Those of us lucky enough to have relatively normal skin all pay lip service to ‘how awful it must be to have bad eczema’ and ‘those poor little children’ with weeping, open sores. (Pictures courtesy of Dr Harry Morrow Brown.) And indeed we do feel genuinely sympathetic – but how little we really understand.
So bravo for Ruth Holroyd who, as many of you will know, runs the excellent What Allergy? blog, for bearing her soul about how totally miserable it is to have a bad eczema flare up. (Read her post here.) As she says, she often talks about her
allergies (anaphylactic to nuts and milk and possibly celery, intolerant to tomatoes and a whole raft of other foods) as allergies make for interesting conversation – but eczema… Who wants to know that you are itchy, hot, scratchy, slimy from too much moisturiser, cannot bear to look at your red, rough skin in the mirror or let anyone else see you either, are grumpy from too little sleep….
Because it is Ruth, and, despite her allergies and her eczema, she is a totally upbeat person, the post contains not only her vent on the horribleness of an eczema flare up, but eleven really useful tips for minimising the misery and helping the eczema to clear.
Ruth’s rant reminded me of reading, some year’s ago, Jennifer worth’s ‘Eczema and food Allergy: the hidden cause?’ Jennifer, who sadly died last year, was not only a generous donor and supporter of the allergy charity Action Against Allergy, of which I am a trustee, but the author of Call the Midwife, her hugely successfully reminiscences of her life as a midwife in the East End of London in the 1950s which has now been made into an even more successful prime time telly series.
Jennifer was brought down, in her early 60s, by appalling eczema that covered her from head to foot, her skin cracking, weeping and itching all over her body. It turned out that her eczema was caused by food allergy and was finally successfully treated by a combination of a rigid elimination diet and Enzyme Potentiated Desensitisation (EPD) – an immunotherapy type treatment which worked on a range of allergens at the same time.
You can still get Jennifer’s book about eczema from Merton Books (also the first publishers of Call the Midwife). You can read the article that she wrote for Foods Matter about EPD here. But, before you get too excited about EPD as a possible treatment for allergy or for allergy-related eczema, I have to tell you that it is not currently available in this country – or, indeed, anywhere.
Pioneered by Dr Len McEwen (now retired), EPD was never adopted by the NHS although it was used quite widely in the US. However, an American regulation banning the use of multiple allergens in the formulation virtually halved the market and meant that it was not longer viable to produce in the UK.
However, all is not yet lost. I have just spoken to the the Friends of EPD, who are part of the National Society for Research into Allergy , who told me that they are hoping to raise sufficient funds to reopen an EPD laboratory and to restart both production and treatment. They suggest that, if you are interested, you stay in touch with them.
- Scientists identify unique subtype of eczema linked to food allergy
- The Link Between Food Allergies and Eczema
- Eczema elimination diet and foods to eat
- Can food fix eczema?
- Avoiding foods that cause an allergic reaction rarely prevents AD flare-ups
- Eliminating foods can do more harm than good
- Eat this, not that! Why diet advice changes
- No quick fix for atopic dermatitis
- Related posts:
Wednesday, February 20, 2019
Children with both conditions have abnormal skin near eczema lesions, NIH-funded research finds
A researcher demonstrates the minimally invasive collection of skin samples using small, clear tape strips.National Jewish Health
Atopic dermatitis, a common inflammatory skin condition also known as allergic eczema, affects nearly 20 percent of children, 30 percent of whom also have food allergies. Scientists have now found that children with both atopic dermatitis and food allergy have structural and molecular differences in the top layers of healthy-looking skin near the eczema lesions, whereas children with atopic dermatitis alone do not. Defining these differences may help identify children at elevated risk for developing food allergies, according to research published online today in Science Translational Medicine. The research was supported by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.
“Children and families affected by food allergies must constantly guard against an accidental exposure to foods that could cause life-threatening allergic reactions,” said NIAID Director Anthony S. Fauci, M.D. “Eczema is a risk factor for developing food allergies, and thus early intervention to protect the skin may be one key to preventing food allergy.”
Children with atopic dermatitis develop patches of dry, itchy, scaly skin caused by allergic inflammation. Atopic dermatitis symptoms range from minor itchiness to extreme discomfort that can disrupt a child’s sleep and can lead to recurrent infections in scratched, broken skin.
A drawing of skin and a hair follicle. In this study, scientists analyzed the outermost layer of the skin, the stratum cornea, highlighted here in yellow.NIAMS, NIH
The study, led by Donald Y.M. Leung, M.D., Ph.D., of National Jewish Health in Denver, examined the top layers of the skin, known as the stratum corneum, in areas with eczema lesions and in adjacent normal-looking skin. The study enrolled 62 children aged 4 to 17 who either had atopic dermatitis and peanut allergy, atopic dermatitis and no evidence of any food allergy, or neither condition. Investigators collected skin samples by applying and removing small, sterile strips of tape to the same area of skin. With each removal, a microscopic sublayer of the first layer of skin tissue was collected and preserved for analysis. This technique allowed researchers to determine the skin’s composition of cells, proteins and fats, as well as its microbial communities, gene expression within skin cells and water loss through the skin barrier.
Researchers found that the skin rash of children with both atopic dermatitis and food allergy was indistinguishable from the skin rash of children with atopic dermatitis alone. However, they found significant differences in the structure and molecular composition of the top layer of non-lesional, healthy-appearing skin between children with atopic dermatitis and food allergy compared with children with atopic dermatitis alone. Non-lesional skin from children with atopic dermatitis and food allergy was more prone to water loss, had an abundance of the bacteria Staphylococcus aureus, and had gene expression typical of an immature skin barrier. These abnormalities also were seen in skin with active atopic dermatitis lesions, suggesting that skin abnormalities extend beyond the visible lesions in children with atopic dermatitis and food allergy but not in those with atopic dermatitis alone.
“Our team sought to understand how healthy-looking skin might be different in children who develop both atopic dermatitis and food allergy compared to children with atopic dermatitis alone,” said Dr. Leung. “Interestingly, we found those differences not within the skin rash but in samples of seemingly unaffected skin inches away. These insights may help us not only better understand atopic dermatitis, but also identify children most at risk for developing food allergies before they develop overt skin rash and, eventually, fine tune prevention strategies so fewer children are affected.”
Allergy experts consider atopic dermatitis to be an early step in the so-called “atopic march,” a common clinical progression found in some children in which atopic dermatitis progresses to food allergies and, sometimes, to respiratory allergies and allergic asthma. Many immunologists hypothesize that food allergens may reach immune cells more easily through a dysfunctional skin barrier affected by atopic dermatitis, thereby setting off biological processes that result in food allergies.
NIAID conducts and supports research—at NIH, throughout the United States, and worldwide—to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID website.
About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
NIH…Turning Discovery Into Health®
D Leung, et al. Non-lesional skin surface distinguishes atopic dermatitis with food allergy as unique endotype. Science Translational Medicine DOI: 10.1126/scitranslmed.aav2685 2019.
The Link Between Food Allergies and Eczema
The list of irritants and allergens that can trigger an eczema rash includes everything from dry skin and scratchy clothes to cold weather. Since about one third of children with eczema may also have food allergies, you may be wondering if it could also play a role in your child’s symptoms.
“There is an increased association of food allergies in children with eczema, but the overwhelming majority of children with eczema do not have food allergies,” says Daniela Kroshinsky, MD, director of pediatric dermatology at Massachusetts General Hospital in Boston. “In general, children with more severe eczema are more at risk for developing food allergies,” she says.
In addition, a July 2013 study published in the Journal of Investigative Dermatology found that infants with eczema had a higher risk of developing food allergies. Researchers theorize that the breakdown in the skin barrier may contribute to an allergic immune response in food.
If your child does have food allergies, they could be making the skin rash worse. Daniel Searing, MD, a pediatrician and assistant professor in the department of pediatrics, division of allergy and immunology at National Jewish Health in Denver, says double-blind, placebo controlled food challenges (the gold standard of allergy testing) have confirmed that food allergens can trigger atopic dermatitis, the most common type of eczema.
The connection between food allergies and an eczema rash is complicated. According to the American Academy of Dermatology, food allergies and a flare-up of eczema don’t always go hand-in-hand. For the majority of people with both eczema and food allergies, eating a food they are allergic to will not cause a skin rash to flare. Research shows that a food allergy is most likely to bring on a flare of eczema skin rash only in infants and in those with severe eczema.
Food Allergies as Potential Eczema Causes
According to Dr. Searing, these seven foods are most often linked with food allergies:
- Tree nuts
Food allergy reactions can range from mild to potentially life-threatening and usually happen a few hours after eating. Typical food allergy symptoms can include:
- Vomiting, diarrhea, and cramps
- Swelling or itching of the lips, tongue, mouth, or throat
- Wheezing or difficulty breathing
- Lowered blood pressure
If your child’s eczema seems to flare after eating a certain food, tell your doctor, says Dr. Kroshinsky. But she adds that since most kids with eczema do not have food allergies, you should have your child evaluated by a dermatologist to see if the eczema is flaring for other reasons — perhaps because conventional eczema treatments aren’t working. Stronger treatments may be necessary.
When Food Allergy Testing May Be Needed
If you continue to think food allergies could be causing eczema symptoms or if the skin rash continues to flare despite treatment, you may want to consult with an allergist. Searing says an allergist will help determine whether food allergy testing is needed and can properly interpret the results.
A blood test to look for antibodies linked to questionable food is one tool an allergist may use. Another is a skin prick test in which a suspected allergen is placed on the skin and is then “scratched” into the skin. If the skin starts to swell, itch, or turn red, that’s a positive test. Other than slight discomfort, there are usually no side effects or complications of skin testing, Searing says.
Still, blood and skin test results can be misleading. While a negative test is strong evidence that a child is not allergic to a specific food, positive results aren’t as trustworthy. Just because a child reacts to a certain food on a test, it doesn’t mean he’ll have an eczema flare when the food is eaten. False positives are common.
The only way to know for sure if food allergies are an eczema cause is by performing an oral food challenge. In a medically-supervised setting — never at home — your child is given increasingly larger samples of a suspect food and allergists watch for reactions. If he shows signs of eczema, such as redness, papules, and rash, or gets very itchy within two hours, the test shows that the food is triggering the eczema.
Successfully Treating Eczema Rash
Even if food allergies are proven to trigger the skin rash, avoiding the foods won’t make eczema disappear completely. It takes a multi-pronged approach to successfully manage it. This includes taking medication as directed, using eczema-friendly skin care products, and avoiding the most common eczema triggers.
The good news is that food allergies and eczema usually aren’t carried into adulthood. While some allergies, like a peanut allergy, can last a lifetime, most people eventually outgrow their food allergies and their eczema.
Eczema elimination diet and foods to eat
Food-sensitive eczema reactions will typically occur about 6 to 24 hours after a person eats a particular food. Sometimes, these reactions may be delayed even longer.
To determine what foods may be causing the reaction, a doctor will often recommend an elimination diet. This diet involves avoiding some of the most common foods known to cause eczema.
Before eliminating any foods, a person will need to slowly add each food type into their diet and monitor their eczema for 4 to 6 weeks to determine if they are sensitive to any particular food.
If a person’s symptoms get worse after adding a particular food to the diet, they may wish to consider avoiding it in the future. If a person’s symptoms do not improve when eliminating a food, they probably do not need to remove it from their diet.
Some common foods that may trigger an eczema flare-up and could be removed from a diet include:
- citrus fruits
- gluten or wheat
- spices, such as vanilla, cloves, and cinnamon
- some types of nuts
A doctor may also recommend allergy testing. Even if a person is not allergic to a particular food, they may have sensitivity to it and could experience skin symptoms after repeat exposure. Doctors call this reaction food responsive eczema.
People with dyshidrotic eczema, which typically affects the hands and feet, may experience benefits from eating foods that do not contain nickel. Nickel is found in trace amounts in the soil and can, therefore, be present in foods.
Foods that are high in nickel include:
- black tea
- canned meats
Some people with eczema also have oral allergy syndrome or sensitivity to birch pollen. This means they may have reactions to other foods, including:
- green apples
People with eczema are more prone to oral allergy syndrome and should speak to their doctor if they have a pollen allergy or experience mild allergic reactions to the above foods.
Can food fix eczema?
For many parents who have a child with atopic dermatitis (AD), the most common type of eczema, the cure seems simple. Fix the child’s diet, and you’ll get rid of the AD. What years of researching food and AD have shown, however, is that AD is much more complex.
Here’s what the research findings tell us.
Avoiding foods that cause an allergic reaction rarely prevents AD flare-ups
Food allergies are common in children who have AD. About 40% of babies and young children with moderate or severe AD have food allergies.
Many parents believe that avoiding the foods that cause an allergic reaction will prevent allergic reactions and AD flare-ups. That’s not what usually happens.
When a child has food allergies, removing the foods that cause an allergic reaction from a child’s diet rarely stops the AD.
Food and eczema
Parents often experiment with food in hopes of curing eczema, but research shows this seldom works.
To get AD relief, parents still need to use:
Baths and moisturizers
Most children can get relief from AD with this approach.
If your child still has AD flare-ups, then it’s possible that a food could be the causing the AD flare-ups. Experts recommend allergy testing for foods only when a child has:
Moderate to severe AD that skin care, trigger management, and medication cannot control
An immediate allergic reaction after eating a specific food
If you think a food allergy is causing your child’s eczema, talk with a board-certified dermatologist. Ask if the food allergy could be causing the eczema to flare.
Eliminating foods can do more harm than good
To relieve the unbearably itchy skin, parents may stop feeding their child the foods that are most likely to cause a food allergy. This list of foods includes anything that contains milk, eggs, wheat, soy, and nuts.
Eliminating all of these foods for long periods can have a harmful effect on the child. Research shows that removing so many foods can cause:
Diseases due to lack of vitamins and minerals
Malnutrition due to lack of protein in the diet
If you feel that it’s necessary to remove foods from your child diet to prevent AD flare-ups, talk with a board-certified dermatologist first.
Testing can find out if it’s necessary to stop feeding your child certain foods. If it’s necessary to remove any food for a long time, help from a dietician can prevent health problems.
Eat this, not that! Why diet advice changes
People often believe that eating certain foods or supplements can get rid of AD. This belief is so common that researchers have been studying the effects of different foods and supplements for years.
The list of supplements they’ve studied includes:
Evening primrose oil
Vitamins B12 and B6
The findings from a few studies suggest that some supplements can be helpful. This explains why you may have seen an article that supports adding a certain food or supplement to your child’s diet to help relieve AD.
When researchers look at all of the studies, however, they see little evidence to support eating certain foods or supplements.
For example, when researchers analyzed the results of 12 scientifically sound studies that looked at probiotics and AD, they saw that adding a probiotic to a child’s diet had no effect on the AD.
In looking at the studies involving food or supplements, one thing stands out. The results vary.
While the results from studies vary, we do know one thing. A healthy, balanced diet provides the nutrients that a growing child needs.
No quick fix for atopic dermatitis
As researchers continue to study this common childhood disease, one finding stands out. No one thing can fix eczema. Following an eczema friendly skin care plan, helping your child avoid triggers, and using medication when needed can bring welcomed relief.
Do certain foods cause eczema flares?
When does a child with eczema need allergy testing?
Can you prevent peanut allergy when a child has eczema?
American Academy of Dermatology. “Dermatologists caution that atopic dermatitis is a strong precursor to food allergies.” New release issued February 4, 2011. Last accessed January 31, 2018.
Castro-Rodriguez JA and Garcia-Marcos L. “What are the effects of a Mediterranean diet on allergies and asthma in children?” Front Pediatr. 2017; 5: 72.
Nowak-Węgrzyn A and Chatchatee P. “Mechanisms of tolerance induction.” Ann Nutr Metab. 2017;70 Suppl 2:7-24.
Shokeen D. “Influence of diet in acne vulgaris and atopic dermatitis.” Cutis. 2016; 98(3):E28-9.
Sidbury R, Tom WL, et al. “Guidelines of care for the management of atopic dermatitis: Section 4. Prevention of disease flares and use of adjunctive therapies and approaches.” J Am Acad Dermatol. 2014; 71(6):1218-33.
Silverberg NB, Lee-Wong M, et al. “Diet and atopic dermatitis.” Cutis. 2016; 97(3):227-32.
All content solely developed by the American Academy of Dermatology
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