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Diet and your Child's Atopic Eczema

Introduction

Many people think that diet is an important factor in atopic eczema and in some cases this is true. However, it is also possible that some parents restrict their child's diet without any real benefit to their child's eczema and very restrictive diets could harm your child's growth.

This leaflet summarises some of the commonest questions that we get asked about diet and atopic eczema.

1 How important is food allergy in atopic eczema?
Nobody knows the answer to this question with any certainty because the effects of foods on the skin are complicated and difficult to assess. What evidence is available suggests that food may occasionally be an aggravating factor in atopic eczema, usually in children under the age of 1 year.

2 How do I know if my child is allergic to any particular food?
The most reliable way of knowing whether your child is allergic to a particular food, is to eliminate the suspected food for 6 weeks, and then have the courage to reintroduce your child with that food at the end of this period. If your child develops swollen patches on the skin, vomiting and diarrhoea and a clear flare up of his/her eczema 24-48 hours after eating the food in question, then this is a fairly reliable guide that your child may be allergic to that food. If you are unsure whether this food has really worsened your child's eczema, bearing in mind that eczema is a condition which tends to go up and down of its own accord anyway, then have the courage to reintroduce your child again to make doubly sure. This form of parental observation is the most important way of diagnosing food allergy in a child with atopic eczema.

3 Are there any tests which can help us?
Unfortunately, no. We certainly can perform a blood test which will look for evidence of an antibody to egg and cows' milk protein, but many children have such a positive test and do not have any evidence of atopic eczema or food allergy. Similarly, skin prick tests tell us something about your child's immune system, but they are poor at predicting whether or not your child's atopic eczema is due to a particular food. Careful observation of your child with particular foods is still the most useful way of diagnosing food allergy in atopic eczema.

4 What should I do if I suspect food allergy in my child?
You should really discuss this with your doctor or skin specialist before excluding any foods in your child's diet. Remember that milk in particular is an excellent source of calcium and protein for a growing child. It is important to make sure that you child has enough protein and calcium if you give your child a milk free diet. You should also bear in mind that some children can also be allergic to soya milk, so it is important to discuss your child's diet with your doctor or paediatric dietician if at all possible. The commonest food allergies in atopic eczema are:

1 milk
2 eggs
3 citrus products e.g orange, fruit juice
4 chocolate
5 colourings
6 peanuts

Sometimes avoiding these foods is practically impossible. Providing they do not upset your child's eczema too much, it is probably better to avoid them as much as possible rather than avoid them completely.

5 Will my child always be allergic to certain foods?
Most food allergies that occur in the first year of life are unlikely to be lifelong. For this reason, even if you are convinced that your child is allergic to cows' milk or eggs at the age of 6 months, you should have the courage to try and reintroduce such foods gently at yearly intervals to see if your child is able to tolerate it. Peanut allergy tends to be more persistent and if this is associated with severe symptoms, then peanuts should be avoided lifelong. You should discuss this further with your doctor.

Summary

1 Food allergy is not a major cause of worsening of atopic eczema above the age of 1 year.

2 The commonest foods to upset atopic eczema are: cows' milk, eggs, citrus fruits, chocolate, colourings and peanuts.

3 The only reliable way of knowing whether your child is allergic to a suspected food is to avoid that food for 6 weeks and then reintroduce your child with it. If you are not convinced there has been a definite worsening of your child's eczema within 24-48 hours, then repeat the process again.

4 Always test one food at a time.

5 Skin prick tests and blood tests are not as helpful as your observations of your child's eczema and diet. These tests often confuse us rather than make things clearer.

6 If you do suspect that your child's atopic eczema is worsened by particular foods, then please discuss it with your doctor before starting on a strict diet.

7 If you do decide to avoid cows' milk and dairy products, then please talk to your doctor to make sure that your child has enough calcium, protein and calories to grow healthily.

8 Even if your child does have a food allergy when he/she is very young, then do consider reintroducing the food when your child is a little older as he/she may have become tolerant to that food by then.

© Professor Hywel C Williams, Sister Sandra Lawton Staff Nurse Sue Newham Queen's Medical Centre, Nottingham, 1995