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Association of food allergy and atopic dermatitis exacerbations

Emmy M Roerdink¹, Bertine M J Flokstra-de Blok², Janine L Blok³

¹Department of Pediatric Pulmonology and Allergy, University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, the Netherlands.

Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology

|March 8, 2016

Insights

Children with atopic dermatitis (AD) often have food allergies, but asymptomatic sensitization is common. Testing for food allergy is recommended for children with AD, though worsening AD alone may not indicate food allergy.

Area of Science:

Pediatric Allergy and Immunology
Dermatology
Clinical Immunology

Background:

Atopic dermatitis (AD) and food allergy frequently co-occur in pediatric populations.
Understanding the relationship between these conditions is crucial for accurate diagnosis and management.

Purpose of the Study:

To investigate the association between food allergy and atopic dermatitis (AD) in children.
To evaluate the predictive value of specific IgE levels for food allergy diagnosis in children with and without AD.

Main Methods:

Conducted 1186 double-blind, placebo-controlled food challenges (DBPCFCs) between 2001 and 2011.
Assessed immediate and delayed allergic reactions post-challenge.
Utilized logistic regression to analyze the correlation between specific IgE and DBPCFC outcomes in children with varying AD status.

Main Results:

Food sensitization was significantly higher in children with a history of AD.
Specific IgE showed significant predictive value for DBPCFC outcomes in children with and without AD, with stronger association in those without current AD.
DBPCFC positivity rates varied by AD severity: 53.3% (mild), 51.7% (moderate), and 100% (severe).
Children with AD and only worsening AD symptoms reacted similarly to placebo and challenge foods.

Conclusions:

Children with active AD exhibit higher rates of asymptomatic food sensitization compared to those without AD.
Food allergy testing is advised for children with suspected food allergy, irrespective of AD severity.
Isolated AD exacerbation without other allergic symptoms suggests a low likelihood of actual food allergy.

Read full analysis

Abstract

Background:

Atopic dermatitis (AD) and food allergy frequently coexist in children.

Objective:

To examine the association between food allergy and AD.

Methods:

Between 2001 and 2011, children referred to our tertiary care center underwent double-blind, placebo-controlled food challenges (DBPCFCs) for one or more suspected food allergies as part of regular care. Immediate reactions were observed and recorded by allergy nursing staff, whereas late reactions were ascertained by semistructured telephone interview 48 hours after challenge. To test to which degree specific IgE results were predictive in the outcome of DBPCFCs in children with and without (previous and current) AD, logistic regression analysis was performed.

Results:

A total of 1186 DBPCFCs were studied. Sensitization to foods occurred significantly more often in children with previous AD. The association between specific IgE results and the outcome of DBPCFCs was significant for children with and without (previous and current) AD but stronger for children without current AD. The positivity rate of DBPCFCs in children with mild, moderate, and severe AD was 53.3%, 51.7%, and 100%, respectively. Children with AD and a history of worsening AD as their only symptom reacted as often to placebo as to challenge food.

Conclusion:

Children with current AD are more frequently asymptomatically sensitized to the foods in question than those without AD. In addition, children suspected of food allergy should be considered for testing, regardless of the severity of their AD. Our results suggest that children with exacerbation of AD in the absence of other allergic symptoms are unlikely to be food allergic.

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