Atopic eczema is the most common inflammatory skin disease of childhood in developed countries. The cause of atopic eczema is probably due to a combination of genetic and environmental factors. Atopic eczema varies in severity, often from one hour to the next and the disease can be associated with complications such as bacterial and viral infections. There is a substantial economic cost not only to the family of the person with atopic eczema but also to health services. Although there is currently no cure for atopic eczema, a wide range of treatments are used to control the symptoms. One such approach is a dietary one, whereby certain foods such as cows' milk are excluded on the basis that they are thought to cause eczema to worsen. The reason for undertaking this review is because the effectiveness of removing various foods from the diet in the short term management of atopic eczema is unclear.
The general quality of the studies was poor. The main findings of the review suggest that there is some evidence from one study for the use of an egg-free diet in infants with a suspected egg allergy who have positive specific IgE antibodies to eggs in their blood. Other studies that compared a dietary exclusion with ordinary diets did not test the people taking part to see if they were allergic to the foods concerned. There appears to be little benefit in eliminating cows milk from the diet or using an elemental (liquid diet containing only amino acids, carbohydrates, fat, minerals and vitamins) or 'few foods diet' for improving atopic eczema in people who have not undergone any form of testing.
Three of the studies used soya based substitute which itself can be allergenic to people with atopic eczema.
Adhering to elimination diets is difficult. The studies were performed in different populations with only one study describing the severity of the atopic eczema. The clinical relevance of changes in severity scores obtained in many studies is unknown.