How do you know if your child is potentially susceptible to allergies later in life? It turns out that developing atopic dermatitis – often referred to as eczema – during infancy could be an indication, say experts.
The phenomenon is known as atopic or allergic march, and it refers to the genetic tendency to develop other allergic diseases such as asthma, allergic rhinitis and food allergies over time, according to Asthma and Allergy Foundation of America (AAFA). The course of disease progression tends to take on the following pathway, according to the website:
Dry skin: Begins at birthAtopic dermatitis: First few weeks or months of lifeFood allergies: First few months or years of lifeRhinitis (or nasal allergies): After age threeAsthma: First few months to years of life
WHAT’S THE LINK BETWEEN A SKIN CONDITION AND OTHER ALLERGIES?
Atopic march typically begins in infancy when babies born with dry skin tend to develop atopic dermatitis. But how does a dry skin condition lead to nasal or food allergies?
Think of skin as a protective barrier. When this protection becomes dry and develops cracks as it does when you have atopic dermatitis, it allows substances to get past the outer layer of skin.
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“It is hypothesised that an impaired skin barrier in atopic dermatitis facilitates allergen penetration, sensitisation and development of allergic diseases such as food allergy, allergic asthma and allergic rhinitis,” said Dr Chong Yi Rui Tricia, a consultant with National Skin Centre.
“Scientists think this may be what leads some children to develop food allergies. When a baby’s cracked skin touches food such as peanut, egg or cow’s milk, their immune cells may respond and overreact to the food,” said Dr Ho.
The result is the immune system’s production of antibodies known as immunoglobulin E (IgE). These antibodies travel to cells that release chemicals and typically tend to create symptoms in the nose, lungs, throat or on the skin, according to American Academy of Allergy Asthma & Immunology.
Interestingly, IgE responses to inhalant allergens tend to develop later in childhood than food-specific IgE, which probably explains the delayed onset of asthma and allergic rhinitis.
DOES FAMILY HISTORY PLAY A PART?
Yes, the prevalence of atopic dermatitis, asthma or allergic rhinitis among your immediate family members is an indication of your child’s situation.
In a study on 16,336 participants from Malaysia and Singapore, atopic dermatitis was found to be more frequent in participants who had one parent (more prevalent if it’s the father) with the skin condition than participants whose parents didn’t. Your child’s chances of hitting the atopic dermatitis jackpot are at their highest if you, your partner as well as your other children have the skin condition.
Similar findings were also shown when the study evaluated the association between family history of asthma and allergic rhinitis to atopic dermatitis.
You can also try to prevent the progression of atopic dermatitis to food allergies. If your baby has mild atopic dermatitis, introduce egg and peanut (two common food allergens) one food at a time once he or she is able to tolerate solids but no earlier than four months of age, according to Dr Chong.
Best to consult the paediatrician prior to introducing any new food to your little one, especially foods that are known to be allergens.
Infants with moderate to severe atopic dermatitis may already have a pre-existing food allergy, so it is a good idea to consider allergy testing. A skin prick test will assess the specific IgE that your baby is sensitive to, said Dr Chong. If the results are negative, you can introduce egg and peanut into your baby’s diet. Avoid egg and peanut if the test results are positive, and test again after at least six months.
There are also other ways to protect your child, according to AAFA:
Avoid cigarette smoke, pollution and certain viruses (such as RSV). This may help prevent asthma.Breastfeed your baby to support lung growth and reduce respiratory infections. There is some evidence this may be one way to cut asthma risk for young children.Eliminate dust mites from your home. This may prevent dust mite allergy, which then may help prevent asthma or atopic dermatitis.
The key is to stay vigilant, according to this study. Although many affected patients grow out of mild childhood atopic dermatitis as they get older, atopic dermatitis can reoccur at any point in their life after a prolonged environmental trigger.