Oral allergy syndrome in patients with airborne pollen allergy treated with specific immunotherapy

According to literature, approximately 20%-70% of patients sensitized to pollen allergens experience oral allergy syndrome (OAS) symptoms after eating raw fruits and vegetables. There is no standard treatment established for OAS except avoiding implicated food. However, in patients with airborne pollen allergy treated with specific immunotherapy (SIT), an improvement of OAS symptoms has been reported in 30% to even 84% of individuals examined. The aim of the present study was to evaluate the prevalence of OAS symptoms in patients with various manifestations of pollen airborne allergy (atopic dermatitis (AD), asthma, allergic rhinitis) treated with subcutaneous type of SIT. In addition, the most common patterns of cross-reactivity in OAS were analyzed and correlations between OAS symptoms and patient age, type of sensitizing pollen allergens and atopy manifestations investigated. Also, the relationship between SIT duration and clinical improvement of both OAS symptoms and pollen allergy symptoms was analyzed. The study included 57 patients with airborne allergy treated with allergen vaccination (60% male and 40% female). Allergic rhinitis was diagnosed in 71%, AD in 19%, AD and asthma in 4%, allergic rhinitis and asthma in 4%, and both AD and allergic rhinitis in 2% of study patients. Twenty-eight percent of study patients complained of overt symptoms of OAS (22% of allergic rhinitis patients and 27% of AD patients); 69% of the subjects presenting with OAS showed polyvalent airborne allergy to pollens and 31% were sensitized to only one group of pollen allergens (mostly grass pollens, tree pollens and mugwort pollens). There was no statistically significant correlation between the presence of OAS symptoms and patient diagnosis, patient age and type of allergen vaccination used. According to patients' opinion, SIT significantly improved oral symptoms in 50% of study patients, 44% reported no impact of SIT on OAS symptoms and 6% of patients observed worsening of OAS symptoms after unintentional ingestion of implicated food during the course of SIT. The study revealed OAS as a significant problem in patients sensitized to various pollen allergens. The results on OAS prevalence in atopic subjects (28%) were consistent with some literature data. There was clear association between OAS and polyvalent airborne allergy (69%). Cross-reactivity patterns were typical (for example, tree pollen allergy - intolerance of apples, carrots and potatoes; grass pollen allergy - intolerance of kiwi fruit and tomatoes). Questionnaire analysis indicated that subcutaneous SIT significantly alleviated OAS symptoms associated with ingestion of the responsible fruit and vegetables in half of study subjects. Further evaluation of the duration/persistence and stability of the phenomenon is planned for the future.     

Kontaktallergie und Atopie

Retrospective studies demonstrate that the prevalence of skin sensitization does not significantly differ between atopic and non-atopic patients. In children and adolescents the risk for sensitization seems to occur independently from AD. According to the results of a recent study, AD patients are overrepresented in the group of polysensitized patients. IgE-mediated sensitization as well as an early onset of AD and duration of the disease have been identified as possible risk factors for skin sensitization to contact allergens. A defective permeability barrier with increased epidermal water loss is a hallmark of AD and contributes to sensitization against common allergens. A highly significant association between FLG mutations and the risk of early onset, severe, persistent AD and an increased risk for asthma has been shown in several studies. A more recent study revealed an association between FLG mutations and increased nickel sensitization, but not other contact allergens. However, further large prospective studies with well-characterized patients are necessary to clarify the correlation between impaired skin barrier, atopic dermatitis and allergic contact dermatitis.     

Spezifische Immuntherapie bei der Behandlung der atopischen Dermatitis

Atopic dermatitis (AD) is a common chronic inflammatory skin disease that is part of the atopic syndrome and is frequently associated with asthma and allergic rhinoconjunctilitis. Acute eczematous lesions are characterized by erythema, cozing and crusting, whereas chronic lesions show thickened skin and papules. In addition to local and systemic therapy adjusted to the stage of the disease, the search for relevant trigger factors and consecutively their avoidance plays a crucial role in disease management. Aeroallergens like house-dust-mites, pollen and animal epithelia represent important trigger factors in sensitized patients. While allergen-specific immunotherapy (SIT) is widely and most effective used in allergy to insect venoms and allergic rhinitis, its use in AD is still controversial. Double-blind, placebo-controlled clinical trials show that SIT is effective in patients with AD and clinically relevant sensitization to house dust mites and grass pollen and leads to clinical improvement of eczema. Despite these encouraging data, the use of SIT as a routine therapeutic approach in AD requires further evaluation.     

The Prevalence, Characteristics of and Risk Factors for Eczema in Belgian Schoolchildren

Abstract:  Childhood eczema is common in infants, but its nature and extent during later childhood remains unclear. In this cross-sectional study we examined the prevalence and characteristics of eczema in an unbiased community population of 2,021 Belgian schoolchildren, aged 3.4 to 14.8 years with skin prick testing and parental questionnaires. Our study identified an eczema prevalence of 23.3% and a considerable allergic co-morbidity, mainly in sensitized children. The reported prevalence of eczema in infancy was 18.5% and for current eczema 11.6%. The overall sensitization rate (33.2%) as well as sensitization rates for the individual allergens were significantly higher in children with "eczema ever." Sensitization to Dermatophagoides pteronyssinus (19.6%), mixed grass pollen (15.1%), and cat (9.1%) were most common. Until the age of 6 years, boys with eczema were significantly more sensitized than girls (p = 0.007). Children with both eczema in infancy and current eczema show a tendency to be more sensitized than children with eczema in infancy only or current eczema only, but significance was only noted for a few individual allergens. Analysis of factors associated with eczema revealed a predominantly atopic profile characterized by family or personal history of allergy. Breastfeeding and environmental factors seemed to assume little relevance except for a protective effect of prematurity and having a dog at birth.     

Specific immunotherapy in atopic dermatitis--Four-year treatment in different age and airborne allergy type subgroups

Atopic dermatitis (AD) is a common inflammatory disease involving the skin and frequently other organs and systems such as respiratory system. The recently recognized atopic nature of the skin inflammation in AD has raised a growing interest in the treatment with allergen-specific immunotherapy (SIT). In this study, the efficacy of SIT was evaluated in a group of 37 AD patients aged 5-44 years: 14 allergic to house dust mites (HDM), 17 to grass pollen allergens, and 6 allergic to grass and mugwort pollen allergens. IgE-mediated airborne allergy was well documented in all cases. SIT was performed with Novo Helisen Depot allergy vaccines of appropriate composition. Control group included 29 patients with AD and confirmed IgE-mediated airborne allergy to analogous allergens: HDM, 14 patients; grass pollen allergens, 11 patients; and grass and mugwort pollen allergens, 4 patients. Conventional methods of AD treatment were used in the control group. Clinical evaluation of patients was performed with W-AZS index after 12, 24, 36 and 48 months of therapy. SIT was found to be an efficacious and safe method of treatment for selected patients with AD and IgE-mediated airborne allergy. The efficacy of this therapeutic method was significantly higher than that recorded by conventional methods used in the control group in all 3 age subgroups and all 3 types of airborne allergy (HDM, grass pollen, and grass and mugwort pollen). It is concluded that SIT may be highly promising method of controlling skin inflammation in AD with the potential to prevent the development of AD into respiratory allergy.     

Association factors for atopic dermatitis in nursery school children in Ishigaki islands - Kyushu University Ishigaki Atopic Dermatitis Study (KIDS)

Atopic dermatitis (AD) is a multifactorial disease that usually decreases the quality of life of affected patients. The purpose of this study was to evaluate the associated factors for atopic dermatitis, asthma, rhinitis, and food allergy by physical examination of the skin and a questionnaire in nursery school children in Ishigaki Island, Okinawa, Japan. Enrolled in this study were 460 children from 0 to 6 years of age. Physical examination of skin symptoms and blood tests were performed. Information on past history and family history of atopic dermatitis, asthma, rhinitis, and food allergy were collected by questionnaire. The prevalence of atopic dermatitis was 12.2% (56/460). The cumulative prevalence of asthma, rhinitis, and food allergy was 19.9% (91/458), 3.3% (15/457), and 5.5% (25/456), respectively. In multivariate analysis, maternal history of rhinitis, atopic dermatitis siblings, past history of asthma and food allergy, and elevation of total IgE were significantly related to atopic dermatitis. A high total IgE level was a strong risk factor specific for atopic dermatitis in this population.     

Allergic contact sensitization in the general adult population: a population-based study from Northern Norway

Few studies have so far addressed the prevalence and risk factors for contact sensitization in the general adult population; however, many such studies have been conducted in hospitals. We present the prevalence of contact sensitization in a general adult population and its relationship to potential risk factors like smoking, ear piercing and atopic diseases. 1236 adults (44.2% men and 55.8% women) were randomly selected from a cross-section of the population in Sør-Varanger municipality, Norway, and patch tested with TRUE Test (Pharmacia, Hillerød, Denmark). Contact sensitivity to at least 1 out of 24 allergens was found in 35.4% of the women and in 14.8% of the men. The most common allergens were nickel (17.6%), cobalt (2.8%), thiomersal (1.9%), fragrance mix (1.8%) and colophony (1.2%). All other allergens were observed in 1.0% or less. In women, ear piercing was an important risk factor for nickel sensitization. No such significant correlation was seen in men [in women relative risk (RR) = 3.30, 95% confidence interval (CI) = 2.01–5.43, and in men RR = 1.82, 95% CI = 0.66–5.00], and contact sensitivity was associated with atopic dermatitis (AD) [adjusted odds ratio (OR) = 1.58, 95% CI = 1.04–2.40] and smoking (adjusted OR = 1.42, 95% CI = 1.01–1.99) in women but not in men. The prevalence of contact sensitivity was common in this general population, especially in women. Smoking and AD might be a risk factor for contact sensitization.     

Frequency of atopic dermatitis and relevance of food allergy in adults in Germany

Many factors may aggravate atopic dermatitis. The aim of this study was to determine the frequency of atopic dermatitis in an unselected population sample and to evaluate the role of food allergy. Patients with atopic dermatitis were recruited from the population in Berlin, Germany, using a postal questionnaire. Skin prick tests for allergens were performed, followed by food challenges. A total of 1739 questionnaires was returned. In all, 23.5% of patients stated that they had atopic dermatitis, and 146 persons (8.4%) fulfilled our atopic dermatitis criteria after a detailed telephone interview. Of these, 111 were examined, and 28 (1.6%) were identified as currently suffering from atopic dermatitis. Twenty-seven patients were further evaluated: 9/27 were found to be skin prick test negative, 19/27 were skin prick test positive either to pollen and/or food allergens. Nine of 27 were challenged with the suspected food allergen: 1/9 showed a worsening of the eczema, 3/9 had oral symptoms, and 5/9 were negative. In conclusion, only 20% of adults with a positive history of atopic dermatitis show active eczema lesions at a given time point. The data indicate that most individuals with atopic dermatitis were sensitized against pollen allergens and according to that, pollen-associated food allergens. A non-selected AD patient cohort does not frequently suffer from clinically relevant pollen-associated food allergy.     

遗传过敏性皮炎致敏因素分析

目的：了解遗传过敏性皮炎（AD）患者接触过敏的情况以及各种常见变应原特异性IgE的阳性检出率。方法：对90例AD患者进行斑贴试验和血清Mast SIgE检测。结果：斑试阳性率为52．22%,与非AD患者的斑试阳性率比较无显著性差异（P＞0．05）,硫酸镍、4－苯二胺、芳香混合物的阳性率分别为16．67％、10．0％和6．67％。AD患者屋尘螨、粉尘螨的SIgE阳性检出率分别为50．0％、47．8％,屋尘的SIgE阳性检出率为44．4％。结论：AD患者斑试阳性率与非AD患者的斑试阳性率比较无显著性差异。硫酸镍、4－苯二胺、芳香混合物和螨类、屋尘、真菌、花粉等是广东地区AD患者常见的变应原。     

Natural history of sensitizations in atopic dermatitis. A 3-year follow-up in 250 children: food allergy and high risk of respiratory symptoms.

BACKGROUND AND DESIGN--The aim of the study was to define the natural history of sensitization in atopic dermatitis (AD) through cross-sectional (comparison of three age classes) and longitudinal study: 250 children with minor (32.5%), moderate (32.5%), and severe (35%) AD were examined for aeroallergen and food hypersensitivity (skin tests, clinical scoring after allergen elimination, and food challenges). RESULTS--The allergic screening was negative in minor AD and positive in 33% of cases of moderate AD that were concerned with aeroallergen sensitizations with only limited respiratory involvement. This suggests that nonspecific cutaneous hyperreactivity remains an almost exclusive precipitating factor in moderate or minor AD. Severe AD was characterized by a positive allergologic assessment in 100% of patients: food allergens were incriminated as flare factors in 96% of patients, with associated aeroallergen sensitization in 36%. Even at a young age (less than or equal to 2 years), the severe AD group is marked by an extreme frequency of food sensitization (93%) that persists in 73% of children younger than 7 years and 67% younger than 16 years. From the comparison of three age classes, the sequence of food and respiratory sensitization seems to be part of the natural course of AD. Prospective study in 29 children of group 1 (less than 2 years) with a 3-year follow-up confirms the data of the cross-sectional study since 27 had development of aeroallergen sensitization, with respiratory symptoms as early as age 3 years in 23 of these children. CONCLUSION--The detection of food allergy in a child presenting with AD is likely to indicate a prognosis of severe AD and should be considered by dermatologists as a potentially important predictor of further respiratory symptoms.     

The natural history of sensitizations to food and aeroallergens in atopic dermatitis: a 4-year follow-Up

The natural history of atopic dermatitis (AD) is variable. Generally the dermatitis disappears during the first years of life, but it is often followed by the appearance of allergic respiratory diseases (ARDs). Our aim was to establish the risk factors for developing an ARD in children with AD. We followed up for 4 years 78 children (51 boys, 27 girls) with mild (26%), moderate (48%), and severe (26%) AD (clinical score proposed by Rajka and Langeland). In all the patients IgE serum levels were checked and skin prick tests (SPTs) were performed at the first examination. The SPTs were repeated in 68 children at the end of the study. The children with severe AD had significantly higher IgE serum levels than those with mild or moderate AD. SPTs at the first observation were positive in 47% of cases, mostly in patients with severe AD, with a prevalence of food allergens, particularly in younger patients. At the second observation, SPTs were positive in 65% of cases, including 100% of children with severe AD. Inhalants were the most common allergens. An ARD appeared in 38% of all patients: in 75% of those with severe AD and in 54% of those with a positive first SPT. Allergic screening should be carried out at an early age, especially in severe AD, since SPT positivity to food allergens, associated with severe clinical AD symptoms and a high IgE serum level, identifies those children ages 0-3 years at high risk of development of ARD.     

The effect of environmental tobacco smoke on eczema and allergic sensitization in children

BACKGROUND: The negative impact of environmental tobacco smoke (ETS) on airway diseases in children is well known. Whether there is an effect on atopic eczema is not clear. OBJECTIVES: To determine the impact of ETS on atopic eczema, allergic sensitization and allergic airway diseases in 1669 school beginners. METHODS: The prevalence of atopy-related health outcomes was assessed by questionnaire, dermatological examination, skin prick testing and specific immunoglobulin E measurement. Exposure assessments were based on measurement of cotinine [expressed as cotinine to creatine ratio (CCR)] in spot urine samples (n = 1220) together with questionnaire and interview data on smoking behaviour of the parents. RESULTS: In the total study group, prevalence of atopic eczema diagnosed on examination was significantly associated with urinary CCR values. The odds ratio (OR) and 95% confidence interval (CI), calculated for an increase of 100 ng mg-1 CCR was 1.97 (95% CI 1.23-3.16). The prevalence of skin manifestations according to questionnaire data as well as a history of asthma, wheezing, and hay fever were positively although not significantly associated with ETS exposure. When genetically predisposed children (defined by the presence of parental atopy) were compared with children whose parents had no atopy, the ORs of allergic outcome variables were generally higher in the first group. In the group of predisposed children, significant associations with urinary CCR were found for allergic sensitization against house dust mites as measured by skin prick test (OR 3.10, 95% CI 1.63-5.90). CONCLUSIONS: Children are at a higher risk of developing an atopic eczema when exposed to ETS and genetically predisposed children are at higher risk of developing a sensitization against house dust mites.     

Atopic dermatitis flare provoked by inhalant allergens

We report on 2 patients with atopic dermatitis (AD) exacerbated by inhalant allergens: grass pollens in spring (AD as hay fever equivalent) and nonbiting red midges (chironomides) in pet fish food. These clinical observations confirm the existence of an 'extrinsic', IgE-mediated type of AD in a minority of patients, in which the IgE sensitization against specific allergens plays a causal role for the skin disorder.     

Can atopy patch tests with aeroallergens be an additional diagnostic criterion for atopic dermatitis?

The complex pathomechanisms underlying skin lesions in atopic dermatitis (AD) result in variations of the clinical picture and frequent diagnostic difficulties. The purpose of this study was to evaluate the usefulness of atopy patch tests (APT) for aeroallergens in the diagnosis of AD. The study involved 115 adult patients with AD and 98 healthy volunteers (the control group). APTs for cat dander allergens, birch pollen, a mixture of house dust mite species and a mixture of 5 grass pollen allergens were applied for both groups. Positive reaction to at least one test allergen was found in 53.9% patients compared to 6.2% in the control group (p<0.001). The most frequent hypersensitivity (45.2%) observed was to house dust mite allergens. Polyvalent allergy to 2-4 allergens was found in 56.5% patients. The specificity of tests exceeded 75%, whereas the sensitivity varied from 18 to 66%. CONCLUSIONS: 1. Atopy patch tests, which are characterised by considerable specificity, confirm the role of polyvalent contact hypersensitivity to aeroallergens in the development of atopic dermatitis. 2. Positive aeroallergen ATP results are observed in the majority of patients and can thus be regarded as an additional diagnostic criterion in atopic dermatitis.     

Isolation of α-toxin-producing Staphylococcus aureus from the skin of highly sensitized adult patients with severe atopic dermatitis

Background  Staphylococcus aureus (S. aureus) is a well-known trigger factor of atopic dermatitis (AD). Besides staphylococcal superantigens, α-toxin may influence cutaneous inflammation via induction of T-cell proliferation and cytokine secretion.
Objectives  To investigate the association between sensitization to inhalant allergens and skin colonization with α-toxin-producing S. aureus in AD.
Patients and methods  We investigated 127 patients with AD, aged 14–65 years, who were on standard anti-inflammatory and antiseptic treatment before investigation. We evaluated skin colonization, medical history, severity of AD and sensitization to inhalant allergens.
Results  Forty-eight of 127 patients were colonized with S. aureus , suffered from more severe AD, had asthma more often and showed higher sensitization levels to inhalant allergens. Thirty of 48 patients with S. aureus skin-colonizing strains produced α-toxin and had higher total IgE and specific IgE to birch pollen and timothy grass pollen.
Conclusions  Under topical treatment with antiseptic and anti-inflammatory agents the colonization of lesional skin with S. aureus was clearly lower than commonly found in untreated patients with AD. Colonization with S. aureus was associated with a higher severity of AD, higher degree of sensitization, and a higher frequency of asthma. The proportion of patients whose skin was colonized with α-toxin-producing S. aureus was higher than expected from a former study. Cutaneous colonization with α-toxin-producing S. aureus was associated with a higher sensitization level to birch pollen allergen in AD. This may point to a higher susceptibility of patients with higher T-helper 2 polarization towards α-toxin-producing S. aureus .     

An evalution of atopic diseases in relation to immediate skin test reactions among schoolchildren in the Sør-Varanger community

Aim To compare the frequency of questionnaire based diagnosis of atopic diseases to those of clinical findings and sensitization and to evaluate the reliability of self-reported reactions to allergens with those confirmed by skin prick tests. Background Not only airborne allergens but also environmental indoor and outdoor air pollution are regarded as risk factors for the development of respiratory diseases in children. Metals, soot, SO₂, passive smoking and pollution from new building materials irritate both the skin and the respiratory mucosa and also increase the risk of atopic sensitization. A strong indication that atopic diseases are common in Sør-Varanger community, an area heavily polluted by the nearby Russian smelting plants, prompted us to investigate this hypothesis. Subjects The clinical and immunological examination involved 424 out of 575 schoolchildren aged 7–12 years. Results A total of 36% of the subjects were atopic; i.e. atopic dermatitis was established in 23% and mucous membrane atopy in 18%. 44% were definite non-atopies, leaving 14% not classifiable in either group and 6% latent atopies. Sensitization was confirmed by positive prick tests in 69% of children with a history of pollen allergy and 11% of those with a history of allergy to animal dander. Conclusions Skin prick tests are of little value in the diagnosis of atopic dermatitis but of major importance for the confirmation of mucous membrane atopy. In cases of controversy between history, clinical findings and sensitization, it is difficult to decide between atopies and non-atopies. Allergological examinations may be restricted to individuals with a positive symptom-based diagnosis only.     

Epidemiology of atopic dermatitis in Poland according to the Epidemiology of Allergic Disorders in Poland (ECAP) study

Epidemiological studies (International Study of Asthma and Allergies in Childhood [ISAAC], The European Community Respiratory Health Survey [ECRHS]) revealed considerable geographical differences in prevalence of atopic dermatitis (AD). The aim of our study is to present the epidemiology and the risk factors of AD in a Polish population. A total of 18 617 subjects were selected. The sample included respondents in eight cities and one rural area each over 150 000 citizens. The study had two parts: (i) questionnaire survey conducted among all respondents (response rate, 64.4%); and (ii) allergological examination performed among 25.7% with skin prick test (SPT) with 15 aeroallergens. AD was identified in 3.91% of subjects, more often in females, living in the cities, with a mother and/or father with atopy and with a higher education and higher economic status. Comorbidities of AD were atopic rhinitis (AR) in 26.17% and AR and asthma in 14.6%. AD was diagnosed by allergologists in 311 subjects (6.5%). Positive SPT occurred in 66.9% persons with AD (house dust mite, 33.1%; grasses/crop plants, 30.6%). Of the patients, 9.5% with perennial versus 9.3% seasonal and 9.6% with polyvalent versus 9.0% monovalent sensitization had AD. AD prevalence in Poland is below the mean rate for Europe, but risk factor profile is similar to other countries. AD is more frequent in female, well‐educated individuals, of high socioeconomic status, with atopic parents and who live in a city. Seasonal and monovalent atopy play a more essential role in subjects with AD compared with AR and asthma.     

Frequency of contact allergy in children with atopic dermatitis: results of a prospective study of 137 cases

The aim of our study was the evaluation of contact sensitization in pediatric patients with atopic dermatitis (AD). It seems that the frequency of contact allergies in the course of AD, and also the frequency of contact allergies in children, is underestimated in general. Our study has been performed by investigating 137 children with AD. The childrens' history was taken according standardized consultation guidelines and followed by a physical examination. Patch testing was performed systematically, including the European standard series, together with tixocortol pivalate, budesonide and the applied emollient. If necessary, optional patch tests were performed according to the child's history. The results demonstrate contact sensitization in 43% of all children tested. The most frequent contact allergens are: metals (19.3%), fragrance (4.4%), balsam of Peru (2.6%), lanolin (4.4%), neomycin (2.6%) and emollients (2.6%). No contact sensitization to corticosteroids nor any induction of active sensitization were seen. Statistical analysis demonstrates that the risk of developing a contact allergy is significantly elevated in children after the age of 5 years. Female sex is a risk factor only for nickel. Age of onset of AD or its severity is not associated with the development of contact allergy. In conclusion, the results indicate the necessity of performing systematic patch testing in the investigation of allergies in children with AD. Preventive measures from an early age are suggested to avoid exposure to the most frequent contact allergens.     

Retrospective study of specific immunotherapy - what should be done in the future

In this retrospective study, data on 241 atopic patients treated with specific cutaneous immunotherapy during the 1985-2006 period at Allergy Clinic, University Department of Dermatology and Venereology, were reviewed. The following diagnoses were recorded: atopic dermatitis, pure or in combination with allergic rhinitis or allergic bronchitis, or allergic bronchitis and asthma, allergic rhinitis, allergic conjunctivitis, urticaria, and Quincke's edema. The aim was to retrospectively analyze clinical efficacy and laboratory findings in atopic patients undergoing specific immunotherapy. Before specific immunotherapy administration, eosinophil count, immunoglobulins, skin prick test, total IgE (RIST) and specific IgE (IgE UniCAP) were determined. The following allergens were included in specific immunotherapy: Dermatophagoides pteronyssinus, house dust mite (mixed or separately), mixed and single pollens (grass, tree, weed), feather, and animal dander. The most frequent allergens in 241 atopic patients were grass pollen mixture, Dermatophagoides pteronyssinus, ragweed, tree pollen mixture, cocksfoot, birch, animal dander, and feather. Treatment efficacy was demonstrated after 3 years of continuous therapy by clinical evaluation and with the same diagnostic procedure. After several months of therapy, initial clinical improvement was noticed in atopic dermatitis patients as well as in patients with respiratory diseases that were sensitive to airborne allergens. According to literature, specific immunotherapy was used as a treatment option, which may affect the natural course of allergic diseases. It reduces development of asthma in patients with allergic rhinitis and prevents the onset of new sensitizations.     

Food allergy in atopic dermatitis

Food allergy predominantly affects children rather than adult patients with atopic dermatitis (AD). Early sensitization to foods has been found to be significantly associated with AD. Three different patterns of clinical reactions to food allergens in AD patients exist: i. immediate-type reaction, ii. isolated late-type reaction, iii. combined reaction (i.?+?ii.). While in children allergens from cow's milk, hen's egg, soy, wheat, fish, peanut or tree nuts are mostly responsible for allergic reactions, birch-pollen related food allergens seem to play a major role in adolescent and adults with AD in Central and Northern Europe. Defects of the epidermal barrier function seem to facilitate the development of sensitization to allergens following epicutaneous exposure. The relevance of defects of the gut barrier as well as genetic characteristics associated with an increased risk for food allergy remain to be further investigated. Numerous studies focus on prevention strategies which include breast-feeding or feeding with hydrolyzed milk substitute formula during the first 4 months of life.