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The diet in atopic eczema: what and when to recommend
- Silvia Salvatore, Patrizia Marino, Chiara Luini, Serena Arrigo, Anita De Paoli, Luigi Nespoli, Yvan Vandenplas (25 March 2006)
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Silvia Salvatore, Lecturer in Pediatrics Clinica Pediatrica, Università dell'Insubria, Osp. F. Del Ponte, Pzza Biroldi, 21100 Varese, Italy, Patrizia Marino, Chiara Luini, Serena Arrigo, Anita De Paoli, Luigi Nespoli, Yvan Vandenplas
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Atopic eczema is a complex phenomenon in which genetic, environmental and immune factors interplay causing a chronic relapsing skin inflammation. In the review of Brown and Reynolds (1) the authors briefly stated that “food allergy is not commonly an important factor” and “in the small numbers of patients in whom it is important, this is usually obvious to the patient or their carriers”. However some clarification is necessary. The strength of association between IgE-mediated food allergy and atopic dermatitis increases with the increasing severity of the dermatitis (from 12% in the mildest forms to 69% in the most severely affected patients) and the younger age of patients (2). In the last decades an increased number of children are reported to be sensitised to multiple food antigens even during exclusively breast-feeding with allergic manifestations early in life due to an impaired development of oral tolerance. Food hypersensitivity may present a wide spectrum of unspecific clinical manifestations including frequent dismotility (with delayed gastric emptying, gastro-oesophageal reflux, diarrhoea or constipation), severe colics or persistent irritability, rectal bleeding, poor weigh gain, feeding disturbances, napkin rash and eczema (3). No symptoms are pathognomonic of food allergy and no single test is diagnostic (patients with gastrointestinal symptoms but even 10% of food- associated atopic eczema have negative IgE-based tests). Thus diagnosis is often difficult and has to be based on controlled elimination and challenging procedures in expert centres in order to avoid false diagnosis and unnecessary diet. For treatment of food allergies, guidelines worldwide currently recommend exclusion of the causative antigen up to acquisition of tolerance. For the infant who sensitises while breastfed, maternal exclusion of the more relevant antigen is supported. In cow’s milk hypersensitivity, extensive hydrolysed formulas (eHF) or, in those refusing-to-drink or non-responding to eHF, amino acid formulas are recommended. Soy formula may be regarded as an alternative in isolated atopic eczema but should not be considered in enteropathy, preterm babies or in patients younger than 6 months. Goat’s or sheep’s milk should never be proposed (4). Therefore the maintenance of a nutritionally adequate diet is not easy especially in case of compromised absorption or multiple allergies but is crucial for each child and as important as topical treatment. Great advantages in diet intervention derived by manufacturers continuous efforts to offer new formulas with improved hydrolyzation and amino-acid profile, and additional beneficial components such as prebiotics, probiotics, nucleotides, medium and long chain fatty acids, and last but not least decreased cost and better taste. 1. Brown S and Reynolds NJ. Atopic and non-atopic eczema. BMJ 2006;332:584 -588. 2. Hill DK, Hosking CS. Food allergy and atopic dermatitis in infancy: an epidemiologic study. Pediatr Allergy Immunol. 2004;15(5):421-7. 3. Murch S. Clinical manifestations of food allergy: the old and the new. Eur J Gastroenterol Hepatol 2005;17(12):1287-91. 4. Host A, Halken S. Hypoallergenic formulas – when, to whom and how long: after more than 15 years we know the right indication! Allergy 2004: 59 (S78): 45–52 Competing interests: None declared |
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