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Food Sensitization and Food Allergy in Atopic Dermatitis

Year 2019, Volume: 41 Issue: 4, 405 - 412, 01.10.2019
https://doi.org/10.20515/otd.490646

Abstract

Atopic dermatitis
is the most common chronic inflammatory skin disease of childhood and foods are
among the factors that exacerbate eczema. In this study, we aimed to
investigate the frequency of food sensitization and food allergies in atopic
dermatitis and their association with diseaseseverity. The data of 236 patients
aged between 0 -18 years who were diagnosed as atopic dermatitis between
2015-2018 at our Pediatric Allergy and Immunology Department were
retrospectively examined. The food sensitization was positive in 68 (31%)
patients and the most sensitized foods were egg (20%), cow’s milk (11.8 %) and
peanut (4.5%). A total of 147 oral food challenges were performed on 133
patients and 41 (30.8%) patients were diagnosed as food allergy (36 (27%) milk,
4 (3%) egg, 1 (0.8%) pumpkin seed). 
Patients were divided into two groups according to disease severity as
mild (Group 1) and moderate-severe (Group 2) atopic dermatitis. There were no
differences between the groups in terms of age of onset, gender, parental atopy,
IgE level, eosinophil count and inhalan allergen sensitization. Food
sensitization and food allergy were respectively 20%, 8% in group 1 and 34%,
21% in group 2. Both food sensitization and food allergy were significantly
higher in group 2 (p=0.039, p= 0.041, respectively). Approximately one third of
patients with atopic dermatitis are accompanied by food allergies and
moderate-severe atopic dermatitis comprises higher risk. Food allergy diagnosis
should be confirmed by oral food challenges, which is the gold standard
diagnostic test and unnecessary food eliminations should be avoided.

References

  • 1 Shaw TE, Currie GP, Koudelka CW, Simpson EL. Eczema prevalence in the United States: data from the 2003 National Survey of Children’s Health. J Invest Dermatol. 2011;131:67-73.
  • 2.Cork MJ, Danby SG, Vasilopoulos Y, et al. Epidermal barrier dysfunction in atopic dermatitis. J Invest Dermatol. 2009;129:1892-8.
  • 3. Werfel T, Kapp A. Environmental and other major provocation factors in atopic dermatitis. Allergy. 1998;53:731-9.
  • 4. Breuer K, Kapp A, Werfel T. Bacterial infections and atopic dermatitis. Allergy. 2001;56:1034-41.
  • 5. Breuer K, Kapp A; Werfel T. The impact of food allergy in patients with atopic dermatitis. Hautarzt. 2003;54:121-9.
  • 6. Reekers R, Busche M, Wittmann M, Kapp A, Werfel T. Birch pollen-related foods trigger atopic dermatitis in patients with specific cutaneous T-cell responses to birch pollen antigens. J Allergy Clin Immunol. 1999;104:466-72.
  • 7. Atherton DJ, Sewell M, Soothill JF, Wells RS, Chilvers CE. A double-blind controlled crossover trial of an antigen-avoidance diet in atopic eczema. Lancet. 1978;25:401-3.
  • 8.Sampson HA. Role of immediate food hypersensitivity in the pathogenesis of atopic dermatitis. J Allergy Clin Immunol. 1983;7:473-80.
  • 9. Werfel T, Ballmer-Weber B, Eigenmann PA, et al. Eczematous reactions to food in atopic eczema: position paper of the EAACI and GA2LEN. Allergy. 2007; 62:723-8.
  • 10. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Dermatol Venerol Stockh. 1980;92:44-7.
  • 11. Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology. 1993;18:23-31.
  • 12. Yum HY, Yang HJ, Kim KW, et al. Oral food challenges in children. Korean J Pediatr. 2011;54:6-10.
  • 13. Nowak-Wegrzyn A, Assa'ad AH, Bahna SL, Bock SA, Sicherer SH, Teuber SS. Adverse Reactions to Food Committee of American Academy of Allergy, Asthma &Immunology. Work Group report: oral food challenge testing. J Allergy ClinImmunol. 2009;123:365-83.
  • 14. Eigenmann PA, Sicherer SH, Borkowski TA, Cohen BA, Sampson HA. Prevalence of IgE-mediated food allergy among children with atopic dermatitis. Pediatrics 1998;101:E8.
  • 15. Dharma C, Lefebvre DL, Tran MM, et al. Patterns of allergic sensitization and atopic dermatitis from 1 to 3 years: Effects on allergic diseases. Clin Exp Allergy. 2018;48:48-59.
  • 16.Knox SM, Erwin EA, Mosser-Goldfarb JL, Scherzer R. Sensitization patterns among patients with atopic dermatitis evaluated in a large tertiary care pediatric center. Ann Allergy Asthma Immunol. 2017;118:645-7.
  • 17. de Benedictis FM, Franceschini F, Hill D, et al; EPAAC Study Group. The allergic sensitization in infants with atopic eczema from different countries. Allergy. 2009;64:295-303.
  • 18. Bergmann MM, Caubet JC, Boguniewicz M, Eigenmann PA. Evaluation of food allergy in patients with atopic dermatitis. J.Allergy Clin Immunol: In Practice. 2013;1:22-8.
  • 19. Schäfer T, Heinrich J, Wjst M, Adam H, Ring J, Wichmann HE. Association between severity of atopic eczema and degree of sensitization to aeroallergens in schoolchildren. J Allergy Clin Immunol. 1999;104:1280-4.
  • 20.Wolkerstorfer A, Wahn U, Kjellman NI, Diepgen TL, De Longueville M, Oranje AP. Natural course of sensitization to cow's milk and hen's egg in childhood atopic dermatitis: ETAC study group. Clin Exp Allergy. 2002;32:70-3.
  • 21. Flohr C, Perkin M, Logan K, et al. Atopic dermatitis and disease severity are the main risk factors for food sensitization in exclusively breastfed infants. J Invest Dermatol. 2014;134: 345-50.
  • 22.Böhme M, Svensson A, Kull I, Nordvall SL, Wahlgren CF. Clinical features of atopic dermatitis at two years of age: a prospective, population-based case-control study. Acta Derm Venereol. 2001;81:193-7.
  • 23. Mavroudi A, Karagiannidou A, Xinias I, et al. Assessment of IgE-mediated food allergies in children with atopic dermatitis. Allergol Immunopathol (Madr). 2017;45:77-81.
  • 24. Breuer K, Heratizadeh A, Wulf A,et al. Late eczematous reactions to food in children with atopic dermatitis. Clin Exp Allergy. 2004;34:817-24.
  • 25. Eigenmenn P. A, Calza A. M. Diagnosis of Ig-E mediated food allergy among Swiss children with atopic dermatitis. Pediatr Allergy Immunol. 2000;11:95-100.
  • 26. Sampson HA, Albergo R. Comparison of results of skin tests, RAST, and double-blind, placebo-controlled food challenges in children with atopic dermatitis. J Allergy Clin Immunol. 1984;74:26-33.
  • 27. Strömberg L. Diagnostic accuracy of the atopy patch test and the skin-prick test for the diagnosis of food allergy in young children with atopic eczema/dermatitis syndrome. Acta Paediatr. 2002;91:1044-9.

Atopik Dermatitte Besin Duyarlanması ve Besin Alerjisi

Year 2019, Volume: 41 Issue: 4, 405 - 412, 01.10.2019
https://doi.org/10.20515/otd.490646

Abstract

Atopik dermatit
çocukluk çağının en sık görülen kronik inflamatuar cilt hastalığı olup,
besinler egzemayı alevlendiren faktörler arasında yerini almaktadır. Bu
çalışmada atopik dermatitli hastalarda besin duyarlanması ve besin alerjisi
sıklığını araştırmak ve bunların atopik dermatit şiddeti ile ilişkisinin
incelenmesi amaçlanmıştır. Üniversitemiz Çocuk İmmunolojisi ve Alerji
Hastalıkları Bilim Dalı’nda2015-2018 yılları arasında atopik dermatit tanısı
konulan 0-18 yaş arasındaki 236 hastanın verileri sonuçları retrospektif olarak
incelendi. Besin alerjen duyarlanması68 (%31) hastada pozitif olup duyarlanma
saptanan ilk üç besin sırasıyla yumurta (%20), inek sütü (%11,8) ve yer fıstığı
(%4,5) idi. Yüz otuz üç hastaya toplam 147 besin yükleme testi yapıldı. Besin yükleme
testi ile 36 (%27) hastada inek sütü, 4 (%3) hastada yumurta alerjisi
gösterildi. Kabak çekirdeği ile anafilaksi öyküsü ve deri prik testi
pozitifliği olan 1 (%0,8) hasta ile birlikte toplam 41 (% 30,8) hastada besin
alerjisi tanısı konuldu. Hastalar hastalık şiddetine göre hafif (grup 1) ve
orta-ağır(grup 2) şiddette atopik dermatit olarak iki gruba ayrılarak
karşılaştırıldığında; şikayet başlangıç yaşı, cinsiyet, ailede atopi öyküsü,
IgE düzeyi, eozinofil sayısı ve inhalan alerjen duyarlanması açısından iki grup
arasında fark saptanmadı.
  Besin alerjen
duyarlanması ve besin alerjisi grup 1’de sırasıyla %20, %8; grup 2’de %34, %21
olup, grup 2’de anlamlı olarak yüksek saptandı (sırasıyla p=0.039, p= 0.041).
  Atopik dermatitli hastaların yaklaşık üçte birinde
besin alerjisi eşlik etmektedir. Özellikle orta-ağır atopik dermatitli hastalar
bu açıdan riskli gruptadır. Besin alerjisi tanısı altın standart tanı testi
olan besin yükleme testi ile doğrulanmalı, gereksiz besin eliminasyonundan
kaçınılmalıdır

References

  • 1 Shaw TE, Currie GP, Koudelka CW, Simpson EL. Eczema prevalence in the United States: data from the 2003 National Survey of Children’s Health. J Invest Dermatol. 2011;131:67-73.
  • 2.Cork MJ, Danby SG, Vasilopoulos Y, et al. Epidermal barrier dysfunction in atopic dermatitis. J Invest Dermatol. 2009;129:1892-8.
  • 3. Werfel T, Kapp A. Environmental and other major provocation factors in atopic dermatitis. Allergy. 1998;53:731-9.
  • 4. Breuer K, Kapp A, Werfel T. Bacterial infections and atopic dermatitis. Allergy. 2001;56:1034-41.
  • 5. Breuer K, Kapp A; Werfel T. The impact of food allergy in patients with atopic dermatitis. Hautarzt. 2003;54:121-9.
  • 6. Reekers R, Busche M, Wittmann M, Kapp A, Werfel T. Birch pollen-related foods trigger atopic dermatitis in patients with specific cutaneous T-cell responses to birch pollen antigens. J Allergy Clin Immunol. 1999;104:466-72.
  • 7. Atherton DJ, Sewell M, Soothill JF, Wells RS, Chilvers CE. A double-blind controlled crossover trial of an antigen-avoidance diet in atopic eczema. Lancet. 1978;25:401-3.
  • 8.Sampson HA. Role of immediate food hypersensitivity in the pathogenesis of atopic dermatitis. J Allergy Clin Immunol. 1983;7:473-80.
  • 9. Werfel T, Ballmer-Weber B, Eigenmann PA, et al. Eczematous reactions to food in atopic eczema: position paper of the EAACI and GA2LEN. Allergy. 2007; 62:723-8.
  • 10. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Dermatol Venerol Stockh. 1980;92:44-7.
  • 11. Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology. 1993;18:23-31.
  • 12. Yum HY, Yang HJ, Kim KW, et al. Oral food challenges in children. Korean J Pediatr. 2011;54:6-10.
  • 13. Nowak-Wegrzyn A, Assa'ad AH, Bahna SL, Bock SA, Sicherer SH, Teuber SS. Adverse Reactions to Food Committee of American Academy of Allergy, Asthma &Immunology. Work Group report: oral food challenge testing. J Allergy ClinImmunol. 2009;123:365-83.
  • 14. Eigenmann PA, Sicherer SH, Borkowski TA, Cohen BA, Sampson HA. Prevalence of IgE-mediated food allergy among children with atopic dermatitis. Pediatrics 1998;101:E8.
  • 15. Dharma C, Lefebvre DL, Tran MM, et al. Patterns of allergic sensitization and atopic dermatitis from 1 to 3 years: Effects on allergic diseases. Clin Exp Allergy. 2018;48:48-59.
  • 16.Knox SM, Erwin EA, Mosser-Goldfarb JL, Scherzer R. Sensitization patterns among patients with atopic dermatitis evaluated in a large tertiary care pediatric center. Ann Allergy Asthma Immunol. 2017;118:645-7.
  • 17. de Benedictis FM, Franceschini F, Hill D, et al; EPAAC Study Group. The allergic sensitization in infants with atopic eczema from different countries. Allergy. 2009;64:295-303.
  • 18. Bergmann MM, Caubet JC, Boguniewicz M, Eigenmann PA. Evaluation of food allergy in patients with atopic dermatitis. J.Allergy Clin Immunol: In Practice. 2013;1:22-8.
  • 19. Schäfer T, Heinrich J, Wjst M, Adam H, Ring J, Wichmann HE. Association between severity of atopic eczema and degree of sensitization to aeroallergens in schoolchildren. J Allergy Clin Immunol. 1999;104:1280-4.
  • 20.Wolkerstorfer A, Wahn U, Kjellman NI, Diepgen TL, De Longueville M, Oranje AP. Natural course of sensitization to cow's milk and hen's egg in childhood atopic dermatitis: ETAC study group. Clin Exp Allergy. 2002;32:70-3.
  • 21. Flohr C, Perkin M, Logan K, et al. Atopic dermatitis and disease severity are the main risk factors for food sensitization in exclusively breastfed infants. J Invest Dermatol. 2014;134: 345-50.
  • 22.Böhme M, Svensson A, Kull I, Nordvall SL, Wahlgren CF. Clinical features of atopic dermatitis at two years of age: a prospective, population-based case-control study. Acta Derm Venereol. 2001;81:193-7.
  • 23. Mavroudi A, Karagiannidou A, Xinias I, et al. Assessment of IgE-mediated food allergies in children with atopic dermatitis. Allergol Immunopathol (Madr). 2017;45:77-81.
  • 24. Breuer K, Heratizadeh A, Wulf A,et al. Late eczematous reactions to food in children with atopic dermatitis. Clin Exp Allergy. 2004;34:817-24.
  • 25. Eigenmenn P. A, Calza A. M. Diagnosis of Ig-E mediated food allergy among Swiss children with atopic dermatitis. Pediatr Allergy Immunol. 2000;11:95-100.
  • 26. Sampson HA, Albergo R. Comparison of results of skin tests, RAST, and double-blind, placebo-controlled food challenges in children with atopic dermatitis. J Allergy Clin Immunol. 1984;74:26-33.
  • 27. Strömberg L. Diagnostic accuracy of the atopy patch test and the skin-prick test for the diagnosis of food allergy in young children with atopic eczema/dermatitis syndrome. Acta Paediatr. 2002;91:1044-9.
There are 27 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section ORİJİNAL MAKALE
Authors

Burçin Beken 0000-0001-7677-7690

Velat Çelik 0000-0002-8893-9420

Pınar Gökmirza Özdemir This is me 0000-0002-8155-4210

Necdet Süt This is me 0000-0001-6678-482X

Mehtap Yazıcıoğlu 0000-0001-9197-1344

Publication Date October 1, 2019
Published in Issue Year 2019 Volume: 41 Issue: 4

Cite

Vancouver Beken B, Çelik V, Gökmirza Özdemir P, Süt N, Yazıcıoğlu M. Atopik Dermatitte Besin Duyarlanması ve Besin Alerjisi. Osmangazi Tıp Dergisi. 2019;41(4):405-12.


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