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Home / Allergy and immune care / Immune conditions
For clinicians

Eczema and the atopic march: the skin barrier, food allergy and what helps

What eczema is, why it is tied to food allergy and asthma, whether moisturizing a baby's skin prevents it, and which treatments the evidence supports.

4 minute read, written for clinicians10 sources, each checked word for wordLibrary checked October 18, 2026

Hands holding a tube of cream beside green leaves

This is the clinician view. It keeps every sentence of the plain guide and adds, for each section, the study design and citations of its sources. Every added sentence is cited and checked like the rest. Back to plain language.

In short

  • Eczema is the most common chronic inflammatory skin disease, affecting up to 20% of people over a lifetime.Review1
  • It commonly occurs with asthma and allergic rhinitis, and is the strongest known risk factor for IgE-mediated food allergy.E2Good1,2
  • Daily moisturizer from birth did not prevent eczema in large trials, and probably increases skin infections.E1Strong3,4

How sure each claim is:E1StrongE2GoodOfficial textReviewWhat the grades meanUnderlined words open a definition

What is eczema?

Atopic dermatitis, the medical name for eczema, is the most common chronic inflammatory skin disease. It has a lifetime prevalence of up to 20%, causes intense itch and recurring rashes, and comes and goes.Review1

It runs strongly in families and often occurs with other allergic conditions such as asthma and allergic rhinitis.Review1

The evidence in this section (1 source)
SourceDesignGradeCitations (NIH iCite)
1 Weidinger S, Nat Rev Dis Primers, 2018Expert reviewReviewNot tracked

Why does the skin barrier matter?

A weak skin barrier, for example from too little of the skin protein filaggrin, can promote inflammation.Review1

A landmark genetics study found that two common variants that switch off the filaggrin gene are very strong risk factors for eczema. The finding established a key role for the skin barrier in allergic disease.E2Good5

The evidence in this section (2 sources)
SourceDesignGradeCitations (NIH iCite)
1 Weidinger S, Nat Rev Dis Primers, 2018Expert reviewReviewNot tracked
5 Palmer CN, Nat Genet, 2006Observational studyE2GoodNot tracked

What is the atopic march?

The "atopic march" describes how eczema, food allergy, asthma and hay fever tend to travel together. Allergy societies call eczema the highest risk factor for developing IgE-mediated food allergy, and eczema commonly occurs with asthma and allergic rhinitis.E2Good1,2

One proposed explanation is the dual-allergen exposure idea. It holds that allergy develops when a food allergen meets the body through the skin, while eating the food builds tolerance. Its author offered it as a hypothesis that could explain the close link between eczema and food allergy.Review6

The LEAP trial enrolled infants with severe eczema, egg allergy, or both because they are at high risk of peanut allergy.E1Strong7

The evidence in this section (4 sources)
SourceDesignGradeCitations (NIH iCite)
2 Fleischer DM, J Allergy Clin Immunol Pract, 2021Consensus statementE2Good248 (RCR 20.98)
1 Weidinger S, Nat Rev Dis Primers, 2018Expert reviewReviewNot tracked
6 Lack G, J Allergy Clin Immunol, 2008Expert reviewReviewNot tracked
7 Du Toit G, N Engl J Med, 2015Randomized trialE1Strong1,605 (RCR 62.45)

Can moisturizing a baby's skin prevent eczema?

The BEEP trial found no evidence that daily emollient (moisturizer) in the first year of life prevents eczema in high-risk children. It found some evidence of more skin infections.E1Strong3

The PreventADALL trial found that neither early emollients nor early feeding of allergenic foods reduced eczema by 12 months.E1Strong8

A Cochrane review pooling the trials concluded that regular emollients during infancy probably do not prevent eczema and probably increase local skin infections.E1Strong4

The evidence in this section (3 sources)
SourceDesignGradeCitations (NIH iCite)
3 Chalmers JR, Lancet, 2020Randomized trialE1StrongNot tracked
8 Skjerven HO, Lancet, 2020Randomized trialE1StrongNot tracked
4 Kelleher MM, Clin Exp Allergy, 2021Systematic reviewE1StrongNot tracked

What treatments does the evidence support?

Current treatments include moisturizers and anti-inflammatory creams and ointments (such as corticosteroids, calcineurin inhibitors and PDE4 inhibitors). They also include light therapy and medicines that act on the whole immune system.Review1

The 2023 US allergy guideline panel agreed on 25 recommendations for gaining and keeping control of mild, moderate and severe eczema.E2Good9

Dupilumab is an antibody that blocks interleukin-4 and interleukin-13 signaling, two type 2 immune messengers.E1Strong10

Two phase 3 trials tested dupilumab in adults with moderate-to-severe eczema. Compared with placebo, it improved signs and symptoms, itch, anxiety and depression symptoms, and quality of life. Injection-site reactions and conjunctivitis were more frequent with dupilumab.E1Strong10

The evidence in this section (3 sources)
SourceDesignGradeCitations (NIH iCite)
1 Weidinger S, Nat Rev Dis Primers, 2018Expert reviewReviewNot tracked
9 Chu DK, Ann Allergy Asthma Immunol, 2024GuidelineE2GoodNot tracked
10 Simpson EL, N Engl J Med, 2016Randomized trialE1StrongNot tracked

What is not known yet

The dual-allergen exposure idea remains a hypothesis to explain the eczema and food allergy link.Review6

Questions you might bring to your clinician

  1. How severe is this eczema, and what is the plan to keep it controlled?
  2. Does this eczema change the advice on introducing peanut or egg?
  3. Which treatments fit this case, and what are their side effects?
  4. Are skin infections a concern, and what signs would matter?

Every claim in this guide was written from its sources and checked against them word for word. Its clinical review by Dr. Recio, whose specialty is anesthesia, is pending; an allergist has not yet reviewed it. This line changes when each review is done.

Sources

Each source opens on PubMed, DailyMed or the publisher's page. Under each one are the exact words from it that this page relies on, copied word for word and checked against the original.

  1. Atopic dermatitis. Weidinger S, Nat Rev Dis Primers, 2018. Review Expert reviewPMID 29930242
    The words this page rests on
    Atopic dermatitis (AD) is the most common chronic inflammatory skin disease, with a lifetime prevalence of up to 20% and substantial effects on quality of life. AD is characterized by intense itch, recurrent eczematous lesions and a fluctuating course.
    AD has a strong heritability component and is closely related to and commonly co-occurs with other atopic diseases (such as asthma and allergic rhinitis).
    Impairment of epidermal barrier function, for example, owing to deficiency in the structural protein filaggrin, can promote inflammation and T cell infiltration.
    Current treatments for AD include topical moisturizers and anti-inflammatory agents (such as corticosteroids, calcineurin inhibitors and cAMP-specific 3',5'-cyclic phosphodiesterase 4 (PDE4) inhibitors), phototherapy and systemic immunosuppressants.
  2. A Consensus Approach to the Primary Prevention of Food Allergy Through Nutrition: Guidance from the American Academy of Allergy, Asthma, and Immunology; American College of Allergy, Asthma, and Immunology; and the Canadian Society for Allergy and Clinical Immunology. Fleischer DM, J Allergy Clin Immunol Pract, 2021. E2Good Consensus statementPMID 33250376; DOI 10.1016/j.jaip.2020.11.002; cited 248 times, relative citation ratio 20.98 (NIH iCite, 2026-10-16)
    The words this page rests on
    Eczema is considered the highest risk factor for developing IgE-mediated food allergy, but children without risk factors still develop food allergy.
  3. Daily emollient during infancy for prevention of eczema: the BEEP randomised controlled trial. Chalmers JR, Lancet, 2020. E1Strong Randomized trialPMID 32087126
    The words this page rests on
    We found no evidence that daily emollient during the first year of life prevents eczema in high-risk children and some evidence to suggest an increased risk of skin infections.
  4. Skincare interventions in infants for preventing eczema and food allergy: A cochrane systematic review and individual participant data meta-analysis. Kelleher MM, Clin Exp Allergy, 2021. E1Strong Systematic reviewPMID 33550675
    The words this page rests on
    Regular emollients during infancy probably do not prevent eczema and probably increase local skin infections.
  5. Common loss-of-function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis. Palmer CN, Nat Genet, 2006. E2Good Observational studyPMID 16550169
    The words this page rests on
    Here we show that two independent loss-of-function genetic variants (R510X and 2282del4) in the gene encoding filaggrin (FLG) are very strong predisposing factors for atopic dermatitis.
    This work establishes a key role for impaired skin barrier function in the development of atopic disease.
  6. Epidemiologic risks for food allergy. Lack G, J Allergy Clin Immunol, 2008. Review Expert reviewPMID 18539191
    The words this page rests on
    An alternative hypothesis is proposed, suggesting that sensitization to allergen occurs through environmental exposure to allergen through the skin and that consumption of food allergen induces oral tolerance. This hypothesis provides a possible explanation for the close link between eczema and the development of food allergies.
  7. Randomized trial of peanut consumption in infants at risk for peanut allergy. Du Toit G, N Engl J Med, 2015. E1Strong Randomized trialPMID 25705822; DOI 10.1056/NEJMoa1414850; cited 1,605 times, relative citation ratio 62.45 (NIH iCite, 2026-10-16)
    The words this page rests on
    We randomly assigned 640 infants with severe eczema, egg allergy, or both to consume or avoid peanuts until 60 months of age.
  8. Skin emollient and early complementary feeding to prevent infant atopic dermatitis (PreventADALL): a factorial, multicentre, cluster-randomised trial. Skjerven HO, Lancet, 2020. E1Strong Randomized trialPMID 32087121
    The words this page rests on
    Neither early skin emollients nor early complementary feeding reduced development of atopic dermatitis by age 12 months.
  9. Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE- and Institute of Medicine-based recommendations. Chu DK, Ann Allergy Asthma Immunol, 2024. E2Good GuidelinePMID 38108679
    The words this page rests on
    The panel agreed on 25 recommendations to gain and maintain control of AD for patients with mild, moderate, and severe AD.
  10. Two Phase 3 Trials of Dupilumab versus Placebo in Atopic Dermatitis. Simpson EL, N Engl J Med, 2016. E1Strong Randomized trialPMID 27690741
    The words this page rests on
    Dupilumab, a human monoclonal antibody against interleukin-4 receptor alpha, inhibits signaling of interleukin-4 and interleukin-13, type 2 cytokines that may be important drivers of atopic or allergic diseases such as atopic dermatitis.
    In two phase 3 trials of identical design involving patients with atopic dermatitis, dupilumab improved the signs and symptoms of atopic dermatitis, including pruritus, symptoms of anxiety and depression, and quality of life, as compared with placebo.
    Injection-site reactions and conjunctivitis were more frequent in the dupilumab groups than in the placebo groups.