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Did you know that it is possible for children to become sensitized (and even allergic) to food through the skin?
Yep… *mind blown*!
This is something that we're learning more about and that blows a hole in the concept that the only way to become sensitized to food is through the gut.
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My guest today, Jennifer Brand, MPH (Master's degree in public health), MS (Master's degree in nutrition), CNS (Certified Nutrition Specialist) is an integrative and clinical nutritionist and the founder of Jennifer Caryn Brand Nutrition. She specializes in childhood skin rashes (eczema in particular, as well as psoriasis, tinea versicolor, hives, acne, vitiligo, and others), food allergies and sensitivities, and gut problems.
Jennifer’s own struggle with gut problems and disordered eating, her father’s battle with psoriasis and psoriatic arthritis, her brother’s diagnosis of psoriasis, and her mother’s diagnosis of vitiligo left her frustrated and stirred her search for a different approach as conventional means fell flat:
– An approach that doesn’t remove more foods from the diet. Food is not the root cause of the problem. Your body runs off of nutrients from foods you eat. When they are missing, imbalances develop, and symptoms and health problems follow, even skin rashes.
– An approach that doesn’t include stronger prescription steroid creams, and immune-modulating prescriptions that might manage symptoms but don’t address the root cause of the problem, and can cause additional problems long term.
Jennifer is a relentless detective putting her strong knowledge of nutritional biochemistry to work for you, to identify what’s driving symptoms and health problems in order to address the root cause of them.
In 2013 she opened her private, clinical nutrition practice. Jennifer left her corporate healthcare career in 2017 to focus full time on helping clients get relief.
Jennifer is a faculty member of LearnSkin, and her work has been featured in peer-reviewed scientific journals, Voyagela, as well as on podcasts, online summits, and in-person presentations at venues such as Casa Colina Hospital in California.
Join us as we discuss how food allergies can affect skin rashes in children.
Has identifying food allergies helped your little one's skin health? Let me know in the comments!
In this episode:
- How a baby can potentially develop a food allergy at such a young age
- Is it possible to become sensitized to a particular food through the skin barrier?
- The connection between gut bacteria + food allergies
- Foods that feed friendly gut bacteria
- Problems that might come along with moisturizing rashy skin
Quotes
“When we're talking about skin allergies, that includes things like skin inflammation, eczema, hives, and contact type allergies. So when we get to the statistics here, 9.2 million children had skin allergies in 2018.” [1:33]
“One of the most interesting statistics I've come across in the literature is that two out of three kids with rashes do not have food allergies.” [2:17]
Links
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Get Jennifer Brand's FREE Guide To Probiotics For Skin Rashes
Healthy Skin Show #178: Using Probiotics For Eczema in Little Ones w/ Jennifer Brand, MS, MPH, CNS
Follow Jennifer on Instagram | Facebook | Twitter
222: Food Allergies + Skin Rashes in Kids w/ Jennifer Brand, MS, MPH, CNS FULL TRANSCRIPT
Jen Fugo: Thanks, Jen so much for being back. I really appreciate you always as a guest and all of the knowledge that you bring to the show.
Jennifer Brand: Thank you so much for having me, Jen. I'm always happy to be here.
Jen Fugo: I know. And you're the one that I love to talk to you about little ones, little kids who need so much help in figuring out what the heck is going on with their skin. And today we're actually talking about a topic that I've seen you talk a lot about on Instagram, and I knew nothing about any of these topics and found the conversation so fascinating. I was like, we should have this chat on the show. So today we're going to be talking about the connection between skin and skin rashes in conjunction with food allergies. So let's start off with a few stats. I think it'd be helpful to ground the information in statistics that will give parents especially, or parents to be an idea of the frequency of this kind of stuff.
Jennifer Brand: Yeah, absolutely. Statistics are always a great place to start. You can never go wrong once you start off with the data, right? I do see a lot of skin and food allergies. Of course, this is what I focus on in my practice. When we're talking about skin allergies, that includes things like skin inflammation, eczema, hives, and contact type allergies. So when we get to the statistics here, 9.2 million children had skin allergies in 2018.
Jen Fugo: Wow.
Jennifer Brand: Yeah. And kids between the ages of zero to four are most likely to have skin allergies and many parents out there I'm sure are aware the common food allergens are milk, soy, eggs, wheat, peanuts, tree nuts, fish, and shellfish. About 32 million people actually have food allergies in the United States. And about 10, almost 11% of those are adults. And about seven, almost 8% are kids. Milk is the most common allergen for children followed by eggs and peanuts. Shellfish is actually the most common allergen for adults followed by peanuts and tree nuts. All of that said, one of the most interesting statistics I've come across in the literature is that two out of three kids with rashes do not have food allergies, but.
Jen Fugo: Do not.
Jennifer Brand: Do not.
Jen Fugo: Wow.
Jennifer Brand: Yeah. So, kids with eczema, rashes are more likely to have food allergies, but the majority of them actually do not.
Jen Fugo: Hmm. Well, I know we're going to talk a little bit about how you can become sensitized to things, but first let's start with the food piece. How do you develop a food allergy as a little baby?
Jennifer Brand: So well, food allergies, they develop, there's different mechanisms behind this, but the most common way is where there are specific IgE antibodies. So IgEs are your like allergic reactions. Those are the ones that can turn into anaphylaxis when they're severe. So IgE antibodies trigger this cascade of immune reactions in the body. So they trigger certain cells like mast cells. I think a lot of people are probably familiar with mast cells as releasing histamine, but these antibodies trigger other immune cells as well. All of these cells release different types of chemical messengers. Histamine's one of them, but they're cytokines, there's others. So what these chemical messengers then do is enlist the help of neighboring cells to start doing the same thing. So that's where this cascade of the reaction starts to happen. And this is where we start to get those symptoms throughout the body.
Jennifer Brand: So food allergy symptoms happen pretty much immediately. It's usually like a few minutes after eating a food, definitely within a few hours. And so what's happening with people with food allergies is that they actually have an increased absorption of food allergens in the gut. So this allows those allergens to cross over into the bloodstream where they trigger immune responses that lead to the symptoms. And this happens, this is where gut hyperpermeability or leaky gut comes into play. So this is one of the big reasons why when we're talking about allergic conditions, whether that's on the skin, food, et cetera, we are talking about what's happening inside the body, like inside the gut.
Jen Fugo: Now, is it possible to become sensitized to a food through the skin? Is that something that you have seen anything about in the literature?
Jennifer Brand: Yes. So this is really, really fascinating. And this one was really mind blowing to me. So what can happen, and this is particularly the case when we have a broken skin barrier. So when we have like that broken skin barrier, the skin immune function isn't as strong as our gut immune function. So we can come into contact, airborne or touch the skin, food allergens on the hands, on broken skin. This can sensitize someone to a food allergy so that when they then subsequently eat the food, they're going to have an allergic reaction to it.
Jennifer Brand: And so this is where it becomes really important. And why, a reason why the guidelines have change. We used to say, or practitioners used to say to keep out those main allergens of the diet until the child is this old, but now we're seeing that if the child gets sensitized through the skin, before the foods get in through the gut, they're more likely to develop a reaction, an allergy to those foods. So the goal is to get them in through the gut, in orally, introduce these foods first. So this becomes even more important to introduce those foods as long as there's not an already existing allergy, of course, but it becomes even more important to introduce those foods when we do have eczema. And so it's really counterintuitive because we think, oh, we have eczema. So we need to keep all these foods out of the diet and if there's no allergies yet, you've got to introduce those foods.
Jen Fugo: This is like, kind of crazy when you think-
Jennifer Brand: It's totally like flipped. It's flipped.
Jen Fugo: I know. I was making a face because I was like, okay, A, I really feel for people who are listening to this, because I could imagine that someone is like, oh, what? Huh? Like maybe I need to change course. Did I possibly cause my child to develop these allergies? And that's not what we're trying to say, but I think to the science around this is still evolving and our knowledge around it is still evolving. So what you're saying, let me just make sure that I too understand it. So say your child has a broken skin barrier, right? So they have eczema, but you haven't yet introduced certain foods. Maybe it could be something… Well see this is interesting because two, a lot of products on store shelves, so just the traditional conventional skin creams and things could have oats in them, which could have also be contaminated with gluten.
Jen Fugo: Right. Because that could be a way that you get wheat proteins into the body. Sometimes they add wheat to these moisturizers to thicken them up. There could be soy in them. There could be all sorts of things. The child could come into contact with these potential proteins on the skin and because your body is meeting them in a way for the first time, that is in a not, I guess it's inappropriate, but it's like the wrong way to get introduced to someone essentially. So it's a wrong way to get introduced to these proteins. Your body's like, whoa, alarm bells are going off. It's a huge problem. It looks like a burglar almost. And in reality it should be something nourishing, but your body, because it's the wrong way, it's like, it's a bad character in the whole story of what's going on.
Jennifer Brand: Yeah. That's a good way to put it. And it's so fascinating to me that to find this research and to become aware of this, is that skin barrier dysfunction really does precede the development of food allergies.
Jen Fugo: Jen, can I ask you really quick, and it's fine if you don't know, was this specific to children or could this possibly happen to adults as well?
Jennifer Brand: I don't recall the research paper if it was specific to children or adults.
Jen Fugo: It's okay. I know that's not your focus. It's like when people ask me questions about kids and I'm like, I don't know, I didn't dig into that. I'll have to look. I'm just curious because that seems interesting.
Jennifer Brand: I'll have to check too. Well, and I mean, we can develop allergies at any stage of life. I mean, I certainly, I was not an allergic child. I had sensitive skin, but no allergies. As an adult, in the last number of years, I randomly get hives. I randomly get rashes. So I've become allergic to things as I have aged. And so it is always possible. So I would think that with adults too, it might be a little bit different if there's not an existing food allergy, they're already eating these foods, they've already been exposed to them, less chance of it happening through the skin. But again too, so many people are on elimination diets and taking, especially those main trigger foods out of the diet often unnecessarily, which could put them at risk for becoming sensitive to them over time.
Jen Fugo: Well, friends TBD on this topic. We don't know.
Jennifer Brand: We'll check it out.
Jen Fugo: We'll check it out. So let's talk a little bit about, so we talked about the gut first and then we've kind of gone through like the skin barrier issue with triggering allergies. But could bacteria, so certain gut bugs that live in your GI tract, your small intestine and or colon, especially the colon, because it's mostly where our microbiome resides for the most part, is there any connection between the bacteria helping or harming or making you more sensitive, so to speak to potential food allergies?
Jennifer Brand: Yes. So there's a lot of research on this. So I can tell you about some of this different research. So there was a paper that I had found. It was from January 2019 and the title was literally do gut bacteria prevent food allergy. So of course I saw that I'm like, I got to read this. Right. So the study found that healthy infants have gut bacteria that actually helps prevent if you will, food allergies or prevents them from developing. So what the researchers did, they took gut bugs from babies that had cow milk allergy or didn't have cow milk allergy. And then they transplanted that bacteria into mice with fecal samples. And so then the mice that got the gut bugs from babies without cow milk allergy did not have an allergic reaction when they were given milk. But the mice that got the gut bugs from the allergic infants had anaphylaxis when they were given milk. So.
Jen Fugo: Whoa.
Jennifer Brand: Yeah. So totally mind blowing. So that's one study that I thought was really interesting. There's also been some research on for example, clostridia is a good gut bug when it's in balance with everything else and-
Jen Fugo: And we're not talking about clostridia difficile by the way.
Jennifer Brand: Right. This is is different.
Jen Fugo: Not C. Diff. different.
Jennifer Brand: Yeah, this clostridia is part of a class of good gut bugs that makes beneficial metabolites. So what researchers found in this instance with clostridia is that it's often low in people that have food allergies. And so a mechanism behind this is that good gut bugs, so like clostridia make butyrate, which is a short chain fatty acid and short chain fatty acids help modulate inflammation and regulate what the immune system's doing. And so, butyrate is really important to have adequate sufficient levels of that because low levels have been found in people with eczema, which points to those people having lower levels of good gut bugs because they're not getting those short chain fatty acids, like butyrate that are helping keep the immune system strong. Yeah.
Jen Fugo: Is there anything that you have done in practice? Because obviously you can't supplement with clostridium. That's not a, as far as I know, I've never seen clostridium as a strain of probiotics. Is there anything that you find to be helpful in children or little ones where you might see that on a stool test to try to help encourage the regrowth of clostridia species?
Jennifer Brand: So rather than focusing on just okay, we need to regrow clostridia, typically what I might see, I guess there's nothing typical when we look at these tests, but like what I might see, if you have like an imbalance of your good flora, it might not just be clostridia that's low. You might have others that are low. So what we really focus on is that group of bacteria as a whole and work to support their proliferation. So you always start with diet. So are the right foods getting in, of course, probiotic foods, fermented things like sauerkraut, kimchi, other fermented vegetables, prebiotic foods, which are like, starchy vegetables, complex carbohydrates. So getting those in through the diet is a good place to start.
Jen Fugo: So you're saying that carbs are okay, Jen, I'm being real sarcastic here. So carbs are good for our…
Jennifer Brand: I am. Carbs are actually good for the gut. I'm not talking about, eating bowls and bowls of pasta all the time. Sweet potatoes are, quinoa, brown rice. So those types of foods can be a very healthy part of an overall whole foods diet.
Jen Fugo: And so what if mom or mom and dad, or whomever was like, well, I've seen a lot, or maybe they personally have benefited from doing carnivore. Is this an instance where carnivore, so you already had, your child has this depletion of these important strains, is this an instance where carnivore, for example might actually not be a good idea?
Jennifer Brand: I'm going to go with yes. And I don't advocate carnivore for my clients. I know I've heard that people feel better when they go carnivore. That to me begs the question, if you're eating healthy whole real foods, fruits and vegetables, complex carbs, like good whole real foods, and you have symptoms of something, there's something happening internally as to why healthy whole real foods that you should be able to tolerate, you're not able to. So taking them out of the diet, and this goes for any elimination diet, can make you feel better for a period of time. You're still not addressing the root cause of the issue. Now with carnivore, and there's a lot of research on this as well. I know we're not exactly talking about this part of it today, but high fat diets actually contribute to gut hyperpermeability or leaky gut, which is an underlying cause when we're talking about food allergies and rashes. And so something like a carnivore diet can actually contribute to a worsening of those gut symptoms. So I think that's something that needs to be undertaken with caution, especially with children. Yeah.
Jen Fugo: And also too, they're not going to have any of the starches that you need to ferment. It's devoid. It's not like the bacteria will just thrive despite it's food source being missing, it will continue to deplete. Correct?
Jennifer Brand: Correct.
Jen Fugo: Yeah.
Jennifer Brand: Yeah.
Jen Fugo: So, now that we've touched on a bunch of different things, I did want to ask you one last question of something that you've touched on. I feel like there's this whole thing, we assume that we're supposed to moisturize and you're not the first person to have questioned if, especially in little ones that that may or may not be the right thing. I actually spoke with a pediatrician earlier today who made a similar statement as well. And she works with a lot of eczema cases. So what is it that you've seen in terms of problems that might come along with moisturizing rashy skin that parents might want to know about?
Jennifer Brand: Yeah. And this kind of takes me back. You mentioned the oats, like products that have oats in them and such. Because I have seen a number of my clients sensitive to oats, like even gluten free oats, but they're sensitive to these things. So regular moisturizer does not prevent eczema. I mean, it can help soothe and protect the skin barrier, but it doesn't prevent eczema and it can actually promote sensitization through the skin and the development of food allergies. So we were talking about, right, how food allergy can develop through the skin when somebody gets sensitized to it. So what can happen is that, and there's some different mechanisms for how moisturizing can actually make these types of things worse. But so moisturizers might allow substances like including allergens to pass through the skin barrier more easily. Different like elements, buying different things can make it easier to get absorbed into the skin.
Jennifer Brand: So that can happen when you moisturize with certain allergens. Parents, when they're moisturizing their kid or their baby, maybe they just ate something or we're in the kitchen doing something and they have food allergens on their hand and now they're rubbing all over baby. And the moisturizer might also be allowing those substances to enter the skin more easily. And so some people actually too, can be more susceptible to this happening when they have a filaggrin gene mutation. Filaggrin that gene that helps build and repair the skin barrier. Yeah. And so things that you can do, not saying don't moisturize, but don't use food based products. For example, like even I, for a long time was recommending things like sunflower seed oil or people use olive oil on the skin, all of these like food oils can actually lead to sensitization.
Jennifer Brand: So don't use those. And parents, if you're going to moisturize your child with whatever you're going to use, wash your hands first. And then of course also like we mentioned before, we want to get these allergenic foods into baby before there's an opportunity to get sensitized to the skin. So, really like when baby is ready for solids, which tends to be on average about six months old, when you start introducing those other solid foods, include the allergens, little bit at a time. There's some guidelines on this. I know you're going to direct them to my website. And if anybody has,
Jen Fugo: I will. Yeah.
Jennifer Brand: Any questions they can reach out. But I do have some resources there about these allergenic food introductions. But yeah, so we definitely want to get these in through the gut first and not use food based products on the skin.
Jen Fugo: So I know parents are going to be like, but wait, if I'm not supposed to use these, do you have any suggestions then of some moisturizer? I know this is like the tricky question, but I know,
Jennifer Brand: It is.
Jen Fugo: That's what I'm going to get asked.
Jennifer Brand: I know. And that's the hard, tricky part. So based on the literature, they talk about trilipid, skin barrier creams, creams that have ceramides, cholesterol, like free fatty acids. So things that are similar to like the pH and the fat makeup of the skin. I know you have a great product line. A lot of my clients use the Quell products and have some really good results with those. I've had some great results from some of my clients using emu oil, for example.
Jen Fugo: Oh yeah.
Jennifer Brand: Yeah.
Jen Fugo: And also, and do you still recommend the Indigo Calm Balm for people?
Jennifer Brand: It's on my list. It's on my topicals list and some people do find that helpful too.
Jen Fugo: They do have a version just for everybody, if you go to the website for Indigo Calm Balm, they have a no oats. You can select no oats, if you want no oats added to your product. Because she does have different formulations.
Jennifer Brand: Yeah. She does some of the custom, she does a little bit of customization. Yeah. Yeah. And then another one that some of my clients have had good results with is beef tallow. And then always, sometimes natural doesn't necessarily do the trick. And in cases like that, I do always like to let parents know if you are in a pickle and your little one is uncomfortable, he or she does not have to struggle and suffer. The bad words, steroid creams. If you're uncomfortable, if your child's uncomfortable and you need to break the glass in case of an emergency use that prescription cream. I don't think people need to suffer through. So that's an option too for short term use.
Jen Fugo: I think sometimes too, also we, at least I found, and I don't know if this is with children, sometimes we confuse just a flare. We say, oh, well they're flaring. And in reality they have a skin infection.
Jennifer Brand: Yes.
Jen Fugo: And actually need like an actual antibiotic or something like that. So I think it's important to educate oneself on what does a skin infection look like and ask for help when that happens, because a topical steroid probably not going to really do that much. And then obviously being cautious and judicious and also talking to your doctor. I think that's where sometimes having a partnership with like, at least having someone to go back and ask questions of and if like you said, in case of an emergency and doing all the things, instead of just saying, I'm only going to do the one thing or the two things like, there's a lot of different things that you can can do to help support the skin barrier. It sounds like from diet all the way through to the different starches you expose your child to and ourselves, but also how you're approaching that developing skin barrier in a little one which,
Jennifer Brand: Absolutely.
Jen Fugo: Is so important so.
Jennifer Brand: And of course we always have the supplements to resolve those internal imbalances as well. And we want the food based approach where possible. But I always have clients on a probiotic, which is based on their specific testing. Maybe a prebiotic, depends what's happening in there, but diet first, that's why supplements are called supplements. They're supplemental, but often, more often than not, I find that they're needed to help resolve the root cause of the problem.
Jen Fugo: Yeah. Perfect. Well, everybody can find Jennifer at jenniferkarenbrand.com. I will put your links and everything in our show notes for this episode, that way everybody can get in touch with you and connect with you. Especially since you're the person, whenever I get a request for a little one or a kid, I send them to Jen.
Jennifer Brand: Thank you very much. So hi everyone. This is who is on the emails. Yes. Yes.
Jen Fugo: So I'm so glad Jen, you were able to join us today and I look forward to doing another one of these. I'm sure you will be back.
Jennifer Brand: I hope so. I always enjoy talking with you. Thanks so much for having me.
Thank you for this insightful episode! I had no idea food allergies could develop through sensitization of the skin! When my daughter was born her allergist advised to avoid milk, peanuts and tree nuts until she turned one year of age given her history of eczema and her older brother’s food allergies. When she turned one she was tested for food allergies for the first time via skin prick testing. It showed she was positive for those food allergens so we continued to avoid. Is it theoretically possible to develop food allergies if your first exposure to the food protein is through the RAST skin test? I now wonder if I could have prevented her from developing food allergies.