Controlled trial of a few foods diet in severe atopic dermatitis

Abstract

Eighty five children (median age 2.3 years, range 0.3 to 13.3 years) with refractory atopic dermatitis affecting more than 12% of the body surface area, were randomly allocated to receive a few foods diet (eliminating all but five to eight foods) supplemented with either a whey hydrolysate (n=27) or a casein hydrolysate formula (n=32), or to remain on their usual diet and act as controls (n=26), for a six week period. Thirty five patients who received the diet and four controls had to be withdrawn because of noncompliance with the diet or intercurrent illness. The change in dermatitis severity was evaluated by a blinded observer who estimated the extent and severity of the dermatitis, using a skin severity score. After six weeks, there was a significant reduction in all three groups in the percentage of surface area involved (controls, median reduction (MR)=4.9% (95% confidence interval 1.5%, 11.9%); whey hydrolysate group, MR=17.8% (8.3%, 23.0%); casein hydrolysate group, MR=5% (1.6%, 21.2%), and skin severity score (controls, MR=15.9 (5.0, 22.5); whey hydrolysate group, MR=21.8 (12.8, 30.2); casein hydrolysate group, MR=13.5 (3.4, 38.0). Sixteen (73%) of the 22 controls and 15 (58%) of the 24 who received the diet showed a greater than 20%, improvement in the skin severity score. This study failed to show benefit from a few foods diet.