儿童特应性皮炎相关食物过敏诊断与管理专家共识

Expert consensus on diagnosis and management of food allergy in children with atopic dermatitis

临床中,特应性皮炎(AD)相关食物过敏的诊断存在不规范及过度诊断的问题,而由此导致的不必要饮食回避对儿童健康具有潜在影响。与IgE介导的经典食物过敏不同,AD相关食物过敏可表现为非湿疹样表现、独立的湿疹样表现及混合型表现。AD患儿食物过敏的诊断需结合病史(包括详细过敏史和喂养史)、临床表现及相关辅助检查包括皮肤点刺试验、血清特异性IgE检测、特应性斑贴试验及口服食物激发试验。对合并食物过敏的AD患儿需要综合管理,饮食回避是治疗的主要手段,但需对营养状况、生长发育等进行定期监测,皮肤科医师、营养师、儿科医师等多学科合作。

In clinical practice,the diagnosis of food allergy has not been standardized,and food allergy is overdiagnosed in patients with atopic dermatitis(AD).Unnecessary elimination diets due to overdiagnosis of food allergy may exert a potential adverse effect on health in children with AD.Unlike classic IgE-mediated food allergy,food allergy in AD patients may manifest as noneczematous reactions,isolated eczematous reactions and a combination of the two above.The diagnosis of food allergy in children with AD should be made in combination with a thorough clinical history(detailed allergic history and feeding history),clinical manifestations and a laboratory work-up including skin prick tests,serum specific IgE measurements,atopy patch tests and oral food challenge tests.Once an underlying food allergy is confirmed in AD patients,comprehensive management is generally recommended.Avoidance of the incriminated food is the main treatment approach,but regular clinical follow-up is necessary,including evaluation of nutritional status,and supervision of growth and development.Multi-disciplinary cooperation of dermatologists,nutritionists and pediatricians is required.