Atopic Dermatitis (cont.)
What are allergens?
Allergens are substances from foods, plants, or animals that provoke an overreaction of the immune system and
cause inflammation (in this case, the skin). Inflammation can occur
even when the person is exposed to small amounts of the allergen for a limited time. Some examples of
allergens are pollen and dog or cat dander (tiny particles from the
animal's skin or hair). When people with atopic dermatitis come into contact
with an irritant or allergen to which they are sensitive, inflammation-producing cells permeate the skin from elsewhere in the body. These cells
release chemicals that cause itching and redness. As the person
scratches and rubs the skin in response, further damage occurs.
Certain foods act as allergens and may trigger atopic dermatitis or exacerbate it (cause
it to become worse). Food allergens clearly play a role in a number of cases of atopic dermatitis, primarily in
infants and children. An allergic reaction to food can cause skin
inflammation (generally hives), gastrointestinal symptoms (vomiting, diarrhea),
upper respiratory tract symptoms (congestion, sneezing), and wheezing. The most
common allergy-causing (allergenic) foods are eggs, peanuts, milk, fish, soy
products, and wheat. Although the data remain inconclusive, some studies suggest
that mothers of children with a family history of atopic diseases should avoid
eating commonly allergenic foods themselves during late pregnancy and while
they are breastfeeding the baby. Although not all researchers agree,
most experts think that breastfeeding the infant for at least four months may have a
protective effect for the child.
If a food allergy is suspected, it may be helpful to keep a careful diary
of everything the patient eats, noting any reactions. Identifying
the food allergen may be difficult and require supervision by an allergist if the patient is also being exposed
to other allergens. One
helpful way to explore the possibility of a food allergy is to eliminate the
suspected food and then, if improvement is noticed, reintroduce it into
the diet under carefully controlled conditions. A two week trial is
usually sufficient for each food. If the food being tested causes no
symptoms after two weeks, a different food can be tested in like
manner afterward. Likewise, if the elimination of a food does not
result in improvement after two weeks, other foods may be eliminated in turn.
Changing the diet of a person who has atopic dermatitis may not always relieve symptoms. A change may be
helpful, however, when a patient's medical history and specific symptoms
strongly suggest a food allergy. It is up to the patient and his or her
family and physician to judge whether the dietary restrictions outweigh
the impact of the disease itself. Restricted diets often are emotionally and
financially difficult for patients and their families to follow. Unless
properly monitored, diets with many restrictions can also contribute to
nutritional problems in children.
What are aeroallergens?
Some allergens are called aeroallergens because they are present in the air. They may also play a role
in atopic dermatitis. Common aeroallergens are dust mites, pollens,
molds, and dander from animal hair or skin. These aeroallergens,
particularly the house dust mite, may worsen the symptoms of atopic dermatitis
in some people. Although some researchers think that aeroallergens are
an important contributing factor to atopic dermatitis, others
believe that they are insignificant. Scientists also don't understand
the way in which aeroallergens affect the skin -- whether the aeroallergen affects
the person internally after being inhaled or whether the
aeroallergen actually penetrates the patient's skin.
No reliable test is available that determines whether a specific aeroallergen is an exacerbating factor in
any given individual. If the doctor suspects that an aeroallergen is
contributing to a patient's symptoms, the doctor may recommend ways to
reduce exposure to the offending agents. For example, the presence of the
house dust mite can be limited by encasing mattresses and pillows in
special dust-proof covers, frequently washing bedding in hot water, and
removing carpeting. However, there is no way to completely rid the environment of aeroallergens.
What other factors may play a role in atopic dermatitis?
In addition to irritants and allergens, other factors, such as emotional issues, temperature and climate, and
skin infections can affect atopic dermatitis. Although the disease
itself is not caused by emotional factors or personality, it can be
exacerbated by stress, anger, and frustration. Interpersonal problems or major
life changes, such as divorce, job changes, or the death of a loved
one, can also make the disease worse. Often, emotional stress seems to
prompt a flare of the disease.
Bathing with harsh soaps like Ivory or Irish Spring and without proper moisturizing afterward is a common factor that triggers a flare of atopic dermatitis. Typical recommendations include using a very gentle soap-free cleanser or milder soap like Dove, Cetaphil, or Aquanil. The "three-minute rule" of lubricating with a rich moisturizer such as Vaseline, Aquaphor, or Crisco Vegetable Shortening within three minutes of drying off after a bath or shower is particularly helpful for many patients.
The low humidity of winter or the dry year-round climate of some
geographic areas can intensify the disease, as can overheated indoor areas and
long or hot baths and showers. Alternately, sweating and chilling can induce
an attack in some people. Bacterial infections can also prompt or
increase the severity of atopic dermatitis. If a patient experiences a
sudden onset of illness, the doctor may check for a viral infection (such as
herpes simplex) or fungal infection (such as ringworm or athlete's
foot).
Next: How is atopic dermatitis treated? »
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