Dietary Restriction

In patients with food hypersensitivity, food-allergen avoidance results in improvement of AD. Sampson and coworkers have shown that following a strict avoidance diet of relevant food allergens patients experience symptomatic relief of pruritus and clearing of skin rash. Because of the high false-positive rate of prick skin testing and standard RAST for food allergens, an elimination diet followed by a blinded (single- or doubleblind) or open food challenge should be performed to confirm clinical reactivity to a particular food, unless a convincing history of anaphylaxis is obtained. An exception to this rule is when an elevated CAP-FEIA is obtained that demonstrates a greater then 9095% likelihood that a patient will have a positive food challenge. Several investigators have shown the utility of this test for the diagnosis of food allergy without the need for food challenge. Improvements have been made regarding assessment for the development of tolerance among food-allergic patients. Perry and collegues have recently suggested new decision point guidelines for food re-introduction and challenge dependent on CAP-RAST level in previously known food-allergic patients. Extensive elimination diets should not be prescribed on the basis of skin test positivity alone because of the obvious nutritional complications. The period of dietary restriction is allergen dependent, but generally should last for 1-2 yr before reintroduction or rechallenge with the implicated food. For some allergens, such as peanuts, a much longer elimination period may be necessary. In fact, new data suggests that approx 20% of children less than 5 yr with peanut allergy will outgrow the peanut allergy.

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