Angela Chang1, Rachel Robison2, Miao Cai1, Anne Marie Singh3. 1. Division of Allergy/Immunology, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill. 2. Division of Allergy/Immunology, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill; Division of Allergy/Immunology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill. 3. Division of Allergy/Immunology, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill; Division of Allergy/Immunology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill; Division of Allergy/Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill. Electronic address: anne-singh@northwestern.edu.
Abstract
BACKGROUND: Case reports suggest that children with food-triggered atopic dermatitis (AD) on elimination diets may develop immediate reactions on accidental ingestion or reintroduction of an avoided food. OBJECTIVE: The objective of this study was to systematically study the incidence and risk factors associated with these immediate reactions. METHODS: A retrospective chart review of 298 patients presenting to a tertiary-care allergy-immunology clinic based on concern for food-triggered AD was performed. Data regarding triggering foods, laboratory testing, and clinical reactions were collected prospectively from the initial visit. Food-triggered AD was diagnosed by an allergist-immunologist with clinical evaluation and laboratory testing. We identified immediate reactions as any reaction to a food for which there was evidence of sIgE and for which patients developed timely allergic signs and symptoms. Differences between children with and without new immediate reactions were determined by a Mann-Whitney, χ(2), or Fisher's exact test as appropriate. RESULTS: A total of 19% of patients with food-triggered AD and no previous history of immediate reactions developed new immediate food reactions after initiation of an elimination diet. Seventy percent of reactions were cutaneous but 30% were anaphylaxis. Cow's milk and egg were the most common foods causing immediate-type reactions. Avoidance of a food was associated with increased risk of developing immediate reactions to that food (P < .01). Risk was not related to specific IgE level nor a specific food. CONCLUSION: A significant number of patients with food-triggered AD may develop immediate-type reactions. Strict elimination diets need to be thoughtfully prescribed as they may lead to decreased oral tolerance.
BACKGROUND: Case reports suggest that children with food-triggered atopic dermatitis (AD) on elimination diets may develop immediate reactions on accidental ingestion or reintroduction of an avoided food. OBJECTIVE: The objective of this study was to systematically study the incidence and risk factors associated with these immediate reactions. METHODS: A retrospective chart review of 298 patients presenting to a tertiary-care allergy-immunology clinic based on concern for food-triggered AD was performed. Data regarding triggering foods, laboratory testing, and clinical reactions were collected prospectively from the initial visit. Food-triggered AD was diagnosed by an allergist-immunologist with clinical evaluation and laboratory testing. We identified immediate reactions as any reaction to a food for which there was evidence of sIgE and for which patients developed timely allergic signs and symptoms. Differences between children with and without new immediate reactions were determined by a Mann-Whitney, χ(2), or Fisher's exact test as appropriate. RESULTS: A total of 19% of patients with food-triggered AD and no previous history of immediate reactions developed new immediate food reactions after initiation of an elimination diet. Seventy percent of reactions were cutaneous but 30% were anaphylaxis. Cow's milk and egg were the most common foods causing immediate-type reactions. Avoidance of a food was associated with increased risk of developing immediate reactions to that food (P < .01). Risk was not related to specific IgE level nor a specific food. CONCLUSION: A significant number of patients with food-triggered AD may develop immediate-type reactions. Strict elimination diets need to be thoughtfully prescribed as they may lead to decreased oral tolerance.
Authors: George Du Toit; Graham Roberts; Peter H Sayre; Henry T Bahnson; Suzana Radulovic; Alexandra F Santos; Helen A Brough; Deborah Phippard; Monica Basting; Mary Feeney; Victor Turcanu; Michelle L Sever; Margarita Gomez Lorenzo; Marshall Plaut; Gideon Lack Journal: N Engl J Med Date: 2015-02-23 Impact factor: 91.245
Authors: Ikuo Hirano; Edmond S Chan; Matthew A Rank; Rajiv N Sharaf; Neil H Stollman; David R Stukus; Kenneth Wang; Matthew Greenhawt; Yngve T Falck-Ytter Journal: Ann Allergy Asthma Immunol Date: 2020-05 Impact factor: 6.347
Authors: Matthew A Rank; Rajiv N Sharaf; Glenn T Furuta; Seema S Aceves; Matthew Greenhawt; Jonathan M Spergel; Yngve T Falck-Ytter; Evan S Dellon Journal: Ann Allergy Asthma Immunol Date: 2020-05 Impact factor: 6.347