House CallOct/Nov 2012 Issue

Pediactric Allergies Q & A - Skin Health and Allergies, Oral Desensitization and More!

Medical experts answer your questions about allergies and sensitivities

Skin Health and Allergies

I had eczema as a child and now I’ve got food allergies and asthma. Is there anything I can do to reduce the chances that my kids will be allergic?

Dr. Jain Doctors have long known that kids with eczema are more prone to develop other allergic issues, such as food allergies, hay fever or seasonal allergies, and asthma. Now several recent studies suggest that an important protein found in skin cells, called filaggrin, may hold the key to the development and perhaps prevention of many allergic problems, including food allergies. This protein is very important in helping the skin act as a barrier to prevent bacteria, irritants and other proteins from entering the body and stimulating the immune system. If filaggrin isn’t functioning properly, which can occur for a variety of reasons, the skin becomes porous or loose, allowing problematic proteins into its deeper layers, potentially triggering an allergic response. In mice with defective filaggrin production, the topical application of food allergens, such as egg protein, can induce an allergy to eggs.

Eric Simpson, a dermatologist I work with at the National Eczema Association, recently shared some preliminary data that may have important implications for preventing the onset of food allergies and other allergic problems. He’s conducting a study that examines the benefits of applying emollient moisturizers on young children to determine if this can help prevent the development of allergies. The thought is that regular moisturizing will overcome any filaggrin defects. Early results look promising. Infants whose skin was regularly moisturized seem to have less eczema than those whose skin was not. Whether this will translate into less food allergy, asthma or other allergic disease remains to be seen. The best type of moisturizer, how often to apply and other details remain to be worked out.

As a pediatric allergist with two young children, I believe that good skin care is key to helping prevent allergies. I apply a thick moisturizing cream to their skin every day or two, immediately after their bath while they’re still damp. I also avoid the use of harsh soaps and detergents on my children, as these can disrupt the normal skin barrier.

Oral Desensitization

I keep hearing that allergic kids can be desensitized to eggs, milk or peanuts by giving them very small amounts of the very thing they’re allergic to. Can I do this for my egg-allergic child?

Dr. Jain A recent study performed by the Consortium for Food Allergy Research and published in the New England Journal of Medicine suggests that we’re closer than ever to helping kids with egg allergies outgrow their allergies. (About 80 percent of egg-allergic kids outgrow their allergy on their own.) In this study, about 40 children were given increasing doses of purified egg white powder and then given maintenance doses. After ten months, about 55 percent of the kids tolerated an oral challenge to egg white powder and were considered desensitized. At 22 months, about 75 percent of the initial 40 children were desensitized and passed their challenges. All the children who were desensitized avoided eggs for 4 to 6 weeks and were then given another challenge to whole eggs and egg white powder at 24 months of age. At this point, 11 of the 40 patients passed the challenge.

Oral desensitization shows great promise but is this treatment ready for your child? We’re close but not there yet. There are still challenges to be worked out, such as standardizing the forms of egg white protein and properly training and equipping allergists to perform the desensitization process. This potentially could be in place in the next couple of years.

Facial Rash

My 6-year-old daughter gets a rash across her cheeks that lasts a few minutes and then disappears. She’s had this since she was a baby. It isn’t itchy. Allergy tests come back negative but I think it’s caused by food since it gets bad whenever she eats sour candy or lemonade. Do you have an explanation?

Dr. Leo Not knowing your daughter’s medical history and without a physical exam, it’s difficult to diagnose the rash. However, a condition known as Frey’s syndrome causes a facial rash that usually worsens with the ingestion of sour foods. Frey’s is associated with certain types of facial injury or trauma. In particular, infants born with forceps delivery where the forceps sit across the baby’s face can sustain nerve damage or irritation, resulting in recurrent flushing in the trigeminal nerve region. This is harmless and not likely to impact daily life. Given the recurrent nature of the rash, Frey’s syndrome is often mistaken for allergies, particularly those related to food.

Nuts When Expecting

There’s conflicting advice about whether or not to eat nuts during pregnancy in terms of preventing my baby from having nut allergies or asthma. I’m confused. Should I eat nuts when I’m expecting?

Dr. Jain The reason you’re hearing differing opinions is that studies show mixed results. The most recent research, published in the Journal of Allergy and Clinical Immunology, comes from Denmark where over 61,000 pregnant women were surveyed regarding their consumption of nuts and peanuts during pregnancy and the presence of asthma or allergies after their children were born. In this study, kids whose mothers ate peanuts or tree nuts more than once a week seemed to be protected from the development of asthma or allergies later in life. Children born to mothers with allergic problems, including other food allergies, asthma or allergic rhinitis (hay fever), also seemed to be less likely to develop asthma or allergies if their mothers ate peanuts or tree nuts regularly. Given this, it’s hard to recommend that pregnant mothers avoid nuts and peanuts as a way to prevent allergies.

Grass Allergy

My child has grass allergies. Why does he still have a runny nose in the winter?

Dr. Leo People with a history of environmental allergies (allergic rhinitis), such as a grass allergy, are likely to have higher-than-average mucous production year round. This is due to molecular and physiologic abnormalities that exist in their tissue. Viral infections can exacerbate this condition and increase the chance that these people have more nasal mucous production and congestion. In addition, many people with grass allergies are prone to recurrent sinus issues in the winter although their worst allergy symptoms occur in the summer months.

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