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Children with severe eczema may not outgrow their allergies to milk, eggs

Children who have severe atopic dermatitis are less likely to outgrow their milk or egg allergy, according to research presented during the 2011 Annual Meeting of the American Academy of Allergy, Asthma & Immunology in San Francisco.

“While our clinical impression has been that the natural course of food allergy might be related to coexisting atopic dermatitis, previous studies had not provided any clear answers to this important question,” study researcher Robert A. Wood, MD, said in a press release.

As part of the Consortium of Food Allergy Research (CoFAR), researchers from Duke University, Johns Hopkins University, Mount Sinai School of Medicine, National Jewish Health, the National Institute of Allergy and Infectious Diseases, and the University of Arkansas enrolled more than 500 children aged 3 to 15 months. The children had either a convincing history of egg or milk allergy with a positive prick skin test or moderate-severe atopic dermatitis and a positive prick skin test to milk or egg.

Atopic dermatitis severity was scored at baseline and 2 years and was analyzed categorically as none-mild or moderate-severe. Milk and egg allergy was based upon clinical history and food-specific immunoglobulin E with resolution established by successful ingestion of the trigger food.

During 2 years of observation, 46% of children with none-mild eczema at enrollment outgrew their milk allergy vs. 25% of the children enrolled with moderate-severe eczema. Improved eczema severity was not associated with food allergy resolution. Among those with moderate-severe eczema at enrollment who improved to mild or no eczema, 19% resolved their food allergy compared with 32% who remained moderate-severe.

Thirty-nine percent of children with none-mild eczema at enrollment outgrew their egg allergy vs. 21% who were enrolled with moderate-severe eczema. Of those children who had moderate-severe eczema at enrollment who improved to none-mild during a 2-year period, 28% resolved their allergy compared with 22% who remained moderate-severe.

“This is another practical point that a clinician can take back to their practice to have a better idea of how to manage these patients and which of these clinical factors may be useful in predicting the outgrowing of an allergy,” Wood said during a press conference at the meeting.

In conjunction with another CoFAR study, Wood and colleagues also observed a sample of 244 children who were milk allergic at baseline. Milk allergy was based upon clinical history and food-specific IgE with resolution established by successful ingestion of the trigger food.

Of the 244 children, 89 had outgrown their food allergy by month 30 of follow-up, indicating a 39.6% probability of milk allergy resolution. The median age at resolution was 2 years.

In addition, several baseline factors were found to be associated with resolution of milk allergy in the participating children. These were lower milk IgE, a smaller wheal from the prick skin test and mild-none vs. severe atopic dermatitis.

“If you had a low milk-specific IgE, less than 2 on the immunoCAP test, about 75% of those babies outgrew milk allergy in the observation period. If you look at those who had higher numbers, greater than 10, only 7% of those babies outgrew their allergy,” Wood said. “There is a very significant difference based just on that initial IgE level or skin test.”

According to Wood, these findings may offer help to clinicians on how to care for infants with eczema and milk or egg allergy and also provide more accurate advice to parents about the likely course of their child’s allergy.

For more information:

• Scurlock AM. #126. Presented at: 2011 Annual Meeting of the American Academy of Allergy, Asthma & Immunology; March 18-22, 2011; San Francisco.
• Wood R. #268. Presented at: 2011 Annual Meeting of the American Academy of Allergy, Asthma & Immunology; March 18-22, 2011; San Francisco.

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