Does the severity of atopic dermatitis change with allergic sensitization? Is it real or a myth?

Main Article Content

Serdar Al
Suna Asilsoy
Özge Atay
Özge Kangallı
Nevin Uzuner


atopic dermatitis, children, food allergy, oral food challenge, severity of atopic dermatitis


Objective: Atopic dermatitis (AD) is a chronic inflammatory skin disease that can occur at any age. This study aimed to evaluate the impact of food allergy on disease severity as well as clinical/laboratory findings in children with AD.

Methods: Clinical and laboratory data of AD patients evaluated for food allergy between January 2021 and December 2022 were examined retrospectively.

Results: Of the 52 patients evaluated, 32 (61.5%) were males, with a median age of 6 months (2–118 months). Among them, 26 (50%) had food allergies (FA) and five (9.6%) had inhalant allergen sensitivity. No significant difference in AD severity was observed between patients with and without FA. However, the FA group showed higher serum lactate dehydrogenase (LDH) levels (343.3 ± 81.5 U/L vs 297.7 ± 77.4 U/L; P = 0.011) and lower red cell distribution width (RDW). Inhalant allergen sensitivity was associated with higher AD severity.

Conclusion: While guidelines recommend investigating food allergies in moderate to severe AD, this study found no significant difference in the relationship between AD severity and the presence of FA. However, inhalant allergen sensitivity was linked to increased AD severity. Therefore, a comprehensive patient history should include an evaluation of food allergies in children with AD, regardless of disease severity. Elimination and provocation tests related to suspected food items should be performed, and allergenic foods should be removed from the diet if they are found to contribute to the allergy.

Abstract 380 | PDF Downloads 476 HTML Downloads 26 XML Downloads 11


1. Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, et al. Guidelines of care for the management of atopic dermatitis: Section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014;70(2):338–51. 10.1016/J.JAAD.2013.10.010

2. Bousquet J, Heinzerling L, Bachert C, Papadopoulos NG, Bousquet PJ, Burney PG, et al. Practical guide to skin prick tests in allergy to aeroallergens. Allergy. 2012;67(1):18–24. 10.1111/j.1398-9995.2011.02728.x

3. Fergusson DM, Horwood LJ. Early solid food diet and eczema in childhood: A 10-year longitudinal study. Pediatr Allergy Immunol. 1994;5(6 Suppl):44–7. 10.1111/J.1399-3038.1994.TB00347.X

4. Savage J, Johns CB. Food allergy: Epidemiology and natural history. Immunol Allergy Clin North Am. 2015;35(1):45–59. 10.1016/J.IAC.2014.09.004

5. Sampson HA. Utility of food-specific IgE concentrations in predicting symptomatic food allergy. J Allergy Clin Immunol. 2001;107(5 Suppl.):891–6.

6. Gupta RS, Springston EE, Warrier MR, Smith B, Kumar R, Pongracic J, et al. The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics. 2011;128(1):e9–17. 10.1542/PEDS.2011-0204

7. 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;137(4):1071–8. 10.1016/J.JACI.2015.10.049

8. Ramírez-Marín HA, Silverberg JI. Differences between pediatric and adult atopic dermatitis. Pediatr Dermatol. 2022;39(3):345–53. 10.1111/PDE.14971

9. Aksu K, Arga M, Asilsoy S, Avcıl S, Çetinkaya F, Civelek E, et al. Diagnosis and management of atopic dermatitis: National Guideline 2018. Asthma Allergy Immunol. 2018;16(2):16-20.

10. Hanifin JM, Rajka G. Diagnostic features of AD. Acta Dermatovener. 1980;Suppl 92:44–7.

11. Atherton DJ, Bieber T, Bonifazi E, Broberg A, Calza A. Severity scoring of atopic dermatitis: The SCORAD Index. Dermatology. 1993;186(1):23–31. 10.1159/000247298

12. Yanagida N, Minoura T, Kitaoka S, Ebisawa M. A three-level stepwise oral food challenge for egg, milk, and wheat allergy. J Allergy Clin Immunol Pract. 2018;6(2):658–60.e10. 10.1016/j.jaip.2017.06.029

13. Renz H, Skevaki C. Early life microbial exposures and allergy risks: Opportunities for prevention. Nat Rev Immunol. 2021;21(3):177–91. 10.1038/s41577-020-00420-y

14. Ng YT, Chew FT. A systematic review and meta-analysis of risk factors associated with atopic dermatitis in Asia. World Allergy Organ J. 2020;13(11):100477. 10.1016/J.WAOJOU.2020.100477

15. Kramer MS, Kakuma R. Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child. Cochrane Database Syst Rev. 2012;2012(9):CD000133. 10.1002/14651858.CD000133.pub3

16. Piippo S, Viljanen M, Savilahti E, Kuitunen M. Allergic symptoms and sensitisation in adolescents with cows’ milk allergy and atopic eczema in infancy. Immunity Inflamm Dis. 2020;8(3):423–433. 10.1002/iid3.324

17. Morishima Y, Kawashima H, Takekuma K, Hoshika A. Changes in serum lactate dehydrogenase activity in children with atopic dermatitis. Pediatr Int. 2010;52(2):171–4. 10.1111/J.1442-200X.2009.02908.X

18. Mastraftsi S, Vrioni G, Bakakis M, Nicolaidou E, Rigopoulos D, Stratigos A, et al. Atopic dermatitis: Striving for reliable biomarkers. J Clin Med. 2022;11(16):4639. 10.3390/JCM11164639

19. Tamagawa-Mineoka R. Biomarkers for atopic dermatitis in children. Pediatr Allergy Immunol Pulmonol. 2016;29(4):164–9. 10.1089/ped.2016.0703

20. Kantor R, Silverberg JI. Environmental risk factors and their role in the management of atopic dermatitis. Expert Rev Clin Immunol. 2017;13(1):15. 10.1080/1744666X.2016.1212660