Eczema Q&A with Zimbabwean immunologist Elopy Sibanda

When developing countries appear in news stories about eczema, they mostly serve as contrast with industrialized countries, where allergic disease is on the rise. We also tend to hear only from scientists in the US, the UK, Europe, and Japan. That is why I was fascinated to read a recent story about eczema in The Herald, a government newspaper published in Harare, Zimbabwe.

The story focuses on the physical and social costs of eczema that we are so familiar with. It quotes Odwell Gwengo, founder of the Eczema Association of Zimbabwe Trust:

"Judging by the numerous cases attended to, eczema is common in our communities than we had anticipated."

Which makes you think that perhaps Western scientists have not got a complete handle on the statistics of allergic disease in the developing world. This is understandable, when HIV/AIDS, malaria, Ebola, cholera, etc., claim priority. 

The story also quoted Dr. Elopy Sibanda, a professor of clinical immunology and allergy at the University of Zimbabwe. I wrote to Dr. Sibanda with a few questions--I am well aware of my own first-wold slant--and he graciously responded to the cold call. Here's the Q&A:

Spanish Key: In the USA and elsewhere there is a perception that our societies are too clean--this is the "hygiene hypothesis"-- and that infants are not exposed to enough microbes in their early years, so that their immune systems tend toward an allergic response, and we develop eczema and asthma as a result. What is your perspective on the hygiene hypothesis?

Elopy Sibanda: I am familiar with the hygiene hypothesis but I am unsure about the extent to which it applies to our population. In immunological parlance this boils down to a Th1 to Th2 lymphocyte shift. We have seen no evidence of such a shift. The hypothesis is not an adequate explanation for the  the increase in allergic diseases. [SK comment: I'd guess in the end we will find that antibiotic overuse is to blame.]

Spanish Key: There is also a small, but vocal, anti-vaccine movement that claims that the relatively large number of vaccines given to children predisposes them to develop allergic diseases and even autism. As a result quite a few people, some of whom I have met personally, do not vaccinate their children. What is your perspective on this phenomenon?

Elopy Sibanda: There are pockets of religious sects that are against the immunization of children for various reasons. Immunization rates in Zimbabwe are quite high. I have not seen any convincing evidence of immunization influencing allergic trends. The anti-vaccine advocates just have to provide us with the evidence. [SK comment: I would love to see Dr. Sibanda in conversation with a Marin County anti-vaccine advocate.]

Spanish Key: I have read that eczema may be an evolutionary development to protect the body against helminthic worms. What is your opinion?

Elopy Sibanda: My experience is that  people with eczema are at no lesser risk of helminthic infections than those without. If it was developed for that purpose it is failing in its role. [SK comment: very interesting. I wonder why eczema has persisted in our DNA despite being so debilitating in some cases, if it does not have some hidden benefit. But then look at all the other hereditary diseases we are passing along to our children--diabetes, Tay-Sachs, Huntington's, multiple sclerosis, etc.]

Spanish Key: What do you think are the most important therapies that African children and adults with eczema lack?

Elopy Sibanda: Before we can address the issue of therapies, the challenge we face is patient education and disease awareness. Once the people understand the disease, they will begin to appreciate the interventions and establish treatment options and priorities. Like everywhere in the world medical interventions aim to stop the itch (anti-histamines), reduce the dryness (mosturisers and ointments) and prevent infection. [SK comment: very similar to the NEA's outlook here in the US. Although antihistamines generally not considered useful for treating itch of chronic eczema, as I have discussed in earlier blog posts.]

I am grateful to Dr Sibanda for replying and I hope to add other voices to this blog to build a truly global perspective on eczema.