The relationship between allergic disease and eczema is very close
Many parents see how distressing eczema is for their child and worry that allergies are driving this intolerable itching.
We need to treat eczema with great care. Eczema has a huge impact upon quality of life, through affecting sleep quality, children’s ability to engage in sport and social events. If children do not feel comfortable, they may start to avoid activities, feel different and loose confidence.
So, it is important to treat eczema in the first place, as well as look for potential triggers. Here is a brief overview on helping your child’s eczema, however there is more here. The essential steps include;
- Keep the skin consistency in good condition – which may involve daily moisturising with clean hands, and some dry skin types may need regular cream
- Using an anti-inflammatory cream for patches of itchy eczema. It is safe and normal to buy Hydrocortisone 1% cream over the counter, and this should be considered as first treatment for mild patches of eczema.
- Consider antiseptic creams or bath wash lotions such as Dermol 500
- Join Eczema.org to review wide range of advice
Here is a quick checklist of possible eczema triggers to consider;
- Physical triggers, such as heat with synthetic blankets or raw-natural woollen clothing
- Harsh physical skin conditions (use of astringent perfumed sprays and lotions, bubble bath, cosmetic creams, alcohol gels and repeated washing can all dry the skin)
- Irritation from foods (eczema can flare after acidic foods, ketchup tomato sauces, spicy / chocolate flavours as well as foods that contain amine-analogues such as strawberry and hard-pressed cheese like parmesan)
- Infection (both viral sore throat infections, viral and bacterial skin infections worsen eczema)
- Environmental allergens (these may include pollens, house dust mite and animal dander however need history taking and testing before confirmation)
- Avoidance of topical steroid creams (eczema is a dual process of skin dryness and also inflammation; it is impossible to treat established eczema without an anti-inflammatory component of management)
We are learning more about how the skin reacts to different physical exposures, and sometime the skin does not respond as we would think!
- Olive oil may be ‘natural’ however it was not ‘designed for the skin’. There are now concerns that plant oils which are used for cooking may in fact make human skin more dry
- There is some early data from three month old babies to suggest that repeated moisturising of babies’ skin may actually increase the skin’s exposure to environmental food proteins and drive sensitisation.
Eczema as a driver for food allergies
The gut of a baby is designed to sample proteins from foods, and then prevent the body building an allergic immune response to ingested foods.
However, if a baby has eczema and comes into repeated skin contact with food allergens, the body may try to ‘fight it off’ by developing IgE allergy antibodies to foods. This can drive the development of sensitisation and promote IgE-mediated food allergy.
When we look at the stages of food allergy development from birth, we can see that eczema arises before food allergy;
We can also see that the development of eczema means that there is much greater likelihood of egg sensitisation, but also milk and peanut sensitisation, suggesting a disposition towards food allergy.
Not only that, but the more severe a baby’s eczema, the more likely that food allergy will develop, and the more likely that multiple food allergy is present.
From a medical point of view, we can now tick the 7 criteria tests of Causality from Bradford-Hill;
- Strength of association (more allergy in those with eczema)
- Consistency (reproducibility across the world)
- Specificity (there are some food allergies that develop without eczema, however most have dry skin or some other skin injury if the food allergy is persistent)
- Temporality (eczema or skin disorder usually arises first before the IgE food allergy)
- Biological gradient (worse eczema begets worsened food allergy)
- Plausibility (see Dual Allergen Hypothesis explains food is for ingestion, rather than skin exposure; may need testing before oral ingestion is safe in babies with established eczema)
- Coherence (lab work, epidemiological observation and clinical trials are showing a consistent picture)
From an allergy point of view, there are a few specific points to bear in mind;
- The immune system normally decides whether to make food allergy antibodies in the first few years of life; we only have evidence of active eczema driving allergies in early life
- Washing hands from food prior to moisturising babies may help prevent food allergies, however no trial has yet examined this and it is unlikely to be relevant to toddlers and older children
- There is a trial underway in Japan to test whether proactive eczema treatment through infancy can prevent the development of IgE-mediated food allergy
- Perhaps slow access to care and poor treatment of early eczema may lead to more food allergies developing, especially among those managing in areas with limited healthcare access
So, some tips for parents;
- Avoid olive oil for massaging baby skin
- There is no need to bathe a baby every day, and there is no health benefit for playing with your baby in the bath for a long time – prolonged bathing and daily bathing may dry the skin
- For babies, it is best to wash adult hands before applying moisturiser to lower risk of food sensitisation; perhaps moisturising babies after moderated bathing best facilitates clean skin
- Mild or moderate topical steroid creams for eczema applied daily for 1-2 weeks cannot harm the skin, contrary to popular belief. It is likely that not using moderate steroids and leaving the eczema may raise the risk of developing food allergies. Stronger steroid creams will normally only be offered by more experienced health care professionals.
- Consider requesting food sensitisation testing for babies with eczema who need regular topical steroids to normalise the skin’s eczema, or where a pattern of food allergen avoidance has developed without any objective proof yet offered
Read the next blog on introducing food allergens into a babies’ diet if you wish for more advice; coming soon!….