Introduction: Atopic dermatitis (AD) is an inflammatory skin disease very common in children. This chronic medical condition has negative impact on patients and their families’ life. Carrying a child with moderate to severe AD has been associated with parental sleep disturbances, anxiety levels and increased episodes of maternal depression. There has been a vigorous discussion in the literature over the role of food allergy in the pathogenesis of atopic dermatitis for many years. Now the most convincing clinical and laboratory evidence suggests that food hypersensitivity is the major factor inducing the flares of AD in children. The aim of our study was to evaluate how often AD is associated  with cow milk allergy in the second year of life.

Material and methods: We included into the study 50 children (mean age 18.6 month) with AD and suspected food allergy, who were on elimination diet. The intensity of AD was assessed according to SCORAD scale. All children were screened for cow milk, egg, wheat and soy specific IgE level.  The level of total IgE was checked along. Then we performed skin prick and atopy patch tests with those allergens. One month later we performed oral open challenge test with fresh milk, egg and flour (in patients negative for milk challenge). Symptoms as AD exacerbation, vomiting, diarrhea and wheezing were regarded as a positive outcome of challenge.

Results: Elevated total IgE was found in 26 (52%) patients. Specific IgE to food allergens were detected in 14 cases (28%):  CM 5 (10%); HE 6 (12 %); wheat 2 (4%); and soy 1 (2%). Skin prick tests were positive in 15 (30%) of children : CM, 5 (10%); HE, 7 (14 %); wheat 1 (2%); and soy 2 (4%).Positive skin patch test was observed in 16 patients (32%): CM  9(18 %); HE 7(14 %); wheat 1(2%). Of the 50 performed open cow milk challenges 16 (32%) were positive. Generally, basing on open challenge test, food allergy was diagnosed in 26( 52%)  patients.

Conclusions: We strongly recommend allergy evaluation of small children with atopic dermatitis  as there is likelihood that the child is not sensitive to food or has outgrown his sensitivity. Patients with negative results will be allowed to stop unnecessary elimination diet.