Hannah Wilson
FSN 310
Pediatric Research Paper
Nutritional Intervention for Children Suffering from Atopic Dermatitis
Within the past few decades the cases of children suffering from atopic dermatitis has
increased two to three fold (Greer et al.183). Atopic dermatitis is a painful and severe chronic
inflammatory skin disease that is common during early childhood and can be associated with the
genetic prevalence of other atopic diseases (Greer et al. 183). Although atopic diseases have a
clear genetic basis, early infant nutrition has an important influence on their development, which
may present an opportunity to prevent or delay the onset of the disease (Greer et al. 184). This
research paper will evaluate the benefits of exclusive breastfeeding, how to approach the
introduction of solid food, and supplementation for managing atopic dermatitis in young
children.
Immediately after birth, prevention mechanisms for children at high risk of developing atopic
diseases can be established. The World Health Organization (WHO) recommends breastfeeding
for the first 6 months of life and advises that it should be attempted in all infants (Gamboni et al.
84). Scientists have questioned whether maternal diet during lactation has an impact of
developing atopic dermatitis. However, collective evidence suggests maternal dietary restrictions
during pregnancy do not play a significant role in the prevention of atopic disease in infants
(Greer et al. 183). Exclusive breast feeding for at least 4–6 months compared to feeding with
intact cow’s milk protein formula may decrease the cumulative incidence of atopic dermatitis,
problems with early exposure to cow’s milk may relate to the immaturity of the infant’s
gastrointestinal tract (Gamboni et al. 85). Unfortunately, there are situations where an infant is
unable to be exclusively breastfed and infants need to rely formulas. Infants predisposed or
already experiencing symptoms of atopic dermatitis, hypoallergenic hydrolyzed infant formals
may replace breastfeeding to avoid potential allergies from soy or milk based formulas (Greer et
al. 183).
Deciding when to introduce complementary foods is the next initiative mothers can take to
help prevent the onset of atopic dermatitis. The gut has a large antigenic load that develops
overtime and it’s thought that the age of food exposure must play a role in the prevention of or
predisposition to allergic disease (Abrams, Becker, 721). A recent literary review identified 2719
article citations and critically evaluated 13 studies that confirmed early solid feeding (before the
age of 4 months) increases the risk of allergic disease (Gamboni et al. 85). Thus, health
professional agree that the introduction of solids should be around 4 to 6 months for optimal
prevention (Gamboni et al. 85).
There are several solid foods that mothers should pay extra attention to during the
introductory phase, the American Academy of Pediatrics (AAP) recommends delaying the
introduction of cow’s milk until 1 year of age, egg until 2 years of age, and peanut, tree nut, and
fish until 3 years of age (Abrams, Becker, 721). Various chemical ingredients, such as flavoring
agents and preservatives commonly found in processed foods, are also frequently restricted from
the diets of children suffering from atopic dermatitis (Lim et al. 55). Despite the handful of highrisk foods, introducing a variety of foods during this time may have beneficial effects. It appears
that early exposure to allergens, from around 4–6 months of age (opposed to very at less than 4
months) may actually allow the infant’s immune system to become tolerant and prevent the
allergic sensitization to food (Gamboni et al. 87). In conclusion, the timing and types of food be
introduced to young children impact prevention of atopic dermatitis by reducing exposures to
pathogens from food and increasing tolerance by eating a variety of non-risk foods.
Despite commonly practiced efforts to reduce environmental exposures to children,
atopic dermatitis continues to rank as the most common allergic disease, causing countless
children to suffer from various physical problems due to frequent skin damage and itchy
sensation (Hyunjin et al. 2287). As one could imagine, such stress and aggravation during a vital
time of development can have serious impacts on the child’s life. Atopic dermatitis can indirectly
disrupt friendships, learning performance, and family relationships, thus negatively influence the
child’s life (Hyunjin et al. 2287). There are several supplements that are thought to aid in treating
atopic dermatitis and improve overall quality of life in addition to the physical problems
associated with this disease.
For example, vitamin D has been a significant area of research as dietary supplement for
treatment of atopic dermatitis. In its active form, dihydroxyvitamin D promotes antimicrobial
peptide (AMP) gene expression inducing antimicrobial properties and immune system signaling
(Searing et al. 399). Antimicrobial peptide activity is only one potential benefits of vitamin D
supplementation, research indicates potential for vitamin D to suppress inflammatory responses
and promote the integrity of the intestineds (Searing et al. 399). Correspondingly, vitamin D
supplementation provides a possible therapeutic intervention for a variety of skin disorders
including atopic dermatitis (Searing et al. 399). Another potential supplement for treating
symptoms of atopic dermatitis is the use of probiotics. According to clinical findings, probiotic
administration of especially L. rhamnosus GG to infants at high risk of atopy appeared effective
for prevention of development of atopic dermatitis (Betsi et al. 2). Probiotic treatment for one or
two months appeared to also reduce the severity of atopic dermatitis, but probiotics had little
effect on most of the inflammatory markers measured (Betsi et al. 3).
The food, dose, frequency, age of introduction, and genetic predisposition of the child
might all play important roles allergenic diseases. It is important that health care providers to
educate new mothers on the role of introducing foods to their children in effort to decrease the
prevalence of atopic dermatitis. Additionally, the administration of vitamin D supplements and
probiotics are two mechanisms to decrease irritable symptoms and foster the growth of a healthy
and happy child. Atopic dermatitis, along with other food allergies in children is a continuing
area of research with more prevention and treatment mechanisms to be found.
Work Cited
Gamboni SE, Allen KJ, Nixon RL, Infant feeding and the development of food allergies and
atopic eczema: An update. Australasian Journal of Dermatology. 2013; 54: 85–89. Review
Greer FR, Sicherer SH, Burks W. Effects of Early Nutritional Interventions on the Development
of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction,
Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas. The
Official Journal of The American Academy of Pediatrics. 2008; 121: 183-191
Betsi GI, Papadavid E, Falagas ME. Probiotics for the treatment or prevention of atopic
dermatitis: a review of the evidence from randomized controlled trials. National Institute for
Health Research. 2014; 1-3
Searing DA, Leung YM. Vitamin D in Atopic Dermatitis, Asthma and Allergic Diseases.
Immunol Allergy Clin North Am . 2010 August ; 30(3): 397–409.
Lim H, Song K, Sim J, Park E, Kangmo A, Kim j, Han Y. Nutrient Intake and Food Restriction
in Children with Atopic Dermatitis. Clinical Nutrition Research. 2013;2:52-58