• Effect of diet on eczema
      The Article:
      Lever R, MacDonald C, Waugh P, Aitchison T. Randomised controlled trial of advice on an egg exclusion diet in young children with atopic eczema and sensitivity to eggs. Pediatr Allergy Immunol 1998; 9: 13-19

      The problem:
      Food allergies may worsen eczema in some young children. Eczema is usually treated with topical steroids but it is unclear how useful exclusion diets are in the overall treatment of eczema.

      The study:
      Researchers conducted a 4-week clinical trial in 55 children under the age of 2 who had eczema and sensitivity to eggs. The study only included children with egg sensitivity because an egg-free diet is relatively easy for parents to follow after careful instruction by a dietician. The children were divided into 2 groups. Both groups were given general information about treatment of eczema. After instruction and information from dietician, one group excluded egg and egg proteins from the children’s diet, while the other group (control group) continued their normal diet. Both groups continued to treat their eczema with topical steroids. The success of the egg-free diet was measured by measurement of the surface skin area affected by eczema and a severity score of the symptoms caused by the eczema.

      The results:
      Although the skin area affected by eczema was reduced in both groups, the improvement in the group who avoided egg in their diet was much greater than in the control group, who continued their normal diet. The severity scores followed the same pattern. The diet group had a significant decrease in the severity of symptoms caused by the eczema than the control group.

      The conclusion:
      Researchers concluded that children with eczema and egg sensitivity may benefit from a treatment that includes avoidance of eggs and egg products from the children’s diet. Further trials that focus on patients with other specific food allergies are needed.

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    • Food allergy testing for skin rash
      The article:
      Niggemann B, Sielaff B, Beyer K, Binder C, Wahn U. Outcome of double-blind, placebo-controlled food challenge tests in 107 children with atopic dermatitis. In: Clinical and Experimental Allergy, Vol 29, pp 91-96, 1998.

      The problem:
      The effect of food allergy on the degree of skin inflammation and eczema in infants and children has long been questioned. Furthermore, there is a need for reliable measurements for identifying relevant skin reactions in cases of food allergy.

      The study:
      Researchers in Germany conducted a clinical trial in which 107 children suffering from moderate to severe atopic dermatitis (AD) were tested for skin and other allergic reactions to hen’s egg, cow’s milk, soy and wheat protein. The children were fed solutions of each individual allergen mixed with banana flavouring to mask the identity of the allergen. Each child received 2 allergens and one placebo, and the time interval between each dose was 30 minutes. Testing was stopped if clinical signs were observed or the highest dose was reached. The children were observed on an in-patient basis for up to 48 hours after each allergen or placebo challenge.

      The results:
      Of the 107 children tested, 87 (81%) showed a positive reaction to at least one challenge. Forty-nine of the children reacted to one of the allergens tested (56%) and only 5 children (6%) reacted to more than 3 oral challenges. The skin was the most affected organ in positive challenges (94%), followed by digestive reactions (34%) and respiratory symptoms (16%). No anaphylactic reactions were noted in this trial.

      The conclusion:
      The trial shows that double-blind, placebo-controlled oral food challenges are useful in distinguishing children with clinically manifest signs of allergy from among those with suspected food-related allergies. The researchers concluded that accurately identifying children with a food allergy would help doctors to prescribe specific diets on a scientific basis and treat these patients more safely.

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