Anne Marie Singh, MD: Management Strategies for Infant Atopic Dermatitis, Allergy

In this HCPLive interview segment, Anne Marie Singh, MD, spoke more about her presentation at the Revolutionizing Atopic Dermatitis (RAD) 2023 Annual Meeting in Washington, DC, specifically regarding the present and future of atopic dermatitis (AD) and allergy in infancy.

Singh serves as Associate Professor of Pediatric Allergy, Asthma, and Immunology for University of Wisconsin’s School of Medicine and Public Health.

She first went into a description of clinicians’ decisions on whether or not to do allergy testing when infant patients present with AD.

“For the children who are most at risk for having a food allergy associated with atopic derm, this would be younger children,” she said. “And when I say that you know, it’s age 1, age 2. So younger children, the more severely significantly affected children. Chronicity, so AD that is chronic, lasts longer…Staph aureus colonization of the skin has also been associated with food allergies.”

Singh also explained the ways in which this information is used by clinicians in management of AD for this patient population.

“The most important thing to understand when we do food allergy testing is to be thoughtful and targeted with it,” she noted. “So you know, if a child isn't having any of those immediate symptoms, or you can kind of get control of atopic dermatitis using typical management, then the food allergy testing is likely not going to be helpful.”

Singh added that if physicians do decide to order testing, the negative predictive value of the test is strong and is, consequently, helpful. She also added that the negative predictive value is somewhere between 93 to 99%.

“So if someone tests negative, that really helps rule out a food allergy,” she said. “The positive predictive value of these tests is actually not good at all. The positive predictive value is 30 to 50%. So we see a lot of false positives with this testing. We can increase our positive predictive value by increasing our pretest probability.”

Singh noted that food elimination can help improve infants’ AD, in some cases, if they have an immediate IgE hypersensitivity. But she added that they may then need nutritional support, and some do not recommend food elimination.
“The future is so exciting, especially for food allergy where we actually now know that early introduction can prevent the development of food allergy, with the LEAP study. And now, as an allergist, we recommend early introduction of peanut and egg.”

To learn more about new resarch in AD, view Singh’s full HCPLive interview segment above.

The quotes contained in this interview were edited here for clarity.