Hill DJ, Heine RG, Hosking CS, et al. J Pediatr. 2007;151(4):359–363
PURPOSE OF THE STUDY. Because community-based studies, which report immunoglobulin E food sensitization (IgE-FS) in >80% of infants with moderate atopic eczema, may be influenced by referral bias, the researchers assessed the prevalence of IgE-FS in a cohort of infants with moderate atopic eczema who were attending a dermatology department clinic.
STUDY POPULATION. Consecutive infants (n = 51 [39 boys]; median age: 34 weeks [range: 20–51 weeks]) with moderate atopic eczema severity were studied prospectively.
METHODS. Clinical history and eczema severity were documented. IgE-FS was assessed by the skin-prick test (SPT) (n = 51) and food-specific serum IgE antibody levels (CAP-FEIA test; n = 41). IgE-FS was diagnosed if the SPT or CAP-FEIA level exceeded the >95% predictive reference cutoff for positive food-challenge results.
RESULTS. On the basis of the SPT, 44 (86% [95% confidence interval (CI): 74%–95%]) of 51 infants had IgE-FS (cow's milk, 16%; egg, 73%; peanut, 51%). Using age-specific 95% predicted cutoff values, CAP-FEIA identified 34 (83% [95% CI: 68% to 93%]) of 41 infants with IgE-FS (cow's milk, 23%; egg, 90%). Forty-six (90%) infants had IgE-FS to at least 1 food item according to either the SPT or CAP-FEIA test.
CONCLUSIONS. Atopic eczema was found to be closely associated with IgE-FS in infants attending a dermatology department.
REVIEWER COMMENTS. These data should continue to fuel the ongoing debate, especially between allergists and dermatologists, regarding the role of food allergy in infants with atopic dermatitis (AD). This study addressed IgE-FS in infants who already had moderate-to-severe AD and who presented to a dermatology clinic for evaluation and management. These patients had test results (ie, skin testing or in vitro–specific IgE measurements) demonstrating likely clinical allergy to eggs, cow's milk, and/or peanuts on the basis of previous studies correlating test results with oral food-challenge outcomes. The vast majority (90%) of these infants with AD were sensitive to at least 1 of these foods, demonstrating a very strong association between infants with AD and IgE sensitization to common food allergens. Despite extensive data from this study and previous investigations demonstrating a relationship, the specific role of food allergy in AD remains a “hotly contested” area of clinical research and debate. At this point in time, the balance of clinical evidence favors a specific role of IgE-FS in the pathogenesis of AD.
- Copyright © 2008 by the American Academy of Pediatrics