I get a lot of questions about how to diagnose eczema and food allergies, which is an important question. One way to test for food allergies is through an elimination diet. In this article, we will discuss how to do an elimination diet for children with eczema. An elimination diet is a methodical way to introduce and take away food to find out if your child does indeed have a specific food allergy or sensitivity.
Is your child’s diet related to eczema?
As many of us have experienced, eczema (atopic dermatitis) can be caused by eating certain foods. This is a hot topic and has been studied for some time now. Several research papers have studied the relationship between eczema and food as a trigger for eczema.1 One thing to note is that doing an elimination diet for treatment of eczema is not the best thing to do. On the other hand, using an elimination diet as a way to test for eczema seems to be agreeable with many clinicians.
It is very challenging figuring out what foods cause eczema to flare. Some foods can cause flareups almost immediately (within a few minute) or sometimes it can take longer (up to 2 days after eating a specific food).2
How do you test for food allergies?
There are different tests that can be performed to confirm whether someone has food allergies .
Skin Prick Test
The skin-prick test is a common test done to diagnose food allergies.3 It is done by using the most common allergenic foods such as eggs, milk, soy, wheat, fish, peanut, walnut.1 Proteins from these foods are pricked on the skin to see if a reaction occurs. If no reaction is observed from the skin-prick test, then you most likely don’t have an allergy. On the other hand, if the test shows a positive result, then the results are more challenging to interpret. It’s very important to discuss with your allergy doctor regarding these results and not try to interpret yourself.
Food Challenge Test
An excellent way to test for food allergies is the “food challenge test”. The idea is to provide a food that may cause an allergic response and observe what happens. It is always done under the supervision of a doctor (allergy specialist) where they have epinephrine pens, steroids and Benadryl ready to give if an allergic reaction does happen. 5
What are the most common food allergies associated with eczema that should be avoided?
Eggs, milk, fish and peanuts are the most commonly associated foods that can cause eczema to flare.
Foods to Exclude
Here is a list of the most common food types and examples that are usually excluded in an elimination diet:6
| Food Type | Examples |
| 1. Dairy | · Milk, cheese, yogurt, ice cream |
| 2. Starchy food | · Wheat, barley, corn, spelt, rye, oats, bread |
| 3. Meat and fish | · Processed meat, cold cuts, beef, chicken, pork, eggs, shellfish |
| 4. Nuts and seeds | · All types of nuts and seeds |
| 5. Legumes | · Beans, lentils, peas, soy |
| 6. Fats | · Butter, margarine, hydrogenated oils, mayonnaise, spreads |
| 7. Beverages | · Alcohol, coffee, black tea, soda, other caffeinated drinks |
| 8. Sugar and sweets | · White/brown sugar, honey, maple syrup, corn syrup, high-fructose corn syrup, agave nectar, desserts, chocolate |
| 9. Citrus fruits | · Orange, grapefruit |
| 10. Nightshade vegetables | · Tomato, pepper, eggplant, white potato, cayenne pepper, paprika |
Foods To Eat
Foods to eat include those that are rich in omega 3, probiotics, and flavonoid.
Click here for more information about the benefits of probiotics in eczema.
Click here for important supplements that help eczema.
These are foods to consume while on the elimination diet. They are generally known to NOT cause eczema to flare up6
| Food Type | Examples |
| 1. Dairy substitutes | · Coconut milk, unsweetened rice milk |
| 2. Meat and fish | · Turkey, lamb, wild game, cold-water fish like salmon |
| 3. Fats | · Cold-pressed olive oil, flaxseed oil, coconut oil |
| 4. Beverages | · Water, herbal tea |
| 5. Grains | · Rice, buckwheat |
| 6. Fruits | · Most fruits (excluding citrus fruits) |
| 7. Spices, condiments | · Black pepper, fresh herbs & spices (excluding cayenne pepper and paprika), apple cider vinegar |
How does an elimination diet work?
The general principle of an elimination diet is to take out the possible food causing allergies and see how your child reacts. If the symptoms improve, we have a clue. The possible offending food is reintroduced and if symptoms return, then we have an answer. If the food doesn’t cause a reaction, then most likely this is a safe food.
Why should you do an elimination diet for eczema?
Elimination diet is particularly useful in both the diagnosis and treatment of eczema caused by food exposure. Eczema is a chronic condition. It’s very frustrating to deal with, not to mention expensive as you are probably spending a lot of money and time testing products that may or may not work.
For these reasons, an elimination diet can be helpful to figure out what food is causing eczema. Remember, eczema is treated from the inside and outside.
When should an elimination diet not be done for eczema?
If your child is suffering from nutritional deficiencies, you should be careful of starting an elimination diet. Since you are eliminating certain foods that may be essential to your child’s health, you might be depriving them. That’s why it’s important to do an elimination diet under the supervision of your pediatrician. For example, since dairy is usually eliminated in an elimination diet, calcium and vitamin D will not be consumed. It’s important to supplement with certain nutrients while on the elimination diet and the best person to tell you is your child’s pediatrician.
What are the potential risks of an elimination diet when it comes to eczema?
Increased food sensitivity
It can be a great relief to finally improve your child’s eczema from diet restriction. Please be careful. Removing foods for a long period of time may cause more harm than good. Exposure to foods builds tolerance. Since your child’s tolerance decreases due to a lack of exposure, the sensitivity increases. When the possible offending food is reintroduced, this may even result in anaphylaxis (severe allergic reaction) requiring hospitalization.9
Malnutrition
As mentioned, the top eight food allergens are eggs, milk, soy, wheat, fish, shellfish, peanuts and tree nuts. Removing these from your child’s diet may lead to nutritional deficiencies. Appropriate alternatives must be given so as to maintain adequate nutrition.1,3,4
Social isolation
Since your child is avoiding foods that other children are eating, it can cause your child to feel isolated in social settings. For example, birthday parties typically serve pizza (cheese) and ice cream (dairy). Food is a way to bond and by avoiding eating these foods, your child may end up feeling isolated from other children.
Is it safe to try an elimination diet for eczema?
In general, an elimination diet is considered safe for eczema, BUT, you should definitely do it under the guidance of a medical professional.
Despite the benefits that may result from elimination diet, there are still risks as mentioned above. It’s wise to consult with a physician/dietitian/nutritionist to formulate a plan for elimination diet.
Health professionals can guide you to ensure which foods are properly eliminated from the diet AND how to incorporate them back. Also, you can make sure that your child’s nutrition will not be compromised from an elimination diet by supplementing with alternative foods/supplements. Finally, it’s important to monitor for eczema flare-ups and allergic reactions as foods are reintroduced.
The Elimination Diet Plan: 4 Phases of Elimination Diet
Preparation Phase
Commitment is very important for an elimination diet to be successful. If the child is old enough to understand, parents should explain why they can’t eat certain foods that other kids can. Patience is crucial for parents to remind their children why they’re doing an elimination diet. Using a reward system can also be helpful.
Parents should also prepare to consult a physician/nutritionist. This is to prevent the risk of malnutrition and anaphylactic reactions.
Elimination Phase
In the elimination phase, the food suspected to cause eczema is removed from the diet. With the guidance of a physician and nutritionist, this phase may take about 2-4 weeks. It is best to notify them whether your child’s eczema improves or worsens and if there is an emergence of new symptoms so that you may be advised accordingly.
Keeping a diary of reactions can be helpful while doing an elimination diet.
Reintroduction Phase
The following phase involves the gradual reintroduction of the eliminated food back to the regular diet. Take note that a physician’s supervision is of greatest importance in this phase to keep an eye on any allergic reaction whether mild or severe so that appropriate treatment may be given. A good rule of thumb is to add the food back into the diet in small amounts first with an interval of 4 days. This will allow the body to heal in between food exposure as well as to prevent the food’s build up in your system.10
Maintenance Phase
If a certain food can be consumed every 4 days without causing an allergic reaction, then one can assume that it is fine to eat. You may then move on to the next food group to test.
Conclusion
I hope this article helps guide you on how to do an elimination diet for eczema. Again, it’s important to do this under the guidance of a medical professional. It is not easy to do, but it can be very helpful in figuring out what food(s) are causing your child’s eczema to flare. It is hard, but if done correctly, it will be worth it.