Nutr Res Pract.  2013 Dec;7(6):488-494.

The effects of elimination diet on nutritional status in subjects with atopic dermatitis

• Kim J
• Kwon J
• Noh G
• Lee SS

Abstract

A food allergy is an adverse health effect arising from a specific immune response that occurs reproducibly upon exposure to a given food. In those with food allergies that are thought to cause aggravation of eczema, food avoidance is important. The objective of this study was to research the nutritional status of patients with food allergies. A total of 225 subjects diagnosed with atopic dermatitis underwent a skin prick test as well as measurement of serum immunoglobulin E. Food challenge tests were conducted using seven food items: milk, eggs, wheat, soybeans, beef, pork, and chicken. At post-food challenge visits to the test clinic, participants completed a three-day dietary record, which included two week days and one weekend day, in order to evaluate energy intake and diet quality during the challenge. We analyzed nutrient intake based on differential food allergens. Subjects with a food allergy to milk showed lower intake of Ca, Zn, and vitamin B2, and subjects with a food allergy to egg showed lower intake of vitamin A, B1, B2, niacin, and cholesterol. Subjects with a food allergy to wheat and soybean showed lower intake of Ca, P, Fe, K, Zn, vitamin B2, vitamin B6, and niacin; and subjects with a food allergy to beef, pork, and chicken showed lower intake of Fe and higher intake of K, vitamin A, B2. Subjects with atopic dermatitis were lacking in several nutrients, including vitamin A and vitamin C. A greater number of food allergies showed an association with a greater number of nutrient intake deficiencies. Allergen avoidance is the basic treatment for atopic dermatitis. However, when the allergen is food, excessive restriction can lead to nutrition deficiency. Findings of this study suggest the necessity for enhanced nutritional education in order to provide substitute foods for patients with food allergies who practice food restriction.

Keyword

Food allergy; atopic dermatitis; food restriction

MeSH Terms

Allergens
Ascorbic Acid
Chickens
Cholesterol
Dermatitis, Atopic*
Diet Records
Diet*
Eczema
Education
Eggs
Energy Intake
Food Hypersensitivity
Humans
Immunoglobulin E
Immunoglobulins
Milk
Niacin
Nutritional Status*
Ovum
Riboflavin
Skin
Soybeans
Triticum
Vitamin A
Vitamin B 6
Allergens
Ascorbic Acid
Cholesterol
Immunoglobulin E
Immunoglobulins
Niacin
Riboflavin
Vitamin A
Vitamin B 6

Figure

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  Fig. 1 Diagnostic flow for the food challenge test in patients with atopic dermatitis

Reference

1. Bieber T. Atopic dermatitis. N Engl J Med. 2008; 358:1483–1494.

2. Hahn EL, Bacharier LB. The atopic march: the pattern of allergic disease development in childhood. Immunol Allergy Clin North Am. 2005; 25:231–246.

3. NIAID-Sponsored Expert Panel. Boyce JA, Assa'ad A, Burks AW, Jones SM, Sampson HA, Wood RA, Plaut M, Cooper SF, Fenton MJ, Arshad SH, Bahna SL, Beck LA, Byrd-Bredbenner C, Camargo CA Jr, Eichenfield L, Furuta GT, Hanifin JM, Jones C, Kraft M, Levy BD, Lieberman P, Luccioli S, McCall KM, Schneider LC, Simon RA, Simons FE, Teach SJ, Yawn BP, Schwaninger JM. 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:S1–S58.

4. Ebisawa M. Management of food allergy in Japan "food allergy management guideline 2008 (revision from 2005)" and "guidelines for the treatment of allergic diseases in schools". Allergol Int. 2009; 58:475–483.

5. Ito K, Urisu A. Diagnosis of food allergy based on oral food challenge test. Allergol Int. 2009; 58:467–474.

6. Nowak-Wegrzyn A, Assa'ad AH, Bahna SL, Bock SA, Sicherer SH, Teuber SS. Adverse Reactions to Food Committee of American Academy of Allergy, Asthma & Immunology. Work Group report: oral food challenge testing. J Allergy Clin Immunol. 2009; 123:S365–S383.

7. Sicherer SH. Epidemiology of food allergy. J Allergy Clin Immunol. 2011; 127:594–602.

8. Breuer K, Heratizadeh A, Wulf A, Baumann U, Constien A, Tetau D, Kapp A, Werfel T. Late eczematous reactions to food in children with atopic dermatitis. Clin Exp Allergy. 2004; 34:817–824.

9. Bock SA, Lee WY, Remigio L, Holst A, May CD. Appraisal of skin tests with food extracts for diagnosis of food hypersensitivity. Clin Allergy. 1978; 8:559–564.

10. Pelkonen AS, Kuitunen M, Dunder T, Reijonen T, Valovirta E, Mäkelä MJ. Allergy in children: practical recommendations of the Finnish allergy programme 2008-2018 for prevention, diagnosis, and treatment. Pediatr Allergy Immunol. 2012; 23:103–116.

11. Chafen JJ, Newberry SJ, Riedl MA, Bravata DM, Maglione M, Suttorp MJ, Sundaram V, Paige NM, Towfigh A, Hulley BJ, Shekelle PG. Diagnosing and managing common food allergies: a systematic review. JAMA. 2010; 303:1848–1856.

12. Sampson HA, Albergo R. Comparison of results of skin tests, RAST, and double-blind, placebo-controlled food challenges in children with atopic dermatitis. J Allergy Clin Immunol. 1984; 74:26–33.

13. Bindslev-Jensen C, Ballmer-Weber BK, Bengtsson U, Blanco C, Ebner C, Hourihane J, Knulst AC, Moneret-Vautrin DA, Nekam K, Niggemann B, Osterballe M, Ortolani C, Ring J, Schnopp C, Werfel T. European Academy of Allergology and Clinical Immunology. 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.

14. Kurihara K. Immunotherapy for food allergy. Allergol Int. 2010; 59:9–14.

15. Fox AT, Du Toit G, Lang A, Lack G. Food allergy as a risk factor for nutritional rickets. Pediatr Allergy Immunol. 2004; 15:566–569.

16. Noh GW, Ji EJ, Park JN, Kim KH, Do MH, Lee EK, Lee SS. The importance of food open challenge test in atopic dermatitis: the comparison of allergy history, skin-prick test, and specific IgE detection. Nutr Sci. 1999; 2:119–124.

17. Lee SS, Lee KY, Noh G. The necessity of diet therapy for successful interferon-gamma therapy in atopic dermatitis. Yonsei Med J. 2001; 42:161–171.

18. The Korean Nutrition Society. Dietary Reference Intakes For Koreans. Seoul: The Korean Nutrition Society;2010.

19. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venereol Suppl (Stockh). 1980; (92):S44–S47.

20. Liu AH, Jaramillo R, Sicherer SH, Wood RA, Bock SA, Burks AW, Massing M, Cohn RD, Zeldin DC. National prevalence and risk factors for food allergy and relationship to asthma: results from the National Health and Nutrition Examination Survey 2005-2006. J Allergy Clin Immunol. 2010; 126:798–806.

21. Chang EY, Chung SW, Lee JH. Mother's experience of caring child with a severe atopic dermatitis. Korean Parent Child Health J. 2006; 9:17–32.

22. Romieu I, Trenga C. Diet and obstructive lung diseases. Epidemiol Rev. 2001; 23:268–287.

23. Arora P, Kumar V, Batra S. Vitamin A status in children with asthma. Pediatr Allergy Immunol. 2002; 13:223–226.

24. Cook DG, Carey IM, Whincup PH, Papacosta O, Chirico S, Bruckdorfer KR, Walker M. Effect of fresh fruit consumption on lung function and wheeze in children. Thorax. 1997; 52:628–633.

25. Forastiere F, Pistelli R, Sestini P, Fortes C, Renzoni E, Rusconi F, Dell'Orco V, Ciccone G, Bisanti L. Consumption of fresh fruit rich in vitamin C and wheezing symptoms in children. SIDRIA Collaborative Group, Italy (Italian Studies on Respiratory Disorders in Children and the Environment). Thorax. 2000; 55:283–288.

26. Cunningham-Rundles S, McNeeley DF, Moon A. Mechanisms of nutrient modulation of the immune response. J Allergy Clin Immunol. 2005; 115:1119–1128.

27. Novak N, Leung DY. Diet and allergy: you are what you eat? J Allergy Clin Immunol. 2005; 115:1235–1237.