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Dr Morrow-Brown continues:

"My involvement with eczema began many years ago when I observed that the quality of life of many asthmatics was destroyed more by their eczema than their asthma. When I became interested in food as a cause of asthma I found that when a restricted diet had improved the asthma the eczema sometimes got better as well. These were patients had also been attending the Skin clinic for years, so when there had been a remarkable improvement in the eczema I enquired if their improvement had been commented on by the Dermatologist .

To my surprise their improvement had never been commented on or excited any curiosity, so I became deeply interested in eczema as another aspect of allergy. A study of old allergy journals and textbooks, mostly American, revealed much research into finding causes for eczema at a time when there was no effective medication. These efforts had declined considerably after effective steroid creams were introduced about fifty years ago.
It is difficult to understand why British skin specialists often refuse to carry out prick skin tests when requested, yet routinely carry out many 'patch tests' to identify contact allergens. Localised allergy in skin cells is a characteristic of allergy to nickel and many other chemicals, where prolonged exposure is necessary to produce a reaction, therefore patch tests stay in place for two days to produce slow reactions. Positive reactions indicate what to avoid, and in recent years inhalant allergens such as dust mites and food extracts have also been found useful as patch tests in Europe, but not in this country as far as I am aware.

It seems that many dermatologists do not believe that allergy causes eczema, particularly food allergy. This is a very controversial subject, and it is only in recent years that the British Eczema Society has acknowledged that foods can cause eczema, although stated even now in a very reserved manner, with practically no reference to other allergic causes of eczema. (See www.eczema.org/ ) Unfortunately GPs are programmed to refer all eczema cases to the skin department, as they were taught in Medical School, so it is only a very persistent patient or parent who will get the allergic possibilities of eczema investigated. My experience has been mainly when eczema has been another part of the problem. How helpful my personal approach to the eczema problem would be if applied in an average dermatology clinic is quite unknown.

The highest readings for IgE antibodies are to be found in eczema, yet these immunological results, if they are ascertained, are usually rejected by dermatologists as unimportant or misleading, perhaps because they may not be understood. In Europe and the USA the attitude of many dermatologists is quite different, and the importance of foods and inhalant allergens such as dust mite or animals in causing eczema is fully acknowledged, investigated, and treated.. Recent studies from USA, Australia, and New Zealand have confirmed that foods play a very dominant role in the causation of infantile eczema.
Eczema is very common in infancy, as at least one in five infants are affected, positive reassurance that it will clear spontaneously by age five is often given, and steroid creams are the main method of treatment. Foods are seldom considered seriously as a cause, yet infancy is the time of life when the diet is at its most simple and easily altered. Infancy is when it is easiest to eliminate food allergy as a cause of the problem. Unfortunately when the eczema eventually subsides, as it does in most cases, it is often replaced by asthma, rhinitis and hay fever. This progress from one sort of allergy to another is known as the 'Allergic March'. It has been suggested that if the cause is identified and avoided there is some prospect of preventing this response to allergens from becoming a persistent pattern. There is also evidence from recent surveys that if children are desensitised to grass pollen when they develop hay fever they are not so likely to develop other allergies later.

When foods cause eczema the reaction is usually slow. Traces of the food are absorbed into the blood without causing a local reaction in the gut, and pass in the blood and then the tissue fluids to produce eczema in the sensitised skin. The same mechanism operates when the joints, brain, kidney, or any other organ system has become sensitised.
Allergens such as dust mite or animal danders may access the skin through the invisible cracks and defects which are always present in the skin, or the visible cracks from scratching, thus causing eczema to be a sort of constant ongoing skin reaction. Some allergens may also reach the skin by absorption from the respiratory system where an allergic reaction causing asthma may or may not be happening. The itch is always worse when warm in bed, and I think it is probable that that traces of sweat dissolve the allergen from the tiny particles of mite faeces present in all beds. This will produce a very strong extract, much stronger than the usual skin testing solutions, which causes the continuous skin reactions."


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