Identification of trigger factors

• identification of trigger factors
  • should seek to identify potential trigger factors including:
    • irritants, for example soaps and detergents (including shampoos, bubble baths, shower gels and washing-up liquids)
    • skin infections
    • contact allergens
    • food allergens
    • inhalant allergens

Notes (1):

• healthcare professionals should consider a diagnosis of food allergy in children with atopic eczema who have reacted previously to a food with immediate symptoms, or in infants and young children with moderate or severe atopic eczema that has not been controlled by optimum management, particularly if associated with gut dysmotility (colic, vomiting, altered bowel habit) or failure to thrive
• consider a diagnosis of inhalant allergy in children with seasonal flares of atopic eczema, children with atopic eczema associated with asthma or allergic rhinitis, and children aged 3 years or over with atopic eczema on the face, particularly around the eyes
• consider a diagnosis of allergic contact dermatitis in children with an exacerbation of previously controlled atopic eczema or with reactions to topical treatments
• healthcare professionals should offer a 6-8 week trial of an extensively hydrolysed protein formula or amino acid formula in place of cow's milk formula for bottle-fed infants aged under 6 months with moderate or severe atopic eczema that has not been controlled by optimal treatment with emollients and mild topical corticosteroids
  • refer children with atopic eczema who follow a cow's milk-free diet for longer than 8 weeks for specialist dietary advice

Reference:

• (1) NICE (December 2007).Atopic eczema in children - Management of atopic eczema in children from birth up to the age of 12 years