Atopic dermatitis in infants not caused by food allergy

Food allergy is not the primary cause ofatopic dermatitis. This is illustrated in 3 patients with atopic dermatitis, a girl aged 6 months and 2 boys aged 6 and 7 months, respectively, who were referred to our outpatient clinic for evaluation for possible food allergies. All 3 patients were receiving hypoallergenic formula because their parents or health care providers suspected that the atopic dermatitis was caused by a cows' milk allergy. After sufficient explanation of the causes of atopic dermatitis and thorough clarification and use of topical therapy, a remarkable improvement in the severity of the atopic dermatitis was noted. Only 1 patient was allergic to cows' milk as confirmed by a double-blind, placebo-controlled food challenge, but there was no association with the level of eczema activity. It is a common misconception that food allergies and atopic dermatitis are always causally related. In recent years it has become clear that atopic dermatitis may result from defective skin barrier function, for which topical treatment is essential. Unjustified focus on food allergies as the primary cause ofatopic dermatitis increases the risk of unnecessary elimination diets and malnutrition. Only infants with acute allergic symptoms directly related to ingestion, i.e. urticaria and gastrointestinal symptoms, should be evaluated for food allergies by a double-blind, placebo-controlled food challenge.