Study confirms eczema-asthma links

Study confirms eczema-asthma links

A new  study confirming the temporal links between childhood eczema and rhinitis and  adult-onset atopic asthma is highlighting the need to rigorously treat  childhood allergies.
 
Associate  Professor Shyamali Dharmage says this is one of the key implications of new  research from MEGA Epidemiology, within the Melbourne School of Population  Health. This paper focused on childhood eczema and rhinitis as predictors of  atopic (or allergy-triggered) and non-atopic adult asthma.
 
It draws  on the valuable resource of the Tasmanian Longitudinal Health Study (TAHS),  which started in 1968 and profiled the asthma risk of almost all Tasmanian  children born in 1961. Associate Professor Dharmage is the lead investigator of  TAHS, which continues to generate important insights into the complex causal  links between childhood allergies and asthma.

The  lead author of this paper is Pamela Martin, a PhD student based at the Murdoch  Childrens Research Institute (MCRI) and jointly supervised between MCRI and  MEGA Epidemiology. This paper is soon to be published in the influential Journal of Allergy and Clinical  Immunology, the highest-ranking allergy journal. It advances international knowledge in  this field with a series of notable ‘firsts’. It is the first study to show a  strong link between eczema and rhinitis measured in childhood, and atopic  (allergy-triggered) current asthma at age 44. It is also the first to examine  at the population level the relative contributions of combined eczema and  rhinitis, with respect to persistent childhood asthma and new-onset asthma  later in life. Importantly, it is the first to distinguish between atopic and  non-atopic asthma and their occurrence after childhood eczema and rhinitis, as  part of the sequence dubbed the ‘atopic march’.
 
Among  the new study’s very significant results was that having both eczema and  rhinitis in childhood (before age seven) led to a nine-fold increased risk of  current atopic adult asthma. The researchers estimate that up to 30% of current  atopic asthma within the larger population sample could be attributed to a  history of childhood eczema and rhinitis.
 
The  implications of this study are that prevention and rigorous treatment of  childhood eczema and rhinitis may prevent adult asthma.  Associate Professor Dharmage is concerned  that the public is too casual in their attitude to treating eczema and hay  fever, unaware of the potentially debilitating – or even fatal – health  implications that lie ahead in adulthood. “While adult asthma itself is a serious  health issue it should also be noted that asthma itself  is an established risk factor for emphysema and chronic bronchitis,” she  says.  “These chronic respiratory  diseases lead to obstruction of lung function affecting quality of life and  productivity as you age.”  To prevent this sequence of events interventions that can halt the march from  childhood allergies to asthma need to be identified.
 
A MEGA research team has completed a pilot study in  2010 to trial strategies for halting the atopic march. This was led by Research  Fellow Dr Adrian Lowe and he will lead a larger trial in 2011. The aim of this  work is to establish whether a ceramide-based cream can prevent babies  developing eczema and improve their skin barrier function in early life, and  thereby prevent subsequent development of asthma.
 
If successful strategies to arrest the atopic march  are identified this could ultimately save lives and health care costs related  to asthma management and treatment. In 2000, 454 deaths were attributed to  asthma and the total health system cost of asthma was estimated to be $438  million.

Caption: Associate  Professor Shyamali Dharmage