In addition to creating their own disruptive symptoms, food allergies may worsen symptoms of eczema. For children with both conditions, an elimination diet may help uncover food triggers of eczema.
Eczema collectively describes seven different inflammatory skin conditions that share similar symptoms and pathology. Atopic dermatitis is the most common form of eczema, affecting as many as
Many children living with atopic dermatitis also experience related conditions such as food allergies, asthma, and seasonal allergies. These conditions make up the “atopic march,” or “atopic triad,” as they frequently occur together, and having one increases the likelihood of developing another.
According to the National Eczema Foundation, up to 15% of children ages 3–18 months with atopic dermatitis experience at least one food allergy.
This article discusses food allergies co-occurring with eczema and how an elimination diet may help identify food-related triggers.
Eczema conditions such as atopic dermatitis result from skin barrier dysfunction and unusual immune activity, leading to persistent inflammation and symptoms such as dry, cracked skin, rash, and intense itching.
One of the markers of a dysfunctional skin barrier is that it allows in irritants and allergens a functional skin barrier would keep out. Once these irritants get through the skin, they can create an immune response that triggers inflammation.
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Under this concept, exposure to food allergens through a dysfunctional skin barrier in eczema might result in sensitization, causing the body’s already atypical immune system to become hyper-responsive to that food allergen.
An elimination diet involves removing specific foods or food groups from a person’s diet for a set time. The goal is to assess various markers of health as a person eliminates and then reintroduces foods.
Four phases typically make up an elimination diet:
- Planning phase: Based on current health and symptoms, a doctor agrees with the person on a plan regarding which foods to exclude and for how long.
- Avoidance phase: Also known as the elimination phase, this is when a person excludes certain foods, typically one at a time.
- Challenging phase: This is also known as the reintroduction phase. After several weeks of elimination, a person reintroduces one food records symptom responses. They repeat this process for every eliminated food.
- Maintenance phase: Once the individual has reintroduced all foods and diet triggers are identified, a new diet strategy will focus on meeting nutritional needs.
Taking with a doctor first
Elimination diets are not without risk and may not be appropriate for every child.
“If you suspect a certain food may be irritating your child’s symptoms, you may be considering an elimination diet,” Rose Britt, a registered dietician nutritionist specializing in pediatrics, told Medical News Today.
“However, it is important to note that
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An elimination diet for eczema may help reduce food-related allergen exposure that compounds inflammation in the body.
It may also prevent eczema from worsening from repeated contact with food allergens. Skin sensitization can increase when exposed to irritants repeatedly, escalating inflammatory responses and flaring symptoms.
Managing food allergies may help lower levels of inflammation in the body underlying eczema symptoms.
It might also help reduce food allergy symptoms that independently affect quality of life, such as:
- nausea, vomiting, and diarrhea
- hives or rash
- shortness of breath
- coughing or wheezing
- difficulty swallowing
- dizziness
- facial swelling
- mouth itching
- drop in blood pressure
- anaphylaxis
It is important to note that severe vomiting, shortness of breath, and low blood pressure are considered emergency symptoms of food allergies. Seek medical attention immediately if any of these symptoms occur.
Anaphylaxis: Symptoms and what to do
Anaphylaxis is a severe allergic reaction that can be life threatening. The symptoms develop suddenly and include:
- hives
- swelling of the face or mouth
- wheezing
- fast, shallow breathing
- a fast heart rate
- clammy skin
- anxiety or confusion
- dizziness
- vomiting
- blue or white lips
- fainting or loss of consciousness
If someone has these symptoms:
- Check whether they are carrying an epinephrine pen. If they are, follow the instructions on the side of the pen to use it.
- Dial 911 or the number of the nearest emergency department.
- Lay the person down from a standing position. If they have vomited, turn them onto their side.
- Stay with them until the emergency services arrive.
Some people may need more than one epinephrine injection. If the symptoms do not improve in 5–15 minutes, or they come back, use a second pen if the person has one.
However, how beneficial an elimination diet is for eczema remains a topic of debate. According to a systematic review and meta-analysis from 2022, dietary elimination appears to only slightly improve eczema severity, itching, and sleepiness in people with mild to moderate atopic dermatitis.
Researchers in the analysis caution to weigh the small benefits against the potential risks of elimination diets, such as malnutrition.
The most common food allergens in children are:
- soy
- milk
- eggs
- wheat
- peanuts
“Most commonly, the top nine allergen foods could be a trigger — cow’s milk, peanuts, egg, soy, wheat, tree nuts, fish, shellfish, and sesame,” said Britt. “It is important if you suspect one or more of these foods are irritating your child’s skin only to eliminate one at a time.”
She added that testing one food at a time helps ensure the elimination diet is not over-restricted and compromised nutritionally.
Once the first food for elimination is selected, Britt recommends removing all components of that food for 2–4 weeks.
“If there has been a clear improvement in symptoms over this time, reintroduce a small amount of the suspected food and watch for skin irritation,” she advised. “If there has been no change in symptoms with the food elimination, or it is not clear, add that food back in and move onto another suspected food to remove for 2–4 weeks.”
When reintroducing food, caregivers can use the “rule of 3s” for structure. This involves:
- Aiming for 3 weeks of elimination.
- Reintroducing one food at a time, in increasing amounts, during all three meals of the day.
- Waiting at least 3 days before reintroducing another food.
Britt recommends caregivers plan ahead for a doctor’s appointment with details about a child’s eczema symptoms and how they relate to food allergy exposure.
“When bringing an elimination diet up to your child’s doctor, let them know of potential trigger foods you have noticed, family history of food allergies, trends in your child’s flare-ups, and if allergy testing is recommended,” she said. “Have questions ready about which foods to add in if you are thinking about eliminating a large portion of their diet…”
She stated that, personally, she prefers adding beneficial components to a diet, such as synbiotics, versus just eliminating triggers when it comes to eczema.
Eczema and food allergies are treatable independently and through co-therapy, which helps manage shared inflammatory processes.
While there is currently no cure for eczema, symptoms can improve with treatment and
Most children outgrow food allergies, but there is no way to predict if a child’s allergies will improve with time or remain a lifelong issue.
An elimination diet could help identify food allergens that compound inflammation in a person with eczema.
Starting with a food challenge test, limiting one food at a time, and focusing on maintaining nutritional needs can help reduce possible risks from elimination diets, such as malnutrition.