Talking about triggers

Eczema is an allergic condition which can be set off or exacerbated by many trigger factors. Although identifying potential triggers can be challenging, when your patients know what their individual triggers are they can try to reduce contact with their triggers or avoid contact altogether.

Taking a detailed case history can be useful to identify suspected triggers, and these can be confirmed or discounted through tests if necessary.

Food

Food allergy can trigger flare-ups of eczema for some people, with cow's milk, eggs, peanuts, tree nuts, wheat, soya, fish and shellfish most commonly implicated. Some of your patients may be able to pinpoint a particular food they believe is responsible.

The National Eczema Society suggests people keep a diary and make notes on the condition of their eczema.⁷ However, avoiding trigger foods is unlikely to cure a person's eczema completely. There is no good evidence to support the use of 'few foods' diets or elemental diets.¹

Environmental triggers

We are all exposed to pollen, airborne mould spores and other environmental factors on a regular basis. Some of your patients may notice their eczema is particularly bad during the spring and summer when pollen counts are high, so giving them advice like staying indoors when pollen counts are at their highest, may help. It’s important to reinforce the need to maintain a daily emollient routine.

House dust mites

House dust mites can exacerbate eczema for many people. Eliminating dust mites is impossible, however, there are strategies your patients can put in place to reducing dust mites in their home:

• Vacuuming carpets, soft furnishings and mattresses at least once a week, preferably with a model that has an HEPA filter
• Washing their bedding once a week at a high temperature - at least 60°C
• Fitting barrier covers to mattresses, pillows and duvets
• Dusting thoroughly a few times a week (rather than dusting every day which may increase airborne dust) and removing household clutter which can trap dust
• Freezing cuddly toys over night
• Replacing carpets with laminate or stone flooring

Pets

Dander and proteins in the saliva of pets can trigger eczema for many of your patients. Getting rid of a family pet would probably cause significant emotional distress, so providing patients with strategies to reduce contact with dander is useful. For example, people can:

• Limit the amount of time they spend stroking their pet, discourage pets from licking and wash their hands afterwards
• Wear gloves when playing with pets, and if possible, play with them outside
• Wash pet bedding regularly, for example, once a week
• Keep pets off the furniture and out of bedrooms

For those who are considering getting a pet, you can recommend pets that don’t produce dander like fish and reptiles, or caged animals that don’t have a run of the house such as rabbits, hamsters and birds.

Supporting parents » « Providing holistic care

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