Dietas restrictivas no utiles en DA
Dietary elimination for the treatment of atopic dermatitis: a systematic review and meta-analysis
ABSTRACT
BACKGROUND
The influence of diet on atopic dermatitis (AD) is complex, and the use of dietary elimination as a treatment has conflicting views.
OBJECTIVE
To systematically review the benefits and harms of dietary elimination for the treatment of AD.
METHODS
We searched MEDLINE, EMBASE, AMED, PsycINFO and CENTRAL from inception to Jan 18, 2022, without language restrictions, for RCTs and observational studies comparing dietary elimination versus no dietary elimination for treatment of AD. We conducted random-effects meta-analysis of eczema outcomes. We used the GRADE approach to assess certainty of evidence (CRD42021237953).
RESULTS
Ten RCT (n = 599, baseline median of study mean ages 1.5 years, median of study mean SCORAD 20.7, range 3.5-37.6) were included in the meta-analysis. Compared to no dietary elimination, low certainty evidence showed that dietary elimination may slightly improve eczema severity (50% with versus 41% without dietary elimination improved SCORAD by a minimally important difference of 8.7 points, risk difference [RD], 9% [95%CI 0 to 17]), pruritus (daytime itch score [range 0-3], mean difference [MD] -0.21 [95%CI -0.57 to 0.15]) and sleeplessness (sleeplessness score [range 0-3], MD -0.47 [95%CI -0.80 to -0.13]). There were no credible subgroup differences based on elimination strategy (empiric versus guided by testing) or food-specific sensitization. Insufficient data addressed harms of elimination diets among included RCTs, although indirect evidence suggests elimination diets may increase the risk of developing IgE-mediated food allergy.
CONCLUSION
Dietary elimination may lead to a slight, potentially unimportant, improvement in eczema severity, pruritus and sleeplessness in patients with mild-moderate AD. This must be balanced against potential risks of indiscriminate elimination diets including developing IgE-mediated food allergy and withholding more effective treatment options for AD.
Funder: This work was commissioned by the AAAAI and ACAAI through the Joint Task Force on Practice Parameters to inform upcoming guidance on management of atopic dermatitis. The funder contributed to defining the scope of the review but otherwise had no role in study design and data collection. Data were interpreted and the report drafted and submitted without funder input. The funder was provided a copy of the report at time of submission. The review team had the ability, but not obligation, to consider the funder's feedback. The first and corresponding author had full access to all data in the study and had final responsibility for the decision to submit for publication.
Conflicts of Interest: A.D.B. is an investigator for Dermira, Kiniksa, Novartis and Pfizer. J.M.S. declares receiving grants or contracts from Novartis, Abbott, Regeneron, Sanofi, and the National Institutes of Health; receiving royalties or licenses from Up-to-date; consulting fees from Regeneron, Sanofi, Novartis, Takeda, Allakos, and Alladapt; receiving payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Medscape and Rockpointe; and being on the Safety Monitoring Board or Advisory Board of the National Institute of Allergy and Infectious Disease and of Syneos. L.S. is on the Medical Advisory Board for Food Allergy Research and Education and the Data and Safety Monitoring Board for Alladapt; and an investigator for DBV Technologies and Regeneron. M.B. served as a consultant for Regenron Pharmaceuticals, Inc. and Sanofi; and received grants or contracts from Regenron Pharmaceuticals, Inc. and Sanofi. M.G. is a consultant for Aquestive; a member of physician/medical advisory boards for DBV Technologies, Sanofi/Regeneron, Genentech, Nutricia, Novartis, Acquestive, Allergy Therapeutics, Pfizer, US World Meds, Allergenis, Aravax, and Prota; a member of the Scientific Advisory Council for the National Peanut Board; the senior associate editor for the Annals of Allergy, Asthma, and Immunology; a member of the Joint Taskforce on Allergy Practice Parameters; and has received honorarium for lectures from ImSci, the Allergy and Asthma Foundation of America, and the MedLearningGroup. P.L. reports research grants/funding from AOBiome, Regeneron/Sanofi Genzyme, and AbbVie; is on the speaker's bureau for Regeneron/Sanofi Genzyme, Pfizer, AbbVie, Incyte, LEO, Eli Lilly, and Galderma; reports consulting/advisory boards for Almirall, ASLAN Pharmaceuticals, Dermavant, Regeneron/Sanofi Genzyme, Pfizer, LEO Pharmaceuticals, AbbVie, Eli Lilly, Micreos (stock options), L'Oreal, Pierre-Fabre, Johnson & Johnson, Unilever, Menlo Therapeutics, Theraplex, IntraDerm, Exeltis, AOBiome, Realm Therapeutics, Altus Labs (stock options), Galderma, Arbonne, Amyris, Bodewell, Burt's Bees. In addition, P.L. has a patent pending for a Theraplex product with royalties paid and is a Board member and Scientific Advisory Committee Member of the National Eczema Association.
© 2022 Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology
Skin Care Physicians of Costa Rica
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posted by dermatica at
July 29, 2022
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