Here you will find frequently asked questions from those affected. The answers were compiled by experts in atopic dermatitis from the renowned atopic dermatitis training organization AGNES e.V.
Topic of nutrition for the breastfeeding mother / complementary feeding:
The diagnosis of atopic dermatitis does not necessarily coincide with a food intolerance. Therefore, you can continue breastfeeding your child even with the diagnosis of atopic dermatitis, and in most cases, you don’t need to avoid any specific foods yourself. However, you may observe changes in your child’s skin condition after consuming certain foods in your diet. In such cases, a one- to two-week exclusion trial can be attempted to assess the observed connection. It is crucial to consciously reintroduce the specific food after this brief avoidance period and monitor your baby’s skin condition. This is also part of the evaluation! Any avoidance beyond two weeks should only be done in consultation with your doctor and under the supervision of an experienced nutrition professional.
You can find local addresses (for Germany) of nutrition specialists trained in allergy issues on the following websites:
allergiewegweiser.de (external)
ak-dida.de (external)
Today, it is recommended to start introducing complementary foods after completing the fourth month. At this point, most infants are ready to show interest in their surroundings, including the food in their environment. As the baby starts interacting with the environment, the immune system begins to work actively, learning to assess environmental factors correctly. Introducing complementary foods at around five months supports this learning process.
Breastfeeding is the best nutrition for an infant. Through breastfeeding, the young organism receives everything it needs in the first few months. However, to prepare the immune system well for its environment, interaction with that environment is necessary. Therefore, we recommend starting complementary feeding after four months. This does not mean stopping breastfeeding at this time. Instead, breastfeeding meals should ideally be gradually reduced with each additional complementary feeding meal.
It was long believed that a slow introduction of complementary foods provides a better overview of tolerated foods. On the other hand, it is highly unlikely to react to the components in the first solid food (vegetable-potato-meat puree). At the same time, we assume that a diverse diet better trains the immune system than a one-sided diet. Therefore, we now recommend a rapid expansion of the diet, especially in terms of vegetable selection.
In many studies, it has been shown that consuming fish in the first year of life is associated with a lower risk of allergic diseases. The exact reasons for this are not yet clear. On one hand, it could be a sign of diversity if fish is included in the diet in the first year of life. Another explanation could be a positive influence on the composition of gut bacteria. However, the most likely explanation is that the high content of long-chain omega-3 fatty acids plays a significant role in reducing the risk of allergies. Therefore, it is indeed recommended to deliberately introduce fish into complementary feeding in the second half of the first year of life.
Carrot is just as suitable as any other vegetable. However, carrots have a stool-regulating effect, which can lead to firmer stool. The change in stool consistency can be concerning for many parents, which has given carrots a somewhat negative reputation.
Cereals – whether they contain gluten or are gluten-free – are introduced with the second complementary feeding, around the sixth month. Iron-rich varieties such as oats and millet should be preferred.
Ready-made baby foods are strictly regulated and thoroughly tested for their content. Therefore, they are definitely not bad. On the other hand, the introduction of complementary foods aims to transition the infant’s diet to a family-friendly one. Cooking at home has the significant advantage that this transition can be more purposefully implemented, as parents can decide on the ingredients. When cooking at home, make sure to use fresh ingredients and avoid adding salt.
General:
The diagnosis of atopic dermatitis does not necessarily involve a food allergy or a non-allergic intolerance. Therefore, the diagnosis of atopic dermatitis does not automatically mean that the diet must be changed. On the contrary, exclusion diets come with risks and disadvantages that must be considered and discussed with your pediatrician and/or an experienced nutrition specialist. If you want to check whether the diet has an impact on the skin condition, it is recommended to keep an eczema diary for two weeks (e.g. using the Nia App). If you observe that the skin condition changes after certain foods, a one to two-week exclusion trial can be undertaken to verify the observed connection. However, it is important to consciously reintroduce the respective food after this short avoidance period and observe the skin condition. This is also part of the evaluation process!
There are many dietary approaches recommended for atopic dermatitis, but general recommendations are not advisable for this skin condition. Why? Because individual triggers can be observed in each affected person, which must be individually considered. Since nutrition only affects the skin in a portion of those affected and this is also very individual, it is not only senseless but even counterproductive to follow generalized dietary concepts.
A healthy diet should include all components of the food pyramid: vegetables, fruits, grains and bakery products, milk and dairy products, eggs, meat, fish, butter and oils, as well as unsweetened beverages. A moderate consumption of sweets, including sugar, is not a problem based on such a healthy diet – completely independent of whether someone has atopic dermatitis or not. Here you can read more about it.
Broad statements are always out of place with atopic dermatitis. Only if an individual trigger can be found in the diet, should it be considered. Because only a minority of eczema-affected patients have their skin influenced by diet. Additionally, it makes no sense to evaluate all spices equally and essentially hold them collectively responsible.
Spicy foods activate warmth receptors in the skin, leading to increased blood circulation and sweating. For skin irritated by eczema, this can result in heightened itching. The “comfort threshold” for spicy spices is very individual, both with and without atopics dermatitis. Therefore, even with atopic dermatitis, spicy seasonings do not need to be universally banned. What is crucial is to develop a sense of one’s own comfort threshold.
A healthy diet should include all components of the food pyramid: vegetables, fruits, grains and bakery products, milk and dairy products, eggs, meat, fish, butter and oils, as well as unsweetened beverages. A moderate approach to sweets, including sugar, is not a problem based on a well-structured healthy diet—regardless of whether eczema is present or not.
In the case of a confirmed food allergy, it is important to check sweets for the presence of the allergen and offer only suitable products. Seek advice from a nutrition professional with expertise in allergies.
You can find local addresses of nutrition specialists trained in allergy issues on the following websites:
allergiewegweiser.de (external)
ak-dida.de (external)
Cow’s milk is one of the foods that not only have a bad reputation in cases of eczema but are quickly placed on the “avoidance list” for many health conditions. Individuals with eczema are often advised to avoid cow’s milk and products made from it, opting instead for milk from other animal species. However, this blanket condemnation of cow’s milk does not withstand scientific scrutiny. On the contrary, there is even evidence suggesting that early consumption of full-fat cow’s milk, butter, and yogurt may provide protection against allergies. So, once again, blanket statements are not appropriate.
Milk and dairy products are essential components of a balanced diet. Prolonged avoidance comes with risks and disadvantages and is only sensible and justified when a cow’s milk allergy is conclusively proven. A minority of infants severely affected by eczema may have a cow’s milk allergy. Developing a new cow’s milk allergy after the first year of life is highly unlikely.
If you want to check whether your baby or toddler has a cow’s milk allergy, it is recommended to keep a diary of eczema symptoms for two weeks. If you observe changes in the skin condition after consuming milk or dairy products, a one- to two-week trial of avoidance can be attempted to verify the observed correlation. However, it is crucial to consciously reintroduce the respective food after this short period of avoidance and monitor the skin condition. This is also part of the assessment.
Note: In the presence of a cow’s milk allergy, other animal milks are also unsuitable because their ingredients are closely related. Therefore, when a cow’s milk allergy is confirmed, it is important to work with an allergen-trained nutrition professional to find tailored alternatives for your child. After obtaining a certificate of necessity from the attending doctor, counseling sessions are usually subsidized by health insurance.
You can find local addresses of nutrition specialists trained in allergy issues on the following websites:
allergiewegweiser.de (external)
ak-dida.de (external)
General statements are always out of place in cases of atopic dermatitis. Only if an individual trigger can be identified in the diet, should it be considered. This is because only a minority of patients severely affected by atopic dermatitis have skin influenced by their diet. Furthermore, it makes no sense to condemn various vegetables and fruits solely based on their color. Certain varieties such as tomatoes, strawberries, or currants can sometimes lead to skin redness upon contact with skin irritated by eczema. This may affect areas such as the skin around the mouth, chin, and cheeks. However, the redness is harmless and usually subsides quickly in most cases.
Few foods have been as strongly vilified in the media as supposed culprits for illness as wheat. In contrast, a gluten-free diet is often portrayed as generally health-promoting. This portrayal is not correct. On the contrary, there are many arguments and scientific studies that clearly advise against a gluten-free diet unless it is expressly medically indicated (such as in the case of celiac disease). For many symptoms (typically abdominal complaints) attributed to gluten, other causes can be found upon careful examination – foremost among them being an unfavorable dietary pattern. This is also evidenced by the fact that spelt is well tolerated by many individuals, even though it contains more gluten than wheat.
In addition to all the health promises, it is overlooked that a gluten-free diet carries significant risks: for example, the altered and generally lower intake of fiber has adverse effects on our intestinal microbiota (‘gut flora’) and thus on intestinal health. Furthermore, such a drastic change in diet is often perceived as very burdensome.
For eczema, avoiding wheat and wheat products is only advisable when a wheat allergy is clearly diagnosed. A minority of severely affected infants and toddlers with eczema are affected by this allergy.
If you want to check whether your baby or toddler has a wheat allergy, it is recommended to keep a eczema diary (e.g., using the Nia app) for two weeks initially. If you observe that the skin condition changes after consuming wheat products, you can try abstaining from them for one to two weeks to verify the observed correlation. However, it is important to consciously reintroduce the respective food after this short period of avoidance and observe the skin condition. This is also part of the assessment!
Caution: In the case of a wheat allergy, ancient wheat varieties such as spelt, emmer, or einkorn are also unsuitable, as their components are closely related. Therefore, when a wheat allergy is diagnosed, it is important to find tailored alternatives for your child with the help of a nutrition professional experienced in allergy management. After a certification of necessity by the attending physician, counseling sessions are usually subsidized by health insurance.
You can find locally available addresses of allergen-trained nutrition professionals here:
allergiewegweiser.de (external)
ak-dida.de (external)
The background for the poor reputation of convenience foods is mostly the concern that contained additives may worsen the skin in cases of atopic dermatitis. However, the effect of additives as exacerbators of eczema has been classified as “very rare” in scientific studies. So here too, blanket recommendations are out of place. In cases of proven food allergies, convenience meals may have disadvantages: The ingredient lists can be long and confusing, making it difficult to check for the presence of the allergen.
The concern regarding citrus fruits arises from the observation that large consumption amounts of highly acidic fruits can lead to skin irritation in some patients with atopic dermatitis. However, a blanket recommendation to avoid them is misplaced for two reasons: Firstly, it remains a fact that individual factors play a role in each atopic dermatitis sufferer, making blanket recommendations either ineffective or too limiting. Secondly, sensitivity to acidic fruits, if present, is always dependent on quantity. This means that there is always a portion size that is well tolerated. Instead of blanket avoidance, it is important in the case of sensitivity to develop a sense of the individual comfort threshold.
Indeed, regular consumption of large amounts of meat and sausage can lead to an unfavorable modulation of our immune system and promote inflammatory processes in the long term. This effect is particularly described for fatty pork, whereas it is lower for meat from grass-fed animals and generally for lean meat and sausage products.
As part of a healthy diet, a moderate consumption of meat and sausage, around two to three portions per week, is recommended – regardless of whether one has atopic dermatitis or not. A healthy diet should include all components of the food pyramid: vegetables, fruits, grains and bakery products, milk and dairy products, eggs, meat, fish, butter and oils, as well as unsweetened beverages. With moderate consumption of meat and meat products, pork is also suitable. The selection may and should be based on the family’s eating habits and the child’s preferences.
A healthy diet should include all components of the food pyramid: vegetables, fruits, grains and bakery products, milk and dairy products, eggs, meat, fish, butter and oils, as well as unsweetened beverages. Moderate consumption of fast food is not a problem when following such a healthy diet – regardless of whether one has atopic dermatitis or not.
A definite no. Unfortunately, the rumor that atopic dermatitis involves an intolerance to “animal proteins” still persists, leading to the recommendation of a “animal-protein-free” diet, essentially vegan. This depiction is incorrect for several reasons:
Firstly, animal proteins have varying structures, so it makes no sense to evaluate them all equally and essentially hold them all in “guilt by association.” For example, the protein components in chicken egg and chicken meat are so different that even in cases of chicken egg allergy, chicken meat is generally well tolerated. Thus, having an allergy to all animal proteins simultaneously is extremely unlikely.
Secondly, it remains a fact that individual factors play a role in each eczema sufferer, so blanket recommendations are either ineffective or too limited.
It’s also worth noting that within a vegan diet, nuts, seeds, and soy products play an important role as nutrient sources. However, some of these foods are known to trigger both primary and secondary food allergies. Thus, a vegan diet could be particularly challenging to implement, especially in cases of primary allergies to peanuts or certain nuts. Additionally, in cases of birch pollen allergy, secondary food allergies to hazelnuts, soy, and certain fruits and vegetables can occur, further complicating adherence to a vegan diet.
The decision to adopt a vegan diet must be carefully considered and should never be made with the sole aim of promoting health. Unlike a vegetarian diet, which can be healthy with the inclusion of dairy products (and eggs), the body’s nutritional needs on a vegan diet for several nutrients can only be met with the help of supplements.
A vegan diet is particularly problematic in infancy and childhood, as the need for nutrients is especially high during growth and development. Moreover, children may find a vegan diet particularly burdensome.
The diet should be healthy, colorful, and balanced, containing all components of the food pyramid – regardless of whether atopic dermatitis is present or not. It is recommended to regularly consume (2-3 times a week) fatty fish such as salmon, mackerel, or herring. Family dietary habits and individual preferences should be taken into account and accommodated.
With a diverse diet that includes all components of the food pyramid, dietary supplements are not necessary. The only exceptions are vitamin D and long-chain omega-3 fatty acids. If there is insufficient sun exposure, regular intake of vitamin D is recommended even after infancy (see DGKJ statement for reference). This recommendation applies regardless of whether one has atopic dermatitis or not. Additionally, the supply of long-chain omega-3 fatty acids (EPA and DHA) is often very low in a typical Western diet. EPA and DHA influence the immune response and inflammatory processes in the body. There is indeed evidence that low levels of long-chain omega-3 fatty acids are a risk factor for allergic diseases. However, we advise against taking any supplements without supervision: Tailored dosing is necessary to avoid unwanted side effects. Therefore, discuss the usage with your doctor or a nutrition specialist.
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The content quality of this chapter was ensured by the following atopic dermatitis experts, among others:
- Diploma Oecotrophologist Dr. Imke Reese
- Diploma Oecotrophologist Dr. Anja Waßmann
- Diploma Oecotrophologist Sibylle Plank-Habibi
