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Are avoidance diets still warranted in children with atopic dermatitis?
Philippe A Eigenmann1, Kirsten Beyer2, Gideon Lack3
1Department of Woman, Child and Adolescent, Pediatric Allergy Unit, University Hospitals of Geneva, Geneva, Switzerland.
Summary
Nearly 40% of children with atopic dermatitis (AD) have food allergies (FA). While food avoidance may help AD, it doesn't cure it and can be harmful. Optimal medical management is key for AD care.
Area of Science:
- Immunology
- Dermatology
- Pediatrics
Background:
- A significant proportion of children with moderate-to-severe atopic dermatitis (AD) also experience IgE-mediated food allergy (FA).
- Experimental data and clinical observations link skin inflammation in AD to FA, with symptom reproduction during food challenges and improvement upon avoidance.
- Food avoidance, while potentially alleviating AD symptoms, does not represent a cure and carries risks, including progression to immediate-type allergies and anaphylaxis, alongside reduced quality of life.
Purpose of the Study:
- To emphasize the importance of optimal medical management over dietary elimination for atopic dermatitis (AD).
- To clarify the appropriate indications for food allergy testing and dietary elimination in children with AD.
- To inform healthcare providers and families about the limited benefits and potential harms of elimination diets in AD management.
Main Methods:
- Review of existing clinical observations and experimental data linking atopic dermatitis (AD) and food allergy (FA).
- Analysis of the efficacy and risks associated with dietary elimination strategies in AD management.
- Evaluation of the diagnostic criteria and indications for food allergy testing in the context of AD.
Main Results:
- Food avoidance diets do not cure AD and can lead to adverse outcomes, including anaphylaxis.
- Dietary elimination significantly reduces the quality of life for patients and their families.
- Optimal medical management should be the primary focus for AD care, not dietary elimination.
Conclusions:
- Food allergy testing is primarily indicated for concerns about immediate-type allergic reactions.
- Dietary elimination is only recommended for patients with confirmed food allergies via diagnostic food challenges.
- Families must be fully informed about the limited benefits and potential harms of elimination diets before implementation in AD management.
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