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Epicutaneous sensitization to food allergens in atopic dermatitis: What do we know?
Authors:Elizabeth Huiwen Tham MMed  MCI  Mohana Rajakulendran MMed  MRCPCH  Bee Wah Lee MD  Hugo P S Van Bever PhD
Institution:1. Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore;2. Khoo Teck Puat-National University Children’s Medical Institute, National University Hospital, National University Health System, Singapore, Singapore;3. Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

Khoo Teck Puat-National University Children’s Medical Institute, National University Hospital, National University Health System, Singapore, Singapore

Abstract:Atopic dermatitis (AD) is a chronic inflammatory skin disease mainly affecting children, which has no definitive curative therapy apart from natural outgrowing. AD is persistent in 30%-40% of children. Epithelial barrier dysfunction in AD is a significant risk factor for the development of epicutaneous food sensitization, food allergy, and other allergic disorders. There is evidence that prophylactic emollient applications from birth may be useful for primary prevention of AD, but biomarkers are needed to guide cost-effective targeted therapy for high-risk individuals. In established early-onset AD, secondary preventive strategies are needed to attenuate progression to other allergic disorders such as food allergy, asthma, and allergic rhinitis (the atopic march). This review aims to describe the mechanisms underpinning the development of epicutaneous sensitization to food allergens and progression to clinical food allergy; summarize current evidence for interventions to halt the progression from AD to food sensitization and clinical food allergy; and highlight unmet needs and directions for future research.
Keywords:allergy prevention  anaphylaxis  atopic dermatitis  atopic march  epicutaneous sensitization  food allergens  food allergy  food hypersensitivity  nutrition  oral tolerance
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