Is your red, itchy skin flare linked to your diet? Maybe, but foods or drinks aren’t always the trigger for a skin condition called atopic dermatitis (AD). So before you cut out certain foods, get a diagnosis and tests to be sure what you’re eating is really causing your skin flares.
Atopic Dermatitis and Food Triggers
Atopic dermatitis is a chronic skin condition that causes occasional dry, red, cracking skin flares that itch so badly, it’s hard to sleep. It is linked with allergic conditions.
About 18 million people in the U.S. have atopic dermatitis. It’s more common in infants and children, but adults can have it too. Most kids with AD get fewer flares over time, or their flares stop altogether, says Yasmin Bhasin, MD, an allergist in Middletown, NY.
“There’s a tendency to outgrow these skin reactions by age 5 or so, and atopic dermatitis often gets better in 90% of cases,” she says. Only about 30% of people with atopic dermatitis likely have a food trigger for their skin flares. “If you can remove these foods from your child’s diet, about 75-80% of children do see improvement in a few weeks.”
Possible food triggers for skin flares are:
- Milk and other dairy products, including baby formula
- Peanuts or tree nuts
- Fish or shellfish
- Sesame seeds or oil
But before you assume that any food or food group is causing the skin flares and eliminate it, see an allergist or dermatologist. At your appointment, they will:
- Do a physical exam and take a full medical history.
- Ask you questions about where and when skin flares occur.
- Do blood or skin tests to see if common food triggers cause reactions.
- Suggest steps to get rid of likely food triggers and assess results.
- Prescribe treatment to ease skin flares and itching.
If skin tests are positive, the next step is to cut those foods from your or your child’s diet for up to 6 weeks, Bhasin says. If that doesn’t help, treat skin flares with moisturizing creams, or prescription steroid or nonsteroidal topical medications. Oral antihistamines may also help with itching so you or your child can get some sleep.
What’s Really Happening?
If atopic dermatitis flares seem to happen after you eat certain foods, it’s easy to link the two and label the food, like dairy or wheat, as a trigger to avoid. Hold off before you make that connection and ban these foods from your shopping list, says Jessica Hui, MD, a pediatric allergist at National Jewish Health in Denver who researches atopic dermatitis and food allergies.
There are a couple of different myths and terms to clarify, she says. With atopic dermatitis, people will see a rash and think it’s an allergy. But it’s important to note the differences between a true food allergy and atopic dermatitis.
True food allergies cause hives, not atopic dermatitis. They can also lead to anaphylaxis, a life-threatening reaction that stops you from breathing. An allergist can test you or your child to diagnose a food allergy and prescribe an epinephrine injection device to treat severe allergic reactions, Hui says.
If there’s a food you’re allergic to, like peanuts or shellfish, you will get hives. You have to avoid it and must have your injector with you at all times. Every encounter with that allergen will cause you to have hives as a reaction, she says.
Atopic dermatitis, on the other hand, isn’t life-threatening. But it can be uncomfortable. Flares may disrupt sleep or quality of life.
To prepare for your doctor’s appointment, Hui suggests you:
- Tell your doctor exactly when and where rashes occur.
- Keep notes about skin flares to help the doctor find food or other triggers.
- Take a photo of rashes with your phone so you can share them with your doctor in case they go away before your appointment.
Tiny Skin Cracks
Atopic dermatitis may cause tiny cracks in your skin that you can’t see with the naked eye. Normal-looking skin around red, inflamed flares in people with atopic dermatitis who also have a food allergy is different, says Hui, who recently co-authored a study on the topic. It has higher levels of inflammatory proteins and signs of an immune reaction.
Skin acts as a protective barrier for your body, keeping moisture in and disease-causing particles or allergens out, she says.
“If food allergens do penetrate the skin, your body sees these as foreign,” she says. “If an infant or child has a moderate to severe skin reaction, a parent may not be able to control it. Make an appointment with an allergist to not only manage the skin condition, but also give you guidance about food and diet.”
It’s hard to pinpoint triggers for every skin flare, especially in young children, Hui says. Kids may put on a sweater, play on the carpet, snuggle with the dog, then eat a cracker off the floor.
“A mom’s typical reaction is that it must be the cracker,” she says. “Children also may drool, sweat, or take bubble baths with irritating soaps. It’s easy to just blame the food.” Citrus fruits or juice can cause redness or irritation around the mouth or face that you mistake for a skin flare, she says.
Should You Go Gluten-Free?
In recent years, gluten, a protein found in wheat, rye, and barley products, has been linked to different health conditions, but gluten isn’t a common cause of food allergies or skin reactions, Bhasin says.
“Gluten has caused a panic. It’s a fad. People think they can switch to a gluten-free diet, and eat gluten-free bread or pasta, and it’s healthier. Some people swear by it, but often, when you test people, they’re really not allergic to gluten.” Don’t eliminate gluten or any other food before your doctor confirms that it’s an allergen for you and tells you to avoid it, she says.
It may seem logical to cut out a food that seems to trigger skin flares, but many allergists say you should eat a wide range of food to get all the nutrients you need.
Plus, elimination diets, as they’re called, aren’t good for growing children, Hui says. Give your kid a variety of foods early on unless your pediatrician says not to.
“This will allow a child to develop a tolerance to more foods,” she says. “A few decades ago, we did tell people to avoid all these supposedly allergenic foods. Even during pregnancy or breastfeeding, we don’t restrict a mom’s diet. We want children to have a varied diet. You may still have to treat flares with topical medications. As kids get older, this condition tends to improve. With a varied diet, their body will develop tolerance.”
Jessica Hui, MD, researcher, Department of Pediatrics, National Jewish Health, Denver.
Yasmin Bhasin, MD, board-certified allergist and immunologist, Allergy and Asthma Care, Middletown, NY.
National Eczema Association: “Atopic Dermatitis 101.”
Mayo Clinic: “Atopic dermatitis (eczema).”
Allergy & Asthma Network: “Ask the Allergist: The Food Allergy-Eczema Connection.”
FDA: “EpiPen: Epinephrine Injection.”
Science Translational Medicine: “The nonlesional skin surface distinguishes atopic dermatitis with food allergy as a unique endotype.”
Celiac Disease Foundation: “What is gluten?”