The role of nutrition in the prevention and treatment of atopic dermatitis (literature review)
- Authors: Yatsyna I.V.1, Astakhova I.V.1
-
Affiliations:
- Federal Scientific Center of Hygiene named after F.F. Erisman
- Issue: Vol 69, No 1 (2025)
- Pages: 89-94
- Section: CHILDREN AND ADOLESCENTS’ HEALTH
- Submitted: 08.03.2025
- URL: https://hum-ecol.ru/0044-197X/article/view/676944
- DOI: https://doi.org/10.47470/0044-197X-2025-69-1-89-94
- EDN: https://elibrary.ru/sbzaql
- ID: 676944
Cite item
Abstract
Atopic dermatitis (AD) is a multifactorial chronic inflammatory skin disease with a high prevalence in children and adults. The disease characterized by pruritus, recurrent course is associated with other allergic conditions such as food allergies and asthma, forming the concept of “atopic march”. Genetic mutations affect the barrier function of the skin, creating conditions for allergens to penetrate and inflammation to develop. Environmental factors, including air pollution, nutrition, and microbiota, also play a significant role in the etiology and pathogenesis of AD.
Nutrition during infancy and childhood is a key factor influencing growth and development in childhood, contributing to health and disease prevention throughout life. Breastfeeding and the diversity of the mother’s diet may influence the risk of AD in children. The consumption of certain foods during pregnancy and the specifics of complementary feeding may contribute to the development or decrease the risk of allergy in the child. The gut microbiota plays an important role in modulating immune responses and tolerance to food allergens.
Scopus, Web of Science, Medline, The Cochrane Library, EMBASE, Global Health and RISC databases were used to create this review article. The article analyzes the literature on the peculiarities of the preventive diet in pregnant women, nursing mothers, and children in families with an aggravated hereditary history of atopic dermatitis. The review emphasizes the need for further research to identify the influence of early life nutrition on the risk of allergic diseases. The article discusses current approaches to the prevention and treatment of AD, including the use of probiotics, dietary diversity, and breastfeeding support as meaningful strategies to reduce the risk of AD and allergic diseases in children.
Contribution of the authors:
Yatsyna I.V. — research concept and design, writing the text, editing;
Astakhova I.V. — collection and processing of material, writing the text.
All authors are responsible for the integrity of all parts of the manuscript and approval of the manuscript final version.
Acknowledgment. The study had no sponsorship.
Conflict of interest. The authors declare no conflict of interest.
Received: November 5, 2024 / Accepted: December 11, 2024 / Published: February 28, 2025
Keywords
About the authors
Irina V. Yatsyna
Federal Scientific Center of Hygiene named after F.F. Erisman
Email: yacyna.iv@fncg.ru
ORCID iD: 0000-0002-8650-8803
MD, Professor, Deputy Director for scientific work, Federal Scientific Center of Hygiene named after F.F. Erisman, Mytishchi, 141014, Russian Federation
e-mail: yacyna.iv@fncg.ru
Irina V. Astakhova
Federal Scientific Center of Hygiene named after F.F. Erisman
Author for correspondence.
Email: astahova.iv@fncg.ru
ORCID iD: 0000-0003-0340-9314
Dermatovenerologist, Federal Scientific Center of Hygiene named after F.F. Erisman, Mytishchi, 141014, Russian Federation
e-mail: astahova.iv@fncg.ru
References
- Clinical recommendations: Atopic dermatitis. Moscow; 2021–2023. (in Russian)
- Wollenberg A., Barbarot S., Bieber T., Christen-Zaech S., Deleuran M., Fink-Wagner A., et al. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I. J. Eur. Acad. Dermatol. Venereol. 2018; 32(5): 657–82. https://doi.org/10.1111/jdv.14891
- Macharadze D.Sh., Rassanova E.A., Ruzhentsova T.A., Galanina A.V., Malyshev V.S. Role of nonspecific risk factors in atopic dermatitis. Allergologiya i immunologiya v pediatrii. 2024; (1): 5–11. https://doi.org/10.53529/2500-1175-2024-1-5-11 https://elibrary.ru/rtfhgl (in Russian)
- Zhadan I.Yu., Yatsyna I.V., Krasavina E.K., Beshlyy Ya.V. The influence of harmful environmental factors on the dermatological health of the population. Zdravookhranenie Rossiiskoi Federatsii. 2021; 65(4): 342–6. https://doi.org/10.47470/0044-197X-2021-65-4-342-346 https://elibrary.ru/klrklv (in Russian)
- Sroka-Tomaszewska J., Trzeciak M. Molecular mechanisms of atopic dermatitis pathogenesis. Int. J. Mol. Sci. 2021; 22(8): 4130. https://doi.org/10.3390/ijms22084130
- Mandlik D.S., Mandlik S.K. Atopic dermatitis: new insight into the etiology, pathogenesis, diagnosis and novel treatment strategies. Immunopharmacol. Immunotoxicol. 2021; 43(2): 105–25. https://doi.org/10.1080/08923973.2021.1889583
- Strange P., Skov L., Lisby S., Nielsen P.L., Baadsgaard O. Staphylococcal enterotoxin B applied on intact normal and intact atopic skin induces dermatitis. Arch. Dermatol. 1996; 132(1): 27–33.
- Brough H.A., Simpson A., Makinson K., Hankinson J., Brown S., Douiri A., et al. Peanut allergy: effect of environmental peanut exposure in children with filaggrin loss-of-function mutations. J. Allergy Clin. Immunol. 2014; 134(4): 867–75.e1. https://doi.org/10.1016/j.jaci.2014.08.011
- Eigenmann P.A., Sicherer S.H., Borkowski T.A., Cohen B.A., Sampson H.A. Prevalence of IgE-mediated food allergy among children with atopic dermatitis. Pediatrics. 1998; 101(3): E8. https://doi.org/10.1542/peds.101.3.e8
- Burbank A.J., Burks A.W. Natural history of allergic sensitization in infants with early-onset atopic dermatitis: Results from ORCA study. Pediatrics. 2015; 136(6): S331. https://doi.org/10.1542/peds.2015-2776S
- Lack G., Fox D., Northstone K., Golding J. Factors associated with the development of peanut allergy in childhood. N. Engl. J. Med. 2003; 348(11): 977–85. https://doi.org/10.1056/NEJMoa013536
- Roduit C., Frei R., Depner M., Karvonen A.M., Renz H., Braun-Fahrländer C., et al. Phenotypes of atopic dermatitis depending on the timing of onset and progression in childhood. JAMA Pediatr. 2017; 171(7): 655–62. https://doi.org/10.1001/jamapediatrics.2017.0556
- Flohr C., Perkin M., Logan K., Marrs T., Radulovic S., Campbell L.E., et al. Atopic dermatitis and disease severity are the main risk factors for food sensitization in exclusively breastfed infants. J. Invest. Dermatol. 2014; 134(2): 345–50. https://doi.org/10.1038/jid.2013.298
- Sicherer S.H., Sampson H.A. Food hypersensitivity and atopic dermatitis: pathophysiology, epidemiology, diagnosis, and management. J. Allergy Clin. Immunol. 1999; 104(3 Pt 2): S114–22. https://doi.org/10.1016/s0091-6749(99)70053-9
- Martin P.E., Eckert J.K., Koplin J.J., Lowe A.J., Gurrin L.C., Dharmage S.C., et al. Which infants with eczema are at risk of food allergy? Results from a population-based cohort. Clin. Exp. Allergy. 2015; 45(1): 255–64. https://doi.org/10.1111/cea.12406
- Trikamjee T., Comberiati P., D’Auria E., Peroni D., Zuccotti G.V. Nutritional factors in the prevention of atopic dermatitis in children. Front. Pediatr. 2021; 8: 577413. https://doi.org/10.3389/fped.2020.577413
- Zhang P. The role of diet and nutrition in allergic diseases. Nutrients. 2023; 15(17): 3683. https://doi.org/10.3390/nu15173683
- Acevedo N., Alashkar Alhamwe B., Caraballo L., Ding M., Ferrante A., Garn H., et al. Perinatal and early-life nutrition, epigenetics, and allergy. Nutrients. 2021; 13(3): 724. https://doi.org/10.3390/nu13030724
- Willers S.M., Devereux G., Craig L.C., McNeill G., Wijga A.H., Abou El-Magd W., et al. Maternal food consumption during pregnancy and asthma, respiratory and atopic symptoms in 5-year-old children. Thorax. 2007; 62(9): 773–9. https://doi.org/10.1136/thx.2006.074187
- Dunstan J.A., Mori T.A., Barden A., Beilin L.J., Taylor A.L., Holt P.G., et al. Fish oil supplementation in pregnancy modifies neonatal allergen-specific immune responses and clinical outcomes in infants at high risk of atopy: a randomized, controlled trial. J. Allergy Clin. Immunol. 2003; 112(6): 1178–84. https://doi.org/10.1016/j.jaci.2003.09.009
- Loo E.X.L., Ong L., Goh A., Chia A.R., Teoh O.H., Colega M.T., et al. Effect of maternal dietary patterns during pregnancy on self-reported allergic diseases in the first 3 years of life: results from the GUSTO study. Int. Arch. Allergy Immunol. 2017; 173(2): 105–13. https://doi.org/10.1159/000475497
- Venter C., Greenhawt M., Meyer R.W., Agostoni C., Reese I., du Toit G., et al. EAACI position paper on diet diversity in pregnancy, infancy and childhood: Novel concepts and implications for studies in allergy and asthma. Allergy. 2020; 75(3): 497–523. https://doi.org/10.1111/all.14051
- Baïz N., Just J., Chastang J., Forhan A., de Lauzon-Guillain B., Magnier A.M., et al. Maternal diet before and during pregnancy and risk of asthma and allergic rhinitis in children. Allergy Asthma Clin. Immunol. 2019; 15: 40. https://doi.org/10.1186/s13223-019-0353-2
- Venter C., Palumbo M.P., Glueck D.H., Sauder K.A., O’Mahony L., Fleischer D.M., et al. The maternal diet index in pregnancy is associated with offspring allergic diseases: the Healthy Start study. Allergy. 2022; 77(1): 162–72. https://doi.org/10.1111/all.14949
- Zhang P. The role of diet and nutrition in allergic diseases. Nutrients. 2023; 15(17): 3683. https://doi.org/10.3390/nu15173683
- Weidinger S., Novak N. Atopic dermatitis. Lancet. 2016; 387(10023): 1109–22. https://doi.org/10.1016/S0140-6736(15)00149-X
- Julia V., Macia L., Dombrowicz D. The impact of diet on asthma and allergic diseases. Nat. Rev. Immunol. 2015; 15(5): 308–22. https://doi.org/10.1038/nri3830
- Lin Y.P., Kao Y.C., Pan W.H., Yang Y.H., Chen Y.C., Lee Y.L. Associations between respiratory diseases and dietary patterns derived by factor analysis and reduced rank regression. Ann. Nutr. Metab. 2016; 68(4): 306–14. https://doi.org/10.1159/000447367
- Miyake Y., Sasaki S., Tanaka K., Hirota Y. Dairy food, calcium and vitamin D intake in pregnancy, and wheeze and eczema in infants. Eur. Respir. J. 2010; 35(6): 1228–34. https://doi.org/10.1183/09031936.00100609
- Kuzume K., Kusu M. Before-birth climatologic data may play a role in the development of allergies in infants. Pediatr. Allergy Immunol. 2007; 18(4): 281–7. https://doi.org/10.1111/j.1399-3038.2006.00526.x
- Wei Z., Zhang J., Yu X. Maternal vitamin D status and childhood asthma, wheeze, and eczema: A systematic review and meta-analysis. Pediatr. Allergy Immunol. 2016; 27(6): 612–9. https://doi.org/10.1111/pai.12593
- Pacheco-González R.M., García-Marcos L., Morales E. Prenatal vitamin D status and respiratory and allergic outcomes in childhood: A meta-analysis of observational studies. Pediatr. Allergy Immunol. 2018; 29(3): 243–53. https://doi.org/10.1111/pai.12876
- Cuello-Garcia C.A., Brożek J.L., Fiocchi A., Pawankar R., Yepes-Nuñez J.J., Terracciano L., et al. Probiotics for the prevention of allergy: A systematic review and meta-analysis of randomized controlled trials. J. Allergy Clin. Immunol. 2015; 136(4): 952–61. https://doi.org/10.1016/j.jaci.2015.04.031
- Boyle R.J., Ismail I.H., Kivivuori S., Licciardi P.V., Robins-Browne R.M., Mah L.J., et al. Lactobacillus GG treatment during pregnancy for the prevention of eczema: a randomized controlled trial. Allergy. 2011; 66(4): 509–16. https://doi.org/10.1111/j.1398-9995.2010.02507.x
- Chu D.K., Koplin J.J., Ahmed T., Islam N., Chang C.L., Lowe A.J. How to prevent atopic dermatitis (eczema) in 2024: theory and evidence. J. Allergy Clin. Immunol. Pract. 2024; 12(7): 1695–704. https://doi.org/10.1016/j.jaip.2024.04.048
- Kim J.H. Role of breast-feeding in the development of atopic dermatitis in early childhood. Allergy Asthma Immunol. Res. 2017; 9(4): 285–7. https://doi.org/10.4168/aair.2017.9.4.285
- Jiang S., Cai M., Li D., Chen X., Chen X., Huang Q., et al. Association of breast milk-derived arachidonic acid-induced infant gut dysbiosis with the onset of atopic dermatitis. Gut. 2024; 74(1): 45–57. https://doi.org/10.1136/gutjnl-2024-332407
- Stephan Y., Müller H.H., Kühnert M., Meinhold-Heerlein I., Ibrahimi G., Reitz M., et al. The effect of early skin-to-skin contact after cesarean section on breastfeeding duration and development of atopic-allergic diseases. Eur. J. Midwifery. 2024; 8. https://doi.org/10.18332/ejm/176213
- Luo M., Su H.C., Lin J.E., Zhu C.H., Lin L.H., Han Y. A retrospective analysis of risk factors for atopic dermatitis severity. Dermatitis. 2024; 35(S1): S81–90. https://doi.org/10.1089/derm.2023.0037
- Kull I., Böhme M., Wahlgren C.F., Nordvall L., Pershagen G., Wickman M. Breast-feeding reduces the risk for childhood eczema. J. Allergy Clin. Immunol. 2005; 116(3): 657–61. https://doi.org/10.1016/j.jaci.2005.04.028
- Gdalevich M., Mimouni D., David M., Mimouni M. Breast-feeding and the onset of atopic dermatitis in childhood: a systematic review and meta-analysis of prospective studies. J. Am. Acad. Dermatol. 2001; 45(4): 520–7. https://doi.org/10.1067/mjd.2001.114741
- Yang Y.W., Tsai C.L., Lu C.Y. Exclusive breastfeeding and incident atopic dermatitis in childhood: a systematic review and meta-analysis of prospective cohort studies. Br. J. Dermatol. 2009; 161(2): 373–83. https://doi.org/10.1111/j.1365-2133.2009.09049.x
- Lodge C.J., Tan D.J., Lau M.X., Dai X., Tham R., Lowe A.J., et al. Breastfeeding and asthma and allergies: a systematic review and meta-analysis. Acta Paediatr. 2015; 104(467): 38–53. https://doi.org/10.1111/apa.13132
- Kramer M.S., Chalmers B., Hodnett E.D., Sevkovskaya Z., Dzikovich I., Shapiro S., et al. Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the Republic of Belarus. JAMA. 2001; 285(4): 413–20. https://doi.org/10.1001/jama.285.4.413
- Muraro A., Halken S., Arshad S.H., Beyer K., Dubois A.E., Du Toit G., et al. EAACI food allergy and anaphylaxis guidelines. Primary prevention of food allergy. Allergy. 2014; 69(5): 590–601. https://doi.org/10.1111/all.12398
- Fleischer D.M., Spergel J.M., Assa’ad A.H., Pongracic J.A. Primary prevention of allergic disease through nutritional interventions. J. Allergy Clin. Immunol. Pract. 2013; 1(1): 29–36. https://doi.org/10.1016/j.jaip.2012.09.003
- Neville M.C., Anderson S.M., McManaman J.L., Badger T.M., Bunik M., Contractor N., et al. Lactation and neonatal nutrition: defining and refining the critical questions. J. Mammary Gland Biol. Neoplasia. 2012; 17(2): 167–88. https://doi.org/10.1007/s10911-012-9261-5
- Munblit D., Treneva M., Peroni D.G., Colicino S., Chow L.Y., Dissanayeke S., et al. Immune components in human milk are associated with early infant immunological health outcomes: a prospective three-country analysis. Nutrients. 2017; 9(6): 532. https://doi.org/10.3390/nu9060532
- Munblit D., Treneva M., Peroni D.G., Colicino S., Chow L., Dissanayeke S., et al. Colostrum and mature human milk of women from London, Moscow, and Verona: determinants of immune composition. Nutrients. 2016; 8(11): 695. https://doi.org/10.3390/nu8110695
- Minniti F., Comberiati P., Munblit D., Piacentini G.L., Antoniazzi E., Zanoni L., et al. Breast-milk characteristics protecting against allergy. Endocr. Metab. Immune Disord Drug Targets. 2014; 14(1): 9–15. https://doi.org/10.2174/1871530314666140121145045
- Masi A.C., Stewart C.J. Role of breastfeeding in disease prevention. Microb. Biotechnol. 2024; 17(7): e14520. https://doi.org/10.1111/1751-7915.14520
- Rajani P.S., Martin H., Groetch M., Järvinen K.M. Presentation and management of food allergy in breastfed infants and risks of maternal elimination diets. J. Allergy Clin. Immunol. Pract. 2020; 8(1): 52–67. https://doi.org/10.1016/j.jaip.2019.11.007
- Gelsomino M., Liotti L., Barni S., Mori F., Giovannini M., Mastrorilli C., et al. Elimination diets in lactating mothers of infants with food allergy. Nutrients. 2024; 16(14): 2317. https://doi.org/10.3390/nu16142317
- Osborn D.A., Sinn J.K., Jones L.J. Infant formulas containing hydrolysed protein for prevention of allergic disease. Cochrane Database Syst. Rev. 2018; 10(10): CD003664. https://doi.org/10.1002/14651858.CD003664.pub6
- Davisse-Paturet C., Raherison C., Adel-Patient K., Divaret-Chauveau A., Bois C., Dufourg M.N., et al. Use of partially hydrolysed formula in infancy and incidence of eczema, respiratory symptoms or food allergies in toddlers from the ELFE cohort. Pediatr. Allergy Immunol. 2019; 30(6): 614–23. https://doi.org/10.1111/pai.13094
- Khan A., Adalsteinsson J., Whitaker-Worth D.L. Atopic dermatitis and nutrition. Clin. Dermatol. 2022; 40(2): 135–44. https://doi.org/10.1016/j.clindermatol.2021.10.006
- Abrams E.M., Orkin J., Cummings C., Blair B., Chan E.S. Dietary exposures and allergy prevention in high-risk infants. Paediatr. Child Health. 2021; 26(8): 504–5. https://doi.org/10.1093/pch/pxab064
- Turati F., Bertuccio P., Galeone C., Pelucchi C., Naldi L., Bach J.F., et al. Early weaning is beneficial to prevent atopic dermatitis occurrence in young children. Allergy. 2016; 71(6): 878–88. https://doi.org/10.1111/all.12864
- Chatenoud L., Bertuccio P., Turati F., Galeone C., Naldi L., Chatenoud L., et al. Markers of microbial exposure lower the incidence of atopic dermatitis. Allergy. 2020; 75(1): 104–15. https://doi.org/10.1111/all.13990
- Flohr C., Nagel G., Weinmayr G., Kleiner A., Strachan D.P., Williams H.C. Lack of evidence for a protective effect of prolonged breastfeeding on childhood eczema: lessons from the International Study of Asthma and Allergies in Childhood (ISAAC) phase two. Br. J. Dermatol. 2011; 165(6): 1280–9. https://doi.org/10.1111/j.1365-2133.2011.10588.x
- Obbagy J.E., English L.K., Wong Y.P., Butte N.F., Dewey K.G., Fleischer D.M., et al. Complementary feeding and food allergy, atopic dermatitis/eczema, asthma, and allergic rhinitis: a systematic review. Am. J. Clin. Nutr. 2019; 109(Suppl. 7): 890S–934S. https://doi.org/10.1093/ajcn/nqy220
- Savage J.H., Lee-Sarwar K.A., Sordillo J.E., Lange N.E., Zhou Y., O’Connor G.T., et al. Diet during pregnancy and infancy and the infant intestinal microbiome. J. Pediatr. 2018; 203: 47–54.e4. https://doi.org/10.1016/j.jpeds.2018.07.066
- Bisgaard H., Li N., Bonnelykke K., Chawes B.L., Skov T., Paludan-Müller G., et al. Reduced diversity of the intestinal microbiota during infancy is associated with increased risk of allergic disease at school age. J. Allergy Clin. Immunol. 2011; 128(3): 646–52.e1-5. https://doi.org/10.1016/j.jaci.2011.04.060
- Simonyté Sjödin K., Hammarström M.L., Rydén P., Sjödin A., Hernell O., Engstrand L., et al. Temporal and long-term gut microbiota variation in allergic disease: A prospective study from infancy to school age. Allergy. 2019; 74(1): 176–85. https://doi.org/10.1111/all.13485
- Venter C., Brown K.R., Maslin K., Palmer D.J. Maternal dietary intake in pregnancy and lactation and allergic disease outcomes in offspring. Pediatr. Allergy Immunol. 2017; 28(2): 135–43. https://doi.org/10.1111/pai.12682
- Garcia-Larsen V., Ierodiakonou D., Jarrold K., Cunha S., Chivinge J., Robinson Z., et al. Diet during pregnancy and infancy and risk of allergic or autoimmune disease: A systematic review and meta-analysis. PLoS Med. 2018; 15(2): e1002507. https://doi.org/10.1371/journal.pmed.1002507
- Trompette A., Pernot J., Perdijk O., Alqahtani R.A.A., Domingo J.S., Camacho-Muñoz D., et al. Gut-derived short-chain fatty acids modulate skin barrier integrity by promoting keratinocyte metabolism and differentiation. Mucosal. Immunol. 2022; 15(5): 908–26. https://doi.org/10.1038/s41385-022-00524-9
- Du Toit G., Katz Y., Sasieni P., Mesher D., Maleki S.J., Fisher H.R., et al. Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy. J. Allergy Clin. Immunol. 2008; 122(5): 984–91. https://doi.org/10.1016/j.jaci.2008.08.039
- Perkin M.R., Logan K., Marrs T., Radulovic S., Craven J., Flohr C., et al. Enquiring About Tolerance (EAT) study: Feasibility of an early allergenic food introduction regimen. J. Allergy Clin. Immunol. 2016; 137(5): 1477–86.e8. https://doi.org/10.1016/j.jaci.2015.12.1322
- Lundell A.C., Hesselmar B., Nordström I., Adlerberth I., Wold A.E., Rudin A. Higher B-cell activating factor levels at birth are positively associated with maternal dairy farm exposure and negatively related to allergy development. J. Allergy Clin. Immunol. 2015; 136(4): 1074–82.e3. https://doi.org/10.1016/j.jaci.2015.03.022
- Du Toit G., Roberts G., Sayre P.H., Bahnson H.T., Radulovic S., Santos A.F., et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N. Engl. J. Med. 2015; 372(9): 803–13. https://doi.org/10.1056/NEJMoa1414850
- Moon P.D., Han N.R., Kim H.M., Jeong H.J. High-fat diet exacerbates dermatitis through up-regulation of TSLP. J. Invest. Dermatol. 2019; 139(5): 1198–201. https://doi.org/10.1016/j.jid.2018.11.003
- Leung D.Y.M., Berdyshev E., Goleva E. Cutaneous barrier dysfunction in allergic diseases. J. Allergy Clin. Immunol. 2020; 145(6): 1485–97. https://doi.org/10.1016/j.jaci.2020.02.021
- Bäck O., Blomquist H.K., Hernell O., Stenberg B. Does vitamin D intake during infancy promote the development of atopic allergy? Acta Derm. Venereol. 2009; 89(1): 28–32. https://doi.org/10.2340/00015555-0541
- Flohr C., Mann J. New approaches to the prevention of childhood atopic dermatitis. Allergy. 2014; 69(1): 56–61. https://doi.org/10.1111/all.12343
- Tan-Lim C.S.C., Esteban-Ipac N.A.R., Mantaring J.B.V. 3rd., Chan Shih Yen E., Recto M.S.T., Sison O.T., et al. Comparative effectiveness of probiotic strains for the treatment of pediatric atopic dermatitis: A systematic review and network meta-analysis. Pediatr. Allergy Immunol. 2021; 32(1): 124–36. https://doi.org/10.1111/pai.13305
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