Could my child's allergies have been prevented?
As a mum of a child with severe eczema, here's what I wish I'd known.
Last Friday I wrote a tongue-in-cheek post about hindsight - that gut-grinding magic of looking back on things and realising precisely where you messed up. My focus was on some of the stupider moments of my summer, but something that was in the back of my mind when I was writing, but that I didn’t include, was a recent podcast I listened to that made me wonder: could my child’s allergies have been prevented? This was far more painful to contemplate than a missed flight or a mobile phone floating away in the river, so I didn’t include it - it didn’t sit right with the humorous tone. But I want to write briefly about it today - if only to pass on potentially vital knowledge that I truly wish I had had, to someone who may benefit from it.
Admittedly it’s now a decade since I went through the hell of having a baby with extremely severe eczema. Apologies for the following horrific picture but I don’t think people always know what you mean when you say ‘severe eczema’.
Before we go further I must tell you - he is ok now. What we did about it is a story in itself (you can read my old blogs about it in the following links).
His eczema is gone and in 11 years (he just had his birthday), we have had no issues with it, maybe just once or twice a little bit of dry skin - that’s it. But a health issue that remains is that he has severe allergies - to egg, milk, mustard, and honey. Why? My assumption had always been that it’s ‘bad luck’ / ‘genetic’. I am asthmatic and as a child I was allergic to eggs, my dad had eczema, so clearly the gene is just passing along. Why are his generation of children suffering from allergies in must more extreme and sometimes life threatening ways? Well that’s a question I have occasionally pondered, and worried over, but never found an answer. Recently, in the past year or so, he has been expressing more frustration about the foods he cannot eat, so I’ve promised him I’d research it a bit more. On our kitchen fridge we have something the kids call the ‘Whiteboard of Wishes’ - this was my attempt to get them to take some responsibility for remembering stuff eg, ‘I need new socks’, ‘Arrange a sleepover with Amy’ ‘can we go back to that place with the river’, etc rather than expecting it all to be neatly categorised in my Mumbrain. The kids can write anything on it from the basic to the blue sky stuff. This is it currently:
Back in February I set the ball rolling by writing this post here on my substack, asking for your ideas and experiences (and thanks for all your brilliant thoughts), but then I signed a deal to write Ultra Processed Women and I’ve had my head down doing that ever since. I had to put ‘Fix Allergeys’ on the back burner for a while - but there it is on the Whiteboard of Wishes still. So last week I listened to this podcast that caught my eye. And it completely blew my mind, taking me on an emotional rollercoaster of anger, outrage, sorrow and sheer amazement. If I had had this information ten years ago, the course of our entire lives could have been completely different.
Dr Gideon Lack is a Professor of paediatric allergy at King’s College London and head of the children’s allergy service at Guy’s and Thomas. He headed up two important studies (the LEAP study and the EAT study) that have changed all of the advice and thinking about allergies over the past decade. It’s Dr Lack’s research that has shifted the advice away from the complete avoidance of allergens like peanuts, even in pregnancy, towards regular exposure, and - as you will hear if you listen to the podcast - even towards regular, deliberate and early exposure, particularly in babies at risk of developing allergies, like my baby was.
When we were in our eczema hell it was 2014, and although the groundbreaking LEAP study was presumably underway, it was not published until 2015. By then it was too late for us - our allergies were already diagnosed. But I was amazed to listen to Dr Lack explain in the podcast that children like mine with eczema are the most likely of all to develop allergies, because - it is thought - allergens can enter through the broken skin and the body therefore (wrongly) mounts an immune response to them. This thinking comes particularly from a study in mice, but it’s borne out by the high crossover of children with allergies who are also eczema sufferers. The usual way for a body to try new food, and to recognise it as such, is through the mouth - and this is probably why babies spend so much time putting things in their mouths, helping their bodies and their guts to understand and categorise their world. But tiny particles of food entering through the skin rather than through the mouth, can mean a lifetime of the body wrongly recognising that food as a danger - and this is allergy.
In order to make sure the body doesn’t do this, we need to get in early and make sure these typical allergens enter the body orally before they are wrongly categorised. According to Dr Lack this means early weaning, particularly in babies at higher risk of allergy, and intentionally feeding regular amounts of foods like nut butter from about 4 months (more on this in the podcast). This is controversial, I know: WHO advice is no solids before 6 months. But I have to say that, as a mum of a child with allergies, I think I may well have broken this ‘rule’ with my son if I had thought it might have prevented him from potentially a lifetime of anxiety, picky eating, and an inability to ever truly enjoy food, particularly away from home. In his case, at the moment, his allergies are not life threatening, but there are many parents for whom the situation is even harder. I don’t know how they cope with knowing that a trace of peanut could mean a severe reaction, and a medical emergency or even worse for their child. That’s a life sentence for them as parents as well as their child.
Clearly there are still a lot of unanswered questions. In the podcast Dr Lack suggested that the dramatic rise in children with allergies could be down to our washing ‘too much’ and using too much soap, causing the dry skin and eczema that makes us vulnerable to allergens entering the body ‘the wrong way’. In our case, I know this wasn’t what triggered the eczema, as we have always avoided the ‘Johnson and Johnson’ bubble baths etc of babies. We live in a mucky house and we have a dog, something else that Lack suggests can be very helpful in allergy prevention. I must also add a note about vaccines, because every single time I write about our eczema story someone suggests to me it was caused by childhood vaccination. I’m so lucky to be able to tell them that I know for sure it wasn’t: because of how ill he was I declined the routine vaccinations. When people tell me it was caused by vaccines I always think about how awful I would feel if I had had him vaccinated, because I would worry that they were right, and that I had somehow willingly damaged my own child. So please, in our search for answers, let’s be careful what we say to other parents. Remember how much they care and that they have to sleep at night.
In the same way, it’s clearly an over-simplification to say that parents of babies today can prevent severe allergies, problem solved. But I’m writing this post because, in spite of it being nearly ten years since the LEAP study - and there have been several other studies since - I have never heard this idea that babies with dry skin and eczema are highly prone to allergies, and that there are steps that parents can take to prevent it, and I really think this should be common knowledge. I want to do my part in getting it out there, so that hopefully other parents can be spared the struggles and even the life-threatening health risk of a child with allergies. I don’t know everything about this topic but hopefully this post is enough to start you thinking, if you are a parent or may become one soon, about the questions you might need to ask and the steps you might need to take if you are at higher risk of allergies. And if you have heard this advice, particularly as a parent of a baby with eczema, or if you give this advice as a doctor or health visitor (or disagree with it!) I’d love to know that too. For this reason, the comments on this post are open to all.
It’s too late for our family (yes this sucks), so my quest to find out how to shut the door after the horse has bolted continues. I’ve emailed Dr Lack and also got in touch with the Natasha trial which is trying to get the practice of ‘Oral Immunotherapy’ (OIT) - a method of reteaching the body NOT to mount an immune response against certain foods - accepted by the NHS. This is only a topic I write about occasionally but, if we make any progress, I’ll keep you posted. Let’s hope one day I can make that whiteboard wish come true.
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I too could write a lot on this but from the point of view of a breastfeeding counsellor and midwife rather than mother… but my short comment is focused on weaning. I’ve been around long enough to see a range of advice in this respect being ’fashionable’ a word I use deliberately. Personally I believe that the WHO advice is no less … anyway the answer for me rests on that simple idea of being naturally led - learned through attachment parenting (no matter what you think of this parenting strategy, it is informed by nature…) When a child is learning the world from its mother’s lap it creates the perfect opportunity to experience everything from a safe space - when it comes to food this means helping itself to whatever she has in front of her. This manifests as a child trying all sorts of foods (and non foods) as you say in the mouth, but doesn’t necessarily mean eating/swallowing - that comes when they’re ready… each child will be different. I was lucky enough to eventually experience this with my 3rd child, who was ‘weaned’ entirely on ‘finger-food’ ie only what he could pick up himself (which included barbecue ribs before 6 months)… A very complex subject well done for sharing such useful information Milli.
How interesting! I am intolerant of dairy and gluten. When I was born (1983) they said I was born "too quickly" so rushed me off to an incubator - apparently rather than giving my Mum the chance to breastfeed I was given formula, my family has a history of dairy and gluten intolerance (my grandfather is coeliac)
I had horrible eczema as a baby and my Mum has always put it down to this first intake of a dairy as essentially my first meal when realistically I shouldn't have eaten it.
I introduced dairy when I left home for uni, at first I seemed to get away with it, but gradually over about 8-10 years I developed really bad eczema again and my asthma became debilitating, I also gained a lot of weight. I cut out gluten and dairy and gradually recovered over the space of about 6-12 months. I've tried eating it again or just lapsed in times of stress over the last 9 years and always found I quickly deteriorated so I've stopped again!
I've raised my children gluten and dairy free because my eldest used to projectile vomit if I'd had any dairy so I cut it out and thankfully that stopped! She had a tiny gluten breadstick at about 11 months old and her previously perfect skin broke out all over her arms 😭 if she eats anything accidentally now (age 8) she gets really badly blocked ears, so whilst the avoiding things is awful I think she's learning sadly that it's easier than not being able to hear!!!
It must be such a hard balance of introducing things and also allowing for the reactions that might be awful!! I'd love to know more about how the processing of food that now happens affects allergies too - I don't suffer so badly in France for example if I dare to have a pastry from a bakery as I would here!