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Does food allergy cause atopic dermatitis? Food challenge testing to dissociate eczematous from immediate reactions.

Abstract

The objective is to evaluate and diagnose, in a controlled setting, suspected food allergy causation in patients hospitalized for management of severe, unremitting atopic dermatitis (AD). Nineteen children were hospitalized at Oregon Health and Science University with atopic dermatitis from 1986 to 2003 for food restriction, then challenge, following standard recommendations. Challenges were prioritized by categories of (a) critical foods (e.g., milk, wheat, egg, soy); (b) important foods; and (c) other suspected foods. Patients were closely observed for evidence of pruritus, eczematous responses, or IgE-mediated reactions. If results were inconsistent, double-blind, placebo-controlled food challenge was performed. A total of 17 children with atopic dermatitis were assessed. Two could not be fully evaluated, thus were excluded from data tabulations. Only one positive eczematous food response was observed of 58 challenges. Three children had well-documented histories of food-induced IgE-mediated anaphylactoid or urticaria reactions to seafood and/or nuts and were not challenged with those foods. Atopic dermatitis, even in the highest-risk patients, is rarely induced by foods. Undocumented assumptions of food causation detract from proper anti-inflammatory management and should be discouraged. Immediate IgE-mediated food reactions are common in atopic dermatitis patients; such reactions are rapid onset, typically detected outside the clinic, and must be distinguished from eczematous reactions. Diagnosis of food-induced eczema cannot be made without food challenge testing. Such tests can be practical and useful for dispelling unrealistic assumptions about food allergy causation of atopic dermatitis.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Department of Dermatology, Oregon Health and Science University, Portland, 97201, USA.

    ,

    Source

    Dermatologic therapy 19:2 pg 97-103

    MeSH

    Adolescent
    Allergens
    Child
    Child, Preschool
    Dermatitis, Atopic
    Female
    Food Hypersensitivity
    Humans
    Hypersensitivity, Immediate
    Immunoglobulin E
    Infant
    Male
    Oregon
    Skin Tests

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    16669992

    Citation

    Rowlands, Debra, et al. "Does Food Allergy Cause Atopic Dermatitis? Food Challenge Testing to Dissociate Eczematous From Immediate Reactions." Dermatologic Therapy, vol. 19, no. 2, 2006, pp. 97-103.
    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(2):97-103.
    Rowlands, D., Tofte, S. J., & Hanifin, J. M. (2006). Does food allergy cause atopic dermatitis? Food challenge testing to dissociate eczematous from immediate reactions. Dermatologic Therapy, 19(2), pp. 97-103.
    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(2):97-103. PubMed PMID: 16669992.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Does food allergy cause atopic dermatitis? Food challenge testing to dissociate eczematous from immediate reactions. AU - Rowlands,Debra, AU - Tofte,Susan J, AU - Hanifin,Jon M, PY - 2006/5/4/pubmed PY - 2006/10/13/medline PY - 2006/5/4/entrez SP - 97 EP - 103 JF - Dermatologic therapy JO - Dermatol Ther VL - 19 IS - 2 N2 - The objective is to evaluate and diagnose, in a controlled setting, suspected food allergy causation in patients hospitalized for management of severe, unremitting atopic dermatitis (AD). Nineteen children were hospitalized at Oregon Health and Science University with atopic dermatitis from 1986 to 2003 for food restriction, then challenge, following standard recommendations. Challenges were prioritized by categories of (a) critical foods (e.g., milk, wheat, egg, soy); (b) important foods; and (c) other suspected foods. Patients were closely observed for evidence of pruritus, eczematous responses, or IgE-mediated reactions. If results were inconsistent, double-blind, placebo-controlled food challenge was performed. A total of 17 children with atopic dermatitis were assessed. Two could not be fully evaluated, thus were excluded from data tabulations. Only one positive eczematous food response was observed of 58 challenges. Three children had well-documented histories of food-induced IgE-mediated anaphylactoid or urticaria reactions to seafood and/or nuts and were not challenged with those foods. Atopic dermatitis, even in the highest-risk patients, is rarely induced by foods. Undocumented assumptions of food causation detract from proper anti-inflammatory management and should be discouraged. Immediate IgE-mediated food reactions are common in atopic dermatitis patients; such reactions are rapid onset, typically detected outside the clinic, and must be distinguished from eczematous reactions. Diagnosis of food-induced eczema cannot be made without food challenge testing. Such tests can be practical and useful for dispelling unrealistic assumptions about food allergy causation of atopic dermatitis. SN - 1396-0296 UR - https://www.unboundmedicine.com/medline/citation/16669992/Does_food_allergy_cause_atopic_dermatitis_Food_challenge_testing_to_dissociate_eczematous_from_immediate_reactions_ L2 - https://doi.org/10.1111/j.1529-8019.2006.00063.x DB - PRIME DP - Unbound Medicine ER -