Pre-referral guidelines for primary care providers

Eczema is a common condition seen in many children characterised by itchy dry skin, usually triggered by environmental (older infants and children) and/or food-related (younger infants) allergens.

Eczema is commonly familial and is seen in children with atopy, which includes asthma, eczema, rhinitis (hay fever) and food allergies.

For the diagnosis and management of eczema, please refer to the Royal Children’s Hospital clinical practice guidelines.

Eczema and food allergies

Many infants with moderate or severe eczema may also have an immediate allergy to food(s):
  • this does not mean that the food allergy is the cause of the eczema and therefore removal of the food(s) will not result in eczema cure, but will prevent the child from having an immediate reaction (e.g. hives, swelling, breathing difficulty etc) to the foods they are allergic to.
  • In some young infants with severe eczema, removal of certain food(s) may result in better eczema control. This should always be conducted under the supervision of a medical specialist (clinical immunology/allergy specialist) in association with an accredited practising dietitian, with specialised knowledge in food allergies.
    • If the skin improves, foods are introduced one at a time (food challenges) to determine if it causes the eczema to flare.
    • If there is no improvement in two weeks on the elimination diet, it means that food is unlikely to be a problem.
  • Testing for food allergies via skin prick testing (SPT) or RAST in the absence of immediate symptoms (intense itch, swelling and hives) post ingestion is not generally helpful or useful.
    • Children with eczema and/or food allergy can have falsely positive SPT/RAST, which leads to unnecessary dietary restriction.

See also Allergy pre-referral guideline.

Referral pathways