Atopic Dermatitis and its Relation to Food Allergy

François Graham; Philippe A. Eigenmann

Disclosures

Curr Opin Allergy Clin Immunol. 2020;20(3):305-310. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: To present the most recent evidence on atopic dermatitis and its relation to food allergy.

Recent findings: Atopic dermatitis is a chronic inflammatory disorder of the skin characterized by impaired skin barrier because of multifactorial causes including genetic factors, immune dysregulation, and skin microbiome dysbiosis. Infants with temporary skin barrier disruption and/or persistent atopic dermatitis are particularly at risk of developing food allergy (during the so-called atopic march), with up to half of patients demonstrating positive food-specific IgE and one-third of severe cases of atopic dermatitis having positive symptoms on oral food challenge. A high proportion of children with atopic dermatitis exhibit asymptomatic sensitization to foods, and skin testing to identify potential food triggers is not recommended unless the patient has a history suggestive of food allergy and/or moderate-to-severe atopic dermatitis unresponsive to optimal topical care. Indeed, indiscriminate testing can lead to a high proportion of false-positive tests and harmful dietary evictions. Promising strategies to prevent food allergy in children with atopic dermatitis include early skincare with emollients and treatment with topical steroid, and early introduction of highly allergenic foods.

Summary: Further studies are required to identify risk factors for atopic dermatitis to help prevent the development of food allergy in this high-risk population.

Introduction

Atopic dermatitis is the most frequent inflammatory disorder of the skin in children with an incidence of up to 30% in industrialized countries.[1] It is characterized by relapsing episodes of dry skin and pruritus, with frequent skin infections. It is associated with a high negative impact on the quality of life of patients and caregivers, because of chronic pruritus, lack of sleep and resulting limitations in social activities,[2] as well as substantial loss of productivity at work in adults.[3] The pathophysiology of atopic dermatitis is complex, with a genetic predisposition and contribution of environmental factors. The major risk factors for atopic dermatitis include a familial history of atopic dermatitis and genetic mutations such as in the filaggrin gene.[4] Atopic dermatitis is considered the first step in the 'atopic march,' where there is a chronological progression of allergic conditions to food allergy, allergic rhinitis, and asthma.[5] Thus, atopic dermatitis is frequently associated with environmental and food allergen sensitization, and food challenge proven IgE (immunoglobulin E)-mediated food allergy is present in up to one-third of patients with moderate-to-severe atopic dermatitis.[6] The majority of children with milder atopic dermatitis will outgrow the disease. However, a group of patients with more severe phenotypes may develop lifelong disease with frequent relapses.[7] This review will focus on the most recent evidence on atopic dermatitis and its relation to food allergy.

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