The prevalence of sensitization to food allergens in children with atopic dermatitis
Main Article Content
aeroallergen, atopic dermatitis, food allergy, SCORAD, skin prick test
Introduction: Atopic dermatitis (AD) has a complex pathophysiology. The course of the disease is affected by both environmental factors and allergen hypersensitivities. Food and aeroallergens have a significant role in the pathogenesis and disease control.
Objective: In this study, it was aimed to determine the prevalence of food and aeroallergen sensitivity of children with AD.
Methods: Children under 18 years with AD who applied to pediatric allergy and immunology outpatient clinics were evaluated. All patients had a skin prick test (SPT) within most common food and aeroallergens.
Results: One hundred seventy three patients were studied. Most of the moderate and severe AD patients were boys (boys 64% vs. girls 47%). Symptoms started earlier and positive results in SPTs with food allergens were more common in patients with SCORAD (SCORing Atopic Dermatitis) >25 (p < 0.0001). Egg white (39%), egg yolk (31%), cow’s milk (13%) and wheat flour (5%), were the most common allergens, respectively. The SCORAD scores were higher in multiple food sensitized patients’ groups (p < 0.001). Although, food sensitizations were prevalent in patients who had higher SCORAD scores (p = 0.001), there was no significant difference in sensitization with aeroallergens. (p = 0.392).
Conclusion: Sensitizations to both food and aeroallergens are common in patients with AD. In addition, sensitization to these allergens and SCORAD severity in patients with AD have positive correlation.
2. Mortz CG, du Toit G, Beyer K, Bindslev-Jensen C, Brockow K, Brough HA, et al. When and how to evaluate for immediate type food allergy in children with atopic dermatitis. Allergy. 2021;76(12):3845–3848. 10.1111/all.14982
3. Domínguez O, Plaza AM, Alvaro M. Relationship between atopic dermatitis and food allergy. Curr Pediatr Rev. 2020;16(2):115–122. 10.2174/1573396315666191111122436
4. Langan SM, Irvine AD, Weidinger S. Atopic dermatitis. Lancet. 2020;396(10247):345–360. 10.1016/S0140-6736(20)31286-1
5. Warren CM, Jiang J, Gupta RS. Epidemiology and burden of food allergy. Curr Allergy Asthma Rep. 2020 Feb 14;20(2):6. 10.1007/s11882-020-0898-7
6. Hadi HA, Tarmizi AI, Khalid KA, Gajdács M, Aslam A, Jamshed S. The epidemiology and global burden of atopic dermatitis: a narrative review. Life (Basel). 2021 Sep 9;11(9):936. 10.3390/life11090936
7. Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Beyer K, Bindslev-Jensen C, et al. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy. 2014;69(8):1008–1025. 10.1111/all.12429
8. Eigenmann PA, Sicherer SH, Borkowski TA, Cohen BA, Sampson HA. Prevalence of IgE-mediated food allergy among children with atopic dermatitis. Pediatrics. 1998;101(3):E8. 10.1542/peds.101.3.e8
9. Eller E, Kjaer HF, Host A, Andersen KE, Bindslev-Jensen C. Food allergy and food sensitization in early childhood: results from the DARC cohort. Allergy. 2009;64(7):1023–1029. 10.1111/j.1398-9995.2009.01952.x
10. Leung DYM, Berdyshev E, Goleva E. Cutaneous barrier dysfunction in allergic diseases. J Allergy Clin Immunol. 2020;145:1485–1497. 10.1016/j.jaci.2020.02.021
11. Özdoğru EE, Gönülal M. Atopic dermatitis, inhalant allergy and food allergy: a paediatric approach. Dermatol Ther. 2021;34(1):e14542. 10.1111/dth.14542
12. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venereol Suppl (Stockh). 1980;92:44–47. 10.2340/00015555924447
13. Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology. 1993;186(1):23–31. 10.1159/000247298
14. Heinzerling L, Mari A, Bergmann KC, Bresciani M, Burbach G, Darsow U, et al. The skin prick test–European standards. Clin Transl Allergy. 2013 Feb 1;3(1):3. 10.1186/2045-7022-3-3
15. Cartledge N, Chan S. Atopic dermatitis and food allergy: a paediatric approach. Curr Pediatr Rev. 2018;14(3):171–179. 10.2174/1573396314666180613083616
16. Tsakok T, Marrs T, Mohsin M, Baron S, du Toit G, Till S, et al. Does atopic dermatitis cause food allergy? A systematic review. J Allergy Clin Immunol. 2016 Apr;137(4):1071–1078. 10.1016/j.jaci.2015.10.049
17. Flohr C, Johansson SG, Wahlgren CF, Williams H. How atopic is atopic dermatitis? J Allergy Clin Immunol. 2004 Jul;114(1):150–158. 10.1016/j.jaci.2004.04.027
18. Graham F, Eigenmann PA. Atopic dermatitis and its relation to food allergy. Curr Opin Allergy Clin Immunol. 2020 Jun;20(3):305–310. 10.1097/ACI.0000000000000638
19. Eigenmann PA, Calza AM. Diagnosis of IgE-mediated food allergy among Swiss children with atopic dermatitis. Pediatr Allergy Immunol. 2000 May;11(2):95–100. 10.1034/j.1399-3038.2000.00071.x
20. Sampson HA, McCaskill CC. Food hypersensitivity and atopic dermatitis: evaluation of 113 patients. J Pediatr. 1985 Nov;107(5):669–675. 10.1016/S0022-3476(85)80390-5
21. Werfel T, Ballmer-Weber B, Eigenmann PA, Niggemann B, Rancé F, Turjanmaa K, et al. Eczematous reactions to food in atopic eczema: position paper of the EAACI and GA2LEN. Allergy. 2007 Jul;62(7):723–728. 10.1111/j.1398-9995.2007.01429.x
22. Katta R, Schlichte M. Diet and dermatitis: food triggers. J Clin Aesthet Dermatol. 2014;7:30–36.
23. Spergel JM. From atopic dermatitis to asthma: the atopic march. Ann Allergy Asthma Immunol. 2010;105(2):99–117. 10.1016/j.anai.2009.10.002
24. Roduit C, Frei R, Depner M, Karvonen AM, Renz H, Braun-Fahrländer C, et al. Phenotypes of atopic dermatitis depending on the timing of onset and progression in childhood. JAMA Pediatr. 2017 Jul 1;171(7):655–662. 10.1001/jamapediatrics.2017.0556
25. Flohr C, Perkin M, Logan K, Marrs T, Radulovic S, Campbell LE, et al. Atopic dermatitis and disease severity are the main risk factors for food sensitization in exclusively breastfed infants. J Invest Dermatol. 2014 Feb;134(2):345–350. 10.1038/jid.2013.298
26. Martin PE, Eckert JK, Koplin JJ, Lowe AJ, Gurrin LC, Dharmage SC, et al. Which infants with eczema are at risk of food allergy? Results from a population-based cohort. Clin Exp Allergy. 2015 Jan 45(1):255–264. 10.1111/cea.12406
27. Seo E, Yoon J, Jung S, Lee J, Lee BH, Yu J. Phenotypes of atopic dermatitis identified by cluster analysis in early childhood. J Dermatol. 2019 Feb;46(2):117–123. 10.1111/1346-8138.14714
28. Savage JH, Kaeding AJ, Matsui EC, Wood RA. The natural history of soy allergy. J Allergy Clin Immunol. 2010 Mar;125(3):683–686. 10.1016/j.jaci.2009.12.994
29. Jarmila C, Květuše E, Karel E, Jaroslava V, Josef B. Soy allergy in patients suffering from atopic dermatitis. Indian J Dermatol. 2013;58(4):325. 10.4103/0019-5154.113938
30. Akdis CA, Akdis M, Bieber T, Bindslev-Jensen C, Boguniewicz M, Eigenmann P, et al. Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report. Allergy. 2006 Aug;61(8):969–987. 10.1111/j.1398-9995.2006.01153.x