Are avoidance diets still warranted in children with atopic dermatitis? |
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| Authors: | Philippe A Eigenmann Kirsten Beyer Gideon Lack Antonella Muraro Peck Y Ong Scott H Sicherer Hugh A Sampson |
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| Institution: | 1. Department of Woman, Child and Adolescent, Pediatric Allergy Unit, University Hospitals of Geneva, Geneva, Switzerland;2. Department of Pediatric Pneumology, Immunology and Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany;3. Department of Pediatric Allergy, Division of Asthma, Allergy and Lung Biology, King’s College London and Guy’s and St Thomas’ National Health Service Foundation Trust, London, UK;4. Department of Woman and Child Health, Food Allergy Centre, Padua University Hospital, Padua, Italy;5. Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA;6. Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA |
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| Abstract: | Nearly 40% of children with moderate-to-severe atopic dermatitis (AD) have IgE-mediated food allergy (FA). This clinical observation has been extensively documented by experimental data linking skin inflammation in AD to FA, as well as by food challenges reproducing symptoms and avoidance diets improving AD. Although food avoidance may improve AD, avoidance diets do not cure AD, may even have detrimental effects such as progression to immediate-type allergy including anaphylactic reactions, and may significantly reduce the quality of life of the patient and the family. AD care should focus upon optimal medical management, rather than dietary elimination. Food allergy testing is primarily indicated when immediate-type allergic reactions are a concern. In recalcitrant AD, if food is being considered a possible chronic trigger, a limited panel of foods may be tested. An avoidance diet is only indicated in patients clearly identified as food allergic by an appropriate diagnostic food challenge, and after adequately informing the family of the limited benefits, and possible harms of an elimination diet. |
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| Keywords: | anaphylaxis atopic dermatitis avoidance diet food allergy IgE testing oral tolerance induction quality of life |
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