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Diet in Atopic Dermatitis (AD) may turn out to be a factor that significantly affects the course and severity of this disease. Food allergies and the condition of the intestines have a large influence on the occurrence of AD. Therefore, people who struggle with this disease are advised to follow a proper diet, which can alleviate the troublesome symptoms of Atopic Dermatitis.

The role of diet in atopic dermatitis is very complex.Worsening of disease symptoms may be directly related to food allergy , but it can also be very difficult to pinpoint. Is it worth following a diet with AD if there is no allergy? What to eat with AD?

What is atopic dermatitis?

Atopic dermatitis is achronic, recurrent, inflammatory skin disease, primarily manifested by inflammation of the skinaccompanied by itching. Lumps and vesicles appear on the patient's skin. Due to intense scratching and weakening of the natural skin barrier, superinfections of various origins occur. During healing, the skin peels off. Discoloration is possible.Atopic dermatitis can last a lifetime . However, the severity of the disease varies, and the periods of exacerbation are interspersed with periods of silence (remission). Remission can take months or even years with proper treatment.

Atopic dermatitis is a disease that largely affects children. 60% of cases are diagnosed in the age of 1, 30% of cases between 1 and 5 years of age, and only 20% of cases after the age of 5. This statistic applies to all patients, including adults. In 80% of cases, there is a spontaneous remission around the age of 7 or in adolescence at the latest.

Atopic dermatitis affects 4.7-9.2% of children and 0.9-1.4% of adults. Children living in urban areas get sick more often than in the countryside.

Atopic dermatitis and food allergies

The dependence of AD on diet is not clearly confirmed. The mechanism is also not fully known. There is no doubt, however, thatthe occurrence of atopic dermatitis is associated with food allergies and intestinal he alth . It is not known exactly how many patients with AD are also allergic or food intolerant. According to various sources, it is from 40 to even 90% of patients.

It is estimated that about 30% of children who develop ADmoderate or severe, there is an IgE-dependent allergy, the symptoms of which occur up to 2 hours after food consumption. 74% of people with AD and a diagnosed food allergy have allergy skin symptoms such as hives, pruritus and angioedema. A late response in the form of reddening of the skin may also occur in the IgE-mediated reaction. 25% of people show symptoms of an independent IgE reaction, manifested from several hours to several days after consuming food. An independent IgE reaction produces gastrointestinal symptoms such as loose stools with mucus, constipation and vomiting. Behavioral changes are common - anxiety, irritability, refusal to eat. The skin lesions also intensify. About 40% of children have a mixed reaction, IgE-dependent and IgE-independent.

The most commonallergenic foods in childrenwith AD are:

  • cow's milk proteins,
  • egg white,
  • wheat,
  • soybeans,
  • peanuts,
  • cocoa,
  • fish,
  • crustaceans,
  • citrus,
  • preservatives, dyes, flavor and aroma enhancers.

In adultsfoodsmost allergenicthese are:

  • wheat,
  • apples,
  • celery,
  • peanuts,
  • carrot,
  • cherries,
  • seafood,
  • soybeans,
  • kiwi.

Atopic dermatitis - elimination diet

The elimination diet for AD is a diet that excludes foods that lead to an allergic reaction or foods that are not tolerated. If a reaction to a food does not occur immediately after consumption, the food in question is eliminated not only by suspicion, but by attempting to eliminate the suspected product and challenging it orally after a specified period of time. The product is removed from the diet for 4-6 weeks and monitored for improvement. If not, the product is put back into the diet. If there is an improvement in the patient's condition, provocation is used, i.e. introducing food into the diet and monitoring the body's reaction. In case of deterioration, food is excluded from the diet for at least 6 months. An elimination diet requires the skilful introduction of substitutes for food products or their entire groups, therefore it is usually necessary to cooperate with a dietitian.

I have not been diagnosed with any food allergies. So, is the AD diet important?

A special diet is not a classic part of the treatment of atopic dermatitis. However, there are scientific premises that allow to conclude that the condition of people suffering from atopic dermatitis is related not only to allergies, but also to food hypersensitivity and intolerance.histamine, the state of the gut microbiota and the gut itself. Hence, food is important, even if the patient does not have a typical allergic reaction. This approach is supported by doctors who treat holistically, treat he alth as a whole, and not separate individuals from individual systems. In the treatment of atopic dermatitis, you can meet doctors who recommend a diet and those who say that it is an unnecessary effort.

It would seem that since no allergies were found, there is no point in looking at the food any further. But what if there is a reaction? What if after eating certain foods or food groups, you can see skin deterioration or behavioral changes? In addition to common food allergy, there are other mechanisms that have not been thoroughly researched by science to include food intolerances and hypersensitivity. For many people with atopic dermatitis, diet matters, and the key to using it should be careful observation of the body and its response to food.

Diet in AD and histamine intolerance

Histamine is a biogenic amine released by the body, e.g. as a result of allergic reactions. It is responsible for allergy symptoms such as urticaria, bronchial smooth muscle spasm and anaphylactic shock. We also supply histamine with food. It would seem that since the body produces histamine itself, supplied from outside should not be harmful. However, the key here is the concentration of the substance and the ability to metabolize it. When the intestines and cells of the body lack the enzyme diamine oxidase (DAO) and N-methyltransferase, the breakdown of histamine from food is ineffective or even impossible and a pseudoallergic reaction occurs. It follows a different pathway than an allergic reaction, but the symptoms are similar. Symptoms appear 10-60 minutes after eating food, which disappear spontaneously after 6-8 hours. These include hives, reddening of the skin, swelling of the face, as well as headaches, including migraines, nausea and vomiting. Symptoms of histamine intolerance can occur both in people with impaired enzyme function and in he althy people who ate a lot of histamine at one time - more than 500 mg per kg of food.

Histamine intolerance affects an estimated 1-2% of the Western European population. By comparison, allergies affect 3-5% of the population. People with histamine intolerance must follow a low histamine diet, which excludes dietary sources of histamine and products that increase its release.

Atopic dermatitis is a complex disease, its cause is not fully understood. Increasingly, in scientific research it turns toits association with DAO deficiency and histamine intolerance. It is also worth noting that one of the elements of AD treatment is the administration of antihistamines, as histamine increases skin itching. More and more case studies are published that show the effectiveness of introducing an antihistamine diet in the treatment of AD. It can even lead to complete drug withdrawal. This does not mean, however, that an antihistamine diet will work for everyone with AD. It is recommended for people with certain types of urticaria and diagnosed with histamine intolerance. Histamine intolerance is diagnosed on the basis of an interview and analytical methods, which, unfortunately, are neither common nor cheap.

Foods rich in histamine (over 100 mg / kg food):

  • seafood,
  • fish: tuna, mackerel, sardines,
  • sauerkraut, pickled cucumbers,
  • spinach,
  • tomatoes,
  • eggplant,
  • fruit (the more ripe, the more histamine they contain): orange, mandarin, pineapple, strawberry, banana, avocado,
  • peanuts,
  • cheeses (the longer they mature, the more histamine they contain): parmesan, blue cheeses, yellow cheeses,
  • long-ripening cold cuts: salami, Parma ham, "dry" sausages,
  • pork liver,
  • chocolate,
  • cocoa,
  • yeast,
  • wine vinegar,
  • red wine, champagne, beer,
  • highly processed foods with preservatives.

Foods to stimulate the release of histamine:

  • raw pineapple,
  • papaya,
  • kiwi,
  • strawberry,
  • cocoa,
  • nuts,
  • chocolate,
  • egg white.

What to eat with AZS?

There is no one-size-fits-all diet to treat AD. The list of products that may aggravate the symptoms of the disease is very long, so there is no justification for excluding all of them by anyone suffering from atopic dermatitis. The key to eliminating food should be careful observation of the body, the intensification and suppression of symptoms, and where possible - diagnostics through medical analytics.

There is no doubt, however, as to what the diet for atopic dermatitis should be in its general principles. The diet recommended for people with AD is a diet based on real food of known origin, local, low-processed, free from dyes and preservatives. Prepared foods, fast food, shop sweets, s alty snacks, colored jelly beans, marshmallows, etc., colorful drinks and any products that seem artificial at first glance are particularly inadvisable.However, seasonal vegetables and fruits are recommended, bought from a proven farmer, grown using traditional methods. The same goes for meat and eggs - the more naturally the animals are kept, the he althier they are. Therefore, in the case of AD, you have to give up meat from supermarkets and eggs from large cage farms. Some sources say that the symptoms of atopic dermatitis may worsen after consuming saturated fatty acids from fatty dairy products and red meat.

A diet in AD should be an anti-inflammatory diet, rich in food that reduces inflammation indicators in the body, because the disease itself is inflammatory.

What to eat with AD - practical tips

  1. Eat large amounts of vegetables: Most vegetables are hypoallergenic, so even without knowing the existence of an allergy, there is little chance that your skin reactions will worsen by eating vegetables. Vegetables should be free of pesticides and preservatives. Preferably with a BIO food certificate or from a proven farmer. Vegetables are a source of antioxidants that are very valuable in the diet for AD, which reduce inflammation in the body, and therefore indirectly have a positive effect on the condition of the skin. One of the most important antioxidants may be quercetin, which additionally has an antihistamine effect. It can be found in apples, cherries, dark berries, broccoli, spinach and kale.
  2. Choose seasonal fruit and be careful when eating the most allergenic: When buying fruit, consider the seasonality. Eat blueberries in the summer, apples in the fall. It is worth considering giving up eating fruits that come from distant parts of the world and require a long transport time. They are highly conserved so that they survive transport and picked while still unripe. Therefore, they do not present the high nutritional value you would expect from them.
  3. Provide Omega-3 Fatty Acids: Omega-3 fatty acids have a strong anti-inflammatory effect. Research shows that they can be effective in allergic diseases, rheumatoid arthritis, irritable bowel syndrome and atopic dermatitis. The recommended daily dose of omega-3 fatty acids is 250 mg. However, in the case of AD, it may be many times higher. Omega-3 fatty acids can be supplemented or provided with the diet. Its good sources are linseed oil and oily sea fish. However, you should be careful when eating fish, as they can also be an allergenic factor.
  4. Introduce probiotics to the diet: The tendency to allergies and food hypersensitivity is associated with an imbalance in the intestinal microbiota and a deficiency of bacteriaprobiotics. Improper composition of the intestinal microbiota negatively affects the functions of the immune system, reduces the number of T-regulatory cells in the intestines and is suspected of increasing the predisposition to AD. Research suggests that administering probiotics containing mixed bacterial strains for at least 8 weeks to children over 1 year of age may show promise in the treatment of atopic dermatitis. The publications also recommend the use of synbiotics, i.e. probiotic bacteria and prebiotic substances (supporting the growth of good bacteria) taken together.
  5. Consider vitamin D supplementation: The beneficial role of vitamin D in AD is only confirmed in people with frequent bacterial superinfections. However, in Poland, vitamin D deficiency is common, and it is associated with the weakening of the immune system and intensification of inflammatory processes. It is worth checking the level of vitamin D in the body and introducing supplementation in the event of its deficiency.
  6. Avoid sugar and hydrogenated palm oil: Sugar and hydrogenated vegetable oils are dietary components known to be pro-inflammatory. They can be found in practically every highly processed product - in sweets, ready meals, crisps and fast food. It's best to eliminate them from your diet, especially during periods of exacerbation.
  7. Watch out for food additives: The role of food additives in AD and exacerbating symptoms is not fully understood. However, a close relationship was noticed between their consumption and the deterioration of the condition of patients with AD.

List of food additives that should be avoided in the diet with AD

  • Food colors: E123 amaranth, E110 sunset yellow, E122 carmine, E102 tartrazine, E142 green S, E104 quinoline yellow, E132 indigo carmine, E124 cochineal red (4R), E128 red 2G, E129 allura black, E151 allura black brilliant, E155 bronze HT, E154 bronze FK
  • OCCURRENCE: in colorful sweets and drinks, candied fruit, canned food containing red fruit, preserved vegetables, sauces, spices, e.g. curry, pickles, fish spreads, meats, hamburger meat, powdered soups, soy chops, products confectionery, pastry, desserts, ice cream
  • Preservatives: E200 sorbic acid, E202 potassium sorbate, E203 calcium sorbate, E214-219 esters of b-hydroxybenzoic acid, E210-E213 benzoates, E220-228 sulphites, E249-252 nitrates and nitrites, E230 biphenyl, diphenyl, E231 orthophenylphenol, E232 sodium orthophenylphenol, E239 urotropin, E1105 lysozyme
  • OCCURRENCE: in products based on milk and sugar olong shelf life, cold cuts, salads ready to eat and on the surface of citrus fruits
  • Antioxidants: E310 propyl gallate, E311 octyl gallate, E312 dodecyl gallate, E320 BHA, E321 BHT
  • OCCURRENCE: in all confectionery fats and fats used in the production of soups and spices in cubes
  • Gelling and thickening agents: E405 propylene glycol alginate, E410 locust bean gum, E412 guar gum, E413 tragacanth, E414 gum arabic, E466 carboxymethylcellulose
  • OCCURRENCE: in sauces, toppings, creams, ice cream, cottage cheese
  • Stabilizers and emulsifiers E170 calcium carbonate, E322 lecithin
  • OCCURRENCE: in confectionery, drinks, powdered desserts, delicatessen products, sauces
  • Flavor enhancers E620-625 glutamates (sodium, potassium, calcium, magnesium)
  • OCCURRENCE: in ready-made meat and vegetable dishes, popular kitchen spices
  • Sweeteners E951 aspartame, E952 cyclamenic acid
  • OCCURRENCE: in beverages, confectionery.

Sources :

  1. "Atopic dermatitis in children. A practical guide. Edition I "Alabaster Foundation, collective work, license: [CC BY 3.0 PL]
  2. http: //www.haloatopia.pl/download/halo_atopia_publikacja.pdf
  3. http: //alergia.org.pl/wp-content/uploads/2019/09/5_1_2019.pdf
  4. https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC5006549/
  5. https: //pubmed.ncbi.nlm.nih.gov/26882378/
  6. https: //ptca.pl/baza-wiedzy/wszystkie-artykuly/244-atopowy-hit-czyli-nietolerencja-histapii-2
  7. https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC3970830/

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