Eczematous reactions to food in atopic eczema: position paper of the EAACI and GA²LEN

Abstract

Food allergy and atopic eczema (AE) may occur in the same patient. Besides typical immediate types of allergic reactions (i.e. noneczematous reactions) which are observed in patients suffering from AE, it is clear that foods, such as cow's milk and hen's eggs, can directly provoke flares of AE, particularly in sensitized infants. In general, inhaled allergens and pollen-related foods are of greater importance in older children, adolescents and adults. Clinical studies have revealed that more than 50% of affected children with AE that can be exacerbated by certain foods will react with a worsening of skin eczema either alone or in addition to immediate symptoms. Adolescents and adults may also react to foods, but reactions to 'classical' food allergens, such as hen's eggs and cow's milk, are not as common as in childhood. Some patients with AE do react to pollen-associated foods. Food-induced eczema should not be neglected by the allergologist: On the one hand, food can be a relevant trigger factor of persistent moderate-to-severe AE; on the other hand, unnecessary diets which are not based on a proper diagnosis may lead to malnutrition and additional psychological stress on patients suffering from AE. Eczematous reactions to food can only be diagnosed by a thorough diagnostic procedure, taking into account the patient's history, the degree of sensitization and the clinical relevance of the sensitization. The latter has often to be proven by oral food challenges. Upon oral food challenge it is most important to evaluate the status of the skin with an established score (e.g. SCORAD, EASI) after 24 h and later because otherwise worsening of eczema will be missed.

Food allergy and food sensitization in early childhood: results from the DARC cohort

“…Monosymptomatic, late-phase eczematous reactions after food ingestions are rare (32,33). The combination of early, non-eczematous reactions (urticaria, pruritus, and oral allergy syndrome) followed by late-phase flares of eczema is presumably more common; however, the challenge-regimen with massive loading of allergen could prevent this as challenges will be terminated after the initial symptoms.…”

Response of Specific Immunoglobulin E to Foods in Children with Atopic Dermatitis

“…Some authors consider the worsening in the intensity of the eczema as a significant factor that must be evaluated by intensity scores. Therefore, the confirmation of the difference of at least ten points in the SCORAD is considered a positive reaction (Werfel et al 2007), a value obtained in one patient after the process with egg white was triggered.…”

“…Antihistamines were suspended 10 days before the test. In the event of sensitization to both foods, the challenge was performed on separate days with a 2-week gap (Werfel et al 2007). All patients were followed up for 24 h after the end of provocation, and after 1 and 3 weeks, they were re-evaluated and the intensity of itch and eczema was measured by the SCORAD.…”

Besinlerle Yapılan Atopi Yama Testinin SCORAD İle İlişkisi

“…Besinler AD'de tetik çekici faktör olarak yıllardır tartışılmakta ve atopik dermatitli (AD) birçok hastaya ilaveten hastaların ebeveynleri, çocuklarının besinlere karşı allerjisinin olduğunu düşünmektedir 1 . Besinlerin neden olduğu hızlı gelişen semptomlar (çabuk tip reaksiyonlar) iyi bir anamnez, deri testleri ve/veya spesifik IgE (sIgE) düzey ölçümleriyle doğrulanabilirken, AD'de geç ortaya çıkan lezyonlar için tanı koymak oldukça zordur.…”