Atopic dermatitis and IgE-mediated food allergy

Objective: To highlight common mechanistic targets for the treatment of atopic dermatitis (AD) and IgE-mediated food allergy (IgE-FA) with potential to be effective for both diseases and prevent atopic progression. Data Sources: PubMed searches or NCT-registered clinical trials related to AD, IgE-FA, and other atopic conditions, especially focused on the pediatric population. Study Selections: Human seminal studies and/or articles published in the past decade were emphasized with reference to pre-clinical models when relevant. NCT-registered clinical trials were filtered by inclusion of pediatric subjects <18-years of age with special focus on children <12-years as a critical period when AD and IgE-FA diseases may often be concurrent. Results: AD and IgE-FA share several pathophysiologic features, including epithelial barrier dysfunction, innate and adaptive immune abnormalities, and microbial dysbiosis, which may be critical for the clinical progression between these diseases. Revolutionary advances in targeted biologic therapies have demonstrated the benefit of inhibiting type 2 immune responses, using dupilumab (anti-IL-4Rα) or omalizumab (anti-IgE), to potentially reduce symptom burden for both diseases in pediatric populations. While the potential for biologics to promote disease remission (AD) or sustained unresponsiveness (IgE-FA) remains unclear, the refinement of biomarkers to predict infants at risk for atopic disorders provides promise for prevention through timely intervention. Conclusion: AD and IgE-FA exhibit common features that may be leveraged to develop biologic therapeutic strategies to treat both conditions and even prevent atopic progression. Future studies should be designed with consistent age-stratification in the pediatric population and standardized regimens of adjuvant oral immunotherapy or dose-escalation (IgE-FA) to improve cross-study interpretation.