Dietary restrictions in the treatment of adult patients with eczema

Abstract

Improvement was seen in the dermatitis of 262 of 675 patients who followed a restrictive diet for approximately 1 month. Patients included in the study were sensitive to metal salts, balsams or classical food allergens or reacted to oral challenge with food additives. Also included were patients who did not react to diagnostic tests but who experienced improvement of their dermatitis while maintaining an elimination diet. A follow-up study was carried out 1-3 years after diet treatment was instituted. Each of the 262 patients was asked to complete a questionnaire to describe the long-term course of the dermatitis. 206 responded to the questionnaire, and for 144 of them (70%; 95% confidence limits 64-76%), there was long-term improvement of the dermatitis. Long-term improvement was more common among atopic patients than among non-atopics. Symptoms of contact urticaria were more common among patients with hand eczema than those with other types of eczema.

Myroxylon pereiraeresin (balsam of Peru) – A critical review of the literature and assessment of the significance of positive patch test reactions and the usefulness of restrictive diets

“…In the subgroup of the 24 patients with positive patch test reactions to MP, 15 (63%) reported benefit from the diet. 158 In yet another study by the same group, 159 reported long-term improvement. 159 In a final study from this group, in 1996, 160 it was investigated whether the results of oral challenge with MP can predict possible benefit from a low-balsam diet.…”

“…158 In yet another study by the same group, 159 reported long-term improvement. 159 In a final study from this group, in 1996, 160 it was investigated whether the results of oral challenge with MP can predict possible benefit from a low-balsam diet. Fortysix patients with positive patch test reactions to MP and/or FM I and chronic dermatitis with a morphology consistent with systemic dermatitis had experienced improvement after using a low-balsam diet for 1 to 2 months, and continued to use it.…”

“…104,105,110 Various studies on oral provocation with balsam of Peru and the effect of balsam of Peru-restrictive diets in patients allergic (and also in dermatitis patients not allergic) to MP have been performed, mostly between 1981 and 1996 by one group of Danish investigators. [156][157][158][159][160] In the first study, 156 In a second study from these investigators, 157 Two case reports: causative products tea tree oil and topical pharmaceutical Limonene Limonene hydroperoxides are very important allergens; significant association between a history of rash resulting from skin contact with citrus fruits and a positive patch test reaction to MP 120 ; limonene is the major ingredient in citrus peel oils 150 ; MP co-reactivity in 11%, 47 13.5%, 151 18%, 152 21%, 153 24%, 154 33%, 155 and 48% 50 (higher frequency than with fragrance mix I [32%] in patients reacting to limonene hydroperoxides)…”

Adverse reactions to fragrances

“…Many synthetic fragrances are used as spices and flavours. Natural fragrances like cinnamon, clove, vanilla and cardamon, are added to foods, soft drinks, lozenges, chewing gum, sweets, ice cream and tobacco (31)(32)(33). Thus, it can be stated that virtually everyone is in daily contact with fragrance materials.…”

“…In some fragrance-sensitive patients who also react to balsam of Peru (some 50%) and in those reacting to fragrances that are also used as flavours and spices such as cinnamic aldehyde, cinnamic alcohol, vanilla and eugenol, foods and drinks may exacerbate symptoms, either local (worsening of hand eczema, cheilitis, stomatitis) or systemic (e.g., pompholyx) (31)(32)(33) In some patients, especially in those presenting with stomatitis, cheilitis, recalcitrant pompholyx or widespread dermatitis, elimination diets may be indicated (31)(32)(33). However, the benefits of a flavour-avoiding diet are regarded as questionnable by some (221), and may be observed in a small number of patients allergic to balsam of Peru and/ or the fragrance mix only (222).…”