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Gao J, Ma Y, Sheng Y, Zuo X, Wang W, Zheng X, Tang H, Tang X, Zhou F, Yang S, Zhang X, Sun L. Association analysis of allergic sensitization susceptibility loci with atopic dermatitis in Chinese population. J Dermatol Sci 2015; 80:217-20. [DOI: 10.1016/j.jdermsci.2015.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 09/24/2015] [Accepted: 09/25/2015] [Indexed: 10/23/2022]
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102
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Andersen R, Thyssen J, Maibach H. Qualitative vs. quantitative atopic dermatitis criteria - in historical and present perspectives. J Eur Acad Dermatol Venereol 2015; 30:604-18. [DOI: 10.1111/jdv.13442] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 09/07/2015] [Indexed: 01/23/2023]
Affiliation(s)
- R.M. Andersen
- Department of Dermatology; University of California at San Francisco; San Francisco CA USA
- Department of Dermato-Allergology; National Allergy Research Centre; Copenhagen University Hospital; Gentofte Denmark
| | - J.P. Thyssen
- Department of Dermato-Allergology; National Allergy Research Centre; Copenhagen University Hospital; Gentofte Denmark
| | - H.I. Maibach
- Department of Dermatology; University of California at San Francisco; San Francisco CA USA
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103
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Chuh A, Zawar V, Sciallis GF, Lee A. The diagnostic criteria of pityriasis rosea and Gianotti-Crosti syndrome – a protocol to establish diagnostic criteria of skin diseases. J R Coll Physicians Edinb 2015. [DOI: 10.4997/jrcpe.2015.310a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- A Chuh
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong and Prince of Wales Hospital, Shatin, Hong Kong
| | - V Zawar
- Consultant Dermatologist and Honorary Professor, Department of Dermatology, Godavari Foundation Medical College and Research Center, DUPMCJ, India
| | - GF Sciallis
- Consultant and Assistant Professor of Dermatology, Department of Dermatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - A Lee
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong and Prince of Wales Hospital, Shatin, Hong Kong
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104
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Tan HY, Lenon GB, Zhang AL, Xue CC. Efficacy of acupuncture in the management of atopic dermatitis: a systematic review. Clin Exp Dermatol 2015; 40:711-5; quiz 715-6. [DOI: 10.1111/ced.12732] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2014] [Indexed: 11/30/2022]
Affiliation(s)
- H. Y. Tan
- Traditional and Complementary Medicine Research Program; Health Innovations Research Institute; School of Health Sciences; RMIT University; Bundoora Campus Bundoora Campus Victoria Australia
| | - G. B. Lenon
- Traditional and Complementary Medicine Research Program; Health Innovations Research Institute; School of Health Sciences; RMIT University; Bundoora Campus Bundoora Campus Victoria Australia
| | - A. L. Zhang
- Traditional and Complementary Medicine Research Program; Health Innovations Research Institute; School of Health Sciences; RMIT University; Bundoora Campus Bundoora Campus Victoria Australia
| | - C. C. Xue
- Traditional and Complementary Medicine Research Program; Health Innovations Research Institute; School of Health Sciences; RMIT University; Bundoora Campus Bundoora Campus Victoria Australia
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Simpson MR, Dotterud CK, Storrø O, Johnsen R, Øien T. Perinatal probiotic supplementation in the prevention of allergy related disease: 6 year follow up of a randomised controlled trial. BMC DERMATOLOGY 2015; 15:13. [PMID: 26232126 PMCID: PMC4522068 DOI: 10.1186/s12895-015-0030-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 06/30/2015] [Indexed: 12/19/2022]
Abstract
Background Perinatal probiotics supplementation has been shown to be effective in the primary prevention of atopic dermatitis (AD) in early childhood, although the long term effects of probiotics on AD and other allergic diseases is less certain. We have previously reported a significant reduction in the cumulative incidence of AD at 2 years after maternal probiotic supplementation. In this study we present the effects of perinatal probiotics given to women from a general population on allergy related diseases in their offspring at 6 years. Methods Four hundred and fifteen pregnant women were randomised to receive probiotic or placebo milk in a double-blinded trial from 36 week gestation until 3 months postpartum. Probiotic milk contained Lactobacillus rhamnosos GG, L. acidophilus La-5 and Bifidobacterium animalis subsp. lactis Bb-12. At 6 years, children were re-assessed for AD, atopic sensitisation, asthma and allergic rhinoconjunctivitis (ARC). Results At 6 years, 81 and 82 children were assessed for AD in the probiotic and placebo groups, respectively. In a multiple imputation analysis, there was as trend towards a lower cumulative incidence of AD in the probiotic group compared to the placebo group (OR 0.64, 95 % CI 0.39-1.07, p = 0.086; NNT = 10). This finding was statistically significantly in the complete case analysis (OR 0.48, 95 % CI 0.25-0.92, p = 0.027, NNT = 6). The prevalence of asthma and atopic sensitisation, and the cumulative incidence of ARC were not significantly affected by the probiotic regime at 6 years of age. Conclusions Maternal probiotic ingestion alone may be sufficient for long term reduction in the cumulative incidence of AD, but not other allergy related diseases. Trial registration ClinicalTrials.gov identifier: NCT00159523 Electronic supplementary material The online version of this article (doi:10.1186/s12895-015-0030-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Melanie Rae Simpson
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Postboks 8905, MTFS, 7491, Trondheim, Norway.
| | - Christian Kvikne Dotterud
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Postboks 8905, MTFS, 7491, Trondheim, Norway.,Department of Dermatology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ola Storrø
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Postboks 8905, MTFS, 7491, Trondheim, Norway
| | - Roar Johnsen
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Postboks 8905, MTFS, 7491, Trondheim, Norway
| | - Torbjørn Øien
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Postboks 8905, MTFS, 7491, Trondheim, Norway
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106
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Franzese CB. AAOA allergy primer: history and physical examination. Int Forum Allergy Rhinol 2015; 4 Suppl 2:S28-31. [PMID: 25182351 DOI: 10.1002/alr.21390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 06/30/2014] [Accepted: 06/30/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Allergic disease is very common in the general population and makes a significant impact on the quality of life of patients. Immunoglobulin E (IgE)-mediated allergic disease manifests throughout the body, but many signs and symptoms of inhalant allergy are centered in the head and neck region. METHODS A thorough yet focused history of allergic symptoms and potential physical examination findings of inhalant allergy are described. RESULTS History should include types and timing of symptoms, environmental and occupational exposures, family history, associated diseases, and prior treatment, if any. Physical examination should include the skin and structures of the head and neck region. Nasal endoscopy can be helpful in visualization of nasal polyps. CONCLUSION Many times, history alone can serve to make the diagnosis, but physical examination also demonstrates specific findings that confirm the practitioner's presumptive diagnosis of allergic disease. However, should medical treatment fail or the diagnosis be in doubt, further diagnostic investigation with allergy testing should be pursued.
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Affiliation(s)
- Christine B Franzese
- DePaul/EVMS Department of Otolaryngology, Eastern Virginia Medical School (EVMS), Norfolk, VA
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107
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Nampijja M, Webb EL, Kaweesa J, Kizindo R, Namutebi M, Nakazibwe E, Oduru G, Kabuubi P, Kabagenyi J, Kizito D, Muhangi L, Akello M, Verweij JJ, Nerima B, Tukahebwa E, Elliott AM. The Lake Victoria Island Intervention Study on Worms and Allergy-related diseases (LaVIISWA): study protocol for a randomised controlled trial. Trials 2015; 16:187. [PMID: 25902705 PMCID: PMC4413531 DOI: 10.1186/s13063-015-0702-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 04/01/2015] [Indexed: 01/15/2023] Open
Abstract
Background The Hygiene Hypothesis proposes that infection exposure protects against inflammatory conditions. Helminths possess allergen-like molecules and may specifically modulate allergy-related immunological pathways to inhibit responses which protect against them. Mass drug administration is recommended for helminth-endemic communities to control helminth-induced pathology, but may also result in increased rates of inflammation-mediated diseases in resource-poor settings. Immunological studies integrated with implementation of helminth control measures may elucidate how helminth elimination contributes to ongoing epidemics of inflammatory diseases. We present the design of the Lake Victoria Island Intervention Study on Worms and Allergy-related diseases (LaVIISWA), a cluster-randomised trial evaluating the risks and benefits of intensive versus standard anthelminthic treatment for allergy-related diseases and other health outcomes. Methods/Design The setting is comprised of island fishing communities in Mukono district, Uganda. Twenty-six communities have been randomised in a 1:1 ratio to receive standard or intensive anthelminthic intervention for a three-year period. Baseline characteristics were collected immediately prior to intervention rollout, commenced in February 2013. Primary outcomes are reported wheeze in the past 12 months and atopy (skin prick test response and allergen-specific immunoglobulin (asIg) E concentration). Secondary outcomes are visible flexural dermatitis, helminth infections, haemoglobin, growth parameters, hepatosplenomegaly, and responses to vaccine antigens. The trial provides a platform for in-depth analysis of clinical and immunological consequences of the contrasting interventions. Discussion The baseline survey has been completed successfully in a challenging environment. Baseline characteristics were balanced between trial arms. Prevalence of Schistosoma mansoni, hookworm, Strongyloides stercoralis and Trichuris trichiura was 52%, 23%, 13%, and 12%, respectively; 31% of Schistosoma mansoni infections were heavy (>400 eggs/gram). The prevalence of reported wheeze and positive skin prick test to any allergen was 5% and 20%, respectively. Respectively, 77% and 87% of participants had Dermatophagoides- and German cockroach-specific IgE above 0.35 kUA/L. These characteristics suggest that the LaVIISWA study will provide an excellent framework for investigating beneficial and detrimental effects of worms and their treatment, and the mechanisms of such effects. Trial registration This trial was registered with Current Controlled Trials (identifier: ISRCTN47196031) on 7 September 2012. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0702-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Emily L Webb
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - James Kaweesa
- Vector Control Division, Ministry of Health, PO Box 1661, Kampala, Uganda.
| | - Robert Kizindo
- MRC/UVRI Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda.
| | - Milly Namutebi
- MRC/UVRI Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda.
| | | | - Gloria Oduru
- MRC/UVRI Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda.
| | - Prossy Kabuubi
- MRC/UVRI Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda.
| | - Joyce Kabagenyi
- MRC/UVRI Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda.
| | - Dennison Kizito
- MRC/UVRI Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda.
| | - Lawrence Muhangi
- MRC/UVRI Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda.
| | - Mirriam Akello
- MRC/UVRI Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda.
| | - Jaco J Verweij
- Laboratory for Medical Microbiology and Immunology, St Elisabeth Hospital, Postbus 90151, 5000 LC, Tilburg, the Netherlands.
| | - Barbara Nerima
- Uganda Virus Research Institute, PO Box 49, Entebbe, Uganda.
| | - Edridah Tukahebwa
- Vector Control Division, Ministry of Health, PO Box 1661, Kampala, Uganda.
| | - Alison M Elliott
- MRC/UVRI Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda. .,London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
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Garritsen F, Roekevisch E, van der Schaft J, Deinum J, Spuls P, de Bruin-Weller M. Ten years experience with oral immunosuppressive treatment in adult patients with atopic dermatitis in two academic centres. J Eur Acad Dermatol Venereol 2015; 29:1905-12. [DOI: 10.1111/jdv.13064] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/04/2014] [Indexed: 01/29/2023]
Affiliation(s)
- F.M. Garritsen
- Department of Dermatology; Academic Medical Center Amsterdam; The Netherlands
- Department of Dermatology; University Medical Center Utrecht; The Netherlands
| | - E. Roekevisch
- Department of Dermatology; Academic Medical Center Amsterdam; The Netherlands
| | - J. van der Schaft
- Department of Dermatology; University Medical Center Utrecht; The Netherlands
| | - J. Deinum
- Department of Dermatology; University Medical Center Utrecht; The Netherlands
| | - P.I. Spuls
- Department of Dermatology; Academic Medical Center Amsterdam; The Netherlands
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109
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Jacob SE, Hamann D, Goldenberg A, Connelly EA. Easter egg hunt dermatitis: systemic allergic contact dermatitis associated with chocolate ingestion. Pediatr Dermatol 2015; 32:231-3. [PMID: 25529404 DOI: 10.1111/pde.12490] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Pediatric systemic allergic contact dermatitis to nickel has previously been reported in association with cocoa. We present four clinical cases of hypersensitivity temporally associated with chocolate consumption at Easter. Clinicians should be aware of the potential for foods high in nickel to provoke patients with known nickel sensitivity and systemic dermatitis.
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Affiliation(s)
- Sharon E Jacob
- Department of Dermatology, Loma Linda University, Loma Linda, California; Division of Dermatology, University of California at San Diego, La Jolla, California
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111
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Clinical Management of Atopic Dermatitis: Practical Highlights and Updates from the Atopic Dermatitis Practice Parameter 2012. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 2:361-9; quiz 370. [DOI: 10.1016/j.jaip.2014.02.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 02/25/2014] [Accepted: 02/26/2014] [Indexed: 11/20/2022]
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112
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Forsey RGP. Prevalence of childhood eczema and food sensitization in the First Nations reserve of Natuashish, Labrador, Canada. BMC Pediatr 2014; 14:76. [PMID: 24649812 PMCID: PMC3994483 DOI: 10.1186/1471-2431-14-76] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 03/06/2014] [Indexed: 11/10/2022] Open
Abstract
Background The Mushua Innu of Natuashish, Labrador, Canada seem to have a high rate of childhood eczema. Anecdotally this problem seems to be more common now than 20 years ago. There has been speculation that this could be related to food sensitization that may have arisen coincident with a move away from a traditional Innu diet. We undertook to assess the prevalence and severity of pediatric eczema in Natuashish (population 792), and investigate the level of sensitization to common food antigens. Methods Over a three-month period we performed a population survey of all children in the community from the ages of 2–12 inclusive. The one-year prevalence of eczema was assessed using the United Kingdom Working Party’s diagnostic criteria, and graded on the Nottingham Severity Scale. All children with eczema and twice as many age/sex matched controls were offered complete blood counts, total IgE, and food specific IgE levels for egg white, cow’s milk protein and wheat. Results One hundred and eighty two (95% of the eligible children) were assessed. Of the 182 children examined eczema was diagnosed in 30 (16.5%) - 22 females and 8 males. The majority of children with eczema (20/30) were classified as being in the moderate and severe category. Of the 22 with eczema and 40 controls who consented to venipuncture all but 3 had IgE levels above the lab's reference range. Food specific antibody assays showed that 32, 23, and 5 percent of children with eczema were sensitized to egg, milk, and wheat respectively. None of the controls were sensitized. Conclusions The children of Natuashish, Labrador have a high rate of eczema, much of it graded as moderate or severe. IgE levels were markedly elevated in children with and without eczema, with average values at least ten-fold higher than other populations. There is no evidence of an unusual amount of sensitization to egg, milk or wheat.
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Affiliation(s)
- Robert G P Forsey
- Discipline of Family Medicine, Memorial University of Newfoundland, Labrador-Grenfell Health, Happy Valley-Goose Bay, Newfoundland and Labrador, Canada.
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113
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Garritsen F, Brouwer M, Limpens J, Spuls PI. Photo(chemo)therapy in the management of atopic dermatitis: an updated systematic review with implications for practice and research. Br J Dermatol 2014; 170:501-13. [DOI: 10.1111/bjd.12645] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2013] [Indexed: 11/30/2022]
Affiliation(s)
- F.M. Garritsen
- Department of Dermatology; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - M.W.D. Brouwer
- Department of Dermatology; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - J. Limpens
- Medical Library; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - Ph. I. Spuls
- Department of Dermatology; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
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114
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Farajzadeh S, Esfandiarpour I, Sedaghatmanesh M, Saviz M. Epidemiology and clinical features of atopic dermatitis in kerman, a desert area of iran. Ann Dermatol 2014; 26:26-34. [PMID: 24648683 PMCID: PMC3956792 DOI: 10.5021/ad.2014.26.1.26] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 12/17/2012] [Accepted: 01/02/2013] [Indexed: 01/22/2023] Open
Abstract
Background Epidemiologic studies of atopic dermatitis (AD) in desert areas are still lacking. Objective The aim of this study was to investigate the epidemiology of AD in children in Kerman city, a desert area in Iran. Methods We evaluated preschool children (age, 2 to 7 years) and primary school students (age, greater than 7 up to 12 years) in Kerman. We selected 865 students to estimate the prevalence and assess other features of AD such as distribution of lesions, personal history, family history of atopy, aggravating factors, associated symptoms, and morphological variants. Results The prevalence of AD was 9.1% in our study population. The prevalence of AD was 9.17% and 9.09% in males and females, respectively. The prevalence of AD in the age range of 2 to 7 years was 13.53% and 8.33% among children aged greater than 7 up to 12 years. In total, 82.27% of the patients were in chronic stage of the disease, and 31.6% had a personal history of other atopic diseases. At least one first-degree family member with atopy was seen in 46.83% of the patients. The most common sites of involvement were the head and neck. The most involved areas in the limbs were extensor surfaces. The most frequent morphological variant of AD was the common type. Conclusion The prevalence of AD in Kerman was higher than in other Iranian cities but lower than that in developed countries. Diversity in the clinical features of AD has been observed among different studies, and the diagnostic criteria of AD should be adapted in proportion to the studied area.
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Affiliation(s)
- Saeedeh Farajzadeh
- Department of Pediatric Dermatology, Dermatology and Leishmania Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Iraj Esfandiarpour
- Department of Pediatric Dermatology, Dermatology and Leishmania Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Sedaghatmanesh
- Department of Pediatric Dermatology, Dermatology and Leishmania Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahdieh Saviz
- Department of Pediatric Dermatology, Dermatology and Leishmania Research Center, Kerman University of Medical Sciences, Kerman, Iran
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Jadotte YT, Santer M, Vakirlis E, Schwartz RA, Bauer A, Gundersen DA, Mossman K, Lewith G. Complementary and alternative medicine treatments for atopic eczema. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd010938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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116
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Lee SC. Various diagnostic criteria for atopic dermatitis. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2014. [DOI: 10.5124/jkma.2014.57.3.212] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Seung-Chul Lee
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
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117
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Yoon JW, Lee SM, Kim JH, Kim NY, Baek JH, Baek HS, Jee HM, Kim HY, Choi SH, Kim KE, Yum HY, Han MY, Kim J, Shin YH. Sensitization patterns to common allergens in Korean children younger than 6 years of age presenting with typical symptoms or signs of allergic diseases: a single center study. ALLERGY ASTHMA & RESPIRATORY DISEASE 2014. [DOI: 10.4168/aard.2014.2.4.272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jung Won Yoon
- Department of Pediatrics, Myongji Hospital, Goyang, Korea
| | - Sang Min Lee
- Department of Pediatrics, Myongji Hospital, Goyang, Korea
| | - Joon Hwan Kim
- Department of Pediatrics, CHA University School of Medicine, Pocheon, Korea
| | - Na Yeon Kim
- Department of Pediatrics, CHA University School of Medicine, Pocheon, Korea
| | - Ji Hyeon Baek
- Department of Pediatrics, CHA University School of Medicine, Pocheon, Korea
| | - Hey-Sung Baek
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hye Mi Jee
- Department of Pediatrics, CHA University School of Medicine, Pocheon, Korea
| | - Hyeung Yoon Kim
- Department of Pediatrics, Bundang Jaesaeng Hospital, Seongnam, Korea
| | - Sun Hee Choi
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Ki Eun Kim
- Department of Pediatrics, CHA University School of Medicine, Pocheon, Korea
| | - Hye Yung Yum
- Department of Pediatrics, Seoul Medical Center, Seoul, Korea
| | - Man Yong Han
- Department of Pediatrics, CHA University School of Medicine, Pocheon, Korea
| | - Jintack Kim
- Department of Pediatrics, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Youn Ho Shin
- Department of Pediatrics, CHA University School of Medicine, Pocheon, Korea
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118
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Yang H, Xiao YZ, Luo XY, Tan Q, Wang H. Diagnostic accuracy of atopy patch tests for food allergy in children with atopic dermatitis aged less than two years. Allergol Immunopathol (Madr) 2014; 42:22-8. [PMID: 23253686 DOI: 10.1016/j.aller.2012.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 09/28/2012] [Accepted: 10/09/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND Atopy patch tests (APT) have been introduced as a valuable tool for the diagnosis of food allergy. However, interpretation of the readout of APT requires further clarification. OBJECTIVE To investigate the accuracy of APT in identifying atopic sensitisation to hen's eggs (HE), cow's milk (CM), soybean and wheat in Chinese children with atopic dermatitis (AD) aged less than two years and to evaluate skin signs of APT for accurate diagnosis of food allergy. METHODS APT was performed and food allergy confirmed by open oral food challenges with HE, CM, soybean and wheat in 150 Chinese AD children aged less than two years. The sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, positive (LR+) and negative likelihood ratio (LR-) of APT were calculated. RESULTS Erythema and infiltration were not sufficiently indicative of a positive APT. The PPV increased with the appearance of indurations and the number of papules. The true positive APT rate increased from scores of + to +++. The PPV and specificity were 100% while APT scores of +++ were obtained with HE, CM and wheat. The sensitivity of APT with HE, CM, soybean and wheat allergy ranged from 59.6% to 90.5%, while the specificity ranged from 82.1% to 92.4%. CONCLUSION The APT is a suitable method for the diagnosis of AD in Chinese children aged less than two years with food allergies. Erythema and infiltration are not sufficient indicators of APT positivity. The PPV increases with indurations and the number of papules.
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Affiliation(s)
- H Yang
- Department of Dermatology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Y Z Xiao
- Department of Dermatology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - X Y Luo
- Department of Dermatology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Q Tan
- Department of Dermatology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - H Wang
- Department of Dermatology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.
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Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, Berger TG, Bergman JN, Cohen DE, Cooper KD, Cordoro KM, Davis DM, Krol A, Margolis DJ, Paller AS, Schwarzenberger K, Silverman RA, Williams HC, Elmets CA, Block J, Harrod CG, Smith Begolka W, Sidbury R. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol 2013; 70:338-51. [PMID: 24290431 DOI: 10.1016/j.jaad.2013.10.010] [Citation(s) in RCA: 716] [Impact Index Per Article: 65.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 10/03/2013] [Accepted: 10/05/2013] [Indexed: 10/26/2022]
Abstract
Atopic dermatitis (AD) is a chronic, pruritic, inflammatory dermatosis that affects up to 25% of children and 2% to 3% of adults. This guideline addresses important clinical questions that arise in the management and care of AD, providing updated and expanded recommendations based on the available evidence. In this first of 4 sections, methods for the diagnosis and monitoring of disease, outcomes measures for assessment, and common clinical associations that affect patients with AD are discussed. Known risk factors for the development of disease are also reviewed.
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Affiliation(s)
- Lawrence F Eichenfield
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital San Diego, San Diego, California
| | - Wynnis L Tom
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital San Diego, San Diego, California
| | - Sarah L Chamlin
- Department of Dermatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Steven R Feldman
- Department of Dermatology, Wake Forest University Health Sciences, Winston-Salem, North Carolina
| | - Jon M Hanifin
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Timothy G Berger
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - James N Bergman
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - David E Cohen
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Kevin D Cooper
- Department of Dermatology, Case Western University, Cleveland, Ohio
| | - Kelly M Cordoro
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Dawn M Davis
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Alfons Krol
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - David J Margolis
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Hywel C Williams
- Centre of Evidence-Based Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Craig A Elmets
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Julie Block
- National Eczema Association, San Rafael, California
| | | | | | - Robert Sidbury
- Department of Dermatology, Seattle Children's Hospital, Seattle, Washington
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Petry V, Lipnharski C, Bessa GR, Silveira VB, Weber MB, Bonamigo RR, d'Azevedo PA. Prevalence of community-acquired methicillin-resistant Staphylococcus aureus and antibiotic resistance in patients with atopic dermatitis in Porto Alegre, Brazil. Int J Dermatol 2013; 53:731-5. [PMID: 24168078 DOI: 10.1111/ijd.12020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is a skin manifestation of atopy caused by hyperreactivity to various antigens. Studies have shown that 60-100% of patients with this condition present with colonization by Staphylococcus aureus. Given increasing rates of antimicrobial resistance, the sensitivity to antimicrobials of S. aureus colonizing atopic patients has been investigated. Cross-sectional studies worldwide suggest that the prevalence of methicillin-resistant S. aureus infection (MRSA) in the AD population varies from 0% to 30.8%. OBJECTIVES The objectives of this study were to determinate the prevalence of S. aureus and MRSA in patients with AD in two dermatologic centers in Porto Alegre, Brazil. METHODS A total of 91 patients with AD attending two dermatologic centers in Porto Alegre were enrolled in this study from December 2009 to July 2011. Two skin swabs were taken from each patient, one from the nares and the other from a non-infected eczematous skin lesion. The swabs were sent to the laboratory, where standard procedures to isolate bacteria and identify S. aureus, antimicrobial resistance, and sensitivity patterns were carried out. The severity of AD was defined using the Eczema Area and Severity Index (EASI). RESULTS Of the 91 patients sampled, 67 (73.6%) patients were found to be positive for S. aureus colonization. Nasal swabs were positive in 55 (60.4%) patients, lesional swabs in 44 (48.4%) patients, and both lesional and nasal swabs were positive in 32 (35.2%) patients. Patients with positive swabs had a higher mean ± standard deviation EASI score [mean (9.1 ± 8.8)] compared with patients with negative swabs (3.9 ± 3.6) (P = 0.002). None of the 91 patients showed any evidence of MRSA infection. Overall, nearly 32% of the S. aureus isolated from nasal swabs and 36.40% of the S. aureus isolated from lesional swabs was resistant to erythromycin. CONCLUSIONS The results of this study confirm a high rate of S. aureus colonization in pediatric patients with AD and indicate a relevant association between colonization and high EASI score. No MRSA was found in cultures from this sample of patients in southern Brazil. Nearly one-third of isolates were identified as resistant to erythromycin, an antibiotic that is commonly used in pediatric patients.
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Affiliation(s)
- Vanessa Petry
- Department of Dermatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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de Bruin Weller MS, Rockmann H, Knulst AC, Bruijnzeel-Koomen CAFM. Evaluation of the adult patient with atopic dermatitis. Clin Exp Allergy 2013; 43:279-91. [PMID: 23414536 DOI: 10.1111/cea.12030] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease with a large impact on quality of life of the patients and their families. In most cases, the diagnosis of AD can easily be made based on (family) history and clinical examination. If necessary, a practical set of diagnostic criteria such as the UK diagnostic criteria can be used. During the diagnostic phase, it is important to pay attention to atopic comorbidity, such as allergic airway disease (allergic asthma and/or rhinitis), allergic eye disease (atopic (kerato) conjunctivitis) and immediate-type food allergy. This will not have direct consequences for the treatment of AD, but may be important for the overall well-being of the patient. Psychological factors, such as family circumstances, work/school performance and lifestyle factors should also be explored. Severity scoring using properly validated scoring lists may not be necessary for the diagnosis, however, is recommended for monitoring therapy. Simple scoring systems, such as TIS and IGA are easy to perform in daily practice. Several flare factors in AD, such as exposure to irritants or UV light, can be identified by history and clinical examination: in individual cases, additional diagnostic tests may sometimes be useful to confirm clinical suspicion. There is only limited evidence that allergen exposure to aeroallergens and/or food allergens influences AD severity. Therefore, routine allergen testing is not necessary for diagnosis and treatment of AD. The decision to perform allergen tests mainly depends on atopic comorbidity.
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Affiliation(s)
- M S de Bruin Weller
- Department of Dermatology & Allergology, University Medical Centre Utrecht, Utrecht, The Netherlands.
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122
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Jinnestål CL, Belfrage E, Bäck O, Schmidtchen A, Sonesson A. Skin barrier impairment correlates with cutaneousStaphylococcus aureuscolonization and sensitization to skin-associated microbial antigens in adult patients with atopic dermatitis. Int J Dermatol 2013; 53:27-33. [DOI: 10.1111/ijd.12198] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Camilla Ling Jinnestål
- Division of Dermatology and Venereology; Department of Clinical Sciences; Lund University; Lund Sweden
| | - Emma Belfrage
- Division of Dermatology and Venereology; Department of Clinical Sciences; Lund University; Lund Sweden
| | - Ove Bäck
- Division of Dermatology and Venereology; Department of Clinical Sciences; Lund University; Lund Sweden
| | - Artur Schmidtchen
- Division of Dermatology and Venereology; Department of Clinical Sciences; Lund University; Lund Sweden
| | - Andreas Sonesson
- Division of Dermatology and Venereology; Department of Clinical Sciences; Lund University; Lund Sweden
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Schneider L, Tilles S, Lio P, Boguniewicz M, Beck L, LeBovidge J, Novak N, Bernstein D, Blessing-Moore J, Khan D, Lang D, Nicklas R, Oppenheimer J, Portnoy J, Randolph C, Schuller D, Spector S, Tilles S, Wallace D. Atopic dermatitis: a practice parameter update 2012. J Allergy Clin Immunol 2013; 131:295-9.e1-27. [PMID: 23374261 DOI: 10.1016/j.jaci.2012.12.672] [Citation(s) in RCA: 269] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 12/18/2012] [Indexed: 10/27/2022]
Abstract
This parameter was developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma and Immunology. The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Atopic dermatitis: a practice parameter update 2012." This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task Force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma & Immunology. These parameters are not designed for use by pharmaceutical companies in drug promotion. Published practice parameters of the Joint Task Force on Practice Parameters for Allergy & Immunology are available online at http://www.jcaai.org.
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Abstract
Systemic manifestations of allergic contact dermatitis due to consumption of foods containing balsam of Peru (Myroxylon pereirae)-associated chemicals have recently been reported in children. We present seven children with widespread, recalcitrant dermatitis who experienced 60-80% clearance after initiating a diet low in balsam of Peru, specifically the tomato product ketchup. Furthermore, because we have observed a high prevalence of ketchup in our pediatric patients' diets, we recommend consideration of moderate consumption of this product in patients with recalcitrant widespread dermatitis.
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Affiliation(s)
- Elise M Herro
- Division of Dermatology, Rady Children's Hospital and University of California, San Diego, San Diego, California92123, USA.
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125
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Apfelbacher CJ, van Zuuren EJ, Fedorowicz Z, Jupiter A, Matterne U, Weisshaar E. Oral H1 antihistamines as monotherapy for eczema. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [PMID: 23450580 DOI: 10.1002/14651858.cd012167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Eczema is a common skin disease in many countries, and although the majority of cases of eczema occur before the age of five years and often resolve during childhood or adolescence, it can also persist into adulthood. Itch is the most important aspect of eczema, often impacting significantly on the quality of life of an affected individual. OBJECTIVES To assess the effects of oral antihistamines (H1 antagonists) as monotherapy in children and adults with eczema. SEARCH METHODS We searched the following databases up to March 2012: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2012, Issue 3), MEDLINE (from 1946), EMBASE (from 1974), and LILACS (from 1982). We examined the reference lists of excluded studies in order to identify further references to relevant trials. We searched trials registers for ongoing and unpublished trials. We also handsearched the abstracts of the International Research Workshops on eczema, as well as the conference proceedings of the European Academy of Dermatology and Venereology (EADV) and the European Academy of Allergology and Clinical Immunology (EAACI), from 2000 to 2011. SELECTION CRITERIA We sought to include randomised controlled trials that assessed the effects and safety of oral H1 antihistamines as monotherapy in children and adults with eczema. We excluded studies that compared an antihistamine versus another antihistamine and had no placebo control arm. We also excluded topical antihistamines and oral H1 antihistamines as 'add-on' therapy and studies using any concomitant therapy other than emollients or moisturisers, principally because some of these forms of concomitant therapy may be considered treatment modifiers in assessments of the effects of antihistamines on eczema. DATA COLLECTION AND ANALYSIS Our search retrieved 409 references to studies. Based on assessments of their titles, abstracts, or both, we excluded all except 36 of these studies. After evaluation of the full text of each report, we excluded a further 35 studies, and 1 study is awaiting classification pending a response from the trial investigators. MAIN RESULTS No randomised controlled trials met our inclusion criteria. AUTHORS' CONCLUSIONS There is currently no high-level evidence to support or refute the efficacy or safety of oral H1 antihistamines used as monotherapy for eczema. Because most of the studies allowed the use of concomitant medications and involved multi-therapeutic approaches, meaningful assessments of the individual effects of oral H1 antihistamines on eczema were not feasible. Although well-designed randomised controlled trials excluding concomitant medications appear to be needed, consideration should be given to the potential ethical issues raised with the use of antihistamines as monotherapy for the management of eczema by withholding the use of rescue or additional therapies. A further systematic review of studies in which concomitant therapies were permitted might be of value in determining the potential benefits of oral H1 antihistamines as add-on therapy.
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Affiliation(s)
- Christian J Apfelbacher
- Medical Sociology, Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.
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Williams HC. Epidemiology of human atopic dermatitis - seven areas of notable progress and seven areas of notable ignorance. Vet Dermatol 2013; 24:3-9.e1-2. [DOI: 10.1111/j.1365-3164.2012.01079.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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127
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Harpsøe MC, Basit S, Bager P, Wohlfahrt J, Benn CS, Nøhr EA, Linneberg A, Jess T. Maternal obesity, gestational weight gain, and risk of asthma and atopic disease in offspring: a study within the Danish National Birth Cohort. J Allergy Clin Immunol 2012; 131:1033-40. [PMID: 23122630 DOI: 10.1016/j.jaci.2012.09.008] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 08/28/2012] [Accepted: 09/13/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND High pre-pregnancy body mass index (BMI) and excessive gestational weight gain (GWG) are suggested to influence risk of asthma and atopic disease in offspring. OBJECTIVE We examined the effect of BMI and GWG on risk of asthma, wheezing, atopic eczema (AE), and hay fever in children during the first 7 years of life. METHODS This was a cohort study of 38,874 mother-child pairs from the Danish National Birth Cohort (enrollment 1996-2002) with information from the 16th week of pregnancy and at age 6 months, 18 months, and 7 years of the child. Odds ratios (ORs) with 95% CIs were calculated by logistic regression with adjustment for potential confounders. RESULTS During the first 7 years of life, 10.4% of children developed doctor-diagnosed asthma, 25.8% AE, and 4.6% hay fever. Maternal BMI and to a lesser extent GWG were associated with doctor-diagnosed asthma ever. In particular, BMI≥35 (adjusted OR, 1.87; 95% CI, 0.95-3.68) and GWG≥25 kg (adjusted OR, 1.97; 95% CI, 1.38-2.83) were associated with current severe asthma at age 7 years. Maternal BMI was also associated with wheezing in offspring, with the strongest association observed between BMI≥35 and late-onset wheezing (adjusted OR, 1.87; 95% CI, 1.28-2.73). Maternal BMI and GWG were not associated with AE or hay fever. CONCLUSIONS Maternal obesity during pregnancy was associated with increased risk of asthma and wheezing in offspring but not with AE and hay fever, suggesting that pathways may be nonallergic.
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Affiliation(s)
- Maria C Harpsøe
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
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A comparison of criteria for diagnosis of atopic dermatitis in children. World J Pediatr 2012; 8:355-8. [PMID: 23151864 DOI: 10.1007/s12519-012-0381-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 10/04/2011] [Indexed: 10/27/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) diagnosis in children gives rise to many problems. Although the Hanifin and Rajka criteria are acknowledged and used universally in diagnosing AD, their evaluation is a major source of difficulty in pediatrician's daily practice. The simplified criteria, revised by Williams et al, seem to be more useful and represent the most common clinical manifestations of AD. The aim of the present study was to compare the efficacy of the two different criteria for diagnosing AD in children. METHODS This study involved 250 children with AD. All of the patients underwent clinical examinations and the diagnostic procedures according to the criteria of Hanifin and Rajka as well as those of Williams. RESULTS According to the Hanifin-Rajka criteria, AD was diagnosed in 173 children, of whom 153 were diagnosed positive by the criteria of Williams. Among the 77 children who were diagnosed without AD according to the Hanifin and Rajka criteria, 4 were detected with AD by the Williams criteria. Four children with scabies and seborrhoeic dermatitis were misdiagnosed as having AD according to the Williams criteria due to the atypical locations of their lesions and the histories of asthma or hay fever and xerosis. CONCLUSIONS Although the criteria of Hanifin and Rajka are the gold standard for diagnosing AD, the Williams criteria are also very useful in children older than 4 years. The most useful Williams criteria for AD diagnosis in children is pruritus with history of lesions in characteristic locations and history of generally dry skin. The significant increase in the detectability of AD is found by raising the borderline age for the first skin lesion development from 2 to 5 years of age.
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Abstract
Atopic dermatitis (AD) is the most common pregnancy dermatosis. This evidence-based review article provides an evaluation of AD in gestation. Our literature search revealed 4 epidemiologic studies on AD in pregnancy, and a total of 55 articles that provide the basis for this review. The limitations of epidemiologic studies included herein are critically reviewed. The management of AD in gestation is reviewed with an emphasis on drug safety. Further studies are required to determine whether it is the intrinsic ("nonallergic" or "atopiform dermatitis") and/or extrinsic (IgE-associated) AD that is affected by pregnancy, and to establish the postpartum prognosis of "new atopic dermatitis" (AD presenting for the first time in pregnancy). A revision of the diagnostic criteria will allow a more accurate confirmation of the prevalence of AD, and especially "new atopic dermatitis," in pregnancy as well as differentiation of AD from specific dermatoses of pregnancy, such as prurigo and pruritic folliculitis. Addressing the above issues and unraveling the etiopathogenesis of AD in pregnancy will help clarify a suggested overlap with the above specific dermatoses.
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130
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How should an incident case of atopic dermatitis be defined? A systematic review of primary prevention studies. J Allergy Clin Immunol 2012; 130:137-44. [PMID: 22424882 DOI: 10.1016/j.jaci.2012.01.075] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 01/26/2012] [Accepted: 01/27/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Eczema prevention is now an active area of dermatologic and allergy research. Defining an incident case is therefore a prerequisite for such a study. OBJECTIVE We sought to examine how an incident case of atopic dermatitis was defined in previous atopic dermatitis prevention studies in order to make recommendations on a standard definition of new atopic dermatitis cases for use in future prevention trials. METHODS We conducted a systematic review of controlled interventional atopic dermatitis prevention studies by using searches of MEDLINE and Cochrane databases for studies published from 1980 to the end of January 2011. Studies that included atopic dermatitis as a secondary outcome, such as asthma prevention trials, were included. RESULTS One hundred two studies were included in the final analysis, of which 27 (26.5%) did not describe any criteria for defining an incident case of atopic dermatitis. Of the remaining 75 studies with reported disease criteria, the Hanifin-Rajka criteria were the most commonly used (28 studies). A disease definition unique to that particular study (21 studies) was the second most commonly used disease definition, although the sources for such novel definitions were not cited. CONCLUSIONS The results from this systematic review highlight the need for improved reporting and standardization of the definition used for an incident case in atopic dermatitis prevention studies. Most prevention studies have used disease definitions such as the Hanifin-Rajka criteria that include disease chronicity. While acceptable for cumulative incidence outcomes, inclusion of disease chronicity precludes the precise measurement of disease onset. We propose a definition based on existing scientific studies that could be used in future prospective studies.
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131
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Evaluation of a parental questionnaire to identify atopic dermatitis in infants and preschool children. J Allergy (Cairo) 2012; 2012:945617. [PMID: 22500189 PMCID: PMC3303560 DOI: 10.1155/2012/945617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 11/23/2011] [Indexed: 11/17/2022] Open
Abstract
Aim. To develop and validate a questionnaire for detecting atopic dermatitis in infants and small children from the age of 2 months. Methods. Parents to 60 children answered a written questionnaire prior to a physical examination and individual semistructured interview. Qualitative and quantitative analyses of validity, sensitivity, specificity, and predictive values of the questionnaire were performed. Results. A total of 27 girls and 33 boys, aged 2 to 71 months, 35 with and 25 without physician-diagnosed eczema, participated. Validation of the questionnaire by comparisons with physicians' diagnoses showed a sensitivity of 0.91 (95% CI 0.77–0.98) and a specificity of 1 (95% CI 0.86–1). Conclusions. Three questions in a parental questionnaire were sufficient for diagnosing eczema in infants and small children.
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132
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Evaluation of the child with atopic dermatitis. Clin Exp Allergy 2011; 42:352-62. [DOI: 10.1111/j.1365-2222.2011.03899.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 09/09/2011] [Accepted: 09/20/2011] [Indexed: 11/26/2022]
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Hogewoning AA, Bouwes Bavinck JN, Amoah AS, Boakye DA, Yazdanbakhsh M, Kremsner PG, Adegnika AA, De Smedt SKAD, Willemze R, Lavrijsen APM. Point and period prevalences of eczema in rural and urban schoolchildren in Ghana, Gabon and Rwanda. J Eur Acad Dermatol Venereol 2011; 26:488-94. [PMID: 21575064 DOI: 10.1111/j.1468-3083.2011.04106.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Eczema is a growing problem in Africa, particularly amongst children. OBJECTIVES To investigate the point-prevalences of eczema by physical examination in schoolchildren living in rural and urban areas and with different socioeconomic backgrounds in Ghana, Gabon and Rwanda. In Ghana period-prevalences were also estimated by questionnaire and compared with the point-prevalences. METHODS In total, 4839 schoolchildren in Ghana, Gabon and Rwanda were seen by at least one dermatologist. The point-prevalences of eczema were estimated on the basis of physical examination. Period-prevalences were measured in Ghana with questionnaire based-interviews adapted from the International Study of Asthma and Allergies in Childhood (ISAAC). RESULTS The point-prevalences were 1.5% and 1.6% in the two Ghanaian studies; 4% in Gabon and 0.8% in Rwanda. The period-prevalences were 2.6% and 4.4% in the two Ghanaian studies. The prevalences of eczema were not significantly different when comparing the urban and rural groups as well as the different socioeconomic levels. The sensitivity and positive predictive value to identify eczema cases based on the questionnaires compared to the diagnoses by physical examination were only 33% and 22% in the first Ghanaian study and 10% and 4% in the second Ghanaian study respectively. CONCLUSIONS The point-prevalences of eczema in the three African countries studied were low compared with industrialized countries. Physical examination by a dermatologist is still the gold standard to identify eczema cases because the sensitivity and the positive predictive value to identify eczema cases with questionnaires were low in the two Ghanaian studies.
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Affiliation(s)
- A A Hogewoning
- Dermatology, Korle-Bu Teaching Hospital, University of Ghana Medical School, Accra, Ghana
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Schram ME, Roekevisch E, Leeflang MMG, Bos JD, Schmitt J, Spuls PI. A randomized trial of methotrexate versus azathioprine for severe atopic eczema. J Allergy Clin Immunol 2011; 128:353-9. [PMID: 21514637 DOI: 10.1016/j.jaci.2011.03.024] [Citation(s) in RCA: 169] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 03/17/2011] [Accepted: 03/22/2011] [Indexed: 12/26/2022]
Abstract
BACKGROUND Patients with severe atopic eczema frequently require systemic treatment to control their disease. Methotrexate and azathioprine are proposed as off-label treatment options, but direct comparisons are lacking. OBJECTIVES We sought to compare the efficacy and safety of methotrexate versus azathioprine in adults with severe atopic eczema. METHODS Patients with severe atopic eczema were randomly assigned in a 1:1 ratio to receive either methotrexate (dosage, 10-22.5 mg/wk) or azathioprine (dosage, 1.5-2.5 mg/kg/d) for 12 weeks, followed by a 12-week follow-up period. Primary outcome was the mean change in the severity scoring of atopic dermatitis index after 12 weeks. Efficacy assessors blinded for allocation of treatment were used to perform clinical outcome assessment. Analyses were done on an intention-to-treat basis. RESULTS Of the 45 patients screened, 42 were included. At week 12, patients in the methotrexate group had a mean relative reduction in the severity scoring of atopic dermatitis index of 42% (SD, 18%) compared with 39% (SD, 25%) in the azathioprine group (P = .52). Proportions of patients achieving at least mild disease and reductions on impact of quality of life, symptoms, and levels of thymus and activation-regulated chemokine were similar in both groups at weeks 12 and 24. No statistically significant differences were found in the number and severity of adverse events. Abnormalities in blood count were more common in the azathioprine group. No serious adverse events occurred. CONCLUSION Both treatments achieved clinically relevant improvement and were safe in the short term. Methotrexate and azathioprine are appropriate options for the treatment of severe atopic eczema.
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Affiliation(s)
- Mandy Elvira Schram
- Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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135
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Atopic dermatitis diagnostic criteria and outcome measures for clinical trials: still a mess. J Invest Dermatol 2011; 131:557-9. [PMID: 21307951 DOI: 10.1038/jid.2010.369] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The past 2 decades have seen a heightened interest in atopic dermatitis-related research, leading to an exponential increase in publications. However, large numbers of diagnostic criteria and outcome measures hamper study comparability. The Harmonizing Outcome Measures for Eczema (HOME) initiative addresses the urgent need for consensus, but more work will be required.
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Schram ME, Leeflang MMG, DEN Ottolander JPS, Spuls PI, Bos JD. Validation and refinement of the Millennium Criteria for atopic dermatitis. J Dermatol 2011; 38:850-8. [PMID: 21453318 DOI: 10.1111/j.1346-8138.2011.01202.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There is no gold standard for a definite diagnosis of atopic dermatitis. For the time being, several lists of diagnostic criteria have been proposed, some of them in actual use. The Millennium Criteria have been proposed to diagnose atopic dermatitis and to differentiate it from atopiform dermatitis. Our aim was to further refine the Millennium Criteria into a manageable set that can differentiate between atopic and atopiform dermatitis and other entities. The hereby refined Millennium Criteria will be compared with the UK Working Party Criteria and the Hanifin & Rajka Criteria. Data of 210 included patients were used. After multiple logistic regression, a minimum set of five criteria was identified as best discriminators: (i) typical morphology; (ii) early age of onset; (iii) Dennie-Morgan fold; (iv) historical and (v) actual flexural involvement. The refined Millennium Criteria were constituted from these criteria. When comparing the different list for validity in diagnosing atopic dermatitis, the refined Millennium Criteria showed a sensitivity of 81.8% and a specificity of 98.8% compared to a sensitivity of 97.7% and specificity of 72.9% of the UK Criteria and a sensitivity of 100% and specificity of 48.8% of the Hanifin & Rajka Criteria. This refinement and validity study shows that the refined Millennium Criteria are a valid tool to diagnose atopic and atopiform dermatitis in a hospital-based setting and therefore could be incorporated in clinical practice and trials.
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Affiliation(s)
- Mandy E Schram
- Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
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Hogewoning AA, Larbi IA, Addo HA, Amoah AS, Boakye D, Hartgers F, Yazdanbakhsh M, Van Ree R, Bouwes Bavinck JN, Lavrijsen APM. Allergic characteristics of urban schoolchildren with atopic eczema in Ghana. J Eur Acad Dermatol Venereol 2011; 24:1406-12. [PMID: 20456550 DOI: 10.1111/j.1468-3083.2010.03655.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Atopic eczema is an increasing clinical problem in Africa. OBJECTIVE To determine allergic characteristics and to identify possible risk factors for eczema among schoolchildren in an urbanized area in Ghana. PATIENTS AND METHODS Schoolchildren aged 3-16 years with eczema were recruited. For each patient, one to three age- and sex-matched controls were selected. All children completed a questionnaire and were skin prick tested with a panel of allergens. Blood was drawn to determine the total and allergen-specific IgE. Conditional logistic regression models with the matching factors included in the model were used to calculate the odds ratios and to adjust for possible confounders. RESULTS A total of 52 children with eczema (27 boys and 25 girls) and 99 controls were included. Levels of total IgE were found to be 9.1 (1.1; 78.4) times more often elevated in children with eczema. This association was mainly driven by elevated IgE levels against cockroach antigen. Children with eczema were found to have 2.0 (0.87; 4.7) times more often positive skin prick tests (SPT), but this association diminished to 1.2 (0.40; 3.6) after adjustment for total IgE levels. Frequent washing with soap was identified as a risk factor for the development of eczema among these children. CONCLUSION Schoolchildren with eczema in Ghana were characterized by elevated IgE levels especially against cockroach antigen. The association between eczema and positive SPT was much weaker suggesting immune hyporesponsiveness of the skin. After adjustment for IgE level, SPT were less suitable to distinguish children with and without eczema.
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Affiliation(s)
- A A Hogewoning
- Dermatology, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
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138
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Abstract
Cleverly using records obtained from the 2003 National Survey of Children's Health (NSCH), Shaw et al. provide a pioneering glimpse into the burden of eczema across the United States. Using parental reports of a doctor's diagnosis of eczema in the past 12 months, the authors show that eczema affects around 9-18% of children age 17 and under. The study confirms reported associations such as living in metropolitan areas, higher household education level, and black ethnicity. Novel findings include the demonstration of higher eczema prevalence along the East Coast. The study correlates well with previous reports and may help point to environmental factors that contribute to the development of eczema.
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Shi M, Zhang H, Chen X, Guo Y, Tao J, Qi H, Gan J, Jiang A, Yu H, Liang J, Chen J, Yang L, Zhuang Y, Yan M, Gu Y, Yu X, Feng X, Yao Z. Clinical features of atopic dermatitis in a hospital-based setting in China. J Eur Acad Dermatol Venereol 2011; 25:1206-12. [PMID: 21214635 DOI: 10.1111/j.1468-3083.2010.03953.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease. There have been few detailed reports of the clinical evaluation of Chinese patients with AD. OBJECTIVES To give a profile of the clinical features of Chinese AD patients in a university hospital setting. METHODS A total of 1008 cases met Hanifin and Rajka diagnostic criteria of AD were recruited at Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China. RESULTS In our survey, 22.7% patients were mild, 66.6% were moderate and 10.7% were severe according to the SCORAD index. Both the frequency and severity of the male patients were slightly higher. The frequency of asthma among the AD patients was 16.7% and it was increased with the age (χ2 = 205.20, P = 0.000). The frequencies of objective minor signs were demonstrated with age-related changes. Besides, three localized variants including eyelid eczema (49.8%), scalp dermatitis (49.7%), infra-auricular and retroauricular fissuring (44.8%) were commonly observed, especially in the infantile phase (P < 0.01). It was showed significant differences in serum total immunoglobulin E (IgE) and eosinophil cationic protein (ECP) levels of different age groups. The positive rate of Phadiatop was raised after 3 years old and that of the common food allergens were decreased after 6 years old. CONCLUSIONS More males than females had ongoing AD in our survey. Most AD debuted in the first year of the cases. High incidence of the three clinical signs: eyelid eczema, scalp dermatitis and infra-auricular and retroauricular fissuring among the patients suggests it can be a potential valuable diagnostic clue to AD.
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Affiliation(s)
- M Shi
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Strina A, Barreto ML, Cunha S, de Fátima S P de Oliveira M, Moreira SC, Williams HC, Rodrigues LC. Validation of epidemiological tools for eczema diagnosis in Brazilian children: the ISAAC's and UK Working Party's criteria. BMC DERMATOLOGY 2010; 10:11. [PMID: 21062476 PMCID: PMC2992474 DOI: 10.1186/1471-5945-10-11] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 11/09/2010] [Indexed: 12/01/2022]
Abstract
Background Instruments for field diagnosis of eczema are increasingly used, and it is essential to understand specific limitations to make best use of their strengths. Our objective was to assess the validity of ISAAC and UK Working Party criteria for field diagnosis of eczema in children. Methods We performed a cohort study in urban Brazil. Parents/guardians of 1,419 children answered ISAAC phase II questionnaire. Children were examined for skin lesions (UKWP protocol). Two dermatologists examined most cases of eczema (according to ISAAC or UKWP), and a sample without eczema. Results Agreement between repeat questionnaires on the filter question was poor (kappa = 0.4). Agreement between the 2 dermatologists was fair (kappa = 0.6). False positive reports included scabies in 39% of ISAAC cases and 33% of UKWP cases. Sensitivity and PPV were low (ISAAC: 37.1% and 16.1%; UKWP: 28.6% and 23.8%). Specificity and NPV were high (ISAAC: 90.0% and 96.6%; UKWP: 95.3% and 96.2%). One-year prevalence of eczema was 11.3% (ISAAC), 5.9% (UKWP) and 4.9% (adjusted dermatologist diagnosis). Point prevalence of scabies (alone or not) was 43%, 33% and 18%, in eczemas according to ISAAC, to UKWP and to dermatologists. The reasons why children with eczema were not identified by ISAAC or UKWP were wrongly denying dry skin, itchy rash or personal history of atopic diseases. A limitation is that questionnaire was already validated in Brazil, but not field tested in this specific setting. Conclusions Studies using UKWP or ISAAC criteria should include a validation arm, to contribute to the understanding of potential limitations of their use in different contexts and to explore solutions. We list specific recommendations.
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Affiliation(s)
- Agostino Strina
- Universidade Federal da Bahia, Instituto de Saúde Coletiva, Salvador, Brazil.
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Alexander DD, Schmitt DF, Tran NL, Barraj LM, Cushing CA. Partially hydrolyzed 100% whey protein infant formula and atopic dermatitis risk reduction: a systematic review of the literature. Nutr Rev 2010; 68:232-45. [DOI: 10.1111/j.1753-4887.2010.00281.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Bos JD, Brenninkmeijer EEA, Schram ME, Middelkamp-Hup MA, Spuls PI, Smitt JHS. Atopic eczema or atopiform dermatitis. Exp Dermatol 2010; 19:325-31. [PMID: 20100192 DOI: 10.1111/j.1600-0625.2009.01024.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Age period prevalence of atopic eczema (AE), a very common skin disease, has increased during the past decennia. This expansion seems to be ending in wealthy countries, while an increase is observed in developing nations, for which there is no firm explanation. Recent steps in understanding AE are the detection of skin barrier related filaggrin null mutations in approximately 25% of patients and the recognition of IL-31 as a molecule possibly involved in the itch (pruritus). Also interesting are the recognition of thymus and activation-regulated chemokine (TARC) and proliferating-inducing ligand (APRIL), as being associated with AE severity and activity. Immunocentric and corneocentric views on pathogenesis (the inside-outside paradigm) and the diagnostic entity atopiform dermatitis (AFD) are discussed here. We emphasize that diagnosing AE is not simple but challenging. We accentuate that a diagnosis of AE is only possible when there is allergen-specific IgE. Advice as to the need for elimination of allergens and adjustment of lifestyle are only proficient in patients having atopy and true AE, not in those having AFD.
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Affiliation(s)
- Jan D Bos
- Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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143
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Global variations in prevalence of eczema symptoms in children from ISAAC Phase Three. J Allergy Clin Immunol 2010; 124:1251-8.e23. [PMID: 20004783 DOI: 10.1016/j.jaci.2009.10.009] [Citation(s) in RCA: 618] [Impact Index Per Article: 44.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 10/04/2009] [Accepted: 10/07/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND In 1999, The International Study of Asthma and Allergies in Childhood (ISAAC) Phase One reported the prevalence of eczema symptoms in 715,033 children from 154 centers in 56 countries by using standardized epidemiologic tools. OBJECTIVE To update the world map of eczema prevalence after 5 to 10 years (ISAAC Phase Three) and include additional data from over 100 new centers. METHODS Cross-sectional surveys using the ISAAC questionnaire on eczema symptoms were completed by adolescents 13 to 14 years old and by parents of children 6 to 7 years old. Current eczema was defined as an itchy flexural rash in the past 12 months and was considered severe eczema if associated with 1 or more nights per week of sleep disturbance. RESULTS For the age group 6 to 7 years, data on 385,853 participants from 143 centers in 60 countries showed that the prevalence of current eczema ranged from 0.9% in India to 22.5% in Ecuador, with new data showing high values in Asia and Latin America. For the age group 13 to 14 years, data on 663,256 participants from 230 centers in 96 countries showed prevalence values ranging from 0.2% in China to 24.6% in Columbia with the highest values in Africa and Latin America. Current eczema was lower for boys than girls (odds ratio, 0.94 and 0.72 at ages 6 to 7 years and 13 to 14 years, respectively). CONCLUSION ISAAC Phase Three provides comprehensive global data on the prevalence of eczema symptoms that is essential for public health planning. New data reveal that eczema is a disease of developing as well as developed countries.
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Farhi D, Taïeb A, Tilles G, Wallach D. The historical basis of a misconception leading to undertreating atopic dermatitis (eczema):facts and controversies. Clin Dermatol 2010; 28:45-51. [DOI: 10.1016/j.clindermatol.2009.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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145
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Saeki H, Oiso N, Honma M, Odajima H, Iizuka H, Kawada A, Tamaki K. Comparison of prevalence of atopic dermatitis in Japanese elementary schoolchildren between 2001/2002 and 2007/2008. J Dermatol 2009; 36:512-4. [PMID: 19712280 DOI: 10.1111/j.1346-8138.2009.00687.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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146
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Schmitt J, Schäkel K, Fölster-Holst R, Bauer A, Oertel R, Augustin M, Aberer W, Luger T, Meurer M. Prednisolone vs. ciclosporin for severe adult eczema. An investigator-initiated double-blind placebo-controlled multicentre trial. Br J Dermatol 2009; 162:661-8. [DOI: 10.1111/j.1365-2133.2009.09561.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Williams HC, Grindlay DJC. What's new in atopic eczema? An analysis of systematic reviews published in 2007 and 2008. Part 1. Definitions, causes and consequences of eczema. Clin Exp Dermatol 2009; 35:12-5. [PMID: 19874343 DOI: 10.1111/j.1365-2230.2009.03733.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This review summarizes clinically important findings from nine systematic reviews indexed in bibliographical databases between August 2007 and August 2008, dealing with the definitions, causes and consequences of atopic eczema (AE). One review of diagnostic criteria found that out of 10 sets of criteria, only the UK refinement of the Hanifin and Rajka criteria have been adequately tested (in 19 studies). Another review of 20 named outcome measures found that only three [SCORing Atopic Dermatitis (SCORAD), the Eczema Area and Severity Index (EASI) and the Patient Oriented Eczema Measure (POEM)] had been tested and found to perform adequately. In terms of risk factors for developing disease, a review found that birth by caesarean section increased the risk of asthma and hay fever but not eczema in offspring. A review of cohort studies also found evidence that adverse psychological factors in early life predispose to more atopic disease and a worse prognosis. Another review found that filaggrin gene mutations were a consistently strong risk factor for AE, with a person carrying one of these mutations being over three times more likely to exhibit eczema. It has been suggested that eczema might protect against some forms of cancer, and a detailed systematic review of brain cancers that included 53,233 participants from eight case-control and cohort studies found that having atopic disease was associated with a 39% reduction in glioma risk, a finding that was also present for just those with AE (odds ratio 0.69, 95% CI 0.58-0.82). A further review of case-control and cohort studies failed to find any association between keeping furry pets at birth and subsequent risk of eczema, although pet fur might still exacerbate established disease. In terms of disease consequences, a review found that eczema was the commonest cause of chronic sleep loss in young people, affected the whole family. A review of four economic studies from the US found that the annual cost of AE in the States was as high as $3.8 billion when indirect costs are included.
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Affiliation(s)
- H C Williams
- NHS Evidence - Skin Disorders, Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK.
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Mallbris L, Carlén L, Wei T, Heilborn J, Nilsson MF, Granath F, Ståhle M. Injury downregulates the expression of the human cathelicidin protein hCAP18/LL-37 in atopic dermatitis. Exp Dermatol 2009; 19:442-9. [PMID: 19645825 DOI: 10.1111/j.1600-0625.2009.00918.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Reduced production of antimicrobial peptides was proposed to contribute to susceptibility for skin infections in atopic dermatitis (AD). Focusing on the human cathelicidin protein, hCAP18, the aim of the present study was to explore whether reduced hCAP18 expression is a constitutive trait in AD and if established inducers affect the expression of hCAP18 in the skin of AD. First, we compared levels of hCAP18 mRNA between lesional skin in AD and psoriasis and verified significantly lower expression of hCAP18 mRNA in AD. In non-lesional skin, however, there was no difference between AD, psoriasis and healthy, indicating that there is no constitutive defect in the production of hCAP18 in AD patients. In healthy skin, hCAP18 was reported to be rapidly induced following wounding and here we verified this pattern in healthy controls and in psoriasis. In AD lesions, however, the expression of hCAP18 mRNA was markedly suppressed following wounding. Obviously, the inflammation in AD lesions neutralizes the expected induction of hCAP18 and even induces suppression. Notably, the mechanism to upregulate hCAP18 following vitamin D treatment was functional in lesional as well as in non-lesional AD indicating that the CAMP gene is normally regulated in this respect. In addition, cultured primary keratinocytes from non-lesional skin of psoriasis, AD and healthy skin, upregulated hCAP18mRNA following treatment with vitamin D. Itching is a hallmark of AD and scratching inevitably injures the skin. Failure to upregulate hCAP18 in eczema following injury is likely to affect antimicrobial protection and tissue repair in AD.
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Affiliation(s)
- Lotus Mallbris
- Unit of Dermatology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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149
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Flohr C, Weinmayr G, Weiland SK, Addo-Yobo E, Annesi-Maesano I, Björkstén B, Bråbäck L, Büchele G, Chico M, Cooper P, Clausen M, El Sharif N, Martinez Gimeno A, Mathur RS, von Mutius E, Morales Suarez-Varela M, Pearce N, Svabe V, Wong GWK, Yu M, Zhong NS, Williams HC. How well do questionnaires perform compared with physical examination in detecting flexural eczema? Findings from the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Two. Br J Dermatol 2009; 161:846-53. [PMID: 19485999 DOI: 10.1111/j.1365-2133.2009.09261.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Questionnaires are widely used in epidemiological studies to measure eczema symptom prevalence, but there are concerns regarding their accuracy if used as a diagnostic tool. OBJECTIVES To compare the performance of a validated eczema symptom questionnaire and a standardized skin examination protocol employed in the second phase of the International Study of Asthma and Allergies in Childhood (ISAAC). METHODS A total of 30,358 schoolchildren aged 8-12 years from 18 countries were examined for flexural eczema. Parents also completed an eczema symptom questionnaire. We compared prevalence estimates at the population level based on the questionnaire vs. physical examination. We also compared the skin examination and the ISAAC questionnaire in making a diagnosis of flexural eczema. RESULTS The point prevalences for flexural eczema at centre level based on a single examination were lower than the questionnaire-based 12-month period prevalences (mean centre prevalence 3.9% vs. 9.4%). Correlation between prevalences of both outcome measures was high (r = 0.77, P < 0.001). At the individual level, questionnaire-derived symptoms of 'persistent flexural eczema in the past 12 months' missed < 10% of cases of flexural eczema detected on physical examination. However, between 33% and 100% of questionnaire-based symptoms of 'persistent flexural eczema in the past 12 months' were not confirmed on examination. CONCLUSIONS ISAAC questionnaire-derived symptom prevalences are sufficiently precise for comparisons between populations. Where diagnostic precision at the individual level is important, questionnaires should be validated and potentially modified in those populations beforehand, or a standardized skin examination protocol should be used.
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Affiliation(s)
- C Flohr
- Centre for Evidence Based Dermatology, Institute of Clinical Research, University of Nottingham, Nottingham, UK.
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Saeki H, Oiso N, Honma M, Iizuka H, Kawada A, Tamaki K. Prevalence of atopic dermatitis in Japanese adults and community validation of the U.K. diagnostic criteria. J Dermatol Sci 2009; 55:140-1. [PMID: 19427173 DOI: 10.1016/j.jdermsci.2009.04.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 04/03/2009] [Accepted: 04/07/2009] [Indexed: 11/19/2022]
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