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Treatment of eczema, asthma, and allergic rhinitis in children
September 1st, 2018 + The Naturopathic Co.

SPEED READ>> A possible rise in allergies has been linked to a combination of increased hygiene, including chlorination of water, as well as changes in agriculture. Early disruption of the infant microbiome increases the likelihood of the development of eczema, asthma, and allergic rhinitis, and so intestinal barrier function plays an important role in treatment and management, alongside immune regulation and organ-specific support. Common triggers can be dust mites, feathers, cockroaches, animal dander, exercise, pollen, respiratory viral infections, smoke, cold air, chemical exposure, and sulfites.

Developing eczema in infancy is a risk for developing asthma and allergic rhinitis. 50% of children with atopic dermatitis will go on to develop asthma, and 75% will go on to develop allergic rhinitis (Bantz 2014).  This is known as the atopic march.

Why the increase in eczema, asthma, and allergic rhinitis in childhood?

There was little awareness of allergic disease before the first description of hayfever in 1870. Incidence of childhood asthma started increasing by the 1960s and was an epidemic by the 1990s (Platts-Mills 2015).

A possible rise in allergies has been linked to a combination of increased hygiene, including chlorination of water, as well as changes in agriculture.

Infant microbiome link

Early disruption of microbiome increases the likelihood of the development of eczema, asthma, and allergic rhinitis (Dzidic 2017). A contributing factor to these conditions early in life is the development of the microbiome by commensal bacteria (vaginal/caesarian delivery, breastfeeding/formula fed, pre and post-natal antibiotic intake), allergen exposure early in life (cockroaches, dust mites, molds, pets), toxin exposure (pesticide, cleaning products, plastics, chemicals), and exposure to air pollution (industrial, vehicle emissions, tobacco smoke).

Atopic dermatitis

Atopic dermatitis can be very uncomfortable due to the itching of dry, red skin that may easily become infected. It often starts within the first 6 months of life and comes and goes with intense flares.

In infants dermatitis often effects the face, scalp, and trunk, and for older children often the skin behind the knees and in front of elbows. There is very often a family history of eczema, allergy, or asthma.

The good news is that 85% of children have usually outgrown atopic dermatitis by the time they are 5 years of age and their immune system is more developed (Zave 2001).

Gut barrier

Intestinal barrier function plays an important role in the management of atopy disease in children, with foetal to childhood gut microbiota colonization an integral aspect to healthy immunity.

Did you know? Some specific probiotic strains modulate the immune system, improve barrier function, and discourage the adherence of dysbiotic microorganisms. The effects of these selected probiotic strains on the prevention of dermatitis have been proven in a double-blind, randomized, and controlled studies. Results showed that supplementation of specific strains within the first 12 months of life was correlated with a significant decrease in the number of infants with eczema versus the placebo group (Niers 2009).

Barrier function inhibits pathogenic microorganisms from entering the bloodstream. Production of short chain fatty acids as well as beneficial gut bacteria aids the modulation of immune responses in atopy.

Dietary allergens and autoimmune link

IgE-mediated food allergies are known to be a causative factor in atopic dermatitis, with food allergies coexisting in children that develop dermatitis as an infant, and those with familial predisposition. Dermatitis can result from immune dysregulation, with atopy individuals also being more susceptible to autoimmune conditions.

Tips for treatment of atopic dermatitis

Identify possible triggers in consultation with your naturopath. Seek a treatment plan and use functional testing to confirm allergens if required (food, environmental).

Be aware of fabrics (wool), chemicals, detergents, soaps that can worsen symptoms.

Avoid the skin becoming overheated.

Control the itching. To reduce the itch use a soft wet towel for 5-10 minutes.

Keep dry skin thoroughly moisturized with two applications per day. Speak to your naturopath about topical applications. Symptomatic relief such as wet wraps enhance the water content of the skin and barrier function and reduce skin trauma.

Be aware that viruses, vaccinations, teething can cause flares, and therefore seek immune activation during these times, as well as a preventative measure.

Try to control the flare as soon as possible.

Specific support for the skin includes sunflower seed oil, coconut oil, manuka honey, and chamomile.

Allergic rhinitis

Allergic Rhinitis is characterised by continuous or periodic nasal congestion, itching of the nose, roof of the mouth, back of the throat and eyes, watery eyes, inflammation of the lining of the nose, and sneezing. Symptoms vary from person to person, however some people may also develop wheezing, coughing, and headaches.

All of these symptoms have a significant impact on quality of life, learning, decision making, sleep, and may cause a person to become irritable and depressed. Allergic rhinitis often coexists with asthma and eczema.

Functional skin testing combined with the person’s history of symptoms can assist in determining the allergen.

Antihistamine medications have side effects such as drowsiness, dizziness, and tinnitus, tremors, central nervous system disturbances.

Treatment aims to reduce the impact of the allergen by minimizing exposure, reducing the immune response to the exposure, and improving resistance.

Symptomatic relief can be provided by saline nasal solutions. Your naturopath may add drops of a herbal preparation to the saline solution.

Key nutrients in the treatment of allergic rhinitis

A highly nutritious diet with the avoidance of mucus forming foods and trigger foods.

Nutritional supplementation should be centred around fighting infection, easing symptoms, supporting immunity, and reducing inflammation. Important considerations are zinc, vitamin C, quercetin, vitamin D, vitamin E, vitamin A, NAC, and bromelain.

Herbal medicines for allergic rhinitis

Herbal medicines should aim to reduce the allergc response, support immune regulation, and reduce inflammation. Herbs that may prove beneficial are Albizia lebbeck, Scutellaria baicalensis, Urtica dioica, Curcuma longa, Allium sativum, Sambucus Canadensis, Amoracia rustica, Euphrasia officinalis, and Hydrastis Canadensis.

Asthma

The prevalence of asthma is increasing worldwide. Asthma is a chronic inflammatory disorder of the airways that frequently presents in childhood, but can commence at any age.

It is characterized by airway obstruction and hyper-responsiveness, causing wheezing and shortness or breath. These symptoms may be triggered by multiple stimuli.

Early life impacts

Risk factors are increased with maternal history of asthma, eczema, hayfever, or maternal smoking.

Did you know? Research has shown early asymptomatic colonization with streptococcus pneumoniae to be a strong asthma predictor (Teo 2015). The timing of the initial lower respiratory colonization and disruption to the microbiome and the age of the child was a strong factor.

Antibiotic use in the first year of life is associated with the development of asthma later in life. For asthma treatment we need to be looking at what is damaging the lung barrier. Which toxins is the child exposed to, or what have they been exposed to in the past.

Common triggers

Common triggers for asthma are dust mites, feathers, cockroaches, animal dander, exercise, pollen, respiratory viral infections, smoke, cold air, chemical exposure, and sulfites.

Did you know? Research suggests that chlorine is also a key factor in causing irritation to the lungs (Matzinger 2012).

Key nutrients in the treatment of asthma

An increase in antioxidant intake provides a protective factor against asthma, including a varied diet with increased levels of vitamin C, vitamin E, and foods high in omega 3 fatty acids.

Specific nutrients to consider by supplementation are B vitamins, vitamin C, vitamin D, magnesium, omega 3 fatty acids, coenzyme Q10, flavonoids, probiotics (strain specific), and NAC. Asthma treatment should be specific to the phenotype.

Herbal treatments for asthma

Herbal medicines should reduce the allergic response, reduce bronchorestriction, reduce inflammation, and support immune regulation. Herbs to consider in treatment are Boswellia serrata, Coleus forskohlii, Gingko biloba, Euphrasia species, Inula helenium, Verbascum Thapsus, Hydrastis Canadensis, Glycyrrhiza glabra, Albizia lebbeck, Scutellaria baicalensis, and Echinacea purpurea.

Treatment links for eczema, asthma, and allergic rhinitis

When looking at the treatment of atopy in children, it is important to cover three crucial aspects: barrier function and microbiome, immune regulation, and organ specific support.

In order to improve the microbiome, a gluten-free, high fiber, and polyphenol-rich diet should be adhered to (for example, resveratrol, grapeseed extract, and green tea). There should be some targeted antimicrobial support to heal gut dysbiosis, and some attention to rebuilding commensal bacteria with prebiotics and probiotics. Supplements to consider for treatment are quercetin, resveratrol, curcumin, vitamin C, and vitamin D, and herbal medicines should have immune modulating actions.

For best results, be sure to seek a treatment plan from your naturopath or health care provider.

References

https://www.ncbi.nlm.nih.gov/pubmed/25419479

https://www.ncbi.nlm.nih.gov/pubmed/27531072

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2805592/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4433433/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4803042/


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