Introduction

Atopic eczema/atopic dermatitis (AD) has a high disease burden and affects around 20% of children.[1] Most children with AD have mild-moderate disease and can be managed with a combination of emollients and anti-inflammatory treatments, usually topical corticosteroids (TCS). However, topical therapies can be messy and time consuming, and parents commonly worry about their safety.[2] This, combined with the perception that AD creams only treat the symptoms leads many carers to modify their child’s diet or seek food allergy tests, in the belief that this will identify an underlying dietary cause.
The association between AD, food sensitisation and food allergy is recognised.[3] Up to half of children with AD are “sensitised” on blood IgE or skin prick tests to specific foods, without necessarily having any clinical symptoms. The prevalence of food allergy is highest 0–2 years (39.2%) and is associated with early onset and more severe disease.[4] Cow’s milk, hen’s egg, wheat and soya are four of the foods that commonly cause food allergy, raise concern about food allergy among parents, and/or are excluded without professional advice.[5, 6] They are also some of the most challenging foods to attribute to delayed, non-IgE mediated allergy symptoms and to exclude from the diet.
When there is an immediate reaction to these foods, the causal link may be obvious, but parents of children with AD also worry about delayed food allergy, and a food-related worsening of AD. In clinical settings, symptoms usually determine whether a food allergy test is done. However, sometimes clinicians use food allergy tests, in the absence of a relevant allergy symptoms, to guide dietary advice for children with AD.[7] The evidence to support this approach is weak.[8]
To support further research in this area, and to inform clinical practice meanwhile, we conducted a consensus exercise on how symptoms and skin prick test results should be interpreted to guide dietary advice in children with AD.