How are food sensitivities, food allergies or food intolerances linked (or not) with eczema and other childhood inflammatory conditions? My 2 older children have struggled with eczema for most of their lives. My middle child, Jake, had his most severe symptoms during middle school and high school. He never had any type of severe reaction to food, like a peanut allergy for instance, so we assumed his skin problems were NOT food related. Despite topical steroids (this is before I realized the error in my ways), his symptoms continued to worsen particularly on his chest, back, and face. We noticed he didn’t like to take his shirt off at the pool as he became more self conscious over the appearance of his skin. I had just transitioned to my holistic practice and found out about a different type of food test which checks the blood for a more subtle type of food reaction, and thus we uncovered the link.
See his test results below:
He was eating a turkey sandwich almost everyday for lunch – in addition to lots of eggs, almonds, cashews, cow’s milk and gluten. So we eliminated these foods for several months and his resultant skin changes were amazing. Then we started adding back one at a time – and some (cow’s milk), we were never able to bring back as they caused symptoms every time. This was a clear link between his food sensitivities and eczema. Now he is aware of what foods may cause his eczema issues to resurface and can decide for himself whether to eat those. So occasionally he will gorge on pizza knowing that it may cause a flare – but to him it’s worth it.
I continue to get so many questions on the difference between food allergies and sensitivities that I figured it was worth posting and trying to clear the air. The three primary terms used when discussing issues with food are food allergy, food sensitivity, and food intolerance. These terms get thrown around so much that the differences between them have been blurred over time and have led to appropriate skepticism from critics. I think it’s important to understand each term and how it was originally intended to describe issues with food. To consider how each may affect eczema keep on reading.
Classic Food Allergy
Food allergy describes an acute immune reaction to a protein in certain foods. Most people have a general understanding of food allergies such as peanuts, tree nuts, cow’s milk, eggs, soy, wheat, seafood, shellfish, and I even had a friend who swore he was allergic to bananas. Western medicine fully accepts the concept of food allergies and typically supports testing for these allergies. These food allergies cause such an immediate immune inflammatory response that they can be life threatening.
You have probably heard of someone with a peanut allergy who upon exposure to peanuts may experience difficulty breathing, acute hives, racing heart rate, and if not treated emergently may die. In fact, many define their allergy by how much time they have to access their epi pen before their airway closes. To understand this type of immune response we must first learn a bit about the immune system in general.
We have cells in our body that float around in our blood feeling everything they pass. When they feel something that is foreign and they perceive as dangerous, they begin a cascade of events to protect the body from this invader. One of those events is to remember the shape of the invader they just encountered, and then manufacture antibodies against this shape for future defense. That’s why you must first be exposed to a virus or food that your body begins to make antibodies against, so that in subsequent exposures your body is ready to react (this is why the first time in your life you touch poison ivy no rash occurs, but the next time watch out!).
Sometimes the body mistakenly makes antibodies against molecules which are actually friendly. Sometimes those friendly molecules are part of the body itself (this is the concept behind autoimmune disease). The higher the general inflammatory state the body is in, the more likely it is to create antibodies against friendly things. This is why some people tend to have multiple allergies.
Our body creates different types of antibodies based on how severe and acute it perceives the threat. For this type of food allergy, the body puts it into the highest threat category and creates an antibody known as Immunoglobulin E (IgE). When the IgE system gets activated the body mounts an overly aggressive response which can be life threatening. This response is so sensitive that you can typically test for it just by placing the problem substance on the skin. This is the idea behind the most standardized type of food allergy test – skin testing. Dozens of substances may be tested by placing small amounts on a patient’s back and waiting to see which cause an acute skin reaction. Western medicine has traditionally taught (wrongly) that if you don’t have an acute skin response then you have no issue with that particular food.
Classic Skin Testing for Food allergy
However, there are several problems with this approach. First, skin testing has only been shown to be about 85% sensitive to detect these allergies. This means that 15% of patients will have an acute food allergy that doesn’t show up on testing but may be wreaking havoc on the immune system. The second issue is that we now believe certain foods may stimulate another part of the immune system which is more subtle in it’s reaction. This other side of the immune system is where we believe much of the connection exists between eczema and food. Because the massive acute allergic response does not occur with these foods, it has been termed Food Sensitivity.
Food Sensitivity
As mentioned above, the body creates different types of antibodies based on how severe it deems the threat from a particular foreign substance. If the body created IgE antibodies for every foreign substance, we would constantly be faced with life threatening immune responses for things which aren’t all that dangerous. So the body has other types of antibodies to deal with these less acute situations. The one we will focus on for eczema is called Immunoglobulin G or IgG.
IgG is created for long term defense against foreign invaders. For example when we become immune to chickenpox after having the disease, it’s IgG that is providing that immunity. Over the past 20 years, compelling evidence has emerged that a number of chronic diseases may be related to food and an IgG response to that food. While an IgE allergic response occurs within seconds to minutes, IgG response takes anywhere from hours to 7 days. Thus, they are very difficult to find by skin testing. You can use a blood test to find IgG antibodies to many foods, but this is where the major controversy lies. You see, our body also creates antibodies to friendly foods during a process called immune tolerance.
We need to have a system in place that initially tags a new foreign substance (food) as questionable, but once it is deemed safe lets our body accept it without attack. During this “evaluation” phase of the food, IgG antibodies are also made. But here is where it gets tricky – there are 4 different types of IgG. New evidence suggests that IgG type 4 is the antibody made to foods that we will tolerate and not cause an immune response. IgG types 1,2 and 3 however, will all cause an immune response. So if we measure all types of IgG, we should be able to tell if the food is being seen as a harmful invader (IgG types 1-3 present) or if the food is foreign but friendly (IgG type 4). Significant disagreement exists over this concept of food testing between integrative medicine and traditional medicine.
I firmly believe that food sensitivity (IgG mediated) is a major culprit not only in eczema, but many other childhood inflammatory conditions including asthma, ADHD, irritable bowels syndrome, and others.
Food Intolerance
Lastly, is the concept of food intolerance. Certain individuals lack the correct enzymes to process and digest specific substances in food. The classic example is lactose. Lactose is a sugar found in milk. Our bodies require a specific enzyme called lactase, produced in the small intestine, to break down the lactose into simpler sugars which our gut can then absorb and utilize for energy.
People whose small intestine does not produce lactose suffer from lactose intolerance, a condition in which the unprocessed lactose gets passed to the large intestine where the bacteria ingest it and it ferments. This fermentation process in the large intestine leads to bloating and diarrhea. This food intolerance can be corrected by supplementing lactase to break down the lactose. Keep in mind though, there are some individuals who may have both a food intolerance and sensitivity to milk, meaning that simply taking lactase supplement may correct part of the problem, but they are still creating IgG antibodies to the cow’s milk.
Of note, most adults in the world (65-70%) are lactose intolerant. Makes me wonder if humans were really meant to drink cow’s milk!
Take Home Point
The interplay between the 3 types of food reactions discussed above is complex, still only partially understood, and truly an enigma of modern medicine. The reality is that there is likely overlap between the three issues, and that is why the terms have become intermixed and confusing.
We know there is a close interplay between true food allergies and eczema, as the presence of one is much more likely to mean the presence of the other. But how all 3 (food allergies, food sensitivities, and food intolerance) truly interact to contribute to eczema remains to be solved.
The bottom line is that no food allergy or sensitivity test is 100% reliable (or even 90% reliable). Given this discrepancy, the most reliable way to determine an issue with food is to eliminate the problem food and see if the condition improves. Although any individual can be intolerant to a plethora of foods, it turns out that certain foods tend to be the most common culprits. So the most reliable (and cheapest) way to start is to temporarily (and possibly permanently) remove those foods from your child’s diet. Then, progressively reintroduce the desirable foods once the gut has healed, to determine which foods are problematic.
Most of my families realize once they have given up certain problematic junk foods, they have no need to reintroduce them down the road. So its a win-win for the gut and for your skin and eczema! Also remember that our taste buds regenerate every 30 days, so many of the cravings for food that has been removed will simply disappear over time – patience is key.
A word of Caution when working with food sensitivity
One of the biggest mistakes families make with food elimination diets is that they progressively remove the concerning foods rather than replacing them with nutritionally equivalent foods. For example, if spinach is removed from a child’s diet due to histamine concerns, it should be replaced with kale. If nuts are removed from the diet, they should be replaced with olives or pumping seeds. There is a real danger to food eliminations done without expert guidance. The biggest issues I have seen with food elimination plans are that children become malnourished (which prevents eczema from healing), parents become orthorexic (fearful of food), and picky eating emerges as a real problem.
Food is complicated! If you are looking for a guided program for food elimination and reintroduction to treat eczema, check out my course with the button below. If you are interested in obtaining food testing through our clinic please email all inquiries to [email protected]
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Yours in Good Health,
Dr Temple
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