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Many parents make changes to their child's diet to try to improve their skin, but how effective is this?
The past 40 years have seen a dramatic rise in allergic diseases, particularly in the Western world. As well as huge increases in the amount of childhood asthma and hayfever, it's now estimated that atopic or allergic eczema affects almost 20%of children. Atopic eczema (also known as atopic dermatitis) is a chronic [itchy skin]http://parenting.greatvine.com/browse-experts/early-years/allergies/) condition that most commonly develops in early childhood. Eczema tends to be a variable disease with children suffering from dry skin, which flares up with sore patches from time to time, often for no apparent reason.
Fortunately, for most children, eczema is a relatively mild, albeit still irritating condition. However, for a smaller proportion of children, eczema can be more severe and continuous, having a significant impact on a child's quality of life as well as that of their parents. In a recent survey of parents of children with eczema by the National Eczema Society, one in six mums said they would consider having no more children if those children were also to suffer from eczema.
It is estimated that atopic or allergic eczema now affects 20% of children
Conventional medical treatment of eczema revolves around two principles. Emollients (moisturisers) are used regularly all over, together with bath oils, to improve the hydration of the skin. However, these don't prevent the sore, inflamed areas from developing, nor do they calm them down. For these sore or active areas of eczema, anti inflammatory drugs such as steroid skin creams are needed. And if a bacterial infection has caused the flare-up of eczema, antibiotics must be used too. Parents are often very nervous of using steroid creams because of their possible side effects. When used carefully, under the direction of a doctor, steroid creams are both effective and very safe. However, long-term use can cause skin thinning, which is a particular issue in areas where the skin is already thin such as on the face. Consequently, parental concern over steroids often results in eczema being untreated, which can lead to skin damage.
Eczema can flare up for a variety of reasons, including skin infections, irritants (such as abrasive clothing or sweating) and viral infections. Many parents also worry that their child's diet may be a cause. In fact, studies have shown that 75% of parents have changed their child's diet to try to improve their eczema. Many doctors are sceptical that there's any value in such dietary manipulation, as it may place the child at risk of missing out on essential nutrients and force them to endure the considerable hardship the careful avoidance of any specific food leads to. However, our understanding of the possible role of food allergies in eczema has now improved considerably, and it's becoming increasingly clear that, in some children, identifying and excluding problem foods can have a significant impact on eczema. Identifying the correct foods in the correct children still requires considerable expertise, and parents should raise their concerns with their family doctor or paediatrician rather than experimenting themselves.
There appears to have been a large increase in food allergies over recent decades, although this has been less well documented than the rise in other allergic diseases. Peanut allergy, for example, has tripled in just over a decade and now affects almost one in 50 children in the English- speaking world. Food allergies can be broadly divided into immediateallergies, which lead to immediate symptoms such as hives, wheeziness and, in severe cases, anaphylaxis (a life-threatening allergic reaction), and those that cause more delayed symptoms. Immediate reactions are usually quite obvious when they occur, as they produce symptoms very soon after the food is eaten and can also be confirmed with special allergy tests. Delayed reactions involve a different part of the immune system and may be tricky to diagnose, as symptoms can occur many hours after the food has been eaten and as yet there are no reliable tests to confirm which food is the problem. Eczema may be associated with immediate food allergies, delayed food allergies or both.
Children with severe eczema before six months of age are at risk of developing a food allergy
There is a close relationship between eczema and immediate food allergies. Almost all the children in my clinic who have immediate food allergies either have eczema or had it during the first year of life. This strongly suggests that eczema may have a causative role in food allergies, and this is currently the subject of a lot of interest in the scientific world. There is also a clear relationship between the age at which the eczema first appeared, how severe it is and the likelihood of developing food allergies. Studies have shown that children with severe eczema that started before six months of age are at particular risk (and most will have a food allergy), while those who didn't develop eczema until they were over one year old are much less likely to have a food allergy.
Most immediate food allergies are caused by a relatively small number of foods — milk, egg, peanut, tree nuts, fish, shellfish, soy and wheat — although allergies to sesame, kiwi and banana seem to be getting more common. Once an immediate food allergy is diagnosed, there's currently no real alternative to avoiding the food, while also being prepared to treat allergic reactions quickly when they occur. Fortunately, many food allergies are outgrown during the course of childhood, particularly those to milk and egg.
The link between delayed food allergies and eczema remains quite controversial. The suggestion that a child could be regularly eating something that's worsening their eczema still isn't taken seriously by some doctors. While most children with eczema won't be suffering from delayed food allergies, correctly identifying problem foods in the right children can lead to significant improvements in eczema and thus reduce the reliance on steroid creams to keep the skin under control. Research in this area has suggested that milk, egg, soya and wheat are the most likely culprits, and again it's those children whose eczema started early in infancy and is severe who are most likely to respond to dietary changes. However, the allergy tests used to diagnose immediate allergies, such as skin prick tests or a blood test known as Specific IgE, are of much less value in delayed allergies. Many companies offer food testing over the internet to identify foods that may worsen eczema, but there's no research to support these and they often lead to completely pointless food exclusions. Also, such tests aren't used by allergists or dermatologists. While these tests appear to offer a quick and easy solution, there's currently no substitute for evaluation by an experienced doctor or dietician. After taking a detailed history, they may advise the complete elimination of specific foods and carefully evaluate the results. Even if excluding a particular food does appear to help, it's essential that an attempt to reintroduce the food is made (which would be expected to lead to a worsening of the eczema) to confirm the food is a problem.
When evaluating a child with eczema, your doctor will pick up on certain clues that raise the possibility of food being a problem. As mentioned earlier, it's children with moderate to severe eczema that starts before six months of age who are most likely to have a food allergy. Certain foods such as tomatoes or citrus fruits can act as an irritant on eczematous skin. This may cause redness and itching, but isn't an allergy and can be avoided by simply rubbing a barrier cream around the mouth before eating.It's important to remember that food allergy and diet often play no role in eczema and, while it's important to keep an open mind, it's never a good idea to restrict a child's diet without good reason. If removing a food from the diet doesn't seem to help and reintroducing it doesn't make things worse, it's very unlikely to be a problem and shouldn't be further restricted.
If you suspect your child has an immediate food allergy or something they're eating is making their eczema worse, you should discuss this with your doctor. They may wish to trial a food exclusion or recommend that your child has some allergy tests. Most large hospitals have a paediatric or dermatology department where one of the doctors has an interest in allergies, and a few large teaching hospitals have specialist paediatric allergists.Fortunately, most children grow out of their eczema by later childhood and many common food allergies such as milk and egg are also often outgrown. It's therefore important that if a diagnosis of food allergy is made, your child should still receive ongoing follow-up care to check for the possibility that the food could be safely reintroduced.
If you need advice from Adam about your child's Eczema or food allergy you can contact him via his Greatvine profile.
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