NIAID Now | October 17, 2022
Eczema, or atopic dermatitis, is an inflammatory, non-contagious condition that presents as dry and itchy skin that can weep clear fluid when scratched, possibly leaving the body particularly susceptible to bacterial, viral and fungal infections.
The exact cause remains unclear, but links between eczema and autoimmune diseases are being explored by National Institutes of Health scientists. The National Institute of Allergy and Infectious Diseases, a part of NIH, stands with the scientific community in recognizing October as Eczema Awareness Month and acknowledging the need for continued research into possible cures and therapeutics.
Eczema can affect anyone but largely affects children and adolescents. About 7 million children in the U.S. have eczema and an estimated one-third also suffer from food allergy, according to a collaborative paper published by NIAID scientists in the Journal of Allergy and Clinical Immunology.
In general, people with eczema are often diagnosed with allergies they may not have because allergy blood tests measure the level of a type of antibody called immunoglobulin E (IgE) which is specific to a particular food or a protein within the food. People with food allergies make more IgE than normal to that food or protein, but people with eczema are likely to have high total IgE levels in general, resulting in positive allergy test results, even though they may not actually have a food allergy.
False-positive allergy tests can lead to an unnecessarily restrictive food-elimination diet with unwanted outcomes such as malnutrition, weight loss or low weight gain.
Fernanda Young, M.D., a clinician in NIAID’s Laboratory of Allergic Diseases, is leading the Phase 2 clinical trial, Food-Specific and Component IgE Threshold Levels That Predict Food Allergy in People With Elevated Total Serum IgE Levels and Atopic Dermatitis which aims to identify threshold IgE levels to peanut and milk or a component of these foods that predict whether a person has a food allergy.
NIAID spoke with Dr. Young to learn more about her research team’s work.
- What new findings have researchers uncovered since this trial began in 2019?
Since the study is ongoing, it is early to make conclusions, which is why we are thrilled to have patients that are interested in helping us learn more about food allergies and how to better diagnose them. We are particularly excited since patients will be able to undergo the gold standard test-an oral food challenge with us at their bedside-to see if they truly have an allergy to milk or peanut.
- Why are the misdiagnoses of allergies in people with atopic dermatitis such an important area to study? How will this additional knowledge benefit the medical community and the public?
At a community level, knowing which foods someone can safely eat or those they need to avoid is a huge plus for places like day care, school and recreational events. At an individual level, having this knowledge empowers our patients to reintroduce and enjoy foods with less anxiety. It also makes it clear in settings such as going to potlucks or ordering take-out what allergens definitely have to be avoided. We as clinicians desperately want to help and not harm our patients and having better predictive markers will help us to better counsel and treat our patients.
- What are some of the biggest challenges faced so far with this study and in eczema research?
The SARS-CoV-2 pandemic had a tremendous impact on the health of the nation. We paused recruitment and focused on keeping our patients safe. We are resuming enrollment with appropriate precautions to balance the safety of patients while also advancing the understanding of their eczema and food allergy. For example, we start with a telehealth visit and then group the in-person visits as much as possible. We know that eczema is a chronic disease that affects about 1 of every 10 kids. Since this is a school-age population, a major challenge is making sure that they do not miss a lot of school either because of their disease and its complications or because of medical procedures. As such, any child or teen that we can help to manage their allergic disease is a major step toward improving their life.
- Briefly discuss another NIAID study you are excited about.
I mentioned the COVID-19 pandemic. We saw incredible advances in vaccine development, and we saw reactions to vaccines as well. I am very proud of the Laboratory of Allergic Diseases for quickly starting and completing a trial COVAAR (COVID Vaccine Allergy Reaction) to better understand these vaccine responses so that we could ultimately help the patients stay safe. Stay tuned for those results!
- Why did you join the NIH?
I am a firm believer that in service to the government, I am also in service to the nation. I joined NIAID so that I could bring my knowledge and experience in allergy, immunology, food and drug reactions, and vaccine development, to add to what we understand about allergic reactions. There is a lot we do not know and that humbles me and motivates me to find out. Not just because it is important at a fundamental understanding of our world, but more so because there are patients out there that need that information for their diagnostic and therapeutic benefit. Here at the NIH, I can focus on these questions, and I am grateful to the patients and their support systems who make this research possible.