Bikash Oza, MD, and James Treat, MD, explore the topic, ‘Does food cause eczema?’ Dr. Oza, associate professor of dermatology and pediatrics and chief of pediatric dermatology at New York University in New York City, along with Dr. Treat, professor of clinical pediatrics and dermatology at the Perelman School of Medicine and affiliated with Children’s Hospital of Philadelphia, lent their expertise to one of three “Great Debates in Pediatric Dermatology” at the 2024 American Academy of Pediatric Dermatology Annual Meeting in Toronto, Ontario, Canada.
Oza and Treat provided insights from their discussion and shared valuable information for clinicians on allergies and eczema. Oza emphasized that atopic dermatitis (AD) is primarily a skin barrier problem accompanied by an inflammatory response, and current knowledge suggests that foods do not directly affect these processes. However, he acknowledged that when children eat foods they are allergic to, it can cause secondary itch, which can lead to scratching and exacerbate the eczema.
Dr. Treat explained that parents often assume that AD is caused by diet, but as pediatric dermatologists, they often have to change this perception. The doctors pointed out that food is not the root cause of eczema, but it can cause itching and exacerbate the condition. The doctors noted that children with AD are prone to food allergies, and they emphasized the importance of validating parents’ observations. The doctors emphasized that both conditions often coexist, necessitating comprehensive treatment.
Oza and Treat discussed the complexities of diagnosing food-induced eczema, particularly the use of oral food challenges and atopy patch tests. They noted that while these tests can help identify food allergies, they are not always conclusive and false positives can lead to unnecessary dietary restrictions. They also emphasized that early exposure to allergenic foods can prevent sensitization, which is a shift from past practice, which advised delayed introduction of these foods.
The physicians noted that food allergies and eczema are intertwined through complex immune responses and shared their perspectives on the evolution of our understanding of AD. They cautioned against widespread testing for food allergies without solid evidence and emphasized the need for more research to better understand these conditions. They concluded that helping families understand the risks and benefits of dietary decisions is essential for effective management of eczema.
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