title: Duodenal IgE-positive cells and elimination diet responsiveness in children with atopic dermatitis.
abstract: BACKGROUND
  Parameters for identifying eczematous children who could respond to an elimination diet are needed. In children with food allergy, duodenal IgE-containing cells are enhanced.
  
  
  OBJECTIVE
  To determine the presence of duodenal mucosal IgE-positive cells in atopic dermatitis and to determine whether duodenal IgE-positive cells may identify eczematous children who will benefit from an elimination diet.
  
  
  METHODS
  Thirty-one children with severe eczema underwent gastrointestinal endoscopy because of gastrointestinal symptoms and were treated with an elimination diet. A clinical score to skin lesions was given before and after diet. All subjects were skin-prick tested with food antigens and aeroallergens. Serum IgE levels were measured. Duodenal IgE-positive cells were investigated in 18 control subjects and in all eczematous children before diet.
  
  
  RESULTS
  The number of duodenal IgE-positive cells in children with atopic dermatitis was significantly increased compared with that of control group (P < 0.001). Nineteen (61%) eczematous children improved on a few food diet. Diet-responsive children had significantly higher IgE-positive cells compared with both nondiet-responsive and controls. Positive predictive accuracy of duodenal IgE-positive cells was poor, whereas negative predictive accuracy was high at the cutoff level of 50 IgE-positive cells/10 visual fields. Diagnostic accuracy both of SPT reactions with foods and of food-specific serum IgE antibodies was poor.
  
  
  CONCLUSIONS
  An intestinal IgE-mediated reaction occurred in children with severe atopic dermatitis who underwent intestinal endoscopy because of gastrointestinal symptoms. In these eczematous children, the number of IgE-positive cells in the duodenal mucosa might be helpful for excluding a positive response to the elimination diet.
authors: Department of Pediatrics, University of Parma, Italy. carlo.caffarelli@unipr.it
authors: C
authors: C
authors: Caffarelli
authors: G
authors: G
authors: Cavagni
authors: E
authors: E
authors: Romanini
authors: P
authors: P
authors: Caruana
authors: G
authors: G
authors: de Angelis
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000276:immunology*; D004386:Duodenum / Q000166:cytology / Q000276:immunology*; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000032:analysis* / Q000097:blood; D007223:Infant; D007413:Intestinal Mucosa / Q000166:cytology / Q000276:immunology; D008297:Male; D011237:Predictive Value of Tests; D012882:Skin Tests
chemical_list: D007073:Immunoglobulin E