Test-guided dietary advice for children with atopic dermatitis: a
consensus study
Abstract
Background: The use of allergy tests to guide dietary exclusions for
disease control in children with atopic dermatitis (AD) is
controversial. We undertook a consensus exercise on how to interpret
skin prick test (SPT) results and dietary history for cow’s milk, hen’s
egg, wheat and soya in children <2 years old with AD. Methods:
Fourteen clinicians from general practice, paediatrics, paediatric
dermatology, paediatric allergy and paediatric dietetics from UK and
Ireland took part in an online modified Delphi study. Over three rounds,
participants gave their anonymous opinions and received individualised
and group feedback. The findings were discussed in an online workshop.
Results: Of 14 symptoms, 12 were identified as relevant to immediate and
7 to delayed allergy. Regarding SPTs, there was consensus over which
allergens to use for wheat and soya but not cow’s milk or hen’s egg; for
all study foods, wheal size was determined as 0-1 mm negative, ≥5mm
sensitised , but between 2-4 mm categorisation varied by food. During
the final workshop, consensus was reached on dietary advice should be
given according to SPT results and dietary history. Conclusion: We
attained consensus on how SPTs combined with dietary history for four
common food allergens should be interpreted in young children under two
years of age with AD. These pragmatic recommendations may support
clinician education, consistency of decision-making and future research.