eczema and food allergies definitions definitions this is eczema

DEFINITIONS
ECZEMA AND
FOOD ALLERGIES
Peter Lio, MD
“Eczema”: Greek for “the result of boiling over”
Basically synonymous with “Atopic Dermatitis”
“Atopic” ~ Allergic
“Dermatitis” = Inflammation of the skin
DEFINITIONS
Eczema/Atopic Dermatitis:
A red, itchy, scaly/flaky, sometimes oozing rash that can
affect kids and adults
Usually chronic, but frequently kids grow out of it
THIS IS ECZEMA
ATOPIC MARCH
WHAT CAUSES IT?
Eczema
Food Allergies
Asthma
Allergic rhinitis (“hay fever”)
We still don’t really know*
Some theories:
Genetics
Pollution
All have increased in prevalence over the past several
decades.
WHAT CAUSES IT?
Hygeine hypothesis
TRUE OR FALSE?
Most patients with eczema have a
food allergy and should be tested.
Pillsbury DM, Kligman AM, Shelley WB. A manual of cutaneous
medicine, by Donald M. Pillsbury, Walter B. Shelley [and] Albert M.
Kligman. Philidelphia. Saunders, 1961.
FALSE
FOOD ALLERGIES
Definition of allergy: an adverse immune reaction due to
food protein
...but many children with food
allergy also have eczema.
35% of moderate-severe eczema in children is associated
with food allergy
Not in adult eczema
Egg allergy is the most common food allergen associated
with eczema
Sampson HA, J Roy Soc Med 1997
IS FOOD CAUSING
THIS?
ALLERGY TESTING?
WHEN TO SUSPECT
FOOD AS A “CAUSE”
When proper skin care is not working
When eczema flares are consistently associated with a
specific food as a trigger
When the child is not growing well
WHAT DOESN’T CAUSE
IT?
Parenting
Too much TV
Vaccines
In
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Foods that mom ate during pregnancy
Infants and toddlers most likely affected
BUT...
Foods that the patients eat
CONNECTION
Perhaps the “leaky skin” of eczema is
causing some portion of food allergy!
Jin H, He R, Oyoshi M, Geha RS. Animal models of atopic dermatitis. J Invest Dermatol. 2009 Jan;129(1):31-40.
be t t e
r
HOW TO TREAT IT
ANTI-INFLAMMATORY
Topical Steroids
Ointments preferred
Side effects are real but can be avoided
Key: give skin frequent breaks
ANTI-INFLAMMATORY
Tacrolimus/Pimecrolimus
ANTIBIOTICS
MOISTURIZATION
Hydrolated Petrolatum
Eucerin
Oral antibiotics
Topical antibiotcs
Bleach (!)
Aquaphor
CeraVe
Aveeno Advanced Care Wash
Olay Moisturinse
FOR THE ITCH
Antihistamines don’t help many but...
Sarna sensitive skin/Aveeno anti-itch can help
ALTERNATIVE MEDS
SUMMARY
Atopic dermatitis continues to be a challenge
It is related to food allergy, but the “how” is still not clear
One thing is clear: THERE IS NO EASY ANSWER
Working together we hope to help...
...and continue to search for answers!