Here comes the asthma

So it happened, a few weeks ago: Voov showed the first signs of developing asthma. We were always aware that she might, because eczema runs in the family and my sister has eczema and asthma, and asthma is the final part of the famous Atopic Triad. Still, it is a bummer to see your two-year-old with a rubber mask over her face taking her twice-daily dose of an inhaler.

Voov had had a cold, and was in for a checkup, and the doctor noted that she had a slight wheeze; her blood oxygenation was at 95%. So, with her history, the doctor tentatively diagnosed asthma and sent her home with the inhaler and a special mask. Voov was initially pretty excited about the attention, but after a few days, applying the inhaler took two adults, one to straitjacket the kid and the other to handle the inhaler.

Then she got better or at least well enough that she didn't have a wheeze. For now, the inhaler's packed away. Voov is healthy and upbeat and I think she'll cruise right through childhood just fine even if she has to carry an inhaler with her.

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I thought I'd mention this great review I read recently titled "Epidermal Barrier Dysfunction in Atopic Dermatitis." It's from 2009 and provides an encyclopedic view of how known genetic factors are related to the breakdown of the skin barrier, and how many factors such as pH and enzymes and antimicrobial peptides are involved. It also has an interesting section toward the end featuring this graphic

with an accompanying explanation of how it is that many more kids than adults have eczema, and how the condition improves with age for the lucky majority. Basically, when we're newborn, our skin barrier is terrible, the worst it'll ever be. In the first few years of childhood, the quality of our skin improves. In those people who have minor genetic defects that affect the skin barrier, eczema develops early on but fades away as the skin improves past some threshold. People with serious genetic defects like major filaggrin mutations never see their skin improve past the threshold, so they never escape eczema.

At least that's how the authors put it. It's a pretty hand-waving theory. For one thing, many scientists think that a poor skin barrier lets in pathogens and allergens that trigger a heavy immune response early on, and that this response imprints a permanent memory in the body (in the form of antibodies) that powers reactions to certain foods. So if this "memory" is made early on in the 20% of kids who have eczema, why does it go away for most of them after the skin barrier improves?

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One final item: Anacor Pharmaceuticals has begun phase 2 clinical trials of two novel anti-inflammatory ointments for treatment of eczema. The two compounds are boron-based (this is unusual) and have shown promise for treating psoriasis in more advanced clinical trials. For a thorough comparison of psoriasis and eczema, see the most recent JACI Journal Club, which discusses a two-part review paper on the topic.