Episode 46: Hot off the press. What researchers are talking about at AAAAI Allergy Conference.
What to look out for in eczema moisturizers, why eczema babies have rosy red cheeks and can allergies transfer to baby from breast milk? Join Korey Capozza, Dr. Jessica Hui-Beckman (National Jewish Health) and Dr. Kirsi Jarvinen-Seppo (University of Rochester) to find the answers. If you like our podcast, please consider supporting it with a tax deductible donation. Read the transcript.
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Korey: [00:00:00] Welcome to the Eczema Breakthroughs Podcast. I'm Korey Capozza, founder of Global Parents for Eczema Research, and I just got back from the American Academy of Allergy, Asthma, and Immunology annual meeting in San Diego, California. It's one of the biggest conferences in allergy and immunology, and there was a ton of exciting new research that was shared at the meeting on emerging treatments as well as deeper insights into what drives this complex disease.
In this episode, I'll be [00:01:00] sharing some of the most interesting findings I came across,things that could change how we think about eczema and how it's treated in the years ahead. If you're curious about what's on the horizon for eczema care, stay tuned as we dig into the latest research shared at the AAAAI meeting this year.
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One interesting talk I heard was by Dr. Amber Reck Atwater from Duke Dermatology and George Washington University. She talked about how many patients with atopic dermatitis or eczema have reactions to the very products that they put on their skin for eczema. Things like moisturizers and cleansers, for example.
She mentioned a study published in JAMA Dermatology back in 2017, which found that of 174 best selling moisturizers found at stores like Walmart, Target, and so on, only 12% were free of potential skin allergens. Among the most [00:02:00] common allergens found in skincare products were fragrance mixes, formaldehyde releasing agents, lanolin, and surfactants.
Such chemical additives could actually make eczema worse, she noted, and she underscored the importance of screening for such ingredients, as well as performing patch testing to avoid sensitizing patients to these allergens through products.
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Another interesting study was shared by Dr. Jessica Hui from National Jewish Health in Denver. She shared her research about how rosy red cheeks in early childhood could predict later eczema. Here I am interviewing her about her interesting research.
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Could you tell our listeners a little bit more about your study, how you did it, and what you found?
So just to give some background, there have been a handful of birth cohorts that have looked to see if there are early life biomarkers to predict, if kids who have totally [00:03:00] normal skin who don't yet have eczema, but there's anything in the skin barrier that might predict who might go on to develop atopic dermatitis.
Up until now, some of these studies have gone down to about 6 weeks old or 2 months old and the vast majority of them look at the forearm. The thing about skin maturation is that each area of the body actually matures at a different rate. The cheek actually matures much slower. And so really the cheek maturity doesn't get to full steady state until about 7 years old.
So putting our thinking caps on, you know, when you first introduce foods and solids and all of that, you often think about food getting all over the face. And so our thought was, hey, let's look at the cheek specifically. And could this be a site of epicutaneous sensitization in some of our younger kids.
Korey: Just to interject really briefly, here, [00:04:00] can you explain sensitization for our listeners?
Dr. Jessica Hui: Yeah. So, when you become sensitized, the thought is, that it's happening through the skin. So it's exposure to some of these proteins that are able to penetrate an imperfect skin barrier, which we know is in eczema. So if you touch the cheek, the body might look at those foods as foreign.
Korey: So basically these kids with an undeveloped skin barrier on their cheeks might be exposed to food as they're eating and wiping the food on their face, and that might cause the body to overreact, thinking that the food is an invader or something foreign.
Dr. Jessica Hui: Right. So in our study, we enrolled a little bit over 20 patients and our goal was to look specifically at the cheek to see if there's anything in early life that might predict who will go on to develop eczema. One thing we were able to look at is transepidermal water loss.
Korey: Maybe we can just note that [00:05:00] transepidermal water loss is just how quickly the skin loses water, right?
Dr. Jessica Hui: Yeah, marker of the skin barrier integrity. And so we were able to use a superficial device to look at transepidermal water loss in our babies. We followed them within the first month of life, we followed them again at 3 months old. We obtained all of these samples and so in babies who go on to develop atopic dermatitis, they actually had higher levels of transepidermal water loss. And so this is showing that already early in life they have a more compromised skin barrier as it's allowing more water loss to escape through the skin.
We were able to use these specialized tapes, there are these adhesives that are very gentle, and so we pressed four of them against the baby's cheek during the birth visit and at 3 months old and we found that there's certain ceramides, especially protein bound [00:06:00] ceramides. And so these are components that make up our skin barrier and we want them in our skin barrier because they provide the structural integrity of our skin. And we found that these were actually significantly lower in babies with future atopic dermatitis. And going along with that there are certain amino acids that make up important structural proteins in our skin that were also found to be significantly lower. And then there was one cytokine, which another word for cytokines is alarmins. There are some that are made from the skin that kind of react in an inflammatory way, and so these were also increased in these babies with future atopic dermatitis.
So it was really exciting for us just being able to identify some early life biomarkers because this could be a strategy in the future for identifying who might be at risk [00:07:00] and seeing who we might need to develop prevention strategies for.
Korey: Right, so these are sort of early warning signs and you're able to see the specific alarms that are going off in the skin early before the atopic dermatitis develops.
I wondered, are the cheeks somehow better than the forearm or what is the advantage of the cheeks perhaps? So maybe this is a visual cue - if you could comment on that.
Dr. Jessica Hui: Yeah. So, in infants, the cheeks are certainly a hot spot for eczema and if you think about the skin barrier, still being immature, plus the cheeks are a common spot for flares that kind of sets you up for, having the ability for epicutaneous sensitization and things like that. And so that's why , we studied the cheek because it is just clinically relevant,
Korey: So say we got to the point where we're like, we're going to use a little bit of tape stripping on the [00:08:00] cheeks of babies to know if they're going to go on to develop eczema, if we did that, and we found these markers, what could we then do potentially to prevent the course and the later AD?
Dr. Jessica Hui: This is where a lot of our current studies are going to give us a lot of insight. What we did find is: decrease in our protein bound ceramides. And so, potentially replenishing with ceramide based emollients is important. When you're bringing your baby in and out of places and cheeks are a little red. Oh, hey, like, let me just protect my child's skin and apply some emollient and the first sign of any sort of inflammation or potential eczema I would treat it and just make sure that this doesn't develop into something more.
Korey: So thank you so much.
Dr. Jessica Hui: Yeah, it's good to see you.
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Korey: Other interesting research was presented by Dr. Kirsi Järvinen-Seppo. She's a [00:09:00] Professor and Chief of Pediatric Allergy and Immunology at the University of Rochester. Her research program looks at mother's breast milk, what's in it, and if it can protect against allergic disease in the future. Here I am interviewing her about her presentation at Quad AI.
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Dr. Seppo, your presentation was really interesting, and I think a lot of parents want to know the answer to the question. Does the mother's diet influence the later development of eczema or allergy? Could you talk a little bit more about your research and what you're interested in learning?
Dr. Kirsi Jarvinen-Seppo: What our program has been very interested in understanding is how much food antigen from mom's diet goes into breast milk. What are the levels? How many mothers secrete or excrete these food proteins in their breast milk? And whether those levels of, let's say, milk, egg, or peanut proteins [00:10:00] present in some mother's milk, might be a form of tolerance, induction for the infant. In my study at the AAAAI, we have shown that there's actually specific antibodies in breast milk that can, in higher quantities when received by the breastfed infant, can be associated with protection against that very same specific food allergy. And we know that these IgE antibodies are protective antibodies.
Once the baby ingest those, they can find their respective antigen, which is, let's say, egg. Egg specific IgE antibodies bind the egg, and prevent excessive amounts of egg antigens from being absorbed. Or they could be absorbed, but when they're presented in these, what we call immune complexes, when the food is complex with the antibody, it may make it appear less problematic or [00:11:00] dangerous to the immune system especially when it's an IgE antibody. We also showed that the infants who were not breastfed in our cohort, which again was small, but they have a much higher rate of developing egg allergy.
Korey: It makes sense because we know that it's better for the baby's immune system to experience food proteins through the gut versus through the skin. And so this is just a way for the infant to be exposed to those foods, or particles within those foods, very early on during the breastfeeding stage.
Dr. Kirsi Jarvinen-Seppo: Yeah, the early introduction guidelines now specifically ask you to introduce foods early, peanut and egg and others, starting at four to six months of age, because we know that gut exposure can, can tolerize for the most part, as opposed to delaying the tolerizing route and then being exposed through skin, through [00:12:00] inhalation.
We don't know as much yet about the capability of food antigens as they're present in human milk, whether they could do the same.
Korey: It's better for these children to be exposed through the gut but what about if you have a leaky gut, then it's like entering the body and causing this, you know, alarm.
Dr. Kirsi Jarvinen-Seppo: Yeah, the problem is we don't really know how to measure that. So we don't really know which infants might have inflammation in their gut. And which ones of those could have a leakier gut or a more permeable gut. Permeability itself may not also be so problematic. But if it comes with inflammation, for example, that might be more problematic. But truth to be told, we have no way, at this day and age, to really understand who has a leaky gut or who has inflammation and who, who [00:13:00] hasn't.
We are about to start the randomized controlled decentralized study where we'll be recruiting across the country as well as locally for a maternal intervention study where we'll be randomizing pregnant mothers to either ingest or avoid highly allergenic foods, specifically peanut and egg during late pregnancy and during lactation. And it's quite exciting.
Korey: That does sound exciting and hopefully you can add to this preliminary research showing a protective effect of ingesting those foods by the mother and then preventing the allergy in the baby.
Can we talk a little bit about breastfeeding and atopic dermatitis or eczema? Is there a protective effect there as well?
Dr. Kirsi Jarvinen-Seppo: Yeah, there's a fair amount of data, based on multiple studies. Systematic reviews and meta analysis have been able to conclude that, any [00:14:00] breastfeeding and longer periods of breastfeeding are related to less atopic dermatitis.
The best study that has actually gone at least a little bit closer is the study from Belarus that was done a couple of decades ago, where they looked at so called cluster randomized intervention, where they randomized half of the birthing centers for breastfeeding promotion program, where they promoted breastfeeding by educational programs, And breastfeeding success was, length of breastfeeding and rate of breastfeeding was actually increased as a result of this intervention in those birthing centers that received this intervention compared to those that did not. And, they also compared allergic outcomes in those infants. And they found that in the first six months of life. There was a protective effect by breastfeeding on development of atopic [00:15:00] dermatitis.
Korey: Yes, so the question is what's going on here. In the case of breastfeeding and food allergy, we assume the child is being exposed to the food, in a way, in a small amount, which is helping it recognize that food and to remain calm when it does see that food, whereas with eczema or atopic dermatitis, it's probably that breastfeeding is training the immune system early on, um, to behave appropriately by giving it the right things in the gut probably and the gut is where there's this interaction with the immune system. Um, does that seem like what's going on and is the book sort of closed on this question of breastfeeding and eczema or atopic dermatitis?
Dr. Kirsi Jarvinen-Seppo: Yeah, it is. It is AAP guideline recommendation and there is evidence to suggest that that can prevent development of atopic dermatitis and again, early wheezing and potentially [00:16:00] asthma. Although there is no great evidence for food allergy. I believe that there could be a protective effect. My studies show and suggest that there could be a protective effect. And I think we will learn a little bit more about this.
Korey: Thank you so much.
