The Association of Atopic Dermatitis and Food Allergies among Infants in our Primary Care Setting

Background: Food allergens are most relevant in infants with moderate to severe atopic dermatitis (AD) and when there is a history of reactions to food. Skin testing and specific IgE levels are useful diagnostic tools but predict probability, not necessarily the severity of allergic reactions. Children with early-onset severe AD have the greatest risk for positive IgE testing to foods.

Objective: Aim was to analyze the association of AD and food allergies among infants with AD in our primary care setting.

Methods: Retrospective analysis of our patients 1-12 month of age with AD and food allergy, in a period of 3 years (2015-2018). Descriptive statistical analysis was used.

Results: Overall 70 children age 1-12 months had AD. 43 boys (61.4%) and 27 girls (38.6%). Median age for AD was 5 months. Associated food allergy was found in 23 children (32.8%), of which 19 (82.6%) had moderate to severe AD and 4 (17.4%) had mild AD. Most patients 17 (73.9%) had strong positive skin testing for egg and peanut, with elevated specific IgE levels (mostly class 4), 4 patients (17.4%) had positive skin testing for egg, cow’s milk and soy, with specific IgE levels mostly class 3, and 2 patients (8.7%) had positive skin testing for wheat and soy, with specific IgE levels mostly class 3. All children were referred to pediatric dermatologist, elimination diet was introduced only to infants with confirmed food allergy. Most infants 20 (86.9%) with AD and food allergy were breastfed.

Conclusion: Among foods that have been implicated in refractory, moderate to severe AD, egg and peanut are the most common triggers, only 5% of all our infants with AD had a clinically relevant milk allergy. Testing should be considered when infants have severe AD refractory to standard treatments, and a history of a reaction to food.