My daughter had very bad allergies when she was very little and I went to see the amazing Bianca, who always put my mind at rest. At My Baba we often get asked about food allergies in children, and in particular, eczema. It’s a bit of a mine field figuring out what’s what so I’ve called on Paediatric Dietitian Bianca Parau who set the record straight. This is a very informative piece and I hope it helps. 

Eczema (atopic dermatitis) belongs to a group of allergic conditions that includes; asthma, hay fever, and food allergy. It is a complex condition of inflamed skin affecting many children. Eczema causes chronic itching and redness of the skin and at times weeping blisters can develop too.

It is genetic in origin as it tends to run in families where there is a strong family history of eczema, asthma or hay fever, making children with eczema more susceptible to develop asthma, food allergies or skin infections.

The role of healthy skin is to act as a barrier, protecting against moisture losses and irritants entering. With eczema the skin-barrier is not functioning properly, causing the skin to easily get dry, cracked and irritated and over time the skin may thicken. Eczema prone children’s immune system also reacts very strongly to irritants causing the skin to become red and itchy.

Eczema can appear anywhere on the skin, although common patterns are usually seen in specific age groups, but it will differ from person to person and will also likely change with age.

Areas of skin commonly affected:

Infants: The face, including the cheeks, forehead and scalp is usually the first to be affected.

From 6 months onwards: It is often worse on all crawling surfaces including; the forearms, extensor surfaces of the knee and elbow.

For toddlers (2 years and older): The creases of the knees and elbows, wrists, hands and ankles are usually worst affected. Occasionally the skin of the eyelids or mouth can be affected too.

In older children eczema is mostly localised to the hands, but can be elsewhere too.

Eczema usually comes and goes, but when severe it can be extremely disabling as it affects both quality of life and health. When it is uncontrolled it increases the likelihood of developing skin infections and it also affects sleep, physical comfort and social interactions.

Unfortunately there is no cure for eczema, but good news is it does become less severe with time and it can be well managed with the help of a Dermatologist, by taking good care of your child’s skin and avoiding triggers.

Some additional good news is that eczema is not contagious, no (traumatic) blood tests are required to diagnose it and most children will outgrow their eczema at some point.

Factors influencing eczema include:

 

  • Inhalant allergens

House dust mite, grass pollens, feathers and animal dander.

  • Irritants

Soap in excess, bubble baths, perfumed products as well as woolen material (in direct contact with the skin is a major irritant).

  • Weather

Any temperature extremes (hot or cold) can affect eczema. Winter weather (cold temperatures and low humidity) increases skin dryness and will often worsen eczema.

  • Infections

Eczema flare-ups are also common with teething, excessive drooling, mild infections and vaccinations.

  • Food allergy

Although food allergy is more common in children with eczema, food allergy does not cause eczema. It is important to know that these are two separate conditions, but having eczema can increase the likelihood of developing a food allergy.

Currently there is no evidence to support claims that elimination diets can reduce eczema in children who are not diagnosed with food allergies.

Signs of food allergy:

Hives (red, itchy swollen bumps), that look different than eczema that develop within 2 hours of eating a specific food is a sign of a food allergy.

Take your child to see your GP or Dermatologist and do not attempt dietary exclusions and changes without consulting a Paediatric Dietitian to ensure your child is meeting their full nutritional requirements.

Food allergy is age dependant, so symptoms will be worse in infancy and less so as your child gets older. Dairy and egg allergies are the most common food allergy culprits in early years and are usually outgrown, whereas nut(s) or shellfish allergies are likely to continue throughout life.

In terms of reactions, eczema tends to show up in predictable places (as mentioned above) where as food allergy rashes and hives are more unpredictable and can show up anywhere on the body.

Do note that some foods can irritate the inflamed skin further i.e. citrus, tomatoes and strawberries, but this is not an allergy. The aim is to minimize contact of these foods on the affected skin.

Eczema treatment involves multiple processes depending on the severity to, address skin dryness, restore skin elasticity and suppleness and reduce overall itching. Generally your child’s Dermatologist or GP will firstly prescribe a daily bathing and moisturising routine to manage the eczema. There is no single group of products that are right for every child, but generally, products with fewer ingredients are best and expensive products are not always better. Your pharmacist or GP can advise you on what products to buy for bathing and moisturising.

For mild to severe eczema cases, prescribed topical steroids are required as an essential part of the treatment. These prescribed steroid ointments are usually very mild, safe and highly effective as long as they are used appropriately and as prescribed. Other stages of eczema treatment often include; the use of wet dressings, avoidance of allergens (when an allergy has been diagnosed), topical anti-bacterial’s, topical immunosuppressant’s and oral medication.

In general it is recommended to avoid personal irritants and take the following precautions;

  • Avoid synthetic, woolen and feather materials or fabrics as these can aggravate eczema. Rather opt for cotton and feather free clothing and bedding.
  • Use non-biological detergents and avoid fabric softeners.
  • If you live in an area with hard water, steps should be taken to soften the water.
  • Keep your child’s fingernails short to avoid scratching and minimise infection risks.
  • Parents and visitors should avoid smoking inside the house, if they do smoke as these fumes can aggravate your child’s skin.
  • Always aim to keep the house as well ventilated as possible. Damp environments encourage growth of fungi and moulds.
  • Seasonal allergies i.e. grass and pollens are usually problematic in the spring and summer, speak to your Paediatrician on how to deal with these.
  • Children with eczema are usually allergic to cats, dogs and other furry pets and their dander.
  • House dust mites can make eczema worse.
  • Wooden or laminate floors are better than carpets.
  • Invest in a mattress cover.
  • Wash soft toys and bed linen each week at 60°C.
  • Soft toys can be put in a zip-seal bag in the freezer for 24 hours to kill dust mites.
  • Do not put your child on an exclusion diet or remove important foods, such as milk, dairy products, wheat or eggs, without consulting your GP or health professional. Always discuss any dietary changes with a health professional.
  • Minimize the use of scented products such as air freshener, perfume scented lotions etc.
  • Limit contact of foods on affected skin areas.
  • Always wash new clothes and remove all tags before your child wears them.
  • Opt for loose fitting clothes instead of tight fitting clothes.
  • Bubble bath, Epsom salts, and some other bath additives should be avoided as they can irritate the skin and worsen eczema.
  • Sponges, scrubbers, loofahs, and rough washcloths should also be avoided as they can irritate the skin and worsen eczema.

If you think your child has eczema, please see your GP or Dermatologist. Do not try to treat the eczema by yourself as each case is different and requires specific treatment. Although eczema is occasionally associated with an allergy in some children, care should be taken not to start your child on an elimination diet without seeking input from your GP or a health professional, as elimination diets are difficult to adhere to and it is easy for these diets to be lacking in vital vitamins, minerals and other nutrients.

Bianca Parau | Specialist Paediatric Dietitian | La Vie Nutrition
Email: bianca@lavie-nutrition.com