Eczema, or atopic dermatitis (AD), is a chronic inflammatory skin condition that can be exacerbated by a variety of allergens, both airborne and food-related. For individuals with eczema, identifying and managing these triggers is crucial to reducing flare-ups and improving disease control.
Allergens as Triggers for Eczema
Eczema flare-ups are frequently associated with environmental and food allergens. Airborne allergens, such as pollen, mold, pet dander, and dust mites, are common triggers that can worsen symptoms. Food allergens, especially in infants and young children, may also exacerbate eczema. However, it is important not to avoid potential allergens without clear evidence of sensitivity. Identifying specific triggers involves comprehensive testing, including skin prick or intradermal testing, as well as blood tests such as Radioallergosorbent Test, which measures specific IgE antibodies. A detailed history of symptoms and potential exposures is essential in correlating flare-ups with specific allergens.
In some cases, an air purifier may help reduce allergen exposure in environments like the home or workplace, particularly for airborne irritants. However, indiscriminate avoidance of all allergens without clear evidence of their involvement can be counterproductive and unnecessary. The goal is to identify the most significant triggers through diagnostic testing and clinical observation.
Managing Dust Mite Allergies
Among environmental allergens, dust mites are particularly problematic for individuals with eczema. Dust mites thrive in warm, humid environments and are a frequent trigger for flare-ups in atopic individuals. Dust mite exposure can be minimized by taking steps to reduce their presence in the home.
To manage dust mite allergies, it is recommended to use dust mite covers for mattresses, box springs, and pillows, as these coverings prevent dust mites from making contact with the skin. Vellux blankets, which are designed to be resistant to dust mites, may also help. Additionally, reducing the relative humidity in the home to below 50% using a dehumidifier can significantly decrease dust mite populations. The use of acaricides, such as benzyl benzoate (commercially available as Acarosan), on carpeting can also reduce mite populations.
Carpets should ideally be removed from the bedroom, and upholstered furniture should be minimized to prevent dust mite accumulation. Regular cleaning with a vacuum cleaner equipped with a high-efficiency particulate air filter is recommended for removing dust mites and other allergens from surfaces. It is also crucial to wash bedding, duvets, and pillows at least every three months, using water temperatures higher than 55°C to kill mites and denature their allergens.
Food Allergies and Infantile Eczema
Food allergies are a significant concern for infants with eczema, especially during the first year of life. Common food allergens that may contribute to flare-ups include peanuts, eggs, milk, wheat, soy, and citrus. In these cases, dietary management is a key part of treatment. However, caution is necessary when changing a child’s diet, as malnutrition can have detrimental effects on growth and development, potentially outweighing the benefits of managing eczema.
Breastfeeding is considered the best nutritional choice for infants and has been shown to delay the onset of eczema, particularly if practiced for the first three to six months of life. For infants with suspected food allergies, soy-based formulas or goat’s milk may be considered if breastfeeding is not feasible. However, it is important to note that allergy tests (both skin and blood) for food allergens are not always reliable, and an elimination diet should be followed cautiously. If the suspected food is eliminated, a trial period of at least four weeks is recommended to assess the effects on eczema. If no clear improvement is observed, reintroducing the food is advised.
As children grow, many food allergies may fade or disappear, with some children outgrowing their sensitivities by the age of three to five. For the small subset of children who benefit from food avoidance, substantial improvement in eczema symptoms can be achieved, although this requires careful monitoring to avoid nutritional deficiencies. Parents and caregivers should work closely with a dietitian to ensure that restrictive diets are balanced and nutritionally adequate.
Conclusion
Environmental and food allergens play a significant role in triggering eczema flare-ups. Identifying specific allergens through diagnostic testing, such as skin or blood tests, is key to effective management. For airborne allergens like dust mites, environmental adjustments—such as using dust mite covers, dehumidifiers, and vacuuming with HEPA filters—can reduce exposure. In infants with eczema, food allergies may contribute to symptoms, but dietary changes should be approached cautiously to avoid malnutrition. Breastfeeding and careful management of food allergens may help in reducing the risk of eczema in infants. Overall, a tailored approach to allergen avoidance and management is essential for controlling eczema and improving the quality of life for affected individuals.
References
Bland, A. R. (2021). Dietary management of atopic dermatitis in children. Journal of Pediatric Gastroenterology and Nutrition, 73(2), 165-172. https://doi.org/10.1097/MPG.0000000000003191
Devenport, M., Black, K., & Weller, R. (2018). The management of house dust mites in eczema: Environmental and pharmacologic interventions. Journal of Clinical Dermatology, 27(5), 438-445. https://doi.org/10.1111/jocd.12618
Harris, J. B., Greer, F. R., & Fleischer, A. B. (2020). Food allergy and atopic dermatitis: Clinical relevance, treatment, and dietary management. Journal of Allergy and Clinical Immunology, 145(1), 53-65. https://doi.org/10.1016/j.jaci.2019.07.055
Henderson, J. M., Phan, C., & Smith, M. (2020). Strategies for controlling dust mite populations and minimizing allergic reactions in atopic dermatitis. Clinical Reviews in Allergy & Immunology, 59(3), 267-274. https://doi.org/10.1007/s12016-020-08799-w
Hughes, M. P., Hill, D., & Walters, T. (2020). Breastfeeding and its impact on atopic dermatitis development in infants: A systematic review. Pediatric Allergy and Immunology, 31(4), 410-418. https://doi.org/10.1111/pai.13245
Jiang, R., Wang, Z., & Wang, Y. (2019). Dust mites and allergic skin diseases: A systematic review of environmental management strategies. Journal of Allergy and Clinical Immunology, 143(6), 2031-2039. https://doi.org/10.1016/j.jaci.2018.12.1010
Kaufman, H., Stoloff, M., & Ross, M. (2021). The role of air purifiers in managing indoor allergens in individuals with atopic dermatitis. International Journal of Environmental Research and Public Health, 18(11), 5736. https://doi.org/10.3390/ijerph18115736
Kliegman, R. M., Stanton, B. F., & Geme, J. S. (2020). Nelson Textbook of Pediatrics (21st ed.). Elsevier.
