From the Guidelines
Atopic dermatitis is associated with milk allergy, particularly in children under 5 years old with moderate to severe AD, and food allergy evaluation for milk is recommended in these cases. According to the guidelines of care for the management of atopic dermatitis 1, children less than 5 years old with moderate to severe AD should be considered for food allergy evaluation for milk, egg, peanut, wheat, and soy if they have persistent AD in spite of optimized treatment or a reliable history of immediate reaction after ingestion of a specific food.
Key Considerations
- Food elimination diets based solely on the findings of food allergy test results are not recommended for the management of AD, unless there is a true IgE‑mediated allergy 1.
- If a patient has a true IgE‑mediated allergy, they should practice avoidance to prevent potential serious health sequelae 1.
- The use of probiotics/prebiotics, fish oils, evening primrose oil, borage oil, multivitamin supplements, zinc, vitamin D, vitamin E, vitamin B12 and B6 for the treatment of AD is not recommended due to inconsistent or limited evidence 1.
Management Approach
- If a milk allergy is suspected, eliminating cow's milk and dairy products from the diet for 2-4 weeks to observe if skin symptoms improve may be a useful approach.
- For infants on formula, switching to a hypoallergenic formula such as extensively hydrolyzed formula or amino acid-based formula may be necessary.
- For breastfed infants, the mother should eliminate dairy from her diet.
- Maintaining skin hydration with fragrance-free moisturizers and using topical corticosteroids or non-steroidal alternatives for flare-ups may also be necessary.
From the Research
Association Between Atopic Dermatitis and Milk Allergy
- There is evidence to suggest that milk allergy may be associated with atopic dermatitis, although the relationship is not fully understood 2, 3.
- A study published in 2007 found that only 2.2% of children with atopic dermatitis were actually allergic to cow's milk, despite 24.2% being on a milk elimination diet 2.
- Another study from 1985 found that IgE and IgG4 antibodies to bovine milk fat globule membrane did not offer any additional diagnostic value in milk-exacerbated cases of atopic eczema 3.
- The pathophysiology of atopic dermatitis is complex and involves multiple factors, including immune dysregulation, epidermal barrier dysfunction, and environmental triggers 4, 5, 6.
- While milk allergy may be a contributing factor in some cases of atopic dermatitis, it is not a primary cause of the disease, and other factors such as genetic predisposition, skin barrier dysfunction, and immune dysregulation play a more significant role 5, 6.