Eczema Tips

Ask #SkinishMom – Why Can’t the Doc Just Give Me the Allergy Test?

#SkinishMom Parenting Skin Expert
Ask #SkinishMom any question – parenting, skin, eczema or plain venting!

My kid has eczema and we haven’t figured out what is the trigger. I’ve been asking the doc about taking an allergy test but the doctor either say that my kid’s eczema is only at a certain area, so no testing is needed or say that it’s those common allergens that affect almost every child, so again no testing is needed. But there’s no CONCRETE EVIDENCE of WHAT’S TRIGGERING MY CHILD’S ECZEMA – why can’t the doc just give me the test?

Frustrated Mom

I totally understand, many moms feedback the same and many docs replied the same. The short reply is if taking an allergy test is on your mind 24/7, just demand it. If the dermatologist that you’re seeing refuses to prescribe one, go to another doctor. After all, eczema is a long-term situation that requires much working and communication with your doc; if you can’t even agree on something as basic as whether or not to allergy test, it’s unlikely that this is a doctor that you can work with.

Allergy test for eczema child

On presenting both sides of the story:

From the parents’ view:

  1. You’re tearing your hair out figuring out the triggers, you need an allergy test to get some answers.
  2. You’re growing day by day fearful of applying corticosteroid cream on your child, figuring out the trigger means less flare-ups and less need for the steroid.
  3. You’re breastfeeding still and you seriously are going nuts on what you can or cannot eat.

From the doctors’ view:

  1. Your child’s eczema is localized, say on the face, thus likely due to saliva or food residue irritating the child’s skin. 
  2. Allergy testing is unlikely to be accurate for a baby (less than 6 months) and therefore, testing and working on the inaccurate results may turn out to be even more confusing for the parents.
  3. It is true that most of the children are affected by the common allergens of cow’s milk, egg, soy, wheat, seafood, dust mite, pet dander and pollen. Younger children are more affected by food while older children are commonly affected by dust mite. It is therefore a waste of money to be testing for something when you’d already know the test results.

SkinishMom’s view:

  1. Go for allergy testing, even if it’s going to turn out results you’d expect (so you know for sure).
  2. Go for allergy testing at the clinic/hospital where you’d want to see the doctor, because the results have to be interpreted and collaborated, with future action plan for eczema care
  3. Don’t go for allergy testing online or some ‘innovative’ allergy tests – skin prick, blood IgE and skin patch are the standard tests

Do what you (as a mom/dad) think it’d give you peace,


Youtube EczemaBlues Channel

(Video) Quick Guide on Allergy Test for Kids

This is the fifth of baby skincare series, focusing on Allergy Testing. The previous four videos were on Common Baby Rash I Sun Protection for Kids I How to Shower Baby I How to Moisturize. I NEED YOUR SUPPORT, do subscribe to my EczemaBlues channel here. As I’m just starting out, and camera-shy, the video is my voice over slides that I prepared. Do share your comments pleeease on how I can improve them.

Firstly, understand that eczema is also known as atopic dermatitis, inferring that there is an atopy ie hypersensitivity to allergen involved. However, not all eczema children will have an allergy, for instance, my child is tested negative to the common allergens.

For most parents then, it makes sense to find out the allergens involved in your child’s eczema, eliminate/avoid these triggers, so that your child’s skin can heal (versus constantly being provoked to skin inflammation). There are two common allergy tests,

1. Skin Prick Test – this is recommended as it is fast, accurate and low cost, it’s not scary and my daughter didn’t cry at all when she had it at 7 month old. Many parents are worried about how many allergens the child has to be pricked with, but this worry is undue as there are few common food, environment allergens that most kids react to and thus only these need to be tested. Read more on SPT here.

2. Blood IgE test – this is usually recommended for babies without clear patch of skin or unable to go without antihistamine (which is necessary to abstain for a week before the SPT). Read more on allergy test here.

The allergy test is done during consultation and parents should not be afraid to ask your doctor the next course of action and how you’d expect your child’s skin to be within the next few weeks of prescription and allergen avoidance. Don’t be shy!

Do watch the video for more details and as always, appreciate you sharing your experience. Also what other videos would you like to see, do leave me a comment!

Doctor Q&A

Parent (Patient) Eczema Consultation Tips with Dr Susan J. Huang – Before Consultation

It’s fairly common to hear eczema patients lamenting that their doctors seem to be just prescribing creams and not listening enough. It can be even more difficult for parents, particularly as we are not the one ‘experiencing’ the eczema but we’ve got the responsibility to learn as much from the doctor (while keeping our toddler quiet)!

Eczema Consultation How to Talk to Your Child Dermatologist Dr Susan Huang

I am privileged to know Dr Susan J. Huang, the chief resident at the Harvard Dermatology Residency Program, who works at multiple prestigious hospitals in the United States. She has written book chapters, published peer-reviewed articles, and presented at multiple national conferences on issues and topics in dermatology.

Marcie Mom: Thank you Dr Huang for taking your time to offer tips to our parents on what they can do before, during and after consultation, as well as what they need to consider if changing their doctor. Let’s start right away with preparing for a doctor consultation.

How to Prepare for Your Eczema Consultation

MarcieMom: I’m assuming that the child has already been diagnosed with eczema and the parent is looking for a suitable doctor. In Singapore, there are many good doctors, some of whom listed here. I note that each doctor has their own specialty/ interest apart from being a pediatrician – immunology, allergy, asthma and/or dermatology.

Must a parent specifically ask for a doctor in a particular specialty?

Dr Susan Huang: When looking for a doctor for your child with eczema, it is important that the physician has taken care of many children with eczema and thus has sufficient experience and knowledge about eczema.  In the U.S., physicians who routinely take care of children with eczema consist primarily of dermatologists, allergists/immunologists, and pediatricians.  The relationship between the physician and the parent(s) and child is also very important.  Treatment of eczema involves many behavioral components and these take time to review and demonstrate at the visit.  You will likely be seeing this physician many times over years (unless you don’t like him/her!), so it’s important to have a good patient-physician relationship.

Communicating Your Child’s Eczema History

MarcieMom: One of the key reasons why I brought my baby to see a specialist in a children hospital was because allergy tests are not available at a general practitioner or even pediatric clinic. Read here for preparation before a skin prick test. Apart from physical preparation (no antihistamine, good health), how can a parent help the doctor who is seeing the child for the first time to learn as much about the eczema/skin condition?

How can a parent help the doctor who is seeing the child for the first time to learn as much about the eczema/skin condition?

Keep a food diary versus skin condition? If yes, for how long? Write down suspected triggers? Write down how the parent has been managing the skin, for instance, already using hypoallergenic detergent or vacuuming weekly?

Dr Susan Huang: Your physician will ask you questions to get your child’s eczema history. You will likely review whether there are any exacerbating or ameliorating factors to your child’s eczema.  These may include ingested foods or contact allergens.  Having details such as the temporal relationship between the trigger and effect on eczema is helpful. Note that the role of food allergy and food allergy testing in eczema is still a debated one.

Allergy Testing & Eczema Plan of Action

We do know that there is a tendency for allergy, asthma and eczema run together.  Many patients will also recall a clear history of a certain food triggering eczema. In this case, it is important to confirm this potential trigger through allergy testing.  Keep in mind that food allergy testing is not perfect (as is the case for any testing) and can lead to what we call “false positives.” So although it may be tempting to test to all allergens and via skin prick, RAST or oral challenge, it is important to discuss with your physician to come up with the appropriate testing for your child.

Regarding whether food allergy testing should be performed, the guidelines state that testing for milk, egg, peanut, wheat and soy allergy should be considered in “a child younger than 5 years old, and has eczema that does not go away with treatment, or has eczema and a history of allergic reactions to a specific food. Children with moderate to severe eczema are at risk for developing food allergy, especially allergy to mild, egg, and peanut. These children may benefit from a food allergy evaluation.”  If testing is performed, it is important to review with your physician what the plan of action will be.  It is a matter of figuring out which tested allergens are affecting your child’s eczema, and your child’s nutrition should be taken into account as well.

If allergy testing is performed, it is important to review with your physician what the plan of action will be. 

Keep a List of Prior Eczema Treatments

Also have a list of prior treatments on hand. These include medical and non-medical treatments.  In terms of medical treatments, make note of what medication was used, for how long, where it was used (for topical medications), how frequently and how much was used, and the effect the medication had.  Remember to also tell your provider about other treatments such as bleach baths, wet wraps, etc.

MacieMom: Thank you Dr Huang, you raised some points that I didn’t think of such as bleach bath, wet wrap, treatments that the parent may have implemented prior to seeing the doctor. Excited to read your tips for during consultation next week.

Living with Eczema

SOMEONE Manages Allergy Testing for Child

Kristin on Allergy Testing on Eczema Blues
Kristin shares on managing allergy tests for child with multiple severe allergies

This is a series focused on personal journey with eczema while managing a certain aspect of life. Today, we have Kristin Beltaos, whose son has severe food allergies and shares how she manages his allergies via allergy testing. Kristin is a member of the Anaphylaxis & Food Allergy Association of Minnesota’s Speakers’ Bureau and a consultant/licensed trainer and owner of A Gift of Miles.

Marcie Mom: Hi Kristin, thanks for taking time to share with us about allergy testing. Let’s start with you sharing your son’s allergy history – when did he have them and did it show up as rashes on the skin?

Kristin: Hi Marcie, thanks for asking me to participate. My son’s allergies exhibited themselves prior to us leaving the hospital from his birth. He vomited and scream-cried after breastfeeding multiple times a day; physicians and nurses attributed the vomiting to a baby’s underdeveloped digestive tract. At six weeks, his pediatrician decided to have an Upper GI Series to rule out pyloric stenosis, a narrowing of the pylorus, the opening from the stomach into the small intestine that causes severe projectile non-bilious vomiting in the first few months of life. This test came back negative. It was decided that he had severe acid reflux and prescribed Zantac and later Prevacid in order to control his condition.

For the next seven months his vomiting continued, he also had eczema, unexplained hives, did not transition to baby food or table food and was labeled borderline failure to thrive for 18-months.

Two particular instances made us think something more was happening than acid reflux. The first was that I tried to wean a breastfeeding and provided him with a milk-based formula. He literally had one drop on his lips; his head looked like a red, cherry tomato and he scream-cried for over an hour. At first I thought, ok, ok, you’re a breast man and you don’t want a bottle. Then connecting the dots had us questioning…is this a clue for something else?

The second was the straw for my husband and I. I’d describe my son as a happy, but fussy baby. I know that sounds contrary, but he really was happy. One morning, he was fussy and I picked him up and kissed him all over his head to make him laugh. For every kiss that I gave him he had a nickel size hive, there were eight hives for eight kisses. I had cereal that morning, and while my lips weren’t wet with milk, there was residue. Later we found he was allergic to milk by touch and ingestion, along with other allergens.

Lastly, because of missing the window between four and nine months when oral motor skills are developed, he served 18-months in the Children’s Hospitals and Clinics Feeding Clinic to learn how to orally manipulate his food, i.e., chew, transition food from side-to-side, learn how much to chew prior to attempt swallowing and work on food texture issues. Even after he was diagnosed with his food allergies at 11-months, his food challenges haunted him until he was just shy of his fourth birthday.

I have to say all the while this was going on, I always knew something was wrong. I knew the doctors were missing something. So I tell parents, especially mothers, know that you aren’t going crazy and to seek opinions until you find an answer.

Marcie Mom: When was your child’s first allergy test and how did the physician help you to interpret his test results? 

Kristin: At 11 months, my son had a Radioallergosorbent Test, commonly known as RAST Test, which is a blood test used to determine to what substances a person is allergic. Our pediatrician broke the news to us that he was allergic to Cow’s Milk (including by touch due to the cereal and kiss episode), Eggs, Peanuts and Tree Nuts. In the summer of 2011 we added Sesame to his list.

After his diagnosis, we moved to a board certified allergist for care.

Marcie Mom: How often is a repeat allergy test required? And did it benefit your family to learn of new/ outgrown allergies?

Kristin: Obviously allergy testing is recommended whenever you have a new and/or unexplained reaction of course. For management of already diagnosed food allergies, the recommendation may vary from allergist to allergist and based upon each patient’s individual allergies and needs. Personally, I have my son’s allergies reviewed on an annual basis.

Coincidentally, we just had his allergen review within the past week. We received good and bad news. His Cow’s Milk numbers have been on the rise in the past two years, very disappointing as you can imagine. In this last test, his numbers more than doubled, placing him in the next Class level, Class 4 that is labeled as a Strong Positive. Our allergist continues to encourage us to stay hopeful, that the big reveal would be closer to when he enters high school as to whether this may be a lifelong allergy. He’s only seven, soon to be eight, so we have some time yet.

His Egg numbers have stayed the same; however, we are able to do a Baked Egg Challenge to see if he might be able to consume Egg in a baked good, i.e., muffins, cupcakes, cake, bread, etc. This is a test done in a supervised medical environment, clinic or hospital, with your board certified allergist or other medical representative present. I should add that this type of Challenge is not something done at home in your own experimentation.

We’re also investigating, via another blood test, whether he might be a candidate for a Baked Milk Challenge. The results remain to be seen on this front.

Peanut is no longer tested for because his numbers are too high. It is believed that peanuts will be a lifelong allergy.

Interestingly enough, his Tree Nut results have come back negative, pointing to outgrowing this allergy. We will investigate with a skin test to confirm and of course orally test him by having him consume Tree Nut(s) that are processed on dedicated lines with no risk of cross contamination with peanuts.

Lastly, his Sesame results came back very low, which may point to him outgrowing this allergy as well. We will pursue a skin test, should he pass, a Sesame Oral Food Challenge would be in the cards for him.

As you can see, testing regularly not only allows you to know the status of a person’s allergies. Moreover, if a child outgrows an allergy or allergens, it permits the reintroduction of food items permitting an expansion in diet. An expanding diet is ALWAYS a good thing. : )

Marcie Mom: One final question – for a mom who has difficultly with figuring out false positives in test results, what would you recommend to do?

Kristin: I honestly do not have any recommendations regarding false positives. What I do recommend is finding and partnering with a board certified allergist that you truly trust. In doing so, you’ll feel confident in the recommendations provided and can go about living life to the fullest with food allergies.

Marcie Mom: Thank you so much for sharing your journey on managing allergies and allergy testing – many eczema families are also ‘figuring’ this out and your sharing will be useful for them!

About Kristin Beltaos, M.A. – Kristin is the owner of A Gift of Miles, offers food allergy one-on-one consulting, national and local trainings, school consulting, and parent/school advocacy; and serves the markets of stress, with subspecialties, and reproductive challenges. She is a Licensed Trainer with the Minnesota Center for Professional Development, teaching food allergy continuing education to early childhood and school age providers and educators, a member of the Anaphylaxis and Food Allergy Association of Minnesota’s (AFAA) Speaker’s Bureau and a former board member. Kristin wrote and drove the implementation of the first food allergy 504 Plan in her child’s school, was influential in creating a new school food policy which eliminated food celebrations (both in classroom and school wide) – a policy that other schools are interested in emulating. Kristin was named a Top 25 Food Allergy Mom, 2012 by Circle of Moms. Stay happy and informed by following Kristin on her Facebook, Twitter and Pinterest.

Living with Eczema

SOMEONE Managed Allergic March for Son with Eczema

Sarah, with her 3 children, shares on managing allergic march
Sarah, with her 3 children, shares on managing allergic march

This is a series focused on personal journey with eczema while managing a certain aspect of life. Today, we have Sarah Chapman, whose third son has eczema since three-month old. Today, she shares how she managed her son’s Allergic March. Sarah is a volunteer with AllergyUK and had shared her allergy knowledge nationwide.

Marcie Mom: Hi Sarah thanks so much for taking part in my Friday blog series ‘Someone has Eczema’! Let’s start with you sharing a little of your family’s eczema and allergy history, and when did eczema or allergy start and what’s the severity?

Sarah: I had eczema soon after birth, and throughout my childhood. I still get it every now and then. My maternal grandfather had it all his life. I can remember him scratching! My mother and her brothers had eczema as well. There is also a lot of asthma in my family and nickel allergies.

My husband has asthma with links to environmental allergies.

Marcie Mom: I understand that your son, now 17 year old, experienced the Allergic March, progressing from eczema to allergies.  What was his condition from birth to a young child?

Sarah: Our 3rd son had eczema day 10 after birth, and as time went by he had a poor sleep pattern (by that I mean an  inability to sleep for longer than 2 separate hours a night, and 20 min cat naps a day) He also had very slow and poor weight gain, even though breastfeeding was going well. These are the early signs of food allergy in a breast fed infant before three months old.

As he grew his eczema was very hard to control, his daily treatment was 5- 8 all body emollients and twice daily low dose steroid cream. Just before we were about to start wet wrapping treatment we discovered that he had an egg allergy and then peanut at 13 months old. I had also started to suspect that environmental allergies, like pollen, dog and cat were a problem.  At 18 months old immunologist confirmed allergies to, dust mite, cat, dog, tree pollen, hay fever, egg, tree nut, peanut.

As we paid a great deal to lessen dust mite exposure and pollen in our home, and controlled diet and his skin improved. When I stopped breastfeeding him, his skin got instantly better, but he began to catch every infection going, and skin became infected and so on.

Treatment added to original eczema plan, change of emollients, eye drops, nasal sprays, antihistamine during hay fever and tree pollen season.   Age 2 epi pens, and emergency plan for anaphylaxis.

Like many allergic children he physically shows signs of being an allergic child. He has a ‘captains salute’ a small dry crease on top of nose from rhinitis, from using hand to push up nose from constant nose drip. He is a mouth breather child, again a sign of poorly controlled rhinitis.

He has dark rings, and an extra dry crease under his eyes. He also has derma- graphism (am not sure about the spelling of that btw!) which means that if he is slightly scratched a wheal will form within minutes. He also snored as a child which isn’t normal and is a sign of rhinitis.

Rhinitis has a major impact on sleep quality, and babies and young children require sleep to grow. Concentration at school when you have a totally blocked nose 24/7 is very difficult and so has impact on education.

Marcie Mom: How did the eczema progress when he started elementary school?

Sarah: As he neared 5 his eczema improved, this is typical of an allergic march child, and at the same time his rhinitis and environmental allergies were making more of an impact. We had discovered more food allergies to add to list.  Eczema treatment 3 full body emollient a day, and no steroid cream required. Except after food reaction in which eczema would appear as hives and other IgE response symptoms disappeared.

Age 5   allergies, Dust mite, Tree Pollen, hay fever, dog , cat , egg, peanut, legumes, tree nut, kiwi fruit.

Age 7   Dog allergy considered life threatening, change to emergency treatment plan, oral steroids and asthma inhaler (has asthma response during allergic reaction, but not asthmatic) yeast extract new food allergy.

Food challenge in allergy clinic confirmed outgrown cooked egg allergy = increase in  food  choice with higher calories.(still underweight.)

Age 10 Outgrown raw egg allergy in food challenge. Dog allergy lessened and quality of life improved, for instance sleep overs with friends who have dog, controlled with antihistamine.

Eczema,dry skin only.

Marcie Mom: What was his condition as a preteen and teenager? Did puberty change his condition? And how is your son now, as a young adult?

Sarah: By 12 redeveloped raw egg allergy, and by 13 possibly cooked egg, now at 17 prefers to avoid himself.  Food allergies: Egg, Peanut, some Legumes, Brazil nut, Yeast Extract, Kiwi Fruit, Hay Fever, Mold, Tree Pollen, Dust Mite.

Skin very dry, but otherwise OK!

We have used epi pen 3 times so far, but despite this is gaining confidence in his ability to buy food independently and going out with his friends.

Marcie Mom: Thanks Sarah for taking time to share your son’s allergic march, it is useful for parents to know but hopefully, won’t go through the full allergic march!

Doctor Q&A

Friday Dr Q&A with Dr Liew – Allergy Tests

Dr Liew is a pediatrician who practices at the SBCC Baby & Child Clinic, Gleneagles Hospital Singapore and is also a visiting consultant to KK Hospital. He subspecialises in allergy, immunology and rheumatology. He was also awarded several research grants to pursue clinical research in paediatric anaphylaxis, drug allergy, primary immunodeficiencies and Kawasaki disease.

This was an original 4 week Friday Q&A, combined into a single more informative post.

Children’s Allergy Basics

Thank you Dr Liew for taking time to help answer these questions, we’ll start with the basic information on allergy.

What is an allergy? For children with eczema, should parents send their children to allergy tests or should only those with eczema of a certain severity do so?

Dr Liew: An allergy is simply an abnormal immune reaction to a common protein. Symptoms are varied depending on trigger and organ involvement. The most common reaction is on the skin, resulting in itchy rashes like urticaria (hives) or eczema flares.

Atopic eczema starts essentially as a skin barrier defect, with resultant dryness, itch and allergen sensitisation later. It is not a pure allergic disease. Skin tests for eczema patients are generally not necessary, as the most common allergen is house dust mites. Food triggers are more commonly in young infants with significant eczema despite good skin therapy.

Allergy vs Intolerance

MarcieMom: Allergy and intolerance are often mixed up; can you explain the difference between the two, specifically:

How a parent can correctly identify if the child is allergic or intolerant and what follow-up action they should take in each case?

Dr Liew: Allergy and intolerance result in adverse reactions, but the key difference is that the former involves the immune system, whilst the latter do not. If the immune system is involved, there is a potential for severe allergic reaction called anaphylaxis with continued exposure due to immune memory. There is no risk of anaphylaxis in intolerance. Eg. Cow’s milk allergy can result in hives, vomiting and wheezing; in contrast, cow’s milk intolerance presents with diarrhea in lactose deficient individuals.

Skin Prick Test for Kids

Common questions on allergy tests: There are a few allergy tests available – skin prick test, blood IgE test and patch test.

Can you explain a little more about these tests, how it is done on a child and how can a parent decide which to bring their child for?

Dr Liew: The type of allergy test recommended is based on the allergy symptom of the patient. As eczema is a mixed IgE/non-IgE driven disease process, tests for IgE like SPT and blood tests may be useful if positive, as targeted elimination may be attempted. If the tests are negative, empiric elimination of 2-3 weeks duration may still be considered if there appears to be a consistent food trigger.

Prolonged food avoidance however is not necessary and may result in malnutrition.

A skin prick test (SPT) is probably commonest and simplest allergy test performed in outpatient clinics. Essentially it is a scratch test with either a needle or plastic device, thus introducing a tiny amount of allergen protein under the skin surface. The test is completed within 15 minutes and measurement taken. A positive reaction appears as a small hive-like wheal and surrounding redness. It is good for identification of IgE mediated allergic reactions, and also for trending allergy sensitisation over time. Antihistamines would need to be ceased for 5-7 days, and there must be an area of clear skin (preferably the back in young children) for the test to be done. This is my preferred allergy test as there is minimal pain (especially with plastic devices), and results immediate. SPT also correlate better with allergic reactions if properly performed, as it takes into account the blocking antibody responses when the body is “outgrowing” an allergy.

Blood IgE Test

Allergen specific IgE test can also be easily performed for IgE mediated reactions. This is sometimes preferable if the patient has severe eczema and unable to tolerate cessation of antihistamines, or has minimal normal skin to perform the SPT. Blood tests are generally more expensive, as each allergen protein tested cost around $30. Results are usually known within a week.

Patch Testing

Patch tests are designed to test for delayed allergic reactions, rather than acute IgE reactions as the above 2 tests. Patch tests involved placing small area of allergen protein coated on wells or filter paper, and leaving them as a skin patch for 48 to 72 hours. A reading is then performed to look for delayed hypersensitivity reactions and the skin reaction graded. As there are several confounding factors for a successful test, patch tests are currently not recommended for clinical use but confined to research studies.

What to do after Your Child is Tested Positive for Allergens?

Given that allergy tests are not 100% accurate, parents may start to rely on an elimination diet strategy. 

Can you explain how much you would rely on each allergy test and whether they serve a different purpose in your diagnosis?

Dr Liew: Standard allergy tests are accurate, but have their limitations. Unvalidated tests for food allergy include blood IgG testing, intradermal skin testing, applied kinesiology, electrodermal testing, hair mineral testing, and iridology, and should not be performed. Eczema is a chronic medical condition with no curative treatment currently, and some patient would undertake extreme measures to look for the “elusive trigger”.

I would remind your readers that eczema is a skin disease, and not an allergic disease. Removing triggers can reduce the eczema, but will not cure it.

Food Elimination for Kids

Empiric food elimination may be considered for 2-3 weeks if a consistent food trigger is suspected. An objective assessment should be made if food elimination has resulted in any change. Food triggered eczema would improve significantly with elimination. If there is no improvement, as in the majority of cases, the food should be introduced and assessment made if there is a change. I would caution regarding multiple food elimination as I have seen really malnourished and stressed out patient and families.

Young Children’s Developing Allergy Profile

MarcieMom: I understand that it’s good to send the child for a re-test, to check if he or she has outgrown any allergy or developed new ones. 

What’s the reason for the change in the allergy profile of the child? Also, how often do you recommend a re-test and would your recommendation differ for a child who has different type of allergies and/or differ for a child who has different level of severity in eczema?

Dr Liew: Retesting is sometimes required in food allergies, but generally not necessary for eczema. The allergic profile of an individual changes according to his/her immunity and exposure to environmental proteins. We often see food allergens being “outgrown”, but a gain of house dust mite sensitisation with time. Retesting is usually considered if there is a new allergic disease eg. Allergic rhinitis, rather than based on fluctuation in eczema severity.

Common Pediatric Allergens

Based on your experience and knowledge of research studies, what are the common allergens in children? 

Dr Liew: The most common allergens depend on the allergic conditions. For eczema, older patients tend to be sensitised to house dust mites, but not food allergens. Some young infants with eczema has food sensitisation and trigger. The most common food allergens in eczema children include egg, cow’s milk, wheat, peanuts and soy. Some forms of food allergy eg, allergic enteropathy presents with isolated intestinal symptoms without skin involvement.

If a parent suspect a food is causing an allergy, should the parent insist on it being an item to be included in allergy test? 

As a pediatrician, would you test the child on what the parent suspect?

Dr Liew: A detailed history would be obtained prior to allergy testing. If there is a suspected food trigger, I would usually test it. I would usually encourage targeted testing, whereby only the relevant food items are tested. For eg, should the child be tolerating cow’s milk formula for the past 3 years, and eczema commenced after 3 years old, cow’s milk protein is unlikely to be a food trigger, and should not be tested.

Gluten and Eczema

MarcieMom: Gluten has been gaining more awareness and with many food packaging labeling gluten-free, some parents may think it’s gluten that’s causing the eczema. 

Again, how can a parent identify if it’s gluten (is it even a common trigger?) that’s triggering the eczema?

How can this be differentiated from celiac disease?

Dr Liew: There should be a close temporal relationship between food ingestion and eczema flare. If there is inconsistent relationship, it is unlikely a food allergy. Celiac disease is an immune-mediated reaction to glutens, resulting in malabsorption in the gut, and resultant bloatedness, diarrhea and weight loss.

Guest Interview

Sensitive Skin Product Series – Understanding Ingredients & Patch Test

I ‘met’ Laura Verallo Rowell Bertotto, the CEO of VMVGroup, on twitter and learnt that her company is the only hypoallergenic brand that validates its hypoallergenicity.

VMV Hypoallergenics is founded in 1979 by Dr. Vermén Verallo-Rowell who is a world renowned dermatologist, dermatopathologist and dermatology/laser surgeon, also an author, esteemed researcher and speaker. 

Sensitive Skin Skincare Product Interview series with Dr Vermen Verallo Rowell VMV Hypoallergenics
  1. Sensitive Skin Product Series – What is Hypoallergenic?
  2. What does Natural Skincare Product mean?
  3. What is considered Organic and Non-Comedogenic?
  4. What does Suitable for Eczema Children mean?
  5. What is Patch Testing (for skincare product ingredients?)
  6. How do you read ingredients on skincare product label?
  7. What does Irritant-Free mean?
  8. What ingredients in skincare product to avoid?
  9. How is Coconut Oil used in skincare?
  10. What is product cross-reactivity?
  11. How many ingredients in a skincare product?
  12. How to use skincare products on Sensitive Skin?
  13. How to manage the diaper area?

Product Label – Deciphering the Skincare Ingredients

I’ve written in this post on how difficult it has been comparing the ingredients across products and make some sense of what they mean. For one, not all products list all their ingredients and even when they do, different companies seem to be giving the same ingredient different names (because they all sound so similar yet not identical!)

Marcie Mom: Laura, thanks again for continuing to help us understand the product label. This interview will focus on getting a broad understanding of labeling ingredients.

i. Is the ‘Ingredient’ list on product packaging Compulsory and Regulated? Does the Ingredient List cover all ingredients? Or can companies pick and choose what they like to reveal?

Laura: In many countries, yes, it is compulsory to list all ingredients, following a specified format, and using only the INCI (International Nomenclature of Cosmetic Ingredients) names of ingredients. A few countries do not require that ingredients be listed, in full or in part, and/or do not have requirements regarding the names used or formatting.

ii. Why is there no percentage (%) beside each ingredient? That way parents can compare and choose the product with the least % of allergen. Also, I read that certain allergen will not trigger a reaction because its concentration is too low in moisturizers but I also read that some products use an exceptionally high concentration of certain irritants.

How can consumer find out the concentration of allergen/irritant in a product?

Laura: This is quite a complex question…love it! 🙂

First, % are not included mostly because of proprietary concerns. A company does not want its exact formulation copied by anyone else.

Second, if a product is a DRUG (prescription or over-the-counter), it does, actually, have to disclose the % of the active ingredient.

Third, an easy way to get an idea of how much of an ingredient is in the formulation is to look at WHERE it is on the ingredients list. Most regulatory bodies require that ingredients be listed from MOST to LEAST.

Fourth: the % of an irritant or allergen is relevant mostly if someone only has irritant reactions to it. Irritant reactions do have a relationship to concentration of ingredient, frequency of exposure, time on skin, etc. For example, you could be using an allergen most of your life and not really react to it or just have mild irritant reactions like dryness. But if you are ALLERGIC to a substance or develop an allergy to it, any % of it for any amount of time on the skin will cause a reaction. Again, this is why a patch test is so important.

Look at WHERE it is on the ingredients list. Most regulatory bodies require that ingredients be listed from MOST to LEAST.

iii. Can you explain a little more on patch test?

Patch-Testing a Skincare Product before Use

A patch test is a painless procedure where ingredients/substances are put on your back in small dollops and kept on for a few days, with readings by your doctor at intervals like 48 and 72 hours. It can be a little costly upfront, but the amount of time, money and discomfort/skin trauma it can save you (versus random trial and error) over time makes up for that hundredfold. It tells you EXACTLY which ingredients you, in particular, need to avoid.

So, for example, you may need to avoid certain dyes in clothing, certain laundry soaps, and certain metals in your cell phone, etc. but may actually be ok using such natural ingredients as tea tree oil…this helps guide you far more specifically. And if you happen to be in the USA and your dermatologist is a member of the American Contact Dermatitis Society, your patch test results can be entered into the CAMP (Contact Allergen Management Program) database…so that instead of just a list of ingredients to avoid, you get a list of brands and product names that you can use.

Not to over-emphasize a point but this is also why the VH-Rating System is so handy. If you have not yet had a patch test, choosing the highest VH-Rating (showing that zero allergens are included in the formulation) can already significantly improve your chances of non-reaction. If you HAVE had a patch test, if an allergen is included in a product, the VH-Rating will alert you to the presence of which allergen in particular is included (for example Vitamin E). If your patch test shows you’re allergic to parabens and not vitamin E, then you probably can still use the product.

Marcie Mom: Thanks so much Laura for your help in helping us understand the big picture on ingredient labeling. In our next interview, we will learn in greater detail about reading ingredients on the label.

2018 update: Check out SkinSAFE app (developed by Mayo Clinic and licensed to Her Inc.) where you can either have your Personal Allergen Code (for US patients) or you select allergens that you want to exclude from products or use their 11 allergens to exclude from products, namely preservatives, fragrance, parabens, lanolin, coconut, topical antibiotic, MCI/MI, nickel, gluten, soy and propylene glycol.