Evaluating Environmental and Food Allergies in Chronic Atopic Dermatitis

An 18-year-old female reports a 6-7 year history of eczematous dermatitis focused primarily on her eyelids, but also affecting the dorsal aspect of her hands and knuckles, as well as her knees. She has previously seen a dermatologist and had undergone limited patch testing which revealed sensitivity to cobalt. She reports that 5 years ago, she had labs drawn by her primary care doctor which revealed her to have evidence for celiac disease, due to loss of appetite and poor growth, along with abdominal pain and discomfort. The diagnosis was confirmed by endoscopy and biopsy. Upon elimination of gluten from her diet, her eczematous dermatitis improved on her eyelids and elsewhere, but did not resolve. She continues to experience flares of her dermatitis which at times can be severe. She suspects corn may be a contributing factor and has recently cut it from her diet, with some possible improvement in her eczema. She does not wear make-up and reports using only “sensitive-skin” products. She has been prescribed topical calcineurin inhibitors for control of her dermatitis, which do provide benefit, but she is reluctant to continue to use them due to concern they may be carcinogenic. She is extremely careful with gluten avoidance, and her celiac serology has been negative (last tested 2 years ago). She feels as though her ongoing eczema is related either to ongoing gluten exposure or to another food that she may be allergic to that is triggering her to have flares. She denies any clear history of allergy to pollen or animal dander, but has never been tested for environmental aeroallergen sensitization. All of the following would be appropriate next steps, EXCEPT: