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Eczema more severe in children with food allergy

Children who develop eczema early in life may be at a higher risk for food allergy and other allergic diseases later in life, and those with food allergy-associated atopic dermatitis developed the condition earlier and had more severe symptoms than those with non-atopic forms of the disorder, according to research presented during a poster session at the 2011 American Academy of Allergy, Asthma and Immunology Meeting.

“We know that foods may actually make eczema flare, but what this study shows is that children with eczema are more likely to develop food allergy than those without eczema,” the study’s principal researcher, Katie Allen, MBBS, BMedSc, FRACP, PhD, an allergist at the Murdoch Children’s Research Institute at the Royal Children’s Hospital in Melbourne, Australia, told Infectious Diseases in Children.

Allen and colleagues enrolled 2,464 infants aged 12 months to participate in the HealthNuts study. They performed skin-prick testing for peanut, sesame and egg allergies and conducted questionnaires to assess infant and family exposure. There were 299 participants who had eczema with food allergen sensitization and 377 children who had eczema but no food allergies.

On average, children with food-sensitized eczema experienced earlier age of onset (median, 3 vs. 4 months; P=.006), had higher rates of topical steroid use (80.1% vs. 68.5%; P=.009) and were more likely to have a current episode of atopic dermatitis at 12 months of age (60.2% vs. 45.2%; P<.001) compared with those not sensitized to food.

The study’s lead author and PhD scholar, Pamela Martin, BSc, found that both forms of the skin disorder were equally predicted by parental history of eczema, asthma and arthritis, raising the possibility that genetic factors may be involved.

“Our findings indicate that those children with onset of eczema in the first 3 months of life should be reviewed by allergists and be considered for skin-prick testing or testing for other food allergy,” Martin said.

A follow-up of the HealthNuts cohort is under way to determine whether children with eczema go on to develop other allergic conditions at ages 4 and 6 years, according to Martin.

Identifying children with eczema and food allergies early may enable pediatricians and allergists to treat their conditions more effectively; however, certain intervention strategies, including early introduction of potentially allergenic foods into the child’s diet as a preventive strategy and using barrier creams to prevent children at risk for eczema from becoming sensitized to food, are still being studied.

Additional data from the HealthNuts study, published in the October issue of the Journal of Allergy and Clinical Immunology, indicated that children who were introduced to cooked eggs between the ages of 4 and 6 months were five times less likely to develop egg allergy compared with infants who had egg introduced into their diet after 10 months of age.

Dr. Katie Allen

“At this point in time, there are a lot of hypotheses that are being formally tested. Within the next year or two, we should have data to inform parents about modifiable factors that may potentially prevent food allergy,” Allen said.

For more information:

• Dharmage SC. #124. Presented at: 2011 Annual Meeting of the American Academy of Allergy, Asthma & Immunology; March 18-22, 2011; San Francisco.
• Koplin JJ. J Allergy Clin Immunol. 2010;126:807-813.

Disclosure: The researchers reported no relevant financial disclosures.

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