Most children with eczema and food allergy never see a specialist—their GP manages both conditions, often without clear evidence on how to use the two main eczema treatments together safely. This matters because eczema and food allergy frequently occur together, and the burden on families is heavy: disrupted sleep, constant itching, anxiety about allergic reactions, and time-consuming daily care routines. Yet NHS specialist services are overstretched, leaving GPs to handle complex cases with limited research to guide them. Parents are often labelled as "non-adherent" or "steroid phobic," when in reality there is little evidence on how to combine emollients and topical corticosteroids effectively. Meanwhile, food allergy research has focused on immunology and commercial interests, not on what parents and GPs actually need to know. If this research succeeds, it will produce practical tools for primary care: a tested eczema clinic model, clear guidance on combining treatments, and a research agenda for food allergy shaped by patient and clinician priorities. The work also assesses whether recent advice to introduce peanuts and eggs early in weaning is being followed and whether it is reducing allergy rates. The result could be safer, more effective care delivered in GP surgeries, reducing referrals to overstretched hospitals and improving daily life for thousands of children and their families.
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Children commonly develop one or more long-term atopic conditions: eczema, food allergy, asthma or allergic rhinitis. Food allergy is more common in children with eczema. Symptoms and burden of management of both conditions have a big impact on those affected. The social and financial costs to children, parents and the health service are also significant. Most children can and have to be managed by their GP, because access to NHS specialist dermatology and allergy services is poor. The relationship between, and research into, eczema and food allergy is complex and challenging. Research is needed on how to best use existing eczema treatments and structure patient's care. We know that parents have concerns about the core treatments for eczema (emollients and topical corticosteroids - TCS) and support in primary care for parents to self-manage the condition is suboptimal. Labelling parents as 'non-adherent' and 'steroid phobic' is unhelpful because emollients and TCS can both cause harms and there is limited research on how best to use them together, effectively and safely. Eczema care, like asthma, may benefit from a greater emphasis on topical corticosteroids and regular review in dedicated clinics. Food allergy is complex and there is a primary care-relevant evidence void. Research to date has focused on immunology and is commercially influenced. Patient and clinician priorities for food allergy research need to be established. The most relevant, recent research supports early introduction of allergens to prevent food allergy, especially peanut and egg in children with eczema. However, the uptake and impact of changes in complementary feeding (weaning) advice, some of which is conflicting, is uncertain. The aim of this professorship is to transform the treatment of eczema, and research into food allergy and its prevention, in children. Over five work packages, I will lead research that will: a) Through a systematic review, surveys and interviews improve understanding of real world use of topical treatments; and b) Co-design a trial of how best to use emollients and TCS in combination a) Develop a primary care eczema clinic; and b) evaluate it in a cluster trial a) Determine the research priorities of parents and clinicians for food allergy in children, and b) deliver at least one study addressing at least one of the identified research priorities Through surveys, interviews and a cohort study assess understanding, implementation and effects of early allergen introduction advice Integrate public, patient (parent/child) and stakeholder opinion into all of the above, ensuring inclusivity and relevance of the research to all of society The programme of work is ambitious, striking a balance between building on existing work, with guaranteed deliverables within five years (1a,2a&b,3a,4&5), and more open-ended projects (1b&3b) which promise a step-change in trajectory with high impact in five years. Close working with patient public partners and stakeholders, paying attention to inclusivity, spans all the above programme of work. They will help plan, and assist with, the dissemination of findings, using a range of approaches tailored to the target audiences.
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