Eczema, otherwise known as Atopic Dermatitis, affects up to 20% of our population. Eczema is included in what’s referred to as the Atopic Triad, which includes asthma, eczema and hay fever. What that means is that if a child has a family history of any of those three conditions, they are at a higher risk for developing eczema.
Children will typically experience eczema before the age of five years old. It usually appears as red, scaly patches that are sometimes itchy. For kids less than two years old it appears on the cheeks, and the outside of the arms and legs. For kids ages 2 to 5 years old it often appears on the backs of the elbows and knees. Older children and adults often can find patches anywhere on their body, including the hands and eyelids.
There is always concern of what causes and triggers eczema. The reason the cause of eczema is so complex is that individuals with eczema have a different immune system that is sensitive to certain triggers and exposures. One of those exposures or triggers is food. This becomes a kind of “chicken or the egg” debate. What are the links between food allergies and eczema? Does having eczema increase food allergy risk or do certain foods increase eczema risk?
There are studies looking into the food allergy question and how to minimize a child’s risk of getting a food allergy – in particular a peanut allergy. The Peanut and Allergy (LEAP) trial in 2015 showed that early consumption of peanut products in high-risk infants with severe eczema, egg allergy or both reduced the risk of developing a peanut allergy by 80% by five years of age. The persistent of oral tolerance to peanuts (LEAP-On) trial recently published in March 2016 also had consistent findings. That trial asked that all of the children who participated in the initial trial not eat any peanut products for a full year after the trial ended. The study showed that children who had eaten peanut products during the first trial had a much lower percentage develop a peanut allergy than those who had stayed away from peanut products during the trial – even when both groups stayed away from peanut products for a full year after the initial trial ended.
Looking beyond peanuts alone, the Enquiring about Tolerance (EAT) trial out of the United Kingdom published in March 2016 in the New England Journal of Medicine investigated the question of whether early exposure to certain allergenic foods would reduce the risk of developing an allergy to those foods.
In general, the World Health Organization recommends that children less than six months old be exclusively fed breast-milk. This EAT trial examined whether early exposure to allergenic foods as early as three months old could lower the risk of developing allergies. In the UK, an infant feeding survey showed that 45% of mothers of infants 8 to 10 months old reported avoiding giving their child certain foods such as nuts, dairy, and fish since the fear was exposure to these foods could increase the development of a food allergy. This trend pushed the trial to answer the question of early exposure.
In the EAT study, the foods that were studied were peanuts, egg, milk, sesame, fish and wheat. Subjects were put into two groups: one that had exposure to the foods before six months old, and one with exposure to the foods at six months old or more. The study showed that early exposure to peanuts and eggs lowered the risk of developing a food allergy to these foods, but it did not show the same affect with milk, sesame, fish, and wheat.
To boil it down, the LEAP, LEAP-On and EAT trials showed that early exposure to peanuts and eggs can lower the risk of allergy to these foods. This may be particularly true for children at a high risk of eczema. Stay tuned for more future studies to help us navigate the concern of food allergies and what we can do to lower the risk of food allergies.