My daughter, aged 11, has eczema and IgE 860. How to manage?

Question

Hello doctor,

I am reaching out regarding my 11-year-old daughter, who has been dealing with atopic dermatitis since the age of 5. Recently, her condition has worsened, with more frequent flare-ups with intense itching and redness, particularly on her arms and neck.

Her recent lab results showed elevated IgE levels (860 IU/mL), and a skin biopsy confirmed chronic eczema. We have been using Mometasone ointment, but unfortunately, the improvement has been quite limited. I want to know the following:

Given the persistent symptoms, would you consider systemic treatment options such as Dupilumab at this stage?
Additionally, would allergy testing help identify potential triggers, or is its value limited in cases of chronic atopic dermatitis?
Lastly, are there any evidence-based dietary modifications that might help reduce flare-ups in children?

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

Atopic dermatitis (eczema) is a chronic skin condition that causes itchy, dry, red, and cracked skin, and when it’s severe or ongoing, it can be incredibly tough on both the child and their family.

Here is an overview of current treatment options and supportive care:

1. Topical treatments

Medications like Mometasone (a mid-strength steroid cream) can help with mild to moderate eczema, especially during flare-ups. However, if your child has frequent or severe flare-ups that do not improve much with creams and moisturizers, it might be time to consider more advanced options.

2. When to consider biologic treatments

Dupilumab is an injectable biologic approved for children six and older with moderate to severe eczema that has not responded well to standard treatments. It works by calming the immune response that causes inflammation and itching, and is both effective and safer long-term than relying heavily on steroids or immunosuppressant drugs. It's usually considered when creams and moisturizers just aren’t enough.

3. Allergy testing

In many kids with chronic eczema, allergy tests (like IgE blood tests or skin prick testing) show multiple sensitivities, but not all of them are truly causing symptoms. Testing is usually most helpful when eczema clearly flares after exposure to specific triggers, like certain foods or things in the environment (example, dust mites, pets, peanuts).

4. Diet and lifestyle

There’s no special “eczema diet” that works for everyone. Unless your child has a confirmed food allergy, cutting out foods isn’t usually necessary. That said, a nutritious, balanced diet with plenty of fruits, vegetables, and healthy fats (like those from fish or flaxseed) can help support skin health.

Just as important is a consistent skincare routine:

Use fragrance-free moisturizers daily, especially after baths.
Give lukewarm baths (not hot) to avoid drying out the skin.
Dress your child in soft, breathable cotton clothes.
Avoid harsh soaps and detergents that can irritate the skin.

With the right mix of medical treatment and daily care, many children see big improvements in their symptoms and in their overall quality of life.

If standard creams are not reducing it, talk to your child’s doctor about other options like Dupilumab and whether it might be a good fit.

I hope this helps.

Kindly revert if there are any queries.

Thank you.