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Is Food-Triggered Atopic Dermatitis a Form of Systemic Contact Dermatitis?

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Abstract

Food allergy in atopic dermatitis is mediated by complex immune interactions between genetics, diet, environment, and the microbiome. When contact between inflamed skin and food antigens occurs, contact hypersensitivity can develop. Consequently, systemic contact dermatitis (SCD) can occur after ingestion of allergenic foods or food additives in the setting of a Th2 response with CLA-positive T cells, triggering dermatitis where skin resident memory lymphocytes reside. This phenomenon explains food-triggered dermatitis. Atopy patch tests (APTs) detect sensitization to food proteins responsible for SCD, which in turn can be confirmed by oral food challenge with delayed interpretation. We summarize the literature on using APTs to identify foods for oral challenge with dermatitis as an outcome. In dermatitis patients at risk for Th2 skewing based on a history of childhood-onset flexural dermatitis, shared decision-making should include a discussion of identifying and avoiding food and food additive triggers, as well as identifying and avoiding all contact allergens, prior to initiation of systemic therapy for dermatitis.

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Data Availability

The data that support the findings of this study are available on request from the corresponding author.

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Acknowledgements

The authors thank Hanna Orillaza MD for suggestions about the manuscript.

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Authors and Affiliations

  1. Eastern Virginia Medical School, Norfolk, USA

    Kripa Ahuja

  2. Oakland University William Beaumont School of Medicine, Rochester, USA

    Christopher J. Issa

  3. Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Christopher J. Issa & Peter A. Lio

  4. Dermatologists of the Central States, Case Western Reserve University, Columbus, OH, USA

    Susan T. Nedorost

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KA, CJI, STN and PAL contributed to drafting and editing of the manuscript, and SJN contributed to conceptualization of the manuscript.

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Correspondence to Kripa Ahuja.

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Dr. Peter A. Lio reports research grants/funding from AOBiome, Regeneron/Sanofi Genzyme, and AbbVie; is on the speaker's bureau for Regeneron/Sanofi Genzyme, Pfizer, Incyte, Eli Lilly, LEO, Galderma, and L'Oreal; reports consulting/advisory boards for Almirall, ASLAN Pharmaceuticals, Bristol-Meyers, Dermavant, Regeneron/Sanofi Genzyme, Merck, Pfizer, LEO Pharmaceuticals, AbbVie, Eli Lilly, Micreos (stock options), L'Oreal, Pierre-Fabre, Johnson & Johnson, Unilever, Menlo Therapeutics, Theraplex, IntraDerm, Exeltis, AOBiome, Realm Therapeutics, Altus Labs, Galderma, Verrica, Arbonne, Amyris, Bodewell, YobeeCare, Burt's Bees, My-Or Diagnostics, Sibel Health, and Kimberly-Clark. In addition, Dr. Lio has a patent pending for a Theraplex product with royalties paid and is a Board member and Scientific Advisory Committee Member Emeritus of the National Eczema Association. Dr. Nedorost reports consulting and advisory board membership for Pfizer and is a former member of the Scientific Advisory Committee of the National Eczema Association. Kripa Ahuja, Christopher J. Issa, and Susan T. Nedorost have no conflicts of interest to declare.

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Ahuja, K., Issa, C.J., Nedorost, S.T. et al. Is Food-Triggered Atopic Dermatitis a Form of Systemic Contact Dermatitis?. Clinic Rev Allerg Immunol 66, 1–13 (2024). https://doi.org/10.1007/s12016-023-08977-x

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