Today we’re going to get a little more scientific and talk about the atopic march- which is the link between eczema, food allergies, and asthma. Eczema (or atopic dermatitis) is pretty common in kids and is characterized by inflammation, redness, and irritation of the skin. We don’t know the cause, but if you have eczema as a baby, you are at more risk for allergies (including food allergies) and asthma.
Step two in the march is food allergies. We know about that here- it’s an immune over reaction to food. But how does that relate to eczema? Well, there’s been research that exposure through the GI system by eating the food allergens promotes food tolerance while exposure to food allergens through the skin can lead to food allergy. Eczema can affect the skin barrier, which can effect a baby's exposure to food. There’s also an overlap of causes of the two diseases- genes, the environment, etc that I'm not going to pretend to understand.
The best advice now is: early treatment of the impaired
skin barrier and early introduction of food allergens (through eating) to try
to prevent the development of severe food allergies. This is different than a
lot of advice I’ve seen online that warns against early introduction of common
food allergens in kids with moderate to severe eczema. I get it- if you have
eczema and there’s an increase likelihood of developing food allergies, the
last thing you want to do is give your kid something to try and have them react to it. But right now, there’s no
cure for food allergies, and the only thing we have is prevention. The only
way to do that is early introduction.
Third on the march is asthma. Asthma is a chronic
respiratory disease characterized by recurrent wheezing/shortness of breath due
to irritation causing swelling and narrowing of the airway. Food allergies and asthma
are common together, though there doesn’t seem to be as straight of a path from
food allergies to asthma as there is from eczema to food allergies. The normal association of asthma with allergies, focuses on environmental
allergies like dust and cat dander. There has been some research looking at how
breathing in aerosolized food allergens can cause asthma exacerbations. Most of
this research has been on adults, but one study did find that a child’s asthma
was worse when the family cooked with the foods that they were allergic to and improved when they stopped.
There also appears to be some connection of asthma to IgE
levels. Usually, kid’s asthma is less controlled in the spring (due to pollen)
and fall (due to dust mites) and this matches with higher levels of IgE in the
blood. There was also a study that found that higher levels of IgE at 6 months
age was associated with early onset asthma.
Whatever the connection between food allergies and asthma, one
thing if for sure- it’s not good to have both of them. If you have both, your
risk of severe reaction to food (anaphylaxis) increases AND your risk of
severe asthmatic episodes also increases. So, make sure you have both your epinephrine
and your rescue inhaler.
TL;DR
- With moderate to severe eczema, it’s important to take good care of the skin AND early introduction to food is still best.
- If your kid has food allergies and asthma, cooking with their food allergens can irritate their lungs.
- Always have your epinephrine and rescue inhaler with you!
Atopic Dermatitis and Food Allergy
Food Allergy and Asthma
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