Kristy Luciano is a Physician Assistant who graduated from Midwestern University-Downers Grove Physician Assistant Program in 1999. She is an Assistant Professor and Director of Didactic Education at Midwestern University and serves as a Member at Large on the Board of Directors for the Society for Physician Assistants in Pediatrics.
Food allergies are a hot topic on the playground, at schools, and in pediatric offices. Parents of children with eczema or atopic dermatitis (AD) often have a lot of questions regarding the connection between eczema, exposure to common food allergens, and the development of or exacerbation of AD. Pediatricians must advise families on when to start solid foods; if infants should be exposed to eggs, peanuts, or other common allergens; if labs should be ordered; and when they should be evaluated by a pediatric allergist.
The September 2019 issue of Contemporary Pediatrics addresses these issues in Food allergy: A trigger for atopic dermatitis? an article by Lisette Hilton. This article discusses many of the complex questions that clinicians must answer when evaluating pediatric patients with AD.
What comes first
In the article, Dr. Pooja Varshney, clinical assistant professor of pediatrics at Dell Medical School at the University of Texas at Austin and a pediatric allergist states that food allergy is rarely the primary cause of AD. It is well known that food allergies, AD, and allergic rhinitis are related. This relationship is often explained by the term atopic march, indicating that some children start out with AD and subsequently develop allergic rhinitis and asthma. This article discussed another way to potentially think of this relationship. Rather than a direct march, these conditions may travel together, and are influenced by genetic and environmental factors.
Potential triggers
While food allergies may not cause AD, in some patients they may exacerbate the condition. The author, citing a recent guideline from the National Institute of Allergy and Infectious Disease, provides some helpful guidance for clinicians who evaluate children with AD. First, pediatricians should know that almost 40% of children with moderate-to-severe AD have immunoglobulin E- (IgE-) mediated food allergy. A thorough history in these patients should include questions regarding IgE-mediated allergy symptoms. If present, recommend strict avoidance, refer to an allergist, and consider prescribing an EpiPen.
Children with severe AD should be tested for an allergy before introducing peanuts. These patients should be evaluated by a board certified allergist trained in food allergy. Allergists can conduct skin prick testing, food challenges, provide advice on the safety of early introduction of peanut allergy in high-risk children who are not allergic, and provide follow-up to pediatric patients who have the potential to outgrow their allergies.
Order labs or refer?
Many pediatricians may be tempted to order food IgE panels in patients with AD. Parents may prefer this option as it is often simpler for families to address issues within the primary care setting rather than establish a new relationship with a specialist. However, ordering food IgE panels may cause more confusion than clarity as they can result in misdiagnosis. For instance, what do you say to the patient with AD who tests positive for egg allergy but eats eggs without allergy symptoms? The article reminds us that the diagnosis of allergy is most reliable when guided by a solid history and physical exam. In addition, the elimination of foods unnecessarily may increase the risk of developing an anaphylactic food allergy. This is especially important to remember in children with AD who are at higher risk for developing food allergies. When possible, evaluation by an allergist is in the patients best interest rather than eliminating a food he or she may not be allergic to.
Elimination diet
It can be difficult to make evidence-based management recommendations to families of infants with mild- to moderate-AD whose parents are concerned about food allergies. In the past, these parents may have been told to try an elimination diet, either in the mothers or childs diet depending on the age of the patient. Elimination diets were seen as a low-risk way to determine if eliminating common food allergens would improve the patients AD and perhaps help indicate a potential food allergen. The article in Contemporary Pediatrics reminds us that there is not much evidence to support management of AD with an elimination diet. In fact, it may increase the patients risk of developing an anaphylactic food allergy.
The article also cites an American Academy of Pediatrics guideline regarding nutritional interventions for the prevention of AD. The guideline does not recommend changing the mothers diet or support the use of hydrolyzed formulas to prevent the development of allergies.
Food allergies represent a constantly evolving field. This article helps clinicians stay up-to-date and navigate the daily decisions that will help protect their patients from food allergies and maximize control of AD.
Read the original:
How treating food allergies and AD has changed - Contemporary Pediatrics
- Eczema: Read About Symptoms and Medications - October 15th, 2014 [October 15th, 2014]
- Dermatitis - Wikipedia, the free encyclopedia - October 15th, 2014 [October 15th, 2014]
- Eczema and Your Skin | Eczema Types, Symptoms, Causes, and ... - October 15th, 2014 [October 15th, 2014]
- Kangen Water Testimony - Eczema, Weight Loss, Headaches - Video - October 15th, 2014 [October 15th, 2014]
- Controlling eczema - Video - October 17th, 2014 [October 17th, 2014]
- Eczema update! - When To Seek Medical Attention - Video - October 18th, 2014 [October 18th, 2014]
- My Makeup Routine For Eczema & Psoriasis - Video - October 18th, 2014 [October 18th, 2014]
- Dyson launches humidifier to combat eczema and psoriasis - October 20th, 2014 [October 20th, 2014]
- Sanofi, Regeneron Begin Phase 3 Study For Eczema Drug Dupilumab - October 20th, 2014 [October 20th, 2014]
- Ayurvedic treatment for Atopic Eczema - Video - October 20th, 2014 [October 20th, 2014]
- How To Treating Eczema at Home? EASY! Find it On This Video - Video - October 20th, 2014 [October 20th, 2014]
- Topical BioMedics Announces "Soothe the Skin They're in," a New Program for Children Who Suffer with Eczema - October 21st, 2014 [October 21st, 2014]
- Vitamin D Might Help Kids With Eczema - October 21st, 2014 [October 21st, 2014]
- Edguard tube cream for acne, eczema, scars and pregnancy blemishes - Video - October 21st, 2014 [October 21st, 2014]
- Cara Veldman #1848200 Eczema Cream - Video - October 21st, 2014 [October 21st, 2014]
- Tampa dermatologists clinical trial for sufferers of eczema ongoing - October 23rd, 2014 [October 23rd, 2014]
- Eczema - A recurrent rash everyone complains about - October 23rd, 2014 [October 23rd, 2014]
- My Essentials for Dry Skin & Eczema - Video - October 23rd, 2014 [October 23rd, 2014]
- Taking a 'Selfie' May Help With Dermatology Care, Study Shows - October 24th, 2014 [October 24th, 2014]
- EP.2 Cures Thermales : Business ou Sant ? - EczemaHelp - Video - October 24th, 2014 [October 24th, 2014]
- EP.1 Cures Thermales : Business ou Sant ? - EczemaHelp - Video - October 24th, 2014 [October 24th, 2014]
- Home remedy for eczema - Beat eczema - Video - October 24th, 2014 [October 24th, 2014]
- Trailer - EczemaHelp - Video - October 24th, 2014 [October 24th, 2014]
- Family First: Calming the symptoms of severe eczema - October 25th, 2014 [October 25th, 2014]
- what causes eczema - Eczema Free Providing ... - October 27th, 2014 [October 27th, 2014]
- Atopic eczema - Treatment - NHS Choices - Your health ... - October 27th, 2014 [October 27th, 2014]
- Atopic dermatitis - Wikipedia, the free encyclopedia - October 27th, 2014 [October 27th, 2014]
- Atopic eczema - NHS Choices - October 27th, 2014 [October 27th, 2014]
- Eczema Treatment Options : How To Cure Eczema & Home Remedies For Eczema - Video - October 27th, 2014 [October 27th, 2014]
- Chamomile: A herbal medicine of the past with bright future - October 29th, 2014 [October 29th, 2014]
- How SELFIES can help cure skin conditions - October 30th, 2014 [October 30th, 2014]
- Eczema linked to bone fractures, injuries in new Northwestern study - October 30th, 2014 [October 30th, 2014]
- Adult eczema may be unrecognized risk factor for fracture, other injuries - October 30th, 2014 [October 30th, 2014]
- Mom Tips: Relief for Baby Eczema - Video - October 30th, 2014 [October 30th, 2014]
- BEST BABY ECZEMA PRODUCTS - Video - October 30th, 2014 [October 30th, 2014]
- Eczema Tied to Bone Fracture Risk in Study - October 30th, 2014 [October 30th, 2014]
- Accident prone eczema patients - October 30th, 2014 [October 30th, 2014]
- Eczema girl's agony is over thanks to allergen-busting extra washing machine rinse cycles - November 1st, 2014 [November 1st, 2014]
- Helping Healing Eva's Eczema with Applied Kinesiology - Video - November 1st, 2014 [November 1st, 2014]
- Eczema May Increase Risk of Injury - Video - November 1st, 2014 [November 1st, 2014]
- treatmyeczema - November 2nd, 2014 [November 2nd, 2014]
- My Eczema Care Routine March 2014 | ... ... - November 2nd, 2014 [November 2nd, 2014]
- The Psoriasis Eczema Skin Puzzle #42 - Video - November 3rd, 2014 [November 3rd, 2014]
- Can some patients' bodies become 'addicted' to topical steroids? - November 5th, 2014 [November 5th, 2014]
- How To Treat Eczema Naturally Review DO NATURAL REMEDIES REALLY WORK - Video - November 5th, 2014 [November 5th, 2014]
- I Will Beat Anyone I Find Eczema On His/Her Body - Video - November 5th, 2014 [November 5th, 2014]
- Proper amount of bathing and moisturizing your baby may help prevent skin disease - November 8th, 2014 [November 8th, 2014]
- How to get rid of super dry skin psoriasis, eczema and more! - Video - November 12th, 2014 [November 12th, 2014]
- Easy Homemade Remedy For Eczema - Pulse Daily - Video - November 13th, 2014 [November 13th, 2014]
- Aveeno Eczema Therapy Moisturizing Cream - Video - November 15th, 2014 [November 15th, 2014]
- aveeno eczema moisturizing cream | Sample Promo - Video - November 16th, 2014 [November 16th, 2014]
- Psoriasis & Eczema : Rain soul by Johnny - Video - November 16th, 2014 [November 16th, 2014]
- aveeno baby eczema therapy moisturising cream | Sample Promo - Video - November 17th, 2014 [November 17th, 2014]
- aveeno baby eczema therapy reviews | Sample Promo - Video - November 18th, 2014 [November 18th, 2014]
- Peanut in household dust linked to peanut allergies, especially for children with eczema - November 19th, 2014 [November 19th, 2014]
- Peanut in household dust linked to peanut allergy in children with eczema during infancy - November 19th, 2014 [November 19th, 2014]
- 10 Tips to Manage Psoriasis and Eczema this Winter - November 19th, 2014 [November 19th, 2014]
- Tampa dermatologist excited over eczema clinical trial results - November 20th, 2014 [November 20th, 2014]
- aveeno baby eczema moisturizing cream | Sample Promo - Video - November 20th, 2014 [November 20th, 2014]
- Why I am sharing my eczema journey and what I deal with everyday living with eczema - Video - November 20th, 2014 [November 20th, 2014]
- Cetaphil Restoraderm Restoring Formulated Eczema - Video - November 20th, 2014 [November 20th, 2014]
- Cetaphil Restoraderm Restoring Moisturizer 10 Fluid - Video - November 20th, 2014 [November 20th, 2014]
- Childhood Eczema Cure With Kangen Water - Testimonial - Video - November 22nd, 2014 [November 22nd, 2014]
- Natural Remedies for Eczema - The Best Eczema Treatment - Video - November 23rd, 2014 [November 23rd, 2014]
- Eczema in Kids - Read More About It - Video - November 23rd, 2014 [November 23rd, 2014]
- Hypoallergenic labels may not be accurate - November 23rd, 2014 [November 23rd, 2014]
- Danielle Sheehan's life transformed after Botox eradicates her eczema - November 25th, 2014 [November 25th, 2014]
- Eczema's effects can be bone-deep - November 25th, 2014 [November 25th, 2014]
- New recommendations for treating kids with eczema - November 25th, 2014 [November 25th, 2014]
- Eczema cases rising among U.S. children - November 25th, 2014 [November 25th, 2014]
- Eczema Cases Rising Among U.S. Children: Report - November 25th, 2014 [November 25th, 2014]
- New guidelines released for treating kids with eczema - Video - November 25th, 2014 [November 25th, 2014]
- TCM Recipe Natural Herbal Eczema Cream Review - Video - November 25th, 2014 [November 25th, 2014]
- New product to heal eczema to use topically and progress pictures - Video - November 25th, 2014 [November 25th, 2014]
- 15 Proven Natural Cures for Eczema - Baby dermatitis: how ... - November 26th, 2014 [November 26th, 2014]
- Aveeno Moisturizing Bar - Aveeno Eczema Therapy Moisturizing Cream - Video - November 26th, 2014 [November 26th, 2014]
- How to psychologically & physically confront eczema in you. - Video - November 26th, 2014 [November 26th, 2014]
- Woman, 21, left looking sunburnt by severe eczema finally has the perfect complexion - thanks to a 'magical' cream - November 27th, 2014 [November 27th, 2014]
- Aveeno Baby Sunscreen - Aveeno Baby Coupons - Aveeno Baby Eczema - Video - November 27th, 2014 [November 27th, 2014]
- How I cured my eczema in just over 10 days and you can to. My personal review - Video - November 28th, 2014 [November 28th, 2014]