The relevance of diet in atopic dermatitis (AD) and recommended and prohibited items

Atopic dermatitis (AZS) is one of the most prevalent allergic conditions, typically manifesting shortly after birth. While symptoms may subside in some individuals after several years, the disease often progresses to a chronic state. AZS is particularly common in developed nations, where the incidence of skin-related immune dysfunction continues to rise and frequently persists beyond childhood. The primary cause of this condition is an overactive immune response, which, upon exposure to various allergens (food-based, environmental, etc.), triggers the production of antibodies, leading to characteristic skin reactions. Additionally, atopic skin tends to be excessively dry, and a compromised skin barrier facilitates the penetration of allergens into deeper layers, exacerbating the immune response. This results in itching, redness, and flaking, particularly in joint creases, elbow folds, and the face. Scratching further complicates the condition by promoting bacterial and fungal infections, intensifying inflammation. Continuous exposure to irritants (detergents, synthetic fabrics) hinders remission, and treatment primarily focuses on alleviating itching and improving skin condition through moisturizing products. Although such interventions provide relief, they do not address the underlying cause – the immune system, constantly exposed to allergens, continuously produces antibodies that provoke skin reactions. Therefore, treatment should encompass not only symptomatic management but also causal intervention, including the elimination of food allergens.

While atopic dermatitis (AZS) is classified as an allergic disorder rather than a digestive condition, diet plays a crucial role in its progression. Research [1] confirms the link between intestinal barrier function and skin symptoms. Increased intestinal permeability (Leaky Gut Syndrome, LGS) may allow undigested particles to enter the bloodstream, triggering immune responses that worsen skin condition. Restoring intestinal barrier integrity can alleviate AZS symptoms, as indicated by studies [2]. Additionally, probiotics and gut microbiota balance can improve intestinal barrier function and reduce atopic dermatitis symptoms, supported by multiple studies [3] [4] [5]. Therefore, minimizing exposure to allergens and factors that increase intestinal permeability is key in AZS management.

In AZS, there is no universal list of foods that must be eliminated from the diet, as immune responses vary among patients. The foundation of an elimination diet in AZS treatment is laboratory testing to identify food allergies and intolerances. Only after determining which components trigger antibody production (IgE, IgA, IgG) can an elimination diet be implemented. It is crucial that the diet does not lead to nutrient deficiencies. For instance, eliminating dairy requires replacing it with alternative calcium sources, which is particularly important for children. The diet should not be monotonous to prevent secondary intolerances. Rotation of non-allergenic foods is recommended. Common allergens such as gluten, dairy, soy, and chicken egg protein are often excluded, but this decision should be discussed with a dietitian.

Research indicates that probiotics have a beneficial impact on alleviating symptoms of atopic dermatitis. Since AZS therapy often excludes dairy products, a source of probiotic bacteria, supplementation with appropriate microbial strains is advisable. Anti-inflammatory products, such as turmeric, contribute to reducing inflammation. Additionally, ensuring adequate levels of vitamin A and beta-carotene in the diet is crucial, as these compounds support skin health and regeneration. Sources of these nutrients include carrots, pumpkin, and offal. Furthermore, omega-3 fatty acids found in fatty marine fish and flaxseed oil aid in restoring the skin's protective barrier. Atopic dermatitis is a chronic allergic condition triggered by an abnormal immune response to allergens. Effective treatment involves both symptom management and addressing the underlying causes. Studies reveal that increased intestinal permeability, associated with dysbiosis and allergen penetration into the bloodstream, is common in patients with immunological disorders. Therefore, maintaining intestinal barrier integrity and minimizing allergen exposure may be a critical component of successful therapy. Diet plays a significant role in managing the progression of atopic dermatitis.