***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND The gastrointestinal microflora is an important constituent of the gut mucosal defense barrier . We have previously shown that a human intestinal floral strain , Lactobacillus GG ( ATCC 53103 ) , promotes local antigen-specific immune responses ( particularly in the IgA class ) , prevents permeability defects , and confers controlled antigen absorption . OBJECTIVE The aim of this study was to evaluate the clinical and immunologic effects of cow 's milk elimination without ( n = 14 ) and with ( n = 13 ) the addition of Lactobacillus GG ( 5 x 10(8 ) colony-forming units/gm formula ) in an extensively hydrolyzed whey formula in infants with atopic eczema and cow 's milk allergy . The second part of the study involved 10 breast-fed infants who had atopic eczema and cow 's milk allergy . In this group Lactobacillus GG was given to nursing mothers . METHODS The severity of atopic eczema was assessed by clinical scoring . The concentrations of fecal alpha 1- antitrypsin , tumor necrosis factor-alpha , and eosinophil cationic protein were determined as markers of intestinal inflammation before and after dietary intervention . RESULTS The clinical score of atopic dermatitis improved significantly during the 1-month study period in infants treated with the extensively hydrolyzed whey formula fortified with Lactobacillus GG . The concentration of alpha 1-antitrypsin decreased significantly in this group ( p = 0.03 ) but not in the group receiving the whey formula without Lactobacillus GG ( p = 0.68 ) . In parallel , the median ( lower quartile to upper quartile ) concentration of fecal tumor necrosis factor-alpha decreased significantly in this group , from 709 pg/gm ( 91 to 1131 pg/gm ) to 34 pg/gm ( 19 to 103 pg/gm ) ( p = 0.003 ) , but not in those receiving the extensively hydrolyzed whey formula only ( p = 0.38 ) . The concentration of fecal eosinophil cationic protein remained unaltered during therapy . CONCLUSION These results suggest that probiotic bacteria may promote endogenous barrier mechanisms in patients with atopic dermatitis and food allergy , and by alleviating intestinal inflammation , may act as a useful tool in the treatment of food allergy Objective . There is a growing body of clinical and laboratory evidence to support the notion that food allergy plays a role in the pathogenesis of atopic dermatitis ( AD ) . However , the incidence of IgE-mediated food allergy in children with AD is not well established . Design . A prospect i ve study to determine the prevalence of IgE-mediated food hypersensitivity among patients referred to a university-based dermatologist for evaluation of AD . Setting . University hospital pediatric dermatology clinic . Patients . A total of 63 patients with AD were recruited ( 35 male ; 32 white , 24 African-American , 7 Asian ) . Methods . Patients were assigned an AD symptom score ( SCORAD ) and were screened for food-specific serum IgE antibodies to six foods ( milk , egg , wheat , soy , peanut , fish ) known to be the most allergenic in children . The levels of food-specific serum IgE were determined by the CAP System fluoroscein-enzyme immunoassay ( CAP ) ; patients with a value ≥0.7 kIUa/L were invited for an additional allergy evaluation . Those with CAP values below the cutoff were considered not food allergic . Patients were considered to be allergic if they met one of the following criteria for at least one food : 1 ) reaction on food challenge ; 2 ) CAP value more than the 95 % confidence interval predictive for a reaction ; 3 ) convincing history of an acute significant ( hives , respiratory symptoms ) reaction after the isolated ingestion of a food to which there was a positive CAP or prick skin test . Results . A total of 63 patients ( median age , 2.8 years ; median SCORAD , 41.1 ) were recruited ; 22 had negative CAP values ( without a significant difference in age or SCORAD score , compared with the 41 with positive specific IgE values ) . Further allergy evaluation was offered to the 41 remaining patients ; 10 were lost to follow-up and 31 were evaluated further . Of these , 19 underwent a total of 50 food challenges ( 36 double-blind , placebo-controlled , and 14 open ) , with 11 patients experiencing 18 positive challenges ( 94 % with skin reactions ) . Additionally , 6 patients had a convincing history with a predictive level of IgE ; 5 had a convincing history with positive , indeterminate levels of IgE ; and 1 had predictive levels of IgE ( to egg and peanut ) without a history of an acute reaction . Overall , 23/63 ( 37 % ; 95 % confidence interval , 25 % to 50 % ) had clinical ly significant IgE-mediated food hypersensitivity without a significant difference in age or symptom score between those with or without food allergy . Conclusions . Approximately one third of children with refractory , moderate – severe AD have IgE-mediated clinical reactivity to food proteins . The prevalence of food allergy in this population is significantly higher than that in the general population , and an evaluation for food allergy should be considered in these patients Thirty seven breast fed infants with eczema were studied to see whether changes in their mothers ' diets affected their skin condition .  Nineteen mothers and babies took part in a double blind crossover trial of exclusion of egg and cows ' milk , and 18 took part in open exclusion of 11 foods  followed by double blind challenge to those mothers whose infants seemed to respond . Babies were examined at the beginning and end of each dietary period , and the extent and severity of the rash were given a numerical score . The eczema improved in six infants when their mothers avoided egg and cows ' milk and worsened again when these were reintroduced . Two infants suffered gastrointestinal reactions after maternal ingestion of egg and cows ' milk , one developing colitis . Maternal dietary exclusion seems to benefit some breast fed babies with eczema OBJECTIVE To evaluate the impact of childhood atopic eczema on families and assess the personal financial cost of its management . DESIGN Cross sectional survey . SETTING Paediatric dermatology and paediatric diabetology outpatient clinics . PATIENTS Parents of 48 r and omly selected children with atopic eczema and 46 with insulin dependent diabetes mellitus . MAIN OUTCOME MEASURES The impact on family score , the reported cost of relevant medical treatments , medical consultations , relevant hospitalisation , and income loss . RESULTS Families of children with moderate or severe atopic eczema had a significantly higher impact on family score than families of diabetic children . A conservative estimate of the annual personal financial cost of managing mild , moderate , and severe eczema was Aus$330 , 818 , and 1255 , respectively . The financial cost to the community for the management of atopic eczema in the study groups was greater . The personal financial cost of managing eczema was greater than for asthma . CONCLUSION Childhood atopic eczema has a profound impact on the social , personal , emotional , and financial perspectives of families Fifty‐three patients with atopic eczema took part in a double blind controlled cross‐over trial of an egg and cow 's milk exclusion diet .  Response to the diet was assessed in terms of areas affected , day and night time itch , and topical steroid usage Over the last two decades the incidence of allergic diseases has increased in industrialized countries , and consequently new approaches have to be explored BACKGROUND The natural history of allergic disease and its potential for prevention merit close examination because of the explosive worldwide increase in the prevalence and morbidity of atopic disorders . This study examines the development of atopy at age 7 years in 165 children in a high-risk cohort , previously reported from birth to age 4 years . METHODS In this prospect i ve , r and omized , controlled study of food allergen avoidance in infancy , the prophylactic-treated group consisted of infants whose mothers avoided cow 's milk , egg , and peanut during the last trimester of pregnancy and lactation and who , themselves ,  avoided cow 's milk until age 1 year ( casein hydrolysate supplementation before age 1 ) , egg until age 2 years , and peanut and fish until age 3 years . The control group consisted of maternal/infant pairs who followed st and ard feeding practice s. RESULTS Despite a significant reduction in food allergy and milk sensitization before age 2 years , none of the following differed between the groups at age 7 years : food allergy , atopic dermatitis , allergic rhinitis , asthma , any atopic disease , lung function , food or aeroallergen sensitization , serum IgE level , or presence of nasal eosinophils or nasal basophilic cells .  Children with food allergy by 4 years evidence d higher 7-year ( current ) prevalences of allergic rhinitis and asthma ( p < 0.01 ) . Atopic diseases/parameters at age 7 years were shown , by multivariate analysis ( p < 0.05 ) , to be associated with several genetic and environmental risk factors ( male gender , maternal nonwhite ethnicity and asthma , and household smoking ) , as well as predictive atopic markers during infancy ( elevated serum IgE level ; egg , cow 's milk , and peanut sensitization ; and nasal eosinophils and nasal basophilic cells ) . CONCLUSIONS These findings help to : ( 1 ) eluci date the natural history of atopic disease in high-risk children ; ( 2 ) document the progression of allergy from atopic dermatitis , food allergy , and food sensitization to respiratory allergy and aeroallergen sensitization despite food allergy prevention in infancy ; ( 3 ) identify allergy predictive markers ; and ( 4 ) exp and our appreciation of the interactions of genetic and environmental factors in the development of atopy While atopic dermatitis ( AD ) usually presents early in life , few prospect i ve studies focus on young children with AD . The objective of this study was to characterize , phenotypically and prospect ively , young children with AD . From a community birth cohort of 2,256 children , consecutive children with AD ( n = 221 ) were followed to 2 years of age , when they were re-examined and screened for atopic sensitization ( skin-prick test to foods ; Phadiatop ) .  Ninety-nine controls were also examined . AD debuted during the first year in 88 % of cases . At the 2-year examination , when the children had already undergone topical treatment , 157/221 ( 71 % ) had ongoing eczema ranging among mild ( 45 % ) , moderate ( 53 % ) and severe ( 2 % ) . Airway problems indicating asthma had occurred in 9 % of cases and 6 % of controls ( not significant ) , and allergic rhinoconjunctivitis in 5 % and 0 % , respectively ( p<0.05 ) . The skin-prick test to common food allergens was positive in 27 % of cases and Phadiatop was positive in 15 % . In 67 % both tests were negative . Eczema severity did not differ between sensitized and non-sensitized children . Positive Phadiatop was more common in boys than in girls with ongoing AD ( 22 % vs 3 % , p<0.01 ) , and more boys than girls had ongoing AD ( 82 % vs 59 % , p<0.001 ) ; otherwise , no differences attributable to gender were found Cow 's milk and soy protein allergies are commonly associated with atopic dermatitis ( AD ) in young children .  Amino acid (AA)-based elemental milk formula may improve AD control in these patients . This study investigates the efficacy of AA-based formula in treating young AD patients irrespective of their food allergy status . AD patients younger than 3 yr old were eligible . Sensitization to food allergens was ascertained by skin prick tests and allergen-specific immunoglobulin E ( IgE ) assay . Patients were then r and omly allocated to take either active treatment or pre-existing formulae ( placebo ) for 6 wk . They were allowed a 6-wk washout period before crossed over to the other intervention for another 6 wk . Fifteen AD patients , with median ( interquartile range , IQR ) age of 1.4 ( 0.6 - 2.6 ) yr , were recruited . Their median ( IQR ) SCORAD score was 23.9 ( 10.5 - 29.7 ) . Seven of them were sensitized to cow 's milk or soybean . Among 11 patients who completed the study , the median changes for all scores and urinary eosinophil protein X ( EPX ) concentration were not statistically significant . There was also no evidence of carry-over effects for SCORAD and its various components and global health score , except for urinary EPX concentration ( p = 0.05 ) . Our results do not support the use of AA-based elemental milk formula in treating young children with AD irrespective of their food allergy status BACKGROUND Little is known about the prevalence of atopic eczema outside Northern Europe . OBJECTIVES We sought to describe the magnitude and variation in the prevalence of atopic eczema symptoms throughout the world . METHODS A cross-sectional question naire survey was conducted on r and om sample s of schoolchildren aged 6 to 7 years 
    Output:
    
There appears to be no benefit of an egg and milk free diet in unselected participants with atopic eczema .
There is also no evidence of benefit in the use of an elemental or few-foods diet in unselected cases of atopic eczema .
There may be some benefit in using an egg-free diet in infants with suspected egg allergy who have positive specific IgE to eggs .
Little evidence supports the use of various exclusion diets in unselected people with atopic eczema , but that may be because they were not allergic to those substances in the first place .