Food Allergy in Dermatology: The Patient With Atopic Dermatitis

Highlights of the NIAID Guidelines

Laura A. Stokowski, RN, MS

March 17, 2011

Dermatology and Food Allergy

Food allergy is an immune-based disease that may be increasing in prevalence in the United States.^[1] Fears about food allergy have become heightened in the general public, although many of these fears are born of myths and misunderstandings about food allergy that occasionally are perpetuated by healthcare professionals.

The National Institute of Allergy and Infectious Diseases (NIAID) recently issued Guidelines for the Diagnosis and Management of Food Allergy in the United States ,^[1] which are a "harmonization of best clinical practices related to food allergy across a wide range of medical specialties." The guidelines address misconceptions surrounding food allergy and attempt to improve the diagnosis and management of this widespread condition. For more information about the NIAID guidelines, see Food Allergy: The Definitive Guide to Clinical Practice .

Patients with suspected food allergy present to many different settings for care depending on the nature and severity of their symptoms. One such setting is the dermatology practice, where the typical nonurgent presentation of a patient with potential food allergy is the infant or child with atopic dermatitis (AD). A skin-based treatment regimen is recommended for most patients with AD,^[2] but parents often wonder whether their child's AD suggests an underlying food allergy that warrants either further testing or dietary restriction.

Atopic Dermatitis

AD (also known as atopic eczema) is a red, scaly, pruritic chronic inflammatory rash that is 2-3 times more prevalent than it was 40 years ago.^[2] This remitting and relapsing disorder also shows predilection for certain body sites: the face, scalp, neck, and extensor surfaces in infants; and the flexural areas (such as the back of the knees and front of elbows) and the hands in children and adults. The skin of affected individuals is often very dry.^[3] AD is managed primarily with topical corticosteroids, emollient therapy, and education about skin care for affected children.

Many children outgrow AD by the time they reach adolescence. In the meantime, however, AD can have a significant impact on the child's quality of life. It is not surprising that parents seek an explanation for their child's AD, hoping that perhaps a quick fix will be offered by food allergen avoidance, or fearing a life-threatening reaction that could be prevented by taking simple precautions.