Why Chronic Inflammation Is On The Rise In Children
As a pediatrician and practitioner at Parsley Health, I see an abundance of children with allergies, eczema, and asthma in my practice. I have patients who have severe eczema and spend most of their time covered in various topical steroid creams, yet they still suffer from the physical and emotional repercussions of damaged skin. Other patients are on antihistamines for their horrible seasonal allergies and still have to avoid the outdoors on high-pollen-count days. I have seen asthmatic patients throughout my training on chronic inhaled steroids that still suffer from near-death asthma attacks.
These conditions have a tremendous impact on families, including missed school for kids, missed work for parents, poor concentration at school and home, chronic use of medications, hospitalizations, and social stigmas. As a mother, I recognize this is not the type of life our children should be living with, but unfortunately it's the reality for many kids and it's on the rise.
How to recognize allergies, eczema, and asthma.
Seasonal allergies result from exposure to airborne substances, causing itchy skin, a runny nose, watery eyes, and nasal congestion. Atopic dermatitis, or eczema, is a chronic inflammatory skin disease recognizable by small bumps on the skin, thick and dry skin that cracks, a persistent itchy rash, and itching and inflammation that lead to skin irritation and damage. It affects one in five kids, with 60 percent of children developing eczema within their first year of life. In fact, rates have tripled in industrialized countries in the past 30 years.
Asthma, or chronic inflammation of the airways, is most recognizable by wheezing, shortness of breath, and coughing after exposure to allergens, environmental irritants, viruses, cold air, or exercise. It's the most prevalent chronic disease, affecting 8.3 percent of children1, according to the most recent data from the CDC.
Unfortunately, these conditions frequently overlap, something we call the "atopic march." For example, 70 to 80 percent of children with asthma also have allergies.
The uptick of the atopic march.
One major reason for the increase in these conditions as well as autoimmune disorders, is immune system dysregulation, which can be triggered by a few different things, including changes in the gut flora. This happens when children eat a diet high in carbohydrates, processed foods, and sugar and containing many food additives. I also see immune dysregulation in children who have been exposed to an overuse of medications and have frequently been on antibiotics or take NSAIDs.
Another big driver can be exposure to environmental toxins2 from the air, water, foods, soaps, lotions, and cleaning products. Children actually absorb more toxins than adults, and their bodies have a harder time getting rid of them. Some scientists think that climate change could be a contributor to the rise of asthma3, specifically, because higher temperatures might increase pollen quantity and lead to longer pollen seasons.
There is also a genetic component to the etiology of allergies, eczema, and asthma. An allergic predisposition in Mom and Dad increases a child's risk of having an allergic disposition. If Mom is more inflammatory during pregnancy, the baby may have a more allergic disposition. Genes may predispose someone, but other factors like diet and environmental exposures determine whether these problematic genes get activated.
How conventional doctors treat allergies, eczema, and asthma.
Most pediatricians treat seasonal allergies with prescription or over-the-counter drugs like glucocorticoid nasal sprays or antihistamines or simply by advising parents to keep their kids indoors or away from allergens. Some doctors even advise surgery to remove tonsils and adenoids. Frequently, pediatricians may misdiagnose seasonal allergies with sinusitis, leading to overuse of antibiotics.
For patients with mild to moderate eczema, doctors typically treat them with topical corticosteroids and emollients, while most asthmatic patients are placed on chronic inhaled corticosteroids as maintenance therapy and require courses of oral steroid for asthma exacerbations.
The functional medicine approach to treating allergies, eczema, and asthma.
I recognize it can be difficult for children to be on medications and inhalers, and often, when treated with a functional medicine approach, I can get to the root cause of their issues and resolve them rather than just treating the symptoms. I'm thrilled to now be able to practice pediatrics through a functional medicine lens—something our members at Parsley Health have been asking for. Here are some of my top tips to help control eczema, allergies, and asthma naturally:
1. Heal the gut.
Reversing gut dysbiosis and working with a doctor to determine any food allergies or sensitivities is the first step in treating all inflammatory conditions, including allergies, eczema, and asthma. At Parsley Health, I use a specific gut healing protocol in my pediatric patients with these inflammatory conditions, and I tailor this protocol for each individual child.
First, I recommend removing common food triggers including gluten, sugar, dairy, eggs, soy, soda, and artificial ingredients that could be leading to inflammation in your child's gut. I also recommend increased fiber and water intake to ensure that your child is having daily bowel movements. Depending on the patient, I might also use oral antimicrobial and anti-yeast agents to remove overgrowth of yeast and bacteria.
After a few weeks on the elimination diet, I usually advise parents to add in supplemental digestive enzymes to their child's regimen, which supports the breakdown of food. Then, I advise adding a high-quality probiotic to repopulate your child's gut with beneficial bacteria and enhance digestion. Although a probiotic cannot reverse asthma, eczema, and allergies, probiotics have been shown to be effective in the long-term prevention of eczema when given to a baby early in life, specifically Lactobacillus rhamnosus.
Lastly, to repair the gut lining, supplements such as aloe vera, licorice, zinc, fish oil, and L-glutamine can be added to the regimen.
2. Consider using additional supplements.
I often recommend a high-quality vitamin D supplement to help boost intake and support the immune system, especially during allergy, eczema, and asthma flares. In children and adolescents, studies have shown that those who suffer from eczema were more likely to have low levels of vitamin D. In addition to increasing sun exposure, be sure to include vitamin-D-rich foods in your child's diet including sardines, eggs, and salmon.
Grapefruit seed extract nasal spray, which has antibacterial properties, can also be beneficial for allergic rhinitis and chronic cough for asthmatic patients. In children 5 years of age and older, you can also consider quercetin and freeze-dried stinging nettles. Both are non-sedating and safe antihistamines for itching and inflammation and added bonus: Quercetin is also healing for the gut. Curcumin has anti-inflammatory properties and is also useful in children. Zinc also supports the health of the respiratory and gut mucosa. Eyebright, an herb, can be used for allergic rhinitis as well.
Specifically, for severe eczema, you can consider licorice extract for eczema flares, as it acts like a natural cortisol. Be sure to talk with a physician prior to starting licorice extract as it can raise blood pressure.
For asthma in particular, vitamin B6 has led to improvement in peak flow rates and a reduction in the frequency and severity of asthma symptoms. Zinc can help to prevent upper respiratory infections, one of the most common triggers for asthma flares. Lastly, I've observed that magnesium can reduce asthma symptoms.
3. Use supportive measures.
For asthma and allergies, reduce environmental triggers, specifically smoke, whenever possible. You can consider purchasing a humidifier or HEPA air filter. Keep your home clean with elimination of dust and mold.
For patients with eczema, after bathing, simply pat the skin dry prior to applying moisturizing creams. Use unscented soaps, or forgo the use of soap altogether. Purchase 100 percent natural cotton clothing. Remember to keep fingernails short so your child does not scratch his/her skin and damage the skin further.
For asthma, it is crucial to find ways to decrease stress, as stress can lead to increased work of breathing and increased frequency and severity of asthma flares. You can teach your child, when it is age-appropriate, deep breathing and yoga techniques.
4. Apply natural topical treatments to the skin.
For flare-ups, topical herbal salves can moisturize, protect, and heal damaged skin. Salves containing comfrey, plantain, and calendula are good for babies with eczema, serving as natural emollients. You can apply these salves one to two times daily for dry skin, at the onset of a flare and to treat active flares. There are certain salves with tea tree oil that adds an antimicrobial function.
Many people have also had success with topical treatments like Eczema Honey and Egyptian Magic. In fact, honey is known for its skin-healing properties, in part by helping the skin retain moisture. Another topical herb that you can consider trying with eczema patients is 2 percent licorice gel, which you can apply topically.
Ozonated olive oil is a topical treatment for eczema, particularly for eczema patches on the face and extremities. It is actually an ancient remedy that has been brought to a new level with cold-processed ozonation, which purifies the oil while simultaneously working to elevate its antioxidant properties. It is designed to moisturize, purify, and nourish the skin. It's best to get recommendations from a doctor when purchasing ozonated olive oils4 since many products are not reliable and do not contain sufficiently ozonated oil.
Interestingly, mothers can try applying their own "hind milk," the breast milk from the end of a feeding, to eczema-affected areas to promote healing.
How to talk to your doctor about natural approaches to eczema, allergies, and asthma.
If you don’t currently work with a doctor trained in functional medicine, you can certainly start to make some of these changes at home. As much as possible, be an advocate for your child.
I also recommend working with doctors who are open to your ideas, so certainly ask your doctor to explore the ideas listed above. Explore these potential dietary changes along with your doctor's help, and promote regular daily bowel movements for your child. Discuss these supportive measures, supplements, and natural topical salves that may be helpful in improving these conditions.
Remember that children are resilient, and with the right support from doctors and parents, they can reach their full health potential.
Gabriella Safdieh, MS, MD is a pediatrician and rheumatologist. Gabriella completed medical school at the University of Pennsylvania, trained in Pediatrics at New York University, and completed a fellowship in Pediatric Rheumatology at the Hospital for Special Surgery in New York City / Weill Cornell Medical center. She has also started her training with the Institute for Functional Medicine which teaches healthcare professionals to get to the root cause of lifestyle-driven disease through a patient-centered, systems biology approach. She has completed the Applying Functional Medicine in Clinical Practice course, which teaches clinicians to more effectively integrate science, research, and clinical insights to treat and prevent disease and maintain health. In addition, she studied with Dr. AnnaLisa Pastore who incorporates the principles of Energetic Nutritional Assessment Technique and Natural Force Healing in her practice.
Gabriella is passionate about helping her patients address the root cause of their disease and to help them reach their health goals in the most natural way possible. She wants to help children and young adults maintain wellness and best treat the root causes of their chronic diseases. With a background in Rheumatology and the frequent autoimmune disease burdening our society, she has a unique expertise to help manage these complex conditions, blending together Eastern and Western medicine in her practice. When she is not helping her patients, Gabriella is spending time with her husband and three children, enjoying nature and the beach, practicing Pilates and yoga, while loving and living life to its fullest.
Photo Credit: JJ Jimenez