Nutrition Research and Practice

The Korean Nutrition Society (한국영양학회)
권호 표지
DOI QR코드

DOI QR Code

Characterization of food allergies in patients with atopic dermatitis

  • Kwon, Jaryoung (Department of Food and Nutrition, Hanyang University) ;
  • Kim, Jungyun (Department of Food and Nutrition, Seojeong College) ;
  • Cho, Sunheui (Department of Food and Nutrition, Hanyang University) ;
  • Noh, Geunwoong (Division of Allergy and Clinical Immunology, Department of Pediatrics, Chungnam National University Hospital) ;
  • Lee, Sang Sun (Department of Food and Nutrition, Hanyang University)
  • Received : 2012.08.28
  • Accepted : 2012.12.12
  • Published : 2013.04.01
Download PDF
⟨ Previous Next ⟩

Abstract

We examined the characteristics of food allergy prevalence and suggested the basis of dietary guidelines for patients with food allergies and atopic dermatitis. A total of 2,417 patients were enrolled in this study. Each subject underwent a skin prick test as well as serum immunoglobulin E (IgE) measurement. A double-blind, placebo-controlled food challenge was conducted using milk, eggs, wheat, and soybeans, and an oral food challenge was performed using beef, pork, and chicken. Food allergy prevalence was found among 50.7% in patients with atopic dermatitis. Among patients with food allergies (n = 1,225), the prevalence of non-IgE-mediated food allergies, IgE-mediated food allergies, and mixed allergies was discovered in 94.9%, 2.2%, and 2.9% of the patients, respectively. Food allergy prevalence, according to food item, was as follows: eggs = 21.6%, milk = 20.9%, wheat = 11.8%, soybeans = 11.7%, chicken = 11.7%, pork = 8.9% and beef = 9.2%. The total number of reactions to different food items in each patient was also variable at 45.1%, 30.6%, 15.3%, 5.8%, 2.2%, and 1.0% for 1 to 6 reactions, respectively. The most commonly seen combination in patients with two food allergies was eggs and milk. The clinical severity of the reactions observed in the challenge test, in the order of most to least severe, were wheat, beef, soybeans, milk, pork, eggs, and chicken. The minimum and maximum onset times of food allergy reactions were 0.2-24 hrs for wheat, 0.5-48 hrs for beef, 1.0-24 hrs for soybeans, 0.7-24 hrs for milk, 3.0-24 hrs for pork, 0.01-72 hrs for eggs, and 3.0-72 hrs for chicken. In our study, we examined the characteristics of seven popular foods. It will be necessary, however, to study a broader range of foods for the establishment of a dietary guideline. Our results suggest that it may be helpful to identify food allergies in order to improve symptoms in patients with atopic dermatitis.

Keywords

References

  1. Oh JW, Kim KE, Pyun BY, Lee HR, Choung JT, Hong SJ, Park KS, Lee SY, Song SW, Kim CH, Ahn KM, Nam SY, Shon MH, Kim WK, Lee MH, Kwon BC, Choi SY, Lee SY, Lee HB, Lee SI, Lee JS. Nationwide study for epidemiological change of atopic dermatitis in school aged children between 1995 and 2000 and kindergarten aged children in 2003 in Korea. Pediatr Allergy Respir Dis 2003;13:227-37.
  2. Nam SY, Yoon HS, Kim WK. Prevalence of allergic disease in kindergarten age children in Korea. Pediatr Allergy Respir Dis 2005;15:439-45.
  3. Son KY, Park KS, Hwang HH, Yun BS, Lee SJ, Kim MA, Park JY, Kim KE, Jang KC. Prevalence of allergic diseases among primary school children in Ilsan, Gyeonggi and changes of symptoms after environmental control in 2005. Pediatr Allergy Respir Dis 2007;17:384-93.
  4. 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: summary of the NIAID-sponsored expert panel report. Nutr Res 2011;31:61-75. https://doi.org/10.1016/j.nutres.2011.01.001
  5. 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;58:475-83. https://doi.org/10.2332/allergolint.09-RAI-0143
  6. Ramesh S. Food allergy overview in children. Clin Rev Allergy Immunol 2008;34:217-30. https://doi.org/10.1007/s12016-007-8034-1
  7. Bernstein IL, Li JT, Bernstein DI, Hamilton R, Spector SL, Tan R, Sicherer S, Golden DB, Khan DA, Nicklas RA, Portnoy JM, Blessing-Moore J, Cox L, Lang DM, Oppenheimer J, Randolph CC, Schuller DE, Tilles SA, Wallace DV, Levetin E, Weber R; American Academy of Allergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology. Allergy diagnostic testing: an updated practice parameter. Ann Allergy Asthma Immunol 2008;100:S1-148.
  8. 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;8:559-64. https://doi.org/10.1111/j.1365-2222.1978.tb01509.x
  9. Nowak-Wegrzyn A, Assaad AH, Bahna SL, Bock SA, Sicherer SH, Teuber SS; Adverse Reactions to Food Committee of American Academy of Allergy. Work Group report: oral food challenge testing. J Allergy Clin Immunol 2009;123:S365-83. https://doi.org/10.1016/j.jaci.2009.03.042
  10. Majamaa H, Miettinen A, Laine S, Isolauri E. Intestinal inflammation in children with atopic eczema: faecal eosinophil cationic protein and tumour necrosis factor-alpha as non-invasive indicators of food allergy. Clin Exp Allergy 1996;26:181-7. https://doi.org/10.1111/j.1365-2222.1996.tb00078.x
  11. 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. https://doi.org/10.1016/0091-6749(84)90083-6
  12. Rance F, Juchet A, Bremont F, Dutau G. Correlations between skin prick tests using commercial extracts and fresh foods, specific IgE, and food challenges. Allergy 1997;52:1031-5. https://doi.org/10.1111/j.1398-9995.1997.tb02427.x
  13. Ito K, Urisu A. Diagnosis of food allergy based on oral food challenge test. Allergol Int 2009;58:467-74. https://doi.org/10.2332/allergolint.09-RAI-0140
  14. 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; 59:690-7. https://doi.org/10.1111/j.1398-9995.2004.00466.x
  15. Imai T. National surveillance of immediate type food allergy in Japan. In: Work Report of a Study for the Development and Prevention of Food Allergy. Tokyo: Ministry of Health, Labour and Welfare; 2007. p.5-9.
  16. Ellman LK, Chatchatee P, Sicherer SH, Sampson HA. Food hypersensitivity in two groups of children and young adults with atopic dermatitis evaluated a decade apart. Pediatr Allergy Immunol 2002;13:295-8. https://doi.org/10.1034/j.1399-3038.2002.01061.x
  17. Lee SS, Lee KY, Noh G. The necessity of diet therapy for successful interferon-gamma therapy in atopic dermatitis. Yonsei Med J 2001;42:161-71. https://doi.org/10.3349/ymj.2001.42.2.161
  18. The Korean Nutrition Society. Dietary Reference Intakes for Koreans. 1st rev. Seoul: The Korean Nutrition Society; 2010.
  19. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venereol Suppl (Stockh) 1980;92:44-7.
  20. Kunz B, Oranje AP, Labreze L, Stalder JF, Ring J, Taieb A. Clinical validation and guidelines for the SCORAD index: consensus report of the European Task Force on Atopic Dermatitis. Dermatology 1997;195:10-9.
  21. Clark AT, Ewan PW. Food allergy in childhood. Arch Dis Child 2003;88:79-81. https://doi.org/10.1136/adc.88.1.79
  22. Burks AW, James JM, Hiegel A, Wilson G, Wheeler JG, Jones SM, Zuerlein N. Atopic dermatitis and food hypersensitivity reactions. J Pediatr 1998;132:132-6. https://doi.org/10.1016/S0022-3476(98)70498-6
  23. Hill DJ, Hosking CS, Zhie CY, Leung R, Baratwidjaja K, Iikura Y, Iyngkaran N, Gonzalez-Andaya A, Wah LB, Hsieh KH. The frequency of food allergy in Australia and Asia. Environ Toxicol Pharmacol 1997;4:101-10. https://doi.org/10.1016/S1382-6689(97)10049-7
  24. 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.
  25. Burks AW, Mallory SB, Williams LW, Shirrell MA. Atopic dermatitis: clinical relevance of food hypersensitivity reactions. J Pediatr 1988;113:447-51. https://doi.org/10.1016/S0022-3476(88)80626-7
  26. Sicherer SH, Sampson HA. Food hypersensitivity and atopic dermatitis: pathophysiology, epidemiology, diagnosis, and management. J Allergy Clin Immunol 1999;104:S114-22. https://doi.org/10.1016/S0091-6749(99)70053-9
  27. Noh G, Ahn HS, Cho NY, Lee S, Oh JW. The clinical significance of food specific IgE/IgG4 in food specific atopic dermatitis. Pediatr Allergy Immunol 2007;18:63-70. https://doi.org/10.1111/j.1399-3038.2006.00478.x
  28. Van Bever HP, Docx M, Stevens WJ. Food and food additives in severe atopic dermatitis. Allergy 1989;44:588-94. https://doi.org/10.1111/j.1398-9995.1989.tb04205.x
  29. Sampson HA, Ho DG. Relationship between food-specific IgE concentrations and the risk of positive food challenges in children and adolescents. J Allergy Clin Immunol 1997;100:444-51. https://doi.org/10.1016/S0091-6749(97)70133-7
  30. Magnolfi CF, Zani G, Lacava L, Patria MF, Bardare M. Soy allergy in atopic children. Ann Allergy Asthma Immunol 1996; 77:197-201. https://doi.org/10.1016/S1081-1206(10)63255-3
  31. Eigenmann PA, Sampson HA. An update on food hypersensitivity. Fundam Clin Immunol 1994;2:121-33.
  32. Jung JA, Lee JS, Lee SI. Serum specific IgE to egg white, cow's milk, soybean in the children with atopic dermatitis. Pediatr Allergy Respir Dis 2003;13:255-62.
  33. Lee HK, Pyun BY, Lee SJ. Etiologic allergens, blood eosinophil count and total IgE level according to age and site of skin lesion in atopic dermatitis. Allergy 1992;12:70-7.
  34. Kim JH, Chung SW, Lim DH, Son BK, Son JA, Lee SI, Cha KE. Food and house dust mite allergens in children with atopic dermatitis. Korean J Allergy 1997;17:165-70.
  35. Lee HS, Kim JS, Pyun BY. Changes of the prevalence and the allergens of atopic dermatitis in children: In between the year of 1992 and 2002. Pediatr Allergy Respir Dis 2002;12:263-71.
  36. Oranje AP, Wolkerstorfer A, de Waard-van der Spek FB. Natural course of cow's milk allergy in childhood atopic eczema/dermatitis syndrome. Ann Allergy Asthma Immunol 2002;89:52-5. https://doi.org/10.1016/S1081-1206(10)62123-0
  37. Hammar H. Provocation with cow's milk and cereals in atopic dermatitis. Acta Derm Venereol 1977;57:159-63.
  38. Hanifin JM. Type I hypersensitivity diseases of the skin: divergent aspects of urticaria and atopic dermatitis. Ann Allergy 1977;39: 153-60.
  39. Atherton DJ. Allergy and atopic eczema II. Clin Exp Dermatol 1981;6:317-25. https://doi.org/10.1111/j.1365-2230.1981.tb02311.x

Cited by

  1. Histoire naturelle de la dermatite atopique vol.146, pp.12, 2013, https://doi.org/10.1016/s0151-9638(20)30015-6
  2. Physiopathologie de la dermatite atopique et des autres maladies atopiques : une approche globale est-elle possible ? vol.147, pp.11, 2020, https://doi.org/10.1016/s0151-9638(20)31082-6
  3. Recommandations pour la prescription et l’interprétation des examens biologiques utilisables dans le cadre du diagnostic ou du suivi des allergies, disponibles en France. Partie 5 : aller vol.61, pp.7, 2013, https://doi.org/10.1016/j.reval.2021.01.006