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. 2008 Jan 23;2008(1):CD005203.
doi: 10.1002/14651858.CD005203.pub2.

Dietary exclusions for established atopic eczema

F Bath-Hextall  1 , F M Delamere, H C Williams
Affiliations

Dietary exclusions for established atopic eczema

F Bath-Hextall et al. Cochrane Database Syst Rev. .

Abstract

Background: Atopic eczema (AE) is a non-infective chronic inflammatory skin disease characterised by an itchy red rash.

Objectives: To assess the effects of dietary exclusions for the treatment of established atopic eczema.

Search strategy: We searched The Cochrane Skin Group Specialised Register (to March 2006), The Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 1, 2006), MEDLINE (2003 to March 2006), EMBASE (2003 to March 2006), LILACS (to March 2006), PsycINFO (1806 to March 2006), AMED (1985 to March 2006), ISI Web of Science (March 2006), www.controlled-trials.com, www.clinicaltrials.gov and www.nottingham.ac.uk/ongoingskintrials (March 2006). Pharmaceutical companies were contacted where appropriate for reviews or unpublished trials.

Selection criteria: People who have atopic eczema as diagnosed by a doctor.

Data collection and analysis: Two independent authors carried out study selection and assessment of methodological quality.

Main results: We found 9 RCTs involving a total of 421 participants of which 6 were studies of egg and milk exclusion (N=288), 1 was a study of few foods (N=85) and 2 were studies of an elemental diet (N=48). There appears to be no benefit of an egg and milk free diet in unselected participants with atopic eczema. There is also no evidence of benefit in the use of an elemental or few-foods diet in unselected cases of atopic eczema. There may be some benefit in using an egg-free diet in infants with suspected egg allergy who have positive specific IgE to eggs - one study found 51% of the children had a significant improvement in body surface area with the exclusion diet compared to normal diet (RR 1.51, 95% CI 1.07 to 2.11) and change in surface area and severity score was significantly improved in the exclusion diet compared to the normal diet at the end of 6 weeks (MD 5.50,95% CI 0.19 to 10.81) and end of treatment (MD 6.10, 95% CI 0.06 to12.14). Methodological difficulties have made it difficult to interpret these studies. Poor concealment of randomisation allocation, lack of blinding and high dropout rates without an intention-to-treat analysis indicates that these studies should be interpreted with great caution.

Authors' conclusions: There may be some benefit in using an egg-free diet in infants with suspected egg allergy who have positive specific IgE to eggs. Little evidence supports the use of various exclusion diets in unselected people with atopic eczema, but that may be because they were not allergic to those substances in the first place. Lack of any benefit may also be because the studies were too small and poorly reported. Future studies should be appropriately powered focusing on participants with a proven food allergy. In addition a distinction should be made between young children whose food allergies improve with time and older children/adults.

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Conflict of interest statement

None known

Figures

Analysis 1.1
Analysis 1.1
Comparison 1 Dried soya vs dried egg and cows milk, Outcome 1 activity score at one month.
Analysis 2.1
Analysis 2.1
Comparison 2 eHF vs Amino acid formula, Outcome 1 Severity of atopic eczema at 2‐3 months.
Analysis 2.2
Analysis 2.2
Comparison 2 eHF vs Amino acid formula, Outcome 2 Severity of atopic eczema at 6‐8 months.
Analysis 3.1
Analysis 3.1
Comparison 3 Egg exclusion vs normal diet, Outcome 1 Number of participants whose body surface are improved.
Analysis 3.2
Analysis 3.2
Comparison 3 Egg exclusion vs normal diet, Outcome 2 Change in body surface area at 6 weeks.
Analysis 3.3
Analysis 3.3
Comparison 3 Egg exclusion vs normal diet, Outcome 3 Change in severity score ‐ end of treatment.
Analysis 4.1
Analysis 4.1
Comparison 4 Few foods with whey vs normal diet, Outcome 1 Change in day time itch at 6 weeks.
Analysis 4.2
Analysis 4.2
Comparison 4 Few foods with whey vs normal diet, Outcome 2 Change in sleep disturbances at 6 weeks.
Analysis 4.3
Analysis 4.3
Comparison 4 Few foods with whey vs normal diet, Outcome 3 Change in body surface area affected at 6 weeks.
Analysis 4.4
Analysis 4.4
Comparison 4 Few foods with whey vs normal diet, Outcome 4 Change in skin severity score at 6 weeks.
Analysis 5.1
Analysis 5.1
Comparison 5 Few foods with casein vs normal diet, Outcome 1 Change in day time itch at 6 weeks.
Analysis 5.2
Analysis 5.2
Comparison 5 Few foods with casein vs normal diet, Outcome 2 Change in sleep disturbances at 6 weeks.
Analysis 5.3
Analysis 5.3
Comparison 5 Few foods with casein vs normal diet, Outcome 3 Change in body surface area affected at 6 weeks.
Analysis 5.4
Analysis 5.4
Comparison 5 Few foods with casein vs normal diet, Outcome 4 Change in skin severity score at 6 weeks.
Analysis 6.1
Analysis 6.1
Comparison 6 Few foods with whey vs few foods with casein, Outcome 1 Change in day time itch at 6 weeks.
Analysis 6.2
Analysis 6.2
Comparison 6 Few foods with whey vs few foods with casein, Outcome 2 Change in sleep disturbances at 6 weeks.
Analysis 6.3
Analysis 6.3
Comparison 6 Few foods with whey vs few foods with casein, Outcome 3 Change in body surface area affected at 6 weeks.
Analysis 6.4
Analysis 6.4
Comparison 6 Few foods with whey vs few foods with casein, Outcome 4 Change in skin severity score at 6 weeks.
Analysis 7.1
Analysis 7.1
Comparison 7 Elemental diet vs normal diet, Outcome 1 Number of participants whose eczema improved (change in intensity and extension) at 3 weeks.
Analysis 7.2
Analysis 7.2
Comparison 7 Elemental diet vs normal diet, Outcome 2 Numbers who improved for pruritus, sleeplessness and antihistamine consumption at 3 weeks.
See this image and copyright information in PMC

Comment in

References

References to studies included in this review

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References to studies excluded from this review

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    1. Majamaa H, Isolauri E. Probiotics: A novel approach in the management of food allergy. Journal of Allergy and Clinical Immunology 1997;99:179‐85. - PubMed

Additional references

    1. Altman DG. Practical statistics for medical research. London: Chapman and Hall, 1991.
    1. Archer CB. The pathophysiology and clinical features of atopic dermatitis. In: Hywel Williams editor(s). Atopic Dermatitis. The epidemiology, causes and prevention of atopic eczema. 1st Edition. Cambridge University Press, 2000:25‐40.
    1. Baena‐Cagnani CE, Teijeiro A. Role of food allergy in asthma in childhood. Current Opinion in Allergy & Clinical Immunology 2001;1(2):145‐9. - PubMed
    1. Baum WF, Schneyer U, Lantzsch AM, Kloditz E. Delay of growth and development in children with bronchial asthma, atopic dermatitis and allergic rhinitis. Experimental & Clinical Endocrinology & Diabetes 2002;110(2):53‐9. - PubMed
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