Why Does Eczema Increase the Risk of Food Allergies?

Why are babies with eczema 6 times more likely to develop food allergies? And what can parents do to prevent them? 

In honor of National Eczema Awareness Month (October), we’re talking about the fascinating connection between eczema and food allergies – and the link might surprise you.

To start, what is eczema?

Eczema is a condition that causes the skin to become itchy or inflamed and creates a rash-like appearance. It is not contagious and while the exact cause is unknown, researchers believe it’s caused by a combination of environmental triggers and genetics. According to the National Eczema Association (NEA), over 31 million Americans have some form of eczema.

Eczema also impacts 20% of children, and young children with eczema are 6 times more likely to develop a food allergy than their peers without eczema. 

“Allergies and eczema are linked,” says Parenting Economist Emily Oster. “If your child has eczema, they’re at a higher risk of allergies. And that fact is just true in the data, there’s a strong correlation there.” 

So what’s the connection? How does eczema increase the risk of food allergies?

Healthy skin keeps moisture in and allergens, bacteria, and irritants out. In eczema, mutations in barrier proteins and chronic inflammation make the skin more porous and dry. Simply put: when that skin barrier is “leaky,” proteins from foods in the environment (like peanut dust or egg proteins on hands or clothes) can pass through the skin and meet immune cells.

According to the Dual-Allergen Exposure Hypothesis, which was first proposed by pediatric allergist and Mission MightyMe Co-founder Dr. Gideon Lack, when this exposure to a food occurs through the skin, it can lead to sensitization and potentially the development of a food allergy, whereas exposure to a food through the gut (oral consumption), leads to tolerance.  

“If it comes in through the mouth very early on, well that must be a food, it must be a good protein antigen, and we mount what’s called a tolerogenic response where the immune system goes in a direction that will prevent the development of food allergies,” explains pediatric allergist and Mission MightyMe Co-founder Dr. Gideon Lack. “If you are exposed very early on through a broken down skin, the immune system and the cell sitting in that skin issue out an alarm, ‘Hey, there’s an invader coming in, let’s mount an allergic response to repel it.’”

Eczema causes small breaks in the skin, which increases the likelihood of exposure to potential food allergens (such as peanut protein) through the skin barrier, therefore increasing the likelihood of developing a food allergy.

One way we see that play out, according to Dr. Lack, is that typically the most common food allergies in a given country also tend to be the most common foods in that culture. “In Scandinavia we see elevated rates of fish allergies, whereas in the U.S. there are more peanut allergies,” says Dr. Lack. “This happens because families are eating and cooking with these foods, so they are in the household environment, but babies aren’t eating them, so their primary exposure comes through the skin.”

Timing matters: the longer the skin is inflamed before foods are introduced orally, the greater the chance the first exposure is through the skin (sensitizing) rather than the gut (tolerizing).

“Eczema tends to develop earlier in life than food allergies,” says Atlanta Dermatologist Dr. Amy Kim, “So there is a crucial window for intervention starting as early as 4-6 months when it is critical to both aggressively control eczema and establish oral tolerance to prevent a food allergy from developing.”

Here’s the TLDR: while eczema doesn’t directly cause food allergies, it sets up the “perfect storm” – broken skin lets allergens in, and an already allergy-prone immune system reacts. Read on to learn more about what you can do to prevent eczema and food allergies.

3 SIMPLE TIPS TO PREVENT ECZEMA AND FOOD ALLERGIES 

If your child has eczema, you might be asking, “What can I do?” Here are some simple things you can do to decrease your child’s chances of developing food allergies.

1. Manage and treat your child's eczema. The NEA encourages a daily bathing and moisturizing routine to keep the skin clean and to prevent dryness. Apply over-the-counter or prescription medication as directed. Avoid skin products that cause further itching or irritation. As always, consult your child's doctor bfore beginning a new treatment plan.

2. Limit allergen exposure through the skin. The LEAP (Learning Early About Peanut Allergy) Study by Dr. Gideon Lack showed the importance of establishing oral tolerance to peanut protein before these proteins penetrate the skin barrier. After handling peanuts or other potential allergens, wash your hands thoroughly before touching your child. Avoid putting peanut butter or any creams or oils that contain peanut oil on your child’s skin.

3. Introduce early, oral, peanut exposure. Based on Dr. Lack’s landmark clinical trial, the LEAP Study, leading medical organizations including The American Academy of Pediatrics and The National Institute of Allergy and Infectious Diseases now recommend that children, especially those with eczema, regularly consume peanut foods, starting as early as 4-6 months, to help prevent peanut allergy. The recommendations for how and when to introduce peanut foods depends on your child’s risk factor which correlates to the severity of their eczema. 

It’s also important that sufficient amounts of peanut are ingested to achieve tolerance. The American Academy of Pediatrics recommends that high-risk babies, with eczema or existing egg allergy, consume 6 grams of peanut protein per week.

“It only takes tiny doses, less than microgram doses, to cause the development of food allergy through the skin,” says Dr. Lack, “whereas to protect orally, you need gram doses. So get the baby onto good amounts of these foods, the same way the rest of the family is eating them, and that ought to protect against peanuts and we believe other food allergies as well.

With 7 grams of peanut protein per pouch, just one pouch of Organic Peanut Butter Puffs per week meets the level consumed by babies in the LEAP Study and recommended by the AAP for high-risk infants. Our Mixed Nut Butter Puffs are carefully crafted to contain equal parts protein from peanuts, almonds, cashews, walnuts and hazelnuts. Two pouches per week delivers 10 grams of nut protein or 2 grams per nut to match the protein levels shown to be effective in the EAT Study.

Also important: diet diversity! Infants should be encouraged to try a broad variety of food, including potentially allergenic foods, once complementary food introduction has begun (Learn more about diet diversity here.)

AAP / NIAID PEANUT ALLERGY PREVENTION GUIDANCE BASED ON RISK FACTORS

High Risk (If your infant has severe eczema, egg allergy, or both): Talk to your doctor before giving any peanut foods to your baby. Your doctor may recommend allergy testing or introducing peanut foods under medical supervision. Once cleared, high risk infants should start peanut foods as early as 4-6 months and consume 6 grams (3 teaspoons) per week to help prevent peanut allergy.

Moderate Risk (If your infant has mild to moderate eczema): Introduce peanut foods around 6 months of age to reduce the risk of developing a peanut allergy. Depending on your preference, you can introduce peanut foods at home or in your doctor’s office under supervision.

Low Risk (No eczema or food allergy): Freely introduce peanut foods into your child’s diet at home in an age-appropriate manner together with other solid foods.

The good news is that the new research and guidelines have given parents the tools to potentially prevent food allergies from developing by being proactive.

“Solid food introduction between 4-6 months of age allows the parents to have a strategic and purposeful way of introducing solids and creating that oral tolerance,” says Moms on Call Co-Founder and LPN Laura Hunter.

When can you start? Is it a date on the calendar? Hunter says the best way to determine when to start solids (after speaking with your pediatrician) is to look for some of these signs:

• • Good head control
    
    
  • Sitting with minimal support
    
    
  • Beginning to show interest in what others are eating 
    
    

For more information see our blog post Introducing Solids, Including Peanuts and Other Potential Allergens with Moms on Call.

HOW EXACTLY DO I INTRODUCE PEANUTS TO MY BABY? 

Now if you’ve successfully started solids, talked with your pediatrician and decided that your baby is ready to start peanut foods, you might be wondering how you’re supposed to feed peanuts to a gummy, toothless baby! It’s important to note that peanuts and peanut butter must never be given to an infant because of the choking risk.

The NIAID Guidelines outline how to introduce peanuts for the first time, the signs of an allergic reaction, and the following recipe suggestions for regularly including peanut in infant’s diets:

• • Thinning peanut butter with warm water until desired consistency is achieved.

  • Mixing peanut butter into fruit or vegetable puree.

  • Adding peanut flour or peanut butter powder into fruit or vegetable puree.

  • Peanut puffs that can be softened with water for infants less than 7 months of age.

Mission MightyMe’s Nutty Puffs were developed for exactly this purpose by Dr. Gideon Lack, who led the landmark research that formed the new feeding guidelines.

“We know that between the U.S. and the U.K. almost 100,000 children develop an allergy to peanut each year,” says LEAP Study author and Mission MightyMe Co-founder Dr. Gideon Lack. “We ought to be able to prevent the majority of those new cases. That is very much our mission and the reason we started Mission MightyMe.”

Remember that all babies, not just those with eczema, can benefit from early peanut exposure and the USDA Dietary Guidelines now recommend that babies start peanut foods in the first year of life to reduce of developing a peanut allergy. The USDA also recommends introducing other potentially allergenic foods when a baby starts solids. 

The actionable takeaway for parents says Emily Oster, “It’s really that oral exposure in a consistent manner to these allergens, starting as soon as you introduce foods, is the best way we know to prevent allergies at the moment.”

TIPS FOR ECZEMA + FOOD ALLERGIES

Some quick takeaways for preventing eczema and food allergies:

🧴Keep the skin barrier strong: Easy does it! Daily moisturizing, gentle bathing and try to treat any flares quickly.

🍳Introduce allergenic foods early & keep in the diet often: Aim to introduce peanut, egg and other common allergens between 4–6 months (after other solids have been tolerated and baby is developmentally ready!) and maintain consistent intake. Pro tip: check out Mission MightyMe’s Early Allergen Introduction Guide for meal planning ideas and more.

🧼 Reduce environmental food contact on skin: Wipe baby’s face and hands after you eat allergenic foods, and if siblings eat peanut butter or egg, keep them wiped and surfaces clean.

👩⚕️Partner with your doctor, especially for high-risk rabies: If your child has had severe eczema or any suspected reactions, discuss with your pediatrician or allergist. Your family’s doctor should be a trusted resource, so speak up at early appointments with any questions about early allergy introduction – and always do your own research, too.

Don’t miss the magic window! Make peanut foods a regular part of your infant’s diet with delicious and nutritious Nutty Puffs!  

CRAVING MORE? READ UP ON LANDMARK PREVENTION TRIALS:

• LEAP (2015): Study by Dr. Gideon Lack of high-risk infants (severe eczema and/or egg allergy) introduced to peanuts between 4–11 months until 5 years old resulted in up to an 86% in peanut allergy risk.

• LEAP-On (2016) This study by Dr. Gideon Lack found that protection from early introduction persisted even after one year of peanut avoidance.

• EAT Trial (2016) –  Study by Dr. Gideon Lack of 1,300 babies with no risk factors, who were given multiple allergens from 3-6 months of age, until age 3. Demonstrated a 67% reduction in egg allergy and 100% reduction in peanut allergy in children who consumed 2g+ weekly of those foods. 

• PETIT (2017) –  Study of 147 infants with eczema who were fed cooked egg powder in gradually increasing doses from 4-10 months, while also undergoing aggressive eczema treatment. Showed early egg exposure reduced the risk of egg allergy by 79%.

• Metaanalysis of LEAP & EAT (2023): Follow-up study led by Dr. Gideon Lack, which found that targeting only the highest-risk infants with severe eczema reduced the population disease burden by only 4.6%, whereas when the intervention was targeted to the larger but lower-risk groups, there was a 77% reduction in peanut allergy. The estimated reduction in peanut allergy diminished with every month of delayed introduction.

• LEAP-Trio (2024) – In this newest follow-up study by Dr. Gideon Lack, the benefit of early introduction offered protective benefits even into adolescence, demonstrating that long-term food allergy prevention and tolerance is achievable. 

 

By Catherine Mitchell Jaxon, Co-founder of Mission MightyMe 

Please note: This blog post is for information purposes only and shouldn’t be used as personal, health, nutritional, or medical advice. Always consult your pediatrician with any questions about what to feed your child.