Rokaite Rūta, Labanauskas Liutauras, Balciūnaite Sigita, Vaideliene Laimute
Department of Children Diseases, Kaunas University of Medicine, Eiveniu 2, 50009 Kaunas, Lithuania.
Medicina (Kaunas). 2009;45(2):95-103.
The aim of this study was to determine the efficiency of individual balanced replacement diet in treatment of children with atopic dermatitis, to compare the course of atopic dermatitis and gastrointestinal disorders, as well as the data of skin patch test after a one-year period of dietary treatment.
The study group included 154 children (their age varied from 6 months to 18 years) with atopic dermatitis, for whom food allergens were determined by allergic skin tests (skin prick and patch). These children were recommended an individual balanced replacement diet, where possible food allergens were replaced by other products that do not cause allergic reactions. After a one-year dietary treatment, 109 (70.8%) children (such number came for the second study) were tested repeatedly. The following aspects were evaluated for all these children: clinical course of atopic dermatitis (children's mothers provided answers about exacerbation of allergic rash during the last 12 months, gastrointestinal disorders, and used medicines), severity of the progress of atopic dermatitis (SCORAD index). Besides, skin patch test with 25 food allergens was carried out.
Children who followed dietary recommendations were younger than children who failed to follow dietary recommendations because of a variety of reasons (P=0.01). Even 49 (62.8%) patients who followed dietary recommendations have shown the following results during the second test: allergic rash disappeared and they did not have to take medicines against allergy anymore. Patients who followed their individual dietary recommendations more rarely suffered from severe allergic rash problems during a 12-month period (P=0.01) and they had to take fewer medicines against allergy, compared to children who did not follow their dietary recommendations (P=0.001). Clinical course of atopic dermatitis in children who followed individual dietary recommendations was easier compared to children who did not follow such recommendations (P=0.001). During a one-year dietary treatment, 28.2% of children with atopic dermatitis became more tolerant to earlier food allergens. After the comparison of skin patch test results (before dietary treatment and after a one-year period), it was determined that only skin patch tests against buckwheat, oat, beef, and cacao did not change statistically significantly. Results of skin patch tests against other food products were found to be positive more rarely. Besides, children who followed their dietary recommendations suffered from gastrointestinal disorders more rarely as compared to children who did not follow their dietary recommendations (P=0.01). They suffered less from abdominal pain (P=0.01), abdominal distention (P=0.044), and constipation (P=0.035).
Individual balanced replacement diet for children with atopic dermatitis helped to fully control nutrition of sick children from various age groups and had a positive effect on the clinical course of atopic dermatitis. Patients who followed their individual dietary recommendations suffered from severe allergic rash more rarely and they had to take fewer medicines against allergy as compared to children who did not follow dietary recommendations. Clinical course of atopic dermatitis in children who followed individual dietary recommendations was easier as compared to children who did not follow such recommendations. One-third of children with atopic dermatitis became more tolerant to earlier food allergens during a one-year period. After a one-year dietotherapy treatment, positive patch test reactions to many food products appeared to be more rarely, except for buckwheat, oat, beef, and cacao. Besides, children who followed their dietary recommendations suffered from gastrointestinal disorders (abdominal pain, abdominal distention, and constipation) significantly more rarely as compared to children who did not follow their dietary recommendations.
本研究的目的是确定个性化均衡替代饮食对特应性皮炎患儿的治疗效果，比较特应性皮炎和胃肠道疾病的病程，以及饮食治疗一年后的皮肤斑贴试验数据。
研究组包括154例特应性皮炎患儿（年龄从6个月至18岁），通过过敏性皮肤试验（皮肤点刺和斑贴试验）确定其食物过敏原。建议这些患儿采用个性化均衡替代饮食，尽可能用不会引起过敏反应的其他产品替代可能的食物过敏原。经过一年的饮食治疗后，对109例（70.8%）患儿（前来参加第二项研究的患儿数量）进行了重复检测。对所有这些患儿评估了以下方面：特应性皮炎的临床病程（患儿母亲提供过去12个月内过敏性皮疹加重情况、胃肠道疾病及用药情况的答案）、特应性皮炎进展的严重程度（SCORAD指数）。此外，还对25种食物过敏原进行了皮肤斑贴试验。
遵循饮食建议的患儿比因各种原因未遵循饮食建议的患儿年龄更小（P = 0.01）。即使是49例（62.8%）遵循饮食建议的患儿在第二次检测时也有以下结果：过敏性皮疹消失，不再需要服用抗过敏药物。与未遵循饮食建议的患儿相比，遵循个性化饮食建议的患儿在12个月期间更少有严重过敏性皮疹问题（P = 0.01），且服用抗过敏药物的次数更少（P = 0.001）。遵循个性化饮食建议的患儿特应性皮炎的临床病程比未遵循该建议的患儿更轻（P = 0.001）。在一年的饮食治疗期间，28.2%的特应性皮炎患儿对先前的食物过敏原耐受性增强。比较皮肤斑贴试验结果（饮食治疗前和一年后）后发现，仅对荞麦、燕麦、牛肉和可可的皮肤斑贴试验结果在统计学上无显著变化。对其他食物产品的皮肤斑贴试验结果呈阳性的情况更少见。此外，与未遵循饮食建议的患儿相比，遵循饮食建议的患儿患胃肠道疾病的情况更少（P = 0.01）。他们腹痛（P = 0.01）、腹胀（P = 0.044）和便秘（P = 0.035）的情况更少。
特应性皮炎患儿的个性化均衡替代饮食有助于全面控制不同年龄组患病儿童的营养状况，并对特应性皮炎的临床病程产生积极影响。与未遵循饮食建议的患儿相比，遵循个性化饮食建议的患儿严重过敏性皮疹更少，服用抗过敏药物的次数也更少。遵循个性化饮食建议的患儿特应性皮炎的临床病程比未遵循该建议的患儿更轻。三分之一的特应性皮炎患儿在一年期间对先前的食物过敏原耐受性增强。经过一年的饮食治疗后，除荞麦、燕麦、牛肉和可可外，对许多食物产品的斑贴试验阳性反应似乎更少见。此外，与未遵循饮食建议的患儿相比，遵循饮食建议的患儿患胃肠道疾病（腹痛、腹胀和便秘）的情况明显更少。
