Eczema is a chronic inflammatory dermatosis that affects 20 percent of the population in industrialised nations, and usually manifests in early childhood. Known also as atopic dermatitis, there is evidence to show that it may give rise to conditions including asthma, food allergy and allergic rhinitis. The precise origins of eczema are not fully understood, suffice to say that a complex interaction between genetic and environmental factors have been implicated in the predisposition and development of the disease. Regarding genetic prediposition, eczema is associated with the foloowing:
* Abnormalities in genes encoding the skin barrier molecules (filaggrin)
* Abnormalities in the cells governing inflammatory responses in the body,
* Abnormalities in the mechanisms regulating the immune system
* Elevation in serum immunoglobulin (IgE)
* Impaired delayed hypersensitivity reactions
* Infectious agents
Of particular interest is the gene responsible for altering hydration of the skin, filaggrin. Professor Irwin McLean and his team from the college of Medicine, Dentistry and Nursing at the University of Dundee reported that defects in the filaggrin gene can cause dry skin, eczema, eczema associated asthma and allergies. At the time of writing Professor McLean and his team have identified 15 mutations in the gene. If you are found to have one of these mutations you have a 60 percent chance of developing eczema, however, if you have two mutations in your gene you have a 100 percent chance of developing eczema. In recent years, geneticists in the United States and Germany have been able to screen for mutations in the filaggrin gene at a cost of $US500. A worthwhile assessment, if the aforementioned factors prove negative.
Food allergy appears to play a role in a subset of patients with eczema, primarily infants and children with severe eczema. Identifying this subset of patients and isolating the relevant food allergens requires a high index of suspicion based on a well taken clinical history, use of appropriate laboratory tests, and in some cases, oral food challenges. Maternal dietary restrictions during pregnancy or lactation do not appear to have any effect on the incidence or severity of eczema, yet, research strongly supports the notion that breastfeeeding, up to and beyond 6 months, can help to reduce the incidence of eczema, especially in infants with a family history of eczema. Moreover, nutritional interventions such as the use of essential fatty acids, may have an effect on eczema.
Research has demonstrated that a combination of food allergy (of particular note, citrus, cow's milk, nuts and fish), defects in the gut mucosal barrier (prominent in irritable bowel syndrome), and increased intestinal permeability may be associated with the development of eczema.
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