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Test-guided dietary advice for children with atopic dermatitis: a consensus study
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  • Ludivine Garside,
  • Robert Boyle,
  • Rosan Meyer,
  • Isabel Skypala,
  • Hilary Allen,
  • Paula Beattie,
  • Justine Dempsey,
  • Matt Doyle,
  • Helen Evans-Howells,
  • Mary Feeney,
  • Sian Ludman,
  • Tom Marrs,
  • Jane Ravenscroft,
  • Gary Stiefel,
  • Thisanayagam Umasunthar,
  • Deepan Vyas,
  • Natalie Yerlett,
  • Jo Walsh,
  • Sara Brown,
  • Matthew Ridd
Ludivine Garside
University of Bristol
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Robert Boyle
Imperial College London National Heart and Lung Institute
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Rosan Meyer
Imperial College London
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Isabel Skypala
Royal Brompton and Harefield Hospitals
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Hilary Allen
Imperial College London
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Paula Beattie
Royal Hospital for Children
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Justine Dempsey
Imperial College Healthcare NHS Trust
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Matt Doyle
Jersey Allergy Clinic
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Helen Evans-Howells
Dr Helen Allergy
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Mary Feeney
King's College London
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Sian Ludman
Royal Devon University Healthcare NHS Foundation Trust
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Tom Marrs
Guy's and St Thomas' NHS Foundation Trust
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Jane Ravenscroft
Nottingham University Hospitals NHS Trust
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Gary Stiefel
University Hospitals of Leicester NHS Trust
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Thisanayagam Umasunthar
Oxford University Hospitals NHS Foundation Trust
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Deepan Vyas
West Hertfordshire Teaching Hospitals NHS Trust
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Natalie Yerlett
Great Ormond Street Hospital for Children NHS Foundation Trust
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Jo Walsh
Castle Partnership
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Sara Brown
The University of Edinburgh
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Matthew Ridd
University of Bristol

Corresponding Author:[email protected]

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Background: The use of allergy tests to guide dietary exclusions for disease control in children with atopic dermatitis (AD) is controversial. We undertook a consensus exercise on how to interpret skin prick test (SPT) results and dietary history for cow’s milk, hen’s egg, wheat and soya in children <2 years old with AD. Methods: Fourteen clinicians from general practice, paediatrics, paediatric dermatology, paediatric allergy and paediatric dietetics from UK and Ireland took part in an online modified Delphi study. Over three rounds, participants gave their anonymous opinions and received individualised and group feedback. The findings were discussed in an online workshop. Results: Of 14 symptoms, 12 were identified as relevant to immediate and 7 to delayed allergy. Regarding SPTs, there was consensus over which allergens to use for wheat and soya but not cow’s milk or hen’s egg; for all study foods, wheal size was determined as 0-1 mm negative, ≥5mm sensitised , but between 2-4 mm categorisation varied by food. During the final workshop, consensus was reached on dietary advice should be given according to SPT results and dietary history. Conclusion: We attained consensus on how SPTs combined with dietary history for four common food allergens should be interpreted in young children under two years of age with AD. These pragmatic recommendations may support clinician education, consistency of decision-making and future research.
06 Nov 2023Submitted to Allergy
06 Nov 2023Assigned to Editor
06 Nov 2023Submission Checks Completed
06 Nov 2023Review(s) Completed, Editorial Evaluation Pending
07 Nov 2023Reviewer(s) Assigned