The "atopic child"

[snanna]

My three year old has had severe excema, mostly seasonally, since he was about five months old, and now, at age three, has had an episode of "reactive airways disease" with wheezing and labored breathing. His skin is very dry, and the excema moves around to different areas depending on various factors. It's most severe (cracking, open sores, widespread over a large surface area) in the winter, but he does have more mild episodes in the summer. At the moment it is mostly around his mouth, eyes, and hands/wrists. He also often gets hive-like outbreaks that cover most of his trunk and legs for a few days and then fade to smaller, more irritated areas that hang around for weeks. 

About a year ago he had an IgG test at a naturopath, and tested in the "no reaction" category to all foods except those containing gluten, to which he had a very mild reaction-- a 1 on a scale of 1-10. We took him off gluten (and me as well, as he was still nursing) and maintained a very strict no-gluten diet for the whole family for about nine months. Challenges were inconclusive. Basically, he got a little better-- could have been coincidence-- and then rapidly back to the usual. We started eating gluten again recently, and there has been no clear worsening of his symptoms (well, except perhaps the reactive airways episode a month into eating gluten?).

We give him fish oil, probiotics, and a vit D supplement, and use Desonide and Triamcinolone pretty constantly, in addition to all the usual excema-care routines (moisturizing, clean detergent, short baths, etc.). The reactive airways was treated at urgent care with a nebulizer and oral steroids, then an inhaler at home. 

The allergist I talked to would want to do skin tests, and I can't imagine holding him down for that at this age, but I want a "next step" to look forward to. The excema really impacts his quality of life, and is poorly controlled even with the topical steroids. I've taken him to two naturopaths, who have both basically said he's genetically predisposed and will hopefully grow out of it. Both prescribed expensive, ineffective topical treatments and expensive, proprietary probiotics. Neither thought an elimination diet would be very informative. I am hesitant to ask the doc for help controlling the excema, because I know the answer is just stronger steroid creams.

I feel kind of stuck. Is he just destined to be the kid with weeping cracks in his face, waking up scratching and crying every night? Is he headed for asthma (as the doc sadly predicted)? Any suggestions for the next step? 

[changingseasons]

None of the naturopaths suggested an elimination diet?! That would be my first step. IgG tests are highly inaccurate.

I would suggest doing an elimination of the top 8 allergens for a few weeks and keeping a detailed food journal with everything eaten and all symptoms (digestive, skin, behavioral, sleep, etc.)

Also- the skin testing isn't that bad. The application is usually really quick, it's the waiting (and not scratching) that can be frustrating for a little one.

[snanna]

That's good to know about the skin test not being so bad. I remember it as being like a bad sunburn when I had it done as a teen. He's such a scratcher, and has such firm body boundaries....

The reason for not doing an elimination diet is that this kind of long-term excema, apparently, has a slow turn-around time, and response/non-response can be very unclear. This was certainly my experience with the gluten elimination. I thought it was helping enough to keep doing it for nine months, before I was persuaded that it was having no effect. I did eliminate corn, soy, chocolate and dairy when he was a baby, for about six weeks, and saw only an intensification. 

The naturopath who did the IgG test seemed to think the lack of response indicated greater, rather than less accuracy in this particular test result-- that test is notorious for many false positives, it sounds like (and I have friends who have tested as allergic to 20 or 30 food items on it-- though there might be a leaky gut situation going on there).

[34me]

Also be aware that at that age even skin testing is not totally reliable.  My boys were tested at 5 and 3 and both were neg to everything.  They were both tested again when they were 7 and ds1 was positive to everything (they test regionally) except mold and ds2 was positive to everything, including mold.  Both boys have had symptoms since birth, ds1 has typical allergy syptoms including allergic shiners, excema and asthma.  Ds2 has excema, RAD and viral and exercise induced asthma.

[snanna]

Originally Posted by 34me 

Also be aware that at that age even skin testing is not totally reliable.  My boys were tested at 5 and 3 and both were neg to everything.  They were both tested again when they were 7 and ds1 was positive to everything (they test regionally) except mold and ds2 was positive to everything, including mold.  Both boys have had symptoms since birth, ds1 has typical allergy syptoms including allergic shiners, excema and asthma.  Ds2 has excema, RAD and viral and exercise induced asthma.

Ah, yes, the doc did talk about that a long time ago, now that I'm reminded. She referred me to the allergist, who I just emailed with (love our electronic medical records system!) and we decided not to take him in for lots of reasons-- I'm sure the unreliability of the test was one of them.

What are your management strategies like now that your boys are older? Do they eat very limited diets to avoid all their allergens? And is that effective in controlling their symptoms?