Significance of dietotherapy on the clinical course of atopic dermatitis.
The aim of this study was to determine the efficiency of individual balanced replacement diet in treatment of children with atopic dermatitis, to compare the course of atopic dermatitis and gastrointestinal disorders, as well as the data of skin patch test after a one-year period of dietary treatment.


METHODS
The study group included 154 children (their age varied from 6 months to 18 years) with atopic dermatitis, for whom food allergens were determined by allergic skin tests (skin prick and patch). These children were recommended an individual balanced replacement diet, where possible food allergens were replaced by other products that do not cause allergic reactions. After a one-year dietary treatment, 109 (70.8%) children (such number came for the second study) were tested repeatedly. The following aspects were evaluated for all these children: clinical course of atopic dermatitis (children's mothers provided answers about exacerbation of allergic rash during the last 12 months, gastrointestinal disorders, and used medicines), severity of the progress of atopic dermatitis (SCORAD index). Besides, skin patch test with 25 food allergens was carried out.


RESULTS
Children who followed dietary recommendations were younger than children who failed to follow dietary recommendations because of a variety of reasons (P=0.01). Even 49 (62.8%) patients who followed dietary recommendations have shown the following results during the second test: allergic rash disappeared and they did not have to take medicines against allergy anymore. Patients who followed their individual dietary recommendations more rarely suffered from severe allergic rash problems during a 12-month period (P=0.01) and they had to take fewer medicines against allergy, compared to children who did not follow their dietary recommendations (P=0.001). Clinical course of atopic dermatitis in children who followed individual dietary recommendations was easier compared to children who did not follow such recommendations (P=0.001). During a one-year dietary treatment, 28.2% of children with atopic dermatitis became more tolerant to earlier food allergens. After the comparison of skin patch test results (before dietary treatment and after a one-year period), it was determined that only skin patch tests against buckwheat, oat, beef, and cacao did not change statistically significantly. Results of skin patch tests against other food products were found to be positive more rarely. Besides, children who followed their dietary recommendations suffered from gastrointestinal disorders more rarely as compared to children who did not follow their dietary recommendations (P=0.01). They suffered less from abdominal pain (P=0.01), abdominal distention (P=0.044), and constipation (P=0.035).


CONCLUSIONS
Individual balanced replacement diet for children with atopic dermatitis helped to fully control nutrition of sick children from various age groups and had a positive effect on the clinical course of atopic dermatitis. Patients who followed their individual dietary recommendations suffered from severe allergic rash more rarely and they had to take fewer medicines against allergy as compared to children who did not follow dietary recommendations. Clinical course of atopic dermatitis in children who followed individual dietary recommendations was easier as compared to children who did not follow such recommendations. One-third of children with atopic dermatitis became more tolerant to earlier food allergens during a one-year period. After a one-year dietotherapy treatment, positive patch test reactions to many food products appeared to be more rarely, except for buckwheat, oat, beef, and cacao. Besides, children who followed their dietary recommendations suffered from gastrointestinal disorders (abdominal pain, abdominal distention, and constipation) significantly more rarely as compared to children who did not follow their dietary recommendations.
Rokaite
Rūta
R
Department of Children Diseases, Kaunas University of Medicine, Eiveniu 2, 50009 Kaunas, Lithuania. rutarokaite@gmail.com
Labanauskas
Liutauras
L
Balciūnaite
Sigita
S
Vaideliene
Laimute
L
D000293:Adolescent; D000485:Allergens; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003627:Data Interpretation, Statistical; D003876:Dermatitis, Atopic / Q000175:diagnosis / Q000178:diet therapy* / Q000209:etiology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005512:Food Hypersensitivity / Q000150:complications / Q000175:diagnosis / Q000178:diet therapy*; D005767:Gastrointestinal Diseases / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007223:Infant; D008297:Male; D010328:Patch Tests; D013997:Time Factors
D000485:Allergens