Laughter, Children, Babies and Eczema

When a young child had eczema the sleepless nights can disturb the whole family (and neighbours in several directions if the child is particularly vocal about distress). Every so often, I come across a researcher who publishes in some quirky areas and I'm intrigued. I wonder about their research group, who funds their research, how easy they find it to attract research fellows, stuff like that. Sometimes, I think ?!? but most of the time, I wonder about what they are doing with their findings and how they might hope to investigate the biological mechanisms involved or to apply their findings to a wider population.

Kimata has published several papers on laughter and eczema; this is the sort of area that piques my interest. When an abstract blips on my quirk-meter, I don't always consult the full paper because I don't want to be disillusioned and learn that underneath the charming eccentricity lies something that is terribly staid. I'm about to mention a couple of Kimata's papers that I haven't seen in their full form, so please be aware of that.

Eve Van Cauter has reported studies that show short sleep duration in young, healthy men is associated with decreased leptin levels, increased ghrelin levels, and increased hunger and appetite, and cortisol disturbances that influence the ability to cope with stress and also promote the laying down of a personal duvet of body fat.

Kimata measured ghrelin levels in a comparison group of healthy children and those with atopic eczema and night-time wakenings. Kimata discovered that the children with eczema had higher ghrelin levels at 02:00 when compared with healthy children.

Neither viewing control non-humorous film nor viewing humorous film had any effect on healthy children. In contrast, viewing humorous film improved night-time wakening and reduced elevation of salivary ghrelin levels in patients with atopic dermatitis, while viewing control film failed to do so.

There are so many possible mechanisms of action here that it nudges across into being a substantial part of PNI (aka, psychoneuroimmunology, psychoendoneuroimmunology, PENI). Are parents desperate enough to add humorous films into their usual night-time routine (whatever that involves)?

Babies seem to laugh a lot; probably at the notion that parents have plans that involve sticking to meticulous timetables that disintegrate with the first unscheduled nappy-change. Babies have eczema but, sophisticated as children's marketing is, I doubt that there is a readily accessible range of humour for the neonate and infant. So, what do you do if your baby has eczema?

If you are Kimata, you recruit currently breastfed babies with atopic eczema and allergies to latex and house dust mite (HDM) in the 5-6 months of age demographic (my first typo of that was demongraphic which seems quite apposite). You arrange matters so that half of mothers have atopic eczema and half are free of it.

You show the mothers an 87 minute video of either Charlie Chaplin or non-humorous weather reporting. After that, you collect and analyse samples of the breastmilk at 2 hourly intervals and measure the amount of melatonin in it. You also study skin wheal responses to HDM an latex in the infants.

Laughter increased the levels of breast-milk melatonin in both mothers with AE and healthy mothers, and feeding infants with increased levels of melatonin-containing milk reduced allergic responses in infants.

I don't want to know any more about this study. I'm entertained just by knowing that Charlie Chaplin is still so popular in Japan. I'm intrigued by the reported results.

Yes, the boring, tedious, obvious response to this paper would be to experiment with ways of delivering melatonin to babies with eczema to dampen their allergic response and enable them to get a good night's sleep. But I like the notion of mother and baby chuckle clubs.

I've written frequently about the inadequacy of allergy services in the NHS. Prof. Hourihane was recently giving evidence to the House of Lords committee that is looking into allergy and allergic diseases. He commented:

The NHS is the laughing stock of Europe for its absence of immunotherapy for allergic diseases.

Several other experts made similar comments about other aspects of the provision of allergy services in the UK. Despite this awareness of the need for proper, clinical diagnosis and management of allergies, sadly, one eczema related document is likely to elicit snorts of derision rather than laughter: the National Institute for Health and Clinical Excellence Guideline for the Management of atopic eczema in children from birth up to the age of 12 years. There is no recommendation that children with atopic eczema should be referred to an allergy specialist; not even when a child has hit the trifecta of eczema, allergic rhinitis and asthma that needs especially careful management, particularly if the child has unstable asthma.

I don't know why the members who drew up this guideline decided not to recommend allergy assessment: given the paucity of paediatric allergists in the UK, it was perhaps inevitable that there was only one in this group. In light of this, it is particularly disappointing that the group will consider:

What is the place of complementary therapies in the treatment of atopic eczema? This will include consideration of homeopathy, and Chinese and Western herbal medicine.

Too many desperate parents feel that they have no option but to consult CAM practitioners precisely because they can not obtain timely access to allergy services on the NHS.

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