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Dietary restriction and supplementation in children with atopic eczema
K L E Hon1, T F Leung, W Y C Kam
1Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China. ehon@cuhk.edu.hk
Insights
Dietary habits in children with atopic eczema (AE) were studied. Many AE patients avoid common foods like fish, beef, eggs, and milk, sometimes based on belief rather than confirmed allergy, risking malnutrition.
Area of Science:
- Pediatric Dermatology
- Nutritional Science
- Allergy and Immunology
Background:
- Dietary factors are crucial in managing atopic eczema (AE), yet empirical research on restrictions and supplementation in affected children remains limited.
- Understanding the dietary habits of children with AE is essential for effective management and preventing potential nutritional deficiencies.
Purpose of the Study:
- To compare the dietary habits of children with atopic eczema (AE) to those without eczema.
- To investigate the reasons behind food avoidance in children with AE and its potential impact on their health.
- To evaluate the appropriateness of current dietary management strategies for AE.
Main Methods:
- A comparative study involving 179 children with AE and 78 controls, followed at a pediatric dermatology clinic.
- Dietary habits, including food avoidance and consumption patterns, were assessed through parental reports.
- Statistical analysis, including odds ratios (OR) and 95% confidence intervals (CI), was used to compare food avoidance between groups.
Main Results:
- Children with moderate-to-severe AE were significantly more likely to avoid fish/seafood (OR 3.84), beef (OR 3.57), eggs (OR 3.05), and cow's milk (OR 5.56) compared to controls.
- Food avoidance in AE patients was often based on parental belief, though 66% reported prior eczema exacerbation linked to these foods.
- Patients with AE also showed higher consumption of 'bird's nest' soup and traditional Chinese medicines.
Conclusions:
- A significant proportion of children with AE avoid common foods, necessitating evaluation for genuine food allergies versus belief-driven avoidance.
- Suboptimal management occurs when children with confirmed food allergies continue consuming trigger foods or when children without allergies unnecessarily restrict their diet, risking malnutrition.
- Further research is needed to differentiate true food allergies from perceived triggers in AE management.
Abstract:
Issues on empirical dietary restriction or supplementation are important but inadequately studied in children with atopic eczema (AE). The dietary habits of children with AE followed at a paediatric dermatology clinic (n = 179) were compared with those without eczema (n = 78). The mothers of 53% of the patients with or without eczema did not breastfeed their children. Common food items avoided by parents whose children have moderate-to-severe AE included fish or seafood [64% vs. 32% of controls, odds ratio (OR) 3.84, 95% CI 2.12-6.95], beef (42% vs. 17%; OR = 3.57, 95% CI 1.79-7.11), eggs (34% vs. 14%; OR = 3.05, 95% CI 1.46-6.34) and cows' milk (18% vs. 4%; OR = 5.56, 95% CI 1.61-19.12); whereas their avoidance was less frequent in children with noneczematous diseases. The avoidance of these foods were often based on belief, but 66% of all AE patients who had avoided any of the above foods reported previous experience of eczema exacerbation by these items. Patients with moderate-to-severe AE were more likely to have consumed 'bird's nest' soup and traditional Chinese medicines. It is important to evaluate whether the AE patients are genuinely 'allergic' to some of these food items. Management is suboptimal if children with food allergy and severe disease continue to consume the culprit food. Conversely, avoidance of common foods in children without food allergy could result in food faddism or malnutrition.
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