Eliminating dairy for atopic dermatitis may not make significant difference

Eliminating dairy products from pediatric patients with atopic dermatitis (AD) may not provide substantial improvement and could put the patient at risk for developing IgE-mediated food allergies.¹

Investigators at the Division of Clinical Immunology and Allergy in the Department of Medicine at McMaster University in Ontario, Canada conducted a systematic review and meta-analysis of 10 randomized trials involving 599 patients with AD, undergoing blind, placebo-controlled food challenges. The baseline median of the study mean age was 1.5 years old, and the median of the study mean SCOring Atopic Dermatitis index was 20.7. Compared with no dairy elimination, investigators found low-certainty evidence that it may slightly improve eczema severity (50% vs 41% without dietary elimination improved the SCOring Atopic Dermatitis index by a minimally significant difference of 8.7 points (95% CI, 0 - 17). Furthermore, insufficient data addressed the harm of elimination diets that include randomized controlled trials(RCTS), although indirect evidence suggests that elimination diets may increase the risk of developing Ige-mediated food allergies.

AD is a chronic inflammatory skin disease characterized by relapsing or persistent pruritus, skin pain, lichenification, excoriation, xerosis, and dyspigmentation and is commonly associated with skin infections and atopic comorbidities. It is one of the most common childhood diseases, affecting approximately 6% to 20% of children around the world, as well as being common in adults. The disease burden is high with significant impacts on mental health, sleep, function, and quality of life, and considerable financial costs for patients and caregivers.

One of the study’s lead investigators, Derek Chu, MD, observed that the influence of diet on AD is complex and the use of dietary elimination has historically conflicting views. He said the study’s findings reflect the view from many practitioners that the impact of dietary restriction (benefits, harms, and practical implications) needs to be carefully weighed and reviewed in every case. Chu concluded that the study data reveals the important need for new and robust randomized controlled trials to further improve the evidence regarding all benefits and harms of diets for AD.

Resources:

Oykhman P, Dookie J, Al-Rammahy H, et al. Dietary Elimination for the Treatment of Atopic Dermatitis: A Systematic Review and Meta-Analysis. J Allergy Clin Immunol Pract. 2022 ;10(10):2657-2666.e8. doi:10.1016/j.jaip.2022.06.044. Epub 2022 Jul 19. PMID: 35987995.