The Link Between Eczema and Food Allergies

How eczema can affect food allergies and vice versa

Eggs, milk, and wheat, foods that can trigger ezcema

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There is now a clear connection between eczema and food allergies. While eczema (atopic dermatitis) may be triggered or worsened by common food allergies such as those to eggs, milk, wheat, soy, and peanuts, eczema itself may be responsible for the developement of food allergies in the first place. Learn about how ezcema can lead to allergies, who is more likely to develop them, and when you may want to be screened for food allergies if you or your are child are newly diagnosed or living with eczema.

Eczema and Allergic Conditions

Both eczema and food allergies are common, with ezcema affecting roughly 20 percent of children and up to 5 percent of adults in developed countries. For many children, the symptoms develop during the first year of life, and many of these children will outgrow their symptoms. For roughly 10 percent of people, however, the symptoms of eczema don't appear until adolescence or adulthood.

It's not surprising that food allergies and eczema are connected. Both are part of what's been coined the "atopic march" in which the conditions eczema, food allergies, hayfever (allergic rhinitis), and asthma often occur together. All of these conditions have a genetic component, and often run in families as well.

Asthma and Food Allergies

While the connection between the different allergic or "atopic" diseases has long been known, a 2017 review of 66 studies published in The Lancet provided a better idea about the scope of the problem. In this review, the connection between ezcema and food allergies was very clear. Looking at the studies together, up to 81 percent of the people with eczema were found to have a food allergy. This was a fairly accurate diagnosis, as the diagnosis of food allergy was made via a food challenge (the people were given the suspect food to eat and developed symptoms of an allergy).

A different 2018 study looking at children with eczema found that food allergies were present in 30 percent of those who had moderate or severe eczema.

Some People are More Likely to Have Food Allergies With Asthma

People who have more severe eczema are more likely to develop food allergies. Food allergies are also more common in those who develop eczema early in life (such as in infancy) than in those who have a later onset of eczema.

Does Eczema "Cause" Food Allergies?

The connection between eczema and food allergies appears to be causal, with eczema actually leading to the development of food allergies.

It's thought that food proteins in the environment are able to have contact with immune cells in the skin due to the weakening of the skin's barriers that occurs with the rash and inflammation of eczema. This sensitization of the immune system via the skin is later seen when the foods are ingested.

Occupational Concern

While many of the studies looking at eczema and food allergies have focused on children, it appears that the connection is becoming a public health concern for adults as well. A study in kitchen workers with eczema found that they had a significantly increased risk of developing food allergies.

Common Food Allergies Associated With Eczema

The foods that most commonly appear to trigger eczema are also among the most common food allergens in the United States:

  • Eggs: An allergy to eggs has been associated most strongly with eczema
  • Milk: Milk allergy is also very common and is different than lactose intolerance
  • Soy: Soy allergy may cause symptoms such as a rash or hives, but also has the potential to be life-threatening with angioedema or anaphylaxis. Soy allergy is different than intolerance (food-protein enterocolitis)
  • Wheat: Wheat allergy can also be severe at times and is different than gluten intolerance
  • Peanuts: Many people are familiar with peanut allergy as even small exposures (like a nearby child eating peanuts) can cause severe reactions for some people

These allergies can all be challenging to diagnose (see below) and avoid as they are present as ingredients in many other foods.

Non-Food Allergy Eczema Triggers

Many people with eczema note that some foods seem to worsen their symptoms.

Food Triggers Without Food Allergies

The "food triggers" that some people associate with a worsening of there eczema is different than the food allergies just discussed. Foods that appear to worsen eczema for some people include the above foods as well as citrus fruits, tomatoes, and some spices such as vanilla.

Eczema, Celiac Disease, and Gluten Sensitivity

There is a link between ezcema and gluten though it is still unclear the actual connection. This is also different than the food allergies noted above.

Symptoms

The signs and symptoms of food allergies may be immediate or delayed, occurring only a few hours after eating the offending food, or occurring 24 hours or later. Food allergies can give rise to a wide variety of symptoms from nasal congestion and sneezing, to abdominal discomfort, nausea, and vomiting, to hives and a rash and more.

Symptoms of anaphylaxis, a severe and life-threatening allergic reaction may include lightheadedness (low blood pressure), palpitations (an irregular heart rate), flushing, itching and hives, difficulty breathing or wheezing, headache and confusion, and others, and urgent medical attention is needed.

Diagnosing Food Allergies in People With Eczema

Some physicians recommend screening for food allergies in anyone with eczema, whereas others believe that not everyone needs to be concerned. The concern that holds some back from testing is that false positives (a positive test for allergies when an allergy does not exist) occur fairly often, and you shouldn't have to change your diet (or that of your child) for no reason.

Testing

Diagnosing food allergies is more difficult than diagnosing some allergies (such as ragweed) due to the number of false positives and false negatives. Skin testing (the prick test)) is the best laboratory test in general, Since there is the potential for a severe reaction on skin testing if a severe allergy is present, doctors may consider other options. The RAST blood test or ELISA testing is not as helpful and is less sensitive, but may be done when a skin test is done to see if a person has outgrown a food allergy or if a severe allergy is suspected.

Food Challenge

Sometimes a food allergy can be diagnosed when a characteristic reaction happens after eating the food. As with skin testing, this isn't a good idea if the allergy may be severe.

Elimination Diet

An elimination diet or exclusion diet is often recommended by pediatricians both for diagnosing food allergies and food intolerances. In general, some foods are eliminated and then added back in, but the degree of exclusion can vary. The diet may eliminate only the suspected food or may eliminate all but a few foods.

Food Diary

A food diary is helpful either with or aside from an elimination diet. In the diary, you record everything you eat as well as your symptoms over a period of time.

Working With Your Doctor

Diagnosing food allergies can be challenging, and most often will require working with your doctor (or your child's doctor) to see what approach is best for you.

Treatment

The treatment of eczema and food allergies is multifaceted and includes eliminating the food from your diet, treating the eczema, and avoiding other triggers.

Eliminating the Offending Food(s)

Avoiding a food may at first glance seem easy, but all of the foods that are most commonly associated with eczema can be "hidden" in a great variety of foods. Not only will you need to avoid the food in question, but will need to learn how to read ingredient labels for food allergies.

Avoiding highly processed foods can reduce your potential for exposure, and is thought to be beneficial for overall health as well.

What to Eat

Even though you will want to avoid the culprit foods in your case, it's important to not unnecessarily limit the variety of foods you eat. Continuing to eat a "rainbow" of colors of food helps ensure you get the variety of phytonutrients you need for good health. It may be helpful to work with both your doctor and a nutritionist to design a meal plan.

Some allergists recommend adopting an anti-inflammatory diet. The anti-inflammatory diet stresses foods that have anti-inflammatory properties such as foods rich in omega-3-fatty acids, There has been some research on probiotics and eczema, though the science is young. For now, eating probiotic-rich foods such as yogurt, miso, and kefir to promote good gut health may have some benefit.

Eliminating Other Triggers

In addition to foods, there are many allergenic (such as dust and pollen), emotional (such as stress), and physical triggers and skin irritants that may worsen your symptoms. It's helpful to learn about your own triggers so you can limit your exposure.

Keeping Skin Moist

Treating skin dryness can reduce your symptoms, and may potentially help prevent food allergies from developing at times. Talk to your doctor about what she recommends, as some lotions and creams can actually dry the skin.

Reducing Inflammation

There are a number of medications that can be used to treat the inflammation associated with eczema. these include:

  • Topical steroids: Topical steroids can range in strength from over-the-counter hydrocortisone to very strong medications. Drugs such as Cultivate (fluticasone) and Dermatop (prednicarbate) are often used.
  • Immunomodulators: The medications Protopic or Elidel can be helpful for some people.
  • Other options: For severe eczema, other options may include oral steroids, ultraviolet light therapy, and more.

Anaphylaxis Awareness

It's really important for everyone to be familiar with the symptoms of anaphylaxis, but especially those who have allergies. If you or your child has a potentially severe allergy your doctor may prescribe an EpiPen to keep with you at all times.

Coping and When to Call Your Doctor

If you or your child are found to have a food allergy, strictly avoiding that food may help you reduce your eczema symptoms. Families may be disappointed, however, to find that a food allergen-free diet isn't a "magic bullet." Not everyone with food allergies and eczema finds that abstaining from food triggers eliminates or even substantially reduces their eczema (although many see some success with this strategy).

Keep in mind that eczema tends to be most severe in children under the age of five and that many families will find that children's symptoms are, if not completely outgrown, far less severe as they grow older.

When to Call Your Doctor

It's important to call your doctor if you or your child's eczema rash becomes painful, unusually swollen or is accompanied by a fever. All of these symptoms can be signs of a secondary infection of the skin. Some skin infections are more common with eczema, including some bacterial, fungal, and viral infections (such as eczema herpeticum). If one of these infections develop, further treatments (such as antibiotics with bacterial infections) will be needed.

Prevention

Since eczema, or at least the damage to the barrier the skin provides due to eczema, seems to lead to the development of food allergies, taking good care of your skin or your child's skin is wise.

For example, if you have a very young child with severe eczema, making sure her skin is well hydrated may help preserve the barrier the skin provides against food allergens in the environment.

It would seem that delaying the introduction of certain foods would be a good idea if a sibling is allergic, but the opposite may actually be true in some cases. The American Academy of Pediatrics recommends exclusive breastfeeding for four to six months. After that time, however, introducing foods earlier rather than later may reduce the chance of food allergies. (This is the thought behind the newer recommendations to introduce peanut butter into a child's diet earlier.) If your child's eczema is severe or if others in the family have serious food allergies, however, it may be better to do testing before introducing the food.

There are so many variables involved and the research is so new, that anyone who has a child with eczema should have a thoughtful discussion with their doctor about current thought and what might be best in your specific situation.

A Word From Verywell

Eczema is a major "quality-of-life" disorder for families dealing with it. The itchy, painful, and sometimes unsightly skin condition can be distressing for both children and parents. Unfortunately, eczema may also lead to food allergies which can add equally distressing challenges to the family.

Fortunately, this is an area of active research and there are a number of treatments that can help control the rash. It's important to be your own advocate in your health or your child's health and work with your doctor to find solutions that work for you.

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