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

Atopic Dermatitis Associations With Food Allergy

Atopic dermatitis has clearly been shown as a major risk factor for food sensitization and the development of IgE-mediated food allergy.[8,9] Epidemiological studies support the progression of the atopic march from atopic dermatitis to food allergy; skin barrier disruption (assessed by transepidermal water loss) and atopic dermatitis were shown to temporally precede the appearance of food allergy.[17,18] Recently, a Canadian birth cohort (CHILD study) found that sensitization and atopic dermatitis at one year of age was a strong risk factor for food allergy at three years (relative excess risk because of interaction: 15.11 [95% confidence interval, 4.19–35.36]).[18] In addition, neonatal skin barrier dysfunction, even if transient, was associated with food allergy at the age of two.[19,20] A recent systematic review supports that atopic dermatitis with earlier onset is associated with the appearance of food allergy.[9]

Numerous population-based studies have found an association between atopic dermatitis and food allergen sensitization. The likelihood of food sensitization in infants with atopic dermatitis is up to six times higher than healthy controls at the age of three months.[9] In addition, up to 53% of children with atopic dermatitis have demonstrable positive food-specific IgE (sIgE) and/or positive skin prick tests (SPTs) with up to 15% demonstrating signs of food allergy on oral food challenge (OFC),[9] compared with 0.1–6% food allergy prevalence in the general population.[10] One important large population-based study highlighting these findings is the HealthNut study, which showed that one in five Australian infants with atopic dermatitis had a food allergy compared with one in 20 without atopic dermatitis (n = 4453).[11] Patients with atopic dermatitis were six times more likely to have an egg allergy, and 11 times more likely to have peanut allergy.

In interventional studies, rates of food allergy in children with moderate-to-severe atopic dermatitis with food allergy confirmed by double-blind, placebo-controlled food challenges (DBPCFC) or open food challenges generally range from 33 to 38.7%,[12–14] with occasional studies having higher rates up to 81%.[15,16] Thus, confirmed food allergy is more frequent in more severe phenotypes of atopic dermatitis.

Finally, the effect of atopic dermatitis on tolerance acquisition to foods is not clearly understood and complex. Atopic dermatitis was associated with persistent egg allergy in some studies.[21,22] Severity of atopic dermatitis at age of diagnosis was inversely associated with timing of resolution of milk allergy.[23] On the other hand, in one recent study, the presence of atopic dermatitis did not seem to affect the natural history of cow's milk allergy.[24] These discrepancies likely depend on confounding factors including severity of atopic comorbidities, baseline SPT and sIgE levels to foods.

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