Eczema and food allergy - is there a causal relationship?

Radoslaw Spiewak

Department of Experimental Dermatology and Cosmetology, Jagiellonian University Medical College, Krakow, Poland

Source: Spiewak R. Wyprysk i alergia pokarmowa - czy istnieje zwiazek przyczynowo-skutkowy? Przegl Lek 2013; 70 (12): 1051-1055. (In Polish)


In spite of popular beliefs, the relationship between eczema and food allergy still puzzles researchers and clinicians, which in part is due to the variety of mechanisms involved in various types of allergy. One has to realize the differences between hypersensitivity reactions to food proteins (allergens capable of initiating immediate hypersensitivity or immune complex reactions) and low-molecular weight compounds (haptens that may initiate cytotoxic reactions or delayed-type allergy). Hardly doubted is the role of IgE specific to food proteins in anaphylactic reactions and allergic urticaria. The involvement of food protein-specific IgE also is well-documented in protein contact dermatitis, with exposure to offending allergens occurring mainly through direct contact to the skin. In case of oral intake, protein allergens can provoke oral allergy syndrome or allergic reactions of esophageal mucosa, yet after arriving in the stomach they undergo hydrolytic digestion and loose antigenicity. The popular notion "food allergy causes eczema" was challenged by last decade's research suggesting that allergy to food proteins develops secondarily to eczema, and in the later course manifests as anaphylaxis or urticaria, not eczema. On the other hand, somewhat unnoticed remains the wide array of haptens present in food - be it natural components, food additives (dyes, aromas, preservatives, emulsifiers, etc.) or contaminations (e.g. pesticides, veterinary drugs). Haptens can be absorbed already through oral mucosa, they don't undergo digestion and are capable of provoking delayed-type hypersensitivity reactions strongly resembling atopic eczema. Induction of such reactions can be facilitated by cosmetics that frequently contain the same haptens as food.

Keywords: eczema, food allergy, causal relationship, atopic eczema, atopic dermatitis, allergic contact dermatitis, food allergens, food haptens, systemic reactivation of allergic contact dermatitis.

Reprint (PDF)



Dermatologist and allergist in Krakow (Cracow), Poland

Estetologia Medyczna i Kosmetologia


  1. Aerts O., Cattaert N., Lambert J., Goossens A.: Airborne and systemic dermatitis, mimicking atopic dermatitis, caused by methylisothiazolinone in a young child. Contact Dermatitis 2013, 68, 250.
  2. Berlin C.M. Jr.: Sensitivity of the young infant to drug exposure through human milk. Adv. Drug Deliv. Rev. 2003, 55, 687.
  3. Cohen S.: Should we treat infantile seborrhoeic dermatitis with topical antifungals or topical steroids? Arch. Dis. Child 2004, 89, 288.
  4. Codreanu F., Morisset M., Cordebar V. et al.: Risk of allergy to food proteins in topical medicinal agents and cosmetics. Eur. Ann. Allergy Clin. Immunol. 2006, 38, 126.
  5. Czarnobilska E., Obtulowicz K., Dyga W., Spiewak R.: A half of schoolchildren with 'ISAAC eczema' are ill with allergic contact dermatitis. J. Eur. Acad. Dermatol. Venereol. 2011, 25, 1104.
  6. Czarnobilska E., Obtulowicz K., Dyga W., Spiewak R.: The most important contact sensitizers in Polish children and adolescents with atopy and chronic recurrent eczema as detected with the extended European Baseline Series. Pediatr. Allergy Immunol. 2011, 22, 252.
  7. Elmariah S.B., Cheung W., Wang N. et al.: Systemic drug-related intertriginous and flexural exanthema (SDRIFE). Dermatol. Online J. 2009, 15, 3.
  8. Flohr C., Weiland S.K., Weinmayr G. et al.: The role of atopic sensitization in flexural eczema: findings from the International Study of Asthma and Allergies in Childhood Phase Two. J. Allergy Clin. Immunol. 2008, 121, 141.
  9. Hanifin J.M.: Critical evaluation of food and mite allergy in the management of atopic dermatitis. J. Dermatol. 1997, 24, 495.
  10. Hanifin J.M., Rajka G.: Diagnostic features of atopic dermatitis. Acta Derm. Venereol. Suppl. 1980, 92, 44.
  11. Hill L.W.: The importance of contact eczema in children. Pediatrics 1959, 23, 797.
  12. Hon K.L., Ying N.S., Cheung K.L.: A tragic case of atopic eczema: malnutrition and infections despite multivitamins and supplements. Iran. J. Allergy Asthma Immunol. 2012, 11, 267.
  13. Kordus K., Spiewak R.: [Emollients from the pharmacy - a help or a threat to patients with eczema?]? Alergia Astma Immunologia 2012, 17, 147.
  14. Lachapelle J.M.: Dermato-allergologie de contact. Nouv. Dermatol. 2001, 20, 450.
  15. Lack G., Fox D., Northstone K., Golding J.: Factors associated with the development of peanut allergy in childhood. N. Engl. J. Med. 2003, 348, 977.
  16. Lio P.A.: Atopic dermatitis and food allergies: true, true and related? Arch. Dis. Child. Educ. Pract. Ed. 2007, 92, ep56.
  17. Mayer R.L.: Experimental sensitization with food dyes and cross-sensitization to paraphenylenediamine. J. Allergy 1949, 20, 159.
  18. Papadopoulos N.G., Agache I., Bavbek S. et al.: Research needs in allergy: an EAACI position paper, in collaboration with EFA. Clin. Transl. Allergy 2012, 2, 21.
  19. Rajka G.: Atopic dermatitis. W. B. Saunders, London 1975, 2.
  20. Rzeznik S.Z., Kordus K., Spiewak R.: ["Cosmeceuticals" and "dermocosmetics" - a unique category of skin care products or a plain marketing trick?] Estetol. Med. Kosmetol. 2012, 2, 101.
  21. Strid J., Hourihane J., Kimber I. et al.: Disruption of the stratum corneum allows potent epicutaneous immunization with protein antigens resulting in a dominant systemic Th2 response. Eur. J. Immunol. 2004, 34, 2100.
  22. Spiewak R.: Alergia kontaktowa i alergiczny wyprysk kontaktowy. W: Fal AM, red. Alergia, choroby alergiczne, astma. Medycyna Praktyczna, Krakow 2011, 371.
  23. Spiewak R.: Food-provoked eczema: A hypothesis on the possible role of systemic contact allergy to haptens present in both cosmetics and foods. Estetol. Med. Kosmetol. 2011, 1, 35.
  24. Spiewak R.: Immunotherapy of allergic contact dermatitis. Immunotherapy 2011, 3, 979.
  25. Spiewak R.: Contact dermatitis in atopic individuals. Curr. Opin. Allergy Clin. Immunol. 2012, 12, 491.
  26. Spiewak R.: [Frequency of skin diseases in a random sample of adult Poles]. Estetol. Med. Kosmetol. 2012, 2, 50.
  27. Spiewak R.: Paraphenylenediamine positive patch tests, foot dermatitis, and azo dyes. Contact Dermatitis 2012, 66(Suppl 2), 42.
  28. Spiewak R., Czarnobilska E.: Not all that looks like eczema is atopic eczema. J. Eur. Acad. Dermatol. Venereol. 2011, 25, 992.
  29. Spiewak R., Kordus K.: [The classification and definitions of diseases from the spectrum of eczema]. Int. Rev. Allergol. Clin. Immunol. 2012, 18, 210.
  30. Thompson M.M., Hanifin J.M.: Effective therapy of childhood atopic dermatitis allays food allergy concerns. J. Am. Acad. Dermatol. 2005; 53(2 Suppl 2): S214.
  31. Wojtanowska J., Spiewak R.: Wspolne skladniki kosmetykow i pokarmow - analiza skladow produktow spozywczych i kosmetycznych pod katem potencjalnie uczulajacych haptenow. Alergia Astma Immunologia 2013, 17(supl 1), 30.
  32. Yates VM, Kerr RE, MacKie RM.: Early diagnosis of infantile seborrhoeic dermatitis and atopic dermatitis - clinical features. Br. J. Dermatol. 1983, 108, 633.

© Radoslaw Spiewak (contact).
This page is part of the website.
Document created: 4 February 2014, last updated: 19 February 2014.