Atopic dermatitis and food hypersensitivity reactions,☆☆,

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Abstract

Objective: To determine the role of food hypersensitivity in atopic dermatitis and to determine whether patients with atopic dermatitis who had food hypersensitivity could be identified by screening prick skin tests using a limited number of food allergens. Study design: Patients with atopic dermatitis attending the Arkansas Children's Hospital Pediatric Allergy Clinic underwent allergy prick skin testing to a battery of food antigens. Patients with positive prick skin tests underwent double-blind, placebo-controlled food challenges. Results: One-hundred sixty-five patients were enrolled and completed the study. Patients ranged in age from 4 months to 21.9 years (mean 48.9 months). Ninety-eight (60%) patients had at least one positive prick skin test. A total of 266 double-blind, placebo-controlled food challenges were performed. Sixty-four patients (38.7% of total) were interpreted as having a positive challenge. Seven foods (milk, egg, peanut, soy, wheat, cod/catfish, cashew) accounted for 89% of the positive challenges. By use of screening prick skin tests for these seven foods we could identify 99% of the food allergic patients correctly. Conclusions: This study confirms that most children with atopic dermatitis have food allergy that can be diagnosed by a prick skin test for the seven foods. (J Pediatr 1998;132:132-6)

Section snippets

Patients

Patients who met the criteria13 for the diagnosis of AD were enrolled in the study. The dermatitis ranged from mild to severe. The patients were from the Pediatric Allergy Clinic at Arkansas Children's Hospital; approximately 50% of patients receive their medical care entirely at the hospital (inner-city population), and 50% are referred (for their AD or other allergic diseases) from primary care physicians in Little Rock and central Arkansas. Parents were informed about the study on their

Entire Group (Group 1)

One hundred sixty-five patients (91 males) were enrolled and completed the study from 1986 through 1995. Patients ranged in age from 4 months to 21.9 years (mean age 48.9 months). The mean age of onset of dermatitis was 16 months (range birth to 20.5 years). The family history was positive for atopic disorders (allergic rhinitis, asthma, or AD) in 92% of the patients. Forty-nine (30%) children had asthma, 84 (51%) had allergic rhinitis, and 37 (22%) had both allergic rhinitis and asthma. Before

Discussion

Despite recent evidence supporting the clinical significance of food allergy in children with AD, this issue continues to be debated. In the studies by Sampson,15 > 60% of children with moderate to severe AD had positive food challenges. The interpretation of these studies for the primary care practitioner, however, has been difficult because of the severity of the AD. Overall, ~75% of these patients had used systemic steroids on at least one occasion before entering their study. In our

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    From the Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital Research Institute, Little Rock, Arkansas

    ☆☆

    Reprint requests: Wesley Burks, MD, Pediatric Allergy and Immunology, Arkansas Children's Hospital, 800 Marshall Street, Little Rock, AR 72202.

    9/21/82708

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