Original Article
Assessment of IgE-mediated food allergies in children with atopic dermatitis
A. Mavroudia,
, A. Karagiannidoua, I. Xiniasa, D. Cassimosb, N. Karantaglisa, E. Farmakic, G. Imvriosd, M. Fotoulakie, M. Eboriadoue, J. Tsanakasa
Corresponding author
a Allergy Unit of the 3rd Pediatric Department, Aristotle University of Thessaloniki, Greece
b Department of Pediatrics, Democritus University of Thrace, Greece
c Immunology Unit 1st Pediatric Department, Aristotle University of Thessaloniki, Greece
d Organ Transplantation Unit, Aristotle University of Thessaloniki, Greece
e 4th Pediatric Department, Aristotle University of Thessaloniki, Greece
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The coding regions (±10 base pairs) of the <span class="elsevierStyleItalic">AICDA</span> gene (NM_020661) has been PCR amplified and sequenced. A homozygous single nucleotide variant has been identified at position c.455T<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>C in exon 4, which resulted in a homozygous missense mutation at position p.Val152Ala of the corresponding protein product. (B) PolyPhen-2 report for the pathogenicity of the amino acid substitution p.Val152Ala in <span class="elsevierStyleItalic">AICDA</span><a class="elsevierStyleCrossRef" href="#bib0215">[19]</a>.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Fazel, S. Kashef, S. Aleyasin, S. Harsini, Z. Karamizadeh, S. Zoghi, S.K. Flores, K. Boztug, N. Rezaei" "autores" => array:9 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Fazel" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Kashef" ] 2 => array:2 [ "nombre" => "S." 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"apellidos" => "Mavroudi" "email" => array:1 [ 0 => "antigonemavrudi@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Karagiannidou" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "I." "apellidos" => "Xinias" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "D." "apellidos" => "Cassimos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "N." 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"apellidos" => "Tsanakas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Allergy Unit of the 3rd Pediatric Department, Aristotle University of Thessaloniki, Greece" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Pediatrics, Democritus University of Thrace, Greece" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Immunology Unit 1st Pediatric Department, Aristotle University of Thessaloniki, Greece" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Organ Transplantation Unit, Aristotle University of Thessaloniki, Greece" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "4th Pediatric Department, Aristotle University of Thessaloniki, Greece" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Diagram 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 730 "Ancho" => 1588 "Tamanyo" => 110797 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Diagram of the study I.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Atopic dermatitis (AD), also known as atopic eczema, is a pruritic chronic inflammatory skin disease that affects 10–12% of the paediatric population.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">1</span></a> Allergic respiratory disease will develop in 50–80% of patients with AD later in life.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Food allergy has been strongly correlated with the development and persistence of AD, especially during infancy and early childhood. Skin is the site that is most often involved in food hypersensitivity reactions with pruritus being the most consistent sign. Several studies support a role of food-specific IgE antibodies in the pathogenesis of AD.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">3–5</span></a> Delayed reactions to food seem to play a role in exacerbations of AD in some patients. Oral Food Challenges (OFCs) have been used to examine if food allergens can induce symptoms of a pruritic type of rash, in children with food allergy and AD. In addition, OFC is the gold standard for the diagnosis of food allergy in subjects with AD.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">6,7</span></a> The aim of our study was to assign the prevalence of food allergy among a study group of children with AD and identify causal food allergens that are involved as trigger factors of AD. The prevalence of clinical active food allergy in paediatric populations with AD has not been extensively investigated. There have not been any previous studies investigating the severity of AD in relation to food sensitisation, eosinophilia or total IgE levels.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">Children between the age of 3 months and 7 years (27.55<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>19.53 months) referred to the Paediatric Allergy Clinic of the 3rd Paediatric Department, Aristotle University of Thessaloniki were evaluated for AD. The clinical criteria of the American Academy of Dermatology had to be fulfilled for establishing diagnosis.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">8</span></a> All patients who met the criteria were considered eligible for participating in the study.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Disease severity evaluation</span><p id="par0020" class="elsevierStylePara elsevierViewall">All the patients were evaluated for AD severity using the Scoring Atopic Dermatitis (SCORAD) index<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">9</span></a> by a Paediatric Allergist (A.M.) at the initial visit. Parents were informed by the Paediatric Allergist that children with AD may have worsening of their symptoms triggered by foods to which they are allergic. None of the patients were previously diagnosed with food allergy. Children with AD and not known or even possible diagnosis of food allergy were offered the opportunity for further investigation regarding food allergy. The parents of these children gave a written consent for participating in the study.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Allergy evaluation</span><p id="par0025" class="elsevierStylePara elsevierViewall">Total and specific IgE antibodies were measured in all patients included in the study with a widely used, commercially available fluorescence enzyme immunoassay (FEIA), (UniCAP™, Phadia, Uppsala, Sweden) in 10 food proteins: α-lactalbumin, ¿-lactoglobulin, casein, whole milk, egg yolk, egg white, wheat, soya, cod fish and beef, which are the most common food allergens in children.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">10</span></a> Microscopy was performed on peripheral blood smear in order to estimate the absolute eosinophil count.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Patients with positive results for specific IgE antibodies to at least one food allergen were contacted by a Paediatric Allergist to return for re-evaluation and counselling. The study was approved by the Ethics Committee of the Aristotle University of Thessaloniki, Greece.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Open Food Challenges (OFCs)</span><p id="par0035" class="elsevierStylePara elsevierViewall">All patients with AD and positive levels of specific IgE antibodies, based on the CAP-results, were considered for further evaluation of food allergy by an OFC to the foods to which they were sensitised. Patients with low-moderate levels of specific IgE antibodies to food allergens were considered eligible for an OFC for the relative food products. Patients who had a CAP value more than 95% of the cut-off predictive value for a positive reaction were considered allergic and were not challenged.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">All the study subjects were instructed to strictly avoid the relevant foods for a six-week period prior to the OFC and to discontinue antihistamine medications for at least 10 days. They were considered eligible for an OFC only after achieving a good control of their AD and reached the conservative treatment phase with the use of emollients alone or in combination with calcineurin inhibitors. OFC protocols were adopted from Niggerman et al.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">11</span></a> and Sicherer.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">12</span></a> All challenges were performed in the 3rd Paediatric Department of the Aristotle University of Thessaloniki under the supervision of a Paediatric Allergist (A.M.). Intravenous access was obtained and emergency medications were available during the challenge procedure. Cow's milk challenge was always started with a lip challenge followed by cow's milk administration after 20<span class="elsevierStyleHsp" style=""></span>min of patient observation. Cow's milk was administered orally with 20<span class="elsevierStyleHsp" style=""></span>min intervals in four consecutive doses of 5, 10, 30 and 150<span class="elsevierStyleHsp" style=""></span>ml of cow's milk containing 0.15, 0.3, 1 and 6.6<span class="elsevierStyleHsp" style=""></span>g of milk proteins respectively. Regarding the egg challenges, a well-cooked egg was used. Each challenge started with a cutaneous application of egg. A thin layer of cooked egg was placed on the patient's forearm and covered with tegaderm for 20<span class="elsevierStyleHsp" style=""></span>min. Subsequently, the dressings and the egg were removed and the patient was evaluated for local (wheal, erythema) or systemic (respiratory distress, hypotension, tachycardia, oxygen desaturation) symptoms and signs. If no reactions occurred, then well-cooked egg was administered orally with 20<span class="elsevierStyleHsp" style=""></span>min intervals in four consecutive doses of 0.5, 4, 10 and 30<span class="elsevierStyleHsp" style=""></span>g of cooked egg containing 0.12, 0.6, 1.25, and 3.75<span class="elsevierStyleHsp" style=""></span>g of egg proteins respectively. Regarding the wheat challenge, this was started with a cutaneous application of cooked wheat (bread) on the patient's forearm covered with tegaderm for 20<span class="elsevierStyleHsp" style=""></span>min. If no reaction occurred, then oral administration of the bread was completed in five consecutive doses of 1, 2, 4, 8 and 16<span class="elsevierStyleHsp" style=""></span>g containing 0.12, 0.6, 1.2, 2.4 and 4.8<span class="elsevierStyleHsp" style=""></span>g of wheat protein respectively, with 20<span class="elsevierStyleHsp" style=""></span>min intervals. Patients were discharged no earlier than six hours after the OFC had been completed and their parents were asked to report any reactions (exacerbation of eczema, pruritus, cough, wheeze, etc.) that might occur following the discharge and within a period of seven days. In subjects with more than one sensitisation consecutive food challenges were performed with 10 days interval.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Statistical analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">Statistical comparisons of patient proportions were performed by using the Chi-Square test or the Fisher's exact test accordingly. Mean value comparisons were performed using the Mann–Whitney <span class="elsevierStyleItalic">U</span> test which was considered appropriate when there was rejection of normality assumptions and low degrees of freedom. <span class="elsevierStyleItalic">p</span>-Values<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05 were considered statistically significant. SPSS 22.0 (IBM Corp., Armonk, NY, USA) was used for data analysis.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">Eighty-eight children with AD (59 boys and 29 girls from 3 months to 7 years of age, mean age 27.55<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>19.53 months) were subjected to investigation for concomitant food allergies. The study group was divided into two subgroups, on the basis of eczema severity: (a) with mild-moderate eczema (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>55, 62.5%) and (b) with severe eczema (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>33, 37.5%). Thirty-nine out of 88 subjects (44.31%) were sensitised to food allergens. Twenty (51.28%) were sensitised to only one food, while 19 (48.71%) had multiple sensitivities. (Chi-square: 0.017, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.895) (<a class="elsevierStyleCrossRef" href="#fig0015">Diagram 1</a>). Twenty-six out of 55 (47.27%) with mild-moderate AD and 13 out of 33 (39.39%) with severe AD were sensitised to various food allergens (Chi-square: 0.203, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.652).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Out of 39 patients sensitised to food allergens, 31 (79.48%) were sensitised to cow's milk, 22 (56.41%) to egg, eight (20.51%) to wheat, one patient was sensitised to cod (2.56%) and one to soya (2.56%) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Of 20 patients with a single sensitisation seven (35%) had severe AD, while among the 19 patients with multiple food sensitisations six (31.57%) had severe AD (Fisher's Test: 1, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.501) (<a class="elsevierStyleCrossRef" href="#fig0020">Diagram 2</a>). The percentages of sensitisation to one or more than one food proteins in relation to AD severity did not differ in a statistically significant manner.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Further evaluation with OFCs was performed in subjects with cow's milk (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>28), egg (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>19) and wheat (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>8) sensitisation and were positive to milk, egg and wheat in 11/28 (39.28%), 8/19 (42.34%) and 0/8 (0%) of cases, respectively (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). OFC was not offered in three subjects with sensitisation to cow's milk and three egg-sensitised patients with very high specific IgE levels. Seventeen subjects had positive OFCs to at least one food, while six were considered as allergic due to high levels of specific IgE antibodies to food proteins. Accordingly, a total of 23 out of 88 patients (26.13%) had a clinically active food allergy.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Forty-one of the 55 children with mild-moderate eczema (74.74%) and 29 out of 33 children with severe AD (87.87%) had increased total serum IgE (Chi-square is 0.252 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.615). Increased total serum IgE was found in (29/39) 74.35% food sensitised patients and in (41/49) 83.67% of the non-food sensitised patients with eczema (Chi-square: 0.132, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.715).</p><p id="par0070" class="elsevierStylePara elsevierViewall">Eleven out of 55 children with mild-moderate AD (20%) and nine out of 33 children with severe AD (27.27%) had peripheral blood eosinophilia (Chi-square is 0.385, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.534). Elevated peripheral blood eosinophils were found also in (11/39) 28.20% of the food sensitised patients and (10/49) 20.40% of the non-sensitised patients (Chi-square: 0.443, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.505). The patients’ rate of severe eczema was (9/39) 23.07% of the food sensitised patients versus (18/49) 36.07% of the patients without food sensitisations (Chi-square: 1.025, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.311).</p><p id="par0075" class="elsevierStylePara elsevierViewall">Comparison of the patients sensitised to food allergens (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>39) and the non-food sensitised (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>49) showed no significant difference of their mean SCORAD (Wilcoxon–Mann–Whitney Test) (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.502). There was no statistically significant difference of the mean SCORAD between the group of patients with a high total IgE and the group with normal IgE (Wilcoxon–Mann–Whitney Test) (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.937). There was no significant mean SCORAD difference between the patient groups with and without peripheral eosinophilia (Wilcoxon–Mann–Whitney Test) (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.907).</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">In this study, children with atopic dermatitis were investigated for clinically active food allergy. Forty-five percent of the children with diagnosed AD were sensitised to food allergens with no statistically significant difference with regards to food sensitisation between subjects with mild-moderate and severe AD. A total percentage of one every four children, of children with AD were truly allergic to milk and or/egg proteins. A percentage of 39.28% (11/28) milk-sensitised patients and 42.34% (8/19) egg-sensitised patients with AD had clinically active food allergy on the basis of the positive OFCs. The predictive value of specific IgE in patients with AD is unclear. Fleischer et al.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">13</span></a> found that allergy testing has a high false positive rate. In their study, negative food challenges occurred in 89% of 364 challenges in 125 children evaluated for AD.</p><p id="par0085" class="elsevierStylePara elsevierViewall">The majority of food sensitisation was referred to whole milk (80%) and a smaller percentage regarded egg sensitisation (55%), wheat (20%), cod and soya (2.5%). Previous studies have shown various rates of food allergy among different paediatric populations with AD.</p><p id="par0090" class="elsevierStylePara elsevierViewall">In the study of the atopic march, 15.9% of a population of >1000 infants with AD developed one or more IgE-mediated food allergies.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">14</span></a> Eigenmann et al. in 1998 for the first time connected AD with food allergy.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">4</span></a> Among 63 patients with AD food allergy was recognised in 23 patients based upon challenge results, “convincing” history, plus a predictive food-specific IgE antibody level as determined by CAP-System FEIA, and/or prick skin test. Twenty-three of the 63 (37%) patients were allergic to at least one food. Comparison of these 23 food-allergic patients with the 40 patients with negative evaluation regarding food allergy showed no significant difference in median SCORAD. The median ages of those with and without food allergy were also similar. The study by Burks et al. showed a higher prevalence of food allergy among children with AD (37%).<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">15</span></a> Wahn et al., in a cohort study performed in children with AD estimated that IgE responses to hen's egg proteins (42%) were most prevalent, while sensitisation to cow's milk and peanut was detected in 24–27% of the children.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">16</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">The patient rates with severe AD were not elevated among food-sensitised children versus those without sensitisation. The use of the SCORAD scale in clinical trials is considered a reliable tool which is not affected by subjective parameters.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">9</span></a> There was no significant mean SCORAD difference between food-sensitised and non-sensitised patients in keeping with previous studies. Guillet and Guillet reported an increasing prevalence of food allergy among patients with increasing severity of AD. However, they did not detect a difference in the prevalence of food allergy in relation to the severity of the disease. Patients with and without food allergy had similar SCORAD scores.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">17</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The majority of the patients who were diagnosed with eczema had a high total IgE, as shown by previous studies, regardless of disease severity. Although the pathogenesis of AD is unknown, several factors suggest a role for IgE-mediated hypersensitivity. Several studies have shown that serum IgE concentrations were elevated in about 50–80% of children with AD.<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">18–20</span></a> In the present study, the rate of a high total IgE was not related to food sensitisation and the severity of the disease. To our knowledge, there are no previous studies comparing the rate of high total IgE between food-sensitised versus non-sensitised patients or between patients with mild-moderate and severe eczema.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Peripheral blood eosinophilia was present in similar rates in the groups of patients with mild-moderate and severe AD. In a previous study it has been suggested that disease severity is an important factor in determining high blood eosinophil levels in AD.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">21</span></a> In this study there has not been a significant difference between food-sensitised patients and those without in terms of peripheral eosinophilia. With regard to disease severity the SCORAD value was not significantly increased among patients with peripheral eosinophilia. There are no previous studies comparing the rate of eosinophilia between food-sensitised versus non-sensitised patients or between patients with mild-moderate and severe eczema.</p><p id="par0110" class="elsevierStylePara elsevierViewall">A limitation of the study is that it assesses the prevalence of clinically-active food allergy only among patients with IgE-mediated food allergies. However, eczema is regarded a clinical manifestation of delayed hypersensitivity. Therefore, it is likely that there must have been children among those who had a negative investigation for food allergy who would benefit from a hypoallergenic diet, such as milk and egg free diet and if challenged after a 4–6-week period of an elimination diet they would probably have had a positive OFC. In that case the percentage of children with eczema and clinically active food allergy would be higher. The association between non-IgE-mediated food allergy and eczema in children has not been well investigated and remains a target for future research.</p><p id="par0115" class="elsevierStylePara elsevierViewall">In conclusion, food allergy was diagnosed at a rate of one every four children of the study group with AD, regardless of disease severity and while sensitisation was found in 44.31% of them. A high total serum IgE and peripheral eosinophilia was recognised in approximately 80% and 25% of the patients’ sample, respectively, regardless of the disease severity and food sensitisation. Food allergy can be hidden in a significant percentage of children with AD and may be a trigger factor that keeps on pumping water to the waterfall of AD. Clinicians need to seek from history possible suspicious allergens in foods. Further investigations and OFCs will establish the diagnosis of underlying food allergies in children with AD. It is a difficult task for the clinicians to break the vicious circle of AD and food allergy seems to be a hidden trigger in some children with AD. It is important to explore from history, such a connection and screen all cases of children with AD, regardless of disease severity.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflicts of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">None.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Ethical disclosures</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Confidentiality of data</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work centre on the publication of patient data and that all the patients included in the study have received sufficient information and have given their informed consent in writing to participate in that study.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Right to privacy and informed consent</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appears in this article.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Protection of human subjects and animals in research</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this investigation.</p></span></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres783850" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Aim" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec782740" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Disease severity evaluation" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Allergy evaluation" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Open Food Challenges (OFCs)" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical analysis" ] ] ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Results" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflicts of interest" ] 7 => array:3 [ "identificador" => "sec0050" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Confidentiality of data" ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "Right to privacy and informed consent" ] 2 => array:2 [ "identificador" => "sec0065" "titulo" => "Protection of human subjects and animals in research" ] ] ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-02-18" "fechaAceptado" => "2016-06-22" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec782740" "palabras" => array:5 [ 0 => "Atopic dermatitis" 1 => "Children" 2 => "Eczema" 3 => "Food allergy" 4 => "Food hypersensitivity reactions" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Atopic dermatitis (AD) is an inflammatory disease of the skin, which is characterised by a chronic relapsing course.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Aim</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The aim of the study was to assign the prevalence of clinically active food allergies among a group of children between 3 months and 7 years of age, with AD.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Eighty-eight children with AD were screened for specific IgE antibodies to food proteins. All patients with AD and specific IgE antibodies to food proteins were subjected to Oral Food Challenges (OFCs) with the relevant foods.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Food-sensitised patients with moderate levels of sIgE had clinically active food allergy to milk (39.28%) and egg (42.34%) on the basis of positive OFCs. High IgE and eosinophilia had a prevalence of almost 80% and 25%, regardless of concomitant food sensitisation and disease severity.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">In this study, clinically active food allergies were recognised in 26.13% of children with AD. Nevertheless, no association was confirmed between food sensitisation and AD severity. High IgE and peripheral eosinophilia have not been found more prevalent among children with severe AD nor among children with food sensitisation. Infants and younger children with AD should be screened for an underlying food allergy, regardless of disease severity.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Aim" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1064 "Ancho" => 2377 "Tamanyo" => 73031 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The prevalence of food sensitisation of specific food allergens among the group of patients with atopic dermatitis who were found sensitised to food allergens.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1027 "Ancho" => 1626 "Tamanyo" => 46372 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The prevalence of positive Oral Food Challenges to milk, egg and wheat among children with atopic dermatitis who had moderate levels of specific IgE antibodies to the relevant foods.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Diagram 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 730 "Ancho" => 1588 "Tamanyo" => 110797 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Diagram of the study I.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Diagram 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 779 "Ancho" => 1304 "Tamanyo" => 60765 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Diagram of the study II – CM: abbreviation for cow's milk.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib0110" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of atopic dermatitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 0 | 6 |
| 2024 October | 38 | 4 | 42 |
| 2024 September | 54 | 13 | 67 |
| 2024 August | 50 | 15 | 65 |
| 2024 July | 44 | 3 | 47 |
| 2024 June | 57 | 7 | 64 |
| 2024 May | 43 | 5 | 48 |
| 2024 April | 42 | 5 | 47 |
| 2024 March | 103 | 12 | 115 |
| 2024 February | 75 | 15 | 90 |
| 2024 January | 105 | 14 | 119 |
| 2023 December | 94 | 28 | 122 |
| 2023 November | 104 | 8 | 112 |
| 2023 October | 145 | 22 | 167 |
| 2023 September | 93 | 11 | 104 |
| 2023 August | 82 | 8 | 90 |
| 2023 July | 95 | 8 | 103 |
| 2023 June | 94 | 7 | 101 |
| 2023 May | 81 | 13 | 94 |
| 2023 April | 72 | 4 | 76 |
| 2023 March | 85 | 12 | 97 |
| 2023 February | 36 | 3 | 39 |
| 2023 January | 55 | 8 | 63 |
| 2022 December | 39 | 10 | 49 |
| 2022 November | 55 | 10 | 65 |
| 2022 October | 43 | 12 | 55 |
| 2022 September | 62 | 27 | 89 |
| 2022 August | 72 | 28 | 100 |
| 2022 July | 35 | 11 | 46 |
| 2022 June | 31 | 14 | 45 |
| 2022 May | 48 | 14 | 62 |
| 2022 April | 44 | 14 | 58 |
| 2022 March | 21 | 11 | 32 |
| 2022 February | 18 | 9 | 27 |
| 2022 January | 29 | 14 | 43 |
| 2021 December | 18 | 16 | 34 |
| 2021 November | 51 | 13 | 64 |
| 2021 October | 32 | 13 | 45 |
| 2021 September | 24 | 18 | 42 |
| 2021 August | 39 | 11 | 50 |
| 2021 July | 15 | 12 | 27 |
| 2021 June | 28 | 7 | 35 |
| 2021 May | 23 | 6 | 29 |
| 2021 April | 29 | 20 | 49 |
| 2021 March | 17 | 21 | 38 |
| 2021 February | 28 | 15 | 43 |
| 2021 January | 30 | 16 | 46 |
| 2020 December | 1 | 1 | 2 |
| 2020 October | 1 | 0 | 1 |
| 2020 July | 0 | 1 | 1 |
| 2019 February | 1 | 2 | 3 |
| 2018 March | 0 | 1 | 1 |
| 2018 February | 2 | 5 | 7 |
| 2018 January | 13 | 0 | 13 |
| 2017 December | 3 | 3 | 6 |
| 2017 November | 2 | 3 | 5 |
| 2017 February | 1 | 0 | 1 |
| 2017 January | 2 | 0 | 2 |
| 2016 November | 0 | 1 | 1 |
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