Skin Diet: Eczema are Not Just about Visible Symptoms

Image credit to FoodAllergyFun

Beneath the ‘Skin’ Surface

How many of you have been told by your doctor that your child’s eczema is not associated with her food? Unfortunately, this is not true!

The link between ‘Eczema’ and ‘Food Allergy’ has now been known for quite some time. Some of the clinical studies – among a sea of many more – support this connection, including:

• Specific foods can indeed worsen dermatitis and avoiding them has provided relief.
• 33-63% of children with eczema also have food allergy.
• Food allergy is likely with earlier onset and increasing severity of condition.
• 56% of children experienced 101 positive food challenges and skin symptoms developed in 84% of these challenges.

Eczema Causing your Child’s Food Sensitization?

Previously, studies had shown that people with impaired skin barrier – as in the case with eczema – do not have adequate protection against external irritants, chemicals or allergies. In another study [1], it was found that babies with a defective skin barrier, particularly if they also have eczema, are 6 times more likely to become sensitized to a variety of foods than healthy babies.

In that study, it was observed that the more severe a baby eczema is, the stronger the association to food sensitization. Egg white was the most common allergen followed by cow’s milk and peanut. The infants in the study were all exclusively breast-fed and had not eaten any solids yet; suggesting that – active immune cells on the skin, rather than the gut – are responsible for developing their sensitization to food.

Paradigm Shift in ‘Allergy’

This is quite an interesting paradigm shift in the way we see allergy! It is no longer what we eat that triggers sensitization or allergy; but what’s on our skin can be equally capable of such trigger!

It is thought that a breakdown in the skin barrier and skin inflammation that occurs in eczema can trigger food sensitivity in babies. This has the potential of eventually becoming food allergy. Contrary to the old belief that allergy or sensitivity is often triggered inside out, this outside in trigger has now been proven and can occur at an early age of eczema. Other factors include higher-than-normal skin pH, scratching, impaired filaggrin (a protein on our skin) and food that come into contact with our skin (Food-to-skin contact is common when we let our babies feed themselves and see them smearing the food all over the body).

On related subject, it had also been discovered that exposure to peanut protein-containing household dust and hydrolyzed wheat-containing soap or cleaning product can significantly increase the risk of sensitization to peanut and wheat respectively.

This also implies another reason to moisturize enough and effectively!

It is thus very crucial to use the right products that can moisturize and seal in moisture (so scratching can be reduced), repair and protect our child’s skin barrier without irritating it; we are able to relieve the eczema and concurrently, preventing potential food sensitivity or allergy.

Sensitivity (Intolerance) vs Allergy

Many parents mistake ‘sensitivity’ (otherwise also known as ‘intolerance’) as ‘allergy’. This probably is due to the blanket term ‘allergy’ commonly used to describe just any types of adverse reactions that occur after say, eating a certain food or touching a substance.

As they are often mixed up yet different, we do feel the need to explain their contrasts:

• Allergy – Negative reactions occur usually within minutes to hours after exposing to trigger. Here, the immune system is involved and severe reaction can prompt anaphylaxis reaction. Common reactions are hives or eczema flares (redness, inflammation, etc).
• Sensitivity or intolerance – The adverse reactions are delayed. Its symptoms can appear from 6-24 hours or even after a few days. Unlike allergy, sensitivity does not involve immune system and hence, no risk of anaphylaxis.

In either case, because they cause adverse reactions, the avoidance of triggers that cause sensitivity or allergy is found to improve the eczema symptoms. Some studies included:

• An eczema child with sensitivity to wheat improved on a wheat-free diet.
• That same child when fed wheat again, the symptoms re-appear [2].
• Improvement in eczema severity was noticed in 55 children with eczema and egg sensitivity after excluding egg from diet after 4 weeks [3].
• Children with food allergy showed significant improvement in their symptoms, within 1 to 2 months, after dietary elimination.

Is Sensitivity or Allergy Worsening your Child’s Eczema?
How to tell if your Child is Allergic to a Specific Food

The chance is that if you have adequately taken steps to remove possible triggers from your child but she is still suffering from eczema flares, then you may like to pay extra attention to food-related sensitivity or allergy.

Because of the complex relationship between eczema and food allergies, diagnosing specific food causing a flare up can be difficult. Allergy testing or skin prick test may not be accurate. In the past, these tests were used to diagnose a food allergy when tested positive – because they indicated the presence of IgE antibodies.

Today, we know that a person with eczema has larger amount of IgE than healthier person, a positive test is no longer an indication of a true allergy unless it is confirmed with a strong history of reactions or by an actual food challenge, that is, feeding a patient the food indicated by the tests and see if he or she has an immediate reaction.

Young children are rarely being put on strict restriction diet because doctors are concerned that they may become malnourished during this growth and development phase. Furthermore, they believe that children may only have food sensitivity, not real allergy. Due to the delayed onset of symptoms in sensitivity cases and interplay of various food, chemical or environmental allergens, it is very confusing and difficult to figure, since typical allergy tests won’t work.

Usually an elimination diet is used to detect these certain foods that cause the intolerance. In an elimination (or rechallenge) diet, you will remove possible allergens or ‘culprits’ from your child’s diet then re-introduce them back once at a time after a certain period to test and assess if the food is actually causing the negative reactions. More details on this test will be covered in Testing Eczema Triggers: What Tests Are Reliable?

Bear in mind that when a baby, toddler or young child is involved, you need to consult with your doctor or nutritionist before eliminating any foods from her diet.

Common Misconceptions Debunked 

Myth #1: If you avoid the ‘common allergenic foods’, you do not need to put your child through an elimination diet.
Milk, eggs, peanuts, nuts, fish, shellfish, soya and wheat are to blame for 90% of allergic reactions. This list of common foods allergens is good for reference purposes only. Do be mindful that many factors some into play, therefore affects a child’s reaction differently or in varying severity. It can be other foods – those that she loves – that may cause all the problems. Randomly removing all listed common ‘foods’ is not a proper long-term solution. It can, however, serve as a ‘watch list’ that you can use to test your child’s reaction.

Myth #2: Your child does not eat that food. She won’t be allergic to it.
In allergy, food in contact with the body can also trigger negative reaction because the food protein may penetrate the damaged skin barrier where it will be tagged as foreign invader by your immune system. Therefore, it is not true to say that if your child does not eat an allergen, she won’t be allergic to it. It can be triggered by that food getting in contact with your child’s skin.

Myth #3: Just a little of the sensitive food won’t hurt.
For food intolerance, you may still eat a certain small amount of the sensitive food in certain manner e.g. by rotation say once every 3 days. However, if you are allergic to a food, even a small amount of that food can develop serious negative reactions.

Myth #4: Organic foods are safer.
Organic foods are safer in terms of free from harmful pesticides, but it does not mean they are safer in terms of allergic reaction to its food protein. A tomato is after all still a tomato, organic or not. They still contain the same food proteins that cause the allergic reaction.

Myth #5: Company must list every single ingredient in food label.
We would think so but unfortunately, not all the times. Different countries have different regulations. Where those that are required to disclose food allergens, they only apply to the top 8 allergens: peanuts, tree nuts, soy, milk, eggs, shellfish, fish, and wheat. Also, warning about cross-contamination during manufacturing, i.e. cross-contact between safe food and allergen food is completely voluntary. Pay attention to the food label that marks “may contain” or “made in factory with”.

 

Reference:

• [1] Carsten Flohr, Michael Perkin, Kirsty Logan, Tom Marrs, Suzana Radulovic, Linda E Campbell, Stephanie F MacCallum, W H Irwin McLean, Gideon Lack. Atopic Dermatitis and Disease Severity are the Main Risk Factors for Food Sensitization in Exclusively Breastfed Infants. Journal of Investigative Dermatology, 2013; DOI: 10.1038/jid.2013.298.
• [2] Engman WF, Weiss RS. Engman MF Eczema and environment. Med Clin North Am. 1936;20:651.
• [3] Lever R, MacDonald C, Waugh P. Aitchison T. Randomised controlled trial of advice on an egg exclusion diet in young children with atopic eczema and sensitivity to eggs. Pediatr Allergy Immunol. 1998;9(1):13–19.