Managing Infant Eczema: Foods to Avoid in Babies with Atopic Dermatitis?

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Eczema, also known as atopic dermatitis (AD), is a fairly common condition in infants and children, typically characterized by red, itchy patches of skin. Managing this condition can be challenging for parents, especially when trying to pinpoint triggers and find effective treatments.

With the link between food allergies and eczema, it is important for parents to understand the risks of food allergen avoidance in infants with eczema.

In this blog post, we'll explore the relationship between food allergies and eczema, the risk of developing food allergies in children with eczema, and practical strategies for managing eczema in babies, including whether or not a special diet is indicated.

What is eczema?

Atopic dermatitis is the most common form of eczema, which is why it is often referred to simply as “eczema.” Evidence suggests that atopic dermatitis affects about 1–3% of adults and 15–20% of children worldwide.

Symptoms of eczema include itchy skin, dryness, inflamed skin, and sleeplessness. In a baby whose skin is lighter, eczema rash can look reddish, while in darker skin, eczema tends to look more purple, brown, or gray.

Eczema is associated with a family history of food allergies, seasonal allergies, asthma, or other allergic diseases. A link has also been found between eczema and the skin microbiome. During infancy, the skin microbiome (i.e., the mix of bacteria on babies’ skin) has been shown to differ between individuals with eczema and those without. 

What are food allergies?

A food allergy is an abnormal immune response to a certain food. It happens when a person’s immune system misinterprets a component of a food (most often a protein) as dangerous and responds with an adverse reaction. 

Typically, immunoglobulin E (IgE) antibodies trigger the release of chemicals in the body (such as histamines), which can cause an allergic reaction to food, causing symptoms ranging from mild to severe.

The most common food allergies in kids include cow’s milk, eggs, peanuts, tree nuts, wheat, sesame, fish, shellfish, and soy. Symptoms usually occur within a few minutes of the food being eaten, although some reactions can take up to 2 hours to emerge and, in rare cases, longer. 

What are the symptoms of food allergies?

The most common signs of a food allergy can include mild symptoms like a few hives, mild to moderate itching around the mouth, vomiting, diarrhea, repetitive coughing, or stomach pain. 

Signs of severe food allergy include generalized, widespread hives on the body, swelling of lips, tongue, and throat, difficulty breathing, loss of consciousness, sudden fatigue, or symptoms that affect more than one organ system.

A food allergy differs from a food intolerance. Food intolerances involve different parts of the immune system and occur when the body cannot correctly digest specific food components, such as lactose in dairy products or gluten in wheat. This can lead to symptoms such as bloating, gas, diarrhea, or stomach cramps. 

Do food allergies cause atopic dermatitis? 

Eczema is a multifactorial condition influenced by genetics, environment, and immune system responses. Because close to 20-30% of babies with eczema also have food allergies, it has been previously thought that food allergies may cause or contribute to the development of eczema symptoms. 

While food allergies may trigger or exacerbate eczema flare-ups in some children, current research suggests that food allergies are NOT a cause of eczema. It's essential to work with a healthcare provider to determine if a food allergy is involved in your child's eczema and to guide any necessary dietary changes.

**KEY POINT: Food allergies DO NOT cause eczema.

Does eczema increase the risk for food allergies?

Recent studies suggest that disruption of the skin barrier due to atopic dermatitis may open up a route of sensitization to specific foods, which increases the likelihood of IgE-mediated food allergies. Severe atopic dermatitis is actually the strongest risk factor for food allergies (much stronger than a family history of food allergies!)

Because of this, it is especially important to prioritize the early and consistent introduction (between 4-6 months when developmentally ready) of top allergenic foods, including peanut and egg, for babies with moderate to severe eczema because they are already at an increased risk for developing food allergies.

For high-risk infants in particular, the more we introduce top allergenic foods early and often during the critical window of time during infancy when early and frequent allergen exposure is more effective, the more we can prevent the development of food allergies. 

As a pediatric registered dietitian AND mother of three, I fully understand that this may be stressful! To help reduce stress, stay educated on the signs of food allergies, what to do if you suspect a food allergy, and remember it is a more significant risk to avoid offering food allergens.

**If you want more information on reducing the risk of food allergies, how to introduce food allergens, and the signs of food allergies, I wrote my NEW baby-led feeding + food allergy prevention book to be a guide to walk you through this process. It is research-backed and filled with dietitian-approved feeding tips, a 9-day allergen introduction plan, and 8 weeks of maintenance meal plans.

** KEY POINT: Unnecessary food avoidance can increase the chance of developing IgE-mediated food allergies. If you feel nervous about introducing a food, you can always request an in-office food introduction challenge with your healthcare provider.

Best Foods for Eczema

While there isn't a specific "eczema diet" per se, some dietary changes may help manage symptoms. Do your best to focus on incorporating anti-inflammatory foods rich in omega-3 fatty acids, such as fatty fish (like salmon) and ground flaxseeds, hemp seeds, and chia seeds.

Aim for a variety of whole foods, fiber-rich foods, and colorful fresh fruits and vegetables, which provide antioxidants, vitamins, and minerals that support skin health, along with an array of other potential health benefits. Probiotic foods like yogurt, kefir, and fermented vegetables may help support gut health and potentially improve eczema symptoms.

While there's little research directly supporting the Mediterranean diet for eczema, it may help due to its anti-inflammatory properties and high levels of omega-3 fatty acids and antioxidants.

Staying hydrated is vital for maintaining healthy skin. In babies, this means getting adequate fluids through breast milk and/or formula, and if 6 months of age or older, adding in a small amount of water at meal times. Try to minimize processed foods high in sugar, saturated fats, and additives, which may contribute to inflammation.

If you suspect food allergies, consult a healthcare provider for testing and guidance. While an elimination diet is not recommended unless instructed by your allergist or pediatrician, it may be helpful to track what your baby eats and any symptoms to help identify potential triggers. If a food is eliminated, it is typically only for 2-3 weeks, then it should be reintroduced to evaluate for any symptoms of food allergy.

Unless a child has a wheat allergy, it is not generally beneficial to follow a gluten-free diet. And unless a child is diagnosed with cow’s milk allergy or avoids dairy for cultural reasons, soy milk-based formulas and/or dairy-free diets are not generally recommended. 

While dietary changes can help some people with eczema, they may not be effective for everyone. It’s important to partner with your healthcare provider and approach dietary adjustments thoughtfully and under professional guidance.

Management of Eczema in Babies

Managing infant eczema can be challenging, but with the right approach, you can help soothe your baby's skin. Here are some tips:

• Moisturize Regularly: Apply a thick layer of fragrance-free moisturizer (creams and ointments are better than lotions!) immediately after bathing while the skin is slightly damp and several times throughout the day. Look for products specifically designed for eczema, such as Aveeno Baby*.

• Choose Gentle Cleansers: Use mild, soap-free cleansers* when bathing your baby. Look closely at ingredient lists and avoid harsh soaps, bubble baths, loofahs, and washcloths.

• Bathe Sparingly: Limit baths to 2-3 times a week. When you do bathe, keep it short (about 5-10 minutes) and use lukewarm water.

• Dress Appropriately: Dress your baby in soft, breathable fabrics like cotton. Avoid wool and synthetic materials that can irritate the skin.

• Keep Nails Short: Trim your baby's nails to prevent scratching, which can worsen eczema and lead to skin infections.

• Identify Triggers: Pay attention to potential triggers such as certain foods, fabrics, or environmental factors (like dust mites or pet dander) and try to minimize exposure.

• Use a Humidifier: Keep the air in your home moist, especially in dry climates or during winter months, to prevent skin from drying out.

• Consider Allergy Testing: If you suspect food allergies may be contributing to eczema flare-ups, consult your pediatrician for advice on testing (i.e., skin or blood tests). 

• ** Note - Routine testing for allergenic foods is not recommended before introducing a new food, even in babies with severe eczema. 

• Follow Medical Advice: If over-the-counter treatments aren’t effective, your pediatrician may recommend topical steroids or other medications. If you notice severe symptoms or signs of infection, such as increased redness, swelling, or oozing, consult your healthcare provider for further treatment.

• Further research is needed, but probiotics, prebiotics, and synbiotics have all been studied as potential treatments for atopic dermatitis, as well as the topical application of breast milk.

Final Thoughts…

In conclusion, managing infant eczema requires a thoughtful approach, especially when it comes to food allergens. It is important to understand that food allergen avoidance rarely leads to an improvement in atopic dermatitis and can lead to the development of IgE-mediated food allergies to previously tolerated foods. 

So, even in babies with severe eczema, it is best to introduce food allergens early and consistently starting at about 6 months (and sometimes even a little earlier, but not before 4 months) to help prevent food allergy development. 

Alongside dietary adjustments, remember to maintain a consistent skincare routine and monitor environmental factors. By combining these strategies, you can help your little one find relief from eczema symptoms, promote healthier, happier skin and help prevent development of food allergies. 

If you’re interested in learning more about how and when to integrate foods into your baby's diet, as well as how to reduce the risk of food allergies during infancy, check out my new baby-led feeding + food allergy prevention guide and cookbook! 

And if you're looking for personalized nutrition support for your babies or kids, I am currently accepting new clients in my virtual private practice.

Thanks for reading!