Elemental diet for refractory atopic eczema

Article Abstract:

Atopic eczema, a skin condition caused by allergic reactions which tend to have a genetic basis, usually responds to medications and avoidance of the substances that stimulate the allergic reaction. However, a very few children with the condition do not respond to such therapy, and alternative treatments such as local or systemic steroids, photochemotherapy, cyclosporine, or cytotoxic agents (cell-killing drugs which modify immune cell function) may be variably effective while also sometimes leading to complications. As a last resort, treatment using an extreme antigen avoidance regimen, in which possibly allergic influences such as foods, pets, and dust mites are avoided by affected children, may be attempted. In this treatment, the child is hospitalized and receives an elemental diet, in which food components such as sugars and amino acids (the building blocks of proteins) but not whole foods are given, and the measures to reduce the level of dust mites and pet-related antigens (allergy triggers) are taken. The effectiveness of such a program in treating 37 children with refractory atopic eczema is described. An elemental diet was given for four to six weeks, depending on the response, before individual foods were reintroduced and checked for allergic responses. The diet caused loss of up to 17 percent of body weight, and serum albumin, a blood protein that reflects nutritional status, fell significantly. Four patients did not respond to the elemental diet. Six patients, classified as late failures, initially responded to the elemental diet but relapsed within 12 months and required steroid treatment. The other 27 patients (73 percent of the entire group) responded to the treatment. Initial improvements were usually observed by two weeks on the elemental diet in responders, but noticeable changes in skin lesions were usually apparent only after four weeks. This was reflected in a decrease in medication, so that 26 of the 27 responders were using emollient lotions only. Seventeen children reacted 40 times to 13 foods, out of 107 total food challenges. Nineteen children, upon return home, reacted to pets, house dust, or skin contact with grass. These results are discussed in terms of the difficulties in treating severe atopic eczema. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Allergy in children, Pediatric allergy, Food allergy in children, Pediatric food hypersensitivity, Elemental diet

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Holidays and atopic eczema

Article Abstract:

Atopic (allergy-associated) eczema can be very severe in children, and parents and physicians frequently tend to focus on triggers that worsen the condition. However, this can mean that factors which improve the condition may be overlooked. Severe skin lesions may improve dramatically when patients go on vacation, but the reasons for the improvement have not been studied. To evaluate these factors, 126 British children with severe atopic eczema and their parents were surveyed about the effects of a total of 300 vacations taken over a three-year period. All vacations were taken in the summer, and eczema severity was much improved on 22 percent of the holidays, slightly improved on 15 percent of holidays, did not change on 42 percent, became slightly worse on 13 percent, and got much worse on 8 percent of holidays. Overall, improvement occurred significantly more often than worsening of the eczema. Improvements most often occurred between the second and seventh days of vacation, while deterioration usually occurred by the fourth day. Deterioration occurred more often in northern Britain, while improvement was significantly correlated with southern holiday destinations. Holidays taken in southern Britain were correlated with improvement, particularly if stays were longer than 10 days and the weather permitted ocean swimming and sunscreen to be used. In patients who had asthma as well as eczema, improvements in asthma correlated significantly with improved eczema, and similar improvements were found in parents with atopic diseases. Removal from homes with pets did not correlate with improvement, although decreased exposure to house dust mites or other environmental triggers may have played a role. Eczema reverted to the preholiday state, usually within two weeks of return. The factors underlying improvement in eczema during vacations could not be further identified; this will require more research. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Environmental aspects, Ultraviolet radiation, Latitude

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Dietary treatment of atopic eczema

Article Abstract:

Eczema is a noncontagious inflammation of the skin marked by redness, itchiness, and sores that become encrusted and scaly. Standard treatment includes antibiotics, bandages, lotions, steroids, antihistamines, and avoidance of irritants in detergents. However, when the condition persists, dietary control might also be a possible way to relieve the symptoms of eczema. Information available from food studies illustrates many difficulties on carrying out and interpreting allergy tests, but has established that eczema can result from intolerance to cows' milk. The author recommends that an elimination diet be tried for at least a six week period if (1) topical treatment is ineffective on extensive eczema; (2) the patient is less than one year old, because diets are simpler to control and manage, and results are supposedly better in this group; (3) eczema occurs in infants fed only breast milk because of the established fact that an intolerance to cows' milk can induce eczema; (4) patients have other systemic problems such as asthma (check pets and dust mites); and (5) the parents have a vested interest in trying a diet. Some patients, albeit a small percentage, benefit from diet therapy and food avoidance, but for the majority of eczema sufferers, simple, conventional methods of treatment are sufficient to manage their eczema. (Consumer Summary produced by Reliance Medical Information, Inc.)

Demographic aspects, Skin diseases

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