Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
J Allergy Clin Immunol Pract. 2022 Oct;10(10):2657-2666.e8. doi: 10.1016/j.jaip.2022.06.044. Epub 2022 Jul 19.
The influence of diet on atopic dermatitis (AD) is complex, and the use of dietary elimination as a treatment has conflicting views.
To systematically review the benefits and harms of dietary elimination for the treatment of AD.
We searched MEDLINE, Embase, AMED, PsycINFO, and the Cochrane Central Register of Controlled Trials from inception to January 18, 2022, without language restrictions, for randomized controlled trials (RCTs) and observational studies comparing dietary elimination and no dietary elimination for the treatment of AD. We conducted random-effects meta-analyses of eczema outcomes. We used the grading of recommendations, assessment, development, and evaluation approach to assess certainty of evidence (CRD42021237953).
Ten RCT (n = 599; baseline median of study mean age, 1.5 years; median of study mean SCOring Atopic Dermatitis index, 20.7, range, 3.5-37.6) were included in the meta-analysis. Compared with no dietary elimination, low-certainty evidence showed that dietary elimination may slightly improve eczema severity (50% with vs 41% without dietary elimination improved the SCOring Atopic Dermatitis index by a minimally important difference of 8.7 points, risk difference of 9% [95% CI, 0-17]), pruritus (daytime itch score [range, 0-3] mean difference, -0.21 [95% CI, -0.57 to 0.15]), and sleeplessness (sleeplessness score [range, 0-3] mean difference, -0.47 [95% CI, -0.80 to -0.13]). There were no credible subgroup differences based on elimination strategy (empiric vs guided by testing) or food-specific sensitization. Insufficient data addressed harms of elimination diets among included RCTs, although indirect evidence suggests that elimination diets may increase the risk for developing IgE-mediated food allergy.
Dietary elimination may lead to a slight, potentially unimportant improvement in eczema severity, pruritus, and sleeplessness in patients with mild to moderate AD. This must be balanced against potential risks for indiscriminate elimination diets including developing IgE-mediated food allergy and withholding more effective treatment options for AD.
饮食对特应性皮炎（AD）的影响复杂，而饮食排除疗法作为一种治疗方法存在争议。
系统评价饮食排除疗法治疗 AD 的益处和危害。
我们检索了 MEDLINE、Embase、AMED、PsycINFO 和 Cochrane 对照试验中心注册库，检索时间截至 2022 年 1 月 18 日，未设置语言限制，纳入比较饮食排除与不进行饮食排除治疗 AD 的随机对照试验（RCT）和观察性研究。我们对湿疹结局进行了随机效应荟萃分析。我们使用推荐评估、制定与评价分级（GRADE）方法评估证据确定性（CRD42021237953）。
10 项 RCT（n=599；基线研究平均年龄中位数为 1.5 岁，研究平均 SCORing 特应性皮炎指数中位数为 20.7，范围 3.5-37.6）纳入荟萃分析。与不进行饮食排除相比，低确定性证据表明饮食排除可能轻度改善湿疹严重程度（50%的患者接受饮食排除治疗后，SCOring 特应性皮炎指数改善了最小有意义差异 8.7 分，风险差异 9%[95%CI，0-17%]；日间瘙痒评分[范围 0-3]差值，-0.21[95%CI，-0.57 至 0.15]；失眠评分[范围 0-3]差值，-0.47[95%CI，-0.80 至-0.13]）。基于排除策略（经验性 vs 基于检测）或食物特异性致敏，无可信亚组差异。纳入的 RCT 中，关于排除饮食的危害的数据不足，尽管间接证据表明排除饮食可能增加 IgE 介导的食物过敏风险。
饮食排除可能轻度、潜在地改善轻至中度 AD 患者的湿疹严重程度、瘙痒和失眠，但必须权衡潜在风险，包括无差别排除饮食导致 IgE 介导的食物过敏和错失 AD 更有效的治疗选择。
