Does eczema cause food allergy? Many times when infants develop eczema early in infancy, and eczema is chronic irritation of the skin that leads to very dry skin, very irritated, red inflamed skin that can be worsened by a whole host of different environmental factors.
Eczema is caused by mutations in the proteins that caused, that build the skin barrier, and there's a very large genetic predisposition. We know that infants who have persistent eczema, especially or severe eczema, are at higher risk to develop food allergies in infancy or later in life. More than likely, this just represents that they are on the spectrum, and they are they have a genetic predisposition to develop additional allergic conditions.
In addition to food allergies, they're also more prone to develop environmental allergies and asthma as well. So, the presence of eczema alone does not cause food allergies. Interestingly, people can become sensitized to food allergens through contact, through the skin. So, with a baby who has eczema, their skin barrier is altered, and if they are rubbing food on their skin or touching food, then it may actually cause their immune system to respond to food in a slightly different way, as opposed to if they just started eating the food.
So, it's not a very straightforward relationship, and I don't want anybody to be scared that if they're their baby with eczema, touched, you know, touched a piece of food for one time that they're going to be allergic to that food. The best advice we can give is introduce allergenic foods into a baby's diet once they're eating solids around four to six months of age and keep letting them eat that food on a regular basis. That's the best way to help prevent food allergies from developing and promote tolerance.
Does food allergy cause eczema?
We used to think that because many babies with eczema also are prone to develop food allergies, environmental allergies, and asthma, that ingestion of specific foods was the cause of eczema. Well, it turns out the evidence does not support that. And all of the recent guidelines actually recommend against doing panel food allergy testing in babies with eczema for many reasons. One, it's unlikely that one specific food is the cause of eczema. Eczema is caused by a defective skin barrier, which leads to very chronic issues in the skin and including increased water loss and dryness of the skin and allows irritants and allergens to enter into the body as well and cause irritation, inflammation.
But ingestion of one specific food is very unlikely to be the sole cause of eczema, and very few babies actually get better by removing food from their diet. The other problem is many children with eczema have high rates of false positive food allergy testing. So, if you do a bunch of food allergy testing on somebody with eczema, you're more than likely going to find falsely positive results. That doesn't actually mean they have allergy, but it may lead to unnecessary avoidance of that food.
And then in some children, this is where it gets really scary. If they are sensitized to a food, meaning you can find detection of this allergy antibody, but they're eating it just fine, then they're told to avoid that food based upon inappropriate testing and misinterpretation of the results. If they avoid that food that they were previously tolerating get sensitized to and they go a period of time, then they eat it again, months later, they might actually become allergic to it. So, this is how food allergies are actually caused by doing unnecessary food allergy testing in children with eczema.
So really, we want to focus eczema care on understanding that this is a chronic condition. Focus on the skin barrier, avoidance of environmental factors and triggers such as fragranced, skin care products. Use very thick, greasy unscented emollients such as Vaseline on a regular basis. Use anti-inflammatory topical treatments long before we even consider a food elimination in babies or children with eczema.
Atopic Dermatitis (Eczema), Food Allergy
David Stukus, MD, is a Professor of Clinical Pediatrics in the Division of Allergy and Immunology, Director of the Food Allergy Treatment Center, and Associate Director of the Pediatric Allergy and Immunology Fellowship Program at Nationwide Children’s Hospital and The Ohio State University College of Medicine. He is board certified in allergy/immunology and pediatrics.
Dr. Stukus has devoted his career to communicating evidence-based medicine and best clinical practice to colleagues, medical professionals of all backgrounds, patients, and the general public. In addition to providing clinical care for children with all types of allergic conditions, he participates in clinical research, quality improvement, patient advocacy, and medical education.
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