Microplastics, baby skincare, and bonus benefits of biologics:The most interesting news from the European Allergy Meeting

By Korey Capozza, executive director

The coldest winter I ever spent was a summer in Glasgow, Scotland. This year’s convention for allergists and immunologists based in Europe (though attended by researchers and physicians from around the world) was held in the Scottish city, and it was the coldest, most blustery June I can remember. But the terrible weather was perfect for attending scientific sessions related to eczema and allergy, and the meeting was packed with new research breakthroughs and helpful insights. Below are three topics that caught my interest at this year’s meeting:

1. A Critical Window: Early Life

​A talk by Dr. Debby Bogaert, head of the Department of Pediatrics at the University of Edinburgh, explained how microbes that colonize a child in the first 100 days of life may be the most important for later immune system function when it comes to allergic conditions and infections. She noted that when beneficial bacteria are present in the respiratory tracts of children during this period, they have a lower risk of future infections compared to children who don’t have such bacteria. She also explained her research showing that early infection with viruses may push the immune system toward inflammation and an overactive immune response. Dr. Bogaert’s research provides hints about how different microbes interact with a child’s immune system to shape future health. 

A second presentation by Dr. Robert Boyle, a pediatric allergist with Imperial College London, summarized research on bathing practices in children with eczema and noted that reduced bathing in the baby years may help reduce eczema risk and symptoms (a study is currently underway on the topic in the UK). He also shared research on the impact of “hard” or mineral-rich water on children’s skin – it can cause dryness and may increase the risk of eczema. Likewise, overuse of detergents and soap on delicate baby skin may contribute to skin barrier damage. However, more research is needed, he noted, to determine if interventions such as installing water softeners or reducing soap use, can improve skin barrier health.

2. You are what you eat: Tiny plastics and chemicals in our bodies

A session devoted to environmental exposures mentioned a newly identified threat: very tiny pieces of plastic that persist in the environment, so-called “microplastics” or “nanoplastics”. These very small bits of plastic are now everywhere and we are all breathing, ingesting, and touching them on a daily basis. 

Extra-small nanoplastics can migrate through the tissues of the skin, digestive tract, or lungs and into the bloodstream. When they come into contact with the body’s protective surfaces, epithelial barriers (including the skin), they cause inflammation, according to several studies. This inflammation, when chronic, leads to allergic conditions like eczema.

A second threat comes from chemicals added to processed foods, which damage the gut and promote inflammation. 

Two speakers at the meeting outlined their research on this topic: Dr. Cezmi Akdis and Ismail Ogulur both from the Swiss Institute of Allergy and Asthma Research. Dr. Akdis called this particular type of inflammation to the body’s epithelial barriers, “epithelitis”, and suggested that it’s linked to a host of chronic diseases, including eczema. Such inflammatory conditions are a direct result of damage to the skin (or gut) which then allows microbes to enter, causing the immune system to respond, ultimately leading to chronic inflammation, he explained.

3. Bonus Benefits of Biologics

An interesting talk by Dr. Marjolein De Bruin-Weller, a dermatologist from the University of Uchtrect in the Netherlands, described insights gleaned from a large database of patients (1300 individuals) using “biologic” drugs for eczema, such as dupilumab, lebrikizumab and tralokinumab. The database, or registry, contains long-term (5 year) follow-up data, and shows some interesting trends: patients using dupilumab had an even lower infection risk than those who used topical steroids alone. They also had improved asthma and food allergy indicators. This is great news for people using such therapies for many years. 

The registry also provides helpful information about the long-term side effects associated with these therapies. Eye inflammation and other complications occur in about one-third of users of dupilumab and about 15% of users of lebrikizumab and tralokinumab. Less common side effects (5% or less) included red face, muscle and joint pain and alopecia.