Therapeutic diets and development of tolerance in children with atopic dermatitis and food allergy

Silya Ottens, K. Breuer, M. Alter, A. Kapp, T. Werfel, Hannover

A rigorous elimination diet has so far been considered as the only effective therapeutic intervention with food allergy and the only way of increasing the rate of oral tolerance induction. The present study is to illuminate a possible connection among results of oral provocation tests, food-specific differences, dietary non-compliance and tolerance induction in a greater number of children with atopic dermatitis and food allergy.

It has been shown that wheat protein more frequently causes isolated late eczematous reactions than other food allergens such as cow’s milk, hen’s egg and soy protein. Soy generated the highest rate of late eczematous reactions combined with immediate reactions . Cow’s milk and hen’s egg, on the other hand, more frequently provoked isolated immediate reactions after an oral food challenge. 73 % of all parents were convinced of a positive influence of an elimination diet which showed itself in less skin reactions such as itching, eczematous lesions and a lower frequency of eczema episodes. The clinical course after oral provocation tests has shown that the development of tolerance was independent of the strictness of the diet adhered to.

Conclusion: Apparently there are food-specific differences among reaction types. An elimination diet is an effective intervention in cases of food allergy and atopic dermatitis, while occasional non-compliance is of secondary importance.

Keywords: atopic dermatitis, food allergy, development of tolerance, deficiency, elimination diet.

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