eczema-atopic-dermatitis-dermnet NZ

Atopic Dermatitis – Eczema: Food Restrictions May Limit Pediatric Growth Interview with:

Adawiyah Jamil, AdvMDerm Associate Professor at Department of Medicine University Kebangsaan Malaysia Medical Center Kuala Lumpur, Malaysia

Adawiyah Jami

Adawiyah Jamil, AdvMDerm
Associate Professor at Department of Medicine
University Kebangsaan Malaysia Medical Center
Kuala Lumpur, Malaysia What is the background for this study?

Response: We commonly observed poor dietary pattern and multiple food restrictions imposed on atopic dermatitis (AD) children by their parents in our daily clinical practice. Food allergy is often associated with AD, however excessive and medically unsubstantiated restriction may lead to various health issues. AD is a chronic skin disease, like any other chronic diseases it affects an individual’s general health. Growth and development are key measures of health in children. We embarked on this study as we were very worried of the consequences of medically unsupervised food restriction, especially those with severe disease.  We were concerned about how our atopic dermatitis children are eating and how to help them. What are the main findings? Do you have recommended nutritional guidelines for children at risk of atopy?

Response: We found that food restriction was very common, which was expected. The top 3 restricted food were shellfish, nuts and egg. Generally, children do not consume shellfish dishes and nuts as it is, very often. However, in our country dried shrimp, shrimp paste, crab sticks etc are very common ingredients in a lot of other dishes. Nuts are commonly eaten in the form of cookies and other snacks. As a result, restriction of shellfish and nuts leads to restriction of a lot of other foods. The same applies for eggs.

Growth of all our atopic dermatitis children, food restricted or not, was below standard population’s mean values and more were underweight. None of the atopic dermatitis children were overweight or obese. Weight, height, head circumference, mid‐upper arm circumference (MUAC) and body mass index (BMI) were significantly lower in food‐restricted compared to non‐food‐restricted children. Stunted height, underweight and lower head circumference were more prevalent in food restricted children.

There are a few nutritional guidelines for prevention of atopic diseases for children at risk, for example:

  • EAACI Food Allergy and Anaphylaxis Guidelines. Primary prevention of food allergy.
  • Early introduction of allergenic foods for the prevention of food allergy from an Asian perspective-An Asia Pacific Association of Pediatric Allergy, Respirology & Immunology (APAPARI) consensus statement.
  • Atopic Dermatitis. Nutrition Guide for Clinicians. Physicians Committee for Responsible Medicine, 2017.

However, there is no clear nutritional guideline for children with AD, research and data in this area is limited. We think the nutritional requirements of AD children and their growth has not been given the attention it deserved, current atopic dermatitis management guidelines give a cursory comment or not at all. What should readers take away from your report?

 Response: Growth is affected in atopic dermatitis children especially those with severe disease. Food restriction is an important contributing factor. Optimization of atopic dermatitis control and good nutrition should be emphasized in clinical practice. What recommendations do you have for future research as a result of this work?

Response: Other factors that may contribute to atopic dermatitis children’s growth like sleep deprivation due to itch, nutrient loss from the skin, ineffective intestinal food adsorption and higher basal metabolic rate should be investigated. Is there anything else you would like to add?

Response: We feel nutritional deficiencies contribute to difficulty in managing atopic dermatitis and the severity of the disease. Good nutrition is an important part of AD management, it should be emphasized.

We do not any conflict of interest to disclose.


The official publication for the Society for Pediatric Dermatology (SPD), Pediatric Dermatology is a peer-reviewed bimonthly journal that captures leading research in the field of children’s skin, hair and nail disorders to promote skin health across the United States and aid the development of new treatments for pediatric patients.


Food restriction, nutrition status, and growth in toddlers with atopic dermatitis

Dy‐Win Low MRCP, Adawiyah Jamil AdvMDerm, Norazirah Md Nor AdvMDerm, Sabeera Begum Kader Ibrahim MPaeds Bee Koon Poh PhD First published:30 October 2019


Mar 18, 2020 @ 12:16 am


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