Allergy Academy Study Day – Allergy for non-healthcare professionals

This was the first Allergy Academy study designed for non-healthcare professionals – more specifically for parents, families, teachers, nurses and carers working with allergy and, in particular, with allergic children. It covered the three main stages of the 'allergic march' – eczema, food allergy and asthma/respiratory allergy.

The eczema presentation is below. For the food allergy presentation, click here; for the allergic rhinitis presentation click here, or click here for a report on the full day.

Is my eczema caused by an allergy?
Dr Claudia Gore, consultant Paediatric allergist, St Mary's Hospital

Normal skin is like a brick wall – an intact barrier against anything on the outside which also hold moisture in the skin.

In eczema that barrier is disrupted – the bricks are not stacked properly or the mortar has fallen out so that moisture escapes (the skin dries out) and infection can get in.

This causes inflammation which, in turn, causes pruritus or itching, which causes the sufferer to scratch the itch. This increases the inflammation and itching which can often break the skin allowing infection to penetrate – such as staphylococcus aureus which most people carry on their skin. This can cause an allergic reaction itself and also allows easier access to other allergens through the broken skin.

Incidence of eczema in children has continued to increase over last 30 years:
1973 – affected approximately 5% of children
1988 – affected approximately 15% of children
2003 – affected approximately 25% of children

What to look for

• dryness
• erythema – redness or darker skin colour
• papulation or bubbly skin
• oedema or swelling
• oozing, crusting
• lichenification or thickening of the skin
• excoriation or scratching

Quality of life

The QOL of 98% of infants (3–6 months) is significantly impaired by eczema.
• They do not sleep well, they are unhappy, itchy.
• They cannot play properly, cannot go swimming, cannot take part in many family activities.
• Treatment – bathing, moisturising etc – takes a lot of time and impacts seriously on family life.

Food allergy

• Although many parents (33%) believe that eczema is caused by food allergy, it rarely is (only 8% of cases). However, food allergy certainly does exacerbate eczema.
• Although there is often a connection with cow's milk allergy it is not clear whether the eczema pre or post dates the CMA.
• It is important to focus on IgE mediated, immediate reaction, food allergy; the most common foods implicated are milk and egg, followed by soy and wheat.
• If the eczema starts when the child is under two year of age, and especially if is starts very early (under 3 months) it is important to test for food allergy.
• Infants with eczema frequently also suffer from reflux, gastroenterological problems, rhinitis, asthma and conjunctivitis.
• If specific food is to be excluded, the skin needs to be clear before you start, otherwise you will not get a clear understanding of what is causing the eczema, and the exclusion needs to be for 4–6 weeks before challenge.
• Only try one treatment at a time (food exclusion, new medication etc) otherwise you will never know which ones do/do not work.

What parents want to know

What caused the eczema – genetic background or environmental problems.
The ItchySneezyWheezy website very helpful.

Treatment

Keeping the skin moist is the most important element of treatment so constant application of creams/emollients is vital.

• Cream should always applied very generously with the whole hand in the direction of the hair. If you rub cream into the skin against the hair you risk rubbing it into the hair follicles and blocking them.
• Use a clean spoon to take creams out of the pot so as not to contaminate them.
• If you are using steroids they should be applied, after the emollient, with the tip of the finger specifically where they are needed, not rubbed all over. Using lots of emollient will reduce the need for steroids.
• Eczematous skin is very temperature sensitive so be careful only to use cool/luke warm water – not either very hot or cold.
• Do not use food based creams or oils as sensitisation can happen via the skin.
• Pre-moisturise before a bath or shower, especially if the eczema is bad.
• Only wash with the hands, do not use cloths or sponges which will be harsh on damaged skin.
• Bathe daily or two or three times per day if the eczema is bad.
• Take care with babies as their skin will be oily/greasy and it will be easy to let them slip!
• If school age, re pot the creams into fun pots so that they will not mind remoisturising during the day.

Steroid creams

• Dermovate – super-strong steroid cream – do not use on the face or on babies.
• 1% hydrocortisone – mild and suitable for use on any part of the body and on babies.
• Any other steroid creams, check with your doctor/consultant/on line before using.
• Apply in finger tip units and smooth in the direction of the hair.
• Prescriptions often too mean; ask for double prescription.
• Skin thinning only occurs if the cream is strong and if it is used for a long time.

 

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