Braun Camille, Graham François, Fleischer David M, Molloy John, Bégin Philippe, Eigenmann Philippe
Department of Pediatrics, Pneumology, Allergy, and Cystic Fibrosis, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France; Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR 5308, Université Lyon 1, ENS de Lyon, Lyon, France.
Service d'Allergologie Pédiatrique, Département de Pédiatrie, CHU Sainte-Justine, Montréal, Quebec, Canada; Department of Medicine, Section of Allergy and Clinical Immunology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
J Allergy Clin Immunol Pract. 2025 Aug;13(8):1879-1886. doi: 10.1016/j.jaip.2025.05.013. Epub 2025 May 12.
The pathophysiology of atopic dermatitis (AD) involves cutaneous inflammation, predominantly mediated by innate immunity and T cells, in which IgE has a marginal role in most patients. Over previous decades, however, there has been an ongoing debate regarding the relevance of IgE-mediated allergy testing in patients with AD. Patients with AD have a defective skin barrier that facilitates a high inflammatory response to environmental antigens, placing them at greater risk for food allergies. Nevertheless, because these patients often produce high levels of IgE, the positive predictive value of skin prick tests and specific IgE measurements is low; such tests should be performed only when there is a concordant immediate hypersensitivity reaction (ie, urticaria or angioedema) rather than eczema. In recent years, numerous studies have emphasized the importance of maintaining oral exposure to foods to prevent the development or progression of food allergies in atopic patients. Although it is acknowledged that food allergens may contribute to AD in certain cases, it is critical that patients understand the risk of developing IgE-mediated food allergies if they exclude allergenic foods from the diet. Ultimately, controlling AD while retaining these foods in the diet should be the goal for all patients.
特应性皮炎（AD）的病理生理学涉及皮肤炎症，主要由固有免疫和T细胞介导，在大多数患者中IgE的作用较小。然而，在过去几十年里，关于IgE介导的过敏检测在AD患者中的相关性一直存在争论。AD患者的皮肤屏障存在缺陷，这使得他们对环境抗原产生高度炎症反应，从而使他们更容易发生食物过敏。然而，由于这些患者通常会产生高水平的IgE，皮肤点刺试验和特异性IgE检测的阳性预测值较低；只有在出现一致的速发型超敏反应（即荨麻疹或血管性水肿）而非湿疹时，才应进行此类检测。近年来，许多研究强调了维持口服食物以预防特应性患者食物过敏的发生或进展的重要性。虽然人们承认食物过敏原在某些情况下可能导致AD，但至关重要的是，如果患者从饮食中排除致敏食物，他们要了解发生IgE介导的食物过敏的风险。最终，在饮食中保留这些食物的同时控制AD应该是所有患者的目标。
