From Medical News Today

According to Dr. Derek Chu, an assistant professor of medicine at McMaster University and lead author of the new study, the influence of diet on atopic dermatitis is complex and the use of dietary elimination as a treatment has historically conflicting views.

 

“Patients and caregivers commonly report strong suspicion and historical teaching among clinicians provided a greater emphasis on the role of food allergy as a driver of atopic dermatitis,” he explained. “However, many clinicians now cast doubt and consternation out of concern for confounding from other triggers or atopic dermatitis flare independent of external factors and avoiding harms that can occur with dieting practices.”

 

“As a result, some patients found current approaches to discussing dietary concerns with their care providers unhelpful, which in turn led to frequent unsupervised and potentially harmful dietary eliminations,” he added.

 

For example, Chu stated people may suspect any kind of food as contributing to their atopic dermatitis. One food associated in the past as a potential trigger for eczema is dairy products made from cow’s milk.

 

“Milk is among the most commonly suspected allergens in infants and children,” he explained. “Dairy, in general, is a common food across all ages, both of which likely contribute to patients and caregivers associating it with flares of atopic dermatitis.”

 

A study in 2002 found children who drank cow’s milk increased their risk of developing additional food allergies and persistent atopic dermatitis.

However, other research shows lower levels of vitamin D — which is found in cow’s milk products — may lead to increased atopic dermatitis symptoms.

 

Is food elimination worth it?

For their study, Chu and his team reviewed data from about 600 people participating in 10 randomized patient trials. Researchers also consulted directly with both participants and their caregivers. The study pool included both adults and children.

 

Through their analysis, researchers found about 50% of people with eczema improved their symptoms when both eliminating certain foods, including dairy products, eggs, and wheat, and continuing standard treatments for the condition.

 

The team also found that 41% of participants improved their atopic dermatitis symptoms strictly by continuing their standard treatment without changing their diet.

 

“Our findings are consistent with both historical patient and clinician perspectives having valid aspects,” Chu said. “Some patients may experience and value a slight improvement in eczema severity, pruritus, and sleeplessness.”

 

However, Chu said, no treatment or intervention is without the potential to harm rather than help.

 

“Many fully informed patients and caregivers may not consider worthwhile a slight improvement in eczema control against the potential harms of developing an IgE-mediated (anaphylactic type) food allergy — particularly the case in infants and young children — the impact of dietary restrictions on the quality of life, nutrition and growth, and/or opportunity cost of more effective treatments better aligned with managing the underlying disease,” he explained. “Thus, the health benefits, harms, and practical implications of dietary elimination should be carefully weighed.”

 

Offering additional guidelines for clinicians

Chu said these findings will be used as part of the upcoming 2022 Atopic Dermatitis Guidelines for practitioners.

 

“Our findings… will encourage understanding patient values and preferences in a shared-decision making model for optimal care of those individuals considering a diet, and other treatments, for atopic dermatitis,” he explained.

 

Additionally, Chu said the study data shows the important need for new and robust randomized controlled trials to further improve the evidence regarding all benefits and harms of diets for atopic dermatitis.

 

“Almost all patients going through eczema will consider a dietary strategy and they now have some hard evidence to hang their hat on,” he continued. “Our data show that going on a diet will not be game-changing for eczema; it may modestly improve it but diets also have important downsides that should be considered before pursuing a diet.”

 

Dr. Angela J. Lamb, an associate professor of dermatology at the Icahn School of Medicine at Mount Sinai in New York said these research findings will allow doctors to give patients some perspective while referencing a large major study.

 

“It confirms what we have known for some time — that elimination diets are not overwhelmingly helpful for treating eczema,” Lamb explained. “It is difficult because, for that one person who is helped with an elimination diet, it can be a major breakthrough; but for the vast majority of patients who are suffering, elimination diets are not helpful. We hope to see studies that enable us to tell, based on someone’s genetics, whether food elimination might work for them.”