November 08, 2025
3 min read
Key takeaways:
- The prospective study included 855 children aged 0 to 12 years.
- Data were drawn from chart reviews and parent questionnaires.
- Researchers recommended emollients to protect the skin barrier.
ORLANDO — Children whose eczema developed earlier, lasted longer and was more severe were less likely to outgrow their food allergy, according to a poster at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting.
With these findings in mind, effective eczema management may promote tolerance in food allergy, Mahboobeh Mahdavinia, MD, PhD, division director, allergy and immunology, University of Texas Health Science Center at Houston, and colleagues wrote.
Treating eczema during infancy may mitigate the duration of food allergy later in childhood. Image: Adobe Stock
“Our big question is, ‘Who’s going to outgrow food allergies?’” Mahdavinia, who also is a member of the Healio Allergy/Asthma Peer Perspective Board, told Healio. “Because some kids do, and some don’t.”
At least 80% of children with food allergy previously have had eczema, she added.
Mahboobeh Mahdavinia
“We wanted to have more clinical information to give to our patients and also recommendations to doctors about what to do with their eczema early on that might help them,” Mahdavinia said.
The multicenter prospective FORWARD cohort study included 855 children aged 0 to 12 years and an average age of approximately 6 years with a history of outgrowing IgE-mediated food allergy, based on caregiver survey responses. The most common food allergies included peanut, milk, egg, tree nuts, sesame, fish and shellfish.
“But we have any type of food allergy you could imagine in the cohort,” Mahdavinia said.
The researchers reviewed each patient’s chart, including any primary care and allergist visits they may have attended for their eczema.
Caregivers also answered questionnaires about the timing of eczema onset and remission among these children as well as surveys to determine severity based on skin distribution and cumulative therapies, scored on a 0 to 6 scale.
“We also had a questionnaire about the medications that have been needed for the eczema,” Mahdavinia said.
Using generalized additive models, the researchers said they found a significant nonlinear association between the duration of eczema and resolution of food allergy (P < .006). The probability of outgrowing a food allergy fell with shorter durations, modestly increased when eczema lasted between 8 and 10 years, and then fell again.
Also, the researchers said there was an association between greater eczema severity and decreased probability of outgrowing a food allergy (P < .001).
Additionally, children whose eczema developed between the ages of 4 and 6 months were significantly less likely to outgrow their food allergy than those children whose eczema developed between ages 0 and 3 months (P = .003). There were no significant differences between children whose eczema developed in later age groups.
Noting these associations between onset, severity and duration, the researchers said that effective eczema management may contribute to tolerance among children with food allergy.
“We’re getting to the point that treatment of eczema is very important,” Mahdavinia said. “If we can help the kids have very good eczema therapy, which would be daily moisturizers combating dry skin, and then treatment as fast and as much as needed to decrease the duration of eczema, we’re going to help them.”
Mahdavinia also said that these data will be helpful when caregivers ask if their child is going to outgrow their food allergy when eczema develops by age 3 months.
“We could tell them, ‘Well, maybe in your case, it would be lasting longer, because that’s what the data show,’” Mahdavinia said. “But what’s in our hands is to treat them properly so the eczema is shortened and there’s less skin involved.”
Mahdavinia encouraged the use of emollients to prevent flares and treat exacerbations as soon as they happen.
“The skin barrier is very important for the development of food allergy. We are potentially showing that the skin barrier might be important in also getting rid of the food allergy,” she said. “Having a better skin barrier and treating eczema potentially can eradicate other causes that might continue this inflammatory atopic process.”
Mahdavinia and her colleagues will continue to study the cohort and prospectively follow up with these patients. They also are conducting a microbiome study with multiple skin samples from each patient.
“We are doing that in children with eczema and without eczema, trying to understand if there’s something linked to a long-lasting eczema, like a microbe on the skin, that might be causing this sustained food allergy and if you could find something that they could fix on their skin microbiome that can help them outgrow food allergy,” she said.
For more information:
Mahboobeh Mahdavinia, MD, PhD, can be reached at [email protected].
Sources/Disclosures
Source:
Koulov N, et al. Association between clinical features of eczema and outgrowing of food allergies in pediatric patients. Presented at: ACAAI Annual Scientific Meeting; Nov. 6-10, 2025; Orlando.
Disclosures:
Mahdavinia reports no relevant financial disclosures.
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