Download Eczema - National Children`s Research Centre

Eczema:
Getting under the skin of
a condition that makes
young lives miserable
The Children’s Medical & Research Foundation
Our Lady’s Children’s Hospital, Crumlin &
the National Children’s Research Centre
Fast Facts > Why Eczema
research matters
Eczema is inflammation of the outer layer of the
skin. It is primarily a disease of children, and it is
on the increase in western society. It is believed
12-15% of all school-age children and 2-10% of
adults also suffer the condition.It is very common in
infancy – some 75 percent of all eczema sufferers
will develop eczema between the ages of 3-12
months. Eczema is often painful and commonly
features include dry, red, scaly skin which is
intensely itchy. If children scratch, their skin can
bleed with blister-like sores and scabs forming and
infection a threat. Often they will suffer at school
because their sleeping patterns are disrupted by
this itchy and painful skin condition. Other children
find themselves battling the considerable hurt that
can result from stigmatisation due to visible skin
problem setting them apart from their peers.
Prof Alan Irvine & Prof Padraic Fallon
Prof Alan Irvine,
Professor of Pediatric
Dermatology
Key question in current research: How can we get to
the bottom of inflammatory-based diseases, like eczema,
so that we can help those whose lives are so profoundly
affected by them?
Ideal outcome from current research: We will have a
much more detailed and sophisticated picture of what is
going on at both a genetic and a cellular level when the
body reacts so dramatically to its environment.
Nature of research: Based on what is already the
biggest DNA collection with detailed clinical information
on children with eczema, the programme is now expanding
into the UK, with funding from the Wellcome Trust – a clear
indication of its huge scope for providing answers and
therapies. It will continue to be managed from the NCRC.
With your support:
Consultant Dermatologist OLCHC, Associate Professor
of Dermatology Trinity College Dublin, Alan has been
involved in research since 1995 when he started his
doctoral thesis in the genetics of skin disease; and he
has been involved in many major breakthroughs in our
understanding of skin diseases. His focus nowadays is on
eczema, the commonest inflammatory disease in children,
which is associated with food allergies and asthma as well
as causing significant distress for patients in many other
respects.
A massive step in Alan’s research was the decision
some years ago to begin developing a ‘case collection’
of detailed clinical information on Irish children with
eczema, and it has since grown into the largest childhood
collection of childhood atopic dermatitis (atopic dermatitis
and eczema are interchangeable terms) in the world.
Collaborating with other investigators using this case
collection Alan has been involved with many of the major
breakthroughs in our understanding of the genetics of
eczema. For instance, in 2006 Alan and Irwin McLean, a
long standing colleague and collaborator in the University
of Dundee published their work identifying a major risk
gene in eczema (filaggrin) and this became a huge news
story in general media.
Since then the collection has expanded and 13 papers
have already been published relating to information derived
from the data. There are now close to 1200 Irish patients
tracked and as well as the original funding from the NCRC
the study now also receives funding from the Wellcome
Trust which means we will include UK patients. Our target
is 4000 patients; we need these large numbers so that
figuring out the genetics becomes easier. This expansion
is project managed from the NCRC, the data management
is based in the NCRC, and the DNA processing is in
Dundee, so it’s a major international collaboration done to
very high standard.
This genetic work has put a new focus back on the skin
barrier as a target for therapy. It has completely changed
the way people see allergy; providing massive evidence
that the skin is a primary source of allergic food reactions,
and exposure through the skin is now considered a
primary event in, for instance, peanut allergies. It has
changed people’s concept of allergy from being primarily
immunological (inside out) to also involving the skin’s
ability to protect the body from allergens (outside in).
With the rapidly improving infrastructure for clinical
research in the country and more and more clinicians
actively involved, we can expect Ireland to start to produce
more quality research - making solid contributions
internationally. But we need to avoid an overly reductionist
and short-term view of what research can achieve.
Previous governments’ focus was solely on the number of
jobs that would be created immediately and while this is
a valid question for government to ask, research doesn’t
work in election cycles and requires a more sophisticated
model of investment.
Researchers based at the NCRC have also created
a specialised atopic dermatitis website to support
their work. This resource provides a wide range of
general and study-specific information to clinical
and nursing researchers, practitioners, patients
and their parents. It can be accessed at ncrc-adc.
nationalchildrensresearchcentre.org
Prof Padraic Fallon,
Director of the Paediatric
Research in Translational
Immunology.
Key question in current research: Why do some
children develop eczema while others don’t – even though
they share a similar underlying genetic or physiological
characteristic?
Ideal outcome from current research: We can help
answer very particular questions about what is triggering
specific reactions in different patients, and meanwhile we
are getting a more and more detailed understanding of
how the reactions might be controlled.
Nature of research: In a partnership with clinicians,
Padraic’s laboratory teams use the latest equipment
and models of the workings of the immune system to
determine what is causing it to go wrong and to test
possible treatments.
With your support:
Underlying many diseases of childhood (and adulthood),
for example asthma, diabetes, or rheumatoid arthritis, is a
breakdown in the immune system.
That’s where Padraic Fallon, Science Foundation
Ireland Stokes Professor in Translational Immunology in
the School of Medicine, Trinity College Dublin (TCD),
comes in. He and his team operate behind-the-scenes
providing clinicians with a cellular perspective on what the
immune system is doing. “We know that some people are
predisposed from birth to certain immunological reactions
which are later triggered by environmental factors. Our
work in conjunction with the clinicians looks for the
triggers and ways of counteracting the response.”
Their particular focus is on the allergic-like diseases
including eczema and asthma, anaphylaxis and
inflammatory bowel disease (Crohn’s disease etc.), as
well as obesity and myocarditis. Using state-of-the-art
equipment and mouse models Padraic’s team can look in
great detail and from many different perspectives at the
immune system’s reactions to see if there are hints as to
where things are going wrong and might be put right.
“We take the questions from the bedside back to bench,
work on them in the laboratory, and bring the answers
back to the bedside.”
The Children’s Medical &
Research Foundation
Our Lady’s Children’s Hospital, Crumlin,
14 – 18 Drimnagh Road, Dublin 12
T: 01 709 1700 | F: 01 455 1045
E: [email protected] | www.cmrf.org
Charity Number: CHY 4483A
If you would like to learn more
or support this programme
please call our Director of
Development, Edel O’Malley
on + 353 1 7091700 or email
[email protected]