Episode 40: Who gets eczema and who grows out of it - and why? Are detergents, antibiotics and tiny plastics to blame?

Jun 26

Written By Global Parents for Eczema Research

Korey Capozza travels to Spain for the European Academy of Allergy and Clinical Immunology Congress where she speaks to researchers that are trying to explain the allergy epidemic and what we can do about it. Highlights: Dr. Magdalena Zemelka-Wiacek (Poland) explains microplastics cause inflammation. Tami Landau (Israel) uses “big data” to determine which children will develop eczema, and Dr Thomas Bieber (Germany) utilizes biobank data to study why some children go into remission. (And if you like our podcast, consider supporting it with a tax deductible donation). Read the transcript.

Lynita: Hello and welcome to the podcast. Earlier this month, June 2024, Korey Capozza, founder of GPER, traveled to Spain to attend the European Academy of Allergy and Clinical Immunology Congress. This is an international gathering of more than 8,000 allergists, immunologists and researchers. Korey, what was the focus this year?
Korey: One thing that was neat for me this year was that it had a particular focus on artificial intelligence tools. As well as the causes of the allergy epidemic, which are questions that we're interested in.
Lynita: I know you were looking out for research that is relevant to eczema. Can you share some of the talks that you attended and why they are important? Was there anything new about what causes eczema in the first place?
Korey: Yeah, thankfully, there was quite a bit on that and actually a lot of the attention was on eczema at this allergy meeting because eczema typically comes first. And as the gateway to things like food allergy and asthma, and some of these other allergic conditions. And as they say through the skin allergies begin. So I was really heartened to see all the attention being paid to eczema at this meeting. And the reasons why it might be on the rise among children worldwide. Eczema is kind of the first domino to fall.
And so if we can understand what's causing eczema or how to stop an eczema. We can probably also figure out how to prevent food allergy, asthma and some of these other, what they call inflammatory conditions that develop over time. We're starting to learn a lot more about how to treat eczema and allergy, but we still don't know how to prevent it. While that number of children, who are developing allergic diseases continues to go up. And we just really don't know why.
At this meeting, there was a lot of attention on the exposome, which is a term that refers to like the full spectrum of things that we're now exposed to that may impact our health. These are things like chemicals in our food, in our home air pollution and even tiny plastic particles that are now really everywhere.
And one presenter from the Swiss Institute of Allergy and Asthma Research, Ismail Ogulur, talked about the impact of an ingredient in processed foods. This ingredient is designed to increase the shelf life of otherwise perishable ingredients. These are things like emulsifiers and preservative agents. And they've been added to so many packaged foods today, things that come in a wrapper, for example, Unfortunately, we're realizing that they also probably wreak havoc on the health of our gut, where the immune system is first trained. And this may be one reason why we see this rise in allergies and immune system driven conditions like eczema, or at least partly contribute to it.
A second study pointed to toxic cleaners and detergents in the home, and one poster showed that laundry detergent in particular can damage the skin barrier, even with just short exposure time, say five minutes, for example. The lead author, Juno Kim, also from the Swiss Institute of Allergy and Asthma Research, said that these chemical surfactants, as they're known, are found in many detergents that are sold in markets today, and they seem to clearly compromise the integrity of the skin when looking at laboratory models.
Still other research looked at how the body responds to exposure to tiny plastic particles which are now essentially everywhere as a result of our overuse of single use plastics and other industries. Dr. Magdalena Zemelka-Wiacek from Wroclaw Medical University in Poland. Shared her study results with me. After she presented at the meeting.
Dr. Zemelka-Wiacek: My research is about nanoplastic assessment and cytotoxicity to humans.
Korey: You gave a presentation today that was talking about the health threat of nanoplastics. Can you talk a little bit about what a nanoplastic is and why we should care about how it impacts our health?
Dr. Zemelka-Wiacek: Okay. So we have a lot of plastics that we made from different sources, mainly from fossils. However, some of them might be made again from used plastics. And they're just breaking down, so they're getting smaller and smaller. They can flow in the air so we can inhale them or we can just eat them because they are floating in the water, fishes are eating them and then we eat those fishes.
You can actually see it with a microscope and this is how they find plastics and feces in blood and placenta. There's more and more data about correlation of the intake of plastics with some diseases. So we assume that these plastics is harmful to different tissues. And our health.
Korey: So heard you say this morning that most people are, we estimate, ingesting enough plastic that's the size of a credit card each week. How is that possible? That's a lot.
Dr. Zemelka-Wiacek: So there's a lot of plastic in the water. Especially in the plastic bottle, bottle water, so there's more plastic in these bottles than in tap water. The plastic can be found in salt, in honey, in fish, in meat, in really a lot of food. Pretty much every food that is being assessed has the plastics and also we inhaled them, but we don't know how much is going through our respiration system. This is not assessed. Just there are a few studies and the amount of plastic around five grams, maybe a little bit more. And when they get in the body, what is the problem?
What happens when we have too many nanoplastics in our body? What happens later? How much do we accumulate? How much do we eliminate? And what happens? Does it break? How fast does it break in our organism? Because we don't know that, right? Does it, this microplastic breaks in nanoplastic in week, month, year? We don't know.
Korey: But we do think that it's causing inflammation in the body and damaging the epithelial barriers, right?
Dr. Zemelka-Wiacek: Yes, exactly. So, there's a really long way to say it with 100 percent sure. Yes, this is the mechanism. This is how it works. But when you search and look at different studies, a lot of them tells us that there's some inflammation going on. We have immune cells, like monocytes, macrophages are being activated. They release proinflammatory particles that can drive to inflammation.
Korey: And you see these changes in the cells going on with exposure to nanoplastic.
Dr. Zemelka-Wiacek: Basically what we found that blood cells, different blood cells, immune blood cells and also erythrocytes change when they're exposed to plastic. We're not sure right now what that means and what is the effect, but we know that they are proinflammatory. So the inflammation is going on. something is going on and obviously further research would be needed to find it out.
Korey: That was a very intriguing finding.
Lynita: Intriguing and a little worrying. I know another field that's advancing quite fast at the moment is our ability to predict which babies will develop eczema. Were there any talks about that at the Congress?
Korey: Yeah, the meeting also showcased advances in our ability to predict who will develop eczema, mostly using what we call big data and computational techniques. One group is using data stored in thousands of electronic medical records to figure out which children will go on to develop eczema and hopefully how to prevent it. Here is the lead investigator, Tami Landau, she's head of data science with a company called Myor, and she's here describing her research.
Tami Landau: We use the electronical medical records. So it's big data driven algorithms for predicting early atopic dermatitis. So the cohort was about 70,000 as the control and 7,000 as the study. We try to predict as early as possible. So we have few algorithms. One of them is the prenatal and we use the more information about parents and siblings, if they exist. And we have another algorithm, and it's up to six months old, and another algorithm that's a bit further down the line, but the main goal is as early as possible, because we know that atopic dermatitis develops in a very early age.
Korey: And then what were the parameters that you found that were predictive of AD in prenatal and early childhood?
Tami Landau: So we found a few interesting predictors. First, family, of course, family history. So if the parents have already any atopic condition, if the mother had it while she's pregnant, if the siblings already have any kind of atopic condition. And another interesting parameter was the antibiotics. And if we predict at a prenatal stage, then even if the mother had consumed antibiotics during pregnancy, it was quite a significant risk factor. So that was interesting. And if we predict a bit further down the line, then if the infant himself consumed antibiotics, it's of course also a risk factor.
Korey: This is yet another study pointing to the importance of maintaining a healthy gut and skin microbiome early in life. Maybe even in the prenatal period. And using antibiotics may kill off some of those microbes that help train the immune system. And ensure that it responds appropriately in the future.
A second group led by Dr. Thomas Bieber from the Kühne-Foundation medicine campus in Davos, Switzerland is taking a slightly different approach using samples in a biobank and a registry of patient data to learn about the different types of eczema. How the disease will develop over time and how to match individuals with the best treatment for their particular and unique type of disease. Here's Dr. Bieber talking with me about his presentation and cutting edge research.
Dr. Thomas Bieber: I have learned in this work the mistake that we have done, in considering atopic dermatitis as a, as a single uniform disorder. What I've learned is that the huge potential of stratification of the patients, particularly the higher the phenotype complexity is, the more is the need for this kind of stratification and precision approach. And that's the reason why, it would make sense to a project that is mainly focused on a patient registry, including all the patients. We are starting from the birth, including the oldest patient, my oldest patient was 99 years old.
All the severity forms. with all the kind of information that you can collect from these patients. So it's a huge questionnaire, from more than 50 sites that the patients have to to fulfill. And on top of that this is coupled to this quite unique biobank system, where from each patient we have a skin microbiome swabs, we have blood, and are taking biopsies and it's a longitudinal study, it's not a screenshot, but we are observing the patients for five years at least.
And we now have more than 2,500 patients, including Control individuals. so we have this project now running. And it's, it's really a gold mine. Because based on that huge amount of data, we can ask a lot of questions and we can answer a lot of questions. This is a huge asset, which will hopefully enable us to unravel the complexity of this disorder.
And with that kind of tool in our hands, we are putting a lot of efforts in trying to identify biomarkers that would predict the emergence of the disease in order to find out whether it's possible in the future to, to stratify the newborn population into those that certainly will develop atopic dermatitis and where it makes sense to, to provide educational and also interventional tools in order to prevent or to block the appearance of the disorder and potentially also everything which emerges afterwards, i. e. the atopic mudge.
Dr. Thomas Bieber: The other project, which is very fascinating, the issue of the spontaneous remission. As you know, more than half of the kids that are affected by the disorder will lose the disorder by some kind of spontaneous remission before the puberty. And this is a huge black box. Nobody understands what is going on here. We don't understand why. Small kids that had the disorder, even very severe forms, why they suddenly lose this disorder. And then, then it's complete quietness for either rest of the life, or as we have seen now in, in many cases, for reasons that we do not understand, the disease seems to be reactivated 20, 30,40, 50 years later in the same patient.
We think that the lessons learned from this kind of insight will provide us potentially also a lot of information and potentially targets and, and interventions that could be of value in the future. So, these are just two aspects of this huge research program that is currently running and supported by the Kühne-Foundation.
Korey: Very interesting research by Dr. Bieber’s group and we'll be watching that closely as it unfolds.
Lynita: Absolutely. It's such a black box, as Dr. Bieber says, why some kids just outgrow eczema. Moving on to what we all want to know. Did anyone at the Congress talk about how we can prevent eczema?
Korey: Yes. the most hopeful presentation showed at the meeting touched on how we can prevent allergic diseases, food allergy, and eczema in the future, which is the passion of our organization. GPER.
Lynita: Absolutely!
Korey: First comes Dr. Gideon Lack of Kings College in London who shared follow-up data from a cohort of babies who were part of a large trial to see if the early introduction of peanuts could actually prevent peanut allergy. And the answer is yes, it can dramatically reduce the risk of developing peanut allergy. And those benefits likely extend well into the adolescent years and beyond. And that was the data that he shared at the meeting. Among infants with eczema sustained peanut consumption beginning in the first year of life was associated with an 80% or more reduction in peanut allergy. And that benefit persists well beyond the infant years.
Meanwhile other researchers reported on the promise of restoring the gut and skin barrier using good bacteria and their metabolites. More to come on that topic at our research symposium this fall on October 24th.

Lynita: Thank you Korey. And if you were interested in that topic and in attending our event virtually, please be sure to sign up for our newsletter at GPER.org/newsletter. That is G P E R.org forward slash newsletter. Thanks for joining today's episode Korey and telling us all about your trip to Spain.
Korey: Thank you