Hill DJ, Hosking CS. Pediatr Allergy Immunol. 2004;15:421–427
Purpose of the Study.
To examine the relationship between atopic dermatitis and IgE-mediated food allergy in infancy.
A birth cohort of 620 infants from the Melbourne Atopy Cohort Study, a cohort with a family history of eczema, asthma, hay fever, or immediate food allergy in a parent or sibling.
A total of 487 children had complete data including skin-prick tests to evaluate IgE-mediated food allergy to cow’s milk, egg, and peanut at the age of 1 year. Participants were grouped as no atopic dermatitis (group 0) or in quartiles of increasing severity of atopic dermatitis (groups 1–4) quantified by days of topical steroid use as reported in monthly interviews. Adverse reactions to foods were recorded.
The cumulative prevalence of atopic dermatitis was 28.9% by 12 months of age (10.3% of the cohort of moderate severity). As atopic dermatitis severity increased, so did the prevalence of IgE-mediated food allergy (group 0: 40 of 346; group 1: 6 of 36; group 2: 8 of 35; group 3: 12 of 35; group 4: 24 of 35; χ2 = 76; P < 10−6). The frequency of reported adverse food reactions was as follows: group 0, 43 of 346; group 1, 4 of 36; group 2, 8 of 35; group 3, 5 of 35; group 4, 13 of 35 (χ2 = 17; P = .002). The relative risk of an infant with atopic dermatitis having IgE-mediated food allergy is 5.9 for the most severely affected group.
Atopic dermatitis is common in infancy. There is a strong association between IgE-mediated food allergy and atopic dermatitis in this age group.
Studies using double-blind, placebo-controlled food challenges show that nearly 40% of infants and young children with severe atopic dermatitis have food allergy. This epidemiologic study focusing on children <1 year of age supports the association of IgE-mediated food sensitization with a history of atopic dermatitis. Therefore, evaluation for food allergies should be considered in infants with severe atopic dermatitis.