The role of food allergy in atopic dermatitis



Atopic dermatitis (AD) is a chronic, pruritic, inflammatory skin disease affecting more than 10% of all children. Sensitization to foods triggers isolated skin symptoms in about 30% of children. These symptoms include immediate reactions within minutes after ingesting food without exacerbation of AD and early and late exacerbations of AD. It is important to identify clinically relevant sensitizations to foods using skin prick tests, a specific IgE blood test (ImmunoCAP; Phadia, Portage, MI, USA), and double-blind, placebo-controlled food challenges to initiate appropriate dietary interventions and avoid unnecessary dietary restrictions. Children with AD triggered by food allergens demonstrate a distinct immune response upon stimulation of their peripheral blood mononuclear cells with food allergen. A defective skin barrier and increased intestinal permeability appear to facilitate allergen sensitization. Appropriate skin care to maintain skin barrier function and dietary avoidance of highly allergenic foods during infancy may help to prevent allergen sensitization, thereby reducing the severity of AD and food allergies.

References and Recommended Reading

  1. 1.
    Leung DYM, Boguniewicz M, Howell MD, et al.: New insights into atopic dermatitis. J Clin Invest 2004, 113:651–657.PubMedGoogle Scholar
  2. 2.
    Williams H, Robertson C, Stewart A, et al.: Worldwide variations in the prevalence of symptoms of atopic eczema in the International Study of Asthma and Allergies in Childhood. J Allergy Clin Immunol 1999, 103:125–138.PubMedCrossRefGoogle Scholar
  3. 3.
    Su JC, Kemp AS, Varigos GA, Nolan TM: Atopic eczema: its impact on the family and financial cost. Arch Dis Child 1997, 76:159–162.PubMedGoogle Scholar
  4. 4.
    Rowlands D, Tofte SJ, Hanifin JM: Does food allergy cause atopic dermatitis? Food challenge testing to dissociate eczematous from immediate reactions. Dermatol Ther 2006, 19:97–103.PubMedCrossRefGoogle Scholar
  5. 5.
    Sicherer SH, Sampson HA: Food hypersensitivity and atopic dermatitis: pathophysiology, epidemiology, diagnosis, and management. J Allergy Clin Immunol 1999, 104(Suppl):S114–S122.PubMedCrossRefGoogle Scholar
  6. 6.
    Sampson HA: Food allergy, I: immunopathogenesis and clinical disorders. J Allergy Clin Immunol 1999, 103:717–728.PubMedCrossRefGoogle Scholar
  7. 7.
    Sampson HA: Update on food allergy. J Allergy Clin Immunol 2004, 113:805–819.PubMedCrossRefGoogle Scholar
  8. 8.
    Wuethrich B: Food-induced cutaneous adverse reactions. Allergy 1998, 53(Suppl):131–135.CrossRefGoogle Scholar
  9. 9.
    Werfel T, Breuer K: Role of food allergy in atopic dermatitis. Curr Opin Allergy Clin Immunol 2004, 4:379–385.PubMedCrossRefGoogle Scholar
  10. 10.
    Burks AW, James JM, Hiegel A, et al.: Atopic dermatitis and food hypersensitivity reactions. J Pediatr 1998, 132:132–136.PubMedCrossRefGoogle Scholar
  11. 11.
    Sampson HA, McCaskill CC: Food hypersensitivity and atopic dermatitis: evaluation of 113 patients. J Pediatr 1985, 107:669–675.PubMedCrossRefGoogle Scholar
  12. 12.
    Eigenmann PA, Sicherer SH, Borkowski TA, et al.: Prevalence of IgE-mediated food allergy among children with atopic dermatitis. Pediatrics 1998, 101:e8.PubMedCrossRefGoogle Scholar
  13. 13.
    Werfel T, Ballmer-Weber B, Eigenmann PA, et al.: Eczematous reactions to food in atopic eczema: position paper of the EAACI and GA2LEN. Allergy 2007, 62:723–728.PubMedGoogle Scholar
  14. 14.
    Jaervinen KM, Turpeinen M, Suomalainen H: Concurrent cereal allergy in children with cow’s milk allergy manifested with atopic dermatitis. Clin Exp Allergy 2003, 33:1060–1066.CrossRefGoogle Scholar
  15. 15.
    Hill DJ, Hosking CS: Food allergy and atopic dermatitis in infancy: an epidemiologic study. Pediatr Allergy Immunol 2004, 15:421–427.PubMedCrossRefGoogle Scholar
  16. 16.
    Hill DJ, Sporik R, Thorburn J, Hosking CS: The association of atopic dermatitis in infancy with immunoglobulin E food sensitization. J Pediatr 2000, 137:475–479.PubMedCrossRefGoogle Scholar
  17. 17.
    Hill DJ, Heine R, Hosking CS, et al.: IgE food sensitization in infants with eczema attending a dermatology department. J Pediatr 2007, 151:359–363.PubMedCrossRefGoogle Scholar
  18. 18.
    Sporik R, Hill DJ, Hosking CS: Specificity of allergen skin testing in predicting positive open food challenges to milk, egg, and peanut to children. Clin Exp Allergy 2000, 30:1540–1546.PubMedCrossRefGoogle Scholar
  19. 19.
    Hill DJ, Hosking CS, de Benedictis FM, et al.: Confirmation of the association between high levels of immunoglobulin E food sensitization and eczema in infancy: an international study. Clin Exp Allergy 2007, 38:161–168.PubMedGoogle Scholar
  20. 20.
    Wolkerstorfer A, Wahn U, Kjellman NI, et al.: Natural course of sensitization to cow’s milk and hen’s egg in childhood atopic dermatitis: ETAC study group. Clin Exp Allergy 2002, 32:70–73.PubMedCrossRefGoogle Scholar
  21. 21.
    Lowe AJ, Abramson MJ, Hosking CS, et al.: The temporal sequence of allergic sensitization and onset of infantile eczema. Clin Exp Allergy 2007, 37:536–542.PubMedCrossRefGoogle Scholar
  22. 22.
    Cork JM, Robinson DA, Vasilopoulos Y, et al.: New perspectives on epidermal barrier dysfunction in atopic dermatitis: gene-environment interactions. J Allergy Clin Immunol 2006, 118:3–21; quiz 22–23.PubMedCrossRefGoogle Scholar
  23. 23.
    Lack G, Fox D, Northstone K, et al.: Factors associated with the development of peanut allergy in childhood. N Engl J Med 2003, 348:977–985.PubMedCrossRefGoogle Scholar
  24. 24.
    Heyman M: Gut barrier dysfunction in food allergy. Eur J Gastroenterol Hepatol 2005, 17:1279–1285.PubMedCrossRefGoogle Scholar
  25. 25.
    Ventura MT, Polimeno L, Amoruso AC, et al.: Intestinal permeability in patients with adverse reactions to foods. Dig Liver Dis 2006, 38:732–736.PubMedCrossRefGoogle Scholar
  26. 26.
    Majamaa H, Isolauri E: Evaluation of gut mucosal barrier: evidence for increased antigen transfer in children with atopic eczema. J Allergy Clin Immunol 1996, 97:985–990.PubMedCrossRefGoogle Scholar
  27. 27.
    Arvola T, Moilanen E, Vuento R, Isolauri E: Weaning to hypoallergenic formula improves gut barrier function in breast-fed infants with atopic eczema. J Pediatr Gastroenterol Nutr 2004, 38:92–96.PubMedCrossRefGoogle Scholar
  28. 28.
    Abernathy-Carver KJ, Sampson HA, Picker LJ, Leung DYM: Milk-induced eczema is associated with the expansion of T cells expressing cutaneous lymphocyte antigen. J Clin Inv 1995, 95:913–918.CrossRefGoogle Scholar
  29. 29.
    Bordignon V, Sinagra JL, Trento E, et al.: Antigen specific cytokine response in pediatric patients with atopic dermatitis. Pediatr Allergy Immunol 2005, 16:113–120.PubMedCrossRefGoogle Scholar
  30. 30.
    Dunstan JA, Hale J, Breckler L, et al.: Atopic dermatitis in young children is associated with impaired interleukin-10 and interferon-gamma responses to allergens, vaccines and colonizing skin and gut bacteria. Clin Exp Allergy 2005, 35:1309–1317.PubMedCrossRefGoogle Scholar
  31. 31.
    Leung DYM, Bieber T: Atopic dermatitis. Lancet 2003, 361:151–160.PubMedCrossRefGoogle Scholar
  32. 32.
    Prescott VE, Forbes E, Foster PS, et al.: Mechanistic analysis of experimental food allergen-induced cutaneous reactions. J Leukoc Biol 2006, 80:258–266.PubMedCrossRefGoogle Scholar
  33. 33.
    Negoro T, Orihara K, Irahara T, et al.: Influence of SNPs in cytokine-related genes on the severity of food allergy and atopic eczema in children. Pediatr Allergy Immunol 2006, 17:583–590.PubMedCrossRefGoogle Scholar
  34. 34.
    Burks W: Skin manifestations of food allergy. Pediatrics 2003, 111:1617–1624.PubMedGoogle Scholar
  35. 35.
    Johnson EE, Irons JS, Patterson R, Roberts M: Serum IgE concentration in topic dermatitis. Relationship to severity of disease and presence of atopic respiratory disease. J Allergy Clin Immunol 1974, 54:94–99.PubMedCrossRefGoogle Scholar
  36. 36.
    El-Khouly F, Lewis SA, Pons L, et al.: IgG and IgE avidity characteristics of peanut allergic individuals. Pediatr Allergy Immunol 2007, 18:607–613.PubMedCrossRefGoogle Scholar
  37. 37.
    Shreffler WG, Lencer DA, Bardina L, Sampson HA: IgE and IgG4 epitope mapping by microarray immunoassay reveals the diversity of immune response to the peanut allergen, Ara h 2. J Allergy Clin Immunol 2005, 116:893–899.PubMedCrossRefGoogle Scholar
  38. 38.
    Sampson HA, Albergo R: Comparison of results of skin tests, RASTs, and double-blind, placebo-controlled food challenges in children with atopic dermatitis. J Allergy Clin Immunol 1984, 74:26–33.PubMedCrossRefGoogle Scholar
  39. 39.
    Osterballe M, Andersen KE, Bindslev-Jensen C: The diagnostic accuracy of the atopy patch test in diagnosing hypersensitivity to cow’s milk and hen’s egg in unselected children with and without atopic dermatitis. J Am Acad Dermatol 2004, 51:556–562.PubMedCrossRefGoogle Scholar
  40. 40.
    Mehl A, Rolnick-Werninghaus C, Staden, et al.: The atopy patch test in the diagnostic workup of suspected food-related symptoms in children. J Allergy Clin Immunol 2006, 118:923–929.PubMedCrossRefGoogle Scholar
  41. 41.
    Muraro A, Dreborg S, Halken S, et al.: Dietary prevention of allergic diseases in infants and small children. Part III: critical review of published peer-reviewed observational and interventional studies and final recommendations. Pediatr Allergy Immunol 2004, 15:291–307.PubMedCrossRefGoogle Scholar
  42. 42.
    Arshad SH, Bateman B, Sadeghnejad A, et al.: Prevention of allergic disease during childhood by allergen avoidance: the Isle of Wight prevention study. J Allergy Clin Immunol 2007, 119:307–313.PubMedCrossRefGoogle Scholar
  43. 43.
    Pesonen M, Kallio MJT, Ranki A, Siimes MA: Prolonged exclusive breastfeeding is associated with increased atopic dermatitis: a prospective follow-up study of unselected healthy newborns from birth to age 20 years. Clin Exp Allergy 2006, 36:1011–1018.PubMedCrossRefGoogle Scholar
  44. 44.
    Fergusson DM, Horwood LJ, Shannon FT: Early solid food feeding and recurrent childhood eczema: a 10-year longitudinal study. Pediatrics 1990, 1986:541–546.Google Scholar
  45. 45.
    Zutavern A, Brockow I, Schaaf B, et al.: Timing of solid food introduction in relation to atopic dermatitis and atopic sensitization: results from a prospective birth cohort study. Pediatrics 2006, 117:401–411.PubMedCrossRefGoogle Scholar
  46. 46.
    Poole JA, Barriga K, Leung DTM, et al.: Timing of exposure to cereal grains and the risk of wheat allergy. Pediatrics 2006, 117:2175–2182.PubMedCrossRefGoogle Scholar
  47. 47.
    Bjorksten B, Sepp E, Julge K, et al.: Allergy development and the intestinal microflora during the first year of life. J Allergy Clin Immunol 2001, 108:516–520.PubMedCrossRefGoogle Scholar
  48. 48.
    Miraglia del Guidice M, De Luca MG: The role of probiotics in the clinical management of food allergy and atopic dermatitis. J Clin Gastroenterol 2004, 38(6 Suppl):S84–S85.CrossRefGoogle Scholar
  49. 49.
    Sistek D, Kelly R, Wickens K, et al.: Is the effect of probiotics on atopic dermatitis confined to food sensitized children? Clin Exp Allergy 2006, 36:629–633.PubMedCrossRefGoogle Scholar
  50. 50.
    Grueber C, Wendt M, Sulser C, et al.: Randomized, placebo-controlled trial of Lactobacillus rhamnosus GG as treatment of atopic dermatitis in infancy. Allergy 2007, 62:1270–1276.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Department of PediatricsNational Jewish Medical and Research CenterDenverUSA

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