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Rebecca Hartman (2m 42s):
You know, they have this clean hypothesis. We live these very clean lives And so our bodies don't see all these other allergens to react to. And so unfortunately, when they're not challenged sometimes then they react to benign innocuous things like peanuts.

Katie Ferraro (2m 55s):
Hey there, I'm Katie Ferraro, registered dietitian, college nutrition professor and mom of seven specializing in baby led weaning. Here on the Baby led weaning with Katie Ferraro podcast. I help you strip out all of the noise and nonsense about feeding, giving you the confidence and knowledge you need to give your baby a safe start to solid foods using baby led weaning. Could your baby's eczema on their skin have anything to do with their risk for food allergy? This is one of the topics that when parents hear one thing online and then another thing from a friend And it maybe something totally different at the pediatrician's office, it can feel really scary, especially because most babies have some degree of eczema, right?

Katie Ferraro (3m 40s):
It's something that I do when I'm working with families for parent coaching. We have some questions about eczema and every family's like, oh yeah, my baby has eczema. But when we're talking about food allergy risk, we're really talking about severe eczema. So in today's episode, we're gonna be looking at that connection between eczema and Food Allergy Risk. What do we know? What do we not know? And then what can parents actually do with this information without spiraling or feeling like they did something wrong? My guest today is Dr. Rebecca Hartman. She's a board certified dermatologist. She also has a master's in public health. She currently serves as the chief of dermatology at VA Boston Healthcare System. She's the director of melanoma epidemiology at Brigham and Women's Hospital and an associate professor of dermatology at Harvard Medical School.

Katie Ferraro (4m 26s):
Don't you love all these doctors with like all these titles? But she also is working with the skincare brand ever Eden, which is how I met her because she's part of their mom's in medicine team. So she helps interpret research and think through evidence-based ingredients for their babies and family skincare line. I formally was an affiliate for ever Eden. I'm no longer associated with them. I'm huge fan of their products. I absolutely love them. But Dr. Hartman is also a mom and she is a food allergy mom. She's a baby led weaning mom. So what I really love about this conversation is that she's not just bringing her professional lens as a physician and a dermatologist, but she's sharing her personal experience as a mom, navigating eczema, trying to do the early food allergen introduction stuff and then concerns about having food allergy with her own child.

Katie Ferraro (5m 15s):
This interview the wheat did was recorded a while back, so you'll hear some references where she's talking about the time that she shared with her own baby. But I always appreciate this conversation because I know her message is so powerful And so relevant. Eczema is common, food allergy concerns are real and parents deserve clear, calm, evidence-based guidance about what this may mean when their baby is starting solid foods. So If your baby has eczema, if you're worried or nervous or confused about how to safely offer your baby allergenic foods or If you just want a better understanding of why the skin barrier matters when we're talking about food allergy risk, then this episode is going to help connect those dots in a way that feels practical and reassuring.

Katie Ferraro (5m 60s):
And so with no further ado, here is Dr. Rebecca Hartman helping us to link the eczema and food allergy risk situation so we can better understand it for our own families.

Rebecca Hartman (6m 14s):
Thank you so much for having me. I'm really excited to be here.

Katie Ferraro (6m 17s):
Ari, can you share the litter bit about your background and the work that you do as a dermatologist?

Rebecca Hartman (6m 21s):
Sure. So I'm a dermatologist. I work at Brigham and Women's Hospital in Boston, which is affiliated with Harvard Medical School. And I also very proudly serve our veterans at the VA in Boston. There are no baby veterans that I've seen fortunately, but I do like working with the veterans as well. And I'm also a mom, so I have a seven month old named Ethan and we are embarking on the adventure of baby weed leaning together.

Katie Ferraro (6m 43s):
Okay. Can you tell me the litter bit about how it's going everyone? I know everyone will have lots of questions about Ethan, so If you don't mind sharing, how is introduction of solids gone? Yeah,

Rebecca Hartman (6m 51s):
So You know, I had a lot of friends. I had like a cousin who did the baby led weaning and I had another friend. You know, it's something that I think is getting more and more interest now. And so at six months we tried it and what I just wanna say to those moms out there doing it is it definitely takes some time. Like I, the first month I was like, oh my goodness, this is never going to work. He just sits there, he like pulls out his bib, he plays with the food it, it's like he like can't pick it up and something after like a month it just clicked and now he is a champion. It is going so well. He eats a variety of foods. He, he loves healthy foods, he loves like kale, he'll just suck on a piece of kale for for a long time. He likes broccoli, he likes meat. We're trying to do a lot of iron rich foods. So it's actually, it's been really great.

Rebecca Hartman (7m 32s):
And one of the benefits I think that people talk about is like my husband and I can eat our dinner while he eats. I mean we're watching him of course for choking and safety, but it's really nice and convenient And it just works well with our lifestyle. We just have some extra food of whatever we make it, try to make it not too salty and we give that to him.

Katie Ferraro (7m 48s):
I love to hear baby led weaning success stories and thank you for the reminder that it is really slow going at the beginning And it doesn't mean you're doing anything wrong. Most babies it will click around four, six, sometimes even eight weeks. So hang in there mom, if you're just getting started, Dr. Hartman, I know we're here today to talk about the relationship between eczema and Food Allergy Risk. Do you mind sharing just the litter bit about Ethan and have you introduced any of the potentially allergenic foods with him as part of baby led weaning?

Rebecca Hartman (8m 12s):
Yeah, so Ethan's seven months old. He was pretty much exclusively breastfed until six months when we felt like he could sit up well and put food to his mouth. And then right away we introduced right before six months actually I tried to introduce allergens based on the data from the LEAP study, which looked at infants aged four to 11 months. The average age was around eight months and they randomly assigned them to eat about three teaspoons of peanut butter per week and about three or more meals versus just avoiding peanuts because the older teaching was just to avoid allergens and the kids that ate the peanut butter regularly actually had far fewer allergies to peanuts. So there was an 86% reduction in the risk of peanut allergies for those kids that ate the peanut butter regularly.

Rebecca Hartman (8m 55s):
So knowing this data as a doctor, I right away tried to give Ethan some peanut butter right before six months and unfortunately with his first exposure he got Hive. So we did some subsequent testing and we think he's probably peanut allergic unfortunately.

Katie Ferraro (9m 7s):
Okay, what about tree nuts?

Rebecca Hartman (9m 8s):
Yeah, so tree, tree nuts, we did almond butter a couple times and he did well

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Rebecca Hartman (9m 42s):
Well, but we tried cashew butter and he got a rash on his face, so we're gonna do more testing for that. So unfortunately, I think about a third, again, I'm not an allergist so I apologize if my allergy data's not spot on, but dermatology you can hold me to it, but about a third of of kids with the peanut allergy or about a fifth can also have the tree nut allergy is my understanding. And

Katie Ferraro (10m 2s):
Do you mind sharing just the litter bit more about like the peanut reaction? Like what did the hives look like and why were those potentially more concerning to you than just the rash that he got on his face from cashew? Like was it full body hives? Were there changes in breathing? Anything else you saw from peanut?

Rebecca Hartman (10m 14s):
Yeah, so fortunately for him it's just been rashes, although I do so there's some question if peanut can pass in breast milk. So I've noticed sometimes if I eat peanut butter in the nurse him I feel like he spits up more. But anyways, that may be anecdotal, but as a dermatologist the key to hives is that you see these kind of red ill-defined splotchy areas, but they also have edema. There's some swelling. So they have these pale areas with palor that are swollen. So to me as a, as a dermatologist, he pretty clear cut had hives and hives are concerning for a food allergy because they're mediated a different way than like an eczema or another type of rash. And the way that they're mediated can unfortunately also be associated with more severe types of reactions like anaphylaxis, which could involve stomach problems like vomiting, babies can actually go limp.

Rebecca Hartman (10m 60s):
And then the most feared complication of anaphylaxis is, is if their blood pressure drops, that can be a very dangerous situation. So unfortunately he just had the hives. But with allergies like this, my understanding from the allergist is they're really unpredictable. So a prior mild reaction does not predict the severity of a future reaction. And so once you see hives in a baby with food introduction, it, it's time to take it seriously and bring it to your doctor.

Katie Ferraro (11m 23s):
And certainly one of the reasons why we recommend introducing it early and often is because it's actually quite unlikely to see the allergic reaction on the first exposure. It tends to be on the second or subsequent exposure as it can certainly happen on the first, but it can also happen on the fifth or the sixth. And that's why we encourage parents that, You know, you do shrimp once, it's not one and done, you gotta continually be reintroducing these foods into the baby's diet. So for our parents that are here, they're interested in the early introduction of allergenic foods. They know there's some data that shows it may help prevent food allergy. Could you speak to the relationship between eczema and Food Allergy Risk? How are those two topics linked?

Rebecca Hartman (11m 57s):
Yeah, so it's interesting when before I had my son, I, I just always thought they were linked because it's genetic. Like people who are predisposed to eczema are predisposed to allergies, they call it to atopic march. They can get allergic rhinitis and they can get asthma. But as I, I did more reading and learned with my own son, they actually, people now think that atopic dermatitis or eczema in and of itself is a direct risk factor of food allergy because the skin barrier is abnormal, it's unhealthy in eczema or atopic dermatitis and this can allow allergens in the air or in contact with our skin to see the immune system in a way that they normally would not be able to do so. And there's some thought that seeing the allergens in your gut through eating promotes a healthy response to these allergens, whereas seeing them in your skin does not.

Rebecca Hartman (12m 43s):
And that's probably part of why the early introduction is helpful. We're we're showing these allergens through the gut and the guts responding and saying, okay, these are safe, these are not a problem. So unfortunately for for babies with eczema, they're at high risk to have the allergens be exposed through their skin and develop an unhealthy response to them. And that's probably why my son, before he had even tried peanut butter, had already had a reaction. But he may have gotten it some through the breast milk. There's some thoughts that it actually, the peanut protein in some women in one study, about half the women did pass it in their breast milk and half did not.

Katie Ferraro (13m 13s):
One thing that I think is confusing for parents, I know myself, I was confused when the leap, the learning early about peanut allergy trial results came out and we were really diving deep into it, was that what was defined as high risk for peanut allergy? That criteria changed after that publication. And to now if a baby has severe eczema and or egg allergy, they're then considered to be high risk for peanut allergy. Parents hear eczema and they're like, whoa, that's me. That's my baby because my baby has eczema. Could you share the litter bit about the difference between mild run of the mill eczema and the severe eczema that puts baby in high risk category for peanut allergy?

Rebecca Hartman (13m 47s):
Yeah, so You know, it's really common for babies in general to have dry skin. Their skin barrier is just not mature and normal like an adult skin barrier. So it, it has problems keeping the water in and babies have a lot more skin for their weight than adults do. So there's just a lot more ways that they can lose water through their skin. So it's not, it's not uncommon common for kids to have or babies to have dry skin. You know, for eczema they, there are different scoring systems, but one of the most common is the EAs score, EASI. And for that eczema's called mild, if it's just barely perceptible, there's not a lot of intensity for the redness thickening thickness, sorry, swelling and lichenification. Lichenification being thickening of the skin.

Rebecca Hartman (14m 28s):
It's rated moderate. If there's obvious abnormalities of the skin, like for example my son I would classify as moderate, sometimes his whole back just feels rough and it's obvious that it's damaged skin. And then severe is where all the skin is really red and inflamed and, and you need to use prescription medicine. So most babies do not fall in the severe category. Probably most fall in the mild. And then the next, You know, know most common would be moderate and I would say severe is pretty rare.

Katie Ferraro (14m 54s):
Hey, we're gonna take a quick break but I'll be right back. And so you're joining us today. The way I got introduced to you was through the brand ever Eden, who I know you are on their team of moms in medicine, I believe you're on their medical advisory board. Could you share the litter bit about why you decided to be affiliated with the ever Eden brand as both a mom and a dermatologist?

Rebecca Hartman (15m 23s):
Yeah, so they approached me with their moms in medicine program and when I learned about their brand I, I really liked how they're science backed. So they wanted me to work with them to look at the evidence for ingredients. So I'm an epidemiologist, I have an MPH h just like you, which I was excited to see that, that you have one as well. And certainly that helps us interpret studies and data and they really wanted to be very data driven with their approach, use ingredients that have evidence behind them. And so, and I, I love reading papers and and examining the data. So I thought it was a great fit and I was really excited to, to help bring products to help kids and their families and their moms use ingredients that are evidence-based.

Katie Ferraro (16m 1s):
And If You guys wanna check out the ever Eden products, I have a discount code. I'll put it on the show notes for this episode. If You guys go to blwpodcast.com and just search ever Eden. This episode with Dr. Hartman will come up and I know I was gifted products by the brand, which I get a lot of products for work, but this one was really unique and as I started looking into it I thought wow, this is cool because not only are the founders moms, but they're also dermatologists working in medicine and research because I know as a mom it's really confusing like when you look at the products like what ingredients do you wanna have and not have? And I was curious If you had any tips for us as moms, dads, caregivers, trying to buy products. Like what do you like to see or not see in a product you're gonna put on your baby's skin?

Rebecca Hartman (16m 40s):
I really wanna see ingredients that have data behind them to work. And so those ingredients include things like colloidal oatmeal which has been shown to restore the skin barrier and also to reduce inflammation. Ceramides, which are these really critical proteins in the skin that help promote the lipid barrier, which protects the skin from water loss. Sunflower oil has been shown to be anti-inflammatory and to help the skin. So these are some of the ingredients that I look for in products that I use. I'm not, You know, a lot of moms like natural. I think natural has the potential to be great. I have to say to me it doesn't matter as much if it's natural or not, I just care if the ingredients work really well.

Katie Ferraro (17m 17s):
And I think it's confusing, like at least in nutrition the term natural means nothing. Like you can literally ascribe it to so many things that are quote unquote unnatural that it gets really confusing. So sometimes parents are like, just tell me, You know, I'm like, hey, no added sugar in the food, no added sodium. Like let's just keep it kind of simple If you can. Sometimes when you read ingredient lists. So they get really long I, I've like, I'm not a dermatologist, I don't know if this is good or not. So I do like taking recommendations from other moms, especially like a physician mom. So thank you for filling us in about the brand. Curious If you would share, I know your son has, would you say it's mild eczema or or mild to moderate? How have you dealt with that?

Rebecca Hartman (17m 52s):
I think it was mild and it's, I now would call it moderate. It's interesting when he got the food allergy at the same time as eczema was like horrible. And when I was talking to one pediatric allergist he said it's often like that. It's like everything's going haywire at once. So I would say his eczema's moderate. I mean we have had to use topical steroids for it and we certainly see in our practice parents that are reluctant to use topical steroids 'cause they're a prescription, they're not natural. But it really worked amazing for my son. It calmed down his angry

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Rebecca Hartman (18m 47s):
Skin. He was really uncomfortable, which is any parent is hard to watch and when I used them they made a big difference and, and now of course the nice thing is we only need to use them as a rescue and now we're just working on kind of maintaining the skin barrier and keeping the inflammation away by using some of these evidence-based ingredients. The wheat discussed.

Katie Ferraro (19m 3s):
So I know that the research around food allergy risk and eczema is still emerging and I've had parents like say that even when you broach this topic, they feel like it's their fault if their baby had eczema and they then developed a food allergy. I am so happy to have you on the podcast to help just raise awareness about the fact that there might be a link, but what do you say to parents who are like, oh my gosh, like you yourself, you have a baby that has eczema and possibly has food allergy. Like is this something the wheat did or didn't do? Like how do you deal with that?

Rebecca Hartman (19m 29s):
Yeah, so that's a really tough one. I think as parents we, You know, our instinct is always to blame ourselves or to be really hard on ourselves and I think we have to do everything we can to, to try and not do that too much because we're all trying to be the best parents we can be. Parenting is definitely tough. It's the hardest thing I've ever done. Harder than med school, harder than residency. So to, to all those parents working hard out there, I salute you, but I don't, I don't think there's anything that anyone did wrong. You know, this is probably a combination of genetics and environment genetics. Like my husband has eczema, there's a common mutation, therin mutation that's really common about one in three people have it And it just predisposes you to eczema. And then environmentally we are seeing just more and more eczema allergies, asthma in our society and that's probably a reflection of, You know, they have this clean hypothesis.

Rebecca Hartman (20m 13s):
We live these very clean lives. We're not as, not as many people are working outdoors in the, in the fields, in the woods. Farming, You know, we're not working with farm animals And so our bodies don't see all these other allergens to react to. And so unfortunately when they're not challenged sometimes then they react to benign, innocuous things like peanuts. But You know, I don't think you can fault yourself. There's nothing that you did wrong. There's no data to show that there anything could have been done differently to prevent this from happening.

Katie Ferraro (20m 39s):
So one thing I've been wanting to ask you as a dermatologist and a, I'm a fellow mom but not a dermatologist. I have seven small kids. I hate bathing them. I only do it once a a week. My grandma always said she bathed their kids once a week whether they needed it or not. And I've heard that that might actually be beneficial. That like bathing your kids too much could be problematic. One of my kids has really bad eczema. Just curious about your thoughts between bathing and then other things we can do for eczema control in our children.

Rebecca Hartman (21m 2s):
These are great questions. I agree. I think over bathing is a problem. It can, You know, really hot water and harsh soaps can disrupt the barrier function of the skin and worsen eczema. And I really, for kids, I'm a fan of kind of age appropriate bathing. So what that means is for the little babies, they really only need to be bathed once a week max. They're just not getting very dirty. They don't sweat, they don't go out and do much. Although they're working hard at developing their brains. They're not, they're not that active and, and If you bathe them more you, you may be damaging their skin as babies get older or like my sunny seven months and he has eczema, then it's important to actually bathe the litter bit more to try and keep bacteria down because bacteria and eczema have a complicated relationship where they both feed off one another.

Rebecca Hartman (21m 43s):
So eczema skin is much more prone to be colonized by staph aureus, which is a problematic bacteria. So I try to bathe my son at least twice a week for that. And I even do something called bleach baths, which I recommend you don't do unless you discuss with your pediatrician or dermatologist. This is something that needs to be discussed with a doctor, a decision made on an individual basis. But for us I think it works well. And it involves basically using a very, very small amount of regular strength bleach in a full bathtub So that the chlorine concentration is like a pool. You never wanna let the baby's head get in there. Of course in general in a bath you're watching the baby you don't want their head to, to get in the water, but just soaking them in that for a few minutes can kind of, the thought is help decolonize some of that problematic bacteria from the eczema and then you rinse it off and then I let 'em have a regular bass.

Rebecca Hartman (22m 27s):
So you can play the litter bit, but harsh bathing for long periods of time with hot water, harsh soaps definitely can strip the skin of its protective layers and can contribute to worsening eczema. So, and then of course I, I call it age appropriate bathing because as kids get older, If you have a 14-year-old sweaty, You know, teenager that's been playing soccer, then they probably need more regular baths And that would be age appropriate for them.

Katie Ferraro (22m 48s):
We were talking the litter bit earlier about the signs and symptoms of food allergy and I know it's not related to the eczema question, but one thing I share a lot on Instagram and parents share with me and I then share with my audience are what pictures of what allergic reactions look like because they do manifest themselves differently, especially in children of different skin colors. And so sometimes I think we traditionally hear hives raised red itchy patches, but if a child has darker colored skin, it may not appear to be red. Do you have any tips for parents on what to be looking for for specifically for hives?

Rebecca Hartman (23m 20s):
Yeah, so that's a great question and it's well known in dermatology that our images of skin problems are disproportionately in lighter skin and, and that's a problem 'cause we're not being trained appropriately to care for everyone. So I think it's a great question. Hives, the key feature of hives is that they're a word we call emini, which means swollen and filled with fluid because what happens is there's so much inflammation that the blood vessels get leaky and they leak out their fluid. So a key feature of hives that they is that they should really be raised and swollen and often they have surrounding redness in central palor or loss of color, but certainly in darker skin types, redness can be more difficult to see. My son is what we would call skin type four. So he has kind of towards the more darker type skin.

Rebecca Hartman (24m 2s):
His skin definitely did get red, so every baby's different. But I think the key is looking kind of for these raised spots, which, You know, a colloquial term would be like welt, but they're, they're kind of raised and swollen almost like a bug bite. A bug bite is like a localized hive.

Katie Ferraro (24m 16s):
And then this is kind of along the same lines, but I do a weekly free workshop called Baby led Weenie for Beginners. And at the end we answer questions and I get like the same questions over and over, but I got a different one the other day, which was, okay. Katie, you've been showing pictures, especially on social media of what babies of different colored skin look like when they're having a reaction. I'm not sure If you would know this, but because it's about skin and color, I wanna ask you as a dermatologist, when we talk about the difference between gagging and choking, gagging bean, a good thing baby tends to turn red or pink, but they're making noise, it's audible air is passing through with choking, babies tend to turn blue and there is no noise in babies with darker skin. Does it look blue or what would you be looking for skin color-wise? Anything you could speak to there if there's a potential choking incident?

Rebecca Hartman (24m 57s):
Yeah, so certain, certainly that would be very scary. But I, I do think when babies are not getting enough oxygen, you can see the blue color really in any skin type. So You know, around, around the mouth is one of the most common sites where you could see cyanosis. And so I think it would be visible even in a darker skin baby. But in general with darker skin, the colors may be harder to see, so one may need to look more closely.

Katie Ferraro (25m 21s):
Well, Dr. Hartman, thank you so much for your time. This has been incredibly informational. I know our audience is appreciative as well. Thank you for sharing your professional expertise, but also your personal story with your son Ethan. Where can our audience go to learn more about you and your work and also your affiliation with Ever Eat and brand?

Rebecca Hartman (25m 36s):
Sure. So I, they can look me up at the Brigham website as well as at Dana-Farber Cancer Center and ever Eden. I can be found on the Moms and medicine page on their homepage.

Katie Ferraro (25m 46s):
And I'll go ahead and link to that for You guys on the show notes for this episode@blwpodcast.com. Dr. Hartman, thank you so much.

Rebecca Hartman (25m 52s):
Thank you Katie, so much for having me. It's my pleasure.

Katie Ferraro (25m 55s):
Well, I hope You guys enjoyed that interview with Dr. Hartman. I seriously don't know how that woman gets so much done. She's incredible. As a professional, she's an amazing contributor to the moms and medicine team at ever Eden. Plus she's dealing with her own family situation and then still has time to graciously come on the show and share this information with our audience. So thank you again, Dr. Hartman. I'll put a link to all of the references that she mentioned in the show notes, which you can find@blwpodcast.com/129. And a very special thank you to our partners at Airwave Media. If You guys like podcasts that feature food and science and using your brain, check out some of the other shows from AirWave. We're online@blwpodcast.com.

Katie Ferraro (26m 35s):
Thank you so much for listening. I'll see you next time.

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