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Approach to suspected food allergy in atopic dermatitis. Guideline of the Task Force on Food Allergy of the German Society of Allergology and Clinical Immunology (DGAKI) and the Medical Association of German Allergologists (ADA) and the German Society of Pediatric Allergology (GPA).

Abstract

The following guideline of the "Arbeitsgruppe Nahrungsmittelallergie der DGAKI" (Task Force on Food Allergy of the German Society of Allergology and Clinical Immunology) and the ADA ("Arzteverband Deutscher Allergologen", Medical Association of German Allergologists) and the GPA (German Society of Pediatric Allergology) summarizes the approach to be taken when food allergy is suspected in patients with atopic dermatitis (neurodermatitis, atopic eczema). The problem is clinically relevant because many patients assume that allergic reactions against foods are responsible for triggering or worsening their eczema. It is important to identify those patients who will benefit from an elimination diet but also to avoid unnecessary diets. Elimination diets (especially in early childhood) are associated with the risk of malnutrition and additional emotional stress for the patients. The gold standard for the diagnosis of food-dependent reactions is to perform placebo-controlled, double-blind oral food challenges because specific IgE, prick tests and history often do not correlate with clinical reactivity. This is particularly true in the case of delayed eczematous skin reactions. Diagnostic elimination diets should be used before an oral provocation test. If multiple sensitizations against foods are discovered in a patient, an oligoallergenic diet and a subsequent stepwise supplementation of the nutrition should be performed. If a specific food is suspected of triggering food allergy, oral provocation should be performed after a diagnostic elimination diet. As eczema-tous skin reactions may develop slowly (i. e. within one or two day), the skin be inspected the day after the provocation test and that a repetitive test be performed if the patient has not reacted to a given food on the first day of oral provocation. The guideline discusses various clinical situations for patients with atopic dermatitis to facilitate differentiated diagnostic procedures.

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  • Authors+Show Affiliations

    ,

    Department of Dermatology and Venereology, Hannover Medical School, Ricklinger StraBe 5, Hannover D-30449, Germany. Werfel.thomas@mh-hannover.de

    , , , , , , , , , , , , ,

    Source

    MeSH

    Allergy and Immunology
    Dermatitis, Atopic
    Food Hypersensitivity
    Germany

    Pub Type(s)

    Journal Article
    Practice Guideline

    Language

    eng ger

    PubMed ID

    19371249

    Citation

    Werfel, Thomas, et al. "Approach to Suspected Food Allergy in Atopic Dermatitis. Guideline of the Task Force On Food Allergy of the German Society of Allergology and Clinical Immunology (DGAKI) and the Medical Association of German Allergologists (ADA) and the German Society of Pediatric Allergology (GPA)." Journal Der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG, vol. 7, no. 3, 2009, pp. 265-71.
    Werfel T, Erdmann S, Fuchs T, et al. Approach to suspected food allergy in atopic dermatitis. Guideline of the Task Force on Food Allergy of the German Society of Allergology and Clinical Immunology (DGAKI) and the Medical Association of German Allergologists (ADA) and the German Society of Pediatric Allergology (GPA). J Dtsch Dermatol Ges. 2009;7(3):265-71.
    Werfel, T., Erdmann, S., Fuchs, T., Henzgen, M., Kleine-Tebbe, J., Lepp, U., ... Zuberbier, T. (2009). Approach to suspected food allergy in atopic dermatitis. Guideline of the Task Force on Food Allergy of the German Society of Allergology and Clinical Immunology (DGAKI) and the Medical Association of German Allergologists (ADA) and the German Society of Pediatric Allergology (GPA). Journal Der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG, 7(3), pp. 265-71. doi:10.1111/j.1610-0387.2008.06901.x.
    Werfel T, et al. Approach to Suspected Food Allergy in Atopic Dermatitis. Guideline of the Task Force On Food Allergy of the German Society of Allergology and Clinical Immunology (DGAKI) and the Medical Association of German Allergologists (ADA) and the German Society of Pediatric Allergology (GPA). J Dtsch Dermatol Ges. 2009;7(3):265-71. PubMed PMID: 19371249.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Approach to suspected food allergy in atopic dermatitis. Guideline of the Task Force on Food Allergy of the German Society of Allergology and Clinical Immunology (DGAKI) and the Medical Association of German Allergologists (ADA) and the German Society of Pediatric Allergology (GPA). AU - Werfel,Thomas, AU - Erdmann,Stephan, AU - Fuchs,Thomas, AU - Henzgen,Margot, AU - Kleine-Tebbe,Jörg, AU - Lepp,Ute, AU - Niggemann,Bodo, AU - Raithel,Martin, AU - Reese,Imke, AU - Saloga,Joachim, AU - Vieths,Stefan, AU - Zuberbier,Torsten, AU - ,, AU - ,, AU - ,, PY - 2009/4/18/entrez PY - 2009/4/18/pubmed PY - 2009/7/10/medline SP - 265 EP - 71 JF - Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG JO - J Dtsch Dermatol Ges VL - 7 IS - 3 N2 - The following guideline of the "Arbeitsgruppe Nahrungsmittelallergie der DGAKI" (Task Force on Food Allergy of the German Society of Allergology and Clinical Immunology) and the ADA ("Arzteverband Deutscher Allergologen", Medical Association of German Allergologists) and the GPA (German Society of Pediatric Allergology) summarizes the approach to be taken when food allergy is suspected in patients with atopic dermatitis (neurodermatitis, atopic eczema). The problem is clinically relevant because many patients assume that allergic reactions against foods are responsible for triggering or worsening their eczema. It is important to identify those patients who will benefit from an elimination diet but also to avoid unnecessary diets. Elimination diets (especially in early childhood) are associated with the risk of malnutrition and additional emotional stress for the patients. The gold standard for the diagnosis of food-dependent reactions is to perform placebo-controlled, double-blind oral food challenges because specific IgE, prick tests and history often do not correlate with clinical reactivity. This is particularly true in the case of delayed eczematous skin reactions. Diagnostic elimination diets should be used before an oral provocation test. If multiple sensitizations against foods are discovered in a patient, an oligoallergenic diet and a subsequent stepwise supplementation of the nutrition should be performed. If a specific food is suspected of triggering food allergy, oral provocation should be performed after a diagnostic elimination diet. As eczema-tous skin reactions may develop slowly (i. e. within one or two day), the skin be inspected the day after the provocation test and that a repetitive test be performed if the patient has not reacted to a given food on the first day of oral provocation. The guideline discusses various clinical situations for patients with atopic dermatitis to facilitate differentiated diagnostic procedures. SN - 1610-0387 UR - https://www.unboundmedicine.com/medline/citation/19371249/Approach_to_suspected_food_allergy_in_atopic_dermatitis__Guideline_of_the_Task_Force_on_Food_Allergy_of_the_German_Society_of_Allergology_and_Clinical_Immunology__DGAKI__and_the_Medical_Association_of_German_Allergologists__ADA__and_the_German_Society_of_Pediatric_Allergology__GPA__ L2 - https://doi.org/10.1111/j.1610-0387.2008.06901.x DB - PRIME DP - Unbound Medicine ER -