Eczema is the word which is normally used for the tenderness and soreness stemming from an inflammation of the skin.

The physical symptoms are usually red and/or swollen places on the skin as well as itchy, red patches in various areas of the body. Anyplace where the skin can be ‘bent’ such as the crook of the arm and behind the knees seems to be a favorite location of eczema. Another area is around the belt line of the stomach

There are a many reasons named for the cause of the inflammation of eczema, but normally, as are nearly all health problems, eczema is an immune-system reaction. Children and adults alike can experience eczema, but more often than not, you will see eczema affecting children, and normally these children will be infants or toddlers. The FDA warns against overuse of several of the topical creams that are available for children who are under two years of age because of the strength of the topical ointment. Natural, “home remedies” as they are sometimes called, seem to be the safest route to use for small children and infants.

All dairy products and most forms of nuts, among other foods, can aggravate the symptoms of eczema. Eczema is believed to be connected to food allergies, so any food that a person or child may be allergic to could in theory cause the symptoms of eczema to worsen. Some of the other common food antigens are fruit, wheat, eggs, seafood, dairy products, and nuts. Keeping a diet log is not a bad idea since this can sometimes show a connection between a particular food being and the eczema symptoms growing in severity.

Eczema and Yeast or Candida albicans Problems

It’s interesting to note that when a person who has both a Candida overgrowth and suffers from eczema as well starts a Candida diet and protocol, as their Candida symptoms improve, so do their eczema symptoms. This fact alone points to a Candida albicans and eczema connection.

Research Studies: According to an article in the Journal of Investigative Dermatology, Malassezia sympodialis is an opportunistic yeast form which normally lives among the natural flora in the human intestines but can also cause a type of mediated sensitization in patients who are suffering from eczema. This is more proof of a connection between eczema and yeast.

In yet another research article, this one published in The Journal of Translational Immunology, a percentage of infantile patients initially diagnosed with infantile eczema also exhibited a defect in yeast opsonization. “Opsonization” is the natural process that causes pathogens such as yeast and disease-causing bacteria in the body to be coated with opsonin, a substance which marks the pathogen for elimination by the immune system.  This proven research outcome showing that infants with a defect in the body’s protective mechanism against yeast also exhibited eczema symptoms is just more proof of the connection.

Antifungals

An antibiotic (a drug which destroys bacteria) does not appear to improve symptoms of eczema when an actual infection is not apparent, and the non-infected cases seem to be the most common when it comes to the symptoms of eczema; however, it makes perfect sense that, since a Candida diet is known to improve eczema, so could an antifungal (a natural or manmade substance which destroys fungi). In fact, some doctors recommend the use of antifungals to their patients suffering from eczema. More proof that eczema is connected to a fungal overgrowth.

Some natural food sources of antifungals are garlic, Brussels sprouts, rutabaga, cloves, ginger root, cinnamon, and virgin coconut oil. Virgin coconut oil can also be rubbed into the eczema patches for relief as well as for better absorption into the bloodstream. Remember, you don’t want to purchase a ‘hydrogenated’ coconut oil, but preferably organic and virgin coconut oil. A natural oil which is also an antifungal is oregano oil but this should not be rubbed on the skin.

NOTE: If you have a Candida albicans overgrowth, you should be very careful with some of the stronger antifungals because they will cause the Candida die-off toxins to be released in your body, so if this is your situation, you should start with very low amounts of the following stronger antifungals; garlic, Brussels sprouts, and especially rutabaga and oil of oregano. Because of its powerful strength, oil of oregano should always be mixed with another oil such as olive oil; a premixed supplement of this can be purchased over the counter at vitamin and health food stores.

Probiotics suggested along with Prebiotics

In a study published in the Journal of Nutrition researchers looked at the effects of probiotics fed to mice. In this study, all of the mice exhibited intolerance to whey which is a component of milk. The mice were given milk, probiotics and prebiotics. Prebiotics are food for the beneficial bacteria in the intestines to help them survive as well as to quickly reproduce and repopulate the intestines. With this combination, the mice that were studied showed significant improvement with a dramatic reduction in skin reactions. Many health supplements as well as probiotic drinks and foods now contain both probiotics and prebiotics.

Beneficial bacteria in the human intestines which make up about 70% of the immune system are like any other living creature in that they must be fed in order to survive. A prebiotic is an indigestible oligosaccharide that is found in many common foods. Prebiotics are digested by the bacteria which live in the human digestive system. They promote growth of the bacteria by providing them with energy and nutrition. The MayoClinic.com website states that prebiotics support our immune function. Prebiotics contained in food are normally stable and can survive during the cooking process.

There are many vegetables which are rich in a compound called inulin which is the most common and abundant type of prebiotic. Examples of prebiotic vegetables are Jerusalem artichokes, garlic, leeks, onions and chicory root or 100% chicory coffee or tea. Chicory coffee and tea is caffeine free; organic 100% chicory tea and/or coffee should be on any Candida or yeast diet. Other vegetables are green vegetables with fiber such as asparagus and lightly steamed cabbage, broccoli, and kale, all of which contain some prebiotic properties.

Silica:  Silica is an essential mineral necessary to the human body; a supplement of silica can also help with eczema problems by increasing the amount of collagen in the skin. This gives the skin additional strength, and in turn will decrease the risk of skin damage that is often contributed to eczema.

Image Credit Care_SMC @ Creative Commons – http://www.flickr.com/photos/75491103@N00/

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Dr Susan Huang interview with MarcieMom, EczemaBlues.com

It’s fairly common to hear eczema patients lamenting that their doctors seem to be just prescribing creams and not listening enough. It can be even more difficult for parents, particularly as we are not the one ‘experiencing’ the eczema but we’ve got the responsibility to learn as much from the doctor (while keeping our toddler quiet)! MarcieMom is privileged to know Dr Susan J. Huang, the chief resident at the Harvard Dermatology Residency Program, who works at multiple prestigious hospitals in the United States.

More on Dr Susan J. Huang – Dr Huang is the chief resident of Harvard Dermatology Residency Program, and works at many hospitals including the Massachusetts General Hospital, Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center, Childrens’ Hospital of Boston, Boston VA Medical Centers, and the Lahey Clinic. She is also the author of DermBytes.com, an online resource and blog on dermatology. Dr. Huang has written book chapters, published peer-reviewed articles, and presented at multiple national conferences on issues and topics in dermatology.

Marcie Mom: Thank you Dr Huang for last week’s pre-consultation preparation, this week we are focusing on the communication during consultation.

MarcieMom: Most parents would have heard about allergy testing and after supposedly sharing with the doctor various suspected food & non-food triggers, he/she may expect to have an allergy test conducted for the child. Is that a reasonable expectation? Are there justifiable circumstances when a doctor would say that an allergy test is not needed? And should a parent always insist to have one? (as to how doctors decide on what triggers to test, refer to Prof Hugo and Dr Liew Q&A)

Dr Susan Huang: The decision whether or not to allergy test is one that is based on your child’s particular situation.  During your consultation, your physician will ask you questions about triggers to your child’s eczema.  Triggers may include food & non-food triggers as you mentioned.

As we discussed in the last post, it’s important to have the details of these triggers ready in preparation for the visit.  The visit will also include a physical examination to see whether findings are consistent with a food allergy.  If certain foods or other exposures are suspected, your physician can then work to help confirm the trigger and come up with an appropriate panel of tests.  Testing may include skin prick, RAST, or oral challenge testing.  If a contact dermatitis is suspected, patch testing is performed (this is where small quantities of different contactants are placed on the skin).

The role of allergy testing in eczema is still a debated topic but we certainly do know that allergies, asthma and eczema run together, creating the “atopic triad.”  Now, studies have shown that 1 in 28 suspected food allergies are not true food allergies, but rather “intolerances.”  So, it’s important to know whether one truly has a food allergy or not, because you don’t want to limit your child’s diet unnecessarily (providing well-balanced nutrition is important for the growth of your child!)

MarcieMom: The prescription given by the doctor is typically moisturizing creams with topical steroid treatment and the instruction usually to moisturize frequently while steroid is to be used sparingly and not more than twice a day. What would you advice the parent to find out more from the doctor? For instance, asking how the eczema rash would appear after a week of application? And when it’d be cause to come back earlier than scheduled for another consultation? (I think doctors usually refrain from talking too much about specific creams, parents can refer to this Q&A with Dr Verallo to identify the top irritants in creams and also this Q&A with Dr Bridgett to learn how to apply topical cream and steroid, and this post on steroid strength and steroid-phobia.)

Dr Susan Huang: Great question.  Questions about the use of topical steroids frequently come up. Make sure you review an Eczema Action Plan with your physician before you and your child leave from your consultation.  Having this information written down is important so that you don’t forget the details. Action items may include non-medication therapies (e.g. moisturizing, bathing techniques include bleach baths, wet wraps or wet pajamas, etc) as well as medications (e.g. topical steroids).  It is important to clarify how much of the lotion/cream/ointment, to where is should be applied, and when it should be applied and for how many days.  As you mentioned, also ask what you should expect to see at the end of the treatment course that your physician has detailed to you.  It is important to have this information written down because it’s hard to remember all these details!  We provide these written eczema action plans in our clinics.

Absolutely clarify follow-up plans before you leave for your visit. Your physician may tell you when to come back or may say to come back if the rash does not get better. In addition, she/he may give you a list of warning signs to look out for, e.g. if your child’s rash doesn’t get better after the treatment course, develops fever/chills, the rash becomes crusty, weepy or ulcerated — showing signs of infection, etc.

MarcieMom: Thank you Dr Huang, it’s good to know your point of view as to what is acceptable to be asked during a consultation, as some parents may be too shy and leave promptly with many questions still unanswered and then (worse), not carry out the treatment as directed cos they are fearful of what has been prescribed!

Kristin shares on managing allergy tests for child with multiple severe allergies

This is a 2013 series focused on personal journey with eczema while managing a certain aspect of life. Today, we have Kristin Beltaos, whose son has severe food allergies and shares how she manages his allergies via allergy testing. Kristin is a member of the Anaphylaxis & Food Allergy Association of Minnesota’s Speakers’ Bureau and a consultant/licensed trainer and owner of A Gift of Miles.

Marcie Mom: Hi Kristin, thanks for taking time to share with us about allergy testing. Let’s start with you sharing your son’s allergy history – when did he have them and did it show up as rashes on the skin?

Kristin: Hi Marcie, thanks for asking me to participate. My son’s allergies exhibited themselves prior to us leaving the hospital from his birth. He vomited and scream-cried after breastfeeding multiple times a day; physicians and nurses attributed the vomiting to a baby’s underdeveloped digestive tract. At six weeks, his pediatrician decided to have an Upper GI Series to rule out pyloric stenosis, a narrowing of the pylorus, the opening from the stomach into the small intestine that causes severe projectile non-bilious vomiting in the first few months of life. This test came back negative. It was decided that he had severe acid reflux and prescribed Zantac and later Prevacid in order to control his condition.

For the next seven months his vomiting continued, he also had eczema, unexplained hives, did not transition to baby food or table food and was labeled borderline failure to thrive for 18-months.

Two particular instances made us think something more was happening than acid reflux. The first was that I tried to wean a breastfeeding and provided him with a milk-based formula. He literally had one drop on his lips; his head looked like a red, cherry tomato and he scream-cried for over an hour. At first I thought, ok, ok, you’re a breast man and you don’t want a bottle. Then connecting the dots had us questioning…is this a clue for something else?

The second was the straw for my husband and I. I’d describe my son as a happy, but fussy baby. I know that sounds contrary, but he really was happy. One morning, he was fussy and I picked him up and kissed him all over his head to make him laugh. For every kiss that I gave him he had a nickel size hive, there were eight hives for eight kisses. I had cereal that morning, and while my lips weren’t wet with milk, there was residue. Later we found he was allergic to milk by touch and ingestion, along with other allergens.

Lastly, because of missing the window between four and nine months when oral motor skills are developed, he served 18-months in the Children’s Hospitals and Clinics Feeding Clinic to learn how to orally manipulate his food, i.e., chew, transition food from side-to-side, learn how much to chew prior to attempt swallowing and work on food texture issues. Even after he was diagnosed with his food allergies at 11-months, his food challenges haunted him until he was just shy of his fourth birthday.

I have to say all the while this was going on, I always knew something was wrong. I knew the doctors were missing something. So I tell parents, especially mothers, know that you aren’t going crazy and to seek opinions until you find an answer.

Marcie Mom: When was your child’s first allergy test and how did the physician help you to interpret his test results? 

Kristin: At 11 months, my son had a Radioallergosorbent Test, commonly known as RAST Test, which is a blood test used to determine to what substances a person is allergic. Our pediatrician broke the news to us that he was allergic to Cow’s Milk (including by touch due to the cereal and kiss episode), Eggs, Peanuts and Tree Nuts. In the summer of 2011 we added Sesame to his list.

After his diagnosis, we moved to a board certified allergist for care.

Marcie Mom: How often is a repeat allergy test required? And did it benefit your family to learn of new/ outgrown allergies?

Kristin: Obviously allergy testing is recommended whenever you have a new and/or unexplained reaction of course. For management of already diagnosed food allergies, the recommendation may vary from allergist to allergist and based upon each patient’s individual allergies and needs. Personally, I have my son’s allergies reviewed on an annual basis.

Coincidentally, we just had his allergen review within the past week. We received good and bad news. His Cow’s Milk numbers have been on the rise in the past two years, very disappointing as you can imagine. In this last test, his numbers more than doubled, placing him in the next Class level, Class 4 that is labeled as a Strong Positive. Our allergist continues to encourage us to stay hopeful, that the big reveal would be closer to when he enters high school as to whether this may be a lifelong allergy. He’s only seven, soon to be eight, so we have some time yet.

His Egg numbers have stayed the same; however, we are able to do a Baked Egg Challenge to see if he might be able to consume Egg in a baked good, i.e., muffins, cupcakes, cake, bread, etc. This is a test done in a supervised medical environment, clinic or hospital, with your board certified allergist or other medical representative present. I should add that this type of Challenge is not something done at home in your own experimentation.

We’re also investigating, via another blood test, whether he might be a candidate for a Baked Milk Challenge. The results remain to be seen on this front.

Peanut is no longer tested for because his numbers are too high. It is believed that peanuts will be a lifelong allergy.

Interestingly enough, his Tree Nut results have come back negative, pointing to outgrowing this allergy. We will investigate with a skin test to confirm and of course orally test him by having him consume Tree Nut(s) that are processed on dedicated lines with no risk of cross contamination with peanuts.

Lastly, his Sesame results came back very low, which may point to him outgrowing this allergy as well. We will pursue a skin test, should he pass, a Sesame Oral Food Challenge would be in the cards for him.

As you can see, testing regularly not only allows you to know the status of a person’s allergies. Moreover, if a child outgrows an allergy or allergens, it permits the reintroduction of food items permitting an expansion in diet. An expanding diet is ALWAYS a good thing. : )

Marcie Mom: One final question – for a mom who has difficultly with figuring out false positives in test results, what would you recommend to do?

Kristin: I honestly do not have any recommendations regarding false positives. What I do recommend is finding and partnering with a board certified allergist that you truly trust. In doing so, you’ll feel confident in the recommendations provided and can go about living life to the fullest with food allergies.

Marcie Mom: Thank you so much for sharing your journey on managing allergies and allergy testing – many eczema families are also ‘figuring’ this out and your sharing will be useful for them!

About Kristin Beltaos, M.A. – Kristin is the owner of A Gift of Miles, offers food allergy one-on-one consulting, national and local trainings, school consulting, and parent/school advocacy; and serves the markets of stress, with subspecialties, and reproductive challenges. She is a Licensed Trainer with the Minnesota Center for Professional Development, teaching food allergy continuing education to early childhood and school age providers and educators, a member of the Anaphylaxis and Food Allergy Association of Minnesota’s (AFAA) Speaker’s Bureau and a former board member. Kristin wrote and drove the implementation of the first food allergy 504 Plan in her child’s school, was influential in creating a new school food policy which eliminated food celebrations (both in classroom and school wide) – a policy that other schools are interested in emulating. Kristin was named a Top 25 Food Allergy Mom, 2012 by Circle of Moms. Stay happy and informed by following Kristin on her Facebook, Twitter and Pinterest.