Itchy kids and food allergies
January 17, 2011 2:04 AM Subscribe
If a baby's eczema was food allergy related - and reacted to the proteins of that food through breast milk - would you expect a flare-up when the food itself was finally introduced directly?
This is a super theoretical question that bugs me. My daughter who is now nearly 4, has had moderate to severe eczema since she was 8 months old. Since we have a family history of milk allergies, on then current advice, we didn't introduce dairy products until she was 12 months old.
So - if her eczema was caused by dairy, would you expect it to flare up worse when she actually had dairy? Because that would make sense to me, but none of the various specialists we've been introduced to over the years have been able to tell me.
(Background details: we've been referred to a dermotologist, skin prick tests said "Minor allergy to cat" and that was the only reaction. Dermotologist said "Keep your cat". A year later, saw immunologist; RAST blood tests, only reaction (from very long list of tests) was "Minor allergy to cat" and immunologist said "Keep your cat".
In a fit of despair we re-homed our cat 6 months ago, hoping it would help, but it didn't, bugger it, and we'd had him nearly 9 years.
Now we have just spent a month on a low salicylate diet and that hasn't done anything either.
Still, in laws say "You need to try her dairy free" - hence my original question. (but then again they are homeopathy-believing deniers of the advantages of evidence-based medicine)
TL;DR: If you've got skin-prick and RAST tests saying there's no allergies (apart from cats) that's a pretty good indicator that there's no food allergies, right?
This is a super theoretical question that bugs me. My daughter who is now nearly 4, has had moderate to severe eczema since she was 8 months old. Since we have a family history of milk allergies, on then current advice, we didn't introduce dairy products until she was 12 months old.
So - if her eczema was caused by dairy, would you expect it to flare up worse when she actually had dairy? Because that would make sense to me, but none of the various specialists we've been introduced to over the years have been able to tell me.
(Background details: we've been referred to a dermotologist, skin prick tests said "Minor allergy to cat" and that was the only reaction. Dermotologist said "Keep your cat". A year later, saw immunologist; RAST blood tests, only reaction (from very long list of tests) was "Minor allergy to cat" and immunologist said "Keep your cat".
In a fit of despair we re-homed our cat 6 months ago, hoping it would help, but it didn't, bugger it, and we'd had him nearly 9 years.
Now we have just spent a month on a low salicylate diet and that hasn't done anything either.
Still, in laws say "You need to try her dairy free" - hence my original question. (but then again they are homeopathy-believing deniers of the advantages of evidence-based medicine)
TL;DR: If you've got skin-prick and RAST tests saying there's no allergies (apart from cats) that's a pretty good indicator that there's no food allergies, right?
I've had eczema since early childhood, and to a varying degree so do my dad, my sister and my four-year-old son. I've tried pretty much every sort of allergy test and food avoidance, and eventually gave up. The conclusion I've reached is this: that eczema isn't an allergy in itself, but a condition that can be made worse by allergic reactions. In my case, both nuts and dairy foods can make me quite itchy for a few hours. But they don't cause my eczema to flare up (unless I actually give in to the itch and do a lot of scratching). Any eczema flare-up happens as a result of scratching. Another experience I've had (which I've heard other people mention) is that sensitivities seem to come and go; for a while I'll be convinced that you've solved the problem by eliminating food X or product Y, only to find a few months down the line that they're no longer a problem, and that something else seems to be a trigger. And on top of all that, eczema has its own cycles - one year it'll be particularly bad, another year it's very mild; stress is supposedly a factor, but to me it seems essentially random.
I've come to the conclusion that the most reliable way to treat eczema is to break the itch/scratch cycle. In other words, it's scratching that damages the skin and triggers the eczema, which causes the itch. Allowing the skin time to heal completely, and then preemptively dealing with any dryness, gets rid of the eczema. And the only way to achieve this is to find the right combination of moisturiser and topical steroid, and to find a strategy for overcoming the incredibly powerful urge to scratch.
So despite the fact that cheese and butter make me a bit itchy, I still eat them. And nuts too, in moderation. As long as I keep my nails short and follow a careful skincare regime, my eczema is mostly under control.
Fingers crossed that your child is one of the lucky majority who don't carry their eczema through to adulthood, anyway.
posted by le morte de bea arthur at 3:04 AM on January 17, 2011 [1 favorite]
I've come to the conclusion that the most reliable way to treat eczema is to break the itch/scratch cycle. In other words, it's scratching that damages the skin and triggers the eczema, which causes the itch. Allowing the skin time to heal completely, and then preemptively dealing with any dryness, gets rid of the eczema. And the only way to achieve this is to find the right combination of moisturiser and topical steroid, and to find a strategy for overcoming the incredibly powerful urge to scratch.
So despite the fact that cheese and butter make me a bit itchy, I still eat them. And nuts too, in moderation. As long as I keep my nails short and follow a careful skincare regime, my eczema is mostly under control.
Fingers crossed that your child is one of the lucky majority who don't carry their eczema through to adulthood, anyway.
posted by le morte de bea arthur at 3:04 AM on January 17, 2011 [1 favorite]
Well, there are allergies and intolerances. One of my kids reacted horribly (GI & skin symptoms) to dairy yet it didn't show up on RAST tests. I guess it's all what works for your kid, not what shows up on diagnostics. What's the harm in going dairy free for a month and seeing if it does make a difference? It did for my kid, but then excema can have many different causes.
I hope she feels better soon!
posted by PorcineWithMe at 5:47 AM on January 17, 2011
I hope she feels better soon!
posted by PorcineWithMe at 5:47 AM on January 17, 2011
I have two daughters who have varying degrees of dairy sensitivity.
The older one is allergic to peanuts, so she's had the whole slew of allergy tests. She tested negative on a RAST test for dairy, but her cheeks were always inflamed like somebody had been slapping her -- so red! When we removed milk from her diet on a hunch, her cheeks became a normal color for the first time in our memory. The red-cheeks sign hen she'd had milk went away when she was about four; but now she's eight and we're noticing now her stomach hurts her if she has dairy, we we think we need to crack down again.
The littler one has epic eczema. We changed every detergent, bought specialty baby wash, used Aquaphor, and eventually started on the nasty prescription eczema cream that causes glaucoma when it gets into your eyes. We asked the doctor if it might be dairy related, and they shrugged but did not test.
When her eczema finally spread to *her eyelids*, we decided just trying wouldn't hurt anything and removed dairy from her diet, too. It was like magic. Within a week she had almost entirely healed up, aside from the scabbing in a few of her worst spots. Now, we let her have limited amounts of dairy, and back off when we notice that she's getting itchy.
We still haven't had her tested, because she's only barely four and we know from experience that it's brutal on a kid who is actually allergic to something... and because we have negative tests from her sister, who also had a visible reaction. We wouldn't get any information from the test that would change how we live.
The moral of my story: Do a little evidence-based medicine yourself. Buy some Rice Dream and vegan margarine and spend a week without cheese to see if it makes a difference. If it does, take that to your doctor. If it doesn't, then you know, and no harm done.
posted by Andrhia at 5:54 AM on January 17, 2011
The older one is allergic to peanuts, so she's had the whole slew of allergy tests. She tested negative on a RAST test for dairy, but her cheeks were always inflamed like somebody had been slapping her -- so red! When we removed milk from her diet on a hunch, her cheeks became a normal color for the first time in our memory. The red-cheeks sign hen she'd had milk went away when she was about four; but now she's eight and we're noticing now her stomach hurts her if she has dairy, we we think we need to crack down again.
The littler one has epic eczema. We changed every detergent, bought specialty baby wash, used Aquaphor, and eventually started on the nasty prescription eczema cream that causes glaucoma when it gets into your eyes. We asked the doctor if it might be dairy related, and they shrugged but did not test.
When her eczema finally spread to *her eyelids*, we decided just trying wouldn't hurt anything and removed dairy from her diet, too. It was like magic. Within a week she had almost entirely healed up, aside from the scabbing in a few of her worst spots. Now, we let her have limited amounts of dairy, and back off when we notice that she's getting itchy.
We still haven't had her tested, because she's only barely four and we know from experience that it's brutal on a kid who is actually allergic to something... and because we have negative tests from her sister, who also had a visible reaction. We wouldn't get any information from the test that would change how we live.
The moral of my story: Do a little evidence-based medicine yourself. Buy some Rice Dream and vegan margarine and spend a week without cheese to see if it makes a difference. If it does, take that to your doctor. If it doesn't, then you know, and no harm done.
posted by Andrhia at 5:54 AM on January 17, 2011
Takes roughly 2 weeks for all dairy proteins to exit the body.
posted by PorcineWithMe at 6:16 AM on January 17, 2011
posted by PorcineWithMe at 6:16 AM on January 17, 2011
TL;DR: If you've got skin-prick and RAST tests saying there's no allergies (apart from cats) that's a pretty good indicator that there's no food allergies, right?
No. Oral food challenges (under the supervision of a physician and/or nutritionist) are the gold standard for food allergies. If your allergist didn't recommend this, find another one.
posted by Wordwoman at 8:16 AM on January 17, 2011 [1 favorite]
No. Oral food challenges (under the supervision of a physician and/or nutritionist) are the gold standard for food allergies. If your allergist didn't recommend this, find another one.
posted by Wordwoman at 8:16 AM on January 17, 2011 [1 favorite]
I should add, to answer your question more directly -- both kids were breastfed; both showed signs of atopy in infancy, especially the older one and her Mystery Hives, but I never changed my diet as a result. (I never worked out what the problems was!).
Neither one showed an immediate or obvious reaction to the introduction of dairy when they began eating solids. The eczema and red cheeks both manifested only gradually over time, and it took us months -- years! -- to put the connection together.
They still don't manifest immediately on a single exposure, either. There seems to be a sort of threshold; too much cheese over the course of two or three days.
posted by Andrhia at 11:23 AM on January 17, 2011
Neither one showed an immediate or obvious reaction to the introduction of dairy when they began eating solids. The eczema and red cheeks both manifested only gradually over time, and it took us months -- years! -- to put the connection together.
They still don't manifest immediately on a single exposure, either. There seems to be a sort of threshold; too much cheese over the course of two or three days.
posted by Andrhia at 11:23 AM on January 17, 2011
They may or may not stay allergic when they move onto solids because of how the gut and immune system develops. When babies are very small their intestinal lining is still leaky, lets whole proteins through to allow them to get the best nutrition from the milk they're drinking. This also allows immunoglobulins from the mum to get in too, forming part of their early immune defence until their own immune system can take over. But the barrier closes up as they develop (I'm not sure of the timeframe) so that most food components aren't able to just pass through and it becomes selective like it in in an adult (so pathogens and stuff are kept out, food is digested before absorption, etc). During this time the gut flora is appearing and maturing and the immune system in the gut is also developing and sorting itself out.
So it may be that as a baby they were letting in whole proteins (or something) that triggered an allergic response and those proteins are now digested before passing into the body so no response. It also may be that the immune system has developed to the stage where it is better at remaining in balance so the allergy doesn't happen regardless. But it also may be that the allergen is still being absorbed (maybe it's a small part of a protein) or that the immune development has had no effect on the issue (which her ongoing eczema does kind of indicate). Or it may have been an intolerance like people have with lactose, where it's not digested or absorbed and causes problems but doesn't involve the immune system. This is why your doctors haven't given you a definite answer, because there isn't really one.
I agree that cutting out dairy for a month is a pretty easy thing to do so you might as well try it and see. Just make sure she has another source of calcium and read the ingredients as diary proteins sneak in all kinds of places. Unfortunately eczema isn't a straight allergic reaction but a complicated inflammatory disease, so dietary triggers may form only a part of the story. But it's still worth finding out.
posted by shelleycat at 12:21 PM on January 17, 2011
So it may be that as a baby they were letting in whole proteins (or something) that triggered an allergic response and those proteins are now digested before passing into the body so no response. It also may be that the immune system has developed to the stage where it is better at remaining in balance so the allergy doesn't happen regardless. But it also may be that the allergen is still being absorbed (maybe it's a small part of a protein) or that the immune development has had no effect on the issue (which her ongoing eczema does kind of indicate). Or it may have been an intolerance like people have with lactose, where it's not digested or absorbed and causes problems but doesn't involve the immune system. This is why your doctors haven't given you a definite answer, because there isn't really one.
I agree that cutting out dairy for a month is a pretty easy thing to do so you might as well try it and see. Just make sure she has another source of calcium and read the ingredients as diary proteins sneak in all kinds of places. Unfortunately eczema isn't a straight allergic reaction but a complicated inflammatory disease, so dietary triggers may form only a part of the story. But it's still worth finding out.
posted by shelleycat at 12:21 PM on January 17, 2011
My daughter seems to have eczema like le morte de bea arthur - flares if she exposed to an acknowledged allergen IF we are also using soap. No soap = no scratching = fewer flares. If we use soap she will start flaring in response to my diet, if we don't, she's fine until she gets a hit of the allergen. And since she's a toddler, she scratches the hell out of herself and we have to go the whole no soap and smothered in hippie moisturiser.
If it were me I'd cut out the dairy for a month, cut out the soap, and see how it went.
posted by geek anachronism at 3:06 AM on January 18, 2011
If it were me I'd cut out the dairy for a month, cut out the soap, and see how it went.
posted by geek anachronism at 3:06 AM on January 18, 2011
Some interesting information here. I've posted on this subject a couple of times since the birth of our second child (now 4). We came to the conclusion that the eczema and the food allergies were almost mutually exclusive (my son is allergic to fish, milk, soy, nuts - anaphylaxis, egg, dust mites ....), as we completely eliminated the identified food groups from his diet, but it had no effect whatsoever on his head to toe eczema. It did however, stop the immediate skin reactions.
We decided to focus on management rather than cure - and really, low dose cortisone cream and sorbalene cream every day (which totally wiped out the eczema), finally allowed him some quality of life.
We recently had a full blood count done and discovered low Vitamin D - which apparently isn't that unusual with children who regularly wear sun screen. At our wits end, we dosed him on a course of D pills, and now he no longer has any eczema (occasionally a bit behind the knees, but nothing requiring anything more than sorbalene to control).
Now, this may be entirely coincidental - but it was marked and immediate. He's still allergic to the aforementioned foods, but we are slowly introducing things like butter and cheese back into his diet - not sure it that's the best thing to do, or not - there is little out there to suggest the correct path in this area - and he seems to be OK, most of the time, with this.
I really feel for you about this - there are few things as soul destroying than seeing your kids suffer as they do with eczema.
Regarding your question - the last 'specialist' I spoke to, basically wasn't sold on eczema being related to the allergies. There's still a lot of work to do in that field.
posted by a non e mouse at 4:46 AM on February 1, 2011
We decided to focus on management rather than cure - and really, low dose cortisone cream and sorbalene cream every day (which totally wiped out the eczema), finally allowed him some quality of life.
We recently had a full blood count done and discovered low Vitamin D - which apparently isn't that unusual with children who regularly wear sun screen. At our wits end, we dosed him on a course of D pills, and now he no longer has any eczema (occasionally a bit behind the knees, but nothing requiring anything more than sorbalene to control).
Now, this may be entirely coincidental - but it was marked and immediate. He's still allergic to the aforementioned foods, but we are slowly introducing things like butter and cheese back into his diet - not sure it that's the best thing to do, or not - there is little out there to suggest the correct path in this area - and he seems to be OK, most of the time, with this.
I really feel for you about this - there are few things as soul destroying than seeing your kids suffer as they do with eczema.
Regarding your question - the last 'specialist' I spoke to, basically wasn't sold on eczema being related to the allergies. There's still a lot of work to do in that field.
posted by a non e mouse at 4:46 AM on February 1, 2011
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Not necessarily. Lack of recent exposure to the suspected allergen can cause false negative results. I've experienced this kind of false reassurance with my own son who had a history of anaphylactic reactions before he was finally accurately diagnosed. This site has a pretty comprehensive explanation of testing procedures and the ways in which false negatives can occur.
posted by amyms at 2:42 AM on January 17, 2011