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Eczema and Food Allergies: Further Clarifying the Connections

***If you haven't yet read the previous post “Eczema and Food Allergies: Clarifying the Connections,” we recommend you check it out then read this post!***

What is the connection between eczema and food allergies?

Eczema, an inflammatory skin condition, impacts nearly 1 in 5 children. Its cause is thought to be multifactorial, but foods are not a cause of eczema. In fact, it's eczema that predisposes children to having food allergies.

How does the skin play such an important role in food allergies?

The waltz of the skin and the bacteria

The skin is the largest immune organ. It's the barrier that prevents us from getting all sorts of infections. The skin does this by being a physical barrier but also permits “good” bacteria to live on its surface. The skin and its immune system is constantly waltzing with the outside world, especially bacteria, many of which help keep the skin happy. Some bacteria, however, are not beneficial to the skin, especially in the case of eczema, and those “bad” bacteria can play a role in the flaring eczema.

An impaired skin barrier can lead to the development of IgE (allergic antibodies)

The immune system within the skin is especially designed to help prevent parasites from infecting the body. Interestingly, some of the same immune machinery used to prevent those parasite infections is what is used during allergic reactions.

Before a person can have a food-induced IgE-mediated allergic reaction, that person must have IgE to that food, e.g. they must be sensitized to the food. How and why exactly the human body has begun developing IgE to foods remains unclear. Foods, such as peanuts, are not parasites, so why are peanut being treated almost as if they do pose danger? That is what the wonderful food allergy researchers are trying to determine.

What is known is that children with eczema are at increased risk of developing food allergies. Also, in mouse models, we know that sensitization can occur when peanut is exposed to impaired skin. Eczema causes an increase in the amount of moisture lost from the skin, such as trans-epidermal water loss (TEWL). TEWL is measured with a wand-like instrument that sits on the skin and literally measures the amount of moisture – water – exiting the skin. Because water loss occurs in eczema, it's important to add moisture to the skin (see “Eczema and Food Allergies: Clarifying the Connections“).

What about filaggrin?

So why does anyone even have eczema? Many cases are associated with a defect in the filaggrin gene. Filaggrin plays a role in creating a strong skin barrier, and a defective filaggrin gene results in skin barrier dysfunction. Such dysfunction leads to increased TEWL. The loss of moisture from skin leaves the skin at risk of dryness, cracking, and, in the case of eczema, flaring.

So what helps eczema?

Skincare strategies for eczema should be discussed with your physician. You likely will be advised to follow a skincare plan the decreases inflammation while increasing hydration. Here are some ways your physician may recommend that be accomplished.

Decreasing Skin Inflammation

Topical steroids are some of the most common medications to diminish inflammation. Some are even available over-the-counter. Steroids range in potency, so it's critical to know when and where and how long to use which topical steroids. There are also non-steroidal medications, such as Eucrisa and Dupixent, that are used to treat eczema.

Your physician may also recommend bleach baths. Bleach baths do not sterilize the skin, rather they improve the skin's environment such that good bacteria live there happily and bad bacteria are unwelcome. While many physicians find bleach baths helpful, some studies suggest that regular water baths can be as effective. When doing bleach baths, it's important to use the correct amount of bleach for the amount of water. Here is a link to the recipe for bleach baths, and check out the video below.

Increasing Skin Hydration

This is where baths are again relevant. Bathing in warm water and limiting soaps, which can be drying and contain fragrance and other skin irritants, helps improve the skin's moisture. Upon exiting the bath tub, blotting as opposed to rubbing the skin dry, then immediately applying a thick emollient, helps seal in the moisture (this is also when topical anti-inflammation meds, such as steroids, are especially well applied). In many cases, emollients are applies multiple times per day. It's critical to focus on moisture whether the eczema is flaring or appears healed.

If your child has eczema and/or food allergies…

Talk with your allergist about a clear plan of management for both these conditions. Both eczema and food allergies are conditions that can be very challenging, especially given the significant discomfort and pain that eczema can cause as well as the anxiety that eczema and food allergies can cause. Remember, continue to seek evidence-based information to inform your discussions with your allergist, and your journey will be all the smoother!

Tune in to this episode to learn all the connections between eczema and food allergies!

Eczema Episode Part 2

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    A note from Dr. Hoyt

    I have talked about a non-profit…

    Pam and I volunteer with the non-profit The Teal Schoolhouse. Its primary program is Code Ana. Code Ana equips schools for medical emergencies like anaphylaxis.

    Code Ana’s Online Epinephrine Training Program helps support that goal. Through this program, you will educate yourself while you support this important mission!

    A medical emergency response plan is important for everyone at any school. Code Ana's program Med-E Ready is a comprehensive approach to school-focused medical preparedness. This program guides schools through the process of creating a medical emergency response plan. A response team is also developed! This is one of the most important components of a school's food allergy policy!

    Does your kiddo’s school have Code Ana?

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