The Interplay Between Food Allergy and Atopic Dermatitis: Mechanism, Diagnosis, and Management
DOI:
https://doi.org/10.37287/ijghr.v8i3.1235Keywords:
atopic dermatitis, diagnosis, food allergy, management, skin barrierAbstract
Atopic dermatitis (AD) and food allergy (FA) are two conditions that frequently coexist and present significant challenges in both diagnosis and management. This review aims to describe the link between atopic dermatitis and food allergy, as well as their diagnosis, management, and prevention, especially in the Asian context. The findings indicate that impairment of the skin barrier and exposure to food allergens through the skin (epicutaneous sensitization) play central roles in the development of FA among individuals with AD. From a diagnostic perspective, it is essential to distinguish between food sensitization and clinically significant food allergy in order to avoid unnecessary elimination diets. Management strategies encompass comprehensive care for AD, including skin-barrier maintenance and anti-inflammatory therapy, alongside evaluation for FA when clinically indicated, and avoidance of confirmed trigger foods. Preventive efforts, particularly in high-risk infants, show promise through early skin-barrier care and controlled introduction of food allergens. In the Indonesian and broader Asian contexts, adaptation of these strategies should consider local dietary patterns and the availability of allergy and dermatology services.
References
Beck, L. A., Cork, M. J., Amagai, M., De Benedetto, A., Kabashima, K., Hamilton, J. D. & Rossi, A. B. (2022). Type 2 Inflammation Contributes to Skin Barrier Dysfunction in Atopic Dermatitis. JID Innovations : Skin Science from Molecules to Population Health, 2(5), 100131. https://doi.org/10.1016/j.xjidi.2022.100131
Braun, C., Coutier, L., Bégin, P. & Nosbaum, A. (2024). Skin-centered strategies in food allergy prevention. Pediatric Allergy and Immunology : Official Publication of the European Society of Pediatric Allergy and Immunology, 35(5), e14130. https://doi.org/10.1111/pai.14130
Brough, H. A., Lanser, B. J., Sindher, S. B., Teng, J. M. C., Leung, D. Y. M., Venter, C., Chan, S. M., Santos, A. F., Bahnson, H. T., Guttman-Yassky, E., Gupta, R. S., Lack, G., Ciaccio, C. E., Sampath, V., Nadeau, K. C. & Nagler, C. R. (2022). Early intervention and prevention of allergic diseases. Allergy: European Journal of Allergy and Clinical Immunology, 77(2), 416–441. https://doi.org/10.1111/all.15006
Brough, H. A., Nadeau, K. C., Sindher, S. B., Alkotob, S. S., Chan, S., Bahnson, H. T., Leung, D. Y. M. & Lack, G. (2020). Epicutaneous sensitization in the development of food allergy: What is the evidence and how can this be prevented? Allergy, 75(9), 2185–2205. https://doi.org/10.1111/all.14304
Calamelli, E., Liotti, L., Beghetti, I., Piccinno, V., Serra, L. & Bottau, P. (2019). Component-Resolved Diagnosis in Food Allergies. Medicina (Kaunas, Lithuania), 55(8). https://doi.org/10.3390/medicina55080498
Darlenski, R., Kozyrskyj, A. L., Fluhr, J. W. & Caraballo, L. (2021). Association between barrier impairment and skin microbiota in atopic dermatitis from a global perspective: Unmet needs and open questions. Journal of Allergy and Clinical Immunology, 148(6), 1387–1393. https://doi.org/10.1016/j.jaci.2021.10.002
Davis, K. L., Claudio-Etienne, E. & Frischmeyer-Guerrerio, P. A. (2024). Atopic dermatitis and food allergy: More than sensitization. Mucosal Immunology, 17(5), 1128–1140. https://doi.org/10.1016/j.mucimm.2024.06.005
de Weger, W. W., Sprikkelman, A. B., Herpertz, C. E. M., van der Meulen, G. N., Vonk, J. M., Koppelman, G. H. & Kamps, A. W. A. (2025). Comparison of Double-Blind and Open Food Challenges for the Diagnosis of Food Allergy in Childhood: The ALDORADO Study. Allergy, 80(1), 248–257. https://doi.org/10.1111/all.16428
Dębińska, A. & Sozańska, B. (2023). Epicutaneous Sensitization and Food Allergy: Preventive Strategies Targeting Skin Barrier Repair-Facts and Challenges. Nutrients, 15(5). https://doi.org/10.3390/nu15051070
Di Cesare, G., Carciofi, A., Borgiani, F., Cappelletti, D., Correani, A., Monachesi, C., Gatti, S. & Lionetti, M. E. (2025). Are We Meeting the Needs? A Systematic Review of Nutritional Gaps and Growth Outcomes in Children with Multiple Food Allergies. Nutrients, 17(9). https://doi.org/10.3390/nu17091590
Dinardo, G., Chiera, F., Arasi, S., Giannetti, A., Caimmi, D., Mastrorilli, C., Pecoraro, L., Gracci, S., Del Giudice, M. M. & Bernardini, R. (2025). Allergy skin tests: an update on Skin Prick Test and Prick to Prick. Italian Journal of Pediatric Allergy and Immunology, 39(1), 26–34. https://doi.org/10.53151/2531-3916/2025-1109
Eigenmann, P. A. & Calza, A. M. (2000). Diagnosis of IgE-mediated food allergy among Swiss children with atopic dermatitis. Pediatric Allergy and Immunology : Official Publication of the European Society of Pediatric Allergy and Immunology, 11(2), 95–100. https://doi.org/10.1034/j.1399-3038.2000.00071.x
Foong, R.-X., Dantzer, J. A., Wood, R. A. & Santos, A. F. (2021). Improving Diagnostic Accuracy in Food Allergy. The Journal of Allergy and Clinical Immunology. In Practice, 9(1), 71–80. https://doi.org/10.1016/j.jaip.2020.09.037
Gargano, D., Appanna, R., Santonicola, A., De Bartolomeis, F., Stellato, C., Cianferoni, A., Casolaro, V. & Iovino, P. (2021). Food Allergy and Intolerance: A Narrative Review on Nutritional Concerns. Nutrients, 13(5). https://doi.org/10.3390/nu13051638
Hansen-Sackey, E. B. & Hartono, S. (2025). Atopic Dermatitis: Pathophysiology and Emerging Treatments. Allergies, 5(40), 1–20.
Kim, J., Kim, B. E., Ahn, K. & Leung, D. Y. M. (2024). Skin Predictive Biomarkers for the Development of Atopic Dermatitis and Food Allergy in Infants. Allergy, Asthma & Immunology Research, 16(4), 323–337. https://doi.org/10.4168/aair.2024.16.4.323
Kim, J., Kim, B. E. & Leung, D. Y. M. (2019). Pathophysiology of atopic dermatitis: Clinical implications. Allergy and Asthma Proceedings, 40(2), 84–92. https://doi.org/10.2500/aap.2019.40.4202
Kotchetkoff, E. C. de A., de Oliveira, L. C. L. & Sarni, R. O. S. (2024). Elimination diet in food allergy: friend or foe? Jornal de Pediatria, 100 Suppl(Suppl 1), S65–S73. https://doi.org/10.1016/j.jped.2023.09.012
Kubo, A., Nagao, K. & Amagai, M. (2012). Epidermal barrier dysfunction and cutaneous sensitization in atopic diseases. Journal of Clinical Investigation, 122(2), 440–447. https://doi.org/10.1172/JCI57416
Liu, E. G., Yin, X., Siniscalco, E. R. & Eisenbarth, S. C. (2024). Dendritic cells in food allergy, treatment, and tolerance. Journal of Allergy and Clinical Immunology, 154(3), 511–522. https://doi.org/10.1016/j.jaci.2024.06.017
Ma, J., Fang, Y., Hu, J., Li, S., Zeng, L., Chen, S., Li, Z., Meng, R., Yang, X., Zhang, F., Ji, G., Liao, P., Chen, L. & Wu, W. (2025). Innovative microbial strategies in atopic dermatitis. Frontiers in Immunology, 16(July), 1–11. https://doi.org/10.3389/fimmu.2025.1605434
Ogulur, I., Mitamura, Y., Yazici, D., Pat, Y., Ardicli, S., Li, M., D’Avino, P., Beha, C., Babayev, H., Zhao, B., Zeyneloglu, C., Giannelli Viscardi, O., Ardicli, O., Kiykim, A., Garcia-Sanchez, A., Lopez, J.-F., Shi, L.-L., Yang, M., Schneider, S. R., … Akdis, C. A. (2025). Type 2 immunity in allergic diseases. Cellular & Molecular Immunology, 22(3), 211–242. https://doi.org/10.1038/s41423-025-01261-2
Papapostolou, N., Xepapadaki, P., Gregoriou, S. & Makris, M. (2022). Atopic Dermatitis and Food Allergy: A Complex Interplay What We Know and What We Would Like to Learn. Journal of Clinical Medicine, 11(14). https://doi.org/10.3390/jcm11144232
Rydzy, M., Bartuzi, Z., Kosztulska, B. & Grze, M. (2025). Basophil Activation Test ( BAT ) for Diagnosing LTP Food Allergy : Where Do We Stand Now ? A Systematic Review. 1–28.
Sicherer, S. H. & Sampson, H. A. (2014). Food allergy: Epidemiology, pathogenesis, diagnosis, and treatment. The Journal of Allergy and Clinical Immunology, 133(2), 291–307; quiz 308. https://doi.org/10.1016/j.jaci.2013.11.020
Simpson, E. L., Michaels, L. C., Ramsey, K., Fagnan, L. J., Nease, D. E., Henningfield, M., Dolor, R. J., Lapidus, J., Martinez-Ziegenfuss, X., Vu, A., Ferrara, L., Zuckerman, K. E., Morris, C. D. & Williams, H. C. (2025). Emollients to Prevent Pediatric Eczema: A Randomized Clinical Trial. JAMA Dermatology, 161(9), 957–965. https://doi.org/10.1001/jamadermatol.2025.2357
Sweeney, A., Sampath, V. & Nadeau, K. C. (2021). Early intervention of atopic dermatitis as a preventive strategy for progression of food allergy. Allergy, Asthma, and Clinical Immunology : Official Journal of the Canadian Society of Allergy and Clinical Immunology, 17(1), 30. https://doi.org/10.1186/s13223-021-00531-8
Tham, E. H. & Leung, D. Y. (2019). Mechanisms by Which Atopic Dermatitis Predisposes to Food Allergy and the Atopic March. Allergy, Asthma & Immunology Research, 11(1), 4–15. https://doi.org/10.4168/aair.2019.11.1.4
Tham, E. H., Yamamoto-Hanada, K., Leung, A. S. Y. & Ohya, Y. (2024). Role of skin management in the prevention of atopic dermatitis and food allergy. Pediatric Allergy and Immunology, 35(3), 1–14. https://doi.org/10.1111/pai.14094
Tsakok, T., Marrs, T., Mohsin, M., Baron, S., du Toit, G., Till, S. & Flohr, C. (2016). Does atopic dermatitis cause food allergy? A systematic review. The Journal of Allergy and Clinical Immunology, 137(4), 1071–1078. https://doi.org/10.1016/j.jaci.2015.10.049
U.S. Department of Health and Human. (2011). Guidelines for the Diagnosis and Management of Food Allergy in the United States. In National Institute of Allergy and Infectious Diseases. https://doi.org/10.1016/B978-0-12-824315-2.00637-0
Yamamoto-Hanada, K. & Ohya, Y. (2024). Management of Infant Atopic Eczema to Prevent Severe Eczema and Food Allergy. Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology, 54(9), 669–681. https://doi.org/10.1111/cea.14515
Yang, G., Seok, J. K., Kang, H. C., Cho, Y.-Y., Lee, H. S. & Lee, J. Y. (2020). Skin Barrier Abnormalities and Immune Dysfunction in Atopic Dermatitis. International Journal of Molecular Sciences, 21(8). https://doi.org/10.3390/ijms21082867
Zhong, Y., Samuel, M., van Bever, H. & Tham, E. H. (2022). Emollients in infancy to prevent atopic dermatitis: A systematic review and meta-analysis. Allergy: European Journal of Allergy and Clinical Immunology, 77(6), 1685–1699. https://doi.org/10.1111/all.15116
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