title: Clinical relevance of food additives in adult patients with atopic dermatitis.
abstract: BACKGROUND
  Adverse reactions to food play an important role in the pathogenesis of atopic dermatitis (AD). In infancy and childhood, food allergies are observed in up to 30%, whereas nonallergic hypersensitivity reactions (pseudoallergic reactions) towards food additives have been reported to occur between 2 and 7%. By contrast, sensitizations towards food allergens are rarely of clinical relevance in adults and little data is available on nonallergic hypersensitivity reactions. To date the role of pseudoallergic reactions as an aggravating factor in AD of adult patients remains controversial. However, many adult patients report on food-related aggravation of the disease and nonallergic hypersensitivity reactions have been incriminated repeatedly.
  
  
  OBJECTIVE
  To elucidate the relevance of food additives in adult patients suffering from AD.
  
  
  METHODS
  Fifty patients were monitored over 4 weeks under regular diet followed by 6 weeks of a diet omitting known pseudoallergens. Skin status of patients was assessed every 2 weeks by a standardized scoring, and serum eosinophilic cationic protein (ECP) was determined before and after diet.
  
  
  RESULTS
  Nine of fifty patients dropped out, 26 showed a significant improvement of the Costa-score by 57%. In 23/26 patients a corresponding reduction of serum ECP level by 52% on average was determined. Responder patients (24/26) were orally challenged with food rich in pseudoallergens followed by double-blind exposure to food additives (n = 15). A worsening of the eczema was seen in 19/24 patients after intake of pseudoallergen-rich food and in 6/15 patients after exposure to food additives.
  
  
  CONCLUSIONS
  These results indicate that a subgroup of adult patients with AD clinically improve on low-pseudoallergen diet but only a small subgroup respond to oral provocation with food additives.
authors.affiliation: Department of Dermatology and Allergy, Charité Clinic, Humboldt University, Berlin, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Worm
authors.forename: I
authors.initials: I
authors.lastname: Ehlers
authors.forename: W
authors.initials: W
authors.lastname: Sterry
authors.forename: T
authors.initials: T
authors.lastname: Zuberbier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000485:Allergens / Q000009:adverse effects*; D001798:Blood Proteins / Q000032:analysis; D003876:Dermatitis, Atopic / Q000178:diet therapy* / Q000209:etiology / Q000276:immunology; D004032:Diet; D004311:Double-Blind Method; D004797:Enzyme-Linked Immunosorbent Assay; D047091:Eosinophil Granule Proteins; D005260:Female; D005503:Food Additives / Q000009:adverse effects*; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D007428:Intradermal Tests; D008297:Male; D008875:Middle Aged; D012260:Ribonucleases
chemical_list: D000485:Allergens; D001798:Blood Proteins; D047091:Eosinophil Granule Proteins; D005503:Food Additives; D018836:Inflammation Mediators; D012260:Ribonucleases