### Atopic Dermatitis and Food Allergies: Which Comes First? Atopic dermatitis (AD), commonly known as eczema, is a skin condition that affects millions of children and adults. There is a known link between AD and food allergies, but it's still unclear which one typically comes first. Some experts believe that AD can lead to skin barrier damage, making it easier for allergens to enter the body and cause food allergies. Others think that food allergies might trigger AD symptoms. #### What is Atopic Dermatitis? AD often starts in childhood and can continue into adulthood. It is caused by an overactive immune system and a disrupted skin barrier. People with AD lack a protein called filaggrin, which helps maintain a healthy skin barrier. This makes it easier for moisture to escape and for allergens and bacteria to enter, causing inflammation and itchy, dry skin. #### Common Triggers - **Food Allergies:** Dairy and eggs are often cited as triggers, but the evidence is mixed. Some people with AD have true food allergies, but their reactions are usually hives or anaphylaxis, not eczema flare-ups. - **Pollens:** Tree and grass pollens can also trigger symptoms, especially when consuming related raw fruits and vegetables. - **Sodium Intake:** High-sodium diets may worsen AD symptoms. A study showed that even a small increase in sodium intake could raise the odds of having AD. - **Pollutants:** Exposure to pollutants like smoke and car exhaust can damage the skin barrier and increase the risk of developing AD. #### Managing AD - **Elimination Diets:** These involve removing potential trigger foods from the diet and then reintroducing them later. However, this should be done under medical supervision to avoid severe reactions. - **Whole-Foods Approach:** Eating a diet rich in nutrients and diverse foods can help manage AD. Nutrients like vitamin D, vitamin A, and probiotics are beneficial. The goal is to develop a comprehensive plan to manage AD, including daily routines to strengthen the skin and microbiome and a rescue plan for flare-ups. Always consult a healthcare provider for personalized advice.