Can you speak to the mechanism by which kids seem to grow out of some disorders such as asthma, eczema or environmental allergies?

This is a great question, and unfortunately, I think the answer is, we don’t know, and I don’t think it’s one single mechanism by which this happens. You mentioned asthma, eczema, environmental allergies, and these are actually different. Eczema potentially has an autoimmune component. Environmental allergies are just a misdirected immune system. Asthma, again, we’re probably looking to some degree there’s maybe excess production of leukotriene. Again, some sort of inflammatory imbalance. I think there are probably different mechanisms.

Asthma is one that, it certainly does seem that kids tend to outgrow, and I think here there have actually been some studies looking at differences in boys and girls. Here, once kids hit puberty, there seems to be some differences where boys do a little bit better. Wait. I’m trying to think if I, I have that backwards. Let me just say that there are differences between the sexes. I don’t remember specifically, but so, if we look at how puberty affects this, and differing responses between boys and girls that suggests that hormones might play a role in at least one of the mechanisms of outgrowing asthma.

Eczema, I’ve seen different kinds of differing thoughts on eczema whether or not there’s truly a difference between overall prevalence of eczema in pediatric versus adult patients, and then there are some proposed theories that maybe they’re actually just different forms of eczema. It might be that some of the pediatric or childhood forms are “outgrown,” and then maybe there are new forms and in adulthood are different forms. Again, I’m not as clear on eczema in particular whether or not we really outgrow that.

Environmental allergies, that’s another great question. It seems that both food and environmental allergies change with age, and I think, as you mentioned, probably there is some relationship to the gut to the microbiome because we think. For example, having exposure to Helicobacter pylori early in life might actually provide some protection against autoimmune and atopic diseases. There probably is something related to the GI microbiome in the gut and how it influences our immune system and in relating to these.

I don’t know. I wish I did, and I think if we did understand the mechanisms, maybe we would have a better treatment approach. Again, I would hypothesize that there are multiple different mechanisms related to GI microbial balance related to our hormones. I certainly have some female patients who notice a correlation between their environmental and food allergy/sensitivities to their cycles. Again, I think this supports that our sex hormones play a role. Certainly, our hypothermic-pituitary-adrenal axis, our cortisol levels, that plays a huge role right in our autoimmune. Ask anyone with an autoimmune disease, inflammatory bowel disease rosacea. I have a lot of patients when their stress flares and that’s when they get their ulcerative colitis flare or their rosacea flare, so cortisol is another mechanism or pathway that’s influencing this. The body’s pretty complex, and I wish I could explain why and what, if there was a single mechanism, but I think so many pieces come together here that I really don’t know. You do ask is it worth pursuing causes of asthma eczema environmental allergies in an adult where symptoms are no longer present. I would say probably not. I don’t like to go looking for trouble in somebody who doesn’t have any symptoms. If they’re having another complaint, then absolutely I would go looking for root causes of inflammation immune deregulation, etc. But I would not say, “Okay, somebody has had a history of asthma, eczema, environmental allergies. Even though they no longer have this, I want to go looking for the underlying cause.” To me, that doesn’t entirely make sense because again maybe it was a change in their sex hormones, and this was somebody who had asthma when he was a boy. He went through puberty, and it resolved, so I wouldn’t go back and try to sort that out. I know it’s so nice to have answers and understand the mechanisms, etc., but I’m just not sure it would be that rewarding or even useful to go back and look. Great question, and I think it’s a really interesting area without a clear answer.