Role of allergy in the development of alopecia areata

Alopecia areata is an autoimmune disease characterized by non-scarring hair loss with preservation of the hair follicle. Hair loss in alopecia areata can be either focal with the appearance of clearly defined foci of alopecia, or diffuse or complete hair loss in any area of the skin where hair follicles are present. Data on the role of food allergy in the development of alopecia areata and the nature of the sensitization spectrum are extremely scarce. Objective: to study the features of the spectrum of sensitization to food and pollen (cross-reacting) allergens in patients with alopecia areata.

The study involved patients with alopecia areata (n = 17), who were divided into groups according to age: group 1 — children (n = 9) and group 2 — adults (n = 8). All patients underwent a specific allergological examination: collection of an allergic history, skin prick testing with food and pollen allergens (Allergopharma, Germany).

Analysis of the spectrum of sensitization to food allergens in patients with alopecia areata revealed features depending on their age. Thus, in the group of sick children, the highest frequency of sensitization to whole chicken eggs, food cereals, yeast, soybeans and cow's milk proteins was noted. In the group of sick adults, the most significant food allergens were: egg protein, rye flour, oats. Among the pollen allergens in the first group of patients, the most common allergens were a mixture of weed and grass pollen, in the second group, a mixture of meadow grass pollen. All patients, taking into account allergological testing, were administered an individual elimination diet with the exclusion of causally significant allergens, taking into account crossreacting allergens. The elimination effect was assessed 2 months after the start of the elimination diet. 70% of patients showed a clinical improvement, i.e., the growth of vellus was noted (vellus depigmented hair) in the foci of alopecia, as well as terminal pigmented hair. Complete regression of alopecia foci occurred on average within 3-6 months from the start of therapy.

The sensitization to food and pollen (cross-reacting) allergens in patients with alopecia areata and the positive effect of the elimination diet revealed in our study well supports the role of food allergy in the development of this disorder. Therefore, the study of the causal relationship between food allergy and alopecia areata is of particular relevance and creates prerequisites for the discovery of new diagnostic and therapeutic options.

1. Barilo A.A., Borisova I.V., Smirnova S.V. The dermato-respiratory syndrome as a manifestation of food allergy in children. Rossiyskiy allergologicheskiy zhurnal = Russian Journal of Allergy, 2019, Vol. 16, no. 1-2, pp. 32-34. (In Russ.)

2. Barilo A.A., Smirnova S.V. The comparative analysis of the spectrum of sensitization to food, pollen and fungal allergens in patients with atopic dermatitis and psoriasis. Voprosy pitaniya = Problems of Nutrition, 2020, Vol. 89, no. 5, pp. 28-34. (In Russ.)

3. Barilo A.A., Smirnova S.V., Olyanina I.M. Clinical case of focal alopecia in a child with atopy. Meditsinskaya immunologiya = Medical Immunology (Russia), 2021, Vol. 23, no. 1, pp. 191-196. (In Russ.) doi: 10.15789/1563-0625-CCO-2074.

4. Barilo A.A., Smirnova S.V., Smolnikova M.V. Immunological indicators of patients with psoriasis in different age groups. Rossiyskiy immunologicheskiy zhurnal = Russian Journal of Immunology, 2017, Vol. 11 (20), no. 4, pp. 680-681. (In Russ.)

5. Vishneva E.A., Namazova-Baranova L.S., Makarova S.G., Alexeeva A.A., Effendieva K.E. Food Allergy to Wheat Proteins. Diagnostic and Treatment Difficulties. Pediatricheskaya farmakologiya = Pediatric Pharmacology, 2015, Vol. 4, pp. 429-434. (In Russ.)

6. Borde A., Astrand A. Alopecia areata and the gut-the link opens up for novel therapeutic interventions. Expert Opin. Ther. Targets., 2018, Vol. 22, no. 6, pp. 503-511.

7. Campana R., Moritz K., Marth K., Neubauer A., Huber H., Henning R., Blatt K., Hoermann G., Brodie T.M., Kaider A., Valent P., Sallusto E, Wohrl S., Valenta R. Frequent occurrence of T cell-mediated late reactions revealed by atopy patch testing with hypoallergenic rBet v 1 fragments. J. Allergy Clin. Immunol., 2016, Vol. 137, no. 2, pp. 601-609.

8. Cianferoni A. Wheat allergy: diagnosis and management. J. Asthma Allergy, 2016, Vol. 9, pp. 13-25.

9. Guo E.L., Katta R. Diet and hair loss: Effects of nutrient deficiency and supplement use. Dermatol. Pract. Concept., 2017, Vol. 7, no. 1, pp. 1-10.

10. Li J.D., Du Z.R., Liu J., Xu Y.Y., Wang R.Q., Yin J. Characteristics of pollen-related food allergy based on individual pollen allergy profiles in the Chinese population. World Allergy Organ J., 2020, Vol. 13, no. 5, 100120. doi: 10.1016/j.waojou.2020.100120.

11. McElwee K.J., Gilhar A., Tobin D.J., Ramot Y., Sundberg J.P., Nakamura M., Bertolini M., Inui S., Tokura Y., King L.E., Duque-Estrada B., Tosti A., Keren A., Itami S., Shoenfeld Y.,. Zlotogorski A, Paus R. What causes alopecia areata? Exp. Dermatol., 2013, Vol. 22, no. 9, pp. 609-626.

12. Morita E., Hide M., Yoneya Y., Kannbe M., Tanaka A., Yamamoto S. An assessment of the role of Candida albicans antigen in atopic dermatitis. J. Dermatol., 1999, Vol. 26, pp. 282-287.

13. Pham C.T., Romero K., Almohanna H.M., Griggs J., Ahmed A., Tosti A. The role of diet as an adjuvant treatment in scarring and nonscarring alopecia. Skin Appendage Disord., 2020, Vol. 6, pp. 88-96.

14. Romantsik O., Tosca M.A., Zappettini S., Calevo M.G. Oral and sublingual immunotherapy for egg allergy. Cochrane Database Syst. Rev., 2018, Vol. 4, no. 4, CD010638. doi:10.1002/14651858.CD010638.pub.

15. Rork J.F., Rashighi M., Harris J.E. Understanding Autoimmunity of Vitiligo and Alopecia Areata. Curr. Opin. Pediatr., 2016, Vol. 28, no. 4, pp. 463-469.

16. Simakou T., Butcher J.P., Reid S., Henriquez F.L. Alopecia areata: A multifactorial autoimmune condition. J. Autoimmun., 2019, Vol. 98, pp. 74-85.

17. Strazzulla L.C., Wang E.H.C., Avila L., Lo Sicco K., Brinster N., Christiano A.M., Shapiro J. Alopecia areata: Disease characteristics, clinical evaluation, and new perspectives on pathogenesis. J. Am. Acad. Dermatol., 2018, Vol. 78, no. 1, pp. 1-12.

18. Thompson J.M., Mehwish A. Mirza, Park M.K., Qureshi A.A., Cho E. The role of micronutrients in alopecia areata: A Review. Am. J. Clin. Dermatol., 2017, Vol. 18, no. 5, pp. 663-679.

19. Yagami A., Ebisawa M. New findings, pathophysiology, and antigen analysis in pollen-food allergy syndrome. Curr. Opin. Allergy Clin. Immunol., 2019, Vol. 19, no. 3, pp. 218-223.