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Provocation with cow's milk and cereals in atopic dermatitis
Insights
Food sensitivity exacerbates atopic dermatitis in young children. While some children outgrow allergies, initial allergy tests like radioallergosorbent test (RAST) have limited value for screening in these cases.
Area of Science:
- Pediatrics
- Allergology
- Immunology
Background:
- Atopic dermatitis is common in children under 5.
- Food sensitivity can trigger or worsen atopic dermatitis.
- Accurate diagnostic tools for food sensitivity in atopic dermatitis are needed.
Purpose of the Study:
- To investigate the role of oral food provocation in identifying food sensitivities in children with atopic dermatitis.
- To assess changes in food sensitivity over time.
- To evaluate the utility of serological markers and radioallergosorbent testing (RAST) in diagnosing food sensitivity.
Main Methods:
- Oral provocation tests with cow's milk and cereals were conducted in 81 children under 5 with atopic dermatitis.
- Positive reactors underwent repeated provocation over 18 months.
- Serum IgE, specific reagins, and RAST were analyzed.
Main Results:
- 15 out of 81 children showed dermatitis exacerbation after food provocation.
- Eleven children lost sensitivity, and 2 became more tolerant over 18 months.
- Initial IgE and specific reagins did not predict positive provocation; however, reagins to egg white increased in positive reactors. RAST showed limited screening value.
Conclusions:
- Oral food provocation is effective in identifying food triggers for atopic dermatitis in young children.
- Food sensitivity in atopic dermatitis can change over time, with some children outgrowing it.
- Standard allergy tests like RAST have limited utility for screening food sensitivity in atopic dermatitis.
Abstract:
Oral provocation test with cow's milk and cereals were performed in 81 children with atopic dermatitis, all below 5 years of age. In 15 of the children exacerbation of the dermatitis occurred on the second or third day after initiation of the tests. These patients, whose mean age was 13 months, underwent repeated provocation during the ensuring 18 months. Eleven children lost their sensitivity to the offending foods and 2 children became more tolerant during this period. Initial levels of serum IgE and specific reagins against the foods tested did not distinguish those patients who were positive to the provocation tests. In this group, however, reagins against egg white were significantly increased. The specific serum reagins were unaltered or increased in the majority of cases during the period of study. The radioallergosorbent test (RAST) was found of limited value as a screening tool in patients with atopic dermatitis in whom exacerbation of the condition appears to be caused by food sensitivity.