This article goes into further detail on our continued problem-solving for our son and our current thoughts on what may be the cause of his persisting eczema. I also give some details about why I think we’ve either delayed the onset, or reduced the severity, of asthma.
Despite the fact that our son seems to be more robust and less generally sensitive to allergens both at home and outside of home since implementing the solveeczema site, he seems much more sensitive to detergent-y environments and detergents in food than our daughter. He seems more sensitive to detergent-y environments than one would expect for a child his age. (Recall as per solveeczema, children become less affected by detergents as they age due to their skin becoming less permeable over time and absorbing fewer detergents; at his age now, especially with his younger sister doing so well, we’d expect him to be more eczema-free if his issue was just detergents).
He is definitely worse when he’s outside the low-allergen-load profile of our home, such as when he is at school. A lay person might suggest he seems to be “allergic to everything” (an overstatement others sometimes use which I find objectionable) whereas a medical professional might say he is “highly allergic”.
In her correspondence with me over the years, A.J. Lumsdaine has shared with me that she has seen several examples of children who presented as if they were highly sensitive and “allergic to everything” whose allergies cleared up after the fungal / mold issue in their body was dealt with. I don’t fully understand the mechanism, but it makes sense to me that something about the mechanism of a systemic fungal issue fills up the “allergy bucket” and leaves very little buffer for the body to encounter other allergens without having an reaction: in short, to appear “allergic to everything” or “highly allergic”.
From the “Not Everything That Affects Eczema is a True Cause” section of solveczema:
I have heard a good analogy for allergy as a bucket — exposure to different things we are allergic to fills the bucket. We experience symptoms when the bucket is filled to overflowing. If the bucket is always close to overflowing because of a lot of exposure to one allergen, then even small exposures to that allergen or to other things we might otherwise tolerate cause the bucket to overflow. But if we are able to keep the bucket relatively empty by avoiding enough of the thing or things to which we are most allergic, then we may be able to tolerate occasional exposures without problems.
In our situation, we’ve cleared the detergents whose presence would normally unnaturally allow more allergens into our son’s body, and we’ve taken significant steps to remove other allergens from the environment (i.e. we typically don’t stock foods that our children are allergic to, we have air purification and filtering to remove pollens and mold, etc.). These actions should raise the threshold for having allergic reactions.
If we presume for a moment that the external allergen load on our son in our home is minimal, which certainly seems plausible given that he’s more reactive outside home and settles down once he returns (with change of clothes and face wash or bath), it’s possible that an internal microbial issue (I lead towards yeast/fungal for various reasons, but I’m not a doctor) could be filling up the bucket and making him appear overly sensitive to allergens he encounters external to his body. It’s possible, though we’ve taken steps both to deduce if this is a problem, and to address the problem — always with the help and blessing of our doctors — and there are still eczema flares that don’t “wash off with soap”.
An internal yeast/fungal issue is one possibility. I don’t discard this as a possible cause or factor, but as time goes on, I subscribe to it less as the sole source of the persisting. It also seems to be a difficult one to prove medically and get doctors onboard to treat, at least in my experience. Another possibility is that he may be encountering more of his allergens outside our home (in fact, this is almost a definite) such as at school, where the kids around him eat snacks containing his food allergens or have pets whose dander they carry on their clothes into the classroom. Exposure to these allergens may cause his eczema to flare from lower levels of detergent exposure. The detergents that cause the flare could be the very ones he encounters outside the home, or it could be those small amounts that he is likely still ingesting because, as fastidious as we are, we can’t control 100% how our food is processed before it gets to us. (And between foods he can’t eat due to true allergy and those we don’t feed him because they’re likely to contain lots of detergents, we really can’t cut any more foods out!)
This quote, again from the “Not Everything That Affects Eczema is a True Cause” section of solveczema, gives some examples and observations of exposure to allergens lowering the detergent threshold that causes a flare:
It is easy, too, to become a slave to addressing the “triggers” rather than getting to the true cause. Dryness, for example, is often called both a “cause” and a “trigger” for eczema. The CAUSE of our son’s eczema was detergent, dryness was a trigger.
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Exposure to pollen has worked the same way. When our son is exposed to oak tree pollen — which gives him the usual respiratory symptoms — he then breaks out from lower levels of detergent exposure. But absent any detergent exposure, the pollens don’t seem to cause him eczema.
The same is true with mold exposure. According to the World Health Organization, “atopic and allergic people are particularly susceptible to biological and chemical agents in damp indoor environments” where molds especially are abundant. (See the WHO Guidelines for Indoor Air Quality – Dampness and Mould) We have seen our son’s eczema completely resolve until he spends time in moldier indoor environments, where he becomes more susceptible to outbreaks from contact, and the typical areas of eczema that he gets from ingestion sources sprout up — and go away if we are laboriously fastidious about the detergents, or just get away from that environment and those exposures.
What’s persisting our son’s eczema in some places may be as simple as the above explanation (and no longer, or maybe never was, an internal yeast/fungal issue). I have watched eczema flares start on his neck which, if kept home from school for even a few days, such as over long weekends or during holidays, seem to simmer at a low level with just soap washing and covering with Aquaphor. It’s as if the body is keeping on top of the eczema flare and given enough time in a low-allergen-load environment, will succeed, and the skin will be healed without further intervention.
More than once, we’ve sent him to school when the flare is at this simmering stage, and after 3 hours, he comes home with the flare much more raised, angry, and itchy, like he was exposed to something(s) at school that made the flare get worse. Then it stays worse until we intervene, and it starts all over again at simmering stage. All of this pondering about what is persisting the eczema is part of the ongoing problem-solving.
I mentioned earlier that I believe we’ve delayed the onset of asthma (at the very least) or (worst case) reduced its severity for if/when he finally develops it. Let me share how I came to believe this before I close off this section about my son’s results.
Prior to us discovering solveeczema, my son had 2 experiences where he ate some food that was highly likely to have been cross-contaminated with one of his food allergens. In both cases, he had his typical IgE-mediated reaction in that, within an hour of him eating the food, he broke out into hives all over his body and was miserable. But both times, something new, something I’d never seen before, accompanied his hives reaction: wheezing. In both cases, and one with input from an emergency room doctor, we were able to conclude that the wheezing appeared to be an indicator of asthma and not of anaphylaxis.
I remember thinking, as my heart sank a little, “And so it begins …”. I was aware of the so-called “Atopic March” which describes the typical progression of allergic disease and typically culminates in developing asthma. I myself have asthma, so I can’t say seeing him wheezing was a surprise, though it was disheartening to see it showing up at such an tender age. I prepared myself for what appeared to be the inevitable and telling myself that asthma (which should rightly raise the anxiety level of most parents significantly above that of eczema) is manageable and not the end of the world. I had managed my asthma without any major life-threatening episodes for all of my adult life, after all.
Since we found solveeczema and cleared the detergents from our home, our son has had a handful of accidental food allergen exposures, and some which occurred after we’d cleared detergents but before we added air purification or removed the carpet. To my initial surprise, he has reverted to having “hives only”, with no accompanying wheezing. To me this seems to indicate that with detergent removal we’ve inadvertently delayed the onset of asthma, and if, as our allergist worries and I think is likely, our son is highly likely to eventually develop asthma, I have reason to hope that its severity will be reduced. (See my own asthma story).