Introduction
Atopic eczema/atopic dermatitis (AD) has a high disease burden and
affects around 20% of children.[1] Most children with AD have
mild-moderate disease and can be managed with a combination of
emollients and anti-inflammatory treatments, usually topical
corticosteroids (TCS). However, topical therapies can be messy and time
consuming, and parents commonly worry about their safety.[2] This,
combined with the perception that AD creams only treat the symptoms
leads many carers to modify their child’s diet or seek food allergy
tests, in the belief that this will identify an underlying dietary
cause.
The association between AD, food sensitisation and food allergy is
recognised.[3] Up to half of children with AD are “sensitised” on
blood IgE or skin prick tests to specific foods, without necessarily
having any clinical symptoms. The prevalence of food allergy is highest
0–2 years (39.2%) and is associated with early onset and more severe
disease.[4] Cow’s milk, hen’s egg, wheat and soya are four of the
foods that commonly cause food allergy, raise concern about food allergy
among parents, and/or are excluded without professional advice.[5,
6] They are also some of the most challenging foods to attribute to
delayed, non-IgE mediated allergy symptoms and to exclude from the diet.
When there is an immediate reaction to these foods, the causal link may
be obvious, but parents of children with AD also worry about delayed
food allergy, and a food-related worsening of AD. In clinical settings,
symptoms usually determine whether a food allergy test is done. However,
sometimes clinicians use food allergy tests, in the absence of a
relevant allergy symptoms, to guide dietary advice for children with
AD.[7] The evidence to support this approach is weak.[8]
To support further research in this area, and to inform clinical
practice meanwhile, we conducted a consensus exercise on how symptoms
and skin prick test results should be interpreted to guide dietary
advice in children with AD.