Childhood Eczema: An Environmental Scan
Table of Contents
4.3 Funding Priorities
Areas identified in the literature as priorities include immunology characteristics and processes to uncover which allergen exposure, especially in early life correlates with allergy development. In addition, an emphasis on developing individualized treatments is paramount in effectively managing such a complex disease. Other important aspects to consider are issues surrounding the daily living of children with eczema such as the quality of life, environmental triggers and food labeling and patient/health care professional education (47;48;54).
Specific recommendations from the environmental scan for areas to focus in the area of childhood eczema include: the environment and clinical management of the disease, specifically in the sub-areas of food sensitization and both clinical and patient education. These recommendations are chosen based on the severity of impact each has on the child suffering with eczema and importantly their parents. Furthermore, support is recommended for research aimed at investigating various aspects of food sensitization and the clinical management of childhood eczema provide opportunity to significantly reduce the morbidity thus, improve the quality of life for patients and families.
Environmental factors are now hypothesized as the leading culprit in the increasing prevalence of eczema. As previously discussed there is an important role in understanding and considering the impact of genetic mutations and predisposition. One’s genetic make-up is set from birth thus; knowing the role of genetics may allow for vigilance against developing eczema and is an important factor in an individual’s health literacy. The literature has demonstrated that knowledge surrounding genetic predispositions to eczema have in fact existed for quite some time; however, a possible and probable explanation for the rate of increase in eczema cannot be explained through genetic factors alone and is likely attributable to environmental exposures to various elements.
Moreover a genetic predisposition is not sufficient to cause eczema; therefore, work into what triggers those who are susceptible is important. Of the triggers discussed, food sensitivity for children is the most prevalent and serious allergen. Research into the mechanisms and understand the reactions from an immunological perspective are crucial in the area of atopic disease and specifically eczema. The possibility of severe sensitization such as anaphylactic reactions, the global exposure to food and food items in the day to day environment, especially for young children and the existence of risk without ingesting food allergens all represent a serious and necessary area to emphasize in atopic disease. Hence initiatives such as the work being done in the area of food labeling are crucial to the well-being for millions of people.
An extremely vital aspect to quality of care for children with eczema is pertinent information on the complexity and seriousness of this skin disease and subsequent problems that may arise. Paramount is support, guidance and information in how childhood eczema affects both the child’s and family’s quality of life on a day to day basis (40;48;55). Throughout the environmental scan and during the key informant interviews, the need of improved education for clinicians, especially primary care providers and pediatricians along with patient and caregiver education was continually emphasized. Given the knowledge regarding the severe psychological impact childhood eczema has on the patient and their family, improved clinical management derived through education is extremely important. Eczema is a complex disease for clinicians to diagnose properly and manage effectively. Furthermore, parents require a high level of health literacy to remain informed and confident about taking care of their child and remaining an effective health advocate for their child. Support and information from organizations such as the Food Allergy and Anaphylaxis Network, who provide education, support, programming and research, are invaluable resources to patients, parents and clinicians.
Patient education at pre/post natal time is extremely important, the education of women who are atopic or who have known atopic risk in the family (both parents) and providing counseling and information surrounding the risk of atopic disease to their child is an opportunity to reduce the onset and severity of future cases of childhood eczema. Research is now beginning to uncover the links among genetic predisposition, maternal-fetus risk and the prophylactic process that may eliminate or lessen atopic disease in children and reduce the incidence of IgE associated eczema. If prenatal risk (or even before pregnancy) education is instituted within primary care practice as a public health primary prevention initiative, the possible impact for reduced cases and severity of disease is very promising.
Once a child is presenting to the clinician with symptoms of atopic disease, health care providers must know what to do to intervene quickly, render an accurate diagnosis and begin effective treatment. Over the long term, it is imperative clinicians understand the relationship among eczema, allergies (including food sensitizations) and the risk of developing co-morbidities such as asthma, which again significantly impacts the child’s quality of life and can become life threatening. The emphasis of early effective clinical management cannot be overstated. Each of the key informants emphasized further education to both primary care physicians and pediatricians; a translation of the academic and research findings to front-line health care services to improve their clinical knowledge surrounding the diagnosing and treatment of atopic disease. Furthermore, there is a need for a global diagnostic tool and clear clinical guidelines for treatment protocols that require further research and transdisciplinary collaboration among health care professionals and researchers dedicated to the area of childhood eczema. Finally concerning treatment, Dr. Krafchic emphasized the need to re-educate clinicians and patients on the use of steroid treatment. She explained the wealth of misinformation associated with negative connotations of using topical steroids and the need for clinicians and patients to understand the safe and very effective use of this treatment option. Furthermore, the avoidance of using this treatment is some specific cases dramatically and unnecessarily increases the patient’s suffering, which she feels is irresponsible to the patients who need aggressive treatment in order to avoid serious morbidity issues.
Although paramount, the focus on the physical aspects of this disease cannot trump the psychosocial issues that may be unaddressed; health professionals require further information to increase their understanding of the social context and burden of illness shared by entire family. In order to realize these improvements in understanding the immunological processes surrounding environmental triggers and institute improved clinical management financial resources and advocacy are required in the areas of food sensitization and clinical and public/patient education.