Managing AD Flares and Debunking the Food Allergy Myth

Lisa Swanson, MD, describes AD as fundamentally unpredictable — a roller coaster of flares and quiet stretches that can wear down patients and families alike. The goal of good treatment, she says, isn't to eliminate that unpredictability but to smooth it out, likening well-controlled AD to trading a thrill ride for a gentler one: the blips that remain are far less disruptive. She points to known flare triggers — illness, travel, stress, and exposure to cigarette or wildfire smoke — while acknowledging that some flares simply happen without explanation. Preparing families in advance for that unpredictability, she says, helps reduce the anxiety a flare can otherwise cause.

Asked for her key takeaways, Swanson emphasizes that AD is a big deal: not every child outgrows it, and even those who eventually do may be suffering with real consequences in the meantime. She cites data showing that parents of children with AD report higher rates of anxiety and depression than the patients themselves, underscoring how much the condition affects the whole family unit. Her guidance to pediatricians: try topical steroids, consider a topical calcineurin inhibitor, and refer to a pediatric dermatologist, allergist, or comfortable dermatology clinician when control isn't achieved or families feel overwhelmed.

She closes with a point she considers essential: food does not cause eczema for roughly 98% of patients. Instead, it's the impaired skin barrier that drives sensitization to food. Elimination diets, she cautions, rarely help, can compromise a growing child's nutrition, and are linked to a higher risk of developing an allergy to the avoided food. Her message to families is simple — treat the skin, and keep the diet varied and unrestricted.

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