Dietary elimination method might improve severe atopic dermatitis symptoms

In individuals with mild to severe atopic dermatitis (AD), dietary elimination may result in a minor, possibly insignificant reduction in the severity of the eczema, pruritus, and insomnia, says an article published in The Journal of Allergy and Clinical Immunology: In Practice.

Skin infections and atopic comorbidities are frequently linked to atopic dermatitis, a chronic inflammatory skin condition characterized by relapsing or persistent pruritus, skin discomfort, lichenification, excoriation, xerosis, and dyspigmentation. Disease activity is thought to be influenced by a variety of factors, such as immune dysregulation, skin barrier dysfunction, and microbial dysbiosis due to internal and external factors. Paul Oykhman and colleagues did this study to comprehensively analyze the advantages and disadvantages of dietary removal for the treatment of AD.

Without regard to language restrictions, we searched MEDLINE, AMED, Embase, PsycINFO, and the Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs) and observational studies contrasting dietary elimination and no dietary elimination for the treatment of AD from the beginning to January 18, 2022. Also carried out were random-effects meta-analyses of eczema outcomes. To rate the degree of evidence's certainty, the development, assessment, and evaluation approach was used.

The key findings of this study were:

1. This meta-analysis included ten RCTs.

2. Low-certainty data suggested that food elimination may only modestly lessen eczema severity, pruritus, and insomnia when compared to no dietary elimination.

3. Based on elimination strategy (empiric vs. guided by testing) or food-specific sensitization, there were no discernible subgroup differences.

4. Although there is indirect evidence that suggests elimination diets may raise the risk of developing IgE-mediated food allergies, there was insufficient data on the negative effects of elimination diets among the included RCTs.

The Authors suggest that dietary elimination should be weighed against the risks of indiscriminate elimination diets, which include the possibility of developing IgE-mediated food allergies and foregoing more potent AD treatments.

Reference: 

Oykhman, P., Dookie, J., Al-Rammahy, H., de Benedetto, A., Asiniwasis, R. N., LeBovidge, J., Wang, J., Ong, P. Y., Lio, P., Gutierrez, A., Capozza, K., Martin, S. A., Silverberg, J. I., Schneider, L., & Chu, D. K. (2022). Dietary Elimination for the Treatment of Atopic Dermatitis: A Systematic Review and Meta-Analysis. In The Journal of Allergy and Clinical Immunology: In Practice (Vol. 10, Issue 10, pp. 2657-2666.e8). Elsevier BV. https://doi.org/10.1016/j.jaip.2022.06.044