Are avoidance diets still warranted in children with atopic dermatitis?
Corresponding Author
Philippe A. Eigenmann
Department of Woman, Child and Adolescent, Pediatric Allergy Unit, University Hospitals of Geneva, Geneva, Switzerland
Correspondence
Philippe A. Eigenmann, Pediatric Allergy Unit, University Hospitals of Geneva, Rue Willy-Donze 6, CH-1211 Geneva 14, Switzerland.
Email: [email protected]
Search for more papers by this authorKirsten Beyer
Department of Pediatric Pneumology, Immunology and Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
Search for more papers by this authorGideon Lack
Department of Pediatric Allergy, Division of Asthma, Allergy and Lung Biology, King’s College London and Guy’s and St Thomas’ National Health Service Foundation Trust, London, UK
Search for more papers by this authorAntonella Muraro
Department of Woman and Child Health, Food Allergy Centre, Padua University Hospital, Padua, Italy
Search for more papers by this authorPeck Y. Ong
Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
Search for more papers by this authorScott H. Sicherer
Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
Search for more papers by this authorHugh A. Sampson
Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
Search for more papers by this authorCorresponding Author
Philippe A. Eigenmann
Department of Woman, Child and Adolescent, Pediatric Allergy Unit, University Hospitals of Geneva, Geneva, Switzerland
Correspondence
Philippe A. Eigenmann, Pediatric Allergy Unit, University Hospitals of Geneva, Rue Willy-Donze 6, CH-1211 Geneva 14, Switzerland.
Email: [email protected]
Search for more papers by this authorKirsten Beyer
Department of Pediatric Pneumology, Immunology and Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
Search for more papers by this authorGideon Lack
Department of Pediatric Allergy, Division of Asthma, Allergy and Lung Biology, King’s College London and Guy’s and St Thomas’ National Health Service Foundation Trust, London, UK
Search for more papers by this authorAntonella Muraro
Department of Woman and Child Health, Food Allergy Centre, Padua University Hospital, Padua, Italy
Search for more papers by this authorPeck Y. Ong
Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
Search for more papers by this authorScott H. Sicherer
Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
Search for more papers by this authorHugh A. Sampson
Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
Search for more papers by this authorAbstract
Nearly 40% of children with moderate-to-severe atopic dermatitis (AD) have IgE-mediated food allergy (FA). This clinical observation has been extensively documented by experimental data linking skin inflammation in AD to FA, as well as by food challenges reproducing symptoms and avoidance diets improving AD. Although food avoidance may improve AD, avoidance diets do not cure AD, may even have detrimental effects such as progression to immediate-type allergy including anaphylactic reactions, and may significantly reduce the quality of life of the patient and the family. AD care should focus upon optimal medical management, rather than dietary elimination. Food allergy testing is primarily indicated when immediate-type allergic reactions are a concern. In recalcitrant AD, if food is being considered a possible chronic trigger, a limited panel of foods may be tested. An avoidance diet is only indicated in patients clearly identified as food allergic by an appropriate diagnostic food challenge, and after adequately informing the family of the limited benefits, and possible harms of an elimination diet.
CONFLICT OF INTERESTS
PAE received speaker's honoraria and research support from Thermo Fisher Scientific, consultant fees from Nestlé, Abbott, DBV Technologies, reports royalty payments from UpToDate and Elsevier, and holds stock options in DBV Technologies. KB reports grants and personal fees from Aimmune, ALK, Danone, Hycor, and InfectoPharm, grants from DBV, Good Mills, Hipp, Thermo Fisher, and VDI, and personal fees from Allergopharma, Bausch & Lomb, Bencard Allergie, Di-Text, Hammer und Rall Media, Mabylon AG, Meda Pharma, Med Update, Mabylon, Meda Pharma, Nestlé, and Thermo Fisher. GL received research support from the National Institute of Allergy and Infectious Diseases, Food Allergy and Research Education, MRC and Asthma UK Centre, UK Department of Health through National Institute for Health Research Biomedical Research Centre based in Guy's and St Thomas' National Health Service Foundation Trust and King's College London, National Peanut Board, Food Standards Agency, and Action Medical Research, has stock/stock options with DBV Technologies, and is a shareholder in Mission Mighty Me. AM received speaker's fee from Mylan, DBV Technologies, and Aimmune, PYO reports research funding from Atopic Dermatitis Research Network, Regeneron, Pfizer, and consultant fees from Pfizer. SHS reports royalty payments from UpToDate and from Johns Hopkins University Press; grants to his institution from the National Institute of Allergy and Infectious Diseases, from Food Allergy Research and Education, and from HAL Allergy; and personal fees from the American Academy of Allergy, Asthma and Immunology, outside of the submitted work. HAS reports being a part-time employee of DBV Technologies, receiving consultant fees from N-Fold Therapeutics, holding stock options in DBV Technologies, and N-Fold Therapeutics, receiving grants from the National Institutes of Health, National Institute of Allergy and Infectious Diseases, and co-owning a patent on FAHF-2.
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