Caregiver Stress May Predict Skin And Allergic Disorders in Children

NEW YORK – Compelling research supports the link between psychological stress and specific skin and allergic disorders, Dr. Rosalind J. Wright said at a dermatology symposium sponsored by Cornell University.

“There is huge biological plausibility to think that there is this psycho-neuro-cutaneous-immunology link to suggest that there is interconnection between these systems, and one important effector organ is the skin,” said Dr. Wright of the department of society, human development, and health at Harvard School of Public Health, Boston.

Atopic dermatitis shows dysregulation of the responsiveness of the hypothalamic-pituitary-adrenal (HPA) axis. “Studies done across the age spectrum show that inpatients with atopic dermatitis seem to have a blunted cortisol response to different types of challenges” when compared with nonatopic dermatitis patients, said Dr. Wright, also of Brigham and Women's Hospital.

Atopic dermatitis is known to start in early childhood. The early experiences shape the stress vulnerability of the older child and adult later in life. “Not only early childhood, but even prenatal exposure to stress is a very critical period of development,” she said.

“There is huge plasticity of the HPA axis early in life. Early experiences in rat experiments–and this has been done in humans as well–also with respect to prenatal stress, show programming of the HPA response in the child postnatally. In animal experiments, social buffering of newborns by the mother seems to dampen the cortisol response,” Dr. Wright said.

In human studies, there seems to be a parallel response. Exposing mothers to stress has been demonstrated to alter the immune function of their children, she noted.

A National Institutes of Health-funded prospective birth cohort study involving a total of 499 mothers recruited at Brigham and Women's at the time of giving birth used asthma to evaluate the external influence of elevated stress on the development of children's immune systems. The patients were genetically predisposed for atopic dermatitis and allergic dermatoses. The question that the investigators hoped to answer was whether stress primed the immune system toward a T helper cell-type pattern of immune response, as is typically seen in allergic dermatoses.

Families with a predisposition to allergic response were followed prospectively every 2 months to see if the children had any clinical manifestations of atopic disease.. “Results indicated that higher caregiver stress predicted a phenotype of early asthma,” Dr. Wright said. Dose-response relationship was seen between a measure of perceived stress over time and the clinical manifestations of wheeze.

Serum IgE, which is a marker for susceptibility to atopic dermatitis, was measured in the blood of children, and high-stress households were associated with elevated levels of IgE expression in their children.

When children were evaluated up to age 6 years, a correlation between stress and eczema was also demonstrated.

“We need to get back to treating the whole patient,” Dr. Wright urged. As a physician, she has seen emotional response and stress affecting the disease process and clinical response to treatment in her patients and said she is fortunate to be able to send patients to the Mind-Body Institute at Beth Israel Deaconess Center in Boston to learn relaxation therapies.

NEW YORK – Compelling research supports the link between psychological stress and specific skin and allergic disorders, Dr. Rosalind J. Wright said at a dermatology symposium sponsored by Cornell University.

“There is huge biological plausibility to think that there is this psycho-neuro-cutaneous-immunology link to suggest that there is interconnection between these systems, and one important effector organ is the skin,” said Dr. Wright of the department of society, human development, and health at Harvard School of Public Health, Boston.

Atopic dermatitis shows dysregulation of the responsiveness of the hypothalamic-pituitary-adrenal (HPA) axis. “Studies done across the age spectrum show that inpatients with atopic dermatitis seem to have a blunted cortisol response to different types of challenges” when compared with nonatopic dermatitis patients, said Dr. Wright, also of Brigham and Women's Hospital.

Atopic dermatitis is known to start in early childhood. The early experiences shape the stress vulnerability of the older child and adult later in life. “Not only early childhood, but even prenatal exposure to stress is a very critical period of development,” she said.

“There is huge plasticity of the HPA axis early in life. Early experiences in rat experiments–and this has been done in humans as well–also with respect to prenatal stress, show programming of the HPA response in the child postnatally. In animal experiments, social buffering of newborns by the mother seems to dampen the cortisol response,” Dr. Wright said.

In human studies, there seems to be a parallel response. Exposing mothers to stress has been demonstrated to alter the immune function of their children, she noted.

A National Institutes of Health-funded prospective birth cohort study involving a total of 499 mothers recruited at Brigham and Women's at the time of giving birth used asthma to evaluate the external influence of elevated stress on the development of children's immune systems. The patients were genetically predisposed for atopic dermatitis and allergic dermatoses. The question that the investigators hoped to answer was whether stress primed the immune system toward a T helper cell-type pattern of immune response, as is typically seen in allergic dermatoses.

Families with a predisposition to allergic response were followed prospectively every 2 months to see if the children had any clinical manifestations of atopic disease.. “Results indicated that higher caregiver stress predicted a phenotype of early asthma,” Dr. Wright said. Dose-response relationship was seen between a measure of perceived stress over time and the clinical manifestations of wheeze.

Serum IgE, which is a marker for susceptibility to atopic dermatitis, was measured in the blood of children, and high-stress households were associated with elevated levels of IgE expression in their children.

When children were evaluated up to age 6 years, a correlation between stress and eczema was also demonstrated.

“We need to get back to treating the whole patient,” Dr. Wright urged. As a physician, she has seen emotional response and stress affecting the disease process and clinical response to treatment in her patients and said she is fortunate to be able to send patients to the Mind-Body Institute at Beth Israel Deaconess Center in Boston to learn relaxation therapies.

NEW YORK – Compelling research supports the link between psychological stress and specific skin and allergic disorders, Dr. Rosalind J. Wright said at a dermatology symposium sponsored by Cornell University.

“There is huge biological plausibility to think that there is this psycho-neuro-cutaneous-immunology link to suggest that there is interconnection between these systems, and one important effector organ is the skin,” said Dr. Wright of the department of society, human development, and health at Harvard School of Public Health, Boston.

Atopic dermatitis shows dysregulation of the responsiveness of the hypothalamic-pituitary-adrenal (HPA) axis. “Studies done across the age spectrum show that inpatients with atopic dermatitis seem to have a blunted cortisol response to different types of challenges” when compared with nonatopic dermatitis patients, said Dr. Wright, also of Brigham and Women's Hospital.

Atopic dermatitis is known to start in early childhood. The early experiences shape the stress vulnerability of the older child and adult later in life. “Not only early childhood, but even prenatal exposure to stress is a very critical period of development,” she said.

“There is huge plasticity of the HPA axis early in life. Early experiences in rat experiments–and this has been done in humans as well–also with respect to prenatal stress, show programming of the HPA response in the child postnatally. In animal experiments, social buffering of newborns by the mother seems to dampen the cortisol response,” Dr. Wright said.

In human studies, there seems to be a parallel response. Exposing mothers to stress has been demonstrated to alter the immune function of their children, she noted.

A National Institutes of Health-funded prospective birth cohort study involving a total of 499 mothers recruited at Brigham and Women's at the time of giving birth used asthma to evaluate the external influence of elevated stress on the development of children's immune systems. The patients were genetically predisposed for atopic dermatitis and allergic dermatoses. The question that the investigators hoped to answer was whether stress primed the immune system toward a T helper cell-type pattern of immune response, as is typically seen in allergic dermatoses.

Families with a predisposition to allergic response were followed prospectively every 2 months to see if the children had any clinical manifestations of atopic disease.. “Results indicated that higher caregiver stress predicted a phenotype of early asthma,” Dr. Wright said. Dose-response relationship was seen between a measure of perceived stress over time and the clinical manifestations of wheeze.

Serum IgE, which is a marker for susceptibility to atopic dermatitis, was measured in the blood of children, and high-stress households were associated with elevated levels of IgE expression in their children.

When children were evaluated up to age 6 years, a correlation between stress and eczema was also demonstrated.

“We need to get back to treating the whole patient,” Dr. Wright urged. As a physician, she has seen emotional response and stress affecting the disease process and clinical response to treatment in her patients and said she is fortunate to be able to send patients to the Mind-Body Institute at Beth Israel Deaconess Center in Boston to learn relaxation therapies.