Advances in the management of food allergy and secondary prevention of atopic dermatitis

Abstract

Summary Infants presenting with atopic dermatitis at an early age are at increased risk of developing multiple food allergy, asthma and nutritional deficiencies. However, unlike established disease, early sensitisation may be prevented or treated effectively. We have evaluated a cohort of 100 infants with atopic symptoms related to cow's milk allergy. The majority of infants showed early onset of symptoms with a diagnosis of cow's milk allergy within 9 months, a second smaller group had later onset of symptoms following weaning. Infants followed a standard elimination diet. Symptomatic infants in the early onset group showed impaired growth with no evidence of catchup growth on a standard elimination diet. We also evaluated a cohort of infants who developed atopic dermatitis during exclusive breast feeding : maternal adherence to a restrictive elimination diet improved symptoms, however, the majority of mothers found the diet difficult and requested a substitute formula at 5 months. When the efficacy of an amino acid-based and protein hydrolysate formula were compared in 73 infants with early development of cow's milk allergy, both groups showed significant improvements in eczema as assessed by SCORAD score. Although the protein hydrolysate formula stabilised growth, only the amino acid-based group achieved catchup growth. Amino acid-based formulas provide an effective, safe treatment for infants with food allergy with the added advantage of promoting growth.