Atopic dermatitis: Clinical relevance of food hypersensitivity reactions

doi:10.1016/S0022-3476(88)80626-7

The Journal of Pediatrics

Volume 113, Issue 3, September 1988, Pages 447-451

https://doi.org/10.1016/S0022-3476(88)80626-7 Get rights and content

Forty-six patients with atopic dermatitis ranging from mild to severe were evaluated for food hypersensitivity with double-blind placebo-controlled food challenges. Twenty-eight (61%) patients had a positive prick skin reaction to one of the foods tested. Sixty-five food challenges were performed; 27 (42%) were interpreted as positive in 15 (33%) patients. Egg, milk, and peanut accounted for 78% of the positive reactions. As in previous studies, patients developed skin (96%), respiratory (52%), or gastrointestinal (30%) symptoms during the challenge. These studies indicate that children who have atopic dermatitis unresponsive to routine therapy or who continue to need dally treatment after several months would benefit from evaluation for food hypersensitivity.

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Cited by (307)

Atopic Dermatitis and Food Allergy: Best Practices and Knowledge Gaps—A Work Group Report from the AAAAI Allergic Skin Diseases Committee and Leadership Institute Project
2022, Journal of Allergy and Clinical Immunology: In Practice
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.
Tips and Tricks for Controlling Eczema
2019, Immunology and Allergy Clinics of North America
Controversies in Allergy: Food Testing and Dietary Avoidance in Atopic Dermatitis
2019, Journal of Allergy and Clinical Immunology: In Practice
Citation Excerpt :
Furthering this work, Sampson and McCaskill6 then found that 57% of a highly selected group of pediatric patients with AD had a positive reaction to food. These findings were supported by Burks et al,7 who examined 46 patients with eczema referred to an allergist, 61% of whom demonstrated sensitization by skin prick testing (SPT) and 33% of whom reacted to foods. However, given the concern of bias related to allergy referral, Eigenmann et al8 examined 63 children referred to a dermatologist.
Cutaneous Manifestation of Food Allergy
2017, Immunology and Allergy Clinics of North America
Assessment of IgE-mediated food allergies in children with atopic dermatitis
2017, Allergologia et Immunopathologia
Citation Excerpt :
The median ages of those with and without food allergy were also similar. The study by Burks et al. showed a higher prevalence of food allergy among children with AD (37%).15 Wahn et al., in a cohort study performed in children with AD estimated that IgE responses to hen's egg proteins (42%) were most prevalent, while sensitisation to cow's milk and peanut was detected in 24–27% of the children.16
Atopic dermatitis (AD) is an inflammatory disease of the skin, which is characterised by a chronic relapsing course.
The aim of the study was to assign the prevalence of clinically active food allergies among a group of children between 3 months and 7 years of age, with AD.
Eighty-eight children with AD were screened for specific IgE antibodies to food proteins. All patients with AD and specific IgE antibodies to food proteins were subjected to Oral Food Challenges (OFCs) with the relevant foods.
Food-sensitised patients with moderate levels of sIgE had clinically active food allergy to milk (39.28%) and egg (42.34%) on the basis of positive OFCs. High IgE and eosinophilia had a prevalence of almost 80% and 25%, regardless of concomitant food sensitisation and disease severity.
In this study, clinically active food allergies were recognised in 26.13% of children with AD. Nevertheless, no association was confirmed between food sensitisation and AD severity. High IgE and peripheral eosinophilia have not been found more prevalent among children with severe AD nor among children with food sensitisation. Infants and younger children with AD should be screened for an underlying food allergy, regardless of disease severity.
Vitamin D and atopic dermatitis: A systematic review and meta-analysis
2016, Nutrition
Despite the evidence supporting the use of vitamin D supplements for managing atopic dermatitis (AD), no meta-analysis providing definite conclusions in this field has been reported. The purpose of the present study was to conduct a systematic review and meta-analysis of all controlled studies of vitamin D for treating AD to elucidate the efficacy of vitamin D for alleviating the symptoms of AD.
Literature searches were conducted using Ovid-MEDLINE, EMBASE, Web of Science, Cochrane Library, and Korean and Chinese databases. Search terms used were “vitamin D”, “atopic dermatitis”, “randomized”, “controlled trial”, and “clinical trial”. Random effects models were used to calculate the mean difference, with 95% confidence intervals to analyze the effects of vitamin D supplementation for severity of AD.
Initial searches yielded 266 citations. Of these original results, nine met specific selection criteria. Four of the randomized controlled trials compared the efficacy of vitamin D with a placebo on severity of AD and were included in the meta-analysis. The vitamin D supplementation interventions showed a higher mean difference in severity of AD symptoms (mean difference = −5.81, 95% CI: −9.03 to −2.59, P = 0.0004, I² = 50%).
Vitamin D has a potentially significant role for improving the symptoms of AD. The results from this study suggest that vitamin D supplementation may help ameliorate the severity of AD, and can be considered as a safe and tolerable therapy. However, larger-scale studies over a longer duration of treatment are needed to confirm this conclusion.

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Original articleAtopic dermatitis: Clinical relevance of food hypersensitivity reactions

J Allergy Clin Immunol

J Pediatr

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Lancet

J Allergy Clin Immunol

J Allergy Clin Immunol

Significance of food hypersensitivity in children with atopic dermatitis

Pediatr Dematol

The prediction of asthma in infantile eczema

J Pediatr

A twenty-one year follow-up of infantile eczema

J Pediatr

Allergic eczema

Late phase of the immediate wheal and flare skin reaction: its dependence on IgE antibodies

J Clin Invest

Diagnostic feature of atopic dermatitis

Acta Derm Venereol (Stockh)

Proper use of skin tests with food extracts in diagnosis of hypersensitivity to food in children

Clin Allergy

Original article
Atopic dermatitis: Clinical relevance of food hypersensitivity reactions