Controversies in Allergy: Food Testing and Dietary Avoidance in Atopic Dermatitis

Atopic Dermatitis is a chronic inflammatory skin disease with complex pathophysiology presenting challenges in management for both patients and providers. We have described the current evidence and controversies regarding FA testing and dietary elimination in AD. It is clear that exacerbations of skin disease do in fact occur in relation to food ingestions, but occurrence of these reactions is not as prevalent as is often perceived by the community. Food-triggered AD is most likely to occur in infants and young children with severe AD. Testing interpretation requires a nuanced clinical history and analysis, as allergic sensitization as determined by SPT and sIgE is frequently discovered in AD patients, however testing does not always aid in determination of disease triggers. In patients with true food- triggered AD, elimination of allergenic foods from the diet may improve AD control, but can also lead to subsequent development of IgE-mediated allergy, including anaphylaxis, in patients undergoing dietary elimination. As both clear risks and benefits exist from food avoidance in a proportion of AD patients, allergists/immunologists must play a vital role in actively determining the relevance of food sensitization in AD management in those at high risk.