TY - JOUR
T1 - Dietary Elimination for the Treatment of Atopic Dermatitis
T2 - A Systematic Review and Meta-Analysis
AU - Oykhman, Paul
AU - Dookie, Jared
AU - Al-Rammahy, Husam
AU - de Benedetto, Anna
AU - Asiniwasis, Rachel N.
AU - LeBovidge, Jennifer
AU - Wang, Julie
AU - Ong, Peck Y.
AU - Lio, Peter
AU - Gutierrez, Alvin
AU - Capozza, Korey
AU - Martin, Stephen A.
AU - Frazier, Winfred
AU - Wheeler, Kathryn
AU - Boguniewicz, Mark
AU - Spergel, Jonathan M.
AU - Greenhawt, Matthew
AU - Silverberg, Jonathan I.
AU - Schneider, Lynda
AU - Chu, Derek K.
N1 - Funding Information:
Conflicts of interest: A. de Benedetto is an investigator for Dermira, Kiniksa, Novartis, and Pfizer. J.M. Spergel declares receiving grants or contracts from Novartis, Abbott, Regeneron, Sanofi, and the National Institutes of Health; receiving royalties or licenses from UpToDate; consulting fees from Regeneron, Sanofi, Novartis, Takeda, Allakos, and Alladapt; and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Medscape and Rockpointe; and being on the Safety Monitoring Board or Advisory Board of the National Institute of Allergy and Infectious Disease and of Syneos. L. Schneider is on the Medical Advisory Board for Food Allergy Research and Education and the Data and Safety Monitoring Board for Alladapt; and is an investigator for DBV Technologies and Regeneron. M. Boguniewicz served as a consultant for Regeneron Pharmaceuticals, Inc and Sanofi; and received grants or contracts from Regeneron Pharmaceuticals, Inc and Sanofi. M. Greenhawt is a consultant for Aquestive; a member of physician/medical advisory boards for DBV Technologies, Sanofi/Regeneron, Genentech, Nutricia, Novartis, Aquestive, Allergy Therapeutics, Pfizer, US World Meds, Allergenis, Aravax, and Prota; a member of the Scientific Advisory Council for the National Peanut Board; the senior associate editor for the Annals of Allergy, Asthma & Immunology; and a member of the Joint Taskforce on Allergy Practice Parameters; and has received honoraria for lectures from IMsci, the Allergy and Asthma Foundation of America, and the Med Learning Group. P. Lio reports research grants/funding from AOBiome, Regeneron/Sanofi Genzyme, and AbbVie; is on the speaker's bureau for Regeneron/Sanofi Genzyme, Pfizer, AbbVie, Incyte, LEO, Eli Lilly, and Galderma; and reports consulting/advisory boards for Almirall, ASLAN Pharmaceuticals, Dermavant, Regeneron/Sanofi Genzyme, Pfizer, LEO Pharmaceuticals, AbbVie, Eli Lilly, Micreos (stock options), L'Oréal, Pierre-Fabre, Johnson & Johnson, Unilever, Menlo Therapeutics, Theraplex, Intraderm, Exeltis, AOBiome, Realm Therapeutics, Altus Labs (stock options), Galderma, Arbonne, Amyris, Bodewell, and Burt's Bees. In addition, P. Lio has a patent pending for a Theraplex product with royalties paid and is a board member and scientific advisory committee member of the National Eczema Association. The rest of the authors declare that they have no relevant conflicts of interest.
Publisher Copyright:
© 2022 American Academy of Allergy, Asthma & Immunology
PY - 2022/10
Y1 - 2022/10
N2 - Background: The influence of diet on atopic dermatitis (AD) is complex, and the use of dietary elimination as a treatment has conflicting views. Objective: To systematically review the benefits and harms of dietary elimination for the treatment of AD. Methods: We searched MEDLINE, Embase, AMED, PsycINFO, and the Cochrane Central Register of Controlled Trials from inception to January 18, 2022, without language restrictions, for randomized controlled trials (RCTs) and observational studies comparing dietary elimination and no dietary elimination for the treatment of AD. We conducted random-effects meta-analyses of eczema outcomes. We used the grading of recommendations, assessment, development, and evaluation approach to assess certainty of evidence (CRD42021237953). Results: Ten RCT (n = 599; baseline median of study mean age, 1.5 years; median of study mean SCOring Atopic Dermatitis index, 20.7, range, 3.5-37.6) were included in the meta-analysis. Compared with no dietary elimination, low-certainty evidence showed that dietary elimination may slightly improve eczema severity (50% with vs 41% without dietary elimination improved the SCOring Atopic Dermatitis index by a minimally important difference of 8.7 points, risk difference of 9% [95% CI, 0-17]), pruritus (daytime itch score [range, 0-3] mean difference, –0.21 [95% CI, –0.57 to 0.15]), and sleeplessness (sleeplessness score [range, 0-3] mean difference, –0.47 [95% CI, –0.80 to –0.13]). There were no credible subgroup differences based on elimination strategy (empiric vs guided by testing) or food-specific sensitization. Insufficient data addressed harms of elimination diets among included RCTs, although indirect evidence suggests that elimination diets may increase the risk for developing IgE-mediated food allergy. Conclusions: Dietary elimination may lead to a slight, potentially unimportant improvement in eczema severity, pruritus, and sleeplessness in patients with mild to moderate AD. This must be balanced against potential risks for indiscriminate elimination diets including developing IgE-mediated food allergy and withholding more effective treatment options for AD.
AB - Background: The influence of diet on atopic dermatitis (AD) is complex, and the use of dietary elimination as a treatment has conflicting views. Objective: To systematically review the benefits and harms of dietary elimination for the treatment of AD. Methods: We searched MEDLINE, Embase, AMED, PsycINFO, and the Cochrane Central Register of Controlled Trials from inception to January 18, 2022, without language restrictions, for randomized controlled trials (RCTs) and observational studies comparing dietary elimination and no dietary elimination for the treatment of AD. We conducted random-effects meta-analyses of eczema outcomes. We used the grading of recommendations, assessment, development, and evaluation approach to assess certainty of evidence (CRD42021237953). Results: Ten RCT (n = 599; baseline median of study mean age, 1.5 years; median of study mean SCOring Atopic Dermatitis index, 20.7, range, 3.5-37.6) were included in the meta-analysis. Compared with no dietary elimination, low-certainty evidence showed that dietary elimination may slightly improve eczema severity (50% with vs 41% without dietary elimination improved the SCOring Atopic Dermatitis index by a minimally important difference of 8.7 points, risk difference of 9% [95% CI, 0-17]), pruritus (daytime itch score [range, 0-3] mean difference, –0.21 [95% CI, –0.57 to 0.15]), and sleeplessness (sleeplessness score [range, 0-3] mean difference, –0.47 [95% CI, –0.80 to –0.13]). There were no credible subgroup differences based on elimination strategy (empiric vs guided by testing) or food-specific sensitization. Insufficient data addressed harms of elimination diets among included RCTs, although indirect evidence suggests that elimination diets may increase the risk for developing IgE-mediated food allergy. Conclusions: Dietary elimination may lead to a slight, potentially unimportant improvement in eczema severity, pruritus, and sleeplessness in patients with mild to moderate AD. This must be balanced against potential risks for indiscriminate elimination diets including developing IgE-mediated food allergy and withholding more effective treatment options for AD.
KW - Atopic dermatitis
KW - Dietary elimination
KW - Dietary exclusion
UR - http://www.scopus.com/inward/record.url?scp=85136082498&partnerID=8YFLogxK
U2 - 10.1016/j.jaip.2022.06.044
DO - 10.1016/j.jaip.2022.06.044
M3 - Article
C2 - 35987995
AN - SCOPUS:85136082498
SN - 2213-2198
VL - 10
SP - 2657-2666.e8
JO - Journal of Allergy and Clinical Immunology: In Practice
JF - Journal of Allergy and Clinical Immunology: In Practice
IS - 10
ER -