From the Guidelines
Yes, eczema can be exacerbated by certain foods in some individuals, particularly those with food allergies or sensitivities. Common food triggers include dairy products, eggs, nuts (especially peanuts), soy, gluten, and some fruits. If you suspect food triggers are worsening your eczema, consider keeping a food diary to track correlations between what you eat and flare-ups. An elimination diet, where you remove suspected trigger foods for 2-4 weeks and then gradually reintroduce them while monitoring symptoms, can help identify problematic foods. This approach works because food allergies can trigger immune responses that increase inflammation throughout the body, including the skin. For children with eczema, common triggers often include cow's milk, eggs, and peanuts, as noted in the guidelines for the diagnosis and management of food allergy in the United States 1. It's essential to consult with a dermatologist or allergist before making significant dietary changes, as they may recommend specific allergy testing to identify your personal triggers, such as skin prick testing (SPT) or serum specific IgE level determination 1. Not everyone with eczema has food triggers, and eliminating foods unnecessarily can lead to nutritional deficiencies. Therefore, it's crucial to approach dietary changes with caution and under professional guidance to ensure the best outcome for managing eczema symptoms and maintaining overall health. Some key considerations include:
- The definition of a food allergy as an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food 1
- The importance of identifying specific food allergens, which are typically proteins, but sometimes also chemical haptens, recognized by allergen-specific immune cells 1
- The phenomenon of cross-reactivity, where an antibody reacts not only with the original allergen but also with a similar allergen, which can trigger an adverse reaction similar to that triggered by the original food allergen 1
From the Research
Eczema and Food Triggers
- Eczema can be exacerbated by eating certain foods, with studies suggesting that foods such as cow's milk, eggs, and tomatoes can trigger eczematous reactions in some individuals 2, 3, 4.
- Clinical studies have revealed that more than 50% of children with atopic dermatitis that can be exacerbated by certain foods will react with a worsening of skin eczema alone or in addition to immediate symptoms 3, 4.
- The role of food allergy in atopic dermatitis remains controversial, but it is clear that foods can directly provoke flares of atopic dermatitis, particularly in sensitized infants 3, 4.
Diagnostic Procedures
- Eczematous reactions to food can only be diagnosed by a thorough diagnostic procedure, taking into account the patient's history, the degree of sensitization, and the clinical relevance of the sensitization 3, 4.
- The gold standard for diagnosis remains the double-blind, placebo-controlled food challenge, as screening methods such as food allergen-specific serum immunoglobulin E tests or skin prick tests may result in false-positive tests for food allergy 5.
Nutritional Hazards
- Elimination diets in children with atopic eczema can be potentially hazardous and require continued pediatric and dietetic supervision, as they may lead to significantly low intakes of essential nutrients such as calcium 6.
- Unnecessary diets that are not based on a proper diagnosis may lead to malnutrition and additional psychological stress on patients suffering from eczema 3.
Food Triggers and Dermatitis
- Dietary factors can indeed exacerbate atopic dermatitis or cause dermatitis due to systemic contact dermatitis, with foods triggering rapid, immunoglobulin E-mediated hypersensitivity reactions or late eczematous reactions 5.
- Systemic contact dermatitis is a distinct T-cell mediated immunological reaction in which dietary exposure to specific allergens results in dermatitis, with balsam of Peru and nickel being well-known causes 5.