Ask the Ecz-perts: Allergies

In Ask the Ecz-perts, leading medical experts answer your most pressing questions about eczema and its related conditions.

In this edition of Ask the Ecz-perts, Ari Zelig, MD, allergist and immunologist at the Asthma and Allergy Associates of Florida, answers questions about allergy shots, patch testing, contact and environmental allergens, and allergic reactions.

Why do some people with severe eczema also suffer from severe allergies and asthma?

Patients with atopic diseases have skewed TH2 immune responses. The arms of the immune system, which are overactivated in atopy, cause inflammation and production of a specific immunoglobin E (IgE) targeted against environmental and food allergens.

Eczema is often the first step of the atopic march. Food allergy, rhinitis and asthma are the other commonly associated atopic conditions. Some patients are lucky enough to outgrow eczema but then develop these other atopic conditions.

Are there any risks of AD in children if their parents only have asthma and hay fever?

Eczema is a complex skin disease with both genetic and environmental components. Any family history with atopy — diseases such as food allergy, eczema, allergic rhinitis (hay fever) and asthma — is a risk factor for development of eczema and other atopic conditions among children.

You mentioned in a recent webinar that eczema is usually the first step in the atopic march. I was wondering if this is also true for people who develop eczema in adulthood?

A small percentage of people develop eczema later in life. It may occur alone, but sometimes people do develop asthma or environmental allergies after childhood as well. You can consider immunotherapy (allergy shots) if you have environmental allergies. Allergy shots may protect against the development of allergic asthma.

Are allergy shots for pollen helpful in reducing eczema?

Allergy shots are typically given to patients with asthma and allergic rhinitis/hay fever. They may benefit some patients with eczema as well. The best data that we have for allergen immunotherapy (allergy shots) is with a dust mite allergy. Allergy shots may decrease the inflammatory responses you have on the skin due to environmental allergy exposure.

What are some ways to help make a home or room environment allergy free?

• Mold: These thrive on humidity, so avoiding use of a humidifier is wise. A dehumidifier would be helpful.
• Dust mite: Vacuum often, removing carpet is beneficial, washing sheets/pillowcases in hot water weekly and using dust mite covers are also helpful.
• Pet allergen: Keep pets out of the bedroom, bathe them weekly and get a HEPA air purifier.
• Pollen: Keep windows closed and shower before bed so you don’t inhale pollen all night.

Four of my five kids have some form of eczema. Three of those four have food allergies and two of them also have asthma. My son with the severest eczema struggles the most with his hands and feet; he has recently started getting patches on the bottom of his feet. Why does the location of eczema flares change as kids age?

The location affected by eczema often changes. It usually starts on the torso and face, and later affects typical sites like elbows and knees. Why it affects those areas, honestly, I am not sure. Some people have eczema that is way worse on the hands and feet — we call this variant dyshidrotic eczema.

If an atypical location is involved, patch testing may be considered in order to evaluate for a possible contact dermatitis diagnosis. I wouldn’t patch test often unless suspicion is high for a new contact allergen playing a role. If it seems a particular product is becoming problematic, you can consider repeating the patch test.

My son started to have runny nose and congestion at 2 weeks old, and this has been going on until now (12 months old). Is this an allergy to milk, dogs or the environment?

Ongoing runny nose and congestion are symptoms that are usually due to inhaled allergens. If there is a dog in the home, you can certainly have your child tested for a possible dog allergy as well as other environmental allergens. At age 1, it is unlikely to be pollen related.

I have found a large sensitivity to toothpaste. I am particularly sensitive to the peppermint, spearmint, coconut oil and teeth whitening ingredients often found in toothpastes. 

You can be allergic or sensitive to ingredients in toothpaste. I would avoid sodium lauryl sulfate. Try CloSys toothpaste. I would advise patch testing so you can get to the bottom of which allergen may be causing this.

What are your opinions of metal-on-metal hip joints and eczema when the metals are cobalt/chrome with a titanium spray for bonding?

Contact dermatitis with metals can lead to implant failure. If you have a history of metal hypersensitivity, patch testing to an array of metals commonly used in orthopedic implants is important before surgery. Depending on patch test results, your allergist can help guide your orthopedic surgeon in their choice of implant. If you do not have a history of metal hypersensitivity, however, you don’t need to have patch testing done in advance.

Is a systemic nickel allergy syndrome a mixed immune-mediated adverse food reaction? Or something else?

You are referring to a systemic contact dermatitis, which is a type 4 hypersensitivity reaction. It is immune mediated and specifically involves T cells. Systemic contact dermatitis presents with a rash, which occurs due to ingestion of a typical contact allergen. Sometimes this can occur with medications that contain allergens. Reactions to nickel-rich foods is possible but very rare.

Contact dermatitis is a type 4 hypersensitivity reaction and often coexists with eczema. Patch testing is helpful to determine which contact allergen is playing a role. The location of your eczema may be a clue that a contact dermatitis is involved. For example, eyelid dermatitis can be a sign of allergy to a contact allergen in cosmetics or shampoo. Hand dermatitis can be due to an allergen in hand soap. Rashes around jewelry may be a sign of a nickel allergy. I advise seeing a dermatologist or allergist for patch testing.

Ari Zelig, MD, allergist and immunologist, Asthma and Allergy Associates of Florida.

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