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Eczema

Eczema is frequently called atopic dermatitis because it was noted to occur in individuals with allergic symptoms, e.g., allergic rhinitis (hay fever) and asthma. The term atopic simply means allergic. Even though eczema was considered to be an allergic problem, allergy seems to be less likely as our understanding of the disease increases. Physicians know that eczema is a very complex disease and contains allergic as well as non-allergic elements in different individuals. As a result, the treatment of every individual may vary.

While the causes of eczema continue to be investigated, certain things are known about the disease. The skin is much more easily irritated than normal skin. Dryness of the skin is a primary component and results in significant itching. Eczema is known as “the itch that rashes”. Itching is made worse by irritants on the skin. Winter months are particularly bothersome because of the dry winter air. Flares in the summer months can occur after exercise because sweat is a significant irritant. Citrus or some vegetables, e.g., tomato, can act as a primary irritant when they touch the skin. Stress in some individuals can affect the skin. While emotional factors may play a role in flaring eczema, they are not considered a primary source of causing the onset of eczema, if it is not already present.

Eczema occurs in about 3% of the population. In about 80% of those individuals, the onset occurs in the first year of life. One-half are free of disease by age 2 years, about one-fourth by the end of adolescence, and the remaining one-fourth will continue to have eczema into adult life. Some individuals do not have the onset of symptoms until adolescence or adulthood.

Treatment is multifaceted and includes lifestyle modification as well as various types of medication. A portion of treatment will be listed in the accompanying tables. Adequate attention to clothing, diet manipulation, and attention to the emotional well-being of the affected patient are very important. It is preferable for a patient with eczema to wear clothing which will not irritate the skin; soft cotton material would be best. The room temperature should be kept moderate with controlled humidity (between 35-50%). Overheating and perspiration should be avoided.

Some investigators believe there is a genetic tendency for eczema with approximately 50% of eczema patients ultimately developing allergic rhinitis and/or asthma. This is compared to about 20% without the presence of eczema. While allergy skin testing and allergy injection treatment are usually helpful in cases of allergic rhinitis and/or asthma, it is generally agreed that this is often not the case with eczema. In some individuals, starting allergy shots for allergic rhinitis and/or asthma may actually result in significant flaring of the eczema.

Prevention

  • Trim fingernails short
  • Cotton gloves at night if needed to decrease scratching
  • Clothing should be double rinsed after washing to remove all residual detergent (irritants)
  • Avoid excessive room temperatures
  • Wear light, non-occlusive clothing (e.g., cotton instead of polyester)
  • Keep the bedroom moderate (cool) and avoid excessive bed clothing
  • Allergen contact or ingestion avoidance (e.g., foods, pets, dust mite) can reduce stimulation of the skin

Treatment

  • Bathing for moisturization, e.g., soaking in tepid water for 30-45 minutes at least once daily and if possible 2-3 times.
  • Within 2 minutes after getting out of the tub, a lubricating cream or ointment should be applied to help hold the moisture in the skin. Examples include Aquaphor, Curel, Moisturel, Eucerin, Keri, Lubriderm, Acid Mantle, Unibase, Vanicream, petrolatum, and chilled Noxzema,etc. Newer medications include Triceram/Certopic, Impruv, Mimyx, Nourica Repair, Cerave, Atopiclair, and Hylira. Some of the newer medications are by prescription only. None of the medications in the above list contain steroids.
  • In general, lotions should be avoided since they contain alcohol which may sting and provide limited moisture.
  • If marked irritation or weeping areas are present, wet wraps with a drying solution (e.g., Burrow’s solution, one tablet mixed in one quart of water is available by prescription) will avoid the stinging or burning sensation that can occur with bathing.
  • Addition of oil or similar substances to the bath water generally has little effect on increasing moisturization.
  • Pat dry with a soft towel; do not “rub” dry since this will remove natural, protective oils from the skin.
  • Showers do not add moisture to the skin and actually remove the protective oils from the skin resulting in increased dryness.
  • Topical steroids are the mainstay of therapy for more severe eczema. Ointments or creams are generally used.
  • Nonsteroidal medications that help the immune system in the skin may be necessary either in addition to or in place of topical steroids if the topical steroids are not adequate for relief. Examples of the nonsteroidal medications are Elidel and Protopic.
  • Antibiotics, topical and/or oral, may be needed if the lesions become infected. An alternative to antibiotics is the use of Clorox baths. One-quarter to one-half cup of Clorox in a full bath provides antibacterial activity that will treat all known bacterial infections. No resistant bacteria to Clorox are known.

Conditions Treated

Recent News

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AAAAI News: Sinusitis’s Impact on Asthma, Shot Brings 4-Season Relief

Chronic Sinusitis’s Impact on Asthma

Asthmatics can add chronic rhinosinusitis (CRS) as a related condition, and one that has a significant health impact, according to new research.

In the study, patients with asthma who also had a chronic bronchial condition were the most likely to have CRS – and to feel the effects of this disease combination. The new findings will be presented at the 2022 annual meeting of the AAAAI (American Academy of Allergy Asthma & Immunology) in Phoenix in late February.

To conduct the study, researchers from Northwestern and Johns Hopkins universities analyzed medical records from 1988 to 2021 on those with asthma, who had CRS and/or bronchiectasis. In the latter chronic condition, the airway walls become thick and damaged. The patient experiences mucus buildup, coughing, and lung infections.

The sinus condition CRS lasts for more than 12 weeks, even with medication, and includes symptoms such as nasal congestion, facial pressure and thick nasal discharge.  

The team studied records spanning more than three decades to capture as many patients as possible, and to follow patients with asthma who did not initially have bronchiectasis, says study author Dr. Margaret Kim.

To measure the impact of CRS on patients with asthma and bronchiectasis, the researchers examined the use of medication, such as antibiotics and oral corticosteroids, along with the need for urgent health care. Of the 5,038 patients identified with asthma, 19 percent had bronchiectasis, 39 percent had CRS, and 10 percent had both conditions.

The study found that 51 percent of asthmatics who had bronchiectasis were more likely to have CRS than patients without it (36 percent).

Need for Medical Attention

The findings point to greater use of health-care resources among that 51 percent of asthma patients. The use of medications and the rate of hospital admissions and emergency room visits were all higher. The researchers conclude that CRS is an important to be aware of, especially in asthma patients with bronchiectasis.

The study is important as more patients are being diagnosed with bronchiectasis, which is associated with high health-care costs and requirements, said Kim, a clinical fellow in allergy and immunology at Northwestern University’s Feinberg School of Medicine.

“This knowledge helps identify patients who need more medical attention,” she said.

To help the identification process, providers can routinely ask about symptoms of CRS in patients who have asthma and bronchiectasis, and patients with CRS. Kim says patients with CRS should also be screened for bronchiectasis if they have symptoms that could suggest the condition, such as a cough with phlegm and difficulty controlling asthma.

Asthma Relief for All Seasons

Patients taking the biologic drug tezepelumab experienced fewer asthma exacerbations during all seasons throughout the year than those taking the placebo as part of a Phase 3 clinical trial, according to results to be presented at the 2022 AAAAI meeting.

Researchers focused on asthma exacerbations based on each season when they analyzed the results of the study called Navigator. That trial divided more than 1,000 teen and adult patients with poorly controlled asthma and frequent exacerbations into two groups. Participants received by injection either tezepelumab or placebo every four weeks for a year (but did not know which, as the trial was “blinded”). The participants also remained on their standard asthma regimens of inhaled corticosteroid inhalers, plus at least one additional controller medication. 

Tezepelumab reduced the annualized asthma exacerbation rate in the 528 patients taking the drug by 63 percent in winter, 46 percent in spring, 62 percent in summer, and 54 percent in fall, according to the study. Compared to those taking the placebo, patients taking tezepelumab had fewer exacerbations in winter (81.7 percent vs. 66.6 percent), spring (84.3 percent vs 76.3 percent), summer (86.8 percent vs 73.1 percent) and fall (79.4 percent vs. 66.6 percent), the study found.

Tezepelumab is a monoclonal antibody designed to work at an early stage of immune system response in the airways, blocking TSLP (thymic stromal lymphopoietin). TSLP is a type of cytokine, or signaling molecule, that triggers immune defenses. In response to a trigger, TSLP cytokines set off a cascade of airway inflammation that leads to asthma symptoms.

In December 2021, the FDA approved Tezspire (tezepelumab-ekko) injection as an add-on maintenance treatment to improve severe asthma symptoms when used with a patient’s current asthma medicine.

To read the entire article online, visit https://www.allergicliving.com/2022/02/03/aaaai-news-sinusitiss-impact-on-asthma-shot-brings-4-season-relief/

The post AAAAI News: Sinusitis’s Impact on Asthma, Shot Brings 4-Season Relief appeared first on Oklahoma Allergy and Asthma Clinic.

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