High-fat food intake is associated with atopic dermatitis (AD), but the role of habitual dietary habits related to the frequency of high-fat food intake remains unclear. To address this, we developed a frequency-based dietary index, Diet Quality based on Dietary Fat Score, to assess high-fat food intake and examined its association with AD in 13 561 young Chinese adults (mean age = 22·51 years, (sd 5·90)) from Singapore and Malaysia. Using an investigator-administered questionnaire aligned with the validated International Study of Asthma and Allergies in Childhood protocol, we conducted multivariable logistic regression analysis, adjusting for demographics, body mass index, genetic predisposition and lifestyle factors, with false discovery rate correction for multiple comparisons. Frequent high-fat food intake was associated with higher odds of AD (adjusted OR (AOR): 1·53; 95 % CI: 1·31, 1·77; P< 0·001). The association remained significant regardless of total fat intake (AOR: 1·45; 95 % CI: 1·05, 1·80; P< 0·001) and among individuals with high fruit and vegetable intake (AOR: 1·49; 95 % CI: 1·19, 1·86; P< 0·001) or low energy intake (AOR: 1·40; 95 % CI: 1·05, 1·86; P< 0·05). No synergistic effects were observed between dietary factors. These findings highlight that frequent intake of high-fat foods is independently associated with AD, emphasising the potential of dietary moderation in AD risk management.

Previous studies have revealed an association between dietary factors and atopic dermatitis (AD). To explore whether there was a causal relationship between diet and AD, we performed Mendelian randomisation (MR) analysis. The dataset of twenty-one dietary factors was obtained from UK Biobank. The dataset for AD was obtained from the publicly available FinnGen consortium. The main research method was the inverse-variance weighting method, which was supplemented by MR‒Egger, weighted median and weighted mode. In addition, sensitivity analysis was performed to ensure the accuracy of the results. The study revealed that beef intake (OR = 0·351; 95 % CI 0·145, 0·847; P = 0·020) and white bread intake (OR = 0·141; 95 % CI 0·030, 0·656; P = 0·012) may be protective factors against AD. There were no causal relationships between AD and any other dietary intake factors. Sensitivity analysis showed that our results were reliable, and no heterogeneity or pleiotropy was found. Therefore, we believe that beef intake may be associated with a reduced risk of AD. Although white bread was significant in the IVW analysis, there was large uncertainty in the results given the wide 95 % CI. Other factors were not associated with AD in this study.

Psychological and educational interventions are valuable adjuncts in the management of adult atopic dermatitis. We performed a systematic review and meta-analysis of randomised controlled trials (RCTs) of the efficacy of these interventions. Twelve articles published between 1986 and 2013 were identified through electronic searches. The methodological quality was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions, version 5.1.1 (Higgins & Green, 2015). A random-effects model was used to estimate the standardised mean difference (SMD). No significant difference was found in eczema severity determined in three RCTs (124 participants; SMD, -0.29; 95% CI [-0.64, 0.07]) and dropout rate in five RCTs (198 participants; relative risk, 0.66; 95% CI [0.20, 2.17]). Education via online video was significantly superior to handouts in ameliorating eczema severity in one RCT (80 participants). We conclude that, rather than a combination of these interventions with conventional therapy being of no value, the data did not have sufficient power to provide evidence-based conclusions.

We investigated the effect of feeding a skin barrier function-augmenting diet early in dogs' lives on the appearance of clinical signs associated with canine atopic dermatitis. Pregnant bitches (starting 5 weeks after mating) and their subsequent litters (up to 1 year of age) were fed either supplemented or unsupplemented diets. Nutrients supplemented were nicotinamide, pantothenate, histidine, inositol and choline. Circulating IgE levels to dust mute allergens Der f and Der p were measured when the puppies were 6 and 12 months old. Two owner questionnaires were used to assess the occurrence of typical signs associated with atopic dermatitis when dogs were between the ages of 22 and 36, and 34 and 48 months. Using linear mixed models we observed higher levels of circulating anti-Der f (P = 0·021) and -Der p IgE (P = 0·01) during the first year in the dogs fed the unsupplemented than in those fed the supplemented diet. The owner-assessed incidence of atopic dermatitis signs amongst the dogs was significantly greater in the unsupplemented group at the time of the second follow-up questionnaire (10/33 dogs v. 2/24 dogs). These outcomes suggest that a nutritionally derived improvement to barrier function early in life may reduce the frequency of signs associated with atopic dermatitis. The effect is possibly the result of making the epidermis, now thought to be a major route of environmental allergen exposure, more resistant to penetration.

In the present study, we sought to conduct a literature review of randomised, double-blind, placebo-controlled trials, which assessed the impact of probiotics intake during pregnancy on the development of eczema in children. A meta-analysis was conducted for comparison of the development of atopic eczema in children whose mothers took probiotics during pregnancy v. placebo. Study selection, quality appraisal and data extraction were performed independently and in duplicate. The studies were rated according to their size in order to calculate the influence of individual studies on the meta-analysis. A total of seven randomised, double-blind, placebo-controlled trials, published between 2001 and 2009, were selected from the PubMed and Ovid databases for the meta-analysis. The meta-analysis was performed with statistical software Stata/SE11.0. The completed meta-analysis of the seven studies shows a significant risk reduction for atopic eczema in children aged 2–7 years by the administration of probiotics during pregnancy (reduction 5·7 %; P = 0·022). However, this effect was only significant for lactobacilli (reduction 10·6 %; P = 0·045), but not for a mixture of various bacterial strains as probiotics (difference 3·06 %, P = 0·204). In conclusion, the meta-analysis shows that the administration of lactobacilli during pregnancy prevents atopic eczema in children aged from 2 to 7 years. However, a mixture of various bacterial strains does not affect the development of atopic eczema, independent of whether they contain lactobacilli or not.

Strategies to manipulate the gut microbiota in infancy have been considered to prevent the development of allergic diseases later in life. We aimed to elucidate the effects of maternal dietary supplementation with a prebiotic oligosaccharide on gut microbiota and spontaneously developing atopic dermatitis-like skin lesions in the offspring of NC/Nga mice. Female NC/Nga mice were fed diets either with or without fructo-oligosaccharide supplementation during pregnancy and lactation. After weaning, offspring were fed the diets supplemented with or without fructo-oligosaccharide for 11 weeks in an air-uncontrolled conventional room. Changes in gut microbiota were assessed by denaturing gradient gel electrophoresis of the PCR-amplified 16S rRNA gene. Skin lesions were evaluated by a clinical score and scratching behaviour. Serum antibody levels were measured by ELISA, and expression levels of cytokines and chemokines in lesional tissue were evaluated by quantitative RT-PCR. Maternal supplementation with fructo-oligosaccharide modulated the gut microbiota in sucklings. Although maternal supplementation with fructo-oligosaccharide suppressed the increase in clinical skin severity score and scratching behaviour in offspring, dietary fructo-oligosaccharide after weaning was less effective. The diminution of skin lesions was accompanied by lower serum concentrations of total IgG1 and lower expression levels of TNF-α in the lesional tissue. These data suggest that maternal consumption of fructo-oligosaccharide diminishes the severity of atopic dermatitis-like skin lesions in the offspring of NC/Nga mice.

We investigated the anti-allergic effects of one strain (T120) of a lactic acid bacteria (LAB) isolated from Mongolian fermented milk using atopic dermatitis (AD) model mice (NC/Nga mice). Strain T120 has already been identified as Enterococcus faecium and shown to induce strong production of IL-12 (Kimura et al. 2006). In in vitro studies, strain T120 suppressed total IgE production and induced IL-12 and IFN-γ production by splenocytes of NC/Nga mice. The additional examination of various neutralization antibodies was performed to elucidate in detail the mechanism of depressed IgE production by strain T120. As a result, it became clear that IL-12 induced by strain T120 increased production of IFN-γ and total IgE production was mainly controlled by the IFN-γ. In order to define the cells which produce IL-12 powerfully by this strain, antigen-presenting cells (APCs) such as macrophages and dendritic cells (DCs) were removed from the splenocytes, and the reactivity of these cells to the strain was examined. Induction of IL-12 and IFN-γ by strain T120 became significantly very low by removal of APCs from splenocytes. Therefore, it was clear that strain T120 acted on APCs and induced production of IL-12. Further, this strain enhanced the production of IL-10 by splenocytes. In in vivo studies, intraperitoneal injection of strain T120 inhibited serum IgE elevation and atopic dermatitis symptoms in NC/Nga mice. These results suggest that an anti-allergic effect of strain T120 depends on the increased production of IL-12 by APCs activated by the strain and following the increased production of IFN-γ. Further, activation of regulatory T cells by strain T120 may inhibit atopic desease.