Food Allergies and Atopic Dermatitis: Differentiating Myth from Reality

Abstract

<P>Adverse food reactions or food allergy can be the source of stress for many families. Some studies have assessed the quality of life for children with food allergy. One study showed that parents of children with food allergy report that family activities and general health perception are negatively affected. Cohen et al, using principles established in measuring disease-specific, health-related quality of life instruments, found that multiple domains are affected in families with food allergy including school, camp, social activities involving food, vacations, children in the care of others, restaurant meals, and being near other children who are eating. Parents also reported anxiety and frustration over nutritional issues, worry over not being able to help their child with a reaction, and whether their child eventually will overcome the allergy. Managing food allergy is an ongoing process involving cooperation between the parent and physician. Determining the etiology of food reactions can better guide therapies.</P> <H4>ABOUT THE AUTHORS</H4> <P>Lisa R. Forbes MD; Rushani W. Saltzman MD; and Jonathan M. Spergel, MD, PhD, are with The Children’s Hospital of Philadelphia, Allergy Section, Division of Allergy and Immunology, Philadelphia, PA.</P> <P>Address correspondence to: Jonathan M. Spergel, MD, PhD, 3550 Market Street, 3rd Floor, Philadelphia PA 19104; or e-mail <a href="mailto:spergel@email.chop.edu">spergel@email.chop.edu</a>.</P> <P>Dr. Forbes, Dr. Saltzman, and Dr. Spergel have disclosed no relevant financial relationships.</P> <H4>EDUCATIONAL OBJECTIVES</H4> <OL> <LI>Discuss the mechanisms behind food-related reactions.</LI> <LI>Describe a systematic approach to the evaluation of food allergy.</LI> <LI>Explain the relationship between IgE-mediated food allergy and atopic dermatitis.</LI> </OL>

Food Allergies and Eczema

“…For example, 80% of children with cow's milk allergy will outgrow it by the time they are age 5 years. 4 Similar findings are seen in children with egg, soy, and wheat allergies. On the other hand, only 20% of patients with tree nut allergy will "grow out" of their allergy.…”

“…Most allergy specialists recommend against blanket testing for all food allergies, because the positive predictive accuracy is approximately 50% depending on the food. 4 One study estimates that 10% of children with food allergies may have false-negative testing. 1 Instead, testing should be directed, and used to confirm suspicion of food allergy based on the child's history.…”

“…On the other hand, only 20% of patients with tree nut allergy will "grow out" of their allergy. 4 For infants, eczema (Figure 2) may not be the only manifestation of food allergy, and babies may exhibit gastrointestinal symptoms, failure to thrive, irritability, and sleep disturbance. For children who are breast-fed, eczema may flare in response to allergens in the mother's diet.…”

Both children and adult patients with difficult‐to‐treat atopic dermatitis have high prevalences of concomitant allergic contact dermatitis and are frequently polysensitized

“…However, in some cases, patients with AD are refractory to these conventional treatments, making it a difficult‐to‐treat disease. Several authors have reviewed the subject of difficult‐to‐treat or difficult‐to‐control AD, stating diverse possible explanations for the problem, such as lack of compliance,1 psychosocial factors,2, 3 skin infections,4, 5 exacerbations triggered by food and aeroallergens,6, 7, 8 and concomitant allergic contact dermatitis (ACD) 9, 10, 11. All these factors may contribute to making the disease difficult‐to‐treat.…”

The Impact of Atopic Dermatitis on Quality of Life

“…However, the percentage of patients exhibiting symptoms is much lower (15%) [6]. Food-induced AD may be found in 1-3% of children who have mild disease, in 5-10% among those with moderate disease, and in up to 20-33% in those with severe AD [7]. Food-exacerbated AD is rare in adults.…”