Oral Food Challenge Failures Frequent in Patients With Atopic Dermatitis

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Investigators examined whether excessive food allergy testing in patients with atopic dermatitis might lead to food intolerance when certain foods are removed from the diet.

In patients with atopic dermatitis (AD), families and healthcare providers need to be cognizant of the risks associated with excessive testing and diet manipulation in their attempts to manage the disorder, which includes the loss of tolerance to a particular food when it is removed from the diet. According to the results of a retrospective chart review published in the Annals of Allergy, Asthma & Immunology, the frequency of oral food challenge (OFC) failure in patients who removed foods suspected of being triggers of AD was 13.3%.

The investigators recognized that the removal of foods from the diet in an attempt to manage AD, according to positive allergy tests, may lead to immediate allergic reactions upon reintroduction of that food, so they sought to examine the frequency of OFC failures in foods removed from the diet as suspected AD triggers. They focused on the 5 major food allergens in the United States: egg, milk, peanut, soy, and wheat.

The current study evaluated OFCs for the 5 major food allergens performed between 2008 and 2014 at the allergy clinic of a US children’s hospital. Oral food challenges were offered to patients according to laboratory values and history. Reasons for food avoidance were classified as food allergy (ie, immunoglobulin E-mediated reaction occurring within 2 hours), sensitization only (lack of introduction of the food because of positive test results), and removal of the food because of test results during evaluation of AD.

A total of 442 OFCs were performed, with 20.1% (89/442) considered failures. The reasons patients underwent OFCs were a history of food allergy (72.4% [320/442]), food sensitization without any introduction (17.4% [77/442]), and the presence of AD (102% [45/442]).

Of note, OFC failures in patients with food allergy (21.9% [70/320]), patients with sensitization only (16.9% [13 of 77], and patients with AD (13.3% [6 of 45]) did not differ significantly (P =.63). Wheat was significantly more likely to be avoided than the other 4 food allergens because of concerns about AD (P <.0001).

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The investigators concluded that the restriction of foods in an attempt to manage AD must be conducted with caution and close monitoring. Primary care providers need to counsel families on the limits of using allergy testing and diet changes to address AD. Families should be advised to use such measures as skin hydration, topical medications, and emollients to address AD.

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Eapen AA, Kloepfer KM, Leickly FE, Slaven JE, Vitalpur G. Oral food challenge failures among foods restricted due to atopic dermatitis [published online October 13, 2018]. Ann Allergy Asthma Immunol. doi:10.1016/j.anai.2018.10.012