Allergies and Immune Dysregulation in Children

Allergies happen when the immune system reacts to something harmless — a food, pollen, dust mites or pet dander. In many children, allergic conditions appear in a recognizable sequence that often starts with eczema. Some of this can be prevented, most notably peanut allergy, through early introduction. An accurate diagnosis matters, because popular food-sensitivity tests often lead families to cut out foods for no benefit.

Doctors use the term atopic march for the pattern in which eczema in infancy is followed by food allergy and later by hay fever (allergic rhinitis) and asthma in some children (Hill & Spergel, 2018). Not every child follows this path, and it is not a fixed sequence, but it explains why a baby with significant eczema deserves attention to both their skin and their diet.

In eczema, the skin barrier is weaker, so allergens can enter through the skin. Meeting a food through inflamed skin is thought to favor allergy, while eating it regularly favors tolerance (Hill & Spergel, 2018). Treating eczema well — gentle cleansing, regular moisturizing and prescribed treatment for flares — is part of allergy prevention, not just skin care.

In the LEAP trial, infants at high risk who began eating peanut regularly between 4 and 11 months of age were far less likely to have a peanut allergy at age five: 1.9% compared with 13.7% of those who avoided peanut (Du Toit et al., 2015). US guidelines now recommend introducing peanut early — as early as 4 to 6 months for high-risk babies after an evaluation, around 6 months for babies with mild-to-moderate eczema, and along with other foods for everyone else (Togias et al., 2017).

• Food allergy is diagnosed from the history of a reaction together with targeted skin-prick or blood (IgE) tests, and sometimes a supervised food challenge. A positive test without symptoms does not prove allergy.
• IgG “food sensitivity” panels are not recommended for diagnosing food allergy or intolerance. IgG to foods reflects normal exposure and tolerance, not disease (Stapel et al., 2008).
• Unnecessary avoidance has costs: gaps in nutrition, stress around eating and, for foods like peanut, possibly a higher chance of developing an allergy later.

• If your child has been prescribed epinephrine, carry two auto-injectors at all times, keep a written action plan, and make sure school staff and caregivers know how to use them.
• For hay fever, limit exposure at high-pollen times, use saline rinses, and use the medicines your clinician recommends.
• For dust mites and pets, focus on the bedroom: washable bedding, mattress and pillow covers, and keeping pets out if a sensitivity is confirmed.
• Don’t avoid a food “just in case” without a plan to confirm the diagnosis.

We take a careful history and look at the whole allergic picture — skin, gut, airways and sleep — and focus on what is safe and effective: good eczema care, a practical plan for introducing foods, and nutritional adequacy when a child genuinely must avoid foods. We don’t use IgG food panels to diagnose allergy. We work alongside your pediatrician and a board-certified allergist, who confirms diagnoses and supervises food challenges and immunotherapy.

• Eczema, food allergy, hay fever and asthma are connected; good eczema care is part of prevention.
• Introduce peanut and other allergens early — after an evaluation if your baby has severe eczema or an egg allergy.
• Skip IgG food-sensitivity panels; they don’t diagnose allergy.
• If epinephrine has been prescribed, carry two auto-injectors, always.