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Not a fan of eczema meta-studies, especially that antibiotics one

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You don’t have to look far for an example of how the media can inflate a trivial scientific result into something that looks like important news.

Take last week’s report in the British Journal of Dermatology that exposure of newborns or infants to antibiotics increases the risk of them developing eczema. It was all over the mainstream media, with headlines such as “Report claims antibiotics cause eczema” and “Could Using Antibiotics As A Child Make You Develop Eczema?” I’m still seeing it on Twitter.

I think it’s almost criminally irresponsible to publish news like this when you just know thousands of parents will now hesitate to give their kids antibiotics. The kids will be the ones who suffer needlessly, when they must endure potentially life-threatening infections without treatment.

If giving a child antibiotics substantially increased the risk of developing severe eczema, then that news would be worth paying attention to. But that is not what the BJD paper concludes.

For a start, the paper is a meta-study: a review and summary of a large number of original population studies that other scientists already carried out.

Meta-studies are a great way for scientists to pad their publication records without getting their hands dirty with real research.

In my experience, a meta-study is suspect just because it exists. I don’t see meta-studies coming out in areas in which the science is indisputable (e.g., that UV from the sun causes skin cancer). I see them in areas in which there’s no scientific consensus and most likely the phenomenon under study has a very small real effect. In the field of eczema research, I see meta-studies published about vitamin D, probiotics, traditional Chinese herbal medicine, and so on.

The reason you see meta-studies in these areas is because the trials are all finding different results and someone wants to obtain a big picture of what is going on. Lots of noise and a small signal. If it was obvious what was going on, there’d be no point in a meta-study.

But one major question is how do you compare studies that are done with different aims and measures? This question is especially relevant for the field of eczema research, where there isn’t even a consensus about how to diagnose or measure atopic dermatitis. Not that long ago I went to San Diego as a patient representative to the HOME meeting (the third such get-together), at which researchers were trying to settle on a single standard survey form for measuring how bad a patient’s eczema is. In several meta-studies I have seen the authors mention (i.e. complain) about how difficult it is to draw conclusions from multiple eczema population studies.

Then, the conclusions of the meta-studies are usually weak. The results are almost always presented as “odds ratios,” which to me seem like mathematical sleight-of-hand to inflate very small results. In the antibiotics-early life meta-study, the researchers reported an odds ratio of about 1.4. What this means is you get the number 1.4 when you divide one number, the odds that a child will develop eczema if they get antibiotics, by another number, the odds the child will develop eczema if they are not given antibiotics. If you assume that the second number is about 2:8, or 20% (given that there’s a 20% chance a kid in general will get some kind of eczema) that means, for an odds ratio of 1.4, that there’s a 26% chance a kid given antibiotics will develop eczema.

Big deal, a 6% increase in risk—if you believe the meta-study, which is comparing 20 other studies that all used different methods and measures.

Is that worth risking your child’s life for?
End Eczema

AAAAI: Study Shows Peanut in House Dust Linked to Peanut Allergies, Especially for Children Prone to Eczema

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Milwaukee, WI (PRWEB) November 18, 2014

According to a new study, led by King’s College in London, infants who have impaired skin barriers and are exposed to peanut proteins – which can be found in household dust – are more likely to develop sensitivities to peanuts.

The article was published on November 18 in The Journal of Allergy and Clinical Immunology (JACI), an official journal of the American Academy of Allergy, Asthma & Immunology (AAAAI).

“Our findings point to a biological plausibility that environmental peanut exposure might be sensitizing children through an impaired skin barrier,” first author Helen Brough, MA (Hons), MSc, MBBS, FRCPCH, explained in the study.

The study examined the amount of peanut proteins which 359 infants, from a high-risk cohort, were exposed to by vacuuming and analyzing household dust found on the living room floor. Peanut-based food can leave peanut proteins behind in household dust, even after regular cleaning.

The children, aged 3-15 months, were considered to be at a high risk of developing peanut allergy because they were either allergic to cow’s milk or egg and/or prone to eczema. In this study, researchers found that exposure to dust with peanut proteins doubled the risk of peanut allergy. Children with a history of eczema were at greater risk.

“The effect of peanut dust exposure on peanut sensitization is augmented in children with a history of atopic dermatitis (eczema) and even further in children with a history of severe eczema,” according to senior author Gideon Lack, MD.

The study calls for further research to examine what’s being coined as dual-allergen-exposure theory, that is, testing the idea that while exposure to allergens through the skin can create sensitivities, perhaps consumption of these food proteins early in life can build a tolerance in the body. Regardless, reducing the environmental exposure to food allergens could be explored to prevent the development of food sensitization and food allergies.

“It may be that the timing and balance of skin and oral exposure to a particular food, early in life, especially for atopic children, could determine whether a child develops an allergy or tolerance to that food,” collaborating author Scott Sicherer, MD, FAAAAI, from Jaffe Food Allergy Institute & Icahn School of Medicine at Mount Sinai explained.

More information on food allergies and eczema is available at the AAAAI website. The full study was performed in collaboration with the NIH/NIAID funded Consortium for Food Allergy Research (CoFAR) and can be accessed through the JACI.

The AAAAI represents allergists, asthma specialists, clinical immunologists, allied health professionals and others with a special interest in the research and treatment of allergic and immunologic diseases. Established in 1943, the AAAAI has more than 6,800 members in the United States, Canada and 72 other countries. The AAAAI’s Find an Allergist/Immunologist service is a trusted resource to help you find a specialist close to home.

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