1 in 10 individuals will develop eczema during their lifetime but prevalence has been shown to peak in early childhood, with up to 20% of infants affected [1,2].
Factors that can contribute to the development of eczema include impaired skin structure and function, disrupted immune function, genetics and environmental factors, as well as allergens and microbial infections .
Honing in on that final point, research has found signs that certain skin and gut bacteria may influence the course of atopic dermatitis (the most common form of eczema) . In the skin, flares of atopic dermatitis are associated with a loss of microbial diversity and increases in certain bacteria such as Staphylococcus aureus . In the gut, reduced bacterial diversity during infancy can impact the maturation of our immune systems and contribute to the chronic inflammation typical of the condition .
But it doesn’t end there! Atopic dermatitis is chronic and multifactorial, and can also be part of the so-called ‘atopic march’. Starting with symptoms such as dryness and itchiness of the skin, atopic dermatitis may also later lead to a series of other allergic disorders if not managed, such as food allergies .
Due to this link, severe atopic dermatitis has now been identified as the strongest risk factor for food allergies. Mechanistically, this may be a knock-on effect from an impaired skin barrier and immune system, and it has been shown that the reduced bacterial diversity in children with atopic dermatitis can determine the course of food allergies .
A full understanding of this relationship is crucial to provide insights into clinical course of atopic dermatitis and food allergies, and to support the development of new methods for treatment and prevention [3,7]. For example, diet and nutrition are key as the food you consume is responsible for supporting and shaping the gut microbiome; and methods such as pre-, pro- and post-biotics are being explored for both atopic dermatitis and food allergies .
To gain another perspective on this topic, and some hands-on advice for parents and guardians, we decided to team up with Malina Malkani, a Registered Dietitian Nutritionist and former media spokesperson for the Academy of Nutrition and Dietetics. Malina is also the founder of of Malina Malkani, LLC (http://www.MalinaMalkani.com), a nutrition lifestyle company dedicated to providing modern moms with tools, recipes, and programs that make it easier to feed their families a mostly plant based, nutrient-dense, whole food diet (that they really like).
Here Malina explores the connection between moderate-to-severe atopic dermatitis in infants and the development of food allergies, as well as methods for prevention and treatment…
Baby eczema and food allergies: what parents need to know
I was compensated by The Secret Life of Skin to write about the connection between moderate-to-severe infant eczema and the development of food allergies in babies, as well as prevention and treatment options for managing infant eczema. All opinions are my own.
Have you ever wondered whether and how food allergies and baby eczema are connected?
A common question I hear from parents and caregivers with babies often sounds something like this: “I’ve heard that babies with severe eczema are at higher risk for developing food allergies, but I don’t understand why?”
Confusion around infant eczema and increased risk of food allergy is understandable. How can a compromised skin barrier have anything to do with whether a certain food triggers an immune system response in the form of an allergic reaction?
While raising awareness about infant eczema is near and dear to my heart for many reasons, it is the connection between eczema in babies and the development of food allergies – as well as the microbiome of the skin and gut – that I find most compelling AND most hopeful.
In this post, I’ll share some comforting news for the parents and caregivers of babies with atopic dermatitis (the most common form of eczema) and provide tips for prevention and management of the symptoms of eczema in babies that may help prevent the development of food allergies along the way.
I’ll also touch on some exciting and new potential therapies that target dysbiosis of the skin and gut as a way to prevent and manage atopic dermatitis.
To clarify, 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. While there are 7 different types of eczema, this article will focus on atopic dermatitis (AD).
This article is meant for informational purposes only, but the hope is that it will answer some of the common questions about the link between infant AD and food allergies and explain which babies are at higher risk for both and what can be done to help prevent and manage complications.
Atopic dermatitis actually happens to be the most common childhood illness. 12-15% of infants develop AD during the first year or two of life, although not all cases are moderate to severe. AD is associated with a family history of food allergies, seasonal allergies, asthma or other allergic diseases. A link has also been found between AD 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 AD and those without. Symptoms of AD include itchy skin, dryness, inflamed skin and sleeplessness. In a baby whose skin is lighter in color, eczema rash can look reddish while in darker skin, AD tends to look more purple, brown or gray.
There is a wide range in the levels of severity of AD, and it is the people with eczema that is moderate-to-severe that tend to have more frequent repeated and significant flare-ups, which can be especially difficult for an infant or child. In fact, moderate-to-severe AD can affect the quality of life of entire families – especially when the itching and discomfort reduces the quality and quantity of everyone’s sleep.
Perhaps lesser known and understood, however, is the link between AD and food allergies.
Severe AD is actually the strongest risk factor for food allergies – even stronger than a family history of food allergies. According to research published in JAMA Pediatrics in October, 2017, babies under 2 years old who have early signs of AD have a greater risk of developing food allergies. Why? We don’t know exactly, but researchers suspect that the skin may play a critical role in shielding us from allergens in the environment. It seems that when that shield is compromised due to eczema, the skin’s immune cells may be left more exposed to food proteins in the environment, increasing the likelihood that food allergens entering through broken skin will trigger an immune response than if those same food allergens were to first enter through the digestive tract.
This is why there is such a push these days for early introduction of top allergenic foods during infancy including peanut and egg, especially in babies who have moderate or severe AD and are already at an increased risk for developing food allergies.
For these infants in particular, the more we can prevent eczema flare-ups and introduce top allergenic foods early and often under the supervision of the child’s pediatrician or allergist, the more we can prevent food allergies from developing during the critical window of time during infancy when early and frequent allergen exposure is more effective.
If you are the parent of a baby or child with AD, the good news is that there is a lot you can do to treat dry itchy skin and prevent, manage, and treat AD flare-ups. Here are answers to some commonly asked questions:
How do you determine whether your child’s eczema is moderate/severe?
The first step is to consult with your pediatrician, who can easily manage the majority of eczema cases in babies and children (about 60-70%). For those with more severe atopic dermatitis, seeing a specialist is recommended.
What are the eczema prevention and treatment options for babies?
- Per the National Eczema Association, bathe babies in warm (not hot) water, limiting bathing time to less than 10 minutes
- Apply daily, liberal applications of fragrance-free emollients after bathing (…if you’re wondering how much emollient to use, it can help to think of frosting a baby almost like a little cake with a good cream or ointment – in other words, use a lot!)
- Avoid harsh, fragranced skin care products that may exacerbate AD
- Consider anti-inflammatory topical therapies, including steroids and non-steroid prescription alternatives under the supervision of your pediatrician or specialist if the eczema is moderate/severe
- More research is needed, but the gut microbiome may determine the course of food allergy and tolerance during infancy. So manipulating the microbiome of formula-fed babies at high risk for AD who are not able to breastfeed by supplementing prenatally and postnatally for 6 months or longer with prebiotics and Lactobacillus probiotic strains may help prevent primary eczema.
What does successful treatment of eczema look like for an infant?
For babies, it means that they can live their lives without symptoms of AD causing discomfort and disrupting their sleep and activities of daily life.
How does the skin and gut microbiome play a role in eczema and food allergy development during infancy?
The gut and skin microbiome may be key factors in the development of AD. Researchers have noticed that there are differences in the set-up of the microbiome of the skin and gut between people with and without AD. As a result, you may soon start hearing more about both newer and well-established treatments that specifically target dysbiosis and pathways in the host-microbe interaction as a way to prevent and manage AD. Further research is needed, but probiotics, prebiotics and synbiotics have all been studied as a potential treatment for AD. Early interventions involving these treatments may help protect the skin barrier during infancy and prevent food proteins from entering the body through broken skin, hopefully also preventing the related development of food allergies.
How can you advocate for a baby struggling with eczema?
First and foremost, talk to your pediatrician about managing your child’s AD. Ask for a referral to a specialist if you need one and always be ready with your questions and concerns about your child’s skin before healthcare appointments.
Zoom back and look at the bigger picture when it comes to the full impact of AD on your little one’s life, considering “green days, yellow days and red days.” On green days, AD isn’t too disruptive, sleep is pretty good, itching is minimal. Yellow days are somewhat disrupted by symptoms, and on red days, symptoms are very difficult and disruptive. While it’s unlikely that there will be no red or yellow days, a great goal is to strive for mostly green days. If you find yourself in a phase of mostly reds and yellows, it may be time to see the specialist and explore some different treatment options.
Most importantly, find trusted and reliable resources that you can turn to regularly for updates on the latest research and breakthroughs in treatment options, such as the Secret Life of Skin, a platform that provides a carefully created and curated collection of content all about the skin microbiome on both the web and on Instagram.
References and further reading from The Secret Life of Skin
- Nowika, D. et al. Host-microbe interaction on the skin and its role in the pathogenesis and treatment of atopic dermatitis. Pathogens 11, 71 (2022).
- Pothmann, A. et al. The micorbiome and atopic dermatitis: a review. Am. J. Clin. Dermatol. 20, 749-761 (2019).
- Wollina, U. Microbiome in atopic dermatitis. Clin. Cosmet. Invest. Dermatol. 10, 51-56 (2017).
- Kim, J. E. & Kim, H. S. Microbiome of the skin and gut in atopic dermatitis (AD): understanding the pathophysiology and finding novel management strategies. J. Clin. Med. 8, 444 (2019).
- Łoś-Rycharska, E. et al. The microbiome and its impact on food allergy and atopic dermatitis in children. Postepy Dermatol. Alergol. 37, 641–650 (2020).