Managing Evolving Pediatric Food Allergies

The treatment of atopic dermatitis (AD) is undergoing a revolution thanks to biologics. Today, an allergist and dietitian told pediatric dermatologists that the treatment of a food allergy related condition is also undergoing a radical transformation as the management approach moves away from general allergen avoidance.

“Over the past 15 years we’ve seen a shift away from a very passive approach where generally we just advise patients to avoid things they’re allergic to,” said British pediatric allergist Adam Fox. , MBBS, MD, in a presentation at the 2021 World Congress of Pediatric Dermatology (WCPD) Annual Meeting. “Now we have a much better understanding of how allergy develops and strategies to minimize allergy risk in the first place, “he said.

According to Carina Venter, PhD, RD, associate professor of pediatrics-allergy / immunology at the University of Colorado, Denver, Colo., Who also spoke at the conference, an estimated 20 to 30 percent of patients with AD have also have food allergies, and up to 90% of infants allergic to cow’s milk develop skin symptoms.

It may not be necessary for a nursing mother to avoid food allergens if a child is allergic, said Fox, of the Guy’s and St. Thomas’ NHS Foundation Trust, London, UK. “Many parents will automatically assume that if their child has an egg or milk allergy, then it is a good idea to eliminate it completely from their diet if they are breastfeeding,” but it is “surprisingly rare” that this approach make a difference, he says. “Less passes through breast milk than people realize,” he said.

He noted that eliminating food from the nursing mother’s diet can have negative consequences. “There is always this risk that if you make life difficult for a nursing mother because she will have to avoid all kinds of foods, she will be more likely to stop breastfeeding. You really need a compelling reason. to stop the food. “

As for the children themselves, Fox suggested that there is often no connection between AD and food allergies. “What usually happens when you see and diagnose these children is that their eczema has been significantly undertreated,” he said. “Once you put them on the right diet, they don’t need to cut food out of their diet. It makes life unnecessarily harder for them.”

Venter said there may be no other choice but to avoid a trigger food if a child develops AD with exposure. However, she noted, it’s important to understand that avoiding certain foods could make allergy and AD worse. “If you have a child or adult with atopic dermatitis that is not controlled by optimal topical therapy, and you plan to avoid it, we should be aware that the development of more severe IgA-mediated symptoms can arise in a short period of time, “she said.

In a slide presented by Venter, the dilemma for physicians was expressed as follows: “The potential benefit of avoiding food as a management strategy for some patients with AD must now be weighed against the evidence. that unnecessarily avoiding a food in children with AD increases the risk of developing anaphylaxis from that food. “

What should pediatric dermatologists do to balance the risks of exposure to allergens with the risks of children developing permanent allergies? Venter highlighted the AD guidelines that were developed by the UK’s National Institute for Health and Care Excellence. She also highlighted the international recommendations on milk allergy in primary care.

She suggested considering creative ways to bypass complete avoidance and increase a child’s tolerance to allergens if possible. “If we want to keep a child with eczema on a mold-free diet for a longer period of time, maybe there is a role in regularly putting small amounts of yogurt or even small amounts of milk in the diet? child feeding at least keep immune tolerance without necessarily worsening eczema symptoms? “

Fox consulted for DBV and Aimmune through his employer, NHS Trust. He is Chairman of the British Society for Allergy and Clinical Immunology and Chairman of the Allergy UK Health Advisory Board, both funded by pharmaceutical companies. Venter received support for allergy research from the National Peanut Board.

Annual Meeting of the World Congress of Pediatric Dermatology (WCPD) 2021: presented on September 23, 2021.

Randy Dotinga is a freelance journalist covering medicine and health.

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