What Is Eczema?
Eczema is a skin condition that is linked to food allergies, asthma and environmental allergies. It affects children more than adults. The rash is red, scaly, itchy and becomes easily infected. Scratching makes the rash turn raw, with oozing and crusts. In infants it may appear on the cheeks, and in older children in the creases of the elbows, knees, and neck. In adulthood, hand eczema is common. Dryness and moisture loss are important in causing symptoms and for treatment.
How Is Eczema Treated?
For mild cases, addressing dryness with moisturizers may be effective. For more more severe eczema, some or all of the following may be used:
- Antihistamines to relieve itching
- Topical steroid creams to reduce inflammation, with varying strengths available
- Topical antibiotic creams to treat associated infection with Staph aureus bacteria
- Bleach baths to reduce bacterial colonization
- Non-steroid topical agents such as Protopic, Elidel, and Eucrisa
- Biologic agents for severe eczema
The Role Of The Allergist In Managing Eczema
Allergists have special expertise in managing eczema and can determine if there are underlying allergies that are inflaming the skin. Testing may reveal allergies to foods, environmental allergens such as dust mites or pets, or a contact allergy to common chemical ingredients.
Addressing these factors may significantly improve the eczema. In addition, allergists have familiarity with biologics such as Dupixent, which is approved for children over age six and adults, and is extremely effective.
Increased Risk For Food Allergy In Eczema
Infants with eczema are at increased risk for developing life-threatening food allergies. Most of our patients with anaphylactic food allergy had eczema as infants. For this reason, any infant with significant eczema should be screened for food allergy between the ages of four and six months, when they are ready to start solid foods. Delaying introduction of allergenic foods until age two is no longer recommended because it may actually result in a higher risk for developing food allergy.
Preventing Food Allergy In Infants With Eczema
If testing is negative for egg, peanut and tree nuts, for example, these foods should be introduced immediately in age-appropriate form, and this will markedly reduce the risk of developing food allergy.
If the testing is positive, in most cases the allergy is not severe yet. In this situation, we will usually recommend a careful introduction of small amounts of the food allergen in the office, with gradual increases over time until it is tolerated.
If the food is NOT proactively introduced, there is a significant risk that the food allergy will spontaneously evolve into an anaphylactic allergy.