There’s a link between what you eat and skin flares due to atopic dermatitis, aka eczema. And it’s personal.
"Unfortunately, there’s no one-size-fits-all eating pattern that would help everyone who is struggling with atopic dermatitis," says Caylee Clay, RDN, CDN. Clay is a New York City-based dietitian who specializes in autoimmune diseases and is the author of Gain Control Over Your Psoriasis. "One food that may aggravate or irritate one person's atopic dermatitis may not affect the next person's. The trick is to identify which foods are your personal individual triggers."
Over time, research has found more evidence that AD drives the development of food allergies, not the other way around. The good news is that it’s not hard to zero in on flare-trigger foods while still enjoying a well-balanced nutrition plan.
Get Tested for Food Allergies
"This is of particular importance, as 35% of adults with atopic dermatitis have allergies that can cause or worsen symptoms," says Clay.
Allergens don’t always cause problems for people. An AD flare happens when your body perceives the allergen as a threat and reacts to defend itself. You might already have ID’d your allergies, or know others who have reactions if they eat or drink certain things. Some common food allergens are:
- Animal meat
- Eggs
- Fish
- Milk
- Nuts
- Peanuts
- Soy
- Wheat
There are blood tests to detect allergies, but AD providers often choose to do tests on your skin. The one most used to test for food allergies is a painless skin prick or scratch test, also called percutaneous test or puncture test. A droplet of a potential allergen is lightly pricked into your skin to see if your body reacts. Your provider likely can report the results to you that day.
They’ll also use your medical history to help decide if you need to avoid certain foods.
Limit Histamines
If you struggle with itching, it can help to limit foods that are high in histamine. Histamine is a chemical your immune system releases. It can play a role in allergic symptoms. Your body stores histamine in certain types of white blood cells: mast cells in your connective tissues and basophils in your blood.
Histamine does good things for your body, too. Some foods carry high loads of it, though, which can add to your flares. They include:
- Aged cheese
- Alcohol
- Avocados
- Dried fruits
- Eggplant
- Smoked or processed meats
- Spinach
- Yogurt
"Working with high-histamine foods is a complex yet poorly understood topic, so it may be best to seek support from a registered dietitian," Clay says.
Find Out Food Sensitivities
Food sensitivities are different from allergies. They can show up as stomach or joint pain, fatigue, or brain fog. Gluten is a good example of a substance that can set off symptoms of food sensitivity. Medical experts think flares happen when certain foods cause an immune reaction in your body, and unpleasant, but not usually dangerous, symptoms happen.
"Food sensitivities will not show up on food allergy tests," says Clay. "If additional food sensitivities are still suspected, then a trial period without that food may be appropriate." This is a different approach than so-called elimination diets, which can be so strict that they lead to disordered eating.
It’s best to take a more gentle, organic route. "To identify a food sensitivity, first choose only one food that you suspect is causing you problems," Clay says. "Many people with autoimmune disease like atopic dermatitis find that they are sensitive to gluten, dairy, or nightshadevegetables" such as peppers, tomatoes, and eggplant.
After you find sources of potential sensitivity in what you normally eat, scope out alternative foods you can enjoy. For example, you might try swapping out regular bread for gluten-free.
"Next, try to avoid consuming your suspected food sensitivity as much as possible for one month, using your acceptable alternatives to help you continue to enjoy eating," says Clay. "After one month, reintroduce your food sensitivity. Monitor your symptom severity to determine if you are reacting to this food. Generally, it is clear whether the food is a trigger or not. A registered dietitian can support you during this process."
Clay notes it can be hard to separate gastrointestinal issues from true food sensitivity. "If multiple food sensitivities (that are not allergies) are identified, then it's likely that an additional medical issue is going on that needs to be treated or addressed. Consult a gastroenterologist and/or dietitian for support in navigating this tricky situation."
Avoid Strict Diets
Clay never recommends trying any kind of strict diet to try to manage your AD. This includes not only elimination diets, but meal plans that focus on particular nutrients or foods instead of a well-rounded plate. "The research shows little to no evidence that these diets work, while there is a strong and growing body of research demonstrating a large risk of developing an eating disorder for people living with atopic dermatitis, as well as other autoimmune diseases," she says.
Eating disorders have a low recovery rate and a high death rate. Dieting is another known risk factor for developing eating disorders.
Focus on Foods You Can Eat
While it’s key to figure out what’s causing your skin flares, maintaining balance in your diet should be the goal. "While people often focus on foods that they should cut out of their life," Clay says, "it’s actually more helpful and beneficial to think about foods you could be adding to your life.
"Finding an eating pattern that is rich in fruits, vegetables, whole grains, protein, fiber, and unsaturated fats is a great place to start."
Except for foods you’re allergic to, there are no specific foods Clay would recommend avoiding entirely. Promoting and maintaining a safe relationship with food is important for your mental health. "Focusing on incorporating specific nutrients can be beneficial as well. For example, vitamins C, D, and E are all known to be beneficial. Fish oil or other sources of omega-3 fatty acids may help as well."
Once you’ve ID’d food allergies and sensitivities you have and you’re comfortable managing your symptoms, you can even have small amounts of foods you’re sensitive to. Clay is a big believer in being your own judge of what you eat.
"I like to tell my patients that it is always their decision whether they want to avoid a flare-up or enjoy a food that may give them some pain," she says. "Sometimes, you would rather be in pain later instead of, for example, missing out on eating a slice of your grandma's homemade cake. There is nothing wrong with that decision, and it's a decision that you get to make every single time for yourself."
Show Sources
SOURCES:
Caylee Clay, RDN, CDN, New York.
Journal of Clinical Medicine: "Atopic Dermatitis and Food Allergy: A Complex Interplay What We Know and What We Would Like to Learn."
Cleveland Clinic: "Histamine."
MedlinePlus: "Allergen."
Mayo Clinic: "Allergy Skin Tests."
American College of Allergy, Asthma, & Immunology: "Testing and Diagnosis."
Harvard Medical School: "Food Allergy, Intolerance, or Sensitivity: What’s the Difference, and Why Does it Matter?"
National Eczema Association: "A Look at the Food Elimination Diet Trend for Atopic Dermatitis."
