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 a clear connection between atopic dermatitis, or what is more commonly known as eczema, and food allergies. While eczema may be triggered or worsened by common food allergies such as those to eggs or milk, eczema itself may be responsible for the development of food allergies in the first place. In some cases, you may want to be screened for food allergies if you or your child are newly diagnosed with eczema.

The Link Between Eczema and Allergic Conditions

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

Like eczema, food allergies are common. It's estimated that 3% to 10% of children have food allergies.

Food allergies are officially recognized as a comorbidity (or related health condition) of eczema, along with hayfever (allergic rhinitis), and asthma.

In fact, eczema is typically the first step in what is called the "atopic march." And march is an apt description, as these atopic conditions often progress one followed by another. Eczema generally appears first, followed by food allergies, seasonal allergies, and asthma. These conditions are referred to as "atopic" diseases, meaning they are a form of allergy or hypersensitivity.

Prevalence of Food Allergies and Eczema

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 eczema and food allergies was very clear.

Looking at the studies together, up to 81% of people with eczema were also 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% of those who had moderate or severe eczema.

People with 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.

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.

Do Food Allergies Cause Eczema or Vice Versa?

It's a bit of a chicken-and-egg situation with eczema and food allergies. If you have food allergies you are more likely to also have eczema, but which came first?

It's still under debate but current research suggests that, while certain foods may cause a worsening or flareup of eczema, food allergies themselves are not the cause of eczema. Instead, food allergy is likely the result of having eczema, rather than the other way around.

The connection between eczema and food allergies appears to be causal, with eczema 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.

But once the conditions have developed, a cycle continues in which food allergens trigger an immune response and inflammation that exacerbates eczema.

The relationship between eczema and allergies is complex. Having a food allergy does seem to be a predictor of severe eczema. Interestingly, this also works the other way. For example, children with eczema are more likely to have food allergies, but those allergies are also more likely to be severe.

Eczema with Allergies May Be a Subtype

A study published in a 2019 issue of Science Translational Medicine has opened the door to a new look at the eczema and food allergy link.

Researchers collected skin samples from 62 children. They found that children with both eczema and food allergies had significant differences in their skin at the molecular level when compared to skin of children with eczema only.

While the samples were taken from healthy skin, and the eczema rashes between the two groups were indistinguishable, children with concomitant food allergies had skin that was more prone to water loss, as well as a skin barrier that was more immature. There were also higher numbers of Staphylococcus aureus bacteria on the skin of children with food allergies and eczema than those with eczema only.

This suggests to researchers that eczema with associated food allergies may be a unique subtype of atopic dermatitis. While much more research needs to be done, this information is one more step in building an understanding of why food allergies and eczema develop.

Common Food Allergies Associated With Eczema

Although food allergies don't cause eczema, they can cause a worsening of existing eczema rashes. True food allergies trigger an IgE-mediated immune system response. The symptoms come on quickly, within a few hours, so in most cases, it's fairly obvious that one is allergic to the specific food.

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. Infants with eczema have a six-times greater chance of being allergic to eggs than infants who do not have 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 child eating peanuts nearby) can cause severe reactions for some people. Infants with eczema are 11 times more likely to have a peanut allergy.

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

Anaphylaxis Awareness

It's 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.

Non-IgE Mediated Food Allergies

Non-IgE-mediated food allergies are a bit trickier to identify. Unlike with IgE-mediated allergies, the body's immune system does not produce antibodies.

Non-IgE food allergies can cause a worsening of eczema; they also cause gastrointestinal symptoms such as vomiting, diarrhea, gas, and stomach pain. But symptoms are most often delayed by days, so it's much harder to pin on the offending food.

The most common non-IgE mediated food allergens that contribute to a worsening of eczema include:

  • Milk
  • Eggs
  • Wheat
  • Soy

You might consider a non-IgE mediated food allergy if eczema is chronically moderate to severe, without responding to any treatment.

There is no diagnostic test for non-IgE mediated food allergies, so it's very difficult to diagnose or prove that a certain food actually causes an eczema flareup. The most common way to test for these types of allergies is an elimination diet (more on elimination diets below).

The good news is that most children with non-IgE mediated allergies do outgrow them by the time they reach adulthood.

Food Sensitivity Eczema Triggers

Many people with eczema note that some foods seem to worsen their symptoms, even with no allergies to speak off. These can be described more aptly as food sensitivities or food intolerances. With food sensitivities, there is no immune response.

With food sensitivities, you may notice only a flaring of eczema symptoms. You may also have symptoms of gas, bloating, heartburn, or general skin itchiness.

Because certain foods have been linked to inflammation, it's hypothesized that certain food may exacerbate eczema symptoms. This is especially true in cases of severe eczema or uncontrolled eczema.

There are no specific diagnostic tests for food sensitivities, and many health care professionals debate that certain foods cause eczema flareups in the absence of a true allergy.

Still, many people with eczema say they consistently notice a worsening of symptoms after eating certain foods.

Food triggers are unique to each person. Some of those foods more commonly linked to the exacerbation of eczema include the foods listed above, as well as:

  • Sugar
  • Citrus fruits
  • Tomatoes
  • Apples
  • Kiwi
  • Tree nuts
  • Spices and/or vanilla

Gluten

Some people say eating gluten triggers a flareup in their eczema, and going gluten-free helps keep eczema under control.

Gluten can cause an eczema-like skin rash called dermatitis herpetiformis. This itchy rash develops in those with celiac disease. Eliminating gluten will eliminate the rash.

Food-Triggered Eczema Symptoms

Eczematous food reactions may occur shortly after eating the offending food or up to days later. Food allergies and sensitivities are more likely to cause eczema flareups in infants and those with severe eczema.

Food allergies can cause cutaneous (skin) symptoms such as:

  • A worsening of eczema (increased redness, itching, blisters, etc.)
  • General itching of the skin
  • Hives

In some cases, foods may not have a direct effect on eczema but rather contribute indirectly to flare-ups. Food allergy or sensitivity can cause general cutaneous itching; eczema nearly always worsens because of scratching. The simple act of scratching may be triggering the eczema flare-up and not the food specifically.

It's also important to understand that eczema naturally waxes and wanes. So, just because a flare-up is occurring doesn't automatically mean that it was caused by something that you (or your child) have just eaten. In can be difficult to know if a flare-up was caused because a certain food was eaten or if it would have happened regardless.

Diagnosing Food Allergies in People With Eczema

There is not a consensus as to who should be tested for food allergies and who should not. 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 quite often. A false positive may trigger a change to your diet, or that of your child, that isn't at all necessary.

The American Academy of Dermatology recommends food allergy testing for all children younger than 5 years old who have eczema that is not being controlled with treatment.

Food allergy testing may also be recommended:

  • For those with moderate to severe eczema that is not being improved with treatment
  • For those whose eczema has recently worsened and is not responding to treatment
  • Any time there is a food allergy suspected

Your physician or allergist will work with you to determine if you or your child should be tested for food allergies. 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.

Labs and Tests

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, however it can cause false positives especially in those with uncontrolled or severe eczema. Also, there is the potential for a severe reaction on skin testing if a severe allergy is present.

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.

During a food challenge test, small amounts of the suspect food are given in a clinical setting, and the patient is observed for a reaction. You should also report delayed reaction symptoms to your doctor.

It's only after a flare-up happens consistently after eating a specific food that you have cause to believe it is linked to a worsening of your eczema.

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.

Before embarking on any type of elimination diet, for you or your child, seek advice from a health care professional.

In general, the suspected food or foods, are removed from the diet for a period of four to six weeks. After that time, they are reintroduced.

If eczema had improved markedly during the elimination period and then flares after the food is introduced, it's a good reason to suspect the food is responsible for the flare.

Interpreting results can be tricky though, as it's common to have allergies or sensitivities to several different foods. Eliminating just one food may not cause an improvement in symptoms because others, still in the diet, are contributing.

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.

Again, because eczema can regularly flare without any contributing factors, it can take several months of consistent recordkeeping to notice any correlation between diet and worsening symptoms.

One flare is not enough to pinpoint a certain food; consistent flares after the same food may. In this case, you may try eliminating the suspect food for a period of a few weeks to see if you notice improvement.

Treatment

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

It's important to understand that eliminating specific foods is not an eczema treatment. This alone will not cure eczema.

Instead, treat diet as a single part of your total eczema management plan. Remember, not everyone needs to or will respond to diet changes. This is something that should be discussed with your physician.

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 you 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.

Unless there is a true IgE-mediated allergy to a specific food, the American Academy of Dermatology does not recommend elimination diets as a treatment for eczema.

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.

Coping

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 5 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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Article Sources

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