Elimination of the food that triggers atopic dermatitis, or eczema, is associated with increased risk of developing immediate reactions to that food, according to the results of a large-scale study recently published in the Journal of Allergy and Clinical Immunology. Immediate reactions to the culprit food range from hives to life-threatening anaphylaxis.

"Our findings suggest that families of children diagnosed with food-triggered atopic dermatitis should be prepared to respond to a full-blown food allergy reaction if the child is accidentally exposed to the food in question," says Anne Marie Singh, MD, senior author of the study and an allergist at Ann & Robert H. Lurie Children's Hospital of Chicago. "These children need an emergency action plan and an injectable epinephrine to keep them safe."

The study followed 298 patients with food-triggered atopic dermatitis. A total of 19 percent of these patients, who had no history of immediate food reactions, developed food allergy after being placed on an elimination diet. Nearly one-third of the new immediate food reactions included anaphylaxis.

Foods are a trigger in up to 30 percent of patients with moderate-to-severe atopic dermatitis, mostly in infants and children younger than 5 years. While these children typically are instructed to avoid the triggering food completely, this recommendation might need to be modified.

"Given that in our study strict elimination diets as management for atopic dermatitis clearly increased the risk of immediate reactions, more research is needed to see if children may benefit from keeping tolerable amounts of the food allergen in their diet," says Singh, who is also an Assistant Professor of Pediatrics and Medicine at Northwestern University Feinberg School of Medicine. "Families should work with an allergist to determine the optimal treatment course for their child."

More research is needed to establish if letting children with atopic dermatitis eat tolerable amounts of allergenic food would prevent the development of immediate reactions to that food.