Welcome to Eczema Matters the Eczema Voice Newsletter - August 2006
In response to some question please find the following fact sheet kindly provided by the National Eczema Society. Please read the disclaimer below.
IMMUNISATION OF CHILDREN WITH ATOPIC ECZEMA
All children in the United Kingdom are offered protection against certain diseases by immunisation. The diseases which children receive immunisation against can kill or cause lasting damage to health. Parents often have concerns about the immunisation programme. Whilst no-one likes to expose their children to unnecessary risks, media reports tend to highlight rare cases of possible vaccine damage. Parents of children with atopic eczema may have additional concerns, which are addressed in this leaflet.
What is immunisation?
Immunisation means giving ‘vaccines’. Vaccines are substances, which prepare the body’s natural defence system (known as the immune system). Antibodies are produced which fight off the infection, if your child comes into contact with the infection in the future. Vaccines are given as an injection except for polio vaccine which is given as a liquid to be swallowed.
Is immunisation really necessary?
It is true that some diseases are much rarer than they once were. However, diseases can spread from other countries if children are unprotected. TB, is a case in point. It had almost died out in the UK, but an increasing incidence is being seen once again. Some diseases like measles may have long- term serious effects on some children. Vaccines may protect others as well as your child; giving rubella (german measles) vaccine to children makes it less likely that pregnant women will come into contact with German measles, which could harm their unborn babies.
What happens if my child is not immunised?
In the UK immunisation is voluntary rather than something you must do. Your health visitor will encourage you to bring your child for vaccinations, as he or she will be at increased risk of diseases and complications without them. Homoeopathic products do not provide the same standard of protection as standard vaccines. Your child could also be a risk to brothers and sisters who have not been immunised, including unborn children. Your child may also pass on infection to other unprotected members of the community. Some nurseries and playgroups therefore have policies for all children admitted to be protected by immunisation.
Can I choose which vaccine my child gets?
The programme of immunisation is looked at regularly to give your child the best protection with currently available vaccines. The Department of Health produces a number of publications which are available from your health visitor, GP surgery or local child health clinic or at www.immunisations.org.uk. Publications include · A new guide to child immunisations for babies up to 15 months · A guide to pre-school immunisations for 3 to 5 year olds · MMR – the facts (also on www.mmrthefacts.nhs.uk) · BCG and your baby Your health visitor and GP will offer your child the full programme, provided that your child has no special risks (see next section). Your permission is needed for each vaccine. If you are concerned about any particular vaccine discuss it with your health visitor. If you are traveling abroad, remember that your child may need additional protection from diseases not found in this country. Ask about this at your doctor’s surgery well in advance, as some vaccines need to be given some months before traveling.
Are certain children more at risk with certain vaccines?
The immunisation programme may have to be altered if a child has had a bad reaction to a vaccine in the past. This may mean a severe reaction on the skin where vaccine was given or a more generalised reaction. Children may also need to have the programme altered if they are taking immuno-supressant drugs by mouth, steroids by mouth or if the child has had a severe allergic reaction to egg. These issues will be discussed in more length later in the leaflet. Children with an infection or fever will usually need to recover before vaccines are given. This includes badly infected eczema. Children with a history of fits, cancer or diseases of the immune system need specialist advice from their health visitor or their GP.
Can vaccines cause or provoke eczema?
This is the main cause of concern for parents of children with atopic eczema or for those who have a family history of eczema. This worry comes from two areas: firstly, the knowledge that eczema does involve the body’s immune system and secondly, individual reports from parents whose children have had a flare-up of their eczema following immunisation. However, it is always difficult to pinpoint the cause of a flare-up and large studies would be needed to show whether immunisation was the real cause or not. There is very little published evidence about eczema and immunisation at present. Parents should also bear in mind the possible effects that catching some of these diseases might have on the child’s eczema e.g. scratching or being confined to bed. The Department of Health has clearly stated that eczema (and asthma and hay fever) is not reasons to avoid immunisation.
What about reactions at the injection site?
Polio vaccine is given by mouth so this is not a problem. The other vaccines given to children are injected but the doctor or nurse will avoid areas where the skin is already sore, inflamed or broken. The Diphtheria, Tetanus and Whooping Cough (DTP) vaccine, given at 2, 3 and 4 months of age, may cause a small lump at the injection site. This is no more likely in children with eczema than in others. Very occasionally a larger area may become red or swollen. The GP or health visitor should be shown a reaction like this as if it is severe the vaccine may need to be given in a different format. In the standard vaccine the diphtheria and tetanus parts of the vaccine are added to a small amount of aluminum to make them more effective. This can cause irritation or soreness at the injection site. It is important not to inject this into an active area of eczema. Measles, Mumps and Rubella, or MMR vaccine sometimes causes a rash like measles 7 to 10 days after vaccination. The child may also have a high temperature and feel unwell. The second dose of MMR vaccine is less likely to cause these problems.
Can my child have MMR in separate parts?
This idea followed the suggestion that single vaccines would have less impact on the body’s immune system, but experts have agreed that it is not necessary. MMR vaccine has been around for nearly 30 years and has been used in >90 countries. No country in the world recommends giving MMR vaccine as 3 separate injections. There is no source of single licensed measles or mumps vaccine in the UK. Those that are being offered privately are unlicensed – which means that there is no British testing on their safety and efficacy.
Is it safe to give vaccines to a child undergoing topical (applied to the skin) steroid treatment?
Topical steroids or those given by inhaler do not pose any risks regarding vaccination. Children who are taking high doses of steroids by mouth or who are using immuno-supressant drugs or have an immune system disorder may have problems with some live vaccines including BCG, oral polio and MMR. Advice should always be sought from the health visitor or GP. Topical tacrolimus (Protopic
) and vaccination
Because of the potential risk of vaccination failure, the manufacturers advise that vaccination should be administered either prior to commencement of treatment with tacrolimus, or after a tacrolimus-free interval of 2 weeks. It also appears to wise to avoid treatment with topical tacrolimus for 3 weeks after vaccination. In the case of live vaccines, treatment with topical tacrolimus is best avoided for 28 days before and after vaccination, to avoid the additional theoretical possibility of an abnormal vaccine infection.
My child is allergic to some foods. Will he or she be allergic to the vaccines?
The only food, which may be a problem, is egg. There is no problem for children who just dislike the taste. MMR vaccine may contain traces of egg protein and children who have suffered allergic reactions could theoretically be at risk. Recent research has shown that 99% of children with egg allergy can safely receive the MMR vaccine. If your child has suffered a severe rash, swollen mouth or throat or had difficulty in breathing after eating egg then you should let your health visitor or GP know. They can arrange for special care to be taken when your child receives the MMR vaccine. Influenza (flu) or yellow fever vaccines should not be given to children with a history of egg allergy who are unable to eat or tolerate any egg in the diet. Overall the advice is consistent and clear that the parents of children are not putting them at increased risk by following the normal immunisation programme. However, all parents should feel able to discuss their concerns with those responsible for the healthcare of their child, whether it is the health visitor, GP, paediatrician or dermatologist. Remember that protection from infectious disease is important for your child and for your community as a whole. Please note that this leaflet covers childhood immunisation only; if vaccines are required for travelling then further information needs to be sought from your GP, health visitor or practice nurses. TABLE OF CHILDHOOD IMMUNISATION Age Immunisation Shortly after birth BCG for babies born to families from countries with a high prevalence of TB 2 months DTP, Polio, HIB vaccine and Men C 3 months DTP, Polio, HIB vaccine, Men C 4 months DTP, Polio, HIB vaccine, Men C 12 to 15 months Measles/Mumps/Rubella (MMR) 3 to 5 years Diphtheria/Tetanus/acellularpertussis and Polio2nd dose of MMR 10 to 14 years BCG, skin test is performed before vaccination either a Heaf or Mantoux test 15 to 18 years Tetanus/diphtheria, Polio Key: DTP = diphtheria, tetanus and pertussis (whooping cough)Hib vaccine = haemophilus influenza vaccineMen C = Menninogoccal CBCG = tuberculosis Disclaimer This information is provided only as a general guide. Individual circumstances differ and the National Eczema Society does not prescribe, give medical advice or endorse products or treatments. We hope you will find the information useful but it does not replace, and should not replace, the essential guidance, which can be given by your doctor or nurse. © National Eczema Society 2004
All rights reserved
National Eczema Society, Hill House, Highgate Hill
London N19 5NA
http://www.eczema.org
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What’s in my emollient?
http://www.prodigy.nhs.uk/eczema_atopic/view_whole_guidance#NodeId178193
National Eczema Week 16-23 September.
http://www.eczema.org/NEW2006.pdf
'Prebiotic' Reduces Risk of Eczema in Infants
THURSDAY, July 27 (HealthDay News) -- Adding a supplement to infant formula that encourages the growth of beneficial intestinal bacteria lowers the chances of high-risk babies developing eczema, German researchers report.
Using this "prebiotic" boosts the development of an immature immune system, the scientists explained, and that can help prevent allergies. Human breast milk contains natural prebiotics.
In the study, researchers made an infant formula based on the prebiotic content of human breast milk, and tested it on a group of high-risk babies. At least one parent of each child had a history of eczema, hay fever or asthma. The study was published in the July 26 online issue of the Archives of Disease in Childhood.
Infants who develop eczema are likely to develop other allergies as they age. In fact, 75 percent of infants who have eczema go on to develop hay fever, and half of those will go on to develop asthma.
The infants were placed into two groups: 102 were given a prebiotic formula, and 104 were given a normal formula.
Over six months, 10 babies receiving the prebiotic formula developed eczema, compared with 24 who received the normal formula.
"Although further studies are needed to understand completely the mechanism behind the immune-modulating effect of the studied prebiotics, the data support the potential role of prebiotics as dietary manipulation for primary allergy prevention during infancy," the study authors concluded.
The study was partially funded by Numico Research Friedrichsdorf, a subsidiary of the Numico infant nutrition food company.
One expert thinks the use of prebiotics to prevent infant allergies will continue to grow, but he cautions that more research is needed before this approach is proven.
"This study demonstrates for the first time that prebiotics given to human infants decreases the likelihood of atopic dermatitis," said Dr. Martin G. Martin, a professor of pediatric gastroenterology and nutrition at Mattel Children's Hospital at the University of California, Los Angeles.
Martin noted the prebiotic was given to children who were at high risk for developing eczema. However, most infants who develop eczema do not have a family history of the disease or of any allergies, he said.
"It would be nice to look at the broader population, where 80 percent have no family history of allergies," Martin said. "It would be nice to see if these prebiotics have the same beneficial effects in this group."
Prebiotics may be the wave of the future in preventing childhood allergies, Martin said. "But these results need to be repeated to see if this first observation is true," he said. It remains to be seen if using prebiotics to prevent eczema also prevents hay fever and asthma from developing, Martin added.
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