July 19, 2024

Drgreesh

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Pediatric Treatment of the Atopic Triad

7 min read
Pediatric Treatment of the Atopic Triad
mother-and-child

One of the first health concerns that brings new mothers into the office is eczema, also known as atopic dermatitis. They typically try applying over-the-counter products including lotions, coconut oil, steroid cream, or some combination thereof, but often the scaly red skin induces panic that brings them in the door when all other efforts are exhausted. This can be a blessing in disguise because it often prompts the doctor to test for food allergies, environmental allergies, and infections that are common precipitating factors in eczema.

Why is the Skin Reacting? 

The clear tangible benefit to investigating these things further is that eliminating allergic triggers, clearing up infections, healing the gut, and desensitizing the body to the allergies produces a noticeable change in the outward appearance of the skin. A less obvious, but important, effect is that this provides the patient with added protection against more than multiple types of asthma and reduces the risk of allergic rhinitis and other allergy symptoms in the future.

Skin inflammation can set off an internal inflammatory cascade that can perpetuate further skin conditions and lead to several inflammation-based illnesses later in life.1, 2 

Pathophysiology of Atopic Triad in Children 

Asthma, eczema, and allergies have very similar triggers and immune reactions. However, there is a difference in the pathophysiology in children vs adults. Each member of the atopic triad is triggered by infections, environmental allergens, certain foods unique to each person, chemicals, and overall inflammation in the gut. The predominant pathway that links all 3 conditions is the activation of cytokines and the release of eosinophils, followed by the release of histamine. The difference lies in the type of interleukin that the CD4 immune complement releases. 

In children with eczema, the issue often arises because the immune response is heavily skewed toward T helper 2 (Th2) cells because there are fewer Th1 cells, not strictly because the body is inflamed. This helps explain why eczema tends to appear before asthma or allergies. When children get viral infections and the immune system activates the Th1 pathway, there is often a decrease in flares while the cascade tends toward the Th1 pathway. In adults, there are increased instances of interleukin 22 (IL-22)-producing CD4 and CD8 T cells within the skin, as well as increased activation of human leukocyte antigen DR, so the pathogenesis is much more complex.3 In asthma, T lymphocytes produce mostly IL-4, IL-5, and IL-13, while in allergies the pathway favors production of IL-4 and IL-5 only.4,5 

Treatment of the Allergies, Asthma and Eczema in Children 

There are several common themes in the treatment of eczema, allergies, and asthma in children. Due to the varying symptoms and location of reactivity, there are specific treatments to each as well. The commonality lies in the need for treatment with supplements such as vitamin D, bromelain, curcumin, quercetin, essential fatty acids, and pre/probiotics. Gut healing, testing for infectious triggers, allergy testing, and desensitization/elimination are also indicated.6 

Essential Fatty Acids 

Working with essential fatty acids can be complicated. It is hard to predict which fatty acid will work best for each patient, so there are several options listed below. It is always best to consult with your doctor for individual dosages, but in general the lower end of the range is appropriate for children under the age of 4, while children between the ages of 4 and 15 will benefit from higher doses. My preference is for any formula with a higher EPA/DHA ratio. 

  • Flaxseed oil: 1-2 tsp, up to 2 times per day 
  • Sunflower oil: 2 grams, 1-2 times per day 
  • Fish oil: 15-30 mL cod liver oil daily or up to 3 grams EPA 1-2 times per day 

Healing of the GI Tract 

  • L-glutamine: 2.5 g 1-2 times per day 
  • Ulmus rubra (aka Ulmus fulva): approximately 100 mg per day 
  • Althea officinalis: approximately 100 mg per day 
  • Larch arabinogalactan: 200-400 mg per day 

Further Considerations 

  • Address any anxiety, as stress creates inflammation 
  • Use stool testing to identify and treat any pathogens or enzyme deficiencies 
  • Blood tests can be done for either mother or child for factors including allergies, Lyme disease, Candida, and Epstein-Barr virus 

Addressing Triggers of Allergies, Asthma and Eczema 

In my experience with testing for IgE-mediated allergic responses to foods and environmental triggers, there are some cases where little to no reaction is detected. In these cases, elimination of foods found to be a sensitivity through IgG or IgA testing is beneficial and sometimes more beneficial than eliminating IgE-mediated food allergies. This is attributed to the fact that several immune pathways can also cause atopic dermatitis or asthma, such as activation of memory T-cells found within the epithelium of the skin and mucous membranes.7,8 

Potential desensitization methods include sublingual immunotherapy, weekly oral immunotherapy, low-dose allergen therapy, mental field therapy/tapping, and acupuncture. My favorite method is weekly oral immunotherapy, as it can address both food and environmental allergic triggers as well as sulfites, nickel, and other chemicals without having to stress the immune system so frequently.

Eczema 

In addition to the above treatments recommended for every atopic triad patient, it is important in the treatment of eczema to consider certain skin irritants such as nickel. Nickel-induced eczema typically occurs on the hands and feet but is limited to those locations. Ingestion of foods high in nickel or cooking with stainless steel can also trigger a flare in those with nickel sensitivity.10 

The microbiome in our GI tract influences our mood, immune system function, and overall health. Imbalance in our microbiome, genetic predisposition, and allergic triggers are very important factors to consider when determining whether a patient is likely to develop eczema. Some less-publicized studies have shown that the microbiome of the skin has a very important role in protecting a child from developing both eczema and allergies. A healthy cutaneous microbiome inhibits colonization with pathogens such as Staphylococcus aureus; it is a crucial component of an intact, functional epidermal barrier. The microbiome of the GI tract has gained increasing attention; the microbiome of the skin is likely not far behind.11 

As the diversity of the cutaneous microbiome decreases, eczema tends to become more severe, and pathogenic bacteria, such as S. aureus, colonize the skin more easily. Early clinical studies suggest that when applied topically, commensal organisms such as Staphylococcus hominis or Roseomonas mucosa can help reduce eczema severity. This application supports the role that commensals may play in decreasing S. aureus colonization in patients with eczema.11 

Asthma 

  • Urtica dioica: 1 tsp herb in infusion 1-2 times per day 
  • Boswellia serrata: 600 mg 2 times per day 
  • Herbal decoction: ¼ ounce of a combination of Tussilago farfara, Verbascum thapsus, Foeniculum vulgare, Lobelia inflata, and Glycyrrhiza glabra decocted in 1-2 pints of water for up to 10 minutes. This can be administered when cool at 1 tbsp every 2-4 hours 
  • Vitamin C: 1-3 g, up to 3 times per day 
  • Biotherapeutic drainage remedies as indicated 
  • Magnesium glycinate: 200-400 mg per day 

Allergies 

  • Natrum muriaticum 200C: 3 pellets up to 5 times per day 

Final Thoughts 

The younger the child is when parents seek eczema treatment – especially through a holistic provider – the more likely it is that the presence of asthma or allergies will be subclinical or nonexistent. Methods used to treat the immune system dysfunction that precipitates eczema often provide the triple benefit of addressing the atopic triad – all at once.12 A naturopathic approach to healing the gut and the skin coupled with elimination of triggers and infections gives a child a chance to get a handle on their health before they even remember there was an issue. 

 

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Autumn Frandsen, ND, received her doctorate in naturopathic medicine from the University of Bridgeport in 2011. She is certified through the Klinghardt Academy in Autonomic Response Testing and uses electrodermal screening and oral immunotherapy to treat allergies, skin conditions, and bronchopulmonary disorders. Dr Frandsen has extensive experience in treating autoimmune conditions, thyroid conditions, chronic Lyme disease, mood disorders, obesity, fibromyalgia, chronic fatigue syndrome, allergies, and dermatological conditions. She treats patients of all ages with Chinese medicine, homeopathy, herbal remedies, and nutritional and lifestyle modifications. Dr Frandsen holds licenses in Maryland and Washington DC and provides both in-office care and telemedicine. 

 

References 

  1. Lyons JJ, Milner JD, Stone KD. Atopic dermatitis in children: clinical features, pathophysiology, and treatment. Immunol Allergy Clin North Am. 2015;35(1):161-183. 
  1. Burgess JA, Lowe AJ, Matheson MC, et al. Does eczema lead to asthma? J Asthma. 2009;46(5):429-436. 
  1. Czarnowicki T, Esaki H, Gonzalez J, et al. Early pediatric atopic dermatitis shows only a cutaneous lymphocyte antigen (CLA)(+) TH2/TH1 cell imbalance, whereas adults acquire CLA(+) TH22/TC22 cell subsets. J Allergy Clin Immunol. 2015;136(4):941-951.e3. 
  1. Min YG. The pathophysiology, diagnosis and treatment of allergic rhinitis. Allergy Asthma Immunol Res. 2010;2(2):65-76. 
  1. Fireman P. Understanding asthma pathophysiology. Allergy Asthma Proc. 2003;24(2):79-83. 
  1. Moghtaderi M, Farjadian S, Kashef S, et al. Specific IgE to common food allergens in children with atopic dermatitis. Iran J Immunol. 2012;9(1):32-38. 
  1. Ryan GE, Harris JE, Richmond JM. Resident Memory T Cells in Autoimmune Skin Diseases. Front Immunol. 2021;12:652191. 
  1. Romagnani S. Th1/Th2 cells. Inflamm Bowel Dis. 1999;5(4):285-294. 
  1. Wood RA. Oral Immunotherapy for Food Allergy. J Investig Allergol Clin Immunol. 2017;27(3):151-159. 
  1. Mahler V, Dickel H. Wichtigste Kontaktallergene beim Handekzem [Most important contact allergens in hand eczema]. Hautarzt. 2019;70(10):778-789. 
  1. Paller AS, Kong HH, Seed P, et al. The microbiome in patients with atopic dermatitis [published correction appears in J Allergy Clin Immunol. 2019 Apr;143(4):1660]. J Allergy Clin Immunol. 2019;143(1):26-35. 
  1. Halken S. Prevention of allergic disease in childhood: clinical and epidemiological aspects of primary and secondary allergy prevention. Pediatr Allergy Immunol. 2004;15 Suppl 16:4-32. 

 

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