Fischer Karen, Jones Mark, O'Neill Hayley M
Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4226, Australia.
Institute for Evidence-Based Healthcare, Bond University, Robina, QLD 4226, Australia.
Nutrients. 2025 May 9;17(10):1628. doi: 10.3390/nu17101628.
BACKGROUND/OBJECTIVES: Elimination diets targeting amines and salicylates have been used since the 1980s to diagnose pharmacological food intolerance in individuals with atopic dermatitis (eczema), yet supporting evidence regarding relevance is limited. To our knowledge, this systematic review with meta-analysis is the first to examine the prevalence and association between atopic dermatitis flares and amine intolerance (including histamine intolerance) and salicylate intolerance in individuals with atopic dermatitis.
Following the PRISMA guidelines, searches of PubMed, Embase, CINAHL, and Cochrane were conducted. Included studies involved children and adults with atopic dermatitis who underwent dietary elimination and double-blind placebo-controlled challenges involving histamine, other amines, or salicylates. Risk of bias was assessed using the Joanna Briggs Institute Checklist for Prevalence Studies. Meta-analysis of the prevalence of atopic dermatitis flare by food chemical type was performed using a random effects model in Stata/MP, version 16.1 for Windows. Heterogeneity was assessed using the I statistic and Cochrane's Q test.
A total of 2323 titles and abstracts were screened, with 46 full-text articles evaluated independently by two reviewers, resulting in the inclusion of four prevalence studies involving 188 participants. Meta-analysis of two trials showed histamine intolerance prevalence at 31% [95% CI, 20-41%] with no heterogeneity (I = 0.01%). Two trials showed amine intolerance prevalence at 32% [95% CI, 16-48%] with moderate heterogeneity (I = 34.91%). Two trials showed salicylate intolerance prevalence at 53% [95% CI, 44-62%] with no heterogeneity (I = 0.00%).
This review suggests there may be low-certainty evidence linking intolerance to histamine, amines, and salicylates to atopic dermatitis flare in a substantial proportion of individuals with atopic dermatitis. Further, well-designed studies are needed to confirm these findings and clarify the role of pharmacological food intolerance in atopic dermatitis.
背景/目的：自20世纪80年代以来，针对胺类和水杨酸盐的排除饮食被用于诊断特应性皮炎（湿疹）患者的药物性食物不耐受，但相关的支持证据有限。据我们所知，这项荟萃分析的系统评价是首次研究特应性皮炎发作与特应性皮炎患者的胺不耐受（包括组胺不耐受）和水杨酸盐不耐受之间的患病率及关联。
按照PRISMA指南，对PubMed、Embase、CINAHL和Cochrane进行检索。纳入的研究涉及患有特应性皮炎的儿童和成人，他们接受了饮食排除以及涉及组胺、其他胺类或水杨酸盐的双盲安慰剂对照激发试验。使用乔安娜·布里格斯研究所患病率研究清单评估偏倚风险。在适用于Windows的Stata/MP 16.1版中，使用随机效应模型对按食物化学类型划分的特应性皮炎发作患病率进行荟萃分析。使用I统计量和Cochrane Q检验评估异质性。
共筛选了2323个标题和摘要，由两名评审员独立评估46篇全文文章，最终纳入四项患病率研究，涉及188名参与者。两项试验的荟萃分析显示，组胺不耐受患病率为31%[95%置信区间，20 - 41%]，无异质性（I = 0.01%）。两项试验显示，胺不耐受患病率为32%[95%置信区间，16 - 48%]，异质性中等（I = 34.91%）。两项试验显示，水杨酸盐不耐受患病率为53%[95%置信区间，44 - 62%]，无异质性（I = 0.00%）。
本综述表明，在相当一部分特应性皮炎患者中，可能存在低确定性证据表明组胺、胺类和水杨酸盐不耐受与特应性皮炎发作有关。此外，需要设计良好的研究来证实这些发现，并阐明药物性食物不耐受在特应性皮炎中的作用。
