July 11, 2024 – When it involves neurodermatitis – probably the most common type of eczema Affecting tens of millions of kids and adults within the US – is it what you eat?
It may depend upon who you ask. Although studies show a transparent link between Dermatitis and food allergiesThere is controversy as to which occurs first – atopic dermatitis or food allergy. And it remains to be unknown how often dermatitis Results from a real food allergy (equivalent to a milk, egg or peanut allergy) or the results of itching and scratching in response to allergy symptoms.
“Food-related eczema is actually very rare,” said Peter A. Lio MD, founding director of the Chicago Integrative Eczema Center. “The confusing thing is that many patients with AD have a true food allergy… but the reaction is not an eczema outbreak, it is hives, and they could Anaphylaxis and swelling,” he said.
“We consider that in lots of patients, it’s since the eczema causes damage to the skin barrier,” he said. That means “that they’ll change into allergic to all varieties of things within the environment.”
About atopic dermatitis
Atopic dermatitis usually begins in childhood and affects up to 9.6 million children under 18 in the United States. Some children outgrow the disease, while in others it persists into adulthood. It can also begin in adulthood; currently, an estimated 16.5 million adults in the United States have been diagnosed with atopic dermatitis.
Atopic dermatitis is thought to develop when the immune system becomes disrupted and overactive. Research also shows that people with AD have physical and chemical disruptions to their skin barrier. They also lack a protein (filaggrin) that helps the body maintain a healthy barrier on the skin's surface. Because the skin microbiome – colonies of microorganisms, immune cells and skin cells – is also altered, moisture can escape and unhealthy allergens, bacteria and other pathogens invade and wreak havoc.
The result? Inflammation and itchy, dry skin that, when scratched, causes redness, swelling, cracking, “oozing” clear fluid, bleeding, crusting and flaking. Repeated scratching can cause the skin to become dry and discolored, and eventually thicker and harder.
Finding out the triggers
Symptoms of Food allergies and neurodermatitis Overlap between symptoms is often present, making it difficult to determine whether the food allergy is causing the outbreak or whether the skin and its protective barrier are becoming “leaky” and allergens can penetrate, triggering an immune reaction.
Dairy products and eggs
“There's some debate that dairy and eggs are the 2 biggest triggers of eczema, but there's not lots of research to support that,” said Jennifer Fugo, a registered dietitian, certified nutritionist and host of the Healthy Skin Show podcast. “I've had clients who haven't been capable of tolerate these foods for whatever reason, often as a result of other issues. So I ask myself: Is it really a trigger food? Does the person even have antibodies (called immunoglobulin E or IgE) that, after eating a food, cause an instantaneous response that could be life-threatening? Of course, these foods needs to be identified and avoided.”
Tree and grass pollen
Other possible culprits include wheat, soy, and foods associated with tree or grass pollen (raw fruits and raw vegetables). Pollen allergies typically cause symptoms in and around the mouth and throat and generally include raw fruits such as apples, peaches, and cherries, and raw vegetables such as carrots, celery, and fennel.
Sodium intake
Insights from a current study in over 200,000 adults found that consumption of high-sodium foods may also play a role.
“We used to think that the kidneys did all of the saltwater processing within the body, but it surely seems that the skin plays an enormous role,” said study co-author Katrina Abuabara, MD, associate professor of dermatology at the University of California, San Francisco. “Almost the entire exchangeable sodium in our body is stored within the skin… to stop water loss. Almost all of those people have poor barrier function and increased water loss… which might trigger a few of the inflammatory patterns we see in eczema.”
Although the study did not establish a causal relationship, the results suggested that a one gram (less than half a teaspoon) increase in sodium intake in the diet was associated with an 11% higher risk of being diagnosed with atopic dermatitis and an 11% higher risk of having severe atopic dermatitis.
There are many reasons to reduce salt intake, especially with regard to heart health.
“Part of the story can also must do with the effect of salt on the gut microbiome,” said Lio, who is also a clinical assistant professor of dermatology and pediatrics at Northwestern Feinberg School of Medicine in Chicago.
In addition, fast food could be one of the biggest culprits: data from the International Study on Asthma and Allergies in Childhood suggest that Eating fast food In adolescents, the risk of atopic dermatitis increased by 20% and the risk of severe atopic dermatitis increased by 70%.
Pollutants
“There's been a really powerful story about pollutants and toxins that has been developing in recent times,” Lio said, pointing to recent wildfires in California and Canada. “It seems that there's a chemical within the smoke called diisocyanate, and that chemical has been shown to break the skin barrier and affect the microbiome. Adults exposed to the smoke had an enormous increase within the likelihood of developing Alzheimer's disease.”
Diisocyanate is also found in fuels and exhaust fumes from cars and trucks. “There's a extremely necessary link between urbanization and eczema,” Lio said. “So children who live in urban areas, especially near highways, are way more prone to develop AD than individuals who don't live there.”
Do elimination diets work?
An elimination diet involves eliminating foods thought to cause allergic reactions or atopic dermatitis — such as dairy, eggs, wheat, soy, peanuts/tree nuts, and fish or shellfish — and adding some of those foods back into the diet at a later date. But these diets come with a “big caveat,” says Kara Fitzgerald, a physician and educator in Sandy Hook, Connecticut, who is board-certified with the Institute for Functional Medicine.
She explained that there is evidence that “for those who put people on a whole elimination weight loss plan, you may actually cause a whole lack of tolerance, an anaphylactic response,” she said. “I still think elimination diets are necessary, but under the supervision of a dietitian and physician.”
Fitzgerald, who is also a naturopathic doctor, also recommends a micro-exposure approach, which involves reducing the reintroduction of potential culprits in the diet, but keeping small amounts of those foods in the diet to avoid severe reactions.
An alternative is the whole foods approach, a strategy advocated by all of the experts interviewed for this article.
“A change in diet can make a difference,” Lio said. “Junk food, sugary foods, highly processed foods all seem [negative] Effects on the entire body – including the skin – and can have an inflammatory effect in some people.”
Fugo recommends thinking about nutrient density and diversity. “Nutrient density is critical; there's lots of data showing that deficiencies in certain nutrients are linked to Alzheimer's. And we want diversity since the more diverse your weight loss plan, the more diverse your gut microbiome,” she said.
Fitzgerald said it's also important to “take into consideration nutrients that reduce inflammation and keep the immune system balanced.” These include vitamin D, vitamin A, probiotics and a plant-rich diet. (Most plant-based foods, like artichoke hearts and chicory, are prebiotics.)
The ultimate goal? Talk to your doctor or therapist “a couple of plan that gets you well under control,” Lio said. “Some people have a persistent flare-up and find yourself using treatments which are too strong or too unsafe for long-term use.”
“We're shifting our goal from eager about what to do in an acute outbreak to having a comprehensive plan for when the skin is insensitive – every day things that can help strengthen the skin and the microbiome – after which a rescue plan if things go haywire,” he said.