Cargando…

Pearls and Pitfalls of Weaning an Infant with Severe Atopic Dermatitis and Sensitization/Allergy to Food

Atopic dermatitis (AD) is a common chronic inflammatory skin disorder in childhood. Skin barrier impairment exposes infants to food allergens, potentially causing sensitization followed by IgE-mediated food allergy. We describe the case of an infant with severe AD in whom several sensitizations to f...

Descripción completa

Detalles Bibliográficos
Autores principales: Giovannini, Mattia, Bolis, Marta, Barni, Simona, Liccioli, Giulia, Sarti, Lucrezia, Morelli, Susanna, Pontone, Matteo, Pessina, Benedetta, Tomei, Leonardo, Valleriani, Claudia, Novembre, Elio, Mori, Francesca
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10298914/
https://www.ncbi.nlm.nih.gov/pubmed/37373584
http://dx.doi.org/10.3390/jcm12123889
_version_ 1785064233956802560
author Giovannini, Mattia
Bolis, Marta
Barni, Simona
Liccioli, Giulia
Sarti, Lucrezia
Morelli, Susanna
Pontone, Matteo
Pessina, Benedetta
Tomei, Leonardo
Valleriani, Claudia
Novembre, Elio
Mori, Francesca
author_facet Giovannini, Mattia
Bolis, Marta
Barni, Simona
Liccioli, Giulia
Sarti, Lucrezia
Morelli, Susanna
Pontone, Matteo
Pessina, Benedetta
Tomei, Leonardo
Valleriani, Claudia
Novembre, Elio
Mori, Francesca
author_sort Giovannini, Mattia
collection PubMed
description Atopic dermatitis (AD) is a common chronic inflammatory skin disorder in childhood. Skin barrier impairment exposes infants to food allergens, potentially causing sensitization followed by IgE-mediated food allergy. We describe the case of an infant with severe AD in whom several sensitizations to foods are detected, with consequently difficult weaning, and a history of anaphylaxis to cashew nut. Foods for which skin tests were negative were introduced into the infant’s diet. Then, when AD control was managed, oral food challenges (OFCs) for foods to which the patient was sensitized, with the exception of cashew nut, were performed. The simultaneous presence of sensitization toward multiple foods made it difficult to introduce them using classic OFC. Therefore, it was decided to perform the low-dose, gradual controlled OFC. This led to an introduction of sensitized foods into the infant’s diet, with the exception of cashew nut, avoiding allergic reactions. Absolute recommendations on how, when, and where to perform OFCs with allergenic food to which the child with AD is sensitized are lacking so far. In our opinion, OFCs and the subsequent ntroduction of allergenic foods should be individualized, evaluating some factors such as their social and nutritional importance, the patient’s age and clinical phenotype (including the history of anaphylaxis), and the sensitization profile. There is agreement on the fact that the dietary approach in children with moderate-severe AD should no longer include a strict elimination diet. We believe that an early, gradual controlled introduction of all allergenics to identify the amount of food tolerated in the absence of reactions, even if low dose, may improve patients’ and families’ quality of life. However, even if discussing a vast relevant literature, the limitation of our work is that we describe the management of a single patient. Extensive and high-quality research is needed in this field to improve the available evidence in the area.
format Online
Article
Text
id pubmed-10298914
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-102989142023-06-28 Pearls and Pitfalls of Weaning an Infant with Severe Atopic Dermatitis and Sensitization/Allergy to Food Giovannini, Mattia Bolis, Marta Barni, Simona Liccioli, Giulia Sarti, Lucrezia Morelli, Susanna Pontone, Matteo Pessina, Benedetta Tomei, Leonardo Valleriani, Claudia Novembre, Elio Mori, Francesca J Clin Med Case Report Atopic dermatitis (AD) is a common chronic inflammatory skin disorder in childhood. Skin barrier impairment exposes infants to food allergens, potentially causing sensitization followed by IgE-mediated food allergy. We describe the case of an infant with severe AD in whom several sensitizations to foods are detected, with consequently difficult weaning, and a history of anaphylaxis to cashew nut. Foods for which skin tests were negative were introduced into the infant’s diet. Then, when AD control was managed, oral food challenges (OFCs) for foods to which the patient was sensitized, with the exception of cashew nut, were performed. The simultaneous presence of sensitization toward multiple foods made it difficult to introduce them using classic OFC. Therefore, it was decided to perform the low-dose, gradual controlled OFC. This led to an introduction of sensitized foods into the infant’s diet, with the exception of cashew nut, avoiding allergic reactions. Absolute recommendations on how, when, and where to perform OFCs with allergenic food to which the child with AD is sensitized are lacking so far. In our opinion, OFCs and the subsequent ntroduction of allergenic foods should be individualized, evaluating some factors such as their social and nutritional importance, the patient’s age and clinical phenotype (including the history of anaphylaxis), and the sensitization profile. There is agreement on the fact that the dietary approach in children with moderate-severe AD should no longer include a strict elimination diet. We believe that an early, gradual controlled introduction of all allergenics to identify the amount of food tolerated in the absence of reactions, even if low dose, may improve patients’ and families’ quality of life. However, even if discussing a vast relevant literature, the limitation of our work is that we describe the management of a single patient. Extensive and high-quality research is needed in this field to improve the available evidence in the area. MDPI 2023-06-07 /pmc/articles/PMC10298914/ /pubmed/37373584 http://dx.doi.org/10.3390/jcm12123889 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Giovannini, Mattia
Bolis, Marta
Barni, Simona
Liccioli, Giulia
Sarti, Lucrezia
Morelli, Susanna
Pontone, Matteo
Pessina, Benedetta
Tomei, Leonardo
Valleriani, Claudia
Novembre, Elio
Mori, Francesca
Pearls and Pitfalls of Weaning an Infant with Severe Atopic Dermatitis and Sensitization/Allergy to Food
title Pearls and Pitfalls of Weaning an Infant with Severe Atopic Dermatitis and Sensitization/Allergy to Food
title_full Pearls and Pitfalls of Weaning an Infant with Severe Atopic Dermatitis and Sensitization/Allergy to Food
title_fullStr Pearls and Pitfalls of Weaning an Infant with Severe Atopic Dermatitis and Sensitization/Allergy to Food
title_full_unstemmed Pearls and Pitfalls of Weaning an Infant with Severe Atopic Dermatitis and Sensitization/Allergy to Food
title_short Pearls and Pitfalls of Weaning an Infant with Severe Atopic Dermatitis and Sensitization/Allergy to Food
title_sort pearls and pitfalls of weaning an infant with severe atopic dermatitis and sensitization/allergy to food
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10298914/
https://www.ncbi.nlm.nih.gov/pubmed/37373584
http://dx.doi.org/10.3390/jcm12123889
work_keys_str_mv AT giovanninimattia pearlsandpitfallsofweaninganinfantwithsevereatopicdermatitisandsensitizationallergytofood
AT bolismarta pearlsandpitfallsofweaninganinfantwithsevereatopicdermatitisandsensitizationallergytofood
AT barnisimona pearlsandpitfallsofweaninganinfantwithsevereatopicdermatitisandsensitizationallergytofood
AT liccioligiulia pearlsandpitfallsofweaninganinfantwithsevereatopicdermatitisandsensitizationallergytofood
AT sartilucrezia pearlsandpitfallsofweaninganinfantwithsevereatopicdermatitisandsensitizationallergytofood
AT morellisusanna pearlsandpitfallsofweaninganinfantwithsevereatopicdermatitisandsensitizationallergytofood
AT pontonematteo pearlsandpitfallsofweaninganinfantwithsevereatopicdermatitisandsensitizationallergytofood
AT pessinabenedetta pearlsandpitfallsofweaninganinfantwithsevereatopicdermatitisandsensitizationallergytofood
AT tomeileonardo pearlsandpitfallsofweaninganinfantwithsevereatopicdermatitisandsensitizationallergytofood
AT vallerianiclaudia pearlsandpitfallsofweaninganinfantwithsevereatopicdermatitisandsensitizationallergytofood
AT novembreelio pearlsandpitfallsofweaninganinfantwithsevereatopicdermatitisandsensitizationallergytofood
AT morifrancesca pearlsandpitfallsofweaninganinfantwithsevereatopicdermatitisandsensitizationallergytofood