Eczema, also known as atopic dermatitis, is a common skin condition characterized by red, itchy, and inflamed skin. It often first appears in early childhood and is estimated to affect around 10-20% of children. While the exact cause of eczema is not fully understood, it is known that both genetic and environmental factors play a role. One of the biggest environmental triggers of eczema flares is certain foods. Identifying and avoiding foods that trigger eczema can be an effective strategy for controlling symptoms in children with this condition.
Common Food Triggers
The most well-known food triggers for eczema are:
- Cow’s milk and dairy products
- Eggs
- Wheat
- Soy
- Peanuts
- Tree nuts
- Fish and shellfish
These foods are common allergens, meaning they frequently cause allergic reactions or sensitivities in those prone to conditions like eczema. However, any food has the potential to aggravate eczema, especially when a true food allergy is present.
How Foods Trigger Eczema
Foods can trigger or worsen eczema through a few different mechanisms:
- Immune system activation – In some children, certain foods are recognized as foreign by the immune system, causing release of antibodies and inflammatory chemicals that lead to eczema flares. This is seen in true food allergy.
- Cross-reactivity – Proteins in some foods mimic proteins in environmental allergens like pollen, resulting in immune activation and eczema flares.
- Chemical sensitivity – Natural or added chemicals in foods may directly irritate the skin and exacerbate eczema.
- Digestive issues – Foods that provoke digestive problems like reflux, diarrhea, or constipation can secondarily worsen eczema.
Identifying Food Triggers
Pinpointing exactly which foods trigger your child’s eczema can take some detective work. Here are some tips for identifying problem foods:
- Keep a food/symptom diary – Record all food eaten each day along with any eczema flares. Look for patterns over time.
- Try an elimination diet – Remove suspected trigger foods for 2-4 weeks, then slowly reintroduce one at a time while watching for reactions.
- Get allergy testing – Skin or blood tests performed by an allergist can detect IgE-mediated food allergies.
- Notice timing – Acute reactions within a few hours indicate a possible food trigger.
- Pay attention to how foods are prepared – Baked goods, fried items, and processed meats are more likely to cause issues than plain foods.
- Consider additives – Food dyes, preservatives like sulfites, and natural chemicals like salicylates may be irritants.
Keep in mind that reactions to problem foods in children with eczema may take a variety of forms including rashes, hives, swelling, digestive issues, changes in behavior or sleep, respiratory symptoms, and more. An itchy eczema flare is just one possible reaction.
The Most Common Eczema Food Triggers
Let’s take a more in-depth look at some of the most problematic foods for children with eczema:
Cow’s Milk and Dairy
Cow’s milk is one of the most allergenic foods, especially in young children. About 2-3% of infants have an IgE-mediated cow’s milk allergy. Additionally, dairy contains complex proteins that often cause non-IgE mediated sensitivities. Children may react to the milk protein casein, whey, or even sheep and goat dairy.
Studies show exclusion of milk results in improvement in about 1/3 of children with moderate to severe eczema. Reactions can occur rapidly or up to several days after dairy ingestion. Fortunately, many children eventually outgrow cow’s milk allergy.
Eggs
Egg allergy affects around 1-2% of young children and can persist longer than milk allergy. Reactions are usually rapid, occurring within minutes or hours after exposure. Children allergic to eggs may react to all egg proteins or specifically to egg whites or yolks.
Both cooked and raw eggs have the potential to trigger eczema flares. Egg is also a common ingredient in many baked goods, dressings, custards, and glazes.
Wheat
Wheat allergy affects 0.4-1% of children and triggers a diverse range of symptoms including eczema, hives, asthma, abdominal pain, diarrhea, nausea, and anaphylaxis in severe cases. Wheat gluten proteins are most frequently implicated.
Reactions to wheat can be immediate or delayed. Wheat avoidance is challenging since it is ubiquitous in bread, pasta, cereals, baked goods, sauces, and other processed foods.
Soy
Allergy to soy affects around 0.4% of children. Soy proteins trigger hives, atopic dermatitis, diarrhea, vomiting, wheezing, and anaphylaxis in susceptible children. Reactions are often rapid after ingestion.
Soy is found in a multitude of processed foods including vegetarian products, protein bars, sauces, baked goods, canned tuna, and more. It may be listed as soy protein, soybean oil, soy lecithin, edamame, tofu, and other terms.
Peanuts
Peanut allergy develops early in around 1% of children and tends to persist lifelong. It is one of the most common causes of severe allergic reactions. Even trace amounts of peanuts can provoke potentially life-threatening anaphylaxis in allergic individuals.
Reactions typically begin within minutes after exposure to peanuts or peanut-containing foods. Peanut oil and powder are also unsafe for those with peanut allergy.
Tree Nuts
Tree nut allergy affects about 0.5% of U.S. children. Typical symptoms include hives, itching, eczema flares, trouble breathing, nausea, abdominal pain, and anaphylaxis. Tree nuts that most commonly trigger allergy include walnuts, almonds, hazelnuts, cashews, pistachios, and Brazil nuts.
Reactions usually start within minutes up to an hour after eating nuts. Even nuts that are baked into products or used as oils can cause reactions. Cross-reactivity is common between different tree nuts.
Fish and Shellfish
Allergy to fish and shellfish like shrimp, lobster, crab, and clams affects around 0.2% of young children but tends to persist throughout life. Symptoms include hives, itching, eczema, wheezing, diarrhea, stomach pain, throat tightness, and full-body reactions.
The proteins causing seafood reactions are resistant to heat, so cooked fish and shellfish can still trigger eczema flares and other symptoms. Even vapors from cooking seafood may be problematic.
Other Potential Food Triggers
While not classified as major food allergens, many other foods can sometimes provoke eczema reactions. These include:
- Fruits and vegetables – Acidic foods like tomatoes and citrus as well as bananas, melons, strawberries, and others can cause irritation.
- Spices – Black pepper, curry, chili powder, garlic, and others contain irritating volatile oils.
- Meats – Processed cold cuts with nitrites or added sugars/fillers tend to be more problematic.
- Beverages – Fruit juices, carbonated drinks, alcohol, coffee, and tea can trigger flares.
- Fats – Greasy, fried, and fatty foods may worsen eczema.
- Preservatives – Sulfites, nitrites, benzoates, BHA, and BHT are potential irritants.
- Food additives – Artificial colors and flavors, emulsifiers, and sweeteners like MSG can cause reactions.
Identifying whether any of these foods aggravate your child’s eczema may require an elimination diet. Keeping a food diary can help determine if symptoms correlate with consumption of specific items.
Food Allergy vs Food Sensitivity
It’s important to distinguish between true IgE-mediated food allergies and non-IgE sensitivities when identifying triggers. Children with eczema often have a mix of both going on:
IgE Food Allergy
- Body produces IgE antibodies to specific food proteins
- Binding of IgE to mast cells releases inflammatory mediators like histamine
- Causes rapid-onset hives, swelling, wheezing, vomiting
- Can be diagnosed with skin prick or blood tests
- Often persists lifelong
Non-IgE Food Sensitivity
- Delayed immune reaction to food compounds
- May involve IgG antibodies or direct mast cell activation
- Causes delayed symptoms like rash, nausea, cramps, eczema
- Diagnosis requires elimination diet
- Often transient – can resolve with age
Children with eczema frequently have combinations of IgE and non-IgE food reactivities. Allergy testing combined with eliminate diets can help identify the full range of food triggers.
Managing Food Triggers
Once problem foods have been identified, strict avoidance is key to preventing symptoms. Here are tips for managing eczema food triggers:
- Read all product labels carefully.
- Notify caregivers and schools about food allergies.
- Develop safe substitutions for excluded foods.
- Carry emergency medication like antihistamines, epinephrine.
- Wash hands and face after eating problem foods.
- Clean cooking surfaces and utensils to prevent cross-contact.
- Purchase allergen-free snacks and treats.
- Cook more meals at home where you control ingredients.
- Inform wait staff at restaurants about food allergies.
- Watch for hidden ingredients like casein or whey in processed foods.
Being vigilant about reading labels and asking questions when dining out is key. With time, avoiding eczema food triggers becomes second nature.
Natural Anti-Inflammatory Foods
While some foods make eczema worse, other foods can help control inflammation and provide symptom relief. Try incorporating more of these eczema-friendly foods:
Fatty Fish
Cold water fish like salmon, mackerel, herring, and sardines are rich in anti-inflammatory omega-3 fatty acids. Aim for at least 8-12 oz per week.
Walnuts
Walnuts are another great plant-based source of omega-3s. Sprinkle on salads or yogurt.
Turmeric
Curcumin, the active compound in turmeric, reduces inflammatory chemicals linked to eczema flares.
Green Tea
Contains potent antioxidants called EGCG that restrain inflammation.
Sweet Potatoes
Provide vitamin A needed for healthy skin barrier function.
Avocados
Rich in inflammation-quelling vitamin E and healthy fats.
Broccoli
Packed with sulforaphane, a phytochemical with anti-inflammatory effects.
Blueberries
Abundant antioxidants called anthocyanins reduce skin inflammation.
| Food | Anti-Inflammatory Effects |
|---|---|
| Fatty Fish | Omega-3 Fats |
| Walnuts | Omega-3 Fats |
| Turmeric | Curcumin |
| Green Tea | EGCG |
| Sweet Potatoes | Vitamin A |
| Avocados | Vitamin E, Healthy Fats |
| Broccoli | Sulforaphane |
| Blueberries | Anthocyanins |
Food Reactions and Eczema Severity
Multiple studies have looked at the relationship between food sensitivities and eczema severity in children. Key findings include:
- Children with moderate to severe eczema reactions are more likely react to multiple foods compared to mild cases.
- Egg and peanut allergy are more common in severe pediatric eczema.
- Cow’s milk allergy occurs with equal frequency across all severities of eczema.
- Multiple food allergies usually correlate with more extensive, stubborn rashes.
- Children with severe eczema often improve when put on elimination diets free of multiple foods.
The takeaway is that identifying and avoiding food triggers becomes especially important for kids with widespread, treatment-resistant eczema. A comprehensive approach is needed to pinpoint all potential sources of inflammation.
Food Reactions According to Eczema Severity
| Eczema Severity | Rate of Food Reactions |
|---|---|
| Mild | Lower rate of reactivity |
| Moderate | More reactivity to multiple foods |
| Severe | Highest rate of multiple food allergy |
Takeaways
Identifying and avoiding foods that trigger flares is an important aspect of eczema management in children. The most problematic foods are cow’s milk, eggs, wheat, soy, peanuts, tree nuts, fish, and shellfish. Both IgE-mediated allergies and non-IgE sensitivities play a role.
Keeping a food diary, trying elimination diets, and getting allergy testing can all help determine personal eczema triggers. Reading labels diligently and always carrying emergency medication is imperative.
While some foods worsen inflammation, others like fatty fish, walnuts, turmeric, and sweet potatoes have natural anti-inflammatory effects. Incorporating more of these foods may aid in controlling eczema.
With a comprehensive approach to identifying and avoiding food triggers, eczema flares can be significantly reduced and skin health improved.
