Atopic Dermatitis and Food Allergy: Best Practices and Knowledge Gaps—A Work Group Report from the AAAAI Allergic Skin Diseases Committee and Leadership Institute Project

Dietary Triggers for Atopic Dermatitis in Children

“…2 The prevalence of food allergies in children, though admittedly fraught with methodological difficulties, is estimated to have more than doubled from 3.4% in 1999 to 7.6% in 2018. 3 As expected, prevalence rates were higher among children with other atopic comorbidities including AD, with up to 50% of children with AD demonstrating convincing food allergy. 4 It is easy to imagine a patient conflating these 2 entities and mistaking their correlation for causation.…”

“…Although it is possible that an IgE-mediated reaction could trigger an AD flare-perhaps simply by causing pruritus, which could initiate the itchscratch cycle-because of the near simultaneity with ingestion of the offending food and the often dramatic clinical presentations, such foods clearly do not represent "hidden" triggers for AD flares. 3 The concept of food-triggered AD (FTAD) is crucial for thinking about foods that could result in true eczematous flares, which historically have been classified as early-type (<2 hours after food challenge) and latetype (≥2 hours after food challenge) reactions. 13,14 A study of more than 1000 DBPCFCs performed in patients with AD was illustrative.…”

“…Historically, elimination diets often were recommended empirically, though more recent studies, meta-analyses, and guidance documents increasingly have recommended against them. 3 In particular, there are major concerns for iatrogenic harm.…”

Atopic dermatitisReview of comorbidities and therapeutics

“…Data reveal a link between AD and food allergy prevalence. [8][9][10] Interestingly, there have been multiple recent studies revealing that elimination diets in pediatric patients with AD may actually increase immediate symptoms of food allergies. In patients with AD, reintroduction of eliminated foods may lead to immediate food allergy symptoms in 13% to 20% of patients, [11][12][13] with up to 30% of these children developing anaphylaxis on re-exposure.…”

Claudin-1 Mediated Tight Junction Dysfunction as a Contributor to Atopic March

“…One recent study showed that 36.9% of children with severe AD developed asthma later on in their life (2), whereas the prevalence of AA in the general population was approximately 7.9% (14). Similarly, the incidence of FA was 40% in patients with AD (15), compared with a rate of 10% in the general population (16). Severe AD onset or a high serum level of IgE may predispose to atopic march development (17).…”