Pediatric Food Allergies Linked to Uncontrolled Atopic Dermatitis, Long-Term Prognosis

Jessica Wong, PhD

Credit: Jessica Wong on LinkedIn

New research is shining light on the relationship between food allergies and atopic dermatitis (AD) in children, with study findings suggesting certain food allergies are associated with uncontrolled AD and long-term AD persistence.¹

Leveraging data for more than 8000 pediatric patients from the Pediatric Eczema Elective Registry (PEER), the study determined food allergy status is associated with uncontrolled AD at registry enrollment and long-term AD persistence over 10 years. Of note, these associations were especially pronounced in subgroup analyses of milk, egg, and peanut allergies.¹

According to the 2022 Global Report on Atopic Dermatitis, AD affects up to 20% of children and up to 10% of adults. Of the 223 million people estimated to be living with AD in 2022, 43 million were 1-4 years of age.² Like AD, food allergy is also especially common in children, with a 2021 National Health Interview Survey conducted by the National Center for Health Statistics finding 5.8% of children aged 0–17 are diagnosed with a food allergy.³

“AD and food allergies are manifestations of atopic disease that share key immunological features, driving inflammation, and hypersensitivity reactions observed in both conditions. These mechanisms may facilitate mutual exacerbation in comorbid cases,” Jessica Wong, PhD, of the department of biostatistics, epidemiology, and informatics at the University of Pennsylvania, and colleagues wrote.¹ “Despite these similarities, the influence of food allergy on long-term AD outcomes remains incompletely understood.”

To investigate the impact of food allergy status on AD control and persistence, investigators analyzed data from the PEER, a US-based prospective cohort study evaluating the long-term safety and efficacy of pimecrolimus cream in children aged 2–17 with AD, tracking participants biannually for 10 years.¹

At enrollment, parents were asked about whether their children had any food allergies and what the specific allergen(s) was. Additionally, AD control was assessed based on parents’ perception of how their child’s skin disease has been managed, with persistent AD defined as the absence of complete control and/or the use of AD medications.¹

In total, the present study included 8015 children with an average enrollment age of 7.5 ± 4.2 years. Among the cohort, 22.73% of participants had food allergies, with peanuts (9.72%), eggs (7.16%), and milk (5.86%) being the most common.¹

Upon analysis, children with food allergies were less likely to have a family history of AD and lower family incomes (< $50,000/year), but more likely to have uncontrolled AD, use additional AD medications beyond pimecrolimus, and have atopic comorbidities. Additionally, investigators noted children with any food allergy were significantly more likely to have uncontrolled AD compared to those without a food allergy (adjusted odds ratio [aOR], 1.29; 95% CI, 1.15–1.45).¹

Over the 10-year study period, children with food allergies had a significantly greater likelihood of persistent AD compared to those without food allergies (aOR, 1.36; 95% CI, 1.17–1.58). Investigators pointed out specific allergens were associated with stronger effects, including milk (aOR, 1.46; 95% CI, 1.20–1.78), egg (aOR, 1.49; 95% CI, 1.26–1.75), and peanut (aOR, 1.50; 95% CI, 1.28–1.77) allergies. Additionally, long-term AD persistence was greatest among those with egg (aOR, 1.83; 95% CI, 1.41–2.38), peanut (aOR, 1.78; 95% CI, 1.43–2.22), and milk (aOR, 1.73; 95% CI, 1.29–2.33) allergies.¹

Investigators outlined multiple limitations to these findings, including the exclusion of severe AD cases and the reliance on caregiver-reported food allergy status without confirmatory diagnostic tests.¹

“The observed relationship between food allergy and AD persistence suggests that food allergy is an important prognostic factor for long-term AD outcomes,” investigators concluded.¹ “This highlights the need for closer monitoring of children with concurrent atopic conditions, as ongoing allergic responses may lead to more persistent manifestations.”

References

1. ^{Wong JJ, Margolis DJ. Association Between Food Allergy Status and Atopic Dermatitis Control and Persistence: A Longitudinal Analysis of the Pediatric Eczema Elective Registry. Pediatric Dermatology. https://doi.org/10.1111/pde.15845}
2. ^{International Eczema Council. Global Report on Atopic Dermatitis 2022. Accessed December 18, 2024. https://www.eczemacouncil.org/assets/docs/global-report-on-atopic-dermatitis-2022.pdf}
3. ^{Food Allergy Research and Education. Facts and Statistics. Accessed December 18, 2024. https://www.foodallergy.org/resources/facts-and-statistics}