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Dietary Elimination for the Treatment of Atopic Dermatitis: A Systematic Review and Meta-Analysis.
Oykhman, Paul; Dookie, Jared; Al-Rammahy, Husam; de Benedetto, Anna; Asiniwasis, Rachel N; LeBovidge, Jennifer; Wang, Julie; Ong, Peck Y; Lio, Peter; Gutierrez, Alvin; Capozza, Korey; Martin, Stephen A; Frazier, Winfred; Wheeler, Kathryn; Boguniewicz, Mark; Spergel, Jonathan M; Greenhawt, Matthew; Silverberg, Jonathan I; Schneider, Lynda; Chu, Derek K.
Afiliação
  • Oykhman P; Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
  • Dookie J; Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
  • Al-Rammahy H; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
  • de Benedetto A; Department of Dermatology, University of Rochester Medical Center, Rochester, NY.
  • Asiniwasis RN; Origins Dermatology Centre, University of Saskatchewan, Regina, Saskatchewan, Canada.
  • LeBovidge J; Division of Immunology, Boston Children's Hospital, Boston, Mass.
  • Wang J; Icahn School of Medicine at Mount Sinai, New York City, NY.
  • Ong PY; Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, Calif.
  • Lio P; Northwestern University Feinberg School of Medicine, Chicago, Ill.
  • Gutierrez A; Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
  • Capozza K; Global Parents for Eczema Research, Santa Barbara, Calif.
  • Martin SA; University of Massachusetts Chan Medical School, Worcester, Mass.
  • Frazier W; Department of Family Medicine, UPMC St Margaret, Pittsburgh, Pa.
  • Wheeler K; Department of Pediatrics, University of Florida, Gainesville, Fla.
  • Boguniewicz M; Divison of Allergy-Immunology, Department of Pediatrics, National Jewish Health and University of Colorado School of Medicine, Denver, Colo.
  • Spergel JM; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa.
  • Greenhawt M; Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo.
  • Silverberg JI; Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC.
  • Schneider L; Division of Immunology, Boston Children's Hospital, Boston, Mass.
  • Chu DK; Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact. McMaster University, Hamilton, Ontario, Canada; Research Institute of St Joe's Hamilton, Hamilton, Ontario, Canada. Electr
J Allergy Clin Immunol Pract ; 10(10): 2657-2666.e8, 2022 10.
Article em En | MEDLINE | ID: mdl-35987995
BACKGROUND: The influence of diet on atopic dermatitis (AD) is complex, and the use of dietary elimination as a treatment has conflicting views. OBJECTIVE: To systematically review the benefits and harms of dietary elimination for the treatment of AD. METHODS: We searched MEDLINE, Embase, AMED, PsycINFO, and the Cochrane Central Register of Controlled Trials from inception to January 18, 2022, without language restrictions, for randomized controlled trials (RCTs) and observational studies comparing dietary elimination and no dietary elimination for the treatment of AD. We conducted random-effects meta-analyses of eczema outcomes. We used the grading of recommendations, assessment, development, and evaluation approach to assess certainty of evidence (CRD42021237953). RESULTS: Ten RCT (n = 599; baseline median of study mean age, 1.5 years; median of study mean SCOring Atopic Dermatitis index, 20.7, range, 3.5-37.6) were included in the meta-analysis. Compared with no dietary elimination, low-certainty evidence showed that dietary elimination may slightly improve eczema severity (50% with vs 41% without dietary elimination improved the SCOring Atopic Dermatitis index by a minimally important difference of 8.7 points, risk difference of 9% [95% CI, 0-17]), pruritus (daytime itch score [range, 0-3] mean difference, -0.21 [95% CI, -0.57 to 0.15]), and sleeplessness (sleeplessness score [range, 0-3] mean difference, -0.47 [95% CI, -0.80 to -0.13]). There were no credible subgroup differences based on elimination strategy (empiric vs guided by testing) or food-specific sensitization. Insufficient data addressed harms of elimination diets among included RCTs, although indirect evidence suggests that elimination diets may increase the risk for developing IgE-mediated food allergy. CONCLUSIONS: Dietary elimination may lead to a slight, potentially unimportant improvement in eczema severity, pruritus, and sleeplessness in patients with mild to moderate AD. This must be balanced against potential risks for indiscriminate elimination diets including developing IgE-mediated food allergy and withholding more effective treatment options for AD.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Dermatite Atópica / Eczema / Distúrbios do Início e da Manutenção do Sono Tipo de estudo: Clinical_trials / Guideline / Observational_studies / Systematic_reviews Limite: Humans / Infant Idioma: En Ano de publicação: 2022 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Dermatite Atópica / Eczema / Distúrbios do Início e da Manutenção do Sono Tipo de estudo: Clinical_trials / Guideline / Observational_studies / Systematic_reviews Limite: Humans / Infant Idioma: En Ano de publicação: 2022 Tipo de documento: Article