MRSA-- like a sourdough starter

An item to emerge from the American College of Allergy, Asthma, and Immunology meeting in Phoenix this week: if someone has an extreme food allergy, you can give them a reaction just by kissing them.

Bizarre, but makes sense, and highlights how sensitive our immune systems can be. If tiny amounts of allergen can cause such severe trouble, it seems more plausible to me that the broken skin of eczema can expose young children to allergens that might sensitize the body for life.

I've read through The Advocate once now (get this-- that picture of the torn-up foot on page 5-- I read that page while I was eating dinner, that's how DEsensitized I am to eczema) and, once again, I appreciated it on several levels.

1. I feel better by comparison, because some people out there evidently have it much worse than me and my daughter
2. I feel like I belong to a wider community facing the same challenges we do
3. I'm interested to hear advice from leading scientists in the field on day-to-day therapy and some of the more advanced/extreme options

My god, the poor kid, Joanna Hamilton's son Jonah, with MRSA. I can relate to him about the food (my mom says at one point she was only feeding me carrots and bananas, and my nose turned orange) and the scratching (my own feet and Voov's have at times looked like that photo) but not the MRSA. That is some bad shit. From what I've heard, the more you can stay out of the hospital, the better chance you have of avoiding it. But what about the doctor's office? When you have a young child, you are in the doctor's office virtually every week getting some rash or cough or weird eye tic checked out. Is MRSA in the doctor's office too? I'd appreciate knowing.

Earlier this year, Voov had some terrible staph all over her hands. She was crying all the time and her hands were all blistered and bloody and crusty and you couldn't even see a spot of decent skin. Naturally, we were on vacation. We got back home and Voov went on some antibiotics and her skin cleared up all over her body. Then, bingo, I suddenly developed a staph infection, a lovely one on the back of my head. It cleared up by itself, fortunately. In these six-kid families that have multiple members with eczema, they must pass an infection around for months, keeping it alive like a sourdough starter.

Eczema under the guns

Today, depending where you are in the non-German Western world, is Remembrance Day (British Commonwealth), Veteran's Day (US), or Armistice Day (France & Belgium).

My father's father, Titus, served in the 48th Nova Scotia Highlanders in WWI. I've seen a map of his regimental movements and although there were a number of famous place names on the path, I remember only one: Passchendaele. I think Ypres might have been there too. Old Titie, as my dad calls him, apparently used to freak out whenever someone burned the toast at home, because the smell reminded him of poison gas.

Titus was the one grandparent of mine who had eczema. His itch was legendary. "Old Titie was always scratching," my dad says. (I don't remember Titus; he died when I was five.) I don't know whether the stress of being under bombardment would exacerbate eczema, or distract the mind from itch, and with any luck I'll never find out. Eczema must have made life in the trenches even worse. Titus, we can't imagine what you went through. Thank you.

These days, eczema is a condition that disqualifies you from service in the US military. The reason: in 2007, a soldier vaccinated against smallpox gave his two-year-old son the often lethal condition eczema vaccinatum. An all-out medical effort saved the kid. Now, one can understand why eczema disqualifies you from active service: it would make sense that all service members have to be vaccinated against smallpox, a major biological weapon; and the military would face a major problem if soldiers, etc., refused to be vaccinated because they or their families might die from eczema vaccinatum.

The military therefore is only ruling out about 3-5% of recruits, is my guess. The crucial question is whether you've been diagnosed with eczema after the age of 9. I'm not sure what the precise number is, but about 20% of infants get eczema, and only 2% of adults continue to suffer from it.

I do think that we can look at the bright side of the smallpox/eczema question. It's a point of leverage for us. The US government spends a lot of money on the military, and probably wouldn't mind spending a few hundred million more. The Atopic Dermatitis Research Network was given $31 million to study MRSA and other infections in patients with eczema-- but the initial request-for-proposals was actually aimed at studying eczema vaccinatum. It wouldn't hurt to make our concerns about smallpox vaccination widely known; we could attract major funding. Eczema infection researchers might discover powerful new antibiotics, or other ways for us to protect ourselves from infections such as MRSA.

Eczema Haul!!!

An End Eczema first today: let's look at a video. As I've said before, this blog is going to be light on photos and such because eczema doesn't make the most attractive visuals. And video? Well, this one is an exception. It's kind of fun. The girl has decided to show us all the panoply or arsenal or whatever of the products that she uses daily to treat her eczema. She's titled her video "Eczema Haul!!!" --must be some new slang term I haven't heard of.

Easy to tell that she's American: well, first, her accent, but if you hadn't registered that, "I don't have insurance" is a dead giveaway. Let me be perfectly clear. I live in the U.S., but I think it's barbaric that this is the only first-world country without universal health insurance. Imagine having eczema and getting a staph infection and wondering whether you ought to go see a doctor because it might cost too much. For one thing, every infection that unnecessarily goes too far puts other people at risk of being infected.

Here's the video (she's disabled embedding).

A couple interesting points. She's obviously very keen on Aveeno. So am I. It's a great company with great products, and the Daily Moisturizing Lotion with dimethicone (a rubbery sealant) is almost the best I've found. The shaving gel is awesome, although a while back they were having manufacturing problems and you couldn't find it in stores, so I've been using some fragrance-free Edge. But you can't go completely Aveeno. I tried Aveeno shampoo and found it little better than ordinary shampoo,  leaving my scalp drier than the Mojave. Here's my secret: tar shampoo, rinse, and then, rubbed into the scalp, some jojoba oil.

Ironically, jojoba grows in the Mojave.

Toward the end she pulls out a bottle of vitamin E capsules and touts its benefits to people with skin diseases. "Vitamins are good for you, period, people." I am not so sure. I confess to taking a daily multivitamin (mostly for the potassium-- I get muscle cramps sometimes), but all that I read about eczema tells me that the way to a happier you is to avoid problem foods rather than take any miracle nostrums.

To quote an impeccable authority, Wikipedia:

The consensus in the medical community is that there is no good evidence to support health benefits from vitamin E supplementation, yet there is strong evidence that taking more than 400 IU of vitamin E per day for extended periods increases the risk of death.

I like to avoid death, myself. It's something that, according to the prophet Mohammed, even black cumin can't cure.

Something I forgot to relate after my trip east to the science writers' conference this past weekend: there is a new book just out on MRSA. Superbug: The Fatal Menace of MRSA. (The author, Maryn McKenna, was on a panel discussing how to publish a popular science book.) I'm not saying you should read it--even the website gives me the willies--but it sure looks like the comprehensive resource on the emergence of this medical hazard that is of concern to everyone with eczema. Perhaps Dr. Sib can give us her perspective on MRSA, what it's like to deal with it in the hospital.

Say no to smallpox vaccine

In March 2007 a two-year-old boy in Chicago contracted the smallpox virus from his father, a soldier who had recently been vaccinated prior to a tour of duty in Iraq. Only an all-out response from a Who's Who of U.S. infectious disease experts saved the boy, who had become a victim, it appears, because of an immune defect associated with eczema.

Why does this matter to you? Or to me? I read this article in Science (sorry about the paywall) at the time and the story just leaped off the page at me. It's scary. If you have eczema, you basically shouldn't get vaccinated for smallpox because the risk of dying is too high. And the effects aren't pretty.

(You may notice that I never post images of this stuff. That's my policy. I have eczema, and it grosses me out enough on my own body that I don't need to see it on anyone else's. I eat dinner after writing these posts.)

In the year following that nasty discovery, the NIH founded a research group called the Atopic Dermatitis and Vaccinia Network (ADVN) to look into why vaccinia virus can cause such an extreme reaction. Vaccinia is closely related to variola, the agent of smallpox, and used as the vaccine. In most people, it's benign. An ADVN group at the La Jolla Institute for Allergy and Immunology found that levels of "natural killer" cells, a class of white blood cells, are low in a strain of mice used as models for atopic dermatitis, and which develop "eczema vaccinatum," the same condition the Chicago boy nearly died from. In normal people, the theory is,  natural killer cells somehow keep the virus in check.

Science is complicated-- this is one paper, and it's a mouse model, but you can imagine that these results might point the way to studies that could find similar results in humans, and possibly therapies to boost natural killer cells to prevent deadly reactions to vaccine. (The ADVN must have published reams of papers, and right now I have no idea what their most significant findings were. Will have to find out.)

The ADVN has now morphed into the ADRN, the Atopic Dermatitis Research Network, the group that in July received $31.5 million from the NIH to conduct extensive research over five years into why patients with eczema are susceptible to deadly microbial infections. In the NIH's original request for proposals for this funding, they define four research areas; the first two are eczema vaccinatum and staph infections. The second two are vaccine reactions and infections from other organisms. The constraint was that applicants had to pick one of the first two areas, plus one to three of the remaining three. The successful consortium, led by Donald Leung at National Jewish Health in Denver, appears to have picked staph infections as their primary focus, according to their press release.

I wrote to Leung and he informed me that the group has not yet determined a protocol for its experiments, but will have done so by the end of the year. I can't wait to find out the details. It is an undertaking of huge scope-- ten academic centers involved. Staphylococcus, and MRSA, is surely a worthy enemy to vanquish. Imagine bringing up a child with eczema knowing that because of what they discovered on this project, you didn't have to worry about runaway staph infections. Life might not be all smooth sailing, but the fear factor would be a lot lower.

Initially, I called the NIH media department, asking whether they made the details of grant applications public. They do not, and the officer directed me to contact the scientists directly. "I'm an eczema sufferer myself," he told me. "I understand why you want to know."