Skin reactions are often caused by foods and appear either as immediate urticarial reactions or as persistent eczema. As the child comes out of diapers, eczema becomes easier to treat. The localization of the lesions gradually changes from the typical facial and trunk involvement of the infant stage to more flexural involvement.
Dry skin and intense itching are constant features. The child is often anxious, irritable and hyperactive. The child's diet is now much more varied than when it was an infant, making the search for causative foods more difficult. It is important not to limit the child's diet too severely, as this can result in malnutrition. An initial approach is often to try a diet avoiding items that are selected on the basis of the history and verified by allergen-specific IgE antibody measurements (ImmunoCAP®).
If, however, the child is severely affected, has IgE antibodies to almost every food tested and does not respond to a more simple exclusion diet, it may be necessary to place it on a total exclusion diet using a complete food substitute. This is a rather drastic last resort and should only be carried out in a hospital. As the skin becomes clearer, challenges with single foods can begin.
House dust mites and pets are known to exacerbate eczema, so attempts to sort out food allergy without also advising environmental control are less likely to succeed. Eczematous children are also prone to develop respiratory symptoms to pets, so parents should be informed about the risks.