Positive Health Online

The itch, the scratch, wet bandages covering the skin, cotton mittens, low self-esteem, exasperated parents, creams and lotions, hopelessness, sleepless nights, spells in hospital and traipsing in vain from one doctor to another. This is the world of the child with atopic eczema.

The incidence of atopic diseases such as dermatitis, allergic rhinitis and asthma is rising in industrialized countries and now affects about 14% of the population of four year old children. Some studies put this incidence even higher, at perhaps 20%. Of these children with allergies, about 50% grow out of their atopy. The incidence of atopic disease is higher among children whose father has atopic related disease than if the mother has atopic related disease.

Atopic eczema and asthma is associated with a genetic predisposition to non-regulation and imbalance of the immune system. The immune system can be seen as having two arms, called TH1 and TH2. These are also called the cellular and the humoral immune responses respectively. These two arms respond to different pathogen and allergen invasions, affecting the differing responses and courses of disease. A simple way of looking at this is to relate the two types of immune defenses to the two types of military defenses – the army and the navy. They operate on different types of invaders and use forces with different descriptions and roles.

People with atopic disease have too many TH2 defenders and a lack of TH1 defenders, as do people who tend to get AIDS, CFIDS, Candidiasis, Multiple allergies, Multiple Chemical Sensitivities (MCS), viral hepatitis, Gulf War Syndrome (GWS), cancer and lupus. People who are prone to get auto-immune diseases such as Type 1 diabetes mellitus (insulin-dependent), multiple sclerosis and, perhaps, rheumatoid arthritis have an immune system that is TH1 predominant. Usually, TH1 responses are activated by foreign substances that get into and inhabit cells, including all viruses, some bacteria (for example the mycobacteria that cause tuberculosis), certain yeasts and a number of parasitic single-celled organisms. In contrast, the cytokines or molecules, produced by TH2 cells, stimulate strong antibody responses that are most effective in combating bacteria, certain yeasts and parasites, including worms.

Researchers have found that the two arms of the immune response appear to be antagonistic to one another. Thus, some allergic or infectious substances that would generate a strong TH2 humoral immune response would tend to suppress the TH1 cellular responses to other antigens and vice versa. Although one immune response tends to suppress the other, both are active with one dominating the other.

The foot soldiers that are called upon to mount the immune defence are molecules that are specific to either the TH1 or TH2. If an invader triggers a TH1 immune response then these molecules are predominantly triggered:

• Interluken-2 (IL-2), Interluken 12 (Il-12) , gamma interferon (IFN-gamma) and IgA (Immunoglobulin type A), amongst others;
For a predominantly TH2 immune response, these molecules are activated for defence:
• Interlukens (IL)4, 5, 6, 10, alpha interferon (IFN-alpha), IgE (Immunoglobulin type E) and IgG.

Atopic allergies, lacking the TH1 defenses, consequently have a tendency to have certain types of bacteria, yeast and fungal overgrowth on the skin and in the body, including the gut. Atopic eczema is probably triggered and exacerbated by elevated levels of specific microbes on the skin, causing irritation. This is backed up by studies that show regular disinfecting of the skin often leads to the remission and control of eczema. This is extremely important and often overlooked by doctors.

In atopic allergies, the goal for treatment is to rebalance the immune system to have an equal strength TH1 and TH2. Practically, this means restricting the TH2 foot soldiers and stimulating an increase in the TH1. Many of the newer and traditional treatments block TH2, including steroids and the new tacrolimus (Protopic) topical creams. The root cause of the imbalance is probably environmental stress. Living in an environment where you are eating an 'unnatural' diet, being exposed to certain bacteria (and excluded from others), breathing in polluted air, drinking chemically processed water, living under psychological pressure for an extended period of time, all contributes to unbalancing the immune system.

Super-clean modern environments allow powerful disinfectants and air conditioning to shut out certain bacteria and let others predominate. To a young child with a developing immune system, this may cause one arm of the immune system to become stronger and dominate over the other arm. This excessive cleanliness is cited as a cause of the high rate of atopic disease in modern cities, while there is almost an absence of atopics among relatively rural primitive populations. This environmental cause of atopic disease is called the 'The Hygiene Hypothesis'. However, cleanliness, or the lack thereof causing a TH2 skew, is only one piece of the complicated picture that is still being composed by science. The main focal points of this picture and the steps required to address the immune imbalance are :

Correcting Faulty Digestion

If you don't digest and absorb adequate nutrients you will get disease. Working out exactly what to eat to achieve the goal of total nutrition is far more complex, especially in a modern world surrounded by food that often bears little resemblance to unprocessed, natural food. A faulty under-nourishing diet can lead to the immune system being compromised and the state of the gut itself being impaired, leading to the vicious cycle of more malnourishment. An impaired gut can lead to absorption of partially digested and unusable proteins and other food particles that increases IgE production – one of the foot soldiers of TH2 leading to a TH2 imbalance. The main aim is to clean up our diets and to try and eliminate all processed food and obtain adequate nutrients.

Increasing Omega-3 and Reducing Omega-6 Fats

N-3 fats are those usually found in fish and n-6 fats are those usually found in plants, seeds and nuts.

A modern, western-type diet favours the n-6 vegetable oils. Ideally, a traditional diet of our hunter-gatherer ancestors will vary from a predominance of n-3 fats to about a ratio of 4:1 n-6:n-3, depending on the geographical area. The Eskimos are at one extreme with almost entirely n-3 fat intake – they suffer far less inflammatory degenerative diseases. N-3 fats have been found to inhibit the pro-inflammatory TH2 immune response. Researchers (Kankaanpaa et al. 1999.) in Boston found that the increase in atopic diseases is closely tied in with an increase in the consumption of omega-6 fatty acids (linoleic acid) which have pushed the ratio of omega-6 to omega-3 fatty acids in the diet to an unfavourably high level (10:1 or higher).

Consuming a diet rich in n-3 or n-6 fats requires a corresponding boost in antioxidant intake, since these fats tend to go rancid, or oxidize, in the body.

Boosting Glutathione and Antioxidants

Studies suggest that atopy is a disease of oxidation. Atopics have a higher incidence of lipid peroxidation or oxidation of fatty deposits and cataracts or oxidation of the eye lens.

Free radicals are the molecules that are generated during oxidation. These free radicals are highly reactive substances that cause damage to tissues in the body. Antioxidants protect the body against this damage. Processed, low nutrient food is deficient in natural antioxidants.

Glutathione is probably the most important antioxidant – the master antioxidant. Glutathione is almost universally low in atopics. Glutathione probably cannot be taken by mouth as a supplement since there is doubt that it can be absorbed intact this way. Glutathione is best boosted in the cells by providing the body with the raw materials to build this antioxidant. These are the proteins cysteine, glycine, glutamic acid and the antioxidant metal selenium. Selenium is a powerful antioxidant and low selenium intake has been associated with increased incidence of asthma in New Zealand, where one study showed that selenium improves the disturbed TH2 imbalance.

Vitamin E decreases IgE and markedly improves or eliminates symptoms of atopy and moves the immune response away from the skewed TH2 toward the TH1. Vitamin C (as ascorbic acid) lowers histamine levels in the body over time and addresses the immune imbalance. It is best to take both Vitamins C and E, since C is soluble in water and E is soluble in fat and both water and fat systems need to be protected from free radicals. C and E also regenerate each other and preserve glutathione.

Special type of antioxidants are alpha lipoic acid (ALA) and NAC (N-Acetylcysteine). These are small molecules, called thiols, that can enter the cell and ALA has the distinction of being both soluble in water and fat, and the thiols have been shown to mitigate against the allergy to diesel fumes in asthmatics. NAC also boosts glutathione very
effectively.

The goal is to increase your intake of fresh fruit and vegetables, eat adequate protein and take antioxidant supplements.

Low Stomach Hydrochloric Acid

Atopics often have low stomach acid or hypochlorhydria, a lack of hydrochloric acid (HCL). HCL is an important component of protein digestion and also in the uptake of micronutrients, such as calcium, magnesium, iron, zinc, vitamin C, folic acid and beta-carotene. One study compared the HCL levels of 200 asthmatic children aged six months to 12 years against a control group of non-asthmatic children. 80% of the asthmatic children had below normal levels of HCl, compared to only 10% of the non-asthmatic children.

Supplementing two 500mg Betaine Hydrochloride capsules with meals will quickly reveal if low HCL is your problem.

Lactic Acid Bacteria or Probiotics

Studies of the flora in the faeces and bowel and the bacteria and yeasts resident in the gut and in patients with atopic eczema have found evidence of gastrointestinal (GI) dysbiosis (flora imbalance and pathogen overload) and subtle malabsorption of nutrients in the majority. Immune sensitivity to colonization by the gastrointestinal yeast Candida albicans or the bacteria Helicobacter pylori are also closely linked with clinical manifestation of atopic eczema.

Supplementation with probiotics, reinoculation of the colon with 'helpful' bacteria, such as lactobacillus, and eating more natural fibre may improve GI barrier mechanisms in patients with atopic dermatitis and thus reduce its inflammatory symptoms.

Vitamins, Herbs and Minerals

Atopics are characterized by certain vitamin and mineral abnormalities.

Magnesium levels are almost always low in atopics. Magnesium has a role in stabilizing the mast cells that break down and release histamine and other inflammatory substances when provoked by allergens. Studies have shown that asthma can be improved by supplementing magnesium. The ideal ratio of calcium:magnesium is approximately 2:1.

Allergic reactions are almost always accompanied by an acidosis of the body. This means the body chemistry shifts to being slightly acid, and this acidosis can cause an increased need for calcium and sodium. Remember that you will not absorb sufficient calcium unless you are producing HCL in your stomach. So take your calcium with ascorbic acid (vitamin C) to be sure.

Copper levels are elevated in atopics and that probably has a lot to do with the fact that vitamin C (ascorbic acid) levels are low. Ascorbic acid regulates the copper levels and removes excess copper.

Zinc levels seem to be low in atopics, although there is some conflicting evidence. Zinc is an important metal in many enzyme processes in the immune system and, certainly, low zinc levels need to be restored to normal in atopics.

Iron is low in atopics. As with the case of copper, iron levels are affected by the levels of ascorbic acid, but with iron the effect is inverse. Ascorbic acid helps increase the absorption of iron. Iron, while being essential, is also a large contributor to the oxidation overload in the body, so an adequate supply of antioxidants should be taken as protection.

Manganese may also be low in atopics. It is needed in small quantities and usually comes as part of a good multi-vitamin.

A lack of almost any of the B vitamins has been implicated in eczema and asthma. Since we know that there is usually an overgrowth of pathogens in the gut of atopics and we also know that the 'good' bacteria produce almost all the B vitamins as part of their metabolism, it is not surprising that atopics often improve with vitamin B supplements.

In infants, atopy is often improved by biotin supplements, but for some reason this does not appear to work for adults, although it is worth trying. In adults, B6 is usually a more successful supplement. B vitamins should be taken together as a balanced supplement.

Liver meat supplies all the B vitamins, zinc, iron and all the proteins. Vegetarian sources of B vitamins are plant foods, including green leafy vegetables, cereals, dairy produce, free-range eggs, yeast extract, soya milk, tempeh, miso and Vitamin B supplement.

Increasing Monounsaturated Fats

Monounsaturated fats are found mainly in nuts and olive oil and have a TH1 favouring cytokine activation. These fats also protect against oxidation of n-3 and n-6 fats in the body.

Reducing Yeast and Bacteria on the Skin and in the Body

Yeast and moulds on the skin, in the air passages and within the body tend to release chemicals that trigger TH2 allergic type immune responses.

Atopics usually demonstrate an increased allergy to some bacteria, yeasts and moulds and have an overpopulation of these pathogens on the skin and in the gut. The yeast Candida albicans and the beer yeast Saccharomyces cerevisiae have been demonstrated to increase atopic allergy. The bacteria S. aureus is extremely irritating to the skin.

Atopic eczema of the head and neck areas, sometimes called seborrhoeic eczema, is very often associated with yeast overgrowth and increased sensitivity to yeasts. The yeast family malassezia and candida is especially involved in this type of eczema.

Use effective topical disinfectants that can control the yeasts and bacteria, without harming the skin, and you will certainly see an improvement in your eczema.

Exposing the Skin to Moderate UVA

It has long been known that sunlight improves atopic eczema. On holiday, a combination of the minerals in the sea water and sunlight invariably clears up eczema. The ultra violet rays from the sun have an antiseptic effect and kill yeast, fungi and bacteria that may cause or exacerbate eczema. Ultra violet rays are divided into A and B rays. B rays burn the skin red, while the A rays tend to turn the skin brown and have a TH1 response. Both UVA and UVB damage the skin and you must be very cautious to limit your exposure.

Increasing Exercise

Moderate exercise is beneficial. It tends to balance the immune response, gets oxygenated blood flowing to the extremities, including the skin, improves the appetite, digestion and sleep and releases endorphins into the brain that make you feel good.

Controlling Stress and Adrenal Overload

This is an extremely important factor in the cause and complications of atopy.

Stress can be defined as any factor that causes the endocrine or hormone system to release the hormone cortisol, familiar to all atopics who ever used a steroid inhaler or cortisone skin cream, and other related hormones in a cascade. Stress can be dietary, environmental , exercise, disease, emotional or be caused by other external triggers that invoke the stress hormones to be released.

There is no doubt that the atopic in a modern environment is under almost constant stress and the hormonal system can eventually be exhausted, causing worsening of the atopic symptoms. Studies have shown that people living in a rural environment, eating traditional foods, are almost entirely free of atopic disease.

The adrenal gland releases cortisol, or cortisone, as part of the complex cascade of hormones that are released under stress. Under prolonged stress in the modern world the adrenals and the entire endocrine system are overworked and the adrenals may eventually 'burnout'.

Avoid all types of stress, as far as possible, have a nutritionally complete diet and, where necessary, take the appropriate supplements. With stress-induced adrenal burnout, ascorbic acid and B5 supplements are essential to bolster this gland. Some atopics get great improvement on high doses (> 300mg) of B5 alone.

Immunotherapy and Vaccines

A skewed immune system can be rebalanced by introducing a pathogen that will provoke a response of the opposite immune arm. This is very efficiently done by vaccines. Vaccines prime the immune system to respond in a manner that is optimal to ward off the attacker of the type that is contained in the vaccine. The smallpox vaccine provokes a TH2 response and the BGC (tuberculosis) vaccine provokes a TH1 response and a similar vaccine is being used to rebalance the immune system of atopics.

There is a school of thought that maintains that the explosion of the incidence of atopy might be traced to the origin of mass compulsory anti-viral vaccinations.

Vaccines are promising, but it is recommended that you rebalance the immune system through healthy living and a more 'natural' diet and, where necessary, supplements.

Conclusion

Atopy is increasing in inner cities. We need to, as far as possible, try to remove the external stress from our lives. We need to take positive steps to redress the immune system imbalance. Never has there been more encouraging advances in the understanding of atopy and more reason to be patient, positive and hopeful.

Resources

Anderson R, Hay I, van Wyk H, Oosthuizen R and Theron A. The effect of ascorbate on cellular humoral immunity in asthmatic children. S Afr Med J. 58(24): 974-7. 1980.
Asako Y, Saito A, Yasueda H, Kawaguchi H, Akiyama K, Endo M, Onishi Y and Takesako K. Analysis of IgE reactivities of purified allergens from Candida albicans and Malassezia furfur among patients with atopic dermatitis. Arerugi. 51(8): 615-21. 2002.
Beeh KM, Micke P, Kornmann O and Buhl R. Correlation of plasma glutathione and total IgE level: evidence for a regulatory role of antipxodants in vivo. Pneumologie. 54(12): 569-71. 2000.
Bleiker TO, Shahidullah H, Dutton E and Graham-Brown RA. The prevalence and incidence of atopic dermatitis in a birth cohort: the importance of a family history of atopy. Arch Dermatol. 136(2): 274. 2000.
Daniels J and Harper J. The epidemiology of atopic dermatitis. Hosp Med. 63(11): 649-52. 2002.
David TJ, Wells FE, Sharpe TC, Gibbs AC and Devlin J. Serum levels of trace metals in children with atopic eczema. Br J Dermatol. 122(4): 485-9. 1990.
Duchen K and Bjorksten B. Polyunsaturated n-3 fatty acids and the development of atopic disease (Review). Lipids. 36(9): 1033-42. 2001.
el-Kholy MS, Gas Allah MA, el-Shimi S, el-Baz F, el-Tayeb H and Abdel-Hamid MS. Zinc and copper status in children with bronchial asthma and atopic dermatitis. J Egypt Public Health Assoc. 65(5-6): 657-68. 1990.
Friedmann PS. The pathogenesis of atopic eczema. Hosp Med. 63(11): 653-6. 2002.
Herrick CA, Xu L, McKenzie AN, Tigelaar RE and Bottomly K. IL-13 is necessary, not simply sufficient, for epicutaneously induced Th2 responses to soluble protein antigen. J Immunol. 170(5): 2488-95. 2003.
Ionescu G, Radovici D, Negoescu A, Preda I and Mahal H. Circulating immune complexes, specific IgE against food and inhalation allergens, serum histamine levels and disorders of intestinal permeability in atopic patients before and after test meals (German). Immun Infekt. 13(4): 147-55. 1985.
Kankaanpaa P et al. Dietary fatty acids and allergy. Annals of Medicine, 31: 282-87. 1999.
Majamaa H and Isolauri E. Probiotics: a novel approach in the management of food allergy. J Allergy Clin Immunol. 99(2): 179-185. 1997.
Marks GB, Ng K, Zhou J, Toelle BG, Xuan W, Belousova EG and Britton WJ. The effect of neonatal BCG vaccination on atopy and asthma at age 7 to 14 years: an historical cohort study in a community with a very low prevalence of tuberculosis infection and a high prevalence of atopic disease. J Allergy Clin Immunol. 111(3): 541-9. 2003.
Matricardi PM, Bouygue GR and Tripodi S. Inner-city asthma and the hygiene hypothesis. Ann Allergy Asthma Immunol. 89(6 Suppl 1): 69-74. 2002.
Mazo VK and Shirina LI. Free radical oxidation and food antioxidants in allergic diseases (Review). Vopr Pitan. 69(5): 12-7. 2000.
Mazzoni A, Young HA, Spitzer JH, Visintin A and Segal DM. Histamine regulates cytokine production in maturing dendritic cells, resulting in altered T cell polarization. J Clin Invest. 108(12): 1865-73. 2001.
Moyal DD and Fourtanier AM. Effects of UVA radiation on an established immune response in humans and sunscreen efficacy. Exp Dermatol. 11 Suppl 1: 28-32. 2002.
Omata N, Tsukahara H, Ito S, Ohshima Y, Yasutomi M, Yamada A, Jiang M, Hiraoka M, Nambu M, Deguchi Y and Mayumi M. Increased oxidative stress in childhood atopic dermatitis. Life Sci. 69(2): 223-8. 2001.
Samuilova TL, Mokronosova MA, Krasnoproshin LI, Sdokhova SA and Sergeeva AS. Candida albicans sensitization in patients with atopic bronchial asthma and atopic dermatitis. Ter Arkh. 69(11): 41-44. 1997.
Shirai T, Suzuki K, Inui N, Suda T, Chida K and Nakamura H. Th1/Th2 profile in peripheral blood in atopic cough and atopic asthma. Clin Exp Allergy. 33(1): 84-9. 2003.
Trujillo C and Erb KJ. Links Inhibition of allergic disorders by infection with bacteria or the exposure to bacterial products (Related Articles, Review). Int J Med Microbiol. 293(2-3): 123-31. 2003.
Uchida T, Suto H, Ra C, Ogawa H, Kobata T and Okumura K. Preferential expression of T(h)2-type chemokine and its receptor in atopic dermatitis. Int Immunol. 14(12): 1431-8. 2002.
Wilson WH. Eczema responsive to treatment for Helicobacter pylori (Letter). Ann Allergy Asthma Immunol. 75(3): 290. 1995.