Does dairy consumption exacerbate eczema symptoms?

Dairy and Eczema: Evidence-Based Management

For most patients with eczema, dairy elimination diets are not recommended as a first-line treatment approach, but may be considered in specific cases where there is suspected cow's milk allergy with clear symptom correlation. 1

Relationship Between Dairy and Eczema

Current Evidence

• The relationship between dairy consumption and eczema is complex and not universally established for all patients
• Guidelines indicate that food avoidance should not be used as a general management strategy for atopic dermatitis (eczema) in individuals without documented or proven food allergy 1
• Skin care optimization should be the primary focus before considering dietary interventions 1

When Dairy May Affect Eczema

• Dairy may exacerbate eczema primarily in two scenarios:
  1. In patients with IgE-mediated cow's milk allergy
  2. In patients with non-IgE-mediated cow's milk allergy (which can manifest as eczema)

Assessment Algorithm for Suspected Dairy-Related Eczema

Step 1: Optimize Skin Care First

• Before considering dietary elimination, ensure optimal skin care with:
  • Regular moisturizer use
  • Appropriate topical steroid treatment
  • Trigger avoidance (environmental)
  • Treatment of secondary infections if present 1

Step 2: Evaluate for Possible Dairy Allergy

• Look for clear temporal relationship between dairy consumption and eczema flares
• Consider testing if history suggests possible allergy:
  • IgE-mediated reactions: skin prick testing or specific IgE blood tests
  • Non-IgE-mediated reactions: elimination-rechallenge protocol

Step 3: Trial Elimination (Only If Indicated)

• If cow's milk allergy is suspected after skin care optimization:
  • For breastfed infants: consider a 1-2 week maternal cow's milk-free diet trial 1
  • For formula-fed infants: consider appropriate hypoallergenic formula
  • For older children/adults: consider a time-limited dairy elimination trial (2-4 weeks)

Step 4: Structured Rechallenge

• Critical: After elimination period, perform a structured rechallenge to confirm diagnosis 1
• This step is essential as prolonged unnecessary elimination can lead to:
  • Risk of nutritional deficiencies 1
  • Paradoxical development of acute allergic reactions upon reintroduction 2, 3

Important Cautions

Risks of Unnecessary Elimination

• Prolonged dairy elimination without confirmed allergy can:
  • Lead to calcium deficiency and growth issues in children 1
  • Paradoxically increase risk of developing acute allergic reactions upon reintroduction 2, 3
  • Create unnecessary dietary burden

Nutritional Considerations

• If dairy elimination is necessary:
  • Nutritional counseling is strongly recommended 1
  • Regular growth monitoring for children 1
  • Calcium and vitamin D supplementation may be needed

Special Considerations

Lactose Intolerance

• Distinct from milk protein allergy
• Can occasionally manifest with skin symptoms 4
• Consider lactose-reduced products rather than complete dairy elimination

Dietary Factors in Acne

• While dairy (particularly skim milk) has been associated with acne, this relationship is distinct from eczema 5
• The American Academy of Dermatology acknowledges emerging evidence for dietary factors in acne but notes more research is needed 1

In conclusion, while dairy elimination is not recommended as a routine approach for eczema management, it may benefit a subset of patients with confirmed cow's milk allergy. Any elimination diet should be conducted under medical supervision with proper nutritional guidance and include a structured rechallenge to confirm diagnosis.