwards,” he told the inquiry.

Many patients, he said, have “multi-system disorders” which are referred to separate specialists.

“GPs are not educated in allergy, medical students are not educated in allergy, and they don’t understand this multi-system disease.

“For example, many patients don’t just present with eczema, they often have an associated allergic disorder.”

But such patients would initially be referred to a dermatologist before being referred to other specialists during their “tortuous” journey.

Dr Nasser added: “The fault doesn’t lie with the doctors themselves, it lies with the system.”

Professor Andrew Wardlaw, president of the British Society for Allergy and Clinical Immunology, said there were only six centres that offered a comprehensive specialist allergy service in the whole of the UK.

He told the committee: “For a disease which is one of the most common diseases in the UK, the service is utterly derisory ... I think it’s a disgrace.”

[EczemaVoice]

Climate may influence prevailing rates of asthma and eczema indicates an international study of almost 670,000 children in Occupational and Environmental Medicine.

Marked seasonal variations in temperature, altitude, outdoor humidity and latitude all affected rates of asthma and eczema.

The conclusions are based on data collected between 1992 and 1996 from children 6 to 7 and 12 to 13 years old from over 50 countries taking part the International Study of Asthma and Allergies in Childhood (ISAAC).

When the findings were analysed against climate data, they showed that for Western Europe every 10 per cent increase in indoor humidity was associated with an almost 3 per cent (2.7%) increase in the rate of asthma for both age groups.

Indoor humidity is important, because house dust mites, a major allergen for asthmatics, thrive in moist air. Humidity also encourages mould, which may also be a respiratory irritant.

Centres where average outdoor humidity drops below 50% for at least one month a year had lower rates of asthma. Similarly, higher altitude and greater seasonal temperature variations were also associated with lower rates of asthma.

Increasing latitude was associated with higher rates of eczema, while higher outdoor temperatures were associated with lower rates.

The authors conclude that climate may be a factor in the prevalence of asthma and eczema, and suggest that climate change from global warming might influence rates of these diseases in the future.

[EczemaVoice]

Scientists have found that large numbers of children are developing severe allergies to kiwifruit .
Researchers from the University of Southampton studied 273 adults and children suspected of having an allergy to the popular fruit, with 45 subjects undergoing testing. Until now little has been known about the numbers of people allergic to the fruit.
One in five subjects suffered severe symptoms including collapse, wheezing and vomiting. Researchers found that 40% of cases occurred in children, a pattern not found with other frequently allergenic foods, such as dairy foods or peanuts.
Almost all (90%) of the children under six in the study had an underlying condition such as hayfever, eczema or asthma, and 60% reported having a peanut allergy.
David Redding of the Anaphylaxis Campaign said a huge majority of those registered with the charity who had problems with kiwifruit are children.
“Of the 367 members registered with us who have a kiwifruit allergy, 295 are under 18. The symptoms of kiwifruit allergy can be varied – they commonly include tingling in the mouth and sore lips, rising to wheezing and rashes. Extreme sufferers may suffer an anaphylactic reaction, collapse and go into shock.”
Curiously, kiwifruit proteins have the same composition as the raw Malaysian rubber used to make latex gloves, balloons and condoms, and those allergic to either kiwifruit or latex experience similar reactions.
Dr Ann Clarke of the Latex Allergy Support Group said: “Problems are on the increase – all in all around 1% of the population are allergic to this protein, and there is really not enough awareness of the dangers.”

[EczemaVoice]

Could the skin prove to be the body's front door to asthma?
That theory is being tested in a ground-breaking study under way at Allegheny General Hospital and 19 other centers across the country that will explore whether halting the skin disease of eczema in young children will prevent asthma and other respiratory allergies from developing later.
The link has been seen for years among clinicians: Between 50 to 80 percent of young children who have flare-ups of the itchy, dry skin rash go on to develop asthma, hay fever or other allergies. The worse the eczema, the higher the likelihood that childhood wheezing will develop, particularly if there's a family history.
Scientists have speculated that the development of eczema and these other allergies have been tied to genes and the environment.
"What's more novel, though, is that we started to think: 'If you don't get eczema, you won't get allergies or asthma,' '' said Dr. David Skoner, Allegheny General's director of the Center for Allergy, Asthma and Immunology who is leading the local arm of the study. ''We never thought that eczema would predispose you to asthma later on.''
Blocking this suspected trigger would have a huge impact on the spiraling rate of asthma that now inflicts 10 million American children -- including an estimated 250,000 cases in Pennsylvania and 24,500 in Allegheny County, according to figures supplied by the American Respiratory Alliance of Western Pennsylvania. It's the most common chronic illness in children.
The cause for the dramatic rise in overall asthma rates -- a 75 percent increase since 1980 -- has baffled the medical community. The incidences of eczema, which affects 10 percent to 12 percent of youngsters, also have climbed.

[EczemaVoice]

Children whose homes contain high levels of endotoxin, a bacterial compound that collects in house dust, may be less likely to develop eczema during their first year of life, according to a study led by Dr. Wanda Phipatanakul, a pediatric allergist and immunologist at Children's Hospital Boston and assistant professor of Pediatrics at Harvard Medical School. The study corroborates other recent work that supports the "hygiene hypothesis" -- speculation that early exposure to infectious or inflammatory agents causes changes in babies' immune systems that reduce their risk of developing allergy-related conditions later in life. Various studies have looked at the relationship between endotoxin and allergies, but this is the first U.S. study to look at the effects of endotoxin exposure on eczema, one of the most common allergic diseases of infancy.
As part of the ongoing, Boston-based Home Allergens and Asthma Study, the researchers followed nearly 500 infants living in the Boston metro area beginning at 2 to 3 months of age. They collected dust samples from the living rooms of 400 of them and analyzed the samples for endotoxin, a component of the cell walls of various bacteria. All the babies had a parent with allergies or asthma.
The more endotoxin in the home, the less likely babies were to be diagnosed with eczema during their first year of life.