Food sensitivity (FS), food allergy (FA), and challenge-proven food allergy (CPFA) are common in patients with atopic dermatitis (AD) and vice versa, according to study findings published in the Journal of the European Academy of Dermatology and Venereology.
Researchers conducted a systematic review and meta-analysis to determine the prevalence and bidirectional associations of AD with FS, FA, and CPFA. They searched the PubMed and Embase databases through October 23, 2021 for relevant studies published in English.
The qualitative analysis included 585 studies, and the quantitative analysis included 465 studies. For the quantitative analysis, 320 studies were included in the category of individuals with FS, FA, or CPFA, and 246 studies were included in the category of FS, FA, or CPFA individuals with AD. There were 101 articles included in both categories.
Among 225,568 patients with AD, the pooled prevalence of FS, FA, and CPFA was 48.4% (43.7-53.2; n=12,821), 32.7% (28.8-36.6; n=51,593), and 40.7% (34.1-47.5; n= 756), respectively. In 1,128,322 reference individuals, the pooled prevalence was 17.9% (12.7-23.7), 9.4% (7.8-11.4), and 15.5% (7.9-25.2), respectively.
Children with AD had a greater pooled prevalence of FS (49.8% [44.4-55.1]) and FA (31.4% [26.9-36.1]) compared with adults with AD (28.6% [13.4-46.8]; and 24.1% [12.1-38.7], respectively). A tendency of an AD severity-dependent increase was observed in the prevalence of FS and FA.
The associations of AD with FS (pooled odds ratio [OR,] 4.17; 95% CI, 3.03-5.75), FA (pooled OR, 3.91; 95% CI, 3.44-4.45), and CPFA (pooled OR, 4.99; 95% CI, 2.20-11.35) were significant and tended to be stronger among children. The strongest individual food associations were observed between AD and egg FS, and AD and egg FA (pooled OR, 4.31; 95% CI, 2.92-6.37; and pooled OR, 3.88; 95% CI, 1.91-7.86).
Among 1,357,793 patients with FS, FA, and CPFA, the pooled AD prevalence was 51.2% (46.3-56.2; n=13,094), 45.3% (41.4-49.3; n=595,862, and 54.9% (47.0-62.8; n=2239), respectively. The pooled prevalence from 1,244,596 reference individuals was 24.4% (20.0-29.0), 17.0% (14.8-19.3), and 30.6% (19.5-43.0), respectively.
Children with FS or FA had a greater pooled AD prevalence (54.8% [50.0-59.5] and 47.5% [43.0-52.0]) compared with adults with FS or FA (34.7% [16.1-56.1] and 26.1% [12.3-43.0], respectively). Patients with peanut FS, FA, or CPFA had the highest pooled AD prevalence (67.1% [56.6-76.9], 58.7% [51.6-65.7], and 69.4% [52.9-83.8], respectively).
The observed associations between participants with FS (pooled OR, 3.92 [95% CI, 2.88-5.33]), FA (pooled OR, 4.06 [95% CI, 3.54-4.65]), and CPFA (pooled OR, 4.93 [95% CI, 2.74-8.84]) and concomitant AD were significant. According to stratification based on different food subtypes, the strongest association tended to be with egg FS and AD (pooled OR, 6.42 [95% CI, 2.23-18.44]) and egg FA and AD (pooled OR, 8.32 [95% CI, 2.52-27.47])
Limitations of the study include variation in study definitions and diagnoses of AD, FS, and FA, which may have led to misclassification. Assessment of AD severity also differed among the studies, as some used validated scales and others used physician-judged severity.
“Physicians should be cognizant of the bidirectional relationship, but it remains unclear what preventative actions are most effective, and to what degree food avoidance in allergic individuals with AD can improve the condition,” the researchers conclude.
Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
This article originally appeared on Dermatology Advisor
Christensen MO, Barakji YA, Loft N, et al. Prevalence of and association between atopic dermatitis and food sensitivity, food allergy and challenge-proven food allergy: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol. Published online January 25, 2023. doi: 10.1111/jdv.18919