Food Allergies and Atopic Dermatitis in the Pediatric Population

Elizabeth Lippner, MD (00:07):

My name's Elizabeth Lippner. I'm a pediatric allergy and immunology physician. I practice out of Ann & Robert H. Lurie Children's Hospital here in Chicago. I see pretty much all children with an emphasis on food allergy and allergic diseases as well as immune deficiency diseases.

(00:29):

So, there's a pretty high rate of food allergy in association with atopic dermatitis, especially in children, but also in adults, actually, and it can be as high as 30% in children, and even more so in adults we see more sensitivity and less true food allergy. But in particular for our patients, there's always, well, not always, but there's often a question of whether a food allergy is part of the atopic dermatitis, whether they need to be worried about a food allergy because of atopic dermatitis, or whether really they need to have testing for food allergies because of atopic dermatitis.

(01:15):

And while there is a high co-rate of disease, it does not seem to be that one is causative necessarily of the other. And so, we generally try to minimize testing for foods unless there has truly been an immediate allergic reaction with hives and swelling. If there is a family that associates a food as a trigger for their atopic dermatitis, then we usually spend a lot of time talking to them about trying to find ways to keep that food in the diet, but doing so in a way where it's less likely to make their eczema harder to control. And we try not to do testing for eczema for food allergies.

(02:00):

So, the reason that we try not to do testing in someone who's concerned about a food allergy, but for a lack of a better way to phrase it, only has eczema, our testing for food allergy tends to be overly positive, especially in those that have eczema. So, I can do a test for 10 foods in someone who has eczema, for example, all of which they've eaten multiple times and never had anything like anaphylaxis. And that person, because they have eczema or sometimes just because of the nature of the test, they may have a positive for over half of those foods. And if I do the testing, then now all of a sudden the child or the family members think, "Okay, now I'm allergic, or my child's allergic to that food." When in reality, they've been eating that food and they've not had an allergic reaction. So, really the body has already told us that they're not allergic to it.

(02:56):

So, the reason that we try not to do food allergy testing in patients who have eczema, as part of their eczema management, is because there's a higher rate of false positive food allergy test results, especially when you have eczema. So, as a pediatric allergist, I do get referrals both from pediatricians and primary care providers as well as dermatologists, asking about whether or not someone needs food allergy testing. And while we're very happy to see these children, and there's certainly a role for us managing this disease together, we generally would not tell people to expect that food allergy testing will be an integral part of their eczema care, but rather something that could be considered, if needed, to keep their child safe.