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Do dietary exclusions work in atopic eczema?

Diets excluding foods such as egg and milk are claimed to ease eczema symptoms – this Cochrane review looks at the evidence.

Diets excluding foods such as egg and milk are claimed to ease eczema symptoms – this Cochrane review looks at the evidence.

Atopic eczema is a non-infective chronic inflammatory skin disease characterised by an itchy red rash. In the absence of a cure, a wide range of treatments are used to control the symptoms. One such approach is a dietary one, whereby certain foods such as cows' milk are excluded on the basis that they are thought to cause eczema to worsen.

The objective of this review was to assess the effects of dietary exclusions for the treatment of established atopic eczema.

Method

We searched the Cochrane Skin Group Specialised Register (to March 2006), the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library (Issue 1, 2006), MEDLINE (2003 to March 2006), EMBASE (2003 to March 2006), LILACS (to March 2006), PsycINFO (1806 to March 2006), AMED (1985 to March 2006), ISI Web of Science (March 2006), www.controlled-trials.com, www.clinicaltrials.gov and www.nottingham.ac.uk/ongoingskintrials (March 2006).

Pharmaceutical companies were contacted where appropriate for reviews or unpublished trials.

Two independent authors carried out study selection and assessment of methodological quality.

Results

We found nine RCTs involving a total of 421 participants, of which six were studies of egg and milk exclusion (n=288), one was a study of few foods (n=85) and two were studies of an elemental diet (n=48).

There appears to be no benefit of an egg- and milk-free diet in unselected participants with atopic eczema.

There is also no evidence of benefit in the use of an elemental or few-foods diet in unselected cases of atopic eczema.

There may be some benefit in using an egg-free diet in infants with suspected egg allergy who have positive specific IgE to eggs – one study found 51% of the children had a significant improvement in body surface area with the exclusion diet compared to normal diet (RR 1.51, 95% CI 1.07 to 2.11) and change in surface area and severity score was significantly improved in the exclusion diet compared to the normal diet at the end of six weeks (MD 5.50,95% CI 0.19 to 10.81) and end of treatment (MD 6.10, 95% CI 0.06 to12.14).

Methodological difficulties have made it difficult to interpret these studies. Poor concealment of randomisation allocation, lack of blinding and high dropout rates without an intention-to-treat analysis indicate that these studies should be interpreted with great caution.

Authors' conclusions

There may be some benefit in using an egg-free diet in infants with suspected egg allergy who have positive specific IgE to eggs.

Little evidence supports the use of various exclusion diets in unselected people with atopic eczema, but that may be because they were not allergic to those substances in the first place.

Lack of any benefit may also be because the studies were too small and poorly reported.

Future studies should be appropriately powered, focusing on participants with a proven food allergy.

In addition, a distinction should be made between young children whose food allergies improve with time and older children or adults.

Atopic eczema

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