Abstract
Parameters for identifying eczematous children who could respond to an elimination diet are needed. In children with food allergy, duodenal IgE-containing cells are enhanced. To determine the presence of duodenal mucosal IgE-positive cells in atopic dermatitis and to determine whether duodenal IgE-positive cells may identify eczematous children who will benefit from an elimination diet. Thirty-one children with severe eczema underwent gastrointestinal endoscopy because of gastrointestinal symptoms and were treated with an elimination diet. A clinical score to skin lesions was given before and after diet. All subjects were skin-prick tested with food antigens and aeroallergens. Serum IgE levels were measured. Duodenal IgE-positive cells were investigated in 18 control subjects and in all eczematous children before diet. The number of duodenal IgE-positive cells in children with atopic dermatitis was significantly increased compared with that of control group (P < 0.001). Nineteen (61%) eczematous children improved on a few food diet. Diet-responsive children had significantly higher IgE-positive cells compared with both nondiet-responsive and controls. Positive predictive accuracy of duodenal IgE-positive cells was poor, whereas negative predictive accuracy was high at the cutoff level of 50 IgE-positive cells/10 visual fields. Diagnostic accuracy both of SPT reactions with foods and of food-specific serum IgE antibodies was poor. An intestinal IgE-mediated reaction occurred in children with severe atopic dermatitis who underwent intestinal endoscopy because of gastrointestinal symptoms. In these eczematous children, the number of IgE-positive cells in the duodenal mucosa might be helpful for excluding a positive response to the elimination diet.
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