Should I give my eczema baby coconut-based skin care products?
Coconut oil has gained popularity as a natural moisturiser for babies, BUT- here’s the important bit: when coconut is used on inflamed skin BEFORE it has been offered in the weaning diet (AKA skin exposure before being offered via the oral route), it may actually increase the risk of developing a food allergy to coconut.
This is because exposure to food products through broken skin can lead to sensitisation, rather than helping babies build oral tolerance. This is known as the dual allergen hypothesis.
What is the dual allergen exposure hypothesis?
The dual allergen exposure hypothesis suggests that babies are more likely to develop food allergies if they are first exposed to allergens through the skin-especially if it's inflamed or broken like in atopic dermatitis / eczema- rather than through the gut. In contrast, early oral exposure to allergens (through food) helps the immune system build tolerance. This is why introducing common allergens during weaning, alongside good skin care (and avoiding food based skin products- particularly those linked to food allergy in babies), can be so important in reducing food allergy risk in high risk babies (such as those with moderate to severe eczema or a strong family history)
While coconut allergy in babies hasn’t been studied as extensively as other food allergies, research is beginning to emerge. In a study of 275 children with positive coconut allergy tests (via skin prick or specific IgE), those who had used coconut-containing skincare products were more likely to have a confirmed allergy (although this was poorly documented in the study).
It’s also worth noting that ‘approximately 50% of oral ingestion reactions’ to coconut in this study was ‘associated with mild/moderate anaphylaxis’ - which is the most severe presentation of food allergy!
The researchers in this study concluded: ‘Given the high prevalence of coconut in skin and hair care products, we suggest that patients are counseled on the potential of topical coconut to cause allergy, particularly in high-risk groups. Specifically, products with higher amount of allergen, such as pure coconut oil, should be the focus of counselling.’
This mirrors what we’ve seen with other allergens like peanut: when food proteins are applied to broken or inflamed skin- rather than eaten- they may actually increase the risk of allergy. Given how commonly coconut oil appears in baby skincare products, especially in pure form, families with high-risk babies should be made aware of this potential link.
For more information on coconut allergy in the UK check out Anaphylaxis UK
Study reference:
Kruse L, Lor J, Yousif R, Pongracic JA, Fishbein AB. Coconut allergy: Characteristics of reactions and diagnostic predictors in a pediatric tertiary care center. Ann Allergy Asthma Immunol. 2021 May;126(5):562-568.e1. doi: 10.1016/j.anai.2021.01.027. Epub 2021 Feb 4. PMID: 33548470; PMCID: PMC8168044. https://pmc.ncbi.nlm.nih.gov/articles/PMC8168044/#R4
The dual allergen hypothesis:
Walker MT, Green JE, Ferrie RP, Queener AM, Kaplan MH, Cook-Mills JM. Mechanism for initiation of food allergy: Dependence on skin barrier mutations and environmental allergen costimulation. J Allergy Clin Immunol. 2018 May;141(5):1711-1725.e9. doi: 10.1016/j.jaci.2018.02.003. Epub 2018 Feb 15. Erratum in: J Allergy Clin Immunol. 2018 Jul;142(1):339. doi: 10.1016/j.jaci.2018.05.013. PMID: 29454836; PMCID: PMC5938139.
https://pmc.ncbi.nlm.nih.gov/articles/PMC5938139/
Brough HA, Nadeau KC, Sindher SB, Alkotob SS, Chan S, Bahnson HT, Leung DYM, Lack G. Epicutaneous sensitization in the development of food allergy: What is the evidence and how can this be prevented? Allergy. 2020 Sep;75(9):2185-2205. doi: 10.1111/all.14304. Epub 2020 May 18. PMID: 32249942; PMCID: PMC7494573.