Lake Fong, Post-Gazette Julie Moore applies a special skin cream on her 8-month-old daughter, Madeline, who is a participant in a study testing the theory that if children's eczema is blocked, it could block asthma from developing later. Click photo for larger image.

Could the skin prove to be the body's front door to asthma?

That theory is being tested in a ground-breaking study under way at Allegheny General Hospital and 19 other centers across the country that will explore whether halting the skin disease of eczema in young children will prevent asthma and other respiratory allergies from developing later.

The link has been seen for years among clinicians: Between 50 to 80 percent of young children who have flare-ups of the itchy, dry skin rash go on to develop asthma, hay fever or other allergies. The worse the eczema, the higher the likelihood that childhood wheezing will develop, particularly if there's a family history.

Scientists have speculated that the development of eczema and these other allergies have been tied to genes and the environment.

"What's more novel, though, is that we started to think: 'If you don't get eczema, you won't get allergies or asthma,' '' said Dr. David Skoner, Allegheny General's director of the Center for Allergy, Asthma and Immunology who is leading the local arm of the study. ''We never thought that eczema would predispose you to asthma later on.''

Blocking this suspected trigger would have a huge impact on the spiraling rate of asthma that now inflicts 10 million American children -- including an estimated 250,000 cases in Pennsylvania and 24,500 in Allegheny County, according to figures supplied by the American Respiratory Alliance of Western Pennsylvania. It's the most common chronic illness in children.

The cause for the dramatic rise in overall asthma rates -- a 75 percent increase since 1980 -- has baffled the medical community. The incidences of eczema, which affects 10 percent to 12 percent of youngsters, also have climbed.

"Asthma is a disease we do not like to deal with,'' said Dr. Edwin Kairis, a pediatrician with Allegheny General. "If this works and we can put something on the skin to avoid asthma, that is just huge.''

Not all children who get asthma have eczema as babies (although Skoner said milder cases in babies may go unrecognized.) And German researchers didn't find an association between eczema and asthma in a seven-year prospective study involving 1,314 children that was published in May.

But the Allegheny General study would be the first to see if treating this skin disorder very early would make a difference.

The six-year study, funded by the drug maker Novartis, will be testing a skin cream on babies aged 3 months to 18 months old. The cream, pimecrolimus, under the brand Elidel, is one of a new class of drugs that prevents the production of immune system triggers that cause the eczema symptoms.

Recognizing these symptoms and getting treatment early will be the challenge in recruiting the 1,100 patients, including 70 by Allegheny General. For that, Skoner and his team are collaborating with Kairis and other hospital pediatricians to identify patients who must be enrolled within three months of developing the skin disorder. To qualify, patients also must have a family member with eczema, asthma or other allergies.

That's the case with 8-month-old Madeline Moore of Moon, whose father, Richard, 42, had eczema as an infant. His condition faded, and he never developed other allergies.

Still, after Madeline's pediatrician diagnosed the small, dry patches on her skin as mild eczema a few weeks ago, her parents agreed to enroll her into the double-blind study, which tests Elidel or a placebo.

"I was a little hesitant at first,'' said her mother, Julie Moore, 35, a principal at Moon Middle School. "Then I realized the education benefit not only would benefit my child, but other children if they can find a link.''

The cream is applied twice a day. Although she doesn't know if Madeline is receiving the real cream, Moore said she's noticed improvement. "There's no redness, the patches are smaller and there's less volume on the body.''

In infants, eczema occurs most often on the forehead, cheeks, forearms, legs, scalp and neck. There is no cure, but in nearly 50 percent of cases involving babies, the condition clears up between ages 5 and 15.

Diagnosis can be tricky in infants, who may have other common skin conditions such as cradle cap, a flaking of the scalp that may also occur on the face, Kairis said. Babies, of course, can't tell anyone they have an itch, but there are subtle signs to look for: such as the child wanting to rub his face against Mom, or rubbing an arm against his body.

"That may be the only clue you get,'' he said.

Milder cases are treated with lotions and creams to keep skin moist. In more severe cases, over-the-counter hydrocortizone and prescription corticosteroid creams can reduce inflammation, although the latter may cause side effects that thin the skin and alter pigment.

Although the Food and Drug Administration has approved Elidel for children 2 and older, it has been tested for safety and effectiveness in hundreds of infants. Kairis said that among his young patients, Elidel has eased stubborn cases without the side effects of steroids.

The trial, led by the National Jewish Hospital and Research Center in Denver, will be conducted in two stages: During the first three years, a double-blind study will compare the safety and effectiveness of Elidel in conjunction with coricosteroid therapy vs. steroid therapy alone. In the remaining three years, youngsters will be followed to see if they develop other allergic diseases.

Enrollment is open to any children, not just those who visit practices affiliated with Allegheny General Hospital. For more information, call 412-359-6639.