Approximately one third of caregivers of children with atopic dermatitis (AD) expressed concerns about the role of diet in their child’s condition, based on new data presented at the American Academy of Allergy, Asthma & Immunology (AAAAI) 2026 Annual Meeting.

The relationship between diet and AD remains a common concern among caregivers of children with AD, but data on nutrition-related support needs for these families are limited, reported Wendy Elverson, RD, LDN, of Boston Children’s Hospital in Boston, and colleagues.

The researchers conducted a chart review of 126 individuals aged 3 months to 18 years diagnosed with AD (median age, 4 years) who initially visited a multidisciplinary center for pediatric patients with AD between 2022 and 2024. Most of the patients had moderate eczema, based on the caregiver-reported Patient-Oriented Eczema Measure (mean score, 13.9) and the Eczema Area and Severity Index (mean score, 12.8).

A total of 79% of caregivers completed an open-ended survey about visit goals and questions. Of these, 35% expressed nutrition-related concerns. The most commonly raised issues were about which foods might cause or trigger AD, when to introduce solid foods, concerns about their child’s growth or nutrition, and treatment of AD through the gut.

Over half (56%) of the patients with AD had immunoglobulin (Ig)E-mediated food allergies, and 44% had multiple food allergies. In addition, 28% of caregivers reported that their child avoided at least one food based only on the caregiver’s suspicion that the food was a trigger for AD.

Overall, the children with IgE-mediated food allergies and AD were, on average, significantly smaller than their peers with AD only: The mean age- and sex-based percentiles for height and weight for children with vs without food allergies were 43.1 vs 64.5 (P = .005) and 37.9 vs 58.8 (P = .002), respectively.

The findings were limited by several factors including the use of data from a single center and the reliance on charts. However, the results highlight the need to ask families about a child’s dietary avoidance patterns based on AD and to consider referrals to dieticians if needed to support growth and nutrition, the researchers concluded.

Food Restrictions May Affect Growth

“Diet is probably the single most common concern I hear from families of children with eczema, and yet we have surprisingly little data on how those concerns translate into real-world behavior and clinical response,” said Peter Lio, MD, clinical assistant professor of dermatology and pediatrics at Northwestern University Feinberg School of Medicine in Chicago, who was not involved in the study.

The current study goes beyond asking whether diet matters for AD, Lio told Medscape Medical News. Instead, “it examines what families are actually doing and what it is costing their children,” he noted. “The finding that more than one fourth of caregivers had already restricted foods based on suspicion alone, without a confirmed diagnosis, is not surprising to anyone who sees these patients regularly.”

However, documenting this restriction in a study helps make the case to address this issue proactively, he said. In fact, the findings may underestimate the number of caregivers with nutrition concerns because the study was based on a chart review, and most families do not volunteer dietary concerns related to AD unless they are directly asked, Lio noted.

“What I found most striking, and most clinically sobering, was the growth data,” Lio commented. “Children with both AD and IgE-mediated food allergies showed meaningfully lower height and weight percentiles compared to children with AD alone, and 10% were below the fifth percentile for height; that is not a trivial difference,” he emphasized. “It is a signal that perhaps unnecessary dietary restriction, combined with the nutritional burden of managing multiple food allergies, can have real consequences for a child’s growth and development,” he said.

Takeaways and Next Steps

The current study highlights the importance of proactively asking families of children with AD about dietary and nutrition concerns, Lio added. “We cannot assume that families will bring up their dietary concerns unprompted, and we cannot assume that food restriction is not happening because a child has AD rather than a confirmed food allergy,” he said. “A brief conversation about what the child is eating and what has been eliminated can open the door to important guidance,” he added.

As for additional research, longitudinal data would help clarify the impact of early dietitian involvement to improve growth outcomes and reduce unnecessary food restriction, Lio said. Other useful research would include whether structured dietary counseling changes caregiver behavior and, if so, what format is most effective in a dermatology setting, he noted.

In addition, the new study data suggest that there is genuine interest from families about the gut-skin axis, which deserves more rigorous investigation, and where real science is emerging, said Lio, noting that patients and families are already acting on information about the gut-skin connection in managing AD.

The study received no outside funding. Lio disclosed having no financial conflicts related to the topic of diet and eczema but disclosed having relationships with multiple companies related to areas including AD.