Eczema patients not protected by intradermal flu vaccine

When I talked to Donald Leung earlier this week (he's head of pediatric allergy & immunology at National Jewish Health, and leads the Atopic Dermatitis Research Network) he mentioned one interesting result that has already emerged from a small-scale ADRN trial. Leung and others showed that patients with atopic dermatitis were not adequately protected, by FDA standards, by the new influenza vaccine Fluzone.

Fluzone is administered using a super-short needle--the technique is called "intradermal" injection in which the vaccine gets squirted into the upper skin layers rather than muscle tissue.

Presumably the super-short needle is less scary than a regular needle, and more people will get their flu vaccinations this way; it could be a public health issue in the event of a flu pandemic.

Scientists know that the immune system functions differently in the skin of patients with eczema. Leung and colleagues looked at how 20 eczema patients fared with Fluzone, compared to 20 non-atopic patients. Twenty-eight days after vaccination, they measured the levels of flu antibodies in the patients' blood. The non-atopic patients met the FDA standard; the eczema patients did not.

The scientists published their results in a preliminary form as an abstract at the meeting earlier this year of the American Academy of Allergy, Asthma and Immunology.

Book review: The Problem Skin Bible

Most books on medical topics are written by doctors who have wide experience in the field. Here’s a different kind: a short e-book by a patient, infused by the passion that comes from suffering from eczema for most of his life. “The Problem Skin Bible,” by Kevin Bk Truong,* founder of Miracle Skincare in Sydney, Australia, details the author’s recommendations for diet and lifestyle that he says will improve the skin of those suffering from chronic conditions including eczema.

I found Truong’s book of interest not because it has all the answers, but because it urges patients to take responsibility for their own conditions and tailor their lives to make their skin better.

In my opinion the best analogy for Truong’s book is not the Bible but rather one of the books that make up the Bible—one of those to be found later in the Old Testament. (The book of Job, perhaps?) It’s one person’s impassioned take on his experience, and best read with an understanding of the scientific and medical context.

Truong focuses largely on diet. From what I know he does not have a scientific or medical background. This is apparent in the inconsistent way he refers to allergy throughout. He knows what worked for him, and he has clearly read widely in the scientific literature.

I found many of his recommendations similar to those I might make myself—avoid processed foods and the products of industrial agriculture, stay clear of alcohol if you can. Toward the end of the book, he has a lot of good advice on skincare regimes and lifestyle choices.

But he also holds views I don’t agree with: e.g., that GMOs are bad for you. (My own view is that GMOs are not inherently bad, although they are engineered to tolerate higher pesticide levels, which could mean GM food contains more toxins).

He’s anti-wheat, which is fashionable these days. Sure, gluten allergies are a problem for some, but hardly everyone. Also he seems to believe that a number of foods generally considered wholesome (especially nuts and seeds) contain things that are bad for you, such as phytic acid—which is only a concern for people who eat a nutritionally restricted diet. To reduce phytic acid levels, Truong advises roasting nuts—which destroys the omega-3 oils that he then advises you take as supplements.

He also mentions that black pepper is a good spice, and in one of his recommended recipes he lists chili sauce as an ingredient. In my experience, black pepper and chili inflame my skin and cause itch. Obviously they don't for him.

For these and many other reasons, I can’t recommend The Problem Skin Bible as anything like an infallible resource. But I like Truong's positive attitude. If you are interested in how a fellow patient has taken the initiative to improve his life, you should check his book out. Contact him to request a copy.

*Truong tells me that "Bk" is his nickname and that he prefers to include it in his name.