Clinical case of early debut of food allergy in a child up to 6 months

   Introduction. It is believed that if the child ate only a cow’s milk formula (CMF), and сow’s milk allergy is the only possible at the age of <6 months. This approach leads to erroneous treatment tactics.

   Presentation of the clinical case. A child aged 3 months with the debut of atopic dermatitis (AtD) of light degree (on the scale of the assessment of the researcher IGA 2).The patient was fed on artificial with a CMF from 1,5 months. Infant was examined at the place of residence. The CMF was changed to full hydrolysis CMF and without examination. Additionally, cosmetics were applied to the skin as needed. The child was examined by an allergologist after 3–4 weeks of diet. Negative dynamics were observed. Atopic dermatitis has become moderately severe with secondary infection complications (IGA 3, 50 % affected skin). Prick-tests with allergens of milk, eggs, wheat, fish were carried out. High sensitization to egg and controversial to cow’s milk was found. The results were clarified during enzyme immunoassay: IgE ovomucoid — 0,78 IU/ml (norm <0,3 IU/ml); cow’s milk 0,01 kUA/l; casein — 0,01 kUA/l (norm < 0,1 kUA/l). Considering the infected AtD, “hydrocortisone + natamycin + neomycin” 2 times a day was used in the therapy. Cosmetics on infected foci was canceled, while maintaining the treatment of dry unaffected skin. It is recommended to limit household contacts with eggs. After 2 weeks, the rash is residual (IGA 0–1). The cow’s milk formula was returned to the diet without exacerbations of the skin process.

   Conclusion. The case illustrates that sensitization in children can begin and be maintained without oral ingestion of the allergen. Sensitization at the age of up to 6 months is likely with a moderate-severe recurrent course of dermatitis. A specific allergological examination can be conduct with a developed disease at an early age. Skin tests and enzyme immunoassay are applicable in infants. The appointment of a diet without examination is unreasonable and should not be used.

1. Wollenberg A, Christen-Zäch S, Taieb A, et al. ETFAD/EADV Eczema task force 2020 position paper on diagnosis and treatment of atopic dermatitis in adults and children. Journal of the European Academy of Dermatology and Venereology. Published online November 17, 2020. doi: 10.1111/jdv.16892.

2. Smolkin YS, Balabolkin II, Gorlanov IA, Kruglova LS, Kudryavtseva AV, Meshkova RY, Migacheva HB, Khakimova RF, Cheburkin AA, Kuropatnikova EA, Lyan NA, Maksimova AV, Masalskiy SS, Smolkina OY. Consensus document APAIR: atopic dermatitis in children — update 2019 (short version) part 1. Allergology and Immunology in Pediatrics. 2020; 60 (1): 4–25. (In Russ.) doi: 10.24411/2500-1175-2020-10001.

3. Matricardi PM, Kleine-Tebbe J, Hoffmann HJ, et al. EAACI Molecular Allergology User’s Guide. Pediatric Allergy and Immunology. 2016; 27 (S23): 1–250. doi: 10.1111/pai.12563.

4. Brough HA, Nadeau KC, Sindher SB, et al. Epicutaneous sensitization in the development of food allergy: what is the evidence and how can this be prevented? Allergy. 2020; 75 (9): 2185–2205.

5. Mikhail I, Prince BT, Stukus DR. Update on early introduction of peanut to prevent allergy development: challenges with implementation. Curr Allergy Asthma Rep. 2019; 19 (11): 51.

6. Frossard CP, Tropia L, Hauser C, Eigenmann PA. Lymphocytes in Peyer patches regulate clinical tolerance in a murine model of food allergy. J Allergy Clin Immunol. 2004; 113 (5): 958–964.

7. Palmer CNA, Irvine AD, Terron-Kwiatkowski A, et al. Common loss-of-function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis. Nat Genet. 2006; 38 (4): 441–446.

8. Krawiec M, Fisher HR, Du Toit G, Bahnson HT, Lack G. Overview of oral tolerance induction for prevention of food allergy — Where are we now? Allergy. 2021; 76 (9): 2684–2698. doi:10.1111/all.14758.

9. Alkotob SS, Cannedy C, Harter K, et al. Advances and novel developments in environmental influences on the development of atopic diseases. Allergy: European Journal of Allergy and Clinical Immunology. 2020; (June): 3077–3086. doi: 10.1111/all.14624.

10. Wood Heickman LK, Davallow Ghajar L, Conaway M, Rogol AD. Evaluation of Hypothalamic-Pituitary-Adrenal Axis Suppression following Cutaneous Use of Topical Corticosteroids in Children: A Meta-Analysis. Horm Res Paediatr. 2018; 89 (6): 389–396. doi: 10.1159/000489125.

11. Galliano MF, Bäsler K, Caruana A, et al. Protective effect of Aquaphilusdolomiae extract-G1, ADE-G1, on tight junction barrier function in a Staphylococcus aureus-infected atopic dermatitis model. J Eur Acad Dermatol Venereol. 2020; 34 Suppl 5: 30–36. doi: 10.1111/jdv.16516.

12. Chalmers JR, Haines RH, Bradshaw LE, et al. Daily emollient during infancy for prevention of eczema: the BEEP randomized controlled trial. The Lancet. 2020; 395 (10228): 962–972. doi: 10.1016/S0140-6736(19)32984-8.

13. Smolkin YuS, Masalskiy SS, Cheburkin AA, Gorlanov IA. The role of food allergy in the development of atopic dermatitis. Position paper of the Association of Children’s Allergists and Immunologists of Russia. Pediatrics. Consilium Medicum. 2020; 1: 26–35. DOI: 10.26442/26586630.2020.1.200019.

14. Kowalski ML, Ansotegui I, Aberer W, et al. Risk and safety requirements for diagnostic and therapeutic procedures in allergology: World Allergy Organization Statement. The World Allergy Organization journal. 2016; 9 (1): 33. doi: 10.1186/s40413-016-0122-3.