Eczema and Food Allergy Concerns

Key Messages

• Most eczema is not allergy-driven, and food exclusion carries potential risks such as nutrient deficiencies and increased allergy development.
• IgE-mediated food allergies are characterized by a rash (usually hives) appearing within an hour of eating a specific food and usually clearing completely with antihistamine use.
• Active eczema management, including daily care and prevention measures, is essential.
• Early weaning, as per BSACI guidance, may benefit babies with eczema from the first 1-2 months of life

What to Do

History Review:

Identify timing of rash onset, specific triggering food, nature of rash, and resolution method. IgE-mediated allergies usually involve hives appearing within an hour of eating and clearing completely with antihistamine.

Eczema Management:

Implement aggressive daily routine including moderate-temperature baths, emollient application, mild to moderate topical corticosteroid use during flare-ups, and protective clothing at night.

Dietary Management:

If food triggers are suspected, maintain a food diary and perform a careful food exclusion and reintroduction process. Emphasize the importance of food reintroduction due to the lack of reliable diagnostic tests for food-triggered eczema.

What Not to Do

Avoid IgE or skin prick testing for children with eczema without IgE symptoms to prevent confusion and unnecessary dietary restrictions.

When to Refer

• If eczema is difficult to control, refer to a dermatology service.
• If symptoms indicate an IgE-mediated food allergy, refer with details to an allergy clinic.
• If the child is excluding significant foods like milk or wheat, refer to a dietetic service.

Potential Risks of Food Exclusion

• Potential nutrient deficiencies and increased allergy development are key concerns. Balancing food exclusion with these potential risks should be discussed. The importance of food reintroduction is paramount in managing food-triggered eczema flare-ups.

Additional Resources

• BSACI Early Feeding Guidelines
• Chang et al - Natural History of Food-Triggered Atopic Dermatitis and Development of Immediate Reactions in Children
• Irish Skin Foundation - what you need to know about Eczema
• Irish Skin Foundation - 20 questions about food allergies and Eczema Acknowledgements to Dr Fiona for adaptation of existing guidance