Challenge of food allergy testing and avoidance in children with atopic dermatitis

2021 ◽  
Vol 14 (6) ◽  
pp. e243141
Author(s):  
Stephanie Ann Kubala ◽  
Paula Mariam Mohyi ◽  
Kristin Sokol ◽  
Pamela Frischmeyer-Guerrerio

Atopic dermatitis (AD) is a common presenting complaint by children and their caretakers to their primary care providers. On testing, children with AD frequently exhibit positive food-specific IgE levels in the absence of immediate allergic reactions. Misinterpretation of these false positive tests can lead to unnecessary food avoidance, which can have tremendous psychosocial, economic and nutritional consequences and, in some cases, facilitate the development of an immediate hypersensitivity to the food. We present a child with persistent AD who underwent broad testing that led to unnecessary food avoidance resulting in Vitamin D deficiency, growth failure and the development of an IgE-mediated food allergy. This case underscores the need for caution by primary care clinicians in using food avoidance diets as a treatment for AD and the importance of limiting allergy testing to foods only when the clinical history indicates an immediate hypersensitivity reaction.

2018 ◽  
Vol 121 (6) ◽  
pp. 668-672 ◽  
Author(s):  
David E. Tapke ◽  
Rebecca Scherzer ◽  
Mitchell H. Grayson

2020 ◽  
Vol 33 (4) ◽  
pp. 626-635
Author(s):  
Patrick Fleming ◽  
Yue Bo Yang ◽  
Charles Lynde ◽  
Braden O'Neill ◽  
Kyle O. Lee

2020 ◽  
Vol 2 (1) ◽  
pp. 35-38
Author(s):  
Tina Banzon ◽  
Donald Y.M. Leung ◽  
Lynda C. Schneider

Atopic dermatitis (AD), characterized by intense pruritus, eczematous lesions, and a relapsing disease course, is a chronic inflammatory skin disease that affects both children and adults. AD often begins in infancy and is associated with atopic diseases in the personal or family history.1 Environmental factors may trigger AD by affecting the skin barrier and by triggering inflammation. The elicitation of T-helper type 2 cytokines further impairs the epidermal barrier and leads to the penetration of irritants and allergens into the epidermis and thereby perpetuating inflammation. The presence of AD and its severity has been shown to positively correlate with risk of developing food allergy (FA). Children with AD are estimated to be six times more likely to develop FA compared with their healthy peers. It has been reported that nearly 40% of children with moderate-to-severe AD have immunoglobulin E (IgE) mediated FA compared with only 6% in the general population. Although analysis of experimental data has linked skin inflammation in AD to FA, with food challenges reproducing symptoms and avoidance diets improving AD, elimination diets are not known to cure AD and may have unfavorable consequences, such as loss of tolerance, which leads to immediate-type allergy, including anaphylaxis, nutritional deficiencies, growth failure, and reduction of quality of life for the patient and family. Exacerbation of AD can be inaccurately attributed to foods. Individuals with AD are often sensitized to foods with positive testing results, however, able to tolerate the food. In light of widespread ordering and commercial availability of serum specific IgE for FA, testing for FA is recommended only if, from a detailed clinical history, immediate-type allergic symptoms occur with ingestion of food, or in infants with AD who do not improve with optimal skin care.


Author(s):  
Trevor K. Young ◽  
Alexander F. Glick ◽  
H. Shonna Yin ◽  
Avani M. Kolla ◽  
Jessica J. Velazquez ◽  
...  

2017 ◽  
Vol 34 (4) ◽  
pp. 402-407 ◽  
Author(s):  
Maria E. Miyar ◽  
Megan Brown ◽  
Karina L. Vivar ◽  
Kimberly Jablon ◽  
Christy Boscardin ◽  
...  

PEDIATRICS ◽  
2015 ◽  
Vol 136 (3) ◽  
pp. 554-565 ◽  
Author(s):  
L. F. Eichenfield ◽  
M. Boguniewicz ◽  
E. L. Simpson ◽  
J. J. Russell ◽  
J. K. Block ◽  
...  

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