Food allergy and atopic dermatitis: Prediction, progression, and prevention

Abstract

The rising burden of allergic diseases in childhood requires a compelling need to identify individuals at risk for atopy very early in life or even predict the onset of food allergy and atopic dermatitis since pregnancy. The development and clinical phenotypes of atopic diseases in childhood depend on a complex interaction between genetic and environmental factors, such as allergen exposure, air pollution, and infections. Preventive strategies may include avoidance measures, diet supplements, and early complementary food introduction. Overall, the management of allergic diseases has been improving to date toward a patient's tailored approach. This review will cover the current understanding of risk factors, prediction, and management of food allergy and atopic dermatitis in childhood and discuss how these may contribute to the modification of the natural history of food allergy and atopic dermatitis.

SnapshotDx Quiz: December 2019

“…Sensitivity to food allergens is more common in children above 10, while sensitivity to aeroallergens is more common in younger children with AD: Food allergies in AD may result in IgEmediated immediate and non-IgEemediated late eczematous reactions. Approximately 50% constitute IgE-mediated food allergies, which can manifest as urticaria, angioedema, erythema, pruritus, and morbilliform eruptions (Mastrorilli et al, 2017). IgE mediates the induction of mast cell activation releasing preformed mediators such as histamine and Th2-cytokines (IL-4 and IL-13).…”

Fecal metabolites and early sensitization influence asthma, and how to prevent anaphylaxis in the community

“…7 Overall, the interrelation of the gut microenvironment, related metabolites, and allergy is complex and deserves further explorations. 8 The second highlighted article by Ann-Marie Malby Schoos and colleagues reports data generated from the Copenhagen Prospective Studies on Asthma in Childhood (COPSAC). 9 Specific IgE (sIgE) levels and skin prick test (SPT) results from 22 food allergens and aeroallergens were assessed at different time points up to age 13 years.…”

“…Also, indirect interventions, such as early‐life antibiotic use and its impact on the gut microbiome, are known to influence the development of allergy . Overall, the interrelation of the gut microenvironment, related metabolites, and allergy is complex and deserves further explorations …”

Do we still need oral food challenges for the diagnosis of food allergy?

“…The role of food allergy in eczema has been most controversial for years. Diagnosing food allergy in patients with atopic eczema has always been a very challenging clinical situation . Indeed, many of these patients are sensitized to common foods, but have recurrent non‐allergic flares of their eczema.…”

“…Diagnosing food allergy in patients with atopic eczema has always been a very challenging clinical situation. 9 Indeed, many of these patients are sensitized to common foods, but have recurrent non-allergic flares of their eczema. This has led to overdiagnosis of food allergy in a large percentage of children sensitized to common foods such as milk, egg, or nuts.…”