Children with atopic eczema. I: Clinical response to food elimination and subsequent double-blind food challenge

The role of foods in the exacerbation of atopic eczema was studied by offering a food elimination diet and subsequent random order, double-blind food challenges to 91 eczematous patients, [49 males and 42 females, median age 4.5 years (range 0.5-15)]. Eczema improved in 49 of 66 (74 per cent) (skin score fall greater than or equal to 3) after stopping cows' milk, eggs and various other foods, with significant decreases in erythema, excoriation, lichenification and extent of eczema. One hundred and ninety-four food challenges were given to 64 patients who had shown objective or subjective improvement. Eczema and associated symptoms were significantly worse after cows' milk and tomato compared with placebo. Egg did not worsen eczema, but 48 per cent of 44 challenges were incomplete, mainly due to hypersensitivity reactions and challenge refusal. The longer a food had been avoided, the less likely was the chance of a positive food reaction. Clinical history did not predict response to dietary manipulation. A standard elimination diet avoiding cows' milk, egg, tomatoes and possibly colours and preservatives should help up to three-quarters of patients, and is easy to implement with the help of a dietician. This diet may be considered in all children with moderate or severe eczema.