Should You Try An Elimination Diet to Determine The Root Cause of Eczema?

If you’re living with eczema or atopic dermatitis, you know targeting your triggers and keeping your skin moisturized are two essentials for happy, healthy skin. When it comes to eczema triggers, there are some known culprits — think fragrance, laundry detergent, hot or cold weather, and even stress — notes the National Eczema Association.

Yet what you put at the end of your fork may also play a role in your risk for flare-ups.

Typically, after eating a triggering food, your skin will get itchy or red. You may also notice swollen, hive-like patches or a flare of preexisting lesions, past research suggests. The symptoms may not be immediate — they could take a few hours or up to two days to appear.

To identify those triggers in yourself or your infant, maybe you’ve considering trying an elimination diet. This involves avoiding specific foods that you think are responsible for your symptoms, according to the University of Wisconsin in Madison School of Medicine and Public Health. These diets are used mainly to identify triggers for health conditions such as irritable bowel syndrome, autoimmune disorders such as rheumatoid arthritis, multiple sclerosis, or eosinophilic esophagitis (EoE), and migraines. Sometimes, people with eczema try them, too, if they suspect food is triggering their symptoms.

Indeed, according to the aforementioned research, infants with moderate to severe eczema are more likely to have food allergies, so identifying the foods that trigger their allergy symptoms may also help control eczema.

How Can an Elimination Diet Work for Eczema?

Everyone responds to foods differently — not everyone with eczema will have the same reaction to milk, for instance — so an elimination diet may not be the right tool to add to your arsenal against eczema.

The University of Wisconsin in Madison outlines these general steps for following an elimination diet:

  1. Make a list. Include all the foods you eat throughout the day and note your body’s reaction to eating them. The ones that seem to worsen your eczema symptoms are your potential problem foods.
  2. Cut out the problem foods. Omit these potential problem foods from your diet for two to four weeks. Pay close attention to food labels during this time. That’s important because if you mistakenly eat something containing the ingredient, you’ll need to start the clock over. Note how you feel during this period.
  3. Challenge your body. If symptoms don’t improve over the two-to-four-week period, decide if you want to start again with a different set of problem ingredients. Or, if your symptoms have improved, one of the foods you eliminated is likely causing your issues. Then it’s time to reintroduce the eliminated foods back into your diet. Do this one at a time every three days in order to determine which food is to blame, starting with a small amount on day one and increasing that amount each day. Note how your body reacts. Should the symptoms return, you’ve found your trigger. Add that food to your “allergic” list and avoid it going forward.

Is It a Good Idea to Try an Elimination Diet for Eczema?

It can be — but not always, says Susan Bard, MD, a board-certified dermatologist with Vive Dermatology Surgery & Aesthetics in Brooklyn, New York. According to the American Academy of Allergy, Asthma & Immunology foods are a trigger in 20 to 30 percent of moderate to severe eczema cases.

Dr. Bard says an elimination diet for eczema is worth trying only if it seems clear that a food is to blame for an outbreak. “I tell patients that if they see an obvious association between a certain food and eczema flares to avoid that food,” she says.

Alice Hoyt, MD, an allergist and clinical immunologist with Cleveland Clinic in Ohio, also doubts food is always to blame. “The reason we don't recommend elimination diets to modify atopic dermatitis is because there's no evidence that it will actually change the disease process because foods are not causing atopic dermatitis,” she says. She says it might seem like there’s a link because eczema patients are at increased risk of developing other allergies, including food allergies, but says it’s much more beneficial to look at what people are putting on their skin rather than what they’re eating.

What Are the Potential Risks of Elimination Diets When It Comes to Eczema?

The downside of elimination diets is they can lead to unbalanced eating because you may rule out entire food groups in an effort to find your trigger, Bard says. This excessive restriction can lead to nutritional deficiencies, according to a past study. That’s why Dr. Hoyt pairs patients who are trying an elimination diet with a registered dietitian, who can advise them on how to source necessary nutrients. For instance, if you eliminate dairy, you’ll need to find other ways to meet your calcium needs. “The point is to optimize good nutrition,” she says.

The Most Common Food Allergies Associated With Eczema

According to The Journal of Allergy and Clinical Immunology: In Practice study, the most common triggers for 183 study participants were milk (57.5 percent), eggs (30.6 percent), and soy (21 percent). Daniel P. Friedmann, MD, a board- certified dermatologist with Westlake Dermatology in Austin, adds wheat and peanuts to the list of common allergens for people with eczema, and a past article notes fish is another usual suspect.

Visit an Allergist for Guidance on the Elimination Diet

Though you’re likely used to visiting your dermatologist for eczema, if a food allergy could be in play, it’s best to see an allergist as well.

Dr. Friedmann says your dermatologist will likely recommend you visit a board- certified allergy specialist to determine what food allergies you have and to advise on whether an elimination diet will be right for you.

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