School of Medicine and Health Sciences Poster Presentations

Title

Impact of Food Allergy on the Growth of Children with Moderate-Severe Atopic Dermatitis

Poster Number

181

Document Type

Poster

Status

Medical Student

Abstract Category

Clinical Specialties

Keywords

Food Allergy, Atopic Dermatitis, Obesity, Nutrition

Publication Date

Spring 2018

Abstract

Background

Atopic dermatitis (AD) is a chronic inflammatory skin disease that affects 10-20% of children in the United States. Significant sleep disturbance due to itching, and increased metabolic demands due to rapid skin turnover and chronic inflammation, are thought to impact the growth of children with AD. Between 15-40% of children with AD have food allergy as well, which can also have adverse growth consequences. This study aims to determine the impact food allergy status has on height, weight and BMI Z-scores of children with moderate-severe AD.

Methods

A detailed food allergy history was acquired on children aged 2-20 years old enrolled in a natural history of atopic dermatitis protocol at the NIH who were identified as having moderate-severe AD. The children were categorized into three groups based on their food allergy (FA) status: IgE FA: those with IgE-mediated FA to the most common food allergens – cow’s milk, egg, wheat, soybean, and/or peanut; Skin Only: those avoiding any of the most common food allergens due to worsening of their AD upon ingestion of the food; and No FA: those nonallergic to food following an unrestricted diet. The height, weight, and BMI were compared between the three patient subgroups as well as between patients who avoided milk and did not avoid milk.

Results

The BMI Z-score (0.08±0.98) of the IgE FA group was significantly lower than in the Skin Only group (0.77±1.07; p=0.04) and No FA group (0.99±1.17; p=0.003). The weight Z-score (-0.42±1.12) of the IgE FA group was significantly lower than in the Skin Only group (0.45±1.14); p=0.047) and No FA group (0.58±1.12; p=0.007). The average BMI Z-score of the Skin Only group was significantly above zero (p=0.003). 3/10 (30%) of the Skin Only group were overweight or obese compared to 7/42 (16%) in the IgE FA group. The average BMI Z-score of the No FA group was significantly above zero (p<0.001). 12/25 (48%) of the No FA group were overweight or obese compared to 7/42 (16% in the IgE FA group.

Conclusions

The growth of children with AD is significantly impaired by the simultaneous presence of IgE FA, particularly milk allergy. In contrast, patients with moderate-severe AD alone are more likely to have elevated BMI and weight. These data suggest that all children with moderate-severe eczema warrant close nutritional follow-up.

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Impact of Food Allergy on the Growth of Children with Moderate-Severe Atopic Dermatitis

Background

Atopic dermatitis (AD) is a chronic inflammatory skin disease that affects 10-20% of children in the United States. Significant sleep disturbance due to itching, and increased metabolic demands due to rapid skin turnover and chronic inflammation, are thought to impact the growth of children with AD. Between 15-40% of children with AD have food allergy as well, which can also have adverse growth consequences. This study aims to determine the impact food allergy status has on height, weight and BMI Z-scores of children with moderate-severe AD.

Methods

A detailed food allergy history was acquired on children aged 2-20 years old enrolled in a natural history of atopic dermatitis protocol at the NIH who were identified as having moderate-severe AD. The children were categorized into three groups based on their food allergy (FA) status: IgE FA: those with IgE-mediated FA to the most common food allergens – cow’s milk, egg, wheat, soybean, and/or peanut; Skin Only: those avoiding any of the most common food allergens due to worsening of their AD upon ingestion of the food; and No FA: those nonallergic to food following an unrestricted diet. The height, weight, and BMI were compared between the three patient subgroups as well as between patients who avoided milk and did not avoid milk.

Results

The BMI Z-score (0.08±0.98) of the IgE FA group was significantly lower than in the Skin Only group (0.77±1.07; p=0.04) and No FA group (0.99±1.17; p=0.003). The weight Z-score (-0.42±1.12) of the IgE FA group was significantly lower than in the Skin Only group (0.45±1.14); p=0.047) and No FA group (0.58±1.12; p=0.007). The average BMI Z-score of the Skin Only group was significantly above zero (p=0.003). 3/10 (30%) of the Skin Only group were overweight or obese compared to 7/42 (16%) in the IgE FA group. The average BMI Z-score of the No FA group was significantly above zero (p<0.001). 12/25 (48%) of the No FA group were overweight or obese compared to 7/42 (16% in the IgE FA group.

Conclusions

The growth of children with AD is significantly impaired by the simultaneous presence of IgE FA, particularly milk allergy. In contrast, patients with moderate-severe AD alone are more likely to have elevated BMI and weight. These data suggest that all children with moderate-severe eczema warrant close nutritional follow-up.