Květuše Ettlerová

Egg allergy in patients over 14 years old suffering from atopic eczema.

Objective  The aim of this study was to evaluate the occurrence of egg allergy in patients over 14 years old suffering from atopic eczema and especially to evaluate if egg allergy can deteriorate the course of atopic eczema in this group of patients.

Evaluation of allergy to soy in patients with atopic dermatitis older than 14 years of age

Atopic dermatitis is associated with food allergies. The aim of this study is to evaluate soy allergy in patients suffering from atopic dermatitis. Altogether 228 persons were included; specific IgE, skin prick tests, atopy patch tests, challenge tests with soy and history of soy allergy were evaluated. Soy allergy was confirmed in eight patients (3.5%, in four patients with worsening of atopic dermatitis, in four patients with oral allergy syndrome), sensitisation to soy was found in another 47 patients (20%) with no clinical manifestation after soy ingestion. Dependence was confirmed statistically between soy allergy and pollen allergy and soy sensitivity and pollen allergy. About 20% of patients suffering from atopic dermatitis are sensitised to soy. Clinical symptoms of soy allergy occur only in 3.5% of patients suffering from atopic dermatitis.

Evaluation of food allergy to wheat, cow milk, egg, soy and peanuts in patients suffering from atopic dermatitis

Few large studies concerning the importance of food allergy in adolescents and adult patients with atopic dermatitis exist. The evaluation of food allergy to egg white and yolk, peanuts, soy, cow milk and wheat in patients suffering from atopic dermatitis. Two hundred forty patients (70 men, 170 women) were examined. Complete dermatological and allergological examination was performed in all patients, including specific IgE, skin prick test and atopy patch test. The challenge test was performed according to the results of examinations with suspected foods. The food allergy to peanuts was confirmed in 20% of patients, to egg in 6%, to soy in 3.3%, to wheat in 2.5% and to milk in 0.8% – altogether in 65 patients (27.5%). The positive results in examinations without clinical symptoms of food allergy were recorded in another 78 patients (32.5%). The diagnostic work-up should comprise not only the laboratory methods, but also the diagnostic hypoallergenic diet and the challenge test.

Food allergy, asthma bronchiale, and rhinitis in atopic dermatitis patients with total immunoglobulin E under and above 200 IU/ml

The objective of this study is to evaluate if there is a difference in the occurrence of asthma bronchiale, rhinitis, pollen allergy, food allergy and sensitization to basic food allergens, onset of atopic dermatitis (AD), family history about atopy, and duration of eczematic lesions in AD patients with the level of total immunoglobulin E (IgE) under or above 200 IU/ml. Complete allergological and dermatological examination was performed and the statistical evaluation of the relations among the patients with the level of IgE under 200 IU/ml and above 200 IU/ml was performed. Out of 277 patients suffering from AD, we included 87 men and 190 women; the average age was 25.9 years. From 277 patients, 92 patients (33%) have IgE under 200 IU/ml; in these patients, the occurrence of tested parameters is significantly lower in comparison to patients with IgE above 200 IU/ml.

The peanut allergy in patients suffering from atopic dermatitis

Aim. The evaluation of the occurrence of peanut allergy in adolescent and adult patients suffering from atopic dermatitis. Methods. Altogether 175 persons suffering from atopic dermatitis were included in the study. A diagnostic work-up for food allergy to peanuts was performed (specific IgE, skin prick tests, atopy patch tests, history), and the patients were also examined for pollen allergy containing Bet v 1 and Bet v 2 allergens. Results. Allergic reactions to peanuts were recorded in 23% of patients, and another 16% of patients were sensitised to peanuts. A dependency between the occurrence of pollen allergy with Bet v 1 and Bet v 2 allergens and the results of the examination for peanut allergy is confirmed in our study. Conclusion. One-fifth of patients with atopic dermatitis suffer from peanut allergy; the most common symptom is oral allergy syndrome.

The Effect of Hypoallergenic Diagnostic Diet in Adolescents and Adult Patients Suffering from Atopic Dermatitis

Aim: To evaluate the effect of a diagnostic hypoallergenic diet on the severity of atopic dermatitis in patients over 14 years of age. Materials and Methods: The diagnostic hypoallergenic diet was recommended to patients suffering from atopic dermatitis for a period of 3 weeks. The severity of atopic dermatitis was evaluated at the beginning and at the end of this diet (SCORAD I, SCORAD II) and the difference in the SCORAD over this period was statistically evaluated. Results: One hundred and forty-nine patients suffering from atopic dermatitis were included in the study: 108 women and 41 men. The average age of the subjects was 26.03 (SD: 9.6 years), with the ages ranging from a minimum of 14 years to a maximum of 63 years. The mean SCORAD at the beginning of the study (SCORAD I) was 32.9 points (SD: 14.1) and the mean SCORAD at the end of the diet (SCORAD II) was 25.2 points (SD: 9.99). The difference between SCORAD I and SCORAD II was evaluated with the Wilcoxon signed-rank test. The average decrease of SCORAD was 7.7 points, which was statistically significant (P=.00000). Conclusion: Introduction of the diagnostic hypoallergenic diet may serve as a temporary medical solution” in patients suffering from moderate or severe forms of atopic dermatitis. It is recommended that this diet be used in the diagnostic workup of food allergy.

The Role of Atopy Patch Test in Diagnosis of Food Allergy in Atopic Eczema/Dermatitis Syndrom in Patients over 14 Years of Age

UNLABELLED Few studies concerning the importance of food allergy in adolescents and adult patients with atopic eczema exist. The atopy patch tests with food have mostly been studied in infants and children since food allergy plays a role especially in this age group. AIM The evaluation of the contribution of atopy patch tests in the diagnostic work-up of food allergy (to wheat, cow milk, peanuts, soya and eggs) in the patients with atopic eczema older than 14 years of age. METHOD 120 patients were examined in the study in the diagnostic work-up of food allergy--86 women and 34 men, the mean age 26.5 (s.d. 9.8) and the median SCORAD at the beginning of the study 32.9 (s.d. 14.0). Complete dermatological and allergological examinations in the diagnostic work-up of food allergy were performed (assessment of personal history, assessment of serum specific IgE, skin prick tests, atopy patch tests, diagnostic hypoallergenic diet, food challenge tests with egg, soy, wheat, cow milk and double-blind, placebo-controlled food challenge test with cow milk and wheat. The results of atopy patch tests were compared with the results of other diagnostic methods in the diagnosis of food allergy. RESULTS The food allergy to cow milk and wheat was confirmed in double-blind, placebo controlled food challenge test in few patients in our study (4%). The suspicion of food allergy to egg is in 8 %, to peanuts in 13 % and to soya in 4 % of patients in our study. The assessment of atopy patch tests response seems to be of great importance. The reaction in atopy patch tests with more papules has the greatest diagnostic accuracy for predicting the result of challenge tests. At the beginning and at the end of diagnostic hypoallergenic diet the severity of atopic eczema/dermatitis syndrome was recorded in all patients enrolled in the study by evaluating SCORAD. The decrease of SCORAD was statistically important. CONCLUSION Atopy patch tests alone cannot be used as a single test for the determination of food allergy in patients with atopic eczema/dermatitis syndrome but such a test, together with other diagnostic methods, can help to trace the food allergy.

Food hypersensitivity in patients over 14 years of age suffering from atopic dermatitis.

Background: Patients suffering from atopic dermatitis often describe food hypersensitivity. Rising prevalence of food hypersensitivity and severe allergic reactions to foods have been reported, but the data are scarce. Aims and Objectives: Evaluation of food hypersensitivity reactions in patients suffering from atopic dermatitis. Materials and Methods: The dermatological examination was performed in patients of age 14 years and above and the detailed history was taken concerning the food hypersensitivity. Results: A total of 228 patients were examined-72 men, 156 women, average age 26.2 (SD 9.5) years. The food hypersensitivity reactions were recorded in 196 patients from 228 (86%), no reactions were recorded in 32 patients (24%). Foods with the most often recorded reactions are: Nuts (in 35% of patients), tomatoes (in 20%), and kiwi (in 17, 5%), apples and spices (in 16%), tangerines and oranges (in 15%), capsicum (in 13%), fishes (in 12%), celery (in 9%), and chocolate (in 7%). Conclusion: Food hypersensitivity reactions are recorded in 86% of patients suffering from atopic dermatitis. Nuts, tomatoes, and pollen–associated foods play a role in the majority of patients suffering from atopic dermatitis.

Evaluation of cow's milk allergy in a large group of adolescent and adult patients with atopic dermatitis.

UNLABELLED Few studies concerning the occurrence of cows milk allergy with the use of double-blind, placebo controlled food challenge test in adolescents and adult patients suffering from atopic dermatitis exist. AIM To evaluate the occurrence of cows milk allergy in adolescents and adults suffering from atopic dermatitis. METHOD Altogether 179 persons suffering from atopic dermatitis were included in the study: 51 men and 128 women entered the study with the average age of 26.2 (s.d. 9.5 years). Complete dermatological and allergological examinations were performed. RESULTS The positive results in specific IgE and in skin prick tests were recorded in 12% of patients. According to the open exposure tests and double-blind, placebo controlled food challenge tests these patients are only sensitized to cows milk without clinical symptoms of allergy. Double-blind, placebo controlled food challenge test confirmed food allergy to cow milk only in one patient (worsening of atopic dermatitis), the oral allergy syndrome was observed in another one patient, occurrence of this allergy was altogether 1.1%. CONCLUSION Cows milk allergy rarely plays a role in the worsening of atopic dermatitis in adolescent and adult patients.

The effect of wheat allergy on the course of atopic eczema in patients over 14 years of age.

UNLABELLED Few studies concerning the importance of wheat allergy affecting the course ofatopic eczema in adolescents and adult patients exist. AIM The evaluation if wheat allergy can deteriorate the course of atopic eczema. Follow-up of patients with confirmed food allergy to wheat. METHOD Altogether 179 persons suffering from atopic eczema were included in the study: 51 men and 128 women entered the study with an average age of 26.2 (s.d. 9.5 years) Dermatological and allergological examinations were performed, including skin prick tests, atopy patch tests, and specific serum IgE for wheat, open exposure test and double-blind, placebo-controlled food challenge test with wheat flour. RESULTS Wheat allergy affecting the coures of atopic eczema was confirmed in eight patients (4.5%) out of 179 patients enrolled in this study by double-blind, placebo controlled food challenge test. The course of atopic eczema showed a positive trend in patients with confirmed food allergy at 3, 6, 9, 12 month follow-up (statistical evaluation with paired t-test) after the elimination of wheat flour. CONCLUSION Wheat allergy may play an important role in the worsening of atopic eczema (acting as a triggering exacerbating factor) only in a minority of adolescents and adult patients (4.5% in our study). The diagnostic methods (skin prick test, specific IgE, atopy patch test, history) cannot be used as separated tests for the determination of food allergy to wheat in patients with atopic eczema.Open exposure tests and double-blind, placebo-controlled food challenge should be used for the confirmation of wheat allergy affecting the course of atopic eczema.