Respiratory Manifestations of Food Allergy in Babies with Atopic Dermatitis: A Prospective Study in 395 Children

Abstract

Background Scientific evidence accumulated in recent years indicates that food and inhalant allergens can trigger atopic dermatitis (AD). It may be hypothesized that, also in AD, the allergens could induce a cutaneous hyper reactivity analogous to the bronchial hyper reactivity (BHR) described in allergic patients with asthma. Nonspecific stimuli can therefore trigger and worsen the skin lesions. Eosinophils, as in asthma, seem to play an important role in inducing and maintaining the skin lesions.Objective: Taken together, these data suggest that in AD there exists a vicious circle, by which immunologic and non immunologic factors act in various ways and at different levels triggering different, though synergistic, reactions to initiate, amplify and maintain the chronic skin lesions characteristic of the condition. Patients and methods:We have prospectively 395 atopic children attending our Division because they were affected with AD, and found 213/395 babies affected contemporaneously with AD and respiratory allergy. The diagnosis of atopic diseases in the children was done according to family and clinical history, physical examination and positive SPTs and/or RAST to the most common inhalant and/or food allergens Results. Of them 14 babies experienced a positive OFC (open challenge test) to different foods (9 cow milk CM , 5 hydrolysate formulas, HFs and one fish, but we stress that three of them reacted to one drop or two ml of CM) Positivity of family history and elevated total IgE confirm that AD is a genetic disease. Conclusion:The data confirms the studies that have suggested that allergens in turn could elicit respiratory symptoms that can be distinguished as food induced asthma and asthma with food allergy (FA). In summary, FA provokes wheezing in a small, but significant number of children suffering from AD and asthma, thus confronting pediatricians with one of the most demanding challenges