Nutrition homepage

Nutrition 3701

Lecture 19

ECZEMA-29 October 2010




                Vitamin A




                                Breast feeding



                Preventative dietary therapy for children to prevent atopic dermatitis


                Dietary Deficiencies (elimination or reduction causing dermatitis



                                Essential fatty acids









Dose issue in food-more on vitamin A in the next lecture

Issue of dermaceuticals




                       This refers to atopic dermatitis and point up the problem with functional foods



Diet allergens interact with IgE antibodies bound to mast cells the mast cells release IL-4,5,6 and TNF-a (early response)


These cytokines are pro-inflammatory and act accordingly through the IgE mediated late response


Leukocytes are attracted and stimulated to release their own pro-inflammatory cytokines




                                Nickel sensitivity or allergy found in fasting persons given 600 mG nickel in water

                                                -likely atopic dermatitis


                                also in nickel rich foods like chocolate, nuts, beans, porridge oats








Allergy- Breast feeding


                                Various proteins can lead to atopic dermatitis


                                Elimination therapy by infant or mother


Infants with recent atopic dermatitis-breast milk with higher ratios of linoleic to the total of            gamma-linolenic, dihomogammalinolenic , and arachidonic acids-this is consistent with the concept of lowered gamma-linolenic     and  dihomogammalinolenic acids in atopic dermatitis patients-lowered PgE1 allows for IL-4 driven IGE synthesis



The fatty acid ratios may explain why breast feeding does not always prevent atopic dermatitis





Preventative dietary therapy for children to prevent atopic dermatitis


Prevalence and incidence of atopic dermatitis down in children if:


                Kids prolonged breast feeding is anti-allergenic


                                                                -avoidance of cow’s milk

                                                                -immunoprotective factors in breast milk


                                                a diet free of cows milk and eggs to nursing mothers


            supplementation of  soya formula containing sucrose when breast milk is not available



Cooking and other technological advancements



                                                In meat based baby foods


Reduction of severity of response to skin prick antigen (meat)  test  in atopic dermatitis infants fed milled or freeze dried meats in comparison to steam cooked meat



Dietary deficiency




                                Deficiencies of riboflavin lead to dermatitis


Via conversion of vitamin B6  to its coenzyme (necessary for elongation of  gamma linolenic acid to arachidonic acid)- consequently there is less DGLA formed





                                Curtailed conversion of tryptophan to niacin-role of niacin in atopic dermatitis is unclear                   



                Biotin deficiency


Mechanism is unclear but as linoleic acid is elevated and dihomogammalinolenic acid is decreased it is suggested that an interference with delta 6 desaturase and or the elongase that follows




                Essential fatty acids


                                Omega 6


Gamma-linolenic acid is low in the skin and therefore dihomogammalinolenic acid is low in the skin in atopic dermatitis


This deficiency of gamma linolenic acid and its sequelae particularly comes up in parenteral nutrition that is deficient in lipids


This raises the issue of whether linolenic acid is essential as opposed to linoleic acid being essential




                                Omega 3


                                                Issue of alpha-linolenic fatty acid versus eicosapentaenoic acid essentiality


            Recall that eicosapentaenoic acid is anti-inflammatory



                                                Fish protein  can cause allergy so source of eicosapentaenoic acid is important














Such foods are really only functional by elimination or by meeting dietary deficiencies and that is not really a definition of functional foods


Designer functional foods


           Use of fish- fish protein allergy is an issue for some





Retinoic acid-skin creams reduces seborrhoeic dermatitis skin flakiness by inhibiting oil gland activity but it stimulates the inflammation of atopic dermatitis









                  Plasma PGE1 AND PGE2  profiles are identical between atopic dermatitis and healthy controls

              What is the significance of this observation



FIOCCHI –fed 3 g/day of  GLA in the form of evening primrose oil for 4 weeks to children with infantile atopic dermatitis


    A significant decrease in sleep interruption and itching requiring anti-histamine or corticosteroid therapy


        Uncontrolled and short duration failed to account for cyclical nature of atopic dermatitis



BIAGI- fed children with atopic dermatitis a supplement of  22.5 mg GLA /kg  body weight/day  in the form of a 50/50 min (olive oil/evening primrose oil) or 45 mg GLA/kg bodyweight per day (pure evening primrose oil) for 8 weeks

                          Only 45 mg dose produced clinical improvement





WHITTAKER- no improvement in atopic dermatitis patients taking 600 mg GLA/day for 16 weeks in the form of evening primrose oil-complicated by the use of emollient and corticosteroidal cream   







HEDEROS- saw improvement with evening primrose oil in atopic dermatitis patients but used an analogue scale up to 100 (worst ever seen by physician) and reports of child itch by parents






LEHMAN- atopic dermatitis patients-decreases in LTB4 (pro-inflammatory) from leukocytes from patients on evening primrose oil (540 mg GLA/day for 12 weeks


The rise in leukocyte DGLA and DGLA/AA ratio may explain this decrease




BAHMER- atopic dermatitis patients-a positive study used only one patient


ANDREASSI- atopic dermatitis patients fed 548 mg GLA/day in the form of borage oil for 12 weeks-clinical improvement compared to placebo


HENZ-  saw improvements only in those who had significant rises in erythrocyte DGLA levels-however this was only a small percentagew of the the patients-suggests borage oil was only effective in a select group



                                                COMPARE TO EVENING PRIMROSE  OIL



        BORAGE OIL

TOLLESON AND FRITZ- topically applied GLA (0.05 mg/kg body weight) topically applied GLA in the form             of borage oil in the nappy area of children with infantile seborrhoeic dermatitis and age matched healthy controls              twice a date for 4 weeks-improvements in terms of loss of lesions   

TOLLESON AND FRITZ- topically applied GLA (0.05 mg/kg body weight) topically applied GLA in the form         of borage oil in the nappy area of children with infantile seborrhoeic dermatitis and age matched healthy controls          twice a date for 4 weeks-improvements in terms of loss of lesions   -however there was no control group





                                Nothing done




                                Nothing done



         FISH OIL


                                Widespread success-why omega 3 superior?


                                                Brings omega 3 to omega 6 ratio closer to ideal?


                                                Other reasons?