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Highland Park Allergy and Asthma Specialists

  • Writer's pictureHP Allergy and Asthma Specialists

Eczema, also referred to as atopic dermatitis, is an inflammatory skin rash. The skin will get dry, red, and very itchy. Approximately 31 million people in American have eczema. It is the most common chronic skin disease in young children with 10-20% of all children having eczema. Eczema is most common in infants and children usually showing up by age 5, but it can present in adolescents and adults. However, it is unusual to develop eczema after age 60. Eczema is part of the “atopic march”. The atopic march refers to the diagnosis of eczema during infancy, followed by the development of food allergies, then allergic rhinitis (often referred to as hay fever), and finally asthma. Studies have shown that up to 80% of children with eczema develop allergic rhinitis and/or asthma later in childhood.

Why do people get eczema?

Eczema is thought to be caused by a defective skin barrier. The causes of eczema are multifactorial. Genes and environment are both thought to play a role, with genetics playing a larger part. There is not just one gene involved in eczema. One of the most important genes found to play a role in eczema is related to a protein called filaggrin. This is a protein that helps hold moisture in your skin. Many people with eczema do not have enough of this protein or the protein does not work correctly. Eczema is not contagious, meaning you cannot catch it from someone else. It is often hereditary. If your parents have allergies or asthma, you are at increased risk to develop eczema. Environmental factors that are thought to possibly play a role in the development of eczema include climate, growing up in a rural vs. urban setting, exposure to non-pathogenic microorganisms (non-harmful), and water hardness. There have been studies that show increased number of siblings, early daycare exposure, exposure to farm animals, and pet dogs reduce the likelihood of developing eczema. These studies support the theory called the “hygiene hypothesis”. This theory states that exposure to certain germs and infections helps the immune system to develop and teaches to not overreact to harmless substances that cause allergies such as grass, dogs, trees, etc.

What are the symptoms of eczema?

The 2 main symptoms of eczema or severe itching and dry skin. Eczema has a waxing and waning course. You will have times where your skin is clear or much better and then times where your skin is flaring. When flaring, the skin will be extremely itchy with red bumps, flakiness, or blisters. Sometimes there can be weeping or crusting. In darker skin, the skin may be less red or more a deep brown or purply-red color. In chronic eczema, the skin can appear dry and scaly. The skin can crack and bleed. People can often develop secondary infections from scratching the skin. The itch from eczema can be described as unbearable affecting sleep and school/work performance.

How do you treat eczema?

The good news is that most children with eczema will outgrow it. There is no cure for eczema but there are treatments. The most important part of eczema treatment is MOISTURIZE, MOISTURIZE, MOISTURIZE. I always tell my parents/patients that eczema treatment can be time consuming, but it works. Moisturize several times a day if possible. A petrolatum-based moisturizer is the best like Aquaphor or Vaseline. These can be greasy so if you cannot stand the greasiness, you can reserve this for before bed and use a more lotion-like consistency moisturizer during the day. It is important to try to limit baths or showers to 10 minutes or less and use lukewarm water. Pat dry when you get out. The best time to moisturize is right

when you get out of the shower. The next step is usually to use a steroid cream when you have flares. There are a few topical medications that are not steroid-based that also work in eczema. There is a biologic therapy called Dupixent that is approved for moderate-to-severe atopic dermatitis that is not controlled with steroid creams. This should be a conversation between you and your healthcare provider to decide what it the best treatment for you.

There are other factors that can exacerbate eczema. Irritants can make eczema worse. Make sure to avoid fragrances in any moisturizers as well as your soaps and all personal hygiene products. Also, avoid other irritants such as fabric softeners, dryer sheets, bubble baths. Try to use a free and clear detergent. Irritants can also be dryness in the air or extreme heat or cold. Exposure to allergens can also worsen eczema. This can be allergens in the air such as dust or pollens. People often ask me about the role of food allergens. As we said earlier, children with eczema are at increased risk for other allergic conditions including food allergies. There are some children with eczema who will have certain foods which may not cause the stereotypical anaphylactic reaction but could flare their eczema. Milk, egg, wheat, and soy are the most common foods implicated in flaring eczema. We tend to try to not completely remove these foods from their diet unless eczema is severe due to the risk of developing a life-threatening anaphylactic food allergy after removing the food. It is best to speak with an allergic and discuss food allergy testing in this scenario. It is not recommended to test all children with eczema for food allergies as there is a very high false positive rate. This leads to misdiagnosis of and unnecessary food avoidance. Again, this is a very important discussion to have with your allergist.

In summary, it is important to discuss eczema with your healthcare provider and see an allergist for moderate-to-severe eczema. There are many treatment options. It is important to develop a plan that works for you and helps you live your life without eczema getting in the way.

  • Writer's pictureHP Allergy and Asthma Specialists

I hear many parents or kids say they cannot eat Chick-fil-a because they are allergic to peanuts and Chick-fil-a uses peanut oil. There is a lot of confusion surrounding peanut allergy and peanut oil. There are actually 2 different kinds of peanut oils – refined and unrefined.

Refined peanut oil (also called highly refined) undergoes a process in which it is purified, refined, bleached, and deodorized which removes the peanut protein from the oil. These processes extract the oil but eliminate the pigments, aromas, and flavors. Refined peanut oil is stable, has a long shelf life, and has a high smoke-point which makes it ideal for frying foods. Chick-fil-a and Five Guys use peanut oil. Unrefined peanut oil, also referred to as extruded, cold-pressed, aromatic, gourmet, expelled, or expeller-pressed, goes through mechanical processes to extract the oil but does not go through any chemical or high heat steps as with refined peanut oil. This leaves the peanut flavors in the oil. Unrefined peanut oil does contain the peanut protein. Peanut allergy is caused by an allergic antibody (IgE antibody) to the peanut protein and not to the oil.

In 1981, doctors took 10 known peanut allergic patients and gave them peanut oil in increasing doses. They had them return 2 weeks later to eat the peanut oil again. None of the 10 people had any reactions(1). In 1997, researchers fed both refined and unrefined peanut oil on separate occasions to 60 known peanut allergic patients. The study was called a “double blind study” which means the participants did not know which of the 2 oils the were going to receive at which time and neither did the staff who were administering the oils. None of the patients had a reaction to the refined peanut oil. Six out of the 60 had reactions to the unrefined peanut oil(2). Recent studies on peanut allergy show that the amounts of protein found in refined peanut oil do not trigger reactions in people who have experienced very severe reactions(3). In fact, the FDA has specifically stated that highly refined oils (which includes peanut oil) is exempt from the Food Allergy Labeling and Consumer Protection Act.

The take home message is that highly refined peanut oil does not contain the peanut protein and studies have shown it to be safe in peanut-allergic patients. This is the oil that Chick-Fil-A currently uses. Unrefined or gourmet peanut oil does contain the peanut protein and needs to be strictly avoided. Always communicate with the restaurant. Menus/ingredients are always subject to change, and the online version may not change as quickly. So make sure to speak with someone directly at the restaurant to be safe. You can always speak with your allergist to make sure trying peanut oil is right for you. Don’t be afraid to ask and unnecessarily miss out on a lot of mouth watering food out there!


1.) SL Taylor, Busse WW, Sachs MI, Parker JL, Yunginger JW. Peanut oil is not allergenic to peanut-sensitive individuals. JACI 1981;68:372-375.

2.) Hourihane JO, Bedwani SJ, Dean TP, Warner JO. Randomised, double blind, crossover challenge study of allergenicity of peanut oils in subjects allergic to peanuts. BMJ 1997;314(7087):1084-8.

3.) W Marty Blom et al. Assessing food allergy risks from residual peanut protein in highly refined vegetable oil. Food Chem Toxicol. 2017;106:306-313.

Prepare now so your child eases into a symptom-free year

For kids with allergies and asthma, summer break from school can also mean a break from their symptoms. When school starts up again in the fall, classrooms are often filled with allergic triggers kids don’t face at home, causing parents to see a return of allergy and asthma symptoms they haven’t seen since school let out for the summer.

In the fall, allergists see an increase in kids’ visits for allergies and asthma because of a combination of factors, and hospitals see what’s known as the “September Spike” because kids who have been off asthma controller medications for the summer start experiencing flare-ups in the fall. When kids return to school they’re exposed to different allergens – in the classroom, out on the playing fields and in the school cafeteria – many that they probably haven’t run into all summer. In addition, it’s ragweed season and for kids who are allergic, it’s a terrible time of year.

Below are five tips from the American College of Allergy, Asthma, and Immunology to help your child steer clear of fall allergies in order to focus on classwork and school activities rather than suffering from runny noses, headaches and asthma attacks.

1. Find an allergist, find relief – Well before your child heads into the classroom, make an appointment to see your board-certified allergist. Your allergist will create an allergy action plan for your child by identifying triggers your child may run into and helping them understand what causes their symptoms. Children with asthma under the care of an allergist have a 77% reduction in lost time from school, and an allergist can set your child on the right track, for the long term, to handle their allergies or asthma.

2. Identify potential problems at school – Sometimes parents must act as detectives to root out asthma and allergy triggers at school. Does the school have new carpeting? Sometimes volatile organic compounds (known as VOCs) can result from new carpeting and cause wheezing and sneezing. Are there open windows where pollen can drift into the classroom? Is there a class pet that might be causing allergies? How about mold in the bathrooms? Potential triggers should be discussed with the teacher and school administrators to help ease symptoms.

3. Everyone out on the field! – If your child has asthma or allergies, they should still be able to play any sport they choose as long as they follow their allergist’s advice. While playground games, physical education class, and after-school sports can all trigger exercise-induced bronchoconstriction (EIB), if your child’s asthma is under control, they should be able to participate. Asthma symptoms during exercise may indicate poorly controlled asthma. Make sure coaches and physical education teacher know what to do in case of an asthma-related event.

4. An allergist can confirm a food allergy diagnosis – Parents are sometimes given misinformation about food allergies thanks to home tests and unreliable sources. About 5-8% of children have diagnosed food allergies, and it’s important to work with an allergist to arrive at the diagnosis. If your child does have a food allergy, make sure the school is fully informed. Work with your allergist and school staff to have an action plan that lists the foods your child is allergic to, what treatment needs to be given, as well as emergency contact information.

5. Prep your child – Make sure you’ve discussed how to handle emergencies with your child. No matter what state you live in, your child has the right to carry and use asthma and anaphylaxis medications at school. Children who are at risk of anaphylaxis should have auto-injectable epinephrine available to prevent the severe, life threatening reaction caused by allergies to certain foods or insect stings. Consider getting them a medical alert bracelet. Be sure your child and school staff know how to use emergency medications.

A board-certified allergist is the specialist best trained to treat your child’s allergies or asthma. Work with them to make sure your child’s allergy medications are appropriate for their height and weight, their asthma action plan/food allergy action plan is up-to-date, and that symptoms are under control.

Credit: American College of Allergy, Asthma, and Immunology

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