An Eight Month Old with Eczema

2/7/2008

I saw an eight month old baby today for a routine well visit. Two months ago I had examined the baby who had a severe generalized eczema at the time. The baby was strictly breastfed. It was clear that the baby was very uncomfortable at times. Mom was using a variety of creams as well as a mild hydrocortisone topically when needed. Despite topical care, the skin continued to worsen. Mom was not aware of any specific food triggers in her own diet that might be contributing to the rash in the baby.

I suggested a visit to an allergist in order to try and ascertain the possible triggers in mom’s diet that could be causing this rash. I would emphasize that I rarely refer a child so young for an allergy evaluation as these workups are not usually useful in this age group. In most cases, a good history and elimination diet by mom can isolate the offending allergen.

I was happily surprised today to see that the eczema rash was almost completely resolved. The allergist had identified by patch skin testing an allergy to eggs. Although the mom was not eating large amounts of eggs in the pure form (i.e. omelets), she was having mayonnaise and other egg containing foods regularly. Within two weeks of excluding eggs from her diet, the rash resolved. This information was also helpful to me in that I did not give the baby a Flu vaccine today in view of the egg allergy. This is an absolute exclusion for getting a Flu vaccine.

      

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