Vorgehen bei vermuteter Nahrungsmittelallergie bei atopischer Dermatitis

Abstract

The following guideline of the Arbeits-gruppe Nahrungsmittelallergie der DGAKI und des ADA (Task Force on Food Allergy of the German Society for Allergology and Clinical Immunology and the Medical Association of German Allergologists) summarizes different procedures, when food allergy is suspected in atopic dermatitis (neurodermatitis, atopic eczema). The problem is clinically relevant because many patients assume allergic reactions against foods being responsible for triggering eczematous reactions or worsening eczema. It is important to identify such patients who indeed benefit from an elimination diet and to avoid unnecessary diets. Elimination diets (especially in early childhood) are associated with the risk of malnutrition and additional emotional stress for the patients. The gold standard for the diagnosis of food-dependent reactions is to perform placebo-controlled, double-blind oral food challenges because specific IgE, prick tests and anamnestic data often do not correlate with clinical reactivity. This is particularly true in the case of delayed eczematous skin reactions. The instrument of diagnostic elimination diets should be used before an oral provocation test. If multiple sensitizations against foods are discovered in a patient, an oligoallergenic diet and a subsequent stepwise supplementation of the nutrition should be performed. If a specific food is suspected of triggering food allergy, oral provocation should be performed after a diagnostic elimination diet. As eczematous skin reactions may develop slowly (i.e., within one or two days), we recommend that the skin is inspected the day after the provocation test and that a repetitive test should be performed if the patient has not reacted to a given food on the first day of oral provocation. The guideline discusses various clinical situations for patients with atopic dermatitis, allowing for differentiated diagnostic procedures.