Duodenal IgE-positive cells and elimination diet responsiveness in children with atopic dermatitis

Background: Parameters for identifying eczematous children who could respon d to an elimination diet are needed. In children with food allergy, duodena l IgE-containing cells are enhanced. Objective: To determine the presence of duodenal mucosal IgE-positive cells in atopic dermatitis and to determine whether duodenal IgE-positive cells may identify eczematous children who will benefit from an elimination diet. Methods: Thirty-one children with severe eczema underwent gastrointestinal endoscopy because of gastrointestinal symptoms and were treated with an eli mination diet. A clinical score to skin lesions was given before and after diet. All subjects were skin-prick tested with food antigens and aeroallerg ens. Serum IgE levels were measured. Duodenal IgE-positive cells were inves tigated in 18 control subjects and in all eczematous children before diet. Results: The number of duodenal IgE-positive cells in children with atopic dermatitis was significantly increased compared with that of control group (P < 0.001), Nineteen (61%) eczematous children improved on a few food diet . Diet-responsive children had significantly higher IgE-positive cells comp ared with both nondiet-responsive and controls. Positive predictive accurac y of duodenal IgE-positive cells was poor, whereas negative predictive accu racy was high at the cutoff level of 50 IgE-positive cells/10 visual fields . Diagnostic accuracy both of SPT reactions with foods and of food-specific serum IgE antibodies was poor. Conclusions: An intestinal IgE-mediated reaction occurred in children with severe atopic dermatitis who underwent intestinal endoscopy because of gast rointestinal symptoms. In these eczematous children, the number of IgE-posi tive cells in the duodenal mucosa might be helpful for excluding a positive response to the elimination diet.