Dietary exclusions for established atopic eczema

Bath‐Hextall, Fiona; Delamere, FM; Humphreys, Rosemary; Williams, HC; Zhang, W

doi:10.1002/14651858.cd005203

Cited by 18 publications

(29 citation statements)

References 38 publications

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“…The main characteristics of the trials are shown in Table 1. Additional details on methods, interventions and data extraction appear in a more extensive table in the Cochrane review (11) which also lists the three excluded studies and reasons for exclusion.…”

Section: Resultsmentioning

confidence: 99%

“…We searched the Cochrane Skin Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS (Latin American and Caribbean Health Science Information database), AMED (Allied and Complementary Medicine) and ISI Web of Science (last search March 2006). The full search strategy has been published elsewhere (11). References from published studies were checked for further trials.…”

Section: Methodsmentioning

confidence: 99%

“…We also noted the degree of certainty that the participants had atopic eczema; baseline comparability of the participants for age, gender and eczema severity; and assessment of compliance with treatment. A table of quality criteria has been published elsewhere (11).…”

Section: Methodsmentioning

confidence: 99%

“…Because of the uncertainties of the benefits and harms of dietary exclusion in people with atopic eczema, we conducted a systematic review of all relevant randomized controlled trials. A more detailed version of this review has already been published in the Cochrane Library (11).…”

mentioning

confidence: 99%

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Dietary exclusions for improving established atopic eczema in adults and children: systematic review

Bath‐Hextall

Delamere

Williams

2009

Allergy

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Atopic eczema is the most common inflammatory skin disease of childhood in developed countries. We performed a systematic review of randomized controlled trials to assess the effects of dietary exclusions for the treatment of established atopic eczema. Nine trials (421 participants) were included, most of which were poorly reported. Six were studies of egg and milk exclusion (n = 288), one was a study of few foods (n = 85) and two were studies of an elemental diet (n = 48). There appears to be no benefit of an egg‐ and milk‐free diet in unselected participants with atopic eczema. There is also no evidence of benefit in the use of an elemental or few‐foods diet in unselected cases of atopic eczema. There may be some benefit in using an egg‐free diet in infants with suspected egg allergy who have positive specific IgE to eggs – one study found 51% of the children had a significant improvement in body surface area with the exclusion diet as compared with normal diet (95% CI 1.07–2.11) and change in surface area and severity score was significantly improved in the exclusion diet as compared with the normal diet at the end of 6 weeks (MD 5.50, 95% CI 0.19–10.81) and end of treatment (MD 6.10, 95% CI 0.06–12.14). Despite their frequent use, we find little good quality evidence to support the use of exclusion diets in atopic eczema.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Dietary exclusions for improving established atopic eczema in adults and children: systematic review

Bath‐Hextall

Delamere

Williams

2009

Allergy

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“…Exclusion diets for children with AD may consist of the removal of individual single foods; removal of common allergens such as eggs, milk, wheat, nuts, soy and fish; a ‘few foods diet’ (quite a restricted diet); or an elemental diet (elemental formula only). A 2008 Cochrane review found insufficient evidence to support egg‐ and milk‐free diets, elemental or few foods diets in unselected participants with AD 38 . The review identified a total of nine randomised controlled trials that were considered suitable for meta‐analysis.…”

Section: Exclusion Diets For Admentioning

confidence: 99%

Role of food allergy in childhood atopic dermatitis

Campbell

2011

J Paediatrics Child Health

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The interplay between atopic dermatitis (AD) and food allergy is complex and subject to significant misconceptions both by the general public and the medical community. Childhood AD is a very prevalent disorder. In its moderate and severe forms, AD is a challenging disorder to manage from the perspective of the child, parent and treating doctor. As AD is one of the disease manifestations of atopy, it is unsurprising that many children with AD also have a coexisting IgE-mediated food allergy. It is a common misconception that food allergy is causal in the setting of AD. However, in a proportion of sufferers, food allergy does play a role in triggering or exacerbating pre-existing AD by immune-mediated mechanisms and potentially by non-immune mechanisms. It is, therefore, important to differentiate causality, co-existent disease and disease modifiers in this context. This paper seeks to clarify the role of food allergy in childhood AD, and to outline a rational framework for the diagnosis and approach to food allergy in the context of the management of a child with problematic AD.

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Clinical practice. Diagnosis and treatment of cow’s milk allergy

Kneepkens

Meijer

2009

Eur J Pediatr

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Introduction Cow’s milk allergy (CMA) is thought to affect 2–3% of infants. The signs and symptoms are nonspecific and may be difficult to objectify, and as the diagnosis requires cow’s milk elimination followed by challenge, often, children are considered cow’s milk allergic without proven diagnosis. Diagnosis Because of the consequences, a correct diagnosis of CMA is pivotal. Open challenges tend to overestimate the number of children with CMA. The only reliable way to diagnose CMA is by double-blind, placebo-controlled challenge (DBPCFC). Therapy At present, the only proven treatment consists of elimination of cow’s milk protein from the child’s diet and the introduction of formulas based on extensively hydrolysed whey protein or casein; amino acid-based formula is rarely indicated. The majority of children will regain tolerance to cow’s milk within the first 5 years of life. Conclusions Open challenges can be used to reject CMA, but for adequate diagnosis, DBPCFC is mandatory. In most children, CMA can be adequately treated with extensively hydrolysed whey protein or casein formulas.

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Dietary exclusions for established atopic eczema

Cited by 18 publications

References 38 publications

Dietary exclusions for improving established atopic eczema in adults and children: systematic review

Dietary exclusions for improving established atopic eczema in adults and children: systematic review

Role of food allergy in childhood atopic dermatitis

Clinical practice. Diagnosis and treatment of cow’s milk allergy

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