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Birch pollen‐related foods can cause late eczematous reactions in patients with atopic dermatitis
Author(s) -
WassmannOtto A.,
Heratizadeh A.,
Wichmann K.,
Werfel T.
Publication year - 2018
Publication title -
allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.363
H-Index - 173
eISSN - 1398-9995
pISSN - 0105-4538
DOI - 10.1111/all.13454
Subject(s) - medicine , atopic dermatitis , allergy , pollen , sensitization , dermatology , radioallergosorbent test , food allergy , immunology , allergen , botany , biology
Background Previous studies have indicated that in patients with atopic dermatitis (AD) and birch pollen allergy pollen‐related foods are able to cause late eczematous response. However, the relevance of AD worsening by ingestion of birch pollen‐related foods is still a matter of debate. Objective The purpose of this retrospective study was to determine how frequently birch pollen‐related foods induce a deterioration of eczema. Additionally, the diagnostic value of specific IgE (sIgE) determination was evaluated. Methods A total of 182 children and adults with AD and suspected birch pollen‐related food allergy underwent 261 double‐blind placebo‐controlled food challenges (DBPCFC). Total and sIgE levels were determined prior to DBPCFC. Results Sixty‐five patients developed allergic reactions (responders) upon DBPCFC with birch pollen‐related foods (n = 103 DBPCFC). Of these, 32 patients exhibited significant deterioration of AD defined as a median increase of 15.4 severity scoring of atopic dermatitis index points (95% CI 12.4‐16.3) from baseline making up 37% of all positive reactions. Responders showed significantly higher sIgE levels to birch pollen and apple as well as a higher prevalence of allergic rhinoconjunctivitis compared to nonresponders ( P < .05). However, patients with late eczematous response could not be differentiated from those with isolated immediate‐type reactions by sIgE levels. Conclusion In a subpopulation of patients with AD and birch pollen sensitization, related foods should be considered as a trigger for an aggravation of eczema. As sufficient markers for prediction of late eczematous reactions are still lacking, DBPCFC cannot be replaced in diagnosis of birch pollen‐related foods in patients with AD. Clinical implications In patients with AD and birch pollen allergy, birch pollen‐related foods should be considered as a provocation factor for an aggravation of disease signs and symptoms.