Atopic Eczema and Diet
Among eczema sufferers and their families there is a tremendous amount of interest in the role of diet in this condition. Many people try modifying their diet in the hope of curing eczema, but unfortunately this is rarely successful. It is likely that in some individuals, certain foods can aggravate eczema and make it worse. This mostly applies to young children under the age of three, especially those with quite severe eczema. Food is rarely of relevance in older children or in adult eczema. Regrettably, a quick and simple test that says 'yes' or 'no' to the question of whether eczema is food aggravated does not exist, and many of the questions regarding eczema and diet remain unanswered. For the majority of eczema sufferers, current medical advice is to follow a healthy, varied and balanced diet, and to focus their attention and energy on using their treatment most effectively.
The pregnant mother's diet and eczema prevention
There have been several studies looking at whether restricting the mother's diet during pregnancy will reduce the chance of her babies developing eczema. These have shown no evidence of benefit, but have shown a possibly harmful effect because the babies were born smaller than usual. It is extremely important that pregnant mothers have a healthy and varied diet in order to provide their growing baby with a good balance of nutrients. Mothers should not smoke during pregnancy because this has many harmful effects on their baby, as well as increasing the risk of allergies. Alcohol intake during pregnancy has also been linked to allergic conditions, and should be kept to a minimum.
Breastfeeding and eczema
The recommendations for allergy prevention are that newborn babies should be fed only breast milk for the first six months. Breast milk is preferable to formula milk because it is germfree, readily available, and always at the correct temperature. It also contains protective antibodies which give the young baby some immunity against infections. Breastfeeding does not always come naturally, and new mothers may need a lot of practice, help and support in the early weeks after birth to establish a regular feeding routine. Exclusive breastfeeding is physically demanding for the mother as it means not being able to top up with a bottle of formula milk at the end of the day when she's tired and her milk supplies are low. Numerous studies have looked at whether breastfeeding reduces the chance of babies getting eczema and other atopic conditions. Most of these have shown an overall benefit, but there are some inconclusive areas. Breastfeeding probably halves the chance that the baby will get eczema, but does not totally prevent it
One of the complicating factors is that breast milk is not a simple substance, but contains traces of food that the mother has recently eaten, including, for example, cows' milk. If a baby is at high risk of getting atopic conditions it may be of help if the mother stops eating certain allergy provoking foods such as cows' milk and nuts while she is breastfeeding. A few studies have shown that this reduces the chance and severity of baby eczema between 12 and 18 months. Larger studies are needed to find out whether these results are correct.
Formula milk and eczema
Formula milk is an alternative to breast milk that has been specially modified to contain the correct balance of nutrients for a young human baby. Most currently available formula milks are made from cows' milk and contain cows' milk protein, which can cause allergic reactions. Feeding young babies with cows' milk formula instead of breast milk increases the chance that they will become allergic to cows' milk protein. Because of this, 'hypoallergenic' formulas have been developed in which the proteins are digested or hydrolyzed to make them less allergy provoking. Hypoallergenic formula milks are described as 'partially' or 'extensively' hydrolyzed depending on the degree to which the protein is broken down. More recently, formula milks have been made from the smallest possible protein components which are called 'amino acids'. These milks are called 'elemental feeds' and are the only formula milk that is totally non-allergenic and suitable for babies with severe cows' milk protein allergy.
Unfortunately, extensively hydrolyzed and amino acid-based formula milk is much more expensive than standard formula milk and less palatable because it tastes bitter.
There is some evidence that feeding with an extensively hydrolyzed formula milk rather than with standard formula milk, and avoiding cows milk-containing foods for the first six months of life may reduce the chance of developing food allergies and eczema in babies who are at a high risk of getting these conditions (i.e. in families where parents and siblings have atopic conditions).
Soya milk is made from soya beans and is therefore a plant product. The protein in soya milk, is at least as likely to cause allergies as cows' milk protein, so there are no advantages to weaning a baby on to soya formula milk. It can be used as an alternative in babies over six months old who are allergic to cows' milk and on an exclusion diet. However, there are some recent concerns about the long-term safety of giving soya milk in early infancy because it contains estrogen-like substances.
Goats' milk is very similar to cows' milk and is therefore not a suitable alternative for babies allergic to cows' milk.
Rice milk can be used as an alterative for older children. It has a good calcium content, but limited nutrients.
Weaning, infant feeding and eczema
The ideal diet for a baby who is at risk of atopic eczema or already suffers with it is not known with certainty, but some experts recommend avoiding cows' milk-containing foods for the first year, with continued breastfeeding if possible, or giving hydrolyzed formula milk. A baby's digestive system needs time to adapt to food, so solids should not be introduced before six months. However, it is important that babies start some solids at this age in order to gain weight and learn how to feed. Babies should be weaned on to pureed fruit and vegetables, then on to an extra energy source such as baby rice or potatoes. Ideally, food should be prepared flesh to avoid artificial colorings and additives, and any convenience foods should be as free from these as possible. Breast or formula milk should still be the main source of protein and fat for at least the first year. It is recommended that infants at a high risk of developing allergies should not eat peanut-containing food until over three years old, but current advice is that all other foods can be introduced gradually after weaning.
Exclusion diets - who needs them?
Babies' and children's bodies are rapidly developing and growing, and therefore it is essential that their diets contain the correct balance of nutrients. For this reason, major adjustments to the diet such as omitting cows' milk - which is an important source of protein and the main source of vitamin D and calcium should NEVER be undertaken without guidance from a dietician. Well-meaning parents have harmed their children by putting them on exclusion diets without proper advice. A dietician will check that an exclusion diet contains the correct nutrients, and will explain which foods to avoid and how to check ingredient labels properly. Dieticians can give helpful ideas for family meals and snacks as well as advising on how to arrange school meals.
An exclusion diet is carried out for a set length of time, usually four to six weeks. In order to see if it is helping, it is important not to change any other treatment the child receives at this time. The main problem in assessing the effects of an exclusion diet is that eczema naturally fluctuates in severity, and any improvement may have been coincidental rather than because of the diet. If the exclusion diet does not help, the child should resume a normal diet and concentrate on other aspects of eczema treatment.
Exclusion diets are time-consuming and can be difficult to organize in a busy family with other children. Consequently, they are generally only recommended if the child's eczema is , moderately severe and not improving with prescribed treatment, or in milder eczema where there is a history that suggests food allergy.
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