Eczema, also known as atopic dermatitis, is a common skin condition that affects millions of children worldwide. While it primarily manifests as red, itchy, and inflamed skin, its underlying causes can be complex and multifaceted. Recent research has shed light on the strong connection between eczema and allergies, suggesting that kids with eczema may benefit from further allergy tests to manage their condition effectively.
Understanding Eczema
While atopic dermatitis is common and usually develops by age five, allergic contact dermatitis has similar symptoms and can be triggered by a range of substances. In general, eczema is a group of medical conditions causing inflamed, irritated and itchy skin.
In the study, children with atopic dermatitis were more likely to test positive for allergies in patch testing. The findings were published Sept. 26 in the Journal of the American Academy of Dermatology.
"When a dermatologist sees a child who looks like they have eczema, we usually think that it's atopic dermatitis because nearly 1 in 5 children develop it," said senior study author Dr. JiaDe (Jeff) Yu, an assistant professor of adult and pediatric dermatology at Massachusetts General Hospital.
"Sometimes these kids could have allergic contact dermatitis, but the only way to tell is through patch testing, which is designed to identify substances that may be irritating your skin," he said in a journal news release.
The Importance of Allergy Testing
Allergy testing can be a valuable tool for children with eczema and their healthcare providers. Here's why:
- Identification of Triggers: Allergy tests can help pinpoint specific allergens that may be triggering or exacerbating a child's eczema. Knowing these triggers allows for targeted avoidance strategies.
- Customized Treatment Plans: Armed with knowledge about a child's specific allergies, healthcare providers can develop customized treatment plans. This may include allergen avoidance measures, dietary changes, or allergy shots (immunotherapy) to desensitize the immune system.
- Improved Symptom Management: By addressing underlying allergies, it may be possible to reduce the severity and frequency of eczema flare-ups. This can greatly improve a child's quality of life.
Common Allergens in Eczema
- Food Allergies: Certain foods can trigger or worsen eczema symptoms in some children. Common food allergens associated with eczema include cow's milk, eggs, peanuts, tree nuts, soy, wheat, and fish.
- Environmental Allergens: Allergens such as pollen, dust mites, pet dander, and mold can exacerbate eczema symptoms, especially when children with eczema are exposed to them.
- Irritants: Substances like harsh soaps, fragrances, and certain fabrics can irritate sensitive skin and worsen eczema symptoms.
- Contact Allergens: Some children may also have contact allergies to certain substances like nickel or latex, which can worsen their eczema when their skin comes into contact with these allergens.
The Allergy-Eczema Connection
Research has established a strong link between eczema and allergies, particularly food allergies, asthma, and allergic rhinitis (hay fever). Many children with eczema also suffer from one or more of these conditions, collectively known as atopic diseases. This shared connection suggests that there may be common underlying factors at play.
Patient Liz Schoeben knows the importance of testing for this allergic-type eczema.
Schoeben has had atopic dermatitis since she was nine and now knows she also has the allergic contact dermatitis.
"I remember having it in elementary school off and on," the mother of three said in the release. "Years later when I was 47, it became much more severe and spread to my legs and eventually to my face."
Soon, Schoeben learned through patch testing that in addition to having atopic dermatitis she was allergic to six different substances, including several that are commonly found in skincare products. These were causing her allergic contact dermatitis.
The allergies developed over time after repeated exposure, so Schoeben had become increasingly sensitive to them.
"It turns out that most of the things that I'm allergic to are very common ingredients in a lot of products," Schoeben said. "I'm allergic to a type of formaldehyde that's in a lot of skincare products and shampoos. I'm also allergic to beeswax. It was frustrating because I had been using these products for years without realizing they were the cause of my allergic reactions."
Common causes of allergic reactions include poison ivy, poison oak and poison sumac, but also rubber, dyes, cosmetics, preservatives, fragrances and metals such as nickel.
The most effective way to treat allergic contact dermatitis is by identifying and avoiding substances that cause the allergic reaction.
For atopic dermatitis, treatment options include steroids that can be applied to the skin and phototherapy, which uses ultraviolet light to reduce inflammation and ease itch. Other options are medications called biologics and JAK inhibitors.
Lifestyle changes can also relieve eczema symptoms, Yu said. Choosing fragrance-free products can help limit eczema flares.
Types of Allergy Tests
There are several methods for allergy testing, including:
- Skin Prick Tests: Small amounts of allergens are applied to the skin with a tiny needle. If a child is allergic, a small raised bump (wheal) will develop at the test site.
- Blood Tests: These tests measure the level of specific antibodies (IgE) in the blood in response to various allergens. Common blood tests for allergies include the ImmunoCAP test and the RAST test.
- Patch Tests: Used to diagnose contact allergies, patch tests involve applying small amounts of allergens to adhesive patches, which are then placed on the skin for a specific period.
- Oral Food Challenges: Sometimes, a healthcare provider may recommend supervised food challenges to confirm food allergies. This is done in a controlled environment, typically in a clinic or hospital.
People with eczema should test new skincare products by first applying them to a quarter-sized patch of skin on the inside of the arm every day for four weeks before using the product more widely.
If you have signs of eczema, it's important to see a dermatologist.
"Patients can have atopic dermatitis and allergic contact dermatitis at the same time, and it all looks like the same thing," Yu said.
"I imagine it like layers of a cake," he continued. "Maybe the first layer is atopic dermatitis, and then the second layer is allergic contact dermatitis. In these cases, the overall eczema may look very severe, but once you remove the allergic component, the eczema seems much more manageable."
Eczema is a chronic skin condition characterized by inflammation, itching, and dryness. It typically appears during childhood and can continue into adulthood, although its severity often varies over time. Eczema can be triggered or exacerbated by a wide range of factors, including genetics, environmental factors, and allergies.
Eczema is a challenging condition for both children and their parents, but advancements in our understanding of the relationship between eczema and allergies are providing new hope for better management. By identifying and addressing specific allergies through appropriate testing, children with eczema can experience improved symptom control and a better quality of life. If your child is struggling with eczema, it's essential to work closely with a healthcare provider to determine if further allergy testing is necessary and to develop a comprehensive treatment plan tailored to their specific needs.
