Eczema is a frustrating condition. It often starts when children are very young and is itchy, disfiguring and can become easily infected.

It’s not surprising parents try all sorts of creams and ointments to improve this. And I am in full support of them. Every child is different and parents need to find what works best for their child. There is, however, one current trend that I wish to advise some caution against: COCONUT OIL.

One of the current theories on food allergy development is called the DUAL ALLERGEN EXPOSURE HYPOTHESIS. It suggests that food allergies are caused by exposure through the skin to food protein. Let me explain:

We know that almost all children with food allergies has or had eczema. Eczema is an inflammatory condition where the skin lacks certain proteins that normally hold water in the skin. The skin therefore becomes dry, itchy and doesn’t function very well as a barrier. This allows irritants, bacteria and food proteins to get through. When food protein gets through the skin, inflammatory cells take this up and say, “This is something that got through my line-of-defence.” They prime the immune system to treat this as something foreign and harmful. When a child then eats this food, the body mounts a large immune response. This can lead to anaphylaxis – a severe, life-threatening allergic reaction.

When a food is eaten BEFORE a child has gotten exposure through the skin, cells in the stomach called REGULATORY CELLS take this up and tell the immune system, “This is a food and not something harmful.” They down-regulate the immune system so that it doesn’t mount a response.

PLEASE NOTE: THIS IS A VERY SIMPLIFIED VERSION OF THE DUAL ALLERGEN EXPOSURE HYPOTHESIS. There are other cells and mechanisms at work, and again, this is presently just a theory. However, there is very good evidence that continues to mount in support of this theory. For example, if you take a mouse model that has eczema and rub peanut butter on the skin, you can cause a peanut allergy in that mouse.

This theory also explains why EARLY INTRODUCTION OF FOODS CAN HELP PREVENT FOOD ALLERGIES IN CHILDREN.

So how does this relate to coconut oil?

Coconut is a drupe – a dry fruit – not a nut. For full botanical information on coconut, see here (https://www.loc.gov/rr/scitech/mysteries/coconut.html). Coconut is not a common allergy – at least not in the top 10. That said, coconut allergy appears to be increasing over the past several years. I myself have seen approximately 5-10 children with true coconut allergies in the past 3 years. And all of these children had a history of coconut oil use on their eczema.

So while coconut oil might help the eczema, it might also lead to coconut allergy. As there are many alternatives, I suggest avoidance of coconut oil on eczema. This is not published data and has not – to my knowledge – been studied in a large, formal trial. This is simply based on my – and several other allergist’s – observations.

Hope this is helpful. Please feel free to comment below but keep in mind, I cannot answer specific medical questions about you or your children.

19 Comments

  1. Fascinating. Would you say that similarly to children, the elderly or immunosuppressed population would be at this same risk (potentially)? And would this theory also tie in with use of essential oils – although not always resulting as a food allergen but maybe sensitivities to certain products or soaps (thinking of a laundry detergent allergy/irritant)?
    Thanks for sharing!

    • Good questions Tara! I’m not sure about the elderly and immunosuppressed. Theoretically, the biggest risk is to young children because they have eczema and their immune systems are still developing. Often patients on immunosuppressants will get a flare of eczema when they come off their medications so I suppose it would be possible. As for essential oils, this is not something I have seen and I think it would depend on what the oil contained. In general, I think it would be prudent to avoid any food containing essential oils on a child’s eczema. We also know that eczema is easily irritated by scents and perfumes (ie fabric softeners, etc) so I would avoid them for that reason as well.

  2. So would it be ok to try it on an older babys excema after theyre on solids & had eaten some (food grade) coconut oil? And also not allowing to touch potential allergens before they’ve consumed them? I’m not asking for specific advice as my child does not have excema or allergies, I just find it interesting.

    • Thanks for the question Clare! Once a child has a food in their diet and is eating it regularly, it is very uncommon for them to develop an allergy to this. Keep in mind though, allergies develop only to the food protein. In order for the immune system to react to a food, it has to contain the protein. For example, children with anaphylactic allergies to peanut can actually eat peanut oil if it is pure. I do not recommend patients do this because often peanut oils are not pure and contain protein. This is likely why many people use coconut oil on eczema and do not develop allergies. The amount of protein in most coconut oils is likely small however this is not regulated and may differ between oils. So if a child is eating coconut (and not just foods cooked in coconut oil) I would expect it would be very low likelihood that they would develop an allergy to this if their parents began using coconut oil on their eczema AFTER they have had sufficient exposure through the gut. This is speculation based on other food and has not been studied specifically for coconut (to my knowledge). Hope that’s helpful. Cheers!

  3. I believe I read about this theory in Heather Fraser’s book, “The Peanut Allergy Epidemic”. Have you read it and have any thoughts on it?

    Also, OIT has been gaining momentum in the USA–do you think Canada will follow suit? I know of only a couple Drs. in Canada offering OIT.

    Thanks for the coconut oil warning!

    • Haven’t read that one yet but will definitely add it to my “to-read” list. As for oral immunotherapy (OIT), I trained in Vancouver where there are currently trials for OIT ongoing with both peanut and milk. Dr. Edmond Chan is a researcher/clinician there (my mentor) and he is one of the leading food allergy researchers in Canada and world-wide. I also recently returned the AAAAI conference (the largest allergy conference in the USA) and can tell you this, there is A LOT of research with OIT ongoing worldwide. There have already been several trials that have been able to get children to the point where they can tolerate the foods they are allergic to. It is usually a small amount (ie. 1/4 of a peanut) and while this isn’t a cure, it does help with accidental exposure risk. The problems that many trials are having right now are 3-fold: 1. Many children drop out of the trials due to significant side effects (usually abdominal pain) while trying to build up the dosing. 2. The tolerance to the food is often not sustained and the children can quickly revert back to being allergic when the food is not consumed daily. 3. High rates of anaphylaxis during the build up phase.

      My guess is that there will be more wide-spread use of OIT in the near future when these issues have been worked out. For now it is primarily in the research phase and I would steer clear of any online sites advertising “peanut cure”, etc. But the research is happening and my fingers are crossed that we will have something to offer our patients soon.

  4. Super interesting stuff Alex! Couple of questions, I’m guessing this relates to its general use as a moisturizer for things such as cradle cap and dry skin as well as eczema? So it’s general use should be limited to once they have eaten coconut protein? And I use a
    product that is oat based, could the same reaction apply with this product as well (but for oats of course)

    • Hey Nathalie,

      Applying to eczema is slight different than to dry skin or cradle cap because there is an abundance of inflammatory cells under the skin with eczema. As well – and I won’t get too technical here – but the cells under the skin in eczema are primed to cause allergies. They have what is called a Th2 skewing, meaning they produce a lot of chemicals that lead to allergies. So while I would avoid using it on dry skin and cradle cap too (I’m a cautious parent) I suspect the risk wouldn’t be as high.

      As for oats, that’s a great question. As I alluded to in an answer above, it is protein the immune system needs to see in order to develop an allergy. If you think about the common food allergens, they are protein dense foods (ie. nuts, milk, egg, fish, etc). Grains are not a common allergy as they do not have high protein content. I have not seen many children with oat allergy but I think it would be a good idea to avoid putting any food on eczema. Again, not a common problem, but always best to be safe.

      Hope that helps!

      Alex

  5. This is entirely interesting. As an adult I just finished having the worst eczema of my life from 2-3 years ago and only this year it’s finally completely gone…I did a Ig G sensitivity test and a number of foods popped up that I never had issues with in the past…once avoided for a few months the eczema disappeared. While on immunosuppressants and topical steroids…if I came off of the creams my flaring would become worst and worst almost as if my skin developed an addiction to what it was absorbing and/or the steroids was causing some kind of leaky gut problem. Needless to say, I’m very carefully on what my baby has applied to him and definitely would not use coconut oil! It’s a great reminder, thank you and keep up the blog!

  6. Great article! Can I get your thoughts on using burts bee baby oil on eczema ? It has grape seed oil , apricot oil, soybean oil and canola oil amongst other ‘foods’. If you would suggest avoidance are there any good moisturizers for baby’s prone to eczema? TIA

    • Good question. I honestly don’t know the processing that goes into Burt’s Bee Baby Oil. There are two ways to make an oil – hot pressing and cold pressing. If an oil is hot pressed, it is generally pure, whereas cold pressed oils contain protein. It is the protein that the immune system reacts to, so if an oil is pure, putting it on the skin will not prime the immune system and thus create an allergy. I suspect that part of the reason we are now seeing coconut allergy is that people are using food grade coconut oils on eczema which will contain higher levels of the protein. So is it possible to develop allergies to things in Burt’s Bee Baby Oil? Probably. Is it likely? No.

      There have been several large studies comparing different moisturizers and they have generally come to the same conclusions – there isn’t any one specific moisturizer that works much better than others. The key things are: 1. It is thick (ie. ointments > creams > lotions) and 2. It is applied liberally and often. So I tell patients to use inexpensive options. Generally families come back and say that they find these three work the best: 1. Cerave 2. Glaxol Based Cream and 3. Aveeno Eczema Moisturizer.

      Hope that helps!

  7. I appreciate this information since we have been battling eczema and coconut oil has been one of the only things that has worked consistently. This encourages me to find another alternative. Thank you!

    I have posted your blog on my company Facebook page to get the word out as well.

  8. Thanks Dr. Lyttle, this is super interesting. Another interesting thing I just figured out is our Vitamin D (brand Ddrops) comes in coconut oil! So, even though not feeding my baby solids yet as he is only three months, I’m assuming this could potentially be protective as he sort of ingesting it. Having said that, he spits it out often and if its mostly just absorbed in the mouth rather than the gut, would this actually potentially be another risk factor I wonder?

    • Hi Christine, Yes, the coconut oil in VitD has been brought to my attention in the past. While not researched specifically, my suspicion is that it is low risk. For one, the volume is very low. And secondly, it is an oil (the allergenic part of any food is the protein, not the lipid). The oil used on the skin is often ‘food grade’ and therefore more likely to contain protein. There are thousands of children taking VitD drops (my 4 children included) and coconut allergy remains relatively uncommon. The children I have seen with coconut allergy have all been using coconut oil on the eczema directly. Keep in mind there are also lots of parents who used coconut oil on their children’s eczema and DID NOT develop coconut allergy. It is just a risk factor. But one that might be avoidable. I continue to give my children VitD drops because I believe the benefit outweighs the risk. I never tell parents what to do with their children – I try to only give them information so that they can make informed decisions. Hope this helps! – Alex

  9. My 4 yr old son recently had a bout of eczema that started in December. It kept getting worse and worse. I had been using coconut oil on his flare ups since it started, but I had not been putting coconut oil on him before this since he was a baby. He was prescribed steroids twice. The first time a 5 day oral dose that cleared it up for a couple weeks but it came back. Then a topical steroid ointment. My husband then realized that he started breaking out around the time we got a new refrigerator with the water in the door. Before that he always just drank tap or bottled water. We stopped giving him the water from the fridge and it completely cleared up within a couple days. I had only put a small amount of ointment on the worst parts of his eczema twice prior to cutting out the water. I then looked up what the water filter was made out of and it is made from coconut shell compressed carbon. After seeing your article, I am wondering if this a coincidence? Just trying to find some answers. The dermatologist was no help. Waiting to hear back for an allergist referral.

    • My suspicion is that this would have been a coincidence as it is not usually the ingestion of coconut that causes the issue, it is topical exposure. Ingestion of a food (so long as there is no immediate allergic reaction) actually helps to prevent an allergy to that food. Sorry for the delayed response. I’ve been busy and generally neglectful of this blog. :p

  10. Hi, my 3.5 month old baby is also reacting to something and when I checked all soaps, baby oil, baby lotion and detergent had coconut oil or ingredient derived from coconuts. I am exclusively breastfeeding and have severe eczema myself and my little one is starting to develop eczema on his cheeks and couple of spots on his arms. I noted one of the three products you recommended was ceraVe- I looked at the ingredients and second from the list was Caprylic/Capric Triglyceride (mixed triester derived from coconut oil and glycerin)… is this ok to use ? I wanted to try this so bad as it also has other beneficial ingredients that I really like but will choose not to as I had products with this ingredient that and both myself & my baby had tried and resulted in irritated skin. I just wanted to share this as it’s really frustrating as a consumer I am noticing a lot of products out there that is hypoallergenic have ingredients derived from coconuts and maybe that’s why there is an increase in babies/children showing allergies to coconut oil. Also almost all natural products out there have this as a main ingredient as well. I am still hoping to find something that works for my baby and good luck to others in search of finding something that works for their little one.

    • I think using Cerave is fine and unlikely to cause an allergy. It is the coconut protein that needs to get into the skin to cause an allergy and the Caprylic/Capric Triglyceride is a lipid and unlikely to cause a major issue. The concerns highlighted in this article mainly stem from people using food-grade coconut oil (which is not pure and therefore contains protein) on the skin. Alex

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