Helping Children

Some Topics

Eczema

Eczema is a common problem in children and is food allergy until proven otherwise. The problem often appears on the face as patches of reddish, scaling skin. As eczema worsens, the skin becomes more itchy, red, thickened, and grooved, and may blister, weep, and crack.

The typical distribution of eczema is on the face, behind the ears, on the fronts of the elbows, the backs of the knees, the hands, neck, and trunk. Elbow and knee flexures, wrists and ankles and neck are commonly involved. The neck may show increased pigmentation (dirty neck). Hands may be dry and thickened. The face is less frequently affected. The eczematous lesions tend to become more thickened with age. There is a tendency for the eczema to improve or disappear as children get older.

Toddlers and older children will often have food-allergic disease and may also have airborne allergy. Chronic nose and throat congestion is common. Sore throats and chinch coughs are also common. Coughing may progress to asthma attacks. Some children develop the whole complex of delayed pattern food allergy symptoms including behavior and learning disturbances. Children with typical atopy will also tend to develop immediate type allergic disease with seasonal pollen allergy and they may react to house dust mites, fabrics, cigarette smoke and fungi.

We noticed that there was a sub group of children with moderate to severe eczema who are otherwise happy, healthy children - they do not have the other problems suggestive of food allergy and we are inclined to look more closely food non-food environmental causes of their skin eruptions; nevertheless, some of these "healthy" eczematous children also respond well to diet revision.

Villaveces and Heiner reported remission of symptoms in six patients with severe atopic dermatitis by replacing food with an elemental nutrient formula for at least a week and then reintroducing foods to determine reactivity. Ratner et al reported similar success in 16 children and 14 adults with moderate to severe eczema. Sixty percent achieved significant remission after 3-12 days on an elemental nutrient formula. They noted that half the food challenge reactions were immediate and the other half delayed.

Although eczema is included in the atopic group, its mechanism clearly goes beyond type 1 hypersensitivity. Chronic inflammatory changes in the skin, eosinophilic recruitment, circulating IgA, IgG, IgE immune complexes, and demonstrations of associate increased gut permeability implicate all four hypersensitivity mechanisms in the pathogenesis of this common skin disorder. IgG complement-fixing immune complexes have been demonstrated in children with eczema. Complete diet revision is the best way to treat this disorder rather than selective elimination of foods either by history or skin test.

An Italian study of 5500 newborn infants with a family history of allergy found 4677 with elevated IgE levels in cord blood. The parents of these infants were encouraged to take preventive action to prevent atopic disease; breast feeding with reduction in the maternal diet of cow's milk, egg, tomato, fish was recommended for six months. Soya formula was used beyond six months -13.3% of infants on the prescribed regime developed atopic disease; 54.7% of the non-compliant group developed AD. 73.3% of the afflicted infants had skin involvement. Zeigler et al demonstrated a lower incidence of atopy at 12 month in infants whose diet and mothers diet excluded cow's milk, wheat, corn, soya, and citrus.

A prospective, randomized control study of 120 infants showed that avoidance of allergenic foods and smoke prevents allergy. Lactating mothers avoided milk, egg, fish, nuts and excluded these foods as well as soy, wheat, and orange in the infant's diet for the first 12 months. The restricted group had significantly less eczema and asthma. James et al performed double-blind food challenges in a group of 320 children with atopic dermatitis and confirmed food allergy in 64% of children who had skin disease.

The Decision to do Diet Revision The decision to modify the child's diet is made when the eczema is moderate to severe, especially when there are other problems suggesting food allergy. Allergy skin tests are not always helpful in identifying the trigger allergens. With milder eczema and strongly positive skin tests to specific foods, single food elimination may be successful in controlling the eczema. Dermatologists often deny food allergy leaving parents on their own to solve the problem. Allergy who rely only on skin tests are also not helpful.

With more severe, prolonged or complicated eczema, skin tests are never adequate to determine a new diet for the child and complete diet revision must be carried out. Follow Alpha Nutrition. Often, a retreat to phase 1 foods is adequate to improve the skin condition, although 2 to 3 weeks is required for healing to occur.

We have encountered children with extreme food sensitivity who do well only on a few foods and have used Alpha ENF to replace some of the missing foods and to supplement nutrient intake for several weeks to several months. Parents need to be very patient and determined to solve a severe eczema problem. The afflicted child suffers a great deal and may be irritable, hyperactive at times and emotionally unstable.

Eczema sometimes marks the child with food allergy who will go on to have learning problems at school because of hyperactivity and attention deficits. We see this as a packaged deal and treat the child compassionately with careful food and environmental control.