Early Signs of Food Allergies: The Atopic March

Eczema, asthma, seasonal allergies (rhinitis), and food allergies are each allergic diseases that affect different parts of your child’s body - the skin, the lungs, the sinuses, and the gut. All allergic diseases are screw-ups of an overactive immune system.

While some children have just one of these conditions, many have multiple because an overactive immune system tends to cause many problems. This pattern of developing multiple allergic diseases in order is called “the atopic march.”

The picture below shows that eczema usually shows up fist, followed by food allergy in babies. Asthma usually develops in toddlers, and seasonal allergies in young children. 

Atopic March

If you talk to a parent of a child with eczema, asthma or food allergies, they will probably tell you that there were warning signs long before their child was officially diagnosed. I want to tell you about these early warning signs that I wish I had known about. 

If the immune system is overactive, it needs to be calmed down. The warning signs are signals to parents that they need to do something to calm the immune system down.

Early Warning Signs of Eczema

Atopic dermatitis, or allergic eczema, can start extremely early in life. Two early signs of eczema are allergic shiners and trans-epidermal water loss.

Allergic shiners look like eye circles or bags under a baby’s eyes — almost like your little one took up boxing (hence the name “shiners”). These shiners are swelling and discoloration from congestion of small blood vessels beneath the skin in this area. 

Have your child evaluated by their pediatrician for eczema and hay fever if you see allergic shiners on a regular basis.

Trans-epidermal water loss (TWEL) is really a fancy way of saying dry skin. As discussed when talking about your baby’s skincare routine, water loss leaves your baby’s defense barrier weak and prone to infection. 

There are new ways to measure water-loss from skin using a small probe. There are multiple Portable Skin Moisture Analyzers on the market, and while they’re not a staple in doctor’s offices yet, a tool like this can help your doctor understand what you are seeing. 

If you’re not sure if your baby’s skin condition is the start of eczema, this tool may also be helpful for you and your pediatrician to track changes in your baby.

Finding underlying triggers for eczema and keeping your baby’s skin healthy and soft is incredibly important for stopping the atopic march. If you are seeing warning signs of eczema, talk to your doctor about eczema creams and possible triggers in your breastmilk. 

If you are breastfeeding, you may want to take a probiotic that contains L. Rhamnosus. Some studies have shown that this bacteria can reduce the risk of eczema in babies.  

Early Warning Signs of Food Allergy

Food allergies can be hard to identify in infants who have not yet started eating solids because they are only getting trace amounts of food through their mother’s breast milk or formula. For example, only about 30% of women express peanut protein in their breast milk, and it’s always in tiny amounts (meaning not enough to cause a reaction). 

Food allergies are also hard to identify because infants under 6 months only have skin reactions or stomach issues when reacting to a food. The skin reactions can look a lot like eczema, and the stomach issues can look a lot like standard spit up. 

If your baby...

  • Consistently vomits or spits up a lot after feedings
  • Has bad smelling poops (breastmilk poop should smell sweet)
  • Has bloody or mucousy poops
  • Does not poop every day
  • Has severe stomach pain...

do not ignore these symptoms, even if your baby does not seem to be in particular pain. These are clear signs that something in your baby’s GI system is not working correctly. Immediately speak to your pediatrician to evaluate for food intolerance or allergy. Undiagnosed milk allergy is unfortunately common and can cause future ear infections

If your baby is showing warning signs of food allergies, make a plan for early allergen introduction. Your pediatrician may ask you to cut food out of your diet if you are breastfeeding or switch to a hypoallergenic formula to see if it clears up the issues and calms the immune system down.

Early Warning Signs of Asthma

As described in the atopic march image above, babies typically do not develop asthma or seasonal allergies until they are toddlers or older. Eczema and food allergies are the early warning signs of future asthma, and studies are currently underway to see if treating eczema and food allergies can prevent asthma. 

If you have any concerns about the risk of asthma, do not hesitate to talk to your pediatrician.