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The data behind vitamin D for asthma, eczema, and atopic conditions
More than 50 million Americans have an allergy of some kind. If you or a family member has allergies, you know how irritating they can be (literally). Allergies occur when the immune system overreacts to one or more allergens by producing antibodies called immunoglobulin E (IgE).[1],[2] Symptoms may include red eyes, an itchy rash, sneezing, a runny nose, shortness of breath, and/or swelling, any of which can range from mild to severe.
The incidence and severity of allergic reactions is influenced by genetics, the microbiome, the route of exposure, age at exposure, and nutritional status. [3],[4],[5] Recent studies show that vitamin D helps modulate IgE responses[6] and that a deficiency of vitamin D exacerbates allergies.[7],[8],[9] Let’s examine the connection between sunlight, vitamin D, and allergies.
Sun, vitamin D, and allergies
Individuals with low UVB exposure have an increased risk of vitamin D deficiency and of allergies.
Vitamin D is known as the sunshine vitamin because it is generated within the skin when it is exposed to ultraviolet B (UVB) rays, the rays responsible for suntans.[10] Vitamin D formation is diminished in people who live in northern latitudes, work indoors, or have greater skin pigmentation (since melanin acts as a natural sunscreen). Individuals with low UVB exposure have an increased risk of vitamin D deficiency and of allergies.[11],[12],[13],[14]
This connection is dramatically illustrated by the case of a 14-year-old girl who presented with severe atopic dermatitis (eczema), asthma, and food allergies (egg, fish, and shellfish).[15] Due to her condition, she avoided eating fish and going out in the sun. Her serum level of 25-hydroxy-vitamin D (25[OH]D, the best indicator of vitamin D status) was very low at 12 nmol/L, so severely deficient that she was diagnosed with rickets, a softening of bones caused by inadequate vitamin D. Supplementation with vitamin D3 (cholecalciferol) for six months corrected the deficiency and dramatically improved her skin condition.[15]
The authors state, “We advise a high index of suspicion of vitamin D deficiency rickets in children of all ages with atopic dermatitis, particularly during accelerated growth periods and in the presence of other risk factors such as darker skin, living at high latitude, sun avoidance, and low intake of vitamin D-rich foods [such as fatty fish and eggs].”[15]
Although rickets is relatively rare, vitamin D insufficiency is widespread.[16] Growing evidence suggests that insufficient vitamin D plays a role in allergies, as discussed below.
Atopic dermatitis
In the U.S., atopic dermatitis (AD) affects 9.6 million children and 16.5 million adults.[17],[18] Serum 25(OH)D levels are lower in AD patients than in healthy controls, and low 25(OH)D levels are associated with more severe symptoms.[19],[20],[21],[22] This may explain why controlled UVB light treatment is effective for AD: it increases 25(OH)D.[23],[24]
In a randomized placebo-controlled trial (RCT), adults with AD received either vitamin D3 (5000 IU per day) or a placebo for three months.[21] The participants continued standard treatments with topical corticosteroids. Vitamin D supplementation restored serum 25(OH)D to near-adequate levels and “strongly favored” remission of AD.[21] Positive results were also seen in children with AD who were supplemented with a lower dose of vitamin D3 (1000 IU daily for one month.)[22],[25] A meta-analysis of several RCTs reported that vitamin D supplementation may reduce the extent and severity of AD by 50%.[20]
Food allergy
Food allergy affects 5.6 million children and 26 million adults in the U.S.[26],[27] Milk, egg, peanut, tree nuts, wheat, soy, fish, and shellfish are responsible for the majority of IgE-mediated reactions,[26] requiring complete avoidance of the trigger food(s) in susceptible individuals. A study of 3,136 children and adolescents found that sensitization to 11 of 17 allergens, assessed with skin prick tests, was more common in children with vitamin D deficiency than in those with adequate levels.[28] In children with food allergy, low 25(OH)D levels are associated with stronger allergic responses.[29],[30],[31] Thus vitamin D may be an important protective factor for food allergy, at least in children.
Allergic rhinitis
As with atopic dermatitis and food allergy, allergic rhinitis is more common in people with low 25(OH)D levels.
Allergic rhinitis affects up to 60 million people in the U.S.,[32] and its presence increases the risk for asthma.[33],[34] As with atopic dermatitis and food allergy, allergic rhinitis is more common in people with low 25(OH)D levels.[35],[36],[37],[38] In children with allergic rhinitis due to grass pollen, supplementation with vitamin D3 (1000 IU daily) significantly reduced the symptoms.[39] The administration of vitamin D3 also improved symptoms in animal models of allergic rhinitis, suggesting that vitamin D has direct anti-allergic effects.[40],[41]
Asthma
Asthma affects nearly 26 million people in the U.S., including seven million children.[42] Low 25(OH)D levels are associated with greater asthma severity.[43],[44],[45] In a four-year study of children with mild-to-moderate asthma, the group with low 25(OH)D (≤ 30 ng/mL) had a 50% greater risk of any hospitalization or emergency department visit.[46]
Insufficient or deficient 25(OH)D levels were associated with increased asthma severity, frequent flare ups, and the need for a higher inhaled corticosteroid dose.
In a study of adult asthma patients in Italy, 75% of the individuals had a clear vitamin D deficiency (≤20 ng/mL).[44] Insufficient or deficient 25(OH)D levels were associated with increased asthma severity, frequent flare ups, and the need for a higher inhaled corticosteroid dose.[44] Individuals with vitamin D deficiency were supplemented with an initial injection of vitamin D3, followed by oral supplementation with 5000 IU weekly plus 400 IU daily for one year. Those who followed the supplementation protocol experienced a significant decrease in flare ups (from 2.6 to 1.6 per year) and a significantly decreased need for oral corticosteroids.[44]
A review of seven clinical trials involving 955 participants concluded that vitamin D supplementation reduced the number of asthma flare ups requiring oral corticosteroids.[47] In one study, severe adult asthmatics with proven resistance to oral corticosteroids showed an improved response after only four weeks of supplementation with 1,25-dihydroxyvitamin D3.[48]
The effect of maternal vitamin D on childhood allergies
Adequate maternal vitamin D levels during pregnancy and breastfeeding may help reduce the risk of allergic diseases in infants and children.[49],[50],[51] Although the optimal level is a subject of debate, two clinical trials suggest that maternal 25(OH)D of ≥ 40 ng/mL (100 nmol/L) may be needed to decrease asthma risks.[52],[53],[54] Women entering pregnancy with circulating 25(OH)D concentrations ≥ 30 ng/mL (75 nmol/L) who were given 4,000 IU/d vitamin D starting at 10 to 18 weeks’ gestation achieved the maximum protection against asthma development in their infants.[52],[53] The authors of a recent review state: “Careful attention to maternal asthma control, monitoring vitamin D status, and correcting insufficiency at early pregnancy and maintaining the sufficiency status throughout pregnancy have potential preventive roles in offspring asthma.”[55]
How much vitamin D is enough?
The only way to assure you are getting enough vitamin D is to have your blood level of 25(OH)D tested. The Institute of Medicine (IOM) guidelines suggest that serum 25(OH)D levels of 20 ng/mL (50 nmol/L) are adequate for good health.[56] However, compelling evidence suggests that higher levels of 30 ng/mL (75 nmol/L) or even 40 ng/mL (100 nmol/L) may be optimal.[57],[58],[59],[60] This requires approximately 1,000 to 2,000 IU per day of supplemental vitamin D and even higher doses if deficiency exists.[57],[61],[62],[63],[64],[65]
Summary
Although low levels of vitamin D have a strong association with increased incidence of allergic conditions, the data also suggest that by restoring levels to an adequate state these conditions may improve. Thus, in addition to supplementation with vitamin C and other supportive nutrients, making sure vitamin D levels are sufficient should be a primary consideration for individuals who experience allergies and asthma.
Click here to see References[1] Huang CM, et al. Effects of vitamin D levels and supplementation on atopic dermatitis: a systematic review. Pediatr Dermatol. 2018 Nov;35(6):754-60.
[2] Akhouri S, House SA. Allergic Rhinitis. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 [cited 13 Apr 2019]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538186/
[3] Liu Q, et al. Bifidobacterium lactis ameliorates the risk of food allergy in Chinese children by affecting relative percentage of Treg and Th17 cells. Can J Infect Dis Med Microbiol. 2018 Dec 11;2018:4561038.
[4] Chernikova D, et al. Prevention of allergy with diverse and healthy microbiota: an update. Curr Opin Pediatr. 2019 Apr 1. [Epub ahead of print]
[5] Benedé S, et al. The rise of food allergy: environmental factors and emerging treatments. EBioMedicine. 2016 May;7:27-34.
[6] James J, et al. Control of circulating IgE by the vitamin D receptor in vivo involves B cell intrinsic and extrinsic mechanisms. J Immunol. 2017 Feb 1;198(3):1164-71.
[7] Lack G. Update on risk factors for food allergy. J Allergy Clin Immunol. 2012 May;129(5):1187-97.
[8] Poole A, et al. Cellular and molecular mechanisms of vitamin D in food allergy. J Cell Mol Med. 2018 Jul;22(7):3270-7.
[9] Neeland MR, et al. Early life innate immune signatures of persistent food allergy. J Allergy Clin Immunol. 2018 Sep;142(3):857-64.
[10] Linos E, et al. Sun protective behaviors and vitamin D levels in the US population: NHANES 2003-2006. Cancer Causes Control. 2012 Jan;23(1):133-40.
[11] Mullins RJ, et al. Season of birth and childhood food allergy in Australia. Pediatr Allergy Immunol. 2011 Sep;22(6):583-9.
[12] Matsui T, et al. Sun exposure inversely related to food sensitization during infancy. Pediatr Allergy Immunol. 2015 Nov;26(7):628-33.
[13] Camargo CA Jr, et al. Regional differences in EpiPen prescriptions in the United States: the potential role of vitamin D. J Allergy Clin Immunol. 2007 Jul;120(1):131-6.
[14] Kim G, Bae JH. Vitamin D and atopic dermatitis: a systematic review and meta-analysis. Nutrition. 2016 Sep;32(9):913-20.
[15] Borzutzky A, et al. Vitamin D deficiency rickets in an adolescent with severe atopic dermatitis. Pediatrics. 2014 Feb;133(2):e451-4.
[16] Holick MF. The vitamin D deficiency pandemic: approaches for diagnosis, treatment and prevention. Rev Endocr Metab Disord. 2017 Jun;18(2):153-65.
[17] Silverberg JI, Simpson EL. Associations of childhood eczema severity: a US population-based study. Dermatitis. 2014 May-Jun;25(3):107-14.
[18] Chiesa Fuxench ZC, et al. Atopic Dermatitis in America Study: a cross-sectional study examining the prevalence and disease burden of atopic dermatitis in the US adult population. J Invest Dermatol. 2019 Mar;139(3):583-90.
[19] Dogru M. Is vitamin D level associated with the natural course of atopic dermatitis? Allergol Immunopathol (Madr). 2018 Nov – Dec;46(6):546-51.
[20] Kim MJ, et al. Vitamin D status and efficacy of vitamin D supplementation in atopic dermatitis: a systematic review and meta-analysis. Nutrients. 2016 Dec 3;8(12):789.
[21] Sánchez-Armendáriz K, et al. Oral vitamin D3 5000 IU/day as an adjuvant in the treatment of atopic dermatitis: a randomized control trial. Int J Dermatol. 2018 Dec;57(12):1516-20.
[22] Di Filippo P, et al. Vitamin D supplementation modulates the immune system and improves atopic dermatitis in children. Int Arch Allergy Immunol. 2015;166(2):91-6.
[23] Vähävihu K, et al. Narrowband ultraviolet B treatment improves vitamin D balance and alters antimicrobial peptide expression in skin lesions of psoriasis and atopic dermatitis. Br J Dermatol. 2010 Aug;163(2):321-8.
[24] Cicarma E, et al. Influence of narrowband UVB phototherapy on vitamin D and folate status. Exp Dermatol. 2010 Aug;19(8):e67-72.
[25] Camargo CA Jr, et al. Randomized trial of vitamin D supplementation for winter-related atopic dermatitis in children. J Allergy Clin Immunol. 2014 Oct;134(4):831-5.
[26] Gupta RS, et al. The public health impact of parent-reported childhood food allergies in the United States. Pediatrics. 2018 Dec;142(6): e20181235.
[27] Gupta RS, et al. Prevalence and severity of food allergies among US adults. JAMA Netw Open. 2019 Jan 4;2(1):e185630.
[28] Sharief S, et al. Vitamin D levels and food and environmental allergies in the United States: results from the National Health and Nutrition Examination Survey 2005-2006. J Allergy Clin Immunol. 2011 May;127(5):1195-202.
[29] Guo H, et al. Correlation between serum vitamin D status and immunological changes in children affected by gastrointestinal food allergy. Allergol Immunopathol (Madr). 2018 Jan – Feb;46(1):39-44.
[30] Allen KJ, et al. Vitamin D insufficiency is associated with challenge-proven food allergy in infants. J Allergy Clin Immunol. 2013 Apr;131(4):1109-16.
[31] Baek JH, et al. The link between serum vitamin D level, sensitization to food allergens, and the severity of atopic dermatitis in infancy. J Pediatr. 2014 Oct;165(4):849-54.
[32] Meltzer EO, et al. Burden of allergic rhinitis: results from the Pediatric Allergies in America survey. J Allergy Clin Immunol. 2009 Sep;124(3 Suppl):S43-70.
[33] Guerra S, et al. Rhinitis as an independent risk factor for adult-onset asthma. J Allergy Clin Immunol. 2002 Mar;109(3):419-25.
[34] Egan M, Bunyavanich S. Allergic rhinitis: the “Ghost Diagnosis” in patients with asthma. Asthma Res Pract. 2015 Sep 7;1:8.
[35] Demir MG. Comparison of 1α-25-dihydroxyvitamin D3 and IgE Levels between allergic rhinitis patients and healthy people. Int Arch Otorhinolaryngol. 2018 Oct;22(4):428-31.
[36] Keleş E, et al. The relationship between Th1/Th2 balance and 1α,25-dihydroxyvitamin D3 in patients with allergic rhinitis. Turk Arch Otorhinolaryngol. 2015 Dec;53(4):139-43.
[37] Restimulia L, et al. The relationship between serum vitamin D levels with allergic rhinitis incidence and total nasal symptom score in allergic rhinitis patients. Open Access Maced J Med Sci. 2018 Aug 10;6(8):1405-9.
[38] Bener A, et al. The impact of vitamin D deficiency on asthma, allergic rhinitis and wheezing in children: an emerging public health problem. J Family Community Med. 2014 Sep;21(3):154-61.
[39] Jerzyńska J, et al. Clinical and immunological effects of vitamin D supplementation during the pollen season in children with allergic rhinitis. Arch Med Sci. 2018 Jan;14(1):122-31.
[40] Cho SW, et al. Intranasal treatment with 1,25-dihydroxyvitamin D3 alleviates allergic rhinitis symptoms in a mouse model. Allergy Asthma Immunol Res. 2019 Mar;11(2):267-79.
[41] Chen B, et al. Effects of 1,25-dihydroxyvitamin D3 in an ovalbumin-induced allergic rhinitis model. Int Immunopharmacol. 2017 Jun;47:182-9.
[42] Centers for Disease Control and Prevention (US). Asthma facts [Internet]. Atlanta (GA): U S Department of Health and Human Services; 2017 [cited 13 Apr 2019]. Available from: https://www.cdc.gov/nchs/fastats/asthma.htm
[43] Mathyssen C, et al. Vitamin D supplementation in respiratory diseases: evidence from randomized controlled trials. Pol Arch Intern Med. 2017 Nov 30;127(11):775-84.
[44] Solidoro P, et al. Asthmatic patients with vitamin D deficiency have decreased exacerbations after vitamin replacement. Nutrients. 2017 Nov 11;9(11):1234.
[45] Kaaviyaa AT, et al. Vitamin D deficiency as a factor influencing asthma control in children. Indian Pediatr. 2018 Nov 15;55(11):969-71.
[46] Brehm JM, et al. Serum vitamin D levels and severe asthma exacerbations in the Childhood Asthma Management Program study. J Allergy Clin Immunol. 2010 Jul;126(1):52-8.
[47] Jolliffe DA, et al. Vitamin D supplementation to prevent asthma exacerbations: a systematic review and meta-analysis of individual participant data. Lancet Respir Med. 2017 Nov;5(11):881-90.
[48] Nanzer AM, et al. The effects of calcitriol treatment in glucocorticoid-resistant asthma. J Allergy Clin Immunol. 2014 Jun;133(6):1755-7.
[49] Chiu CY, et al. Maternal vitamin D levels are inversely related to allergic sensitization and atopic diseases in early childhood. Pediatr Allergy Immunol. 2015 Jun;26(4):337-43.
[50] Viljoen K, et al. Pregnancy diet and offspring asthma risk over a 10-year period: the Lifeways Cross Generation Cohort Study, Ireland. BMJ Open. 2018 Feb 20;8(2):e017013.
[51] Litonjua AA. Vitamin D and childhood asthma: causation and contribution to disease activity. Curr Opin Allergy Clin Immunol. 2019 Apr;19(2):126-31.
[52] Wolsk HM, et al. Prenatal vitamin D supplementation reduces risk of asthma/recurrent wheeze in early childhood: a combined analysis of two randomized controlled trials. PLoS One. 2017 Oct 27;12(10):e0186657.
[53] Wolsk HM, et al. Vitamin D supplementation in pregnancy, prenatal 25(OH)D levels, race, and subsequent asthma or recurrent wheeze in offspring: secondary analyses from the Vitamin D Antenatal Asthma Reduction Trial. J Allergy Clin Immunol. 2017 Nov;140(5):1423-9.
[54] Litonjua AA, et al. Effect of prenatal supplementation with vitamin D on asthma or recurrent wheezing in offspring by age 3 years: the VDAART randomized clinical trial. JAMA. 2016 Jan 26;315(4):362-70.
[55] Mirzakhani H, et al. Impact of parental asthma, prenatal maternal asthma control, and vitamin D status on risk of asthma and recurrent wheeze in 3-year-old children. Clin Exp Allergy. 2019 Apr;49(4):419-29.
[56] National Institutes of Health, Office of Dietary Supplements. Vitamin D Fact Sheet for Health Professionals [Internet]. Bethesda (MD): US Department of Health and Human Services; 2018 [cited 2019 Apr 13]. Available from: https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/
[57] Holick MF, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011 Jul;96(7):1911-30.
[58] Hollis BW, Wagner CL. New insights into the vitamin D requirements during pregnancy. Bone Res. 2017 Aug 29;5:17030.
[59] Papadimitriou DT. The big vitamin D mistake. J Prev Med Public Health. 2017 Jul;50(4):278-81.
[60] Granado-Lorencio F, et al. Vitamin D status in clinical practice: treatment of deficiency or health promotion?. e-SPEN, the European e-Journal of Clinical Nutrition and Metabolism. 2009 Aug 1;4(4):e203-5.
[61] Chao YS, et al. The importance of dose, frequency and duration of vitamin D supplementation for plasma 25-hydroxyvitamin D. Nutrients. 2013 Oct 11;5(10):4067-78.
[62] Sadat-Ali M, et al. Maintenance dose of vitamin D: how much is enough? J Bone Metab. 2018 Aug;25(3):161-4.
[63] Lukaszuk JM, et al. 25(OH)D status: effect of D3 supplement. Obes Sci Pract. 2017 Mar;3(1):99-105.
[64] Veugelers PJ, Ekwaru JP. A statistical error in the estimation of the recommended dietary allowance for vitamin D. Nutrients. 2014 Oct 20;6(10):4472-5.
[65] Heaney R, et al. Letter to Veugelers, P.J. and Ekwaru, J.P., A statistical error in the estimation of the recommended dietary allowance for vitamin D. Nutrients. 2015 Mar 10;7(3):1688-90.
The information provided is for educational purposes only. Consult your physician or healthcare provider if you have specific questions before instituting any changes in your daily lifestyle including changes in diet, exercise, and supplement use.
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Marina MacDonald, MS, PhD
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