Food hypersensitivity and atopic dermatitis: Evaluation of 113 patients

doi:10.1016/S0022-3476(85)80390-5

The Journal of Pediatrics

Volume 107, Issue 5, November 1985, Pages 669-675

https://doi.org/10.1016/S0022-3476(85)80390-5 Get rights and content

One hundred thirteen patients with severe atopic dermatitis were evaluated for food hypersensitivity with double-blind placebo-controlled oral food challenges. Sixty-three (56%) children experienced 101 positive food challenges; skin symptoms developed in 85 (84%) challenges, gastrointestinal symptoms in 53 (52%), and respiratory symptoms in 32 (32%). Egg, peanut, and milk accounted for 72% of the hypersensitivity reactions induced. History and laboratory data were of marginal value in predicting which patients were likely to have food allergy. When patients were given appropriate restrictive diets based on oral food challenge results, approximately 40% of the 40 patients re-evaluated lost their hypersensitivity after 1 or 2 years, and most showed significant improvement in their clinical course compared with patients in whom no food allergy was documented. These studies demonstrate that food hypersensitivity plays a pathogenic role in some children with atopic dermatitis and that appropriate diagnosis and exclusionary diets can lead to significant improvement in their skin symptoms.

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The influence of diet on atopic dermatitis (AD) is complex, and the use of dietary elimination as a treatment has conflicting views.
To systematically review the benefits and harms of dietary elimination for the treatment of AD.
We searched MEDLINE, Embase, AMED, PsycINFO, and the Cochrane Central Register of Controlled Trials from inception to January 18, 2022, without language restrictions, for randomized controlled trials (RCTs) and observational studies comparing dietary elimination and no dietary elimination for the treatment of AD. We conducted random-effects meta-analyses of eczema outcomes. We used the grading of recommendations, assessment, development, and evaluation approach to assess certainty of evidence (CRD42021237953).
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Dietary elimination may lead to a slight, potentially unimportant improvement in eczema severity, pruritus, and sleeplessness in patients with mild to moderate AD. This must be balanced against potential risks for indiscriminate elimination diets including developing IgE-mediated food allergy and withholding more effective treatment options for AD.
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In recent years, pediatric allergists have observed a worrying increase in cases of food allergies and anaphylaxis in younger and younger children with polyallergies and polysensitizations, involving allergens with high anaphylactic potential, such as peanuts and nuts, greatly impacting the quality of life and the future of these children. After reviewing the current epidemiological data, we discuss the main causes of food allergies increase (including the hygienic hypothesis, the role of the intestinal microbiota and epigenetic modifications), data from studies on the skin barrier and its fundamental role in the development of sensitization and food allergies, data concerning the tolerogenic digestive tract applied in particular to eggs and peanuts, but also data concerning the prevention of allergy to cow's milk proteins. In the light of these studies, we make practical propositions focused on infants. They concern the date of the introduction of cow's milk, the early treatment of eczema and a broad food diversification, from 4 months, including food allergens with high allergic risk such as peanuts and nuts if consumed by family.
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Allergists are often asked to evaluate children with atopic dermatitis (AD) for allergen triggers to disease. Testing, particularly for food triggers, often leads to elimination diets in an effort to improve AD control. However, the dual exposure hypothesis suggests that oral tolerance to food antigens is promoted through high-dose oral exposure, where sensitization occurs through lower dose cutaneous exposure. This suggests that strict elimination diets may pose some risks in children with AD. In addition, emerging evidence suggests an important role of skin inflammation in further allergic disease and the importance of dietary exposure to maintain oral tolerance. This work group report reviews current guidelines-based management for children with moderate-to-severe AD, the evidence for current recommendations for the evaluation and management of these children, provides a nuanced examination of these studies, and addresses current knowledge gaps in the care of these children.
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^†: Supported in part by Grant A119116 from the National Institute of Allergy and Infectious Diseases and by Grant RR-30 from the General Clinical Research Centers Program of the Division of Research Resources, National Institutes of Health.

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Original articleFood hypersensitivity and atopic dermatitis: Evaluation of 113 patients†

Pediatr Clin North Am

J Allergy Clin Immunol

J Invest Dermatol

J Allergy Clin Immunol

Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Pediatr Clin North Am

J Allergy Clin Immunol

Lancet

Lancet

Lancet

J Allergy Clin Immunol

J Pediatr

J Allergy Clin Immunol

Allergic eczema

The prevalence and prognosis of eczema and asthma in Cambridgeshire school children

Med Officer

Dermatologic allergy: asthma and the other allergic diseases

NIH publ 79-387

Original article
Food hypersensitivity and atopic dermatitis: Evaluation of 113 patients†