Role of diet in treating atopic eczema: elimination diets can be beneficial.

Contact urticaria to egg occurring in 3 year old boy with atopic eczema. Pictures were taken before (left) and 15 minutes after (right) application ofraw egg white to cheek. Reprinted with permission ofJ Brostoff, SI Challacombe, eds. Food Allergy and Intolerance. London: Bailliere Tindall, 1987:585 controlled studies. Sadly, data are only available from two such studies. The first was that of our own group.5 The trial diet entailed completely avoiding egg and milk, with soya formula substituting for milk. The control diet similarly avoided egg and milk but the children were given a combination of dried egg and cows' milk in place of the soya formula. A double blind, cross over design was used. Over half the children showed a clear preference for the diet genuinely excluding egg and milk. Of interest was the finding that many children benefited from avoiding egg and milk without any previous parental suspicion that these foods could aggravate their children's eczema. We also found no association between the response to the diet and the presence of positive immediate skin test results and raised titres of IgE antibodies to egg or milk antigens. The second controlled study had a similar experimental design, but included both adults and children.6 This showed a smaller overall rate of response of 25% (35% in those under the age of 8 years). This somewhat less striking response may reflect the recent increased exposure of babies to soya, thus making soya a less satisfactory substitute for milk. A more important reason for the smaller proportion of responders in this study may, however, be related to the fact that today few children attend a dermatology clinic whose parents have not already attempted unsupervised dietary treatment. Children responding to such manipulations are less likely to be referred, so those now seen in hospital will to some extent be selected for their unlikeliness to benefit from a simple elimination diet. Other studies have addressed the possible procontinued on page 1460