Dr James Treat Explains the Relationship Between Atopic Dermatitis, Food Triggers

James Treat, MD, a pediatric dermatologist at the Children's Hospital of Philadelphia, goes over some of the ways food can impact patients' atopic dermatitis, as well as whether elimination diets are effective at mitigating food-related triggers and the role of food allergies in pediatric flare-ups.

At the Society of Pediatric Dermatology conference, Treat discussed all these topics as well as misconceptions about food-related triggers for atopic dermatitis during his presentation entitled, "Does Food Trigger Eczema?" The conference was held in Toronto, Ontario, from July 11 to July 14, 2024.

This transcript has been lightly edited for clarity.

Transcript

How does the consumption of certain foods lead to atopic dermatitis flare-ups on a biological level and what role does the immune system play in food-triggered atopic dermatitis?

Oh, that's a really interesting question, because you're assuming that the foods do actually lead to [atopic dermatitis flares]. I think the big picture is that we don't know. What is pretty well known is that you can actually eat foods and have there be some sort of urticarial response. And when you have an urticarial response, you can get more itchy, and when you get more itchy, you can scratch your eczema and you can make it worse.

I think that's the best correlation that we have. Whether there is a more type 2 or Th2 response to foods remains a little bit of an open question. And there's certainly food additives that people can have a Th2 response to that can probably lead to worsening dermatitis also, or at least worsening itching and scratching. But there is not a perfect link for the biology of how people are responding to their foods.

What are the potential risks and benefits of using elimination diets to identify food triggers for atopic dermatitis?

Yeah, so the biggest risk—I'm going to start with risks—elimination diets take out essential nutrients from what we're eating. So depending on how much of an elimination diet we're talking about; if you eliminate 1 food, that's probably not going to be a huge deal. If you eliminate a lot of foods, we see children who actually get things like kwashiorkor, which is protein energy malnutrition, and we see kids get zinc deficient in the United States, in 2024, where we have abundant access to at least types of foods.

And the reality is that if you have elimination diets and you do it well enough, after you're told whether correctly or not that you're allergic to a lot of different foods or you fear you're allergic to a lot of different foods, you can lead to nutritional deficiency.

What are the pros of doing it? If you come in and you say, "Hey, I know that egg is making my child's atopic dermatitis worse," and you want to eliminate egg for a couple of weeks and see how it goes, that's not unreasonable. You just have to be aware that if you eliminate it for a long enough period of time, you actually can become allergic to the food because your immune system can be like, "OK, it's normal, normal, normal, you're eating it. Oh, you stopped eating it. It must be abnormal; [I'll] develop an immune response." So be careful with eliminating something for too long because you may not be able to add them back in.