Evaluation of the frequency of food allergy and disease severity in patients with atopic dermatitis

Abstract

Purpose Atopic dermatitis is the most common chronic inflammatory skin disease in childhood. Aim of this study is to investigate the effects of food allergy and other factors on severity of atopic dermatitis. Materials and methods Clinical, demographic characteristics and laboratory values of 130 patients with atopic dermatitis (AD) were evaluated. The patients were grouped according to disease severity as “mild” and “moderate/severe”. Food sensitivity was evaluated with skin test and specific-IgE levels. Food allergy was diagnosed with oral food challenge. Results Mean age was 20.9±16.3(2-70) months, 54.6% were male. The onset age of complaints was 5.7±5(0.5-34) months. According to the severity of AD, 37% of patients were mild, 37% moderate, and 26% severe. While 65.4% of patients had food and 13.8% mite sensitivity, food allergy was detected in 38.5%. Responsible foods were eggs (62%), cow's milk-eggs (22%), cow's milk (12%) and hazelnut (4%). Patients with food allergy were younger (p<0.01), had a higher rate of onset before 6 months of age (p=0.03), higher total IgE (p=0.04) and lower vitamin D levels (p=0.03). In moderate/severe AD, rates of symptoms in first 6 months and during exclusive breastfeeding (p=0.021, p=0.01, respectively), rates of atopy and food allergy (p=0.048, p<0.001, respectively), and total IgE levels (p<0.01) were higher than mild patients. Conclusion It should be taken into account that symptoms in moderate/severe AD often develop in early infancy, food allergy accompanies more frequently and total IgE is higher, and unnecessary diets should be avoided in mild AD patients without food allergy.

Keywords

• atopic dermatitis
• disease severity
• food allergy

Atopik dermatitli hastalarda besin alerjisi sıklığının ve hastalık şiddetinin değerlendirilmesi

Abstract

Amaç: Atopik dermatit çocukluk çağının en sık görülen kronik enflamatuar deri hastalığıdır. Bu çalışmanın amacı atopik dermatitli çocuklarda besin alerjisi varlığının ve diğer faktörlerin atopik dermatit şiddeti üzerine etkisinin araştırılmasıdır.
Gereç ve yöntem: Çalışmada atopik dermatitli 130 hasta retrospektif olarak değerlendirildi; klinik, demografik özellikleri ve laboratuvar değerleri kaydedildi. Sonuçların karşılaştırılmasında hastalar, atopik dermatit şiddetine göre ‘hafif’ ve ‘orta veya ağır’ şiddette olmak üzere iki grupta değerlendirildi. Besin duyarlılığı varlığı deri prik testi ve besin spesifik IgE testi ile değerlendirildi. Besin alerjisi tanısı ise açık besin yükleme testi ile kondu.
Bulgular: Hastaların yaş ortalaması 20,9±16,3 (2-70) aydı, %54,6 (n=71)’si erkekti. Şikayet başlangıç zamanı 5,7±5 (0,5-34) aydı. Atopik dermatit şiddetine göre hastaların %37’si hafif, %37'si orta, %26'sı ağır idi. Hastaların %65,4’ünde besin, %13,8'inde akar duyarlılığı mevcuttu; %38,5 hastada besin alerjisi saptandı. Klinik ile ilişkili sorumlu besinler %62 yumurta, %22 inek sütü ve yumurta, %12 sadece inek sütü, %4 fındıktı. Besin alerjisi olan hastaların olmayanlara göre yaş ortalaması daha küçük (p<0,01), total IgE düzeyi daha yüksek (p=0,04), D vitamini düzeyleri daha düşük (p=0,03), şikayetlerin 6 aylıktan önce başlama oranı daha yüksekti (p=0,03). Orta/ağır atopik dermatitli hastalarda semptomların ilk 6 ayda ve sadece anne sütü ile beslenirken görülme oranları (sırasıyla, p=0,02 ve p=0,01), atopi ve besin alerjisi oranları (sırasıyla, p=0,04 ve p<0,001) ve Total IgE düzeyleri (p<0,01) hafif hastalardan daha yüksekti.
Sonuç: Orta/ağır şiddette atopik dermatitli çocuklarda semptomların sıklıkla erken süt çocukluğu döneminde geliştiği, besin alerjisinin daha sık eşlik ettiği ve Total IgE’nin daha yüksek olduğu göz önünde bulundurulmalı, hafif ve besin alerjisinin eşlik etmediği atopik dermatitli hastalarda gereksiz eliminasyon diyetinden kaçınılmalıdır.

Keywords

• atopik dermatit
• hastalık şiddeti
• besin alerjisi

References

1. Referans1. Leung AKC, Hon KLE, Robson WLM. Atopic dermatitis. Adv Pediatr 2007;54:241-273. https://doi.org/10.1016/j.yapd.2007.03.013
2. Referans2. Williams HC. Clinical practice. Atopic dermatitis. N Engl J Med 2005;352:2314-2324. https://doi.org/10.1056/NEJMcp042803
3. Referans3. Kay J, Gawkrodger DJ, Mortimer MJ, Jaron AG. The prevalance of childhood atopic eczema in general population. J Am Acad Dermatol 1994;30:35-39. https://doi.org/10.1016/s0190-9622(94)70004-4
4. Referans4. Cork MJ, Danby SG, Vasilopoulos Y, et al. Epidermal barrier disfunction in atopic dermatitis. J Invest Dermatol 2009;129:1892-1908. https://doi.org/10.1038 /jid.2009. 133
5. Referans5. Sapan N. Atopik dermatit. In: Şekerel BE, ed. Çocukluk çağında alerji astım immünoloji , İstanbul: Ada Basın Yayın, 2015;541-548.
6. Referans6. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venereol (Stockh) 1980;92:44-47.
7. Referans7. Untersmayr E, Jensen Jarolim E. The effect of gastric digestion on food allergy. Curr Opin Allergy Clin Immunol 2006;6:214-219. https://doi.org/10.1097/01.all.0000225163.06016.93
8. Referans8. Peroni DG, Piacentini GL, Bodini A, Rigotti E, Pigozzi E, Boner AL. Prevalence and risk factors for atopic dermatitis in preschool children. Br J Dermatol 2008;158:539-543. https://doi.org/10.1111/j.1365-2133.2007.08344.x

9. Referans9. Schneider L, Tilles S, Lio P, et al. Atopic dermatitis: a practice parameter update 2012. J Allergy Clin Immunol 2013;131:295-299. https://doi.org/10.1016/j.jaci.2012.12.672
10. Referans10. Sicherer SH, Sampson HA. Food hypersensitivity and atopic dermatitis: pathophysiology, epidemiology, diagnosis, and management. J Allergy Clin Immunol 1999;104:114-122. https://doi.org/10.1016/s0091-6749(99)70053-9
11. Referans11. Harmancı K. Atopik dermatit tanı ve tedavisine yaklaşım: Ulusal rehber 2018 ve ürtiker tanı ve tedavisi güncel durum raporu. Astım Allerji İmmünoloji 2018;16:1-95. https://doi:10.21911/aai.2018.2
12. Referans12. Eigenmann PA, Sicherer SH, Borkowski TA, Cohen BA, Sampson HA. Prevalence of IgE mediated food allergy among children with atopic dermatitis. Pediatrics 1998;101:E8. https://doi.org/10.1542/peds.101.3.e8
13. Referans13. Severity scoring of atopic dermatitis: the SCORAD index. Consensus report of the European task force on atopic dermatitis. Dermatology 1993;186:23-31. https://doi.org/10.1159/000247298
14. Referans14. Holick MF, Binkley NC, Bischoff Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2011;96:1911-1930. https://doi.org/10.1210/jc.2011-0385
15. Referans15.Bindslev Jensen C, Ballmer Weber BK, Bengtsson U, et al. Standardization of food challenges in patients with immediate reactions to foods position paper from the European Academy of Allergology and Clinical Immunology. Allergy 2004:59:690-697. https://doi.org/10.1111/j.1398-9995.2004.00466.x
16. Referans16.Vandenplas Y, Koletzko S, Isolauri E, et al. Guidelines for the diagnosis and management of cow’s milk protein allergy in infants. Arch Dis Child 2007;92:902-908. https://doi.org/10.1136/adc.2006.110999
17. Referans17.Sampson HA, Gerth van Wijk R, Bindslev Jensen C, et al. Standardizing double-blind, placebo controlled oral food challenges: American Academy of Allergy, Asthma & Immunology-European Academy of Allergy and Clinical Immunology PRACTALL consensus report. J Allergy Clin Immunol 2012;130:1260-1274. https://doi.org/10.1016/j.jaci.2012.10.017
18. Referans18.Bieber T. Atopic dermatitis. N Engl J Med 2008;358:1483-1494. https://doi.org/10.1056/NEJMra074081
19. Referans19. Boguniewicz M, Leung DYM. Atopic dermatitis. In:Adkinson NF, Holgate ST, Bochner BS, Lemanske RF, Buse W, Simons FE, eds. Middleton’s allergy principles and practice. 7th ed. China:Elsevier, 2009;1083-1103.
20. Referans20.Roos TC, Geuer S, Roos S, Brost H. Recent advances in treatment strategies for atopic dermatitis. Drugs 2004;64:2639-2666. https://doi.org/10.2165/00003495-200464230-00003
21. Referans21. Ricci G, Patrizzi A, Baldi E, Menna G, Tabanelli M, Masi M. Long term follow up of atopic dermatitis: retrospective analysis of related risk factors and association with concomitant allergic diseases. J Am Acad Dermatol 2006;55:765-771. https://doi.org/10.1016/j.jaad.2006.04.064
22. Referans22. Ekback M, Tedner M, Devenney I, et al. Severe eczema in ınfancy can predict asthma development a prospective study to the age of 10 years. PLoS One 2014;9(6):e99609. https://doi.org/10.1371/journal.pone.0099609
23. Referans23. Akdis CA, Akdis M, Bieber T, et al. Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/ PRACTALL Consensus Report. J Allergy Clin Immunol 2006;118:152-169. https://doi.org/ 10.1016/j.jaci.2006.03.045
24. Referans24. Tsakok T, Marss T, Mohsin M, et al. Does atopic dermatitis cause food allergy? A systematic review. J Allergy Clin Immunol 2016;137:1071-1078. https://doi.org/10.1016/j.jaci.2015.10.049 Referans25. Eller E, Kjaer HF, Host A, Andersen KE, Bindslev Jensen C. Food allergy and food sensitization in early childhood: results from the DARC cohort. Allergy 2009;64:1023-1029. https://doi.org/10.1111/j.1398-9995.2009.01952.x
25. Referans26. Hill DJ, Heine RG, Hosking CS, et al. IgE food sensitization in infants with eczema attending a dermatology department. J Pediatr 2007;151:359-363. https://doi.org/10.1016/j.jpeds.2007.04.070 Referans27.Dibek Mısırlıoglu E, Güngör Ş, Nacaroğlu HT, et al. An evaluation of characteristics and concomitant allergic diseases in children with atopic dermatitis. Asthma Allergy Immunol 2014;12:97-103.
26. Referans28. Eigenmann PA, Calza AM. Diagnosis of IgE-mediated food allergy among Swiss children with atopic dermatitis. Pediatr Allergy Immunol 2000;11:95-100. https://doi.org/10.1034/j.1399-3038.2000.00071.x
27. Referans29. Sampson HA. The immunopathogenic role of food hypersensitivity in atopic dermatitis. Acta Derm Venereol Suppl (Stockh) 1992;176:34-37.
28. Referans30. Niggemann B, Sielaff B, Beyer K, Binder C, Wahn U. Outcome of double-blind, placebo-controlled food challenge tests in 107 children with atopic dermatitis. Clin Exp Allergy 1999;29:91-96. https://doi.org/10.1046/j.1365-2222.1999.00454.x
29. Referans31. Breuer K, Heratizadeh A, Wulf A, et al. Late eczematous reactions to food in children with atopic dermatitis. Clin Exp Allergy 2004;34:817-824. https://doi.org/10.1111/j.1365-2222.2004.1953.x
30. Referans32. Boyce JA, Assa'ad A, Burks AW, et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID sponsored expert panel. J Allergy Clin Immunol 2010;126:1105-1118. https://doi.org/10.1016/j.jaci.2010.10.008
31. Referans33. Bergmann MM, Caubet JC, Boguniewicz M, Eigenmann PA. Evaluation of food allergy in patients with atopic dermatitis. J Allergy Clin Immunol Pract 2013;1:22-28. https://doi.org/10.1016/j.jaip.2012.11.005
32. Referans34. Kim MJ, Kim SN, Lee YW, Choe YB, Ahn KJ. Vitamin D status and efficacy of vitamin D supplementation in atopic dermatitis: a systematic review and meta-analysis. Nutrients 2016;8:789. https://doi.org/10.3390/nu8120789