Nutrition Research and Practice

The Korean Nutrition Society (한국영양학회)
권호 표지
DOI QR코드

DOI QR Code

The effects of elimination diet on nutritional status in subjects with atopic dermatitis

  • Kim, Jungyun (Department of Food & Nutrition, Seojeong College) ;
  • Kwon, Jaryoung (Department of Food & Nutrition, Hanyang University) ;
  • Noh, Geunwoong (Division of Allergy and Clinical Immunology, Department of Pediatrics, Chungnam National University Hospital) ;
  • Lee, Sang Sun (Department of Food & Nutrition, Hanyang University)
  • Received : 2013.03.06
  • Accepted : 2013.09.23
  • Published : 2013.12.01
Download PDF
⟨ Previous Next ⟩

Abstract

A food allergy is an adverse health effect arising from a specific immune response that occurs reproducibly upon exposure to a given food. In those with food allergies that are thought to cause aggravation of eczema, food avoidance is important. The objective of this study was to research the nutritional status of patients with food allergies. A total of 225 subjects diagnosed with atopic dermatitis underwent a skin prick test as well as measurement of serum immunoglobulin E. Food challenge tests were conducted using seven food items: milk, eggs, wheat, soybeans, beef, pork, and chicken. At post-food challenge visits to the test clinic, participants completed a three-day dietary record, which included two week days and one weekend day, in order to evaluate energy intake and diet quality during the challenge. We analyzed nutrient intake based on differential food allergens. Subjects with a food allergy to milk showed lower intake of Ca, Zn, and vitamin B2, and subjects with a food allergy to egg showed lower intake of vitamin A, B1, B2, niacin, and cholesterol. Subjects with a food allergy to wheat and soybean showed lower intake of Ca, P, Fe, K, Zn, vitamin B2, vitamin B6, and niacin; and subjects with a food allergy to beef, pork, and chicken showed lower intake of Fe and higher intake of K, vitamin A, B2. Subjects with atopic dermatitis were lacking in several nutrients, including vitamin A and vitamin C. A greater number of food allergies showed an association with a greater number of nutrient intake deficiencies. Allergen avoidance is the basic treatment for atopic dermatitis. However, when the allergen is food, excessive restriction can lead to nutrition deficiency. Findings of this study suggest the necessity for enhanced nutritional education in order to provide substitute foods for patients with food allergies who practice food restriction.

Keywords

References

  1. Bieber T. Atopic dermatitis. N Engl J Med 2008;358:1483-94. https://doi.org/10.1056/NEJMra074081
  2. Hahn EL, Bacharier LB. The atopic march: the pattern of allergic disease development in childhood. Immunol Allergy Clin North Am 2005;25:231-46. https://doi.org/10.1016/j.iac.2005.02.004
  3. NIAID-Sponsored Expert Panel; Boyce JA, Assa'ad A, Burks AW, Jones SM, Sampson HA, Wood RA, Plaut M, Cooper SF, Fenton MJ, Arshad SH, Bahna SL, Beck LA, Byrd-Bredbenner C, Camargo CA Jr, Eichenfield L, Furuta GT, Hanifin JM, Jones C, Kraft M, Levy BD, Lieberman P, Luccioli S, McCall KM, Schneider LC, Simon RA, Simons FE, Teach SJ, Yawn BP, Schwaninger JM. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAIDsponsored expert panel. J Allergy Clin Immunol 2010;126:S1-58. https://doi.org/10.1016/j.jaci.2010.10.007
  4. Ebisawa M. Management of food allergy in Japan "food allergy management guideline 2008 (revision from 2005)" and "guidelines for the treatment of allergic diseases in schools". Allergol Int 2009;58:475-83. https://doi.org/10.2332/allergolint.09-RAI-0143
  5. Ito K, Urisu A. Diagnosis of food allergy based on oral food challenge test. Allergol Int 2009;58:467-74. https://doi.org/10.2332/allergolint.09-RAI-0140
  6. Nowak-Wegrzyn A, Assa'ad AH, Bahna SL, Bock SA, Sicherer SH, Teuber SS; Adverse Reactions to Food Committee of American Academy of Allergy, Asthma & Immunology. Work Group report: oral food challenge testing. J Allergy Clin Immunol 2009;123:S365-83. https://doi.org/10.1016/j.jaci.2009.03.042
  7. Sicherer SH. Epidemiology of food allergy. J Allergy Clin Immunol 2011;127:594-602. https://doi.org/10.1016/j.jaci.2010.11.044
  8. Breuer K, Heratizadeh A, Wulf A, Baumann U, Constien A, Tetau D, Kapp A, Werfel T. Late eczematous reactions to food in children with atopic dermatitis. Clin Exp Allergy 2004;34: 817-24. https://doi.org/10.1111/j.1365-2222.2004.1953.x
  9. Bock SA, Lee WY, Remigio L, Holst A, May CD. Appraisal of skin tests with food extracts for diagnosis of food hypersensitivity. Clin Allergy 1978;8:559-64. https://doi.org/10.1111/j.1365-2222.1978.tb01509.x
  10. Pelkonen AS., Kuitunen M, Dunder T, Reijonen T, Valovirta E, Mäkelä MJ. Allergy in children: practical recommendations of the Finnish allergy programme 2008-2018 for prevention, diagnosis, and treatment. Pediatr Allergy Immunol 2012;23:103-16. https://doi.org/10.1111/j.1399-3038.2012.01298.x
  11. Chafen JJ, Newberry SJ, Riedl MA, Bravata DM, Maglione M, Suttorp MJ, Sundaram V, Paige NM, Towfigh A, Hulley BJ, Shekelle PG. Diagnosing and managing common food allergies: a systematic review. JAMA 2010;303:1848-56. https://doi.org/10.1001/jama.2010.582
  12. Sampson HA, Albergo R. Comparison of results of skin tests, RAST, and double-blind, placebo-controlled food challenges in children with atopic dermatitis. J Allergy Clin Immunol 1984;74: 26-33. https://doi.org/10.1016/0091-6749(84)90083-6
  13. Bindslev-Jensen C, Ballmer-Weber BK, Bengtsson U, Blanco C, Ebner C, Hourihane J, Knulst AC, Moneret-Vautrin DA, Nekam K, Niggemann B, Osterballe M, Ortolani C, Ring J, Schnopp C, Werfel T; European Academy of Allergology and Clinical Immunology. Standardization of food challenges in patients with immediate reactions to foods--position paper from the European Academy of Allergology and Clinical Immunology. Allergy 2004;59:690-7. https://doi.org/10.1111/j.1398-9995.2004.00466.x
  14. Kurihara K. Immunotherapy for food allergy. Allergol Int 2010; 59:9-14. https://doi.org/10.2332/allergolint.09-RAI-0152
  15. Fox AT, Du Toit G, Lang A, Lack G. Food allergy as a risk factor for nutritional rickets. Pediatr Allergy Immunol 2004; 15:566-9. https://doi.org/10.1111/j.1399-3038.2004.00158.x
  16. Noh GW, Ji EJ, Park JN, Kim KH, Do MH, Lee EK, Lee SS. The importance of food open challenge test in atopic dermatitis: the comparison of allergy history, skin-prick test, and specific IgE detection. Nutr Sci 1999;2:119-24.
  17. Lee SS, Lee KY, Noh G. The necessity of diet therapy for successful interferon-gamma therapy in atopic dermatitis. Yonsei Med J 2001;42:161-71. https://doi.org/10.3349/ymj.2001.42.2.161
  18. The Korean Nutrition Society. Dietary Reference Intakes For Koreans. Seoul: The Korean Nutrition Society; 2010.
  19. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venereol Suppl (Stockh) 1980;(92):S44-7.
  20. Liu AH, Jaramillo R, Sicherer SH, Wood RA, Bock SA, Burks AW, Massing M, Cohn RD, Zeldin DC. National prevalence and risk factors for food allergy and relationship to asthma: results from the National Health and Nutrition Examination Survey 2005-2006. J Allergy Clin Immunol. 2010;126:798-806. https://doi.org/10.1016/j.jaci.2010.07.026
  21. Chang EY, Chung SW, Lee JH. Mother's experience of caring child with a severe atopic dermatitis. Korean Parent Child Health J 2006;9:17-32.
  22. Romieu I, Trenga C. Diet and obstructive lung diseases. Epidemiol Rev 2001;23:268-87. https://doi.org/10.1093/oxfordjournals.epirev.a000806
  23. Arora P, Kumar V, Batra S. Vitamin A status in children with asthma. Pediatr Allergy Immunol 2002;13:223-6. https://doi.org/10.1034/j.1399-3038.2002.00010.x
  24. Cook DG, Carey IM, Whincup PH, Papacosta O, Chirico S, Bruckdorfer KR, Walker M. Effect of fresh fruit consumption on lung function and wheeze in children. Thorax 1997;52:628-33. https://doi.org/10.1136/thx.52.7.628
  25. Forastiere F, Pistelli R, Sestini P, Fortes C, Renzoni E, Rusconi F, Dell'Orco V, Ciccone G, Bisanti L. Consumption of fresh fruit rich in vitamin C and wheezing symptoms in children. SIDRIA Collaborative Group, Italy (Italian Studies on Respiratory Disorders in Children and the Environment). Thorax 2000;55:283-8. https://doi.org/10.1136/thorax.55.4.283
  26. Cunningham-Rundles S, McNeeley DF, Moon A. Mechanisms of nutrient modulation of the immune response. J Allergy Clin Immunol 2005;115:1119-28. https://doi.org/10.1016/j.jaci.2005.04.036
  27. Novak N, Leung DY. Diet and allergy: you are what you eat? J Allergy Clin Immunol 2005;115:1235-7. https://doi.org/10.1016/j.jaci.2005.04.004

Cited by

  1. Sensitivity to food additives, vaso-active amines and salicylates: a review of the evidence vol.5, pp.1, 2015, https://doi.org/10.1186/s13601-015-0078-3
  2. The ins and outs of managing avoidance diets for food allergies vol.28, pp.4, 2016, https://doi.org/10.1097/MOP.0000000000000382
  3. Impact of elimination diets on nutrition and growth in children with multiple food allergies vol.17, pp.3, 2017, https://doi.org/10.1097/ACI.0000000000000358
  4. Dietary modifications in atopic dermatitis: patient-reported outcomes vol.28, pp.6, 2017, https://doi.org/10.1080/09546634.2016.1278071
  5. Comparison of nutrient intake in adolescents and adults with and without food allergies pp.09523871, 2017, https://doi.org/10.1111/jhn.12495
  6. Dietary Therapy for Eosinophilic Esophagitis: Elimination and Reintroduction pp.1559-0267, 2017, https://doi.org/10.1007/s12016-017-8660-1
  7. Nutritional Management of Patients With Pollen Food Syndrome: Is There a Need? pp.2196-3053, 2018, https://doi.org/10.1007/s40521-018-0188-y
  8. Role of Vitamin C in Skin Diseases vol.9, pp.1664-042X, 2018, https://doi.org/10.3389/fphys.2018.00819
  9. Nutritional Issues in Food Allergy pp.1559-0267, 2018, https://doi.org/10.1007/s12016-018-8688-x
  10. Food avoidance strategies in eosinophilic oesophagitis vol.49, pp.3, 2019, https://doi.org/10.1111/cea.13360
  11. Next-Generation Approaches for the Treatment of Food Allergy vol.19, pp.1, 2019, https://doi.org/10.1007/s11882-019-0839-5
  12. Food specific oral immunotherapy: a potential treatment for food allergy. vol.9, pp.9, 2013, https://doi.org/10.1586/17474124.2015.1065177
  13. Nutritional Intervention for a Korean Adolescent with Atopic Dermatitis: a Case Report vol.10, pp.4, 2013, https://doi.org/10.7762/cnr.2021.10.4.364
  14. Dietary Management of Eosinophilic Esophagitis: Tailoring the Approach vol.13, pp.5, 2013, https://doi.org/10.3390/nu13051630
  15. The practical dietary management of food protein-induced enterocolitis syndrome vol.127, pp.1, 2013, https://doi.org/10.1016/j.anai.2021.03.007
  16. 탄산음료 섭취와 성인 아토피 피부염 진단 및 현재 유병과의 관련성: 국민건강영양조사(2015-2016년) 자료를 바탕으로 vol.54, pp.5, 2021, https://doi.org/10.4163/jnh.2021.54.5.501