Randomized Controlled Trial of Advice on an Egg Exclusion Diet inYoung Children with Atopic Eczema and Sensitivity to Eggs

Hugh A. Sampson

Lever R,
MacDonald C,
Waugh P,
Aitchison T

(1998) Pediatr Allergy Immunol. 9:13–19.

Purpose of the Study

The role of exclusion diets in the management of atopic dermatitis (AD) in young children remains controversial. The aim of this randomized, controlled trial was to evaluate the effect of excluding egg from the diet in young children with AD and sensitivity to eggs.

Methods

Fifty-five children with AD and egg sensitivity were randomized either to a 4-week egg exclusion diet (diet group, n = 28) or no diet (control, n = 27). The mothers of all children were given advice on the general care of eczema. Randomization for the dietary phase took place only after optimal control of the eczema was achieved and the child was stable on maintenance treatment (mean = 3.5 months). Disease activity was assessed by estimates of the surface area affected by eczema and by an arbitrary severity score. Possible egg sensitivity was identified by radioallergosorbent test (RAST) before randomization and after the trial by double-blind, placebo-controlled egg challenge.

Results

Overall, two thirds of the children with positive RAST results to egg experienced a positive reaction during double-blind challenge. After the dietary period, the dietary group experienced a significantly greater mean reduction in surface area affected by eczema than the control group (P = .02); from 19.6% to 10.9% area affected in dietary group compared with the 21.9% to 18.9% reduction in the control group. A significant improvement also was seen in the severity score (P = .04); from 33.9 to 24.0 units for the dietary group compared with a decrease from 36.7 to 33.5 in the control group. Egg-sensitive patients in the control group were then placed on a 4-week egg exclusion diet and also showed significant improvement in their severity scores.

Conclusions

The authors concluded that advice on the dietary exclusion of eggs is useful as part of the overall management of young children with atopic eczema and sensitivity to eggs.

Reviewer's Comments

Allergists and dermatologists continue to disagree over the role of allergic inflammation in children with AD. A recent study demonstrated that almost 40% of children presenting to a university dermatology clinic with moderate to severe AD have food hypersensitivity (see below). This study by Dr Lever and her dermatology colleagues demonstrates that removal of a food allergen from the diet of a food allergic patient leads to improvement in eczematous symptoms. In fact, it is somewhat remarkable that significant differences were observed in this relatively small number of patients, in such a short period of time, with the exclusion of a single food after an intensive topical steroid regimen. It would have been interesting to see whether a more complete dietary assessment and longer follow-up would have produced even more striking results, and information on whether a significant reduction in medication requirements occurred in the dietary group.