Diagnostic Elimination Diet Research Articles

Approach to suspected food allergy in atopic dermatitis

The following guideline of the "Arbeitsgruppe Nahrungsmittelallergie der DGAKI" (Task Force on Food Allergy of the German Society of Allergology and Clinical Immunology) and the ADA ("Arzteverband Deutscher Allergologen", Medical Association of German Allergologists) and the GPA (German Society of Pediatric Allergology) summarizes the approach to be taken when food allergy is suspected in patients with atopic dermatitis (neurodermatitis, atopic eczema). The problem is clinically relevant because many patients assume that allergic reactions against foods are responsible for triggering or worsening their eczema. It is important to identify those patients who will benefit from an elimination diet but also 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 history often do not correlate with clinical reactivity. This is particularly true in the case of delayed eczematous skin reactions. 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 eczema-tous skin reactions may develop slowly (i. e. within one or two day), the skin be inspected the day after the provocation test and that a repetitive test 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 to facilitate differentiated diagnostic procedures.

Nutritional Management of Pediatric Food Hypersensitivity

The diagnosis and management of food allergy requires attention to several important dietary issues. Successful exclusion of identified dietary allergens requires extensive education regarding the interpretation of ingredient labels of commercial products and an appreciation for issues of cross-contact in settings such as restaurants and commercial manufacturing. Once a food or food group is eliminated, attention must be focused on potential dietary insufficiencies resulting from these exclusions. These dietary issues are also central to the successful use of diagnostic elimination diets and physician-supervised oral food challenges. This review provides a framework for the dietary management of food hypersensitivity in infants and children both for short-term diagnostic and long-term therapeutic purposes. In addition, approaches for maternal dietary restriction for breastfed infants with food allergy and the introduction of solid foods to atopic infants are reviewed.

Vorgehen bei vermuteter Nahrungsmittelallergie bei atopischer Dermatitis

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.

The hypo-allergic diet

A hypoallergenic diet in a proper sense does not exist. The prescription of a dietary treatment for allergic diseases or intolerance reactions is highly dependent on an exact allergologic diagnosis. An IgE-mediated allergy to food is treated by an elimination diet. In chronic disease, e.g. chronic urticaria or chronic abdominal symptoms, the relevance of specific IgE to food allergens can be proved by a diagnostic elimination diet, which is followed by oral provocation. In children at risk for atopic diseases (one or both parents or siblings with atopic diseases) a preventive diet during the first year of life is recommended. The cornerstones of such a diet are breast feeding during the first six months of life, late introduction of solid food and the avoidance of allergenic proteins such as cow's milk, eggs and fish during the first year of life. In intolerance reaction an additive free diet or a diet with low content of biogenic amines may be recommended. Patients with chronic urticaria or atopic dermatitis may suffer from an intolerance to histamine. A diet with a low content of biogenic amines may improve the condition of these patients.