Emollients and food allergies: what's the connection?

For a long time there has been a search for an effective treatment for the skin manifestations of food allergies in children. Recent studies have provided convincing data on the significance of the skin barrier ability in the development and course of hypersensitivity reactions.

As a result, there were suggestions about the possible orientation of the therapy of allergy manifestations on the skin, first of all, to a change in the state of the stratum corneum.

For more information about how rational use of emollients in the treatment of skin manifestations of food allergies, read this article on estet-portal.com.

• Filaggrin gene mutation: defects in skin barrier function in atopic dermatitis
• Involvement of filaggrin in hypersensitivity reactions
• The role of emollients in the treatment of allergic skin pathologyra

Filaggrin gene mutation: defects in skin barrier function in atopic dermatitis

The epidermal barrier plays an important role in protecting the body from infections and other exogenous factors, reduces the level of transepidermal fluid loss and participates in immune processes.

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As a genetic factor that leads to epidermal dysfunction and is closely associated with an increased risk of developing atopic dermatitis, a mutation of the gene encoding the epidermal structural protein − Filaggrin (FLG).

Although not all patients with atopic dermatitis were subsequently found to have a filaggrin mutation, it has been established that atopic dermatitis is partially initiated by defects in skin barrier function (genetically caused and/or acquired) .

Involvement of filaggrin in hypersensitivity reactions

There is evidence that degradation products of filaggrin at physiological concentrations inhibit the growth of S. aureus, which prevents the development of complications from hypersensitivity reactions in the skin.

Filaggrin defects are an important risk factor for every step of the atopic march: atopic dermatitis, allergic sensitization, asthma and rhinitis.

Given the fact that food allergies − the first step of the atopic march and precedes the development of atopic dermatitis, as well as other chronic allergic diseases,

proper organization of its treatment will prevent further sensitization.

Comprehensive skin care for atopic dermatitis in children

Thus, it becomes clear that

topical therapy using topical moisturizers will prevent or break the vicious circle of inflammation in the skin, which is accompanied by fluid loss, and restore the barrier layer of the skin .

The role of emollients in the treatment of allergic skin pathology

Existing domestic protocols for the treatment of atopic dermatitis for external use recommend moisturizing creams −

emollients. Common frequency of use − 1-2 times a day. At the same time, international recommendations emphasize the need to apply emollients on demand at all stages of treatment. Based on the latest understanding of the pathogenesis of atopic march, studies have been conducted regarding modification of emollient use patterns.

 

 

The study involved 60 children aged 1 month to 5 years with acute clinical manifestations of food-related skin allergy. The fact of food allergy was recorded according to the parents and according to the primary medical records.

All patients were prescribed an elimination diet.

Children were randomly divided into 5 groups of 12 people each. Group 1 (comparison group) included 12 children on standard therapy (diet, emollient 1-2 times a day, oral antihistamines of the second generation). Patients of groups 2-5 were also on a diet and received emollient 2, 4, 6 and 8 times per day, respectively.

A

non-fluorinated indifferent moisturizer was used as an emollient. The duration of treatment was 10 days.

Development triggers, diagnosis and treatment of contact dermatitis

The effectiveness of therapy was assessed by integral indicators -

the level of transepidermal fluid loss (TEFL) and subjective sensation of itching on days 3, 5 and 10 of treatment compared with baseline data.

 

 

The prescribed treatment had the same effect on the presence of pruritus (the difference between the groups is not significant, p > 0.05) regardless of the prescription of antihistamines. However, the severity of itching decreased with increasing skin moisture levels.

This fact indicates the possible mechanisms of this symptom and suggests that

itching is not associated with the level of histamine, but with dry skin. The study of the content of filaggrin degradation products depending on the type of emollient will allow us to determine the mechanisms of the effect of moisturizing creams on the course of skin inflammation.

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From the results of the study, the following can be determined:

an indifferent moisturizing cream allows to restore the skin barrier in children with manifestations of food allergy on the skin already on the 10th day of treatment;
Emollients should be prescribed to all children with skin manifestations of allergies 6-8 times per day (approximately 1 application every 2-3 hours) for a minimum of 3 days, optimally − at least 10 consecutive days;
6-8 single applications of emollient made it possible to almost completely (83%) normalize the level of skin moisture;
the first evaluation of their effectiveness is optimally carried out on the 3rd day of treatment.

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