In FY19, we measured levels of food-specific IgE (fs-IgE) to the most common food allergens (milk, egg, wheat, soy, and peanut) in 78 children with moderate-severe atopic dermatitis (AD) and a median age of 10.7 years. 91% were sensitized (fs-IgE > 0.10 kUA/L) and 51% were allergic to at least one of the foods. 26% of the subjects were allergic to cow's milk, 27% to egg, 24% to peanut, 5% to wheat, and 6% to soybean. Neither the severity of AD, as assessed by the atopic dermatitis index score (SCORAD), nor total IgE levels were significantly different between subjects allergic vs. tolerant to any of the 5 foods, except total IgE levels were higher among those with peanut allergy. However, fs-IgE levels to milk, egg, soy and wheat were significantly higher among subjects allergic to these foods compared to those who were tolerant. The results of component testing further discriminated allergic status. A significantly greater proportion of IgE to peanut in allergic subjects was directed against Ara h2 as well as Ara h1, both of which have been associated with severe reactions. In contrast, peanut-IgE in nonallergic subjects was primarily specific for Ara h8, which is homologous to the birch pollen allergen Bet v1 and has been associated with no or only mild local symptoms. The majority of milk-specific IgE was directed against Bos d8 (previously associated with severe and persistent milk allergy) in allergic patients and against Bos d4, Bos d5, and Bos d6 in those without milk allergy. With regard to egg and wheat, IgE to Gal d1 and Tri a19 were associated with allergy to these foods, respectively. We were additionally able to identify threshold values and decision trees (based on sequential evaluation of fs- and/or component IgE values) for milk-, egg-, and peanut/Ara h2- IgE levels that will be helpful in guiding when to perform oral food challenges in this difficult-to-diagnose population. AD subjects with a milk-IgE of 43 kUA/L, egg-IgE of 28 kUA/L and peanut-IgE of 34 kUA/L had at least a 50% chance of not being allergic to the food. Interestingly, despite high total IgE levels in these subjects, the ratio of fs- to total IgE did not provide added information that would further inform clinical decision making.
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