PODCAST: Food Fight - Drs Treat and Oza Debate Eczema Triggers

Vikash Oza, MD, and James Treat, MD, explore the topic, “Does Food Trigger Eczema?” Oza, an associate professor of dermatology and pediatrics and the director of pediatric dermatology at NYU in New York City, alongside Treat, a professor of clinical pediatrics and dermatology at the Perelman School of Medicine and an affiliate of the Children’s Hospital of Philadelphia, lent their expertise to 1 of the 3 “Great Debates in Peds Derm” at the 2024 Society for Pediatric Dermatology Annual Meeting in Toronto, Ontario, Canada.

Oza and Treat provided insights from their debate and share valuable pearls for clinicians concerning allergy and eczema. Oza started by emphasizing that atopic dermatitis (AD) is primarily a skin barrier issue with inflammatory responses, and current knowledge suggests that foods do not directly affect these processes. However, he acknowledged that secondary itching can occur when children eat foods they are allergic to, leading to scratching and worsening of eczema.

Treat explained that parents frequently conceptualize AD as being driven by diet, and as pediatric dermatologists, they often have to reframe this understanding. They pointed out that while food is not the root cause of eczema, it can trigger itching, which exacerbates the condition. The doctors highlighted the importance of validating parents' observations, noting that children with AD are more likely to have food allergies. They stressed that both conditions often coexist, and holistic treatment is necessary.

Oza and Treat discussed the complexities of diagnosing food-triggered eczema, including the use of oral food challenges and atopy patch tests. They noted that while these tests can help identify food allergies, they are not always conclusive, and false positives can lead to unnecessary dietary restrictions. They also emphasized that early introduction of allergenic foods can prevent sensitization, a shift from past practices that advised delaying these foods.

The doctors shared their perspectives on the evolving understanding of AD, noting that food allergies and eczema are intertwined through complex immune responses. They cautioned against broad testing for food allergies without strong evidence and highlighted the need for more research to better understand these conditions. They concluded that helping families navigate the risks and benefits of dietary decisions is crucial for effective eczema management.

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