Eczema and Food Allergies - Takeaways for Pediatricians from the Stanford Symposium: The Future of Food Allergy Prevention

Last week, we attended “The Future of Food Allergy Prevention" Symposium hosted by Dr. Kari Nadeau, SpoonfulONE founder and head of Stanford University's Sean N. Parker Center for Allergy and Asthma Research. The symposium featured pediatric immunology and allergy experts from the US,  Japan, the UK, Australia, Ireland, and Switzerland who reviewed their research covering topics as diverse as moisturizer and bathing frequency, gut microbiome, and prebiotics/probiotics on the development of allergic disease. 

In the first part of our series, we’ve summarized the key takeaways about moisturizers and skin barrier protection that pediatricians immediately put into clinical practice.

Helen Brough, PhD, MBBS from King’s College London and Donald Leung, MD, PhD from National Jewish Health in Denver, Colorado spoke of the relationship between a baby’s skin and food allergy risk. They reviewed how the dual allergen hypothesis* continues to show that any exposure to food particles or food ingredients through the skin can lead to sensitization in early life.

3 key takeaways to share with parents of newborns:

1. Both the type and frequency of the moisturizers matter. More is not better, and some moisturizers may even cause damage. 
2. For healthy infants without atopic dermatitis, skin barrier protection means bathing infants less frequently (no more than 2 times per week) and not using soap, moisturizers, or oils whenever possible. The speakers shared data that found that increased use of some moisturizers, specifically olive oil, could be associated with greater food allergy risk in childhood for a number of potential reasons, including impeding the development of lamellar structures in the skin or potentially facilitating the transfer of allergen to the skin. To be prudent, parents should avoid moisturizers that contain food ingredients (e.g., sesame, almond, peanut).
3. For babies with atopic dermatitis, known to be the leading risk factor for food allergies, the speakers recommended daily bathing because their skin is considered “to be a wound.” Early research supports the use of trilipid cream over petrolatum-based emollients as a moisturizer for eczematous children. It is particularly important that parents wash their hands before applying anything to their baby’s skin, to prevent small food particles from entering the skin that may remain on their hands from eating or food preparation.

 

Please be on the lookout for future articles summarizing other topics from the symposium. Access the full talk here. 

 

Citations: 

1. Leung DYM, Calatroni A, Zaramela LS, et al. The nonlesional skin surface distinguishes atopic dermatitis with food allergy as a unique endotype. Sci Transl Med. 2019;11(480):eaav2685.
2. Perkin MR, Logan K, Marrs T, et al. Association of frequent moisturizer use in early infancy with the development of food allergy. J Allergy Clin Immunol. 2021;147(3):967-976.e1. doi:10.1016/j.jaci.2020.10.044.
3. Sindher S, Alkotob SS, Shojinaga MN, et al. Increases in plasma IgG4/IgE with trilipid vs paraffin/petrolatum-based emollients for dry skin/eczema. Pediatr Allergy Immunol. 2020;31(6):699-703. doi:10.1111/pai.13253

 

*We like the way  Scientific American summarized the process by which an infant’s skin can play in food allergy development: “The dual-allergen exposure hypothesis is the theory that exposure to food allergens through the skin can lead to allergy, while consumption of these foods at an early age may actually result in tolerance, as Lack explains in a 2012 article. Depending on the balance of these exposures, either tolerance or allergy will “win.” Children with eczema, for example, have a disrupted skin barrier that could allow exposure to food proteins in the environment – such as peanut oil in creams or peanut residue on tables. Under the hypothesis, if these children avoid peanuts but are still exposed to them in the environment, they might be more likely to develop peanut allergy.”