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.

An ill-advised comment on peanuts

Upon arriving home this evening I was not only welcomed by Hidden B (torrid spousal kiss), Voov (loud acclamation from high chair), and Shmoop (whiny complaint from the floor, where he was lounging, practising to be a teenager) but also, on the kitchen table, this quarter's issue of The Advocate, the NEA's house publication.

The Advocate is best savored at leisure, like a fine malt whisky, so I'll save my review for future posts. Today I want to mention that the annual meeting of the American College of Allergy, Asthma, and Immunology is still ongoing in Phoenix. It was at this meeting that, on Saturday afternoon, Donald Leung and three other immunology heavyweights engaged in the knock down, drag out brawl known as the Great Atopic Dermatitis Raft Debate. The four presenters each argued that their pet cell types (keratinocytes, T cells, etc.) play the most important role in eczema. Man, I'd like to know what they said, but the event wasn't webcast. I did find out, however, that the proceedings of the entire conference were videorecorded and are available on DVD-ROM-- for me, at the low low price of $340.

Maybe there's some way to get just the session I'm interested in, but it'd probably take more effort than I can spare. (I was also informed that audio recordings might be cheaper... but who's going to pay a hundred dollars for a podcast when these scientists are probably leaning heavily on Powerpoint diagrams?)

* * *

The ACAAI meeting has been in the news, because the president of the whole shebang has gone on the record saying that people take peanut allergies too seriously. I'm sorry, but this immediately discredits his expertise. I know that latex and peanut allergies can be life-threatening; and their incidence is increasing. It doesn't matter if the incidence is low (~0.5%)-- in a school of, say, 1000, that means you have five kids who could potentially die if one of their classmates (it is clinically proven that 100% of kids are capable of being idiots) thought it might be funny to see what happens if Johnny takes a bite out of the wrong sandwich.

I know someone who died of an asthma attack; I also know someone whose wife nearly died from a latex allergy. I'm no expert, but I think peanuts probably pose the same caliber of problem.

This is one area in which America's "sue first, ask questions later" culture will work for the good of society. I can't imagine a school principal revoking a peanut ban because Dr. Bahna said so. Fewer peanut bans may get enacted, though.

For the record, I loves me some Snickers, and I eat PB&J every single day. But I'd quit on the spot if someone's life was endangered.

* * *

A blog post worth checking out: in which a UK citizen of east Indian descent talks about her teenage experience with eczema. For me, too, eczema came on with a vengeance not long after I got interested in the opposite sex. I didn't develop big boobs to compensate, as she did-- but, on reflection, that's probably a good thing.

Teenage years are hard

Not the happiest news today, I'm afraid: some poor kid in Manchester, England apparently committed suicide after being taunted at school about his eczema.

It's hard to be a teenager. Many kids are insecure--they think that others think they're not tough enough, or not cool enough, or whatever-- so they bully and torment kids who don't fit in. And it's easy to single out the boy with the funny rash.

Of course there could be more to this story. The boy may have been suffering from clinical depression, which is distinct from general teenage angst. But who among us adults doesn't still keenly recall every casual remark that wounded us during those years?

I'm lucky. Although I definitely had eczema all the way through high school, nobody made a habit of jeering at me for it. (Instead, they jeered at my accent, haircut, trouser cuffs, and Bryan Adams cassettes, among other things.)

We should tell kids with eczema that life does get better. Your eczema may not improve, if you're one of the unlucky 2% or so. But past high school, you're not trapped in the zoo any more; the cliques aren't as intense, because people have little to gain by making you feel bad. The more life experience people have, the less they care about how your skin looks. And if you can feel confident in yourself, it shows on the outside.

* * *

An important conference opened yesterday in Phoenix: the annual meeting of the American College of Allergy, Asthma, and Immunology. There's a particularly interesting session on Saturday from 1:30 to 3:00 pm. It's titled "The Great Atopic Dermatitis Raft Debate: The Greatest Role in the Pathophysiology of AD." (I don't know what "raft" means here.) It's basically a four-way mano-a-mano between presenting scientists, each of whom is claiming that the cells THEY study play the most important role in eczema. Our good friend Donald Leung (head of the Atopic Dermatitis Research Network) is in the T cell corner. He evidently wrote the abstract, because it says "Upon completion of this session, participants should be able to... describe the scientific evidence that supports T cells as playing the key role in causing AD."

Which is amusing, because the more I read about eczema, even in articles written by Leung, the more it emerges that eczema arises from a barrier defect in the outermost layer of the skin-- a defect in keratinocytes. (He does nod in their direction, saying keratinocytes have a "critical" role, but not the KEY role.

I've snoozed through many an academic conference presentation, but I'd sure like to be at that session! It'd be like Iron Chef, only immunology.

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.