Food Allergy and Atopic Dermatitis: Separating Fact from Fiction

Abstract

The relationship between food and atopic dermatitis (AD) is complex. A common misunderstanding is that food allergies have a significant impact on the course of AD, resulting in uncontrolled attempts at elimination diets and undertreatment of the skin itself. Studies have shown that only a small portion of cutaneous reactions to food in the form of late, eczematous eruptions will directly exacerbate AD in young infants who have moderate-to-severe AD. Given the low frequency of food allergies actually inducing flares of AD, the focus should return to appropriate skin therapy, and identification of true food allergies should be reserved for recalcitrant AD in children in whom the suspicion for food allergy is high. A different relationship between food and AD involves delaying or preventing AD in high-risk infants by exclusive breastfeeding during the first 4 months of life. Finally, the skin barrier defect in AD may allow for easier and earlier sensitization of food and airborne allergens; therefore, exposure of food proteins on AD skin may act as a risk factor for development of food allergies.

Aetiopathogenesis of atopic dermatitis

“…Sensitisation to foods (raised ImmunoCAP values or positive skin-prick tests) is common in AD, but not synonymous with clinically relevant food allergy. About 60% of patients with AD are sensitised to food allergens [29] -a much higher percentage than the overall prevalence of food sensitisation in the general population. In 2011, infants attending a tertiary dermatology clinic for AD were shown to have high sensitisation rates (66% to at least one food), most commonly to egg (52%), peanuts (39%) and cow's milk (25%).…”

“…In 2011, infants attending a tertiary dermatology clinic for AD were shown to have high sensitisation rates (66% to at least one food), most commonly to egg (52%), peanuts (39%) and cow's milk (25%). [30] Approximately 30 -40% of children with AD have a co-existing food allergy, [29] but this is much less common in adults.…”

Food Allergy in Atopic Dermatitis

“…As confirmed in several studies, cow's milk, hen's eggs, wheat, soy, and peanuts are responsible for approximately 75% of food-associated AD [15,16] in IFA, whereas for NFA, meats as well as cow's milk, hen's eggs, soy and wheat were the major causes of AD [13]. In Western country, Hen's eggs and cow's milk are significantly more likely to result in IFA and are associated with elevated food-specific IgE [11]. Soy and wheat are more likely to cause late eczematous flares, but reactions to cow's milk were also observed.…”

“…However, with the recent advance in the diagnosis and treatment of food allergy, it is necessary inevitably to distinguish between IgE-and non-IgE-mediated food allergies that co-exist with AD in order to better understand and control AD [2]. It is well-known that food allergy is an important cause of atopic dermatitis [3]. Although food allergies can be either IgE-or non-IgE-mediated, due to a lack of diagnostic modalities such as laboratory tests to diagnose non-IgE-mediated food allergy [4], it is difficult to clarify the nature of the food allergy, leading to confusion about role of food allergy in AD.…”

The Prevalence of Atopic Dermatitis in Adolescents Living in Denizli, Turkey (ISAAC Phase III): Is a Parent Working in Textile Industry a Risk Factor?

“…49,50 In addition, wide range of the prevalence of AE (33% and 75%) may be due to the differences in the definition of the food allergy in AE or the selection of severe AE patients. 51,52 In some other studies it was reported that, history of measles, respiratory infection, eating vegetables every day, parasite infestation, alcohol intake during pregnancy, the children of mothers who worked during pregnancy and precipitation and humidity were associated with AE. 17,[53][54][55][56] But AE was found negatively correlated with sunny weather.…”