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Does atopic dermatitis cause food allergy? A systematic review.
J Allergy Clin Immunol 2016; 137(4):1071-1078JA

Abstract

BACKGROUND

The association between atopic dermatitis (AD) and food allergy (FA) is not fully understood, although a causal relationship has been suggested. This has important implications for prevention and treatment.

OBJECTIVE

We aimed to review the association between AD and FA, the effect of FA on AD severity, chronicity, and age of onset, and the temporal relationship between the two.

METHODS

Medline and Embase were systematically searched from inception to November 2014 for studies investigating both AD and FA.

RESULTS

Sixty-six studies were identified. Eighteen were population-based, 8 used high-risk cohorts, and the rest comprised patients with either established AD or FA. In population-based studies, the likelihood of food sensitization was up to 6 times higher in patients with AD versus healthy control subjects at 3 months of age (odds ratio, 6.18; 95% CI, 2.94-12.98; P < .001). Other population-based studies reported that up to 53% of subjects with AD were food sensitized, and up to 15% demonstrated signs of FA on challenge. Meanwhile, studies including only patients with established AD have reported food sensitization prevalences up to 66%, with challenge-proven FA prevalences reaching up to 81%. Sixteen studies suggested that FA is associated with a more severe AD phenotype. Six studies indicated that AD of earlier onset or increased persistence is particularly associated with FA. Finally, one study found that AD preceded the development of FA.

CONCLUSIONS

This systematic review confirms a strong and dose-dependent association between AD, food sensitization, and FA. AD of increased severity and chronicity is particularly associated with FA. There is also evidence that AD precedes the development of food sensitization and allergy, in keeping with a causal relationship.

Authors+Show Affiliations

St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom.Department of Children's Allergies, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Division of Asthma, Allergy and Lung Biology, King's College London, London, United Kingdom.Department of Dermatology, East Kent Hospitals University NHS Foundation Trust, Canterbury, United Kingdom.Department of Dermatology, East Kent Hospitals University NHS Foundation Trust, Canterbury, United Kingdom.Department of Children's Allergies, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Division of Asthma, Allergy and Lung Biology, King's College London, London, United Kingdom.Division of Asthma, Allergy and Lung Biology, King's College London, London, United Kingdom.St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom. Electronic address: carsten.flohr@kcl.ac.uk.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

26897122

Citation

Tsakok, Teresa, et al. "Does Atopic Dermatitis Cause Food Allergy? a Systematic Review." The Journal of Allergy and Clinical Immunology, vol. 137, no. 4, 2016, pp. 1071-1078.
Tsakok T, Marrs T, Mohsin M, et al. Does atopic dermatitis cause food allergy? A systematic review. J Allergy Clin Immunol. 2016;137(4):1071-1078.
Tsakok, T., Marrs, T., Mohsin, M., Baron, S., du Toit, G., Till, S., & Flohr, C. (2016). Does atopic dermatitis cause food allergy? A systematic review. The Journal of Allergy and Clinical Immunology, 137(4), pp. 1071-1078. doi:10.1016/j.jaci.2015.10.049.
Tsakok T, et al. Does Atopic Dermatitis Cause Food Allergy? a Systematic Review. J Allergy Clin Immunol. 2016;137(4):1071-1078. PubMed PMID: 26897122.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does atopic dermatitis cause food allergy? A systematic review. AU - Tsakok,Teresa, AU - Marrs,Tom, AU - Mohsin,Mahrose, AU - Baron,Susannah, AU - du Toit,George, AU - Till,Stephen, AU - Flohr,Carsten, Y1 - 2016/02/18/ PY - 2015/01/21/received PY - 2015/09/28/revised PY - 2015/10/27/accepted PY - 2016/2/22/entrez PY - 2016/2/22/pubmed PY - 2016/8/23/medline KW - Atopic dermatitis KW - eczema KW - food allergy KW - food sensitization SP - 1071 EP - 1078 JF - The Journal of allergy and clinical immunology JO - J. Allergy Clin. Immunol. VL - 137 IS - 4 N2 - BACKGROUND: The association between atopic dermatitis (AD) and food allergy (FA) is not fully understood, although a causal relationship has been suggested. This has important implications for prevention and treatment. OBJECTIVE: We aimed to review the association between AD and FA, the effect of FA on AD severity, chronicity, and age of onset, and the temporal relationship between the two. METHODS: Medline and Embase were systematically searched from inception to November 2014 for studies investigating both AD and FA. RESULTS: Sixty-six studies were identified. Eighteen were population-based, 8 used high-risk cohorts, and the rest comprised patients with either established AD or FA. In population-based studies, the likelihood of food sensitization was up to 6 times higher in patients with AD versus healthy control subjects at 3 months of age (odds ratio, 6.18; 95% CI, 2.94-12.98; P < .001). Other population-based studies reported that up to 53% of subjects with AD were food sensitized, and up to 15% demonstrated signs of FA on challenge. Meanwhile, studies including only patients with established AD have reported food sensitization prevalences up to 66%, with challenge-proven FA prevalences reaching up to 81%. Sixteen studies suggested that FA is associated with a more severe AD phenotype. Six studies indicated that AD of earlier onset or increased persistence is particularly associated with FA. Finally, one study found that AD preceded the development of FA. CONCLUSIONS: This systematic review confirms a strong and dose-dependent association between AD, food sensitization, and FA. AD of increased severity and chronicity is particularly associated with FA. There is also evidence that AD precedes the development of food sensitization and allergy, in keeping with a causal relationship. SN - 1097-6825 UR - https://www.unboundmedicine.com/medline/citation/26897122/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0091-6749(15)03165-6 DB - PRIME DP - Unbound Medicine ER -