Giovannini Mattia, Bolis Marta, Barni Simona, Liccioli Giulia, Sarti Lucrezia, Morelli Susanna, Pontone Matteo, Pessina Benedetta, Tomei Leonardo, Valleriani Claudia, Novembre Elio, Mori Francesca
Allergy Unit, Meyer Children's Hospital IRCCS, 50139 Florence, Italy.
Department of Health Sciences, University of Florence, 50139 Florence, Italy.
J Clin Med. 2023 Jun 7;12(12):3889. doi: 10.3390/jcm12123889.
Atopic dermatitis (AD) is a common chronic inflammatory skin disorder in childhood. Skin barrier impairment exposes infants to food allergens, potentially causing sensitization followed by IgE-mediated food allergy. We describe the case of an infant with severe AD in whom several sensitizations to foods are detected, with consequently difficult weaning, and a history of anaphylaxis to cashew nut. Foods for which skin tests were negative were introduced into the infant's diet. Then, when AD control was managed, oral food challenges (OFCs) for foods to which the patient was sensitized, with the exception of cashew nut, were performed. The simultaneous presence of sensitization toward multiple foods made it difficult to introduce them using classic OFC. Therefore, it was decided to perform the low-dose, gradual controlled OFC. This led to an introduction of sensitized foods into the infant's diet, with the exception of cashew nut, avoiding allergic reactions. Absolute recommendations on how, when, and where to perform OFCs with allergenic food to which the child with AD is sensitized are lacking so far. In our opinion, OFCs and the subsequent ntroduction of allergenic foods should be individualized, evaluating some factors such as their social and nutritional importance, the patient's age and clinical phenotype (including the history of anaphylaxis), and the sensitization profile. There is agreement on the fact that the dietary approach in children with moderate-severe AD should no longer include a strict elimination diet. We believe that an early, gradual controlled introduction of all allergenics to identify the amount of food tolerated in the absence of reactions, even if low dose, may improve patients' and families' quality of life. However, even if discussing a vast relevant literature, the limitation of our work is that we describe the management of a single patient. Extensive and high-quality research is needed in this field to improve the available evidence in the area.
特应性皮炎（AD）是儿童常见的慢性炎症性皮肤病。皮肤屏障受损使婴儿暴露于食物过敏原中，可能导致致敏，随后引发IgE介导的食物过敏。我们描述了一名患有重度AD的婴儿病例，该婴儿对多种食物致敏，断奶困难，且有腰果过敏反应史。将皮肤试验阴性的食物引入婴儿饮食。然后，在AD得到控制后，对除腰果外患者致敏的食物进行口服食物激发试验（OFC）。对多种食物同时致敏使得使用经典的OFC引入这些食物变得困难。因此，决定进行低剂量、逐步控制的OFC。这使得除腰果外的致敏食物得以引入婴儿饮食，避免了过敏反应。目前尚缺乏关于如何、何时以及在何处对AD致敏的儿童进行致敏食物OFC的绝对建议。我们认为，OFC及随后引入致敏食物应个体化，评估一些因素，如它们的社会和营养重要性、患者年龄和临床表型（包括过敏反应史）以及致敏情况。对于中重度AD儿童的饮食方法不应再包括严格的排除饮食这一点已达成共识。我们认为，早期、逐步控制地引入所有过敏原以确定在无反应情况下可耐受的食物量，即使是低剂量，也可能改善患者及其家庭的生活质量。然而，即使讨论了大量相关文献，我们工作的局限性在于我们描述的是单个患者的管理情况。该领域需要广泛且高质量的研究来改善该领域现有的证据。
