Up to 6% of adults suffer from atopic dermatitis, a chronic, severe form of eczema that causes dry, red, itchy and chapped skin. If you have them, you’re probably eager to find out if a change in diet might help.
“This is a reasonable question, given that many people, including healthcare professionals, promote the idea that food is the root cause of eczema,” says Peter Lio, MD, founder and director of Chicago Integrative Eczema Center.
Bottom line: it isn’t.
In reality, eczema appears to be the result of an inherited defect in the skin’s ability to act as a barrier and stay in things that are beneficial (like moisture) and prevent things that are harmful ( such as irritants, allergens and germs). .
While food allergies don’t cause eczema, there is a link, especially in young children.
Research shows that moisturizing the skin of babies at high risk for atopic dermatitis and food allergies appears to prevent the development of both.
The link between food allergies and eczema flare-ups
There isn’t a lot of research on the link between adult eczema and food. Researchers know that people with atopic dermatitis are more likely to have food allergies than the rest of us. This is most true in children: 35% of children with moderate to severe eczema have a food allergy that can trigger a flare, with eggs at the top of the list.
Hard data is not available, but experts agree that adults with eczema are much less likely to have food allergies. Better yet: when they do, these allergies usually don’t cause more – or worse – symptoms, says Silverberg. Still, there are cases where food allergies have a potent effect, leading to everything from hives to anaphylaxis, a potentially fatal response.
“Eating food sets off a reaction that then triggers an eczema flare-up,” says Lio.
You don’t have to be allergic to a food for it to cause a flare-up, however.
“Certain foods can fuel inflammation in the body in a less specific way,” says Lio. This is called food sensitivity or food intolerance. The good news about this is that they tend to stop wreaking havoc when atopic dermatitis becomes better controlled.
Once atopic dermatitis is properly treated with the right medication and skin care, studies show that people are generally able to eat foods that they previously couldn’t.
“When [atopic dermatitis] is poorly controlled, food sensitivity tends to go through the roof, ”says Lio. “Once it’s handled well, everything sets in and the foods at the limit end up being OK.”
Diagnose food allergies
When should you be tested for food allergies? Experts say you should see an allergist in two cases:
When your eczema constantly flares up after eating certain foods. Usually this means that you will see a reaction on the lips and around the mouth. Rarely, your skin symptoms get worse.
When you feel like you are doing everything else right and the disease is not responding. If you take care of your skin and use medications as directed and things don’t improve, you should probably get tested.
It is important to know that diagnosing food allergies is difficult. A positive blood test reflects a food allergy in only 65% of cases. A positive skin test is only accurate about 20% of the time. At best, positive tests provide a clue of a possible allergy but should not be accepted as the last word.
“On the one hand, we certainly wouldn’t want to ignore a potentially relevant allergen that could have serious consequences,” says Silverberg. “On the other hand, it could just be a false positive and a lot of ado about nothing.”
The safest way to diagnose an allergy is if your eczema gets worse after eating a specific food. However, sometimes this is just a coincidence. Even so, it would have to be checked with something called a food challenge. This is where the food in question is removed from the diet and then returned to the doctor’s office.
Experts don’t want patients to lead dietary challenges on their own.
“It’s totally reasonable to stop eating a suspicious food for a month or two and then try to add it again,” Lio says. If a bad flare occurs, you can say it’s a contributory food and continue to avoid it. If nothing abnormal happens, you can start eating it again.
The danger can be when people eliminate multiple foods at once. These “elimination diets” can be extreme and very difficult. For example, some try to exclude all foods that people tend to be allergic to – dairy, eggs, soy, gluten, peanuts, tree nuts, fish, shellfish, and wheat.
In addition to being rarely useful, these types of diets can lead to malnutrition and other problems. They should only be tried under the supervision of your doctor.
What about gluten?
Recently, there has been more emphasis on gluten-free diets, even for those without a proven allergy or sensitivity. Some believe that gluten, a protein naturally found in wheat, barley, and rye, increases inflammation which can make eczema worse.
The attention seems justified. One study looked at more than 1,000 patients with celiac disease (where gluten causes the immune system to respond) and found that atopic dermatitis was about three times more common in these people. Unfortunately, one year on a gluten-free diet has not changed the amount of atopic dermatitis or allergies in them.
Still, there are many people, virtually none of whom have celiac disease, who are convinced that gluten has made their atopic dermatitis worse and that removing it has improved their skin, Silverberg says. He suspects that these cases are probably a form of gluten intolerance. It’s almost impossible to prove or disprove with the limited testing available today.
If you are considering going gluten-free, be careful. A gluten-free diet can lack vitamins, minerals, and fiber, and sometimes gluten is replaced with sugar and saturated fat to add flavor. Talk to a nutritionist before trying one.
More food for thought
There are no miracle foods to ward off eczema. But eating a healthy, balanced diet with lots of vegetables and minimal junk food can help, says Silverberg, who notes a study linking atopic dermatitis to a Western-style diet.
Another option is the paleo diet, which consists mostly of meat, fish, vegetables, and fruits and excludes dairy, grain products, and processed foods.
“It’s a very smart anti-inflammatory diet that is very difficult to oppose,” says Lio. “It’s gluten, dairy and processed foods free. It is rich in vegetables and has complete nutrition. If you choose to try the Paleo Diet, Lio recommends eating fish, especially oily fish like salmon, as your primary source of protein to get the most anti-inflammatory benefits.
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