Thompson Michele M, Hanifin Jon M
Department of Dermatology, Oregon Health and Science University, Portland, Oregon 97239-3098, USA.
J Am Acad Dermatol. 2005 Aug;53(2 Suppl 2):S214-9. doi: 10.1016/j.jaad.2005.04.065.
Roughly one third of children with atopic dermatitis (AD) have IgE-mediated food allergy. Most parents and pediatricians assume foods also cause the eczema, a focus that diverts proper skin therapy and has negative outcomes including nutritional deficiency, costly referrals, and unnecessary testing. This project investigates the relationship between food allergy and AD, both before and after treatment in an established AD population. During an open trial of topical tacrolimus we observed a decrease in parental food allergy concern during good control of their child's eczema. We tested this observation by follow-up interviews and a questionnaire study to compare parental estimates of food allergy concerns after therapy with concerns before beginning the trial. Study subjects were children 11 years old and younger with AD and suspicion of food allergy. AD and food allergy parameters, pre- and post-treatment, were retrospectively assessed by a questionnaire given to the parents.
Twenty-three patients were enrolled: 16 had positive food allergy tests (7 RAST and/or 10 skin prick tests) and 30% had a definite history of immediate IgE reactions to foods. Ninety-five percent of parents felt that food allergy exacerbated their child's AD. Treatment durations were 3 to 45 months. Parental concern of food allergy decreased significantly from 7.7 to 4.0 on a 10 point scale (P < .001). Additionally, estimated food reactions decreased by approximately 80% during 1- and 6-month periods (P = .001).
In this selected university-based childhood AD population, nearly all parents were convinced their child had food allergy and further that the food contributed to the AD. The level of concern about food reactions was significantly decreased and the number of food reactions declined during effective topical therapy. This preliminary assessment of parental perceptions suggests that successful, stable therapy of AD reduces perceived food reactions and allays parental concerns about food allergy. Such therapy may encourage parents to refocus on direct skin care as the primary effort in AD therapy. We conclude that the effect of successful AD treatment on food allergy and food allergy concern are of interest and worthy of further study.
大约三分之一的特应性皮炎（AD）患儿存在IgE介导的食物过敏。大多数家长和儿科医生认为食物也会引发湿疹，这种关注点转移了恰当的皮肤治疗，会产生包括营养缺乏、昂贵的转诊和不必要的检测等负面后果。本项目调查既定AD人群在治疗前后食物过敏与AD之间的关系。在一项外用他克莫司的开放试验中，我们观察到在患儿湿疹得到良好控制期间，家长对食物过敏的担忧有所减少。我们通过随访访谈和问卷调查研究来验证这一观察结果，以比较治疗后家长对食物过敏担忧的估计与试验开始前的担忧情况。研究对象为11岁及以下怀疑有食物过敏的AD患儿。通过向家长发放问卷，对治疗前后的AD和食物过敏参数进行回顾性评估。
招募了23名患者：16名食物过敏检测呈阳性（7例放射性变应原吸附试验和/或10例皮肤点刺试验），30%有明确的对食物立即发生IgE反应的病史。95%的家长认为食物过敏会加重孩子的AD。治疗时长为3至45个月。家长对食物过敏的担忧在10分制量表上从7.7显著降至4.0（P < .001）。此外，在1个月和6个月期间，估计的食物反应减少了约80%（P = .001）。
在这个选定的以大学为基础的儿童AD人群中，几乎所有家长都确信他们的孩子有食物过敏，并且认为食物会导致AD。在有效的局部治疗期间，对食物反应的担忧程度显著降低，食物反应的数量也有所减少。对家长认知的这一初步评估表明，成功、稳定的AD治疗可减少感知到的食物反应，并减轻家长对食物过敏的担忧。这种治疗可能会鼓励家长将重点重新放在直接的皮肤护理上，作为AD治疗的主要努力方向。我们得出结论，成功的AD治疗对食物过敏和食物过敏担忧的影响值得关注且值得进一步研究。
