Effective therapy of childhood atopic dermatitis allays food allergy concerns

Abstract

Roughly one third of children with atopic dermatitis (AD) have IgE-mediated food allergy. Most parents and pediatricians assume foods also cause the eczema, a focus that diverts proper skin therapy and has negative outcomes including nutritional deficiency, costly referrals, and unnecessary testing. This project investigates the relationship between food allergy and AD, both before and after treatment in an established AD population. During an open trial of topical tacrolimus we observed a decrease in parental food allergy concern during good control of their child's eczema. We tested this observation by follow-up interviews and a questionnaire study to compare parental estimates of food allergy concerns after therapy with concerns before beginning the trial. Study subjects were children 11 years old and younger with AD and suspicion of food allergy. AD and food allergy parameters, pre- and post-treatment, were retrospectively assessed by a questionnaire given to the parents. Twenty-three patients were enrolled: 16 had positive food allergy tests (7 RAST and/or 10 skin prick tests) and 30% had a definite history of immediate IgE reactions to foods. Ninety-five percent of parents felt that food allergy exacerbated their child's AD. Treatment durations were 3 to 45 months. Parental concern of food allergy decreased significantly from 7.7 to 4.0 on a 10 point scale (P < .001). Additionally, estimated food reactions decreased by approximately 80% during 1- and 6-month periods (P = .001). In this selected university-based childhood AD population, nearly all parents were convinced their child had food allergy and further that the food contributed to the AD. The level of concern about food reactions was significantly decreased and the number of food reactions declined during effective topical therapy. This preliminary assessment of parental perceptions suggests that successful, stable therapy of AD reduces perceived food reactions and allays parental concerns about food allergy. Such therapy may encourage parents to refocus on direct skin care as the primary effort in AD therapy. We conclude that the effect of successful AD treatment on food allergy and food allergy concern are of interest and worthy of further study.