To the Editor—To the Editor—I read with interest the excellent article “Food avoidance does not improve childhood eczema.” by Hon and Leung1 in the December 2015 issue of the Hong Kong Medical Journal. As a nutrition scientist I can agree with the information completely, in principle they also apply to adults.2 Many patients eliminate several foods, but only half consult a physician or dietitian/nutritionist (caution: risk of nutritional deficiencies, eg calcium, zinc, vitamin D, and vitamin E).3 In a recent data analysis of 9417 children and adolescents, Silverberg et al4 concluded that a vegan diet is associated with a higher prevalence of eczema (adjusted odds ratio=2.53; 95% confidence interval, 1.17-5.51) and potentially can be harmful to children’s skin. Elimination diets may also increase the risk of anaphylaxis in children. I refer readers to the updated World Allergy Organization guidelines for the assessment and management of anaphylaxis that can be found in the October 2015 issue of the World Allergy Organization Journal.5

1. Hon KL, Leung TF. Food avoidance does not improve childhood eczema. Hong Kong Med J 2015;21:574-5. Crossref

2. Macchia D, Melioli G, Pravettoni V, et al. Guidelines for the use and interpretation of diagnostic methods in adult food allergy. Clin Mol Allergy 2015;13:27. Crossref

3. Johnston GA, Bilbao RM, Graham-Brown RA. The use of dietary manipulation by parents of children with atopic dermatitis. Br J Dermatol 2004;150:1186-9. Crossref

4. Silverberg JI, Lee-Wong M, Silverberg NB. Complementary and alternative medicines and childhood eczema: a US population-based study. Dermatitis 2014;25:246-54. Crossref

5. Simons FE, Ebisawa M, Sanchez-Borges M, et al. 2015 update of the evidence base: World Allergy Organization anaphylaxis guidelines. World Allergy Organ J 2015;8:32. Crossref