A third of caregivers report mild improvements in child’s AD with elimination diets

Key takeaways:

• The most common triggers included milk, tree nuts, seeds, peanuts and eggs.
• 23% of caregivers removed suspected foods from their child’s diet.
• 79% reintroduced foods with no recurrence of symptoms.

BOSTON — About one-third of children with atopic dermatitis saw mild improvements with elimination diets, according to an abstract presented at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting.

Presented by Nadia Makkoukdji, MD, pediatrics resident at the University of Miami, the cross-sectional study surveyed 298 caregivers of children with AD seen at an ED and at allergy, dermatology and general pediatrics clinics at a single academic center.

“One of my friend's daughters has been struggling with uncontrolled eczema, and despite my efforts to encourage her to come in for a formal evaluation by an allergist or dermatologist, she had been hesitant,” Makkoukdji told Healio.

Nadia Makkoukdji

This friend primarily was concerned that she would arrive at the clinic with her daughter on a highly nutritious diet and then leave with a new restrictive diet, Makkoukdji said, adding that this fear of drastic dietary changes unfortunately often prevents families from seeking the care that their children need.

“I have also seen in my experiences in allergy clinic many patients who had started food elimination diets recommended by other doctors or just started by families themselves for atopic dermatitis and the dangers that this could lead to, such as the development of IgE-mediated food allergies on reintroduction, malnutrition and mental health disorders,” she continued.

“The standard of care at our institution is not to start food elimination diets for atopic dermatitis, and it is against recent guidelines,” Makkoukdji said. “I started this study to explore parental perceptions regarding food elimination diets in management of their children’s atopic dermatitis in our local Miami population.”

The caregivers and children in the study were diverse in terms of language, sex and race, Makkoukdji said. For example, 65% of the households primarily spoke English and 35% primarily spoke Spanish. Also, 55% of the children were girls.

The children additionally included 46% who identified as white, 29% who identified as Black or African American, 13% who identified as two or more races, 3% who identified as Asian, 0.3% who identified as American Indian or Alaska Native, and 8% who did not disclose any race.

Among the caregivers surveyed, 58% (n = 119/205) reported that specific foods did not exacerbate their child’s AD. The most common triggers included milk (32%; n = 61/193); tree nuts, seeds or peanuts (16%; n = 31/193); and eggs (11%; n = 22/193).

“Our participants followed elimination diets ranging from 1 month to over a year,” Makkoukdji said.

The 193 caregivers who identified foods that triggered AD included 19% (n = 36%) who changed their baby’s formula, 20% (n = 39) who eliminated certain foods from their own diets while breastfeeding and 23% (n = 44) who completely removed suspected foods from their child’s diet.

This group also included 38% (n = 33/87) who said there was no improvement in their child’s AD, 35% (n = 30/87) who said there was a 25% improvement and 9% (n = 8/87) who said the AD had completely resolved.

Further, 79% said they reintroduced the foods that were eliminated back into their child’s diet without any AD symptoms returning (P < .001).

“This outcome was both statistically and clinically significant,” Makkoukdji said.

Based on these findings, the researchers concluded that caregivers’ understanding of AD and its links with diet had a significant impact on their child’s diet and added that larger studies are necessary to confirm these findings and explore the role of diet in AD.

“Dietary modifications, despite adherence, often show limited or no effect on eczema control without confirmed food allergies, as reflected in several other previously published studies,” Makkoukdji said. “However, our study shows that food elimination diets are still commonly being used by parents in the local Miami population.”

Makkoukdji also emphasized that restrictive diets can lead to malnutrition, emotional stress in children, and anxiety or depression, while adding stress to parents and the entire family.

Next, Makkoukdji and her colleagues plan on building on the insights gained from this data collection and further exploring how various factors influence parental perceptions of atopic dermatitis management.

“The data highlight that parents’ beliefs about atopic dermatitis flares can be shaped by a range of factors, including their own demographics, family experiences and outdated recommendations or practices,” she said.

The researchers will focus on writing a full manuscript that provides a comprehensive discussion of all their findings.

“This will include a deeper analysis of how these perceptions impact treatment decisions, as well as the potential consequences for children’s health,” Makkoukdji said.

The manuscript also will aim to adhere to practice recommendations offered by the Joint Task Force on Practice Parameters from the ACAAI and American Academy of Allergy, Asthma & Immunology.

Reference:

• Study: Parents’ understanding of atopic dermatitis may influence child’s diet. Published Oct. 24, 2024. Accessed Oct. 24, 2024.

For more information:

Nadia Makkoukdji, MD, can be reached at nadiamakkdep@gmail.com.