Atopic Dermatitis May Increase Risk of Food Allergies

Researchers identified the factors in patients with atopic dermatitis (AD) that may lead to the increased risk of developing food allergies later in life, according to a study published in Mucosal Immunology.¹ With factors including circulating inflammatory signals, the microbiome, metabolites, and neuroimmune interactions, researchers believe the skin-gut axis will be a focus in future research regarding AD management.

“People suffering from immunoglobulin (Ig)E-mediated food allergies (FA) experience mild symptoms to life-threatening anaphylactic reactions after consumption of food antigens to which they are sensitized and harbor food-specific IgE,” wrote authors of the study. “An estimated 1 in 12 children in the United States have at least one FA, which puts them at increased risk for nutritional deficiencies due to restrictive diets, emergency room visits from accidental food exposure, and reduced quality of life for them and their caretakers.”

The researchers' goal was to provide a review of the evidence associating skin inflammation with food allergen sensitization and altered immunity within the gut. | image credit: Pixel-Shot / stock.adobe.com

Researchers then identified AD as one of the “strongest” risk factors for the development of FA. AD is a chronic skin disorder also referred to as eczema.¹ In the US, AD impacts an estimated 16.5 million adults, according to the National Eczema Association.² Furthermore, the disease impacts 9.6 million children under 18, with a third of those patients experiencing moderate-to-severe symptoms.

READ MORE: Allergic Contact Dermatitis Remains Prevalent, Negatively Impacts Quality of Life

“AD lesions in infancy often precede a diagnosis of FA at or around the time of weaning to solids,” they continued.¹ “The dual allergen exposure hypothesis proposes that the defective skin barrier at sites of AD lesions enables enhanced penetration of food antigens, leading to sensitization (i.e. IgE production) to foods before infants have developed oral tolerance.”

Prior to conducting the study, researchers presented extensive knowledge regarding the risks of developing FA among patients with AD. However, their hopes for the current study were to use this knowledge to better understand the existence of a skin-gut axis, where inflammation in the skin causes remodeling in the intestine and promotes increased susceptibility of developing FA.

Their goal was to provide a review of the evidence associating skin inflammation with food allergen sensitization and altered immunity within the gut.

They began their analysis by exploring links between AD and food sensitization. In their review of previous literature, their exploration of AD and food sensitization led to the dual allergen hypothesis, which “proposes that the defective skin barrier at sites of AD lesions enables enhanced penetration of food antigens, leading to sensitization (i.e. IgE production) to foods before infants have developed oral tolerance.”¹

In the context of food sensitization and AD, previous research supported the existence of “crosstalk” between multiple organ systems. In other words, they discovered that alterations within one organ system can have significant impacts on others.

“The remainder of this review seeks to expand on the link between AD and FA to demonstrate that AD not only sets up an ideal scenario for food allergen sensitization through the skin but also that a skin-gut axis exists whereby inflammation in the skin poises the intestine for type 2 immune responses and disrupts oral tolerance mechanisms, thereby predisposing infants to FA,” they wrote.

Further focusing on the link between AD and FA, this section of the review began by exploring previous knowledge linking skin inflammation to intestinal disorders, including inflammatory bowel disease, celiac disease, Crohn’s disease, and ulcerative colitis. While they did not identify a previously discovered link between AD and FA specifically, they noted that skin inflammation’s association with intestinal disorders suggests the existence of a skin-to-gut axis.

With support in the existence of a skin-gut axis, researchers were then led to the understanding that antigen exposure in the gut can have a significant impact on AD patients. “Enhanced microbial antigen exposure in inflamed skin of AD patients may allow for dysregulated antibody-mediated immunoselection of bacteria in the gut and further drive dysbiosis in these patients.”

Going forward, researchers hope their findings can inform the complexities behind multiple organ systems and how they interact with each other. They also hope this study can further inform future approaches to AD management as well as future studies further exploring the skin-gut association.

“This review highlights a multitude of previously understudied factors in AD patients which likely drive increased risk for the development of FA including circulating inflammatory signals, the microbiome, metabolites, and neuroimmune interactions,” concluded the authors.¹ “We anticipate the future of AD management will include a multimodal approach aimed at correcting the pathologic skin-gut axis to prevent FA and the atopic march.”

READ MORE: Dermatology Resource Center

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References

1. Davis KL, Claudio-Etienne E, Frischmeyer-Guerrerio PA. Atopic dermatitis and food allergy: more than sensitization. Mucosal Immunol. 2024;17(5):1128-1140. https://doi.org/10.1016/j.mucimm.2024.06.005

2. Eczema Stats. National Eczema Association. Accessed April 7, 2025. https://nationaleczema.org/eczema-facts/