This section deals with exclusion diets for cases of established atopic eczema. No systematic reviews of dietary manipulation in established atopic eczema could be identified, although some of the published studies have been reviewed by Charman.7 The nine RCTs examining the role of elimination diets in established atopic eczema are summarised in Table 17.5.8-16

The key benefits to emerge from this review are:

• There is little evidence to support an egg-and-milk-free diet in unselected patients with atopic eczema.

• There is no evidence to support the use of an elemental or few-foods diet in atopic eczema.

• There is some evidence that the addition of a probiotic such as Lactobacillus may be beneficial for atopic eczema in those already on a cows'-milk-whey-hydrolysate diet, although in the absence of a control group on no special diet it is hard to say if this is a real benefit.

• There is some evidence to support the use of an egg-free diet in infants with suspected egg allergy who have positive specific IgE to eggs.

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