Food Allergy Test-Guided Dietary Advice for Children With Atopic Dermatitis: A Consensus Study

Area of Science:

• Pediatric Allergy and Immunology
• Clinical Dermatology
• Nutritional Science

Background:

• Atopic dermatitis (AD) management in children under two years often involves controversial dietary exclusions guided by allergy tests.
• Blood specific IgE and skin prick tests (SPT) lack standardized interpretation for guiding dietary choices in pediatric AD.
• A consensus exercise was conducted to clarify the interpretation of SPT results and dietary history for key food allergens.

Purpose of the Study:

• To achieve consensus on interpreting skin prick tests (SPT) and dietary history for cow's milk, hen's egg, wheat, and soy.
• To develop standardized guidelines for managing food allergies in infants with atopic dermatitis (AD).
• To enhance consistency in clinical decision-making regarding dietary interventions for pediatric AD.

Main Methods:

• A modified Delphi study involving 14 UK and Ireland-based clinicians from diverse pediatric specialties.
• Three online rounds of anonymous opinion-giving with feedback, assuming all children underwent SPT.
• A final online workshop to discuss findings and reach consensus on interpretation and dietary advice.

Main Results:

• Consensus was achieved on identifying immediate (12/18) and delayed (7/18) allergy symptoms.
• Agreement on allergens for wheat and soy SPTs, but not cow's milk or hen's egg.
• Defined SPT wheal size categories: 0-1mm (negative), ≥5mm (sensitized), with 2-4mm varying by food; consensus reached on dietary advice for nine SPT/history combinations.

Conclusions:

• Consensus was reached on interpreting SPTs and dietary history for four common food allergens in young children with AD.
• These pragmatic recommendations can aid clinician education and standardize decision-making.
• The findings provide a foundation for future research in pediatric food allergy management.