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Sánchez-Borges M, Capriles-Hulett A, Ortega-Martell JA, Zubeldia IA. New and Potential Treatments for Atopic Dermatitis: Biologicals and Small Molecules. Curr Allergy Asthma Rep 2019; 19:18. [PMID: 30815760 DOI: 10.1007/s11882-019-0849-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW An update on new therapies currently approved or potentially useful in the future for the management of patients suffering moderate-to-severe atopic dermatitis. RECENT FINDINGS New pathogenic mechanisms involved in atopic dermatitis have permitted to propose novel therapeutic approaches devised to control the inflammatory process observed in involved cutaneous tissues by neutralizing mediators, cytokines, and their receptors. Recent research findings have disclosed important and previously unrecognized pathogenic mechanisms that have resulted in innovative targeted therapies, such as dupilumab, and potentially other biologicals and small molecules. Further studies should permit the sub-classification of patients according to the relevance of different mediators and inflammatory cells. It can be concluded that the treatment of atopic dermatitis has entered into the era of personalized/precision medicine.
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Affiliation(s)
- Mario Sánchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela.
- Clínica El Avila, 6a transversal Urb. Altamira, piso 8, consultorio 803, Caracas, 1060, Venezuela.
| | - Arnaldo Capriles-Hulett
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela
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202
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Bridgman AC, Qureshi AA, Li T, Tabung FK, Cho E, Drucker AM. Inflammatory dietary pattern and incident psoriasis, psoriatic arthritis, and atopic dermatitis in women: A cohort study. J Am Acad Dermatol 2019; 80:1682-1690. [PMID: 30797850 DOI: 10.1016/j.jaad.2019.02.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/04/2019] [Accepted: 02/14/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Diet is a modulator of inflammation that might impact inflammatory skin diseases. OBJECTIVE To assess the relationship between pro-inflammatory dietary patterns and incident psoriasis, psoriatic arthritis (PsA), and atopic dermatitis (AD). METHODS We conducted cohort studies among women in the Nurses' Health Study II. The Empirical Dietary Inflammatory Pattern (EDIP) score was calculated at baseline and every 4 years. Incident psoriasis, PsA, and AD were assessed by validated self-report. We used multivariable-adjusted Cox proportional hazards models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between EDIP quintiles and risk for psoriasis, PsA, and AD. RESULTS We had 85,185 participants in the psoriasis analysis and 63,443 in the AD analysis. There were 1432 cases of psoriasis, 262 cases of PsA, and 403 cases of AD. Pro-inflammatory dietary patterns were not associated with the risk for outcomes in multivariable models (all P values for trend >.05). HRs comparing the highest to the lowest EDIP quintile were 0.99 (95% CI 0.83-1.18) for psoriasis, 1.22 (95% CI 0.81-1.83) for PsA, and 0.96 (95% CI 0.69-1.34) for AD. LIMITATIONS Recall and self-report. CONCLUSION Our findings do not support dietary inflammatory potential as a risk factor for psoriasis, PsA, or AD.
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Affiliation(s)
| | - Abrar A Qureshi
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island; Department of Dermatology, Rhode Island Hospital, Providence, Rhode Island; Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Tricia Li
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Fred K Tabung
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Eunyoung Cho
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island; Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Aaron M Drucker
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island; Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada; Women's College Research Institute and Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, Canada.
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203
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Katoh N, Saeki H, Kataoka Y, Etoh T, Teramukai S, Takagi H, Tajima Y, Ardeleanu M, Rizova E, Arima K. Atopic dermatitis disease registry in Japanese adult patients with moderate to severe atopic dermatitis (ADDRESS-J): Baseline characteristics, treatment history and disease burden. J Dermatol 2019; 46:290-300. [PMID: 30756423 PMCID: PMC6594225 DOI: 10.1111/1346-8138.14787] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 12/24/2018] [Indexed: 11/29/2022]
Abstract
Moderate to severe atopic dermatitis (AD) has a high disease burden and a significant effect on quality of life. Observational studies are necessary to determine the patient disease burden and long-term disease control in the Japanese population. ADDRESS-J is a non-interventional, observational registry of adult Japanese patients with moderate to severe AD. Herein, we report baseline data from the ADDRESS-J study describing disease characteristics and current treatment practices. At baseline, 300 adult AD patients with Investigator's Global Assessment (IGA) scores (range, 0-4) of 3 (moderate) or 4 (severe) whose treatments for AD were intensified, were assessed for clinical and patient-reported outcomes and current AD treatments. The registry patients' median age was 34.0 years; 60.7% were male and 71.7% had had AD for more than 20 years. At baseline, 220 study patients had an IGA score of 3 and 80 had an IGA score of 4. The median Eczema Area and Severity Index score was 21.7 (range, 0-72), the median body surface area involvement was 46.25%, and the median pruritus numerical rating scale score was 7.0 (range, 0-10); for each of these measures, higher scores represent greater severity. Most registry patients (86.7%) had recently used topical corticosteroids or topical calcineurin inhibitors as treatment for AD. This registry cohort represents a population of Japanese patients with moderate to severe AD and provides an important resource for characterizing the disease burden and evaluating the safety and effectiveness of various AD treatments.
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Affiliation(s)
- Norito Katoh
- Department of Dermatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hidehisa Saeki
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Yoko Kataoka
- Department of Dermatology, Osaka Habikino Medical Center, Osaka, Japan
| | - Takafumi Etoh
- Department of Dermatology, Tokyo Teishin Hospital, Tokyo, Japan
| | - Satoshi Teramukai
- Department of Biostatistics, Kyoto Prefectural University of Medicine, Kyoto, Japan
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204
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Mikus M, Johansson C, Acevedo N, Nilsson P, Scheynius A. The antimicrobial protein S100A12 identified as a potential autoantigen in a subgroup of atopic dermatitis patients. Clin Transl Allergy 2019; 9:6. [PMID: 30728947 PMCID: PMC6354350 DOI: 10.1186/s13601-019-0240-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 01/04/2019] [Indexed: 01/01/2023] Open
Abstract
Background Atopic dermatitis (AD) is a complex heterogeneous chronic inflammatory skin disease. Specific IgE antibodies against autoantigens have been observed in a subgroup of AD patients, however, little is known about IgG-auto-reactivity in AD. To investigate the presence of autoreactive IgG antibodies, we performed autoantibody profiling of IgG in patients with AD of different severities and in healthy controls (HC). Methods First, we performed an untargeted screening in plasma samples from 40 severe AD (sAD) patients and 40 HC towards 1152 protein fragments on planar antigen microarrays. Next, based on the findings and addition of more fragments, a targeted antigen suspension bead array was designed to profile a cohort of 50 sAD patients, 123 patients with moderate AD (mAD), and 84 HC against 148 protein fragments representing 96 unique proteins. Results Forty-nine percent of the AD patients showed increased IgG-reactivity to any of the four antigens representing keratin associated protein 17-1 (KRTAP17-1), heat shock protein family A (Hsp70) member 4 (HSPA4), S100 calcium binding proteins A12 (S100A12), and Z (S100Z). The reactivity was more frequent in the sAD patients (66%) than in those with mAD (41%), whereas only present in 25% of the HC. IgG-reactivity to S100A12, a protein including an antimicrobial peptide, was only observed in AD patients (13/173). Conclusions Autoantibody profiling of IgG-reactivity using microarray technology revealed an autoantibody-based subgroup in patients with AD. The four identified autoantigens and especially S100A12 could, if characterized further, increase the understanding of different pathogenic mechanisms behind AD and thereby enable better treatment. Electronic supplementary material The online version of this article (10.1186/s13601-019-0240-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria Mikus
- 1Affinity Proteomics, Department of Protein Science, SciLifeLab, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Catharina Johansson
- 2Department of Clinical Science and Education, Karolinska Institutet, and Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Nathalie Acevedo
- 2Department of Clinical Science and Education, Karolinska Institutet, and Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,3Institute for Immunological Research, University of Cartagena, Cartagena, Colombia
| | - Peter Nilsson
- 1Affinity Proteomics, Department of Protein Science, SciLifeLab, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Annika Scheynius
- 2Department of Clinical Science and Education, Karolinska Institutet, and Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,4Clinical Genomics, SciLifeLab, Stockholm, Sweden
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205
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Association between atopic dermatitis and serious cutaneous, multiorgan and systemic infections in US adults. Ann Allergy Asthma Immunol 2019; 120:66-72.e11. [PMID: 29273131 DOI: 10.1016/j.anai.2017.10.019] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/11/2017] [Accepted: 10/15/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is associated with barrier disruption, immune dysregulation, and immunosuppressing treatments that can increase the association with an unusual number of infections. OBJECTIVE To determine whether adults with AD have an unusually large number of serious infections and related outcomes. METHODS Data from the 2002 to 2012 National Inpatient Sample were analyzed, including an approximately 20% sample of all US hospitalizations (n = 72,108,077 adults). Prevalence of serious infections in hospitalized patients with vs without AD, length of stay, cost of care, and inpatient mortality secondary to serious infections were determined. RESULTS The prevalence of serious infections expressed as a percentage (95% confidence interval) was higher in adults hospitalized with than in those without AD (42.1% [41.6-42.6] vs 25.4% [25.2-25.6]; P = .0002). In logistic regression models with multiple predictors (multivariable logistic regression models), AD was associated with 32 of 38 infections examined. Associated cutaneous infections included eczema herpeticum (odds ratio [95% confidence interval] adjusted for other predictors: 67.93 [47.93-96.28]), erysipelas (11.15 [9.47-13.1]), and cellulitis (4.53 [4.42-4.64]). Associated respiratory infections included aspergillosis (1.51 [1.21-1.88]) and tuberculosis (1.57 [1.41-1.76]). AD was associated with extracutaneous, multiorgan, and systemic infections, including infectious arthropathy (2.01 [1.84-2.20]), endocarditis (1.25 [1.12-1.39]), encephalitis (1.65 [1.40-1.96]), and methicillin-resistant Staphylococcus aureus infections (3.29 [3.17-3.42]). Patients with AD hospitalized with vs without any serious infection had an increased geometric mean cost of inpatient care ($8,273 [8,126-8,423] vs $7,179 [7,052-7,307]) and length of stay (5.3 days [5.2-5.3] vs 3.9 [3.9-4.0]; P = .0002), with $11 to $228 million excess annual costs from hospitalization with serious infections in adults with AD. CONCLUSION Adults with AD had increased cutaneous, respiratory, multiorgan, and systemic infections, which were associated with a considerable cost burden.
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Boguniewicz M, Fonacier L, Guttman-Yassky E, Ong PY, Silverberg J, Farrar JR. Atopic dermatitis yardstick: Practical recommendations for an evolving therapeutic landscape. Ann Allergy Asthma Immunol 2019; 120:10-22.e2. [PMID: 29273118 DOI: 10.1016/j.anai.2017.10.039] [Citation(s) in RCA: 178] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 10/25/2017] [Accepted: 10/31/2017] [Indexed: 12/18/2022]
Abstract
The implementation of treatment guidelines for atopic dermatitis is challenging, in part because of different guidance documents being used by different groups of specialists and in part because the language of guidelines often reflects the evidence base rather than the practical "how to." The Atopic Dermatitis Yardstick is part of a series developed in response to the need to proactively address the loss of disease control for atopic illnesses at all levels of severity. It presents a comprehensive update on how to conduct a sustained step-up in therapy for the patient with inadequately controlled or poorly controlled atopic dermatitis. Patient profiles, based on current guidelines and the authors' combined clinical experience, provide a practical and clinically meaningful guide to aid physicians in helping their patients achieve the goal of clear to almost clear. The intent is not to replace guidelines but to complement their recommendations incorporating the latest research and therapies.
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Affiliation(s)
- Mark Boguniewicz
- Division of Allergy-Immunology, Department of Pediatrics, National Jewish Health and University of Colorado School of Medicine, Denver, Colorado.
| | - Luz Fonacier
- Section of Allergy and Immunology, NYU Winthrop Hospital, Mineola, New York
| | - Emma Guttman-Yassky
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at the Mount Sinai Medical Center, New York, New York
| | - Peck Y Ong
- Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles and Department of Pediatrics, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Jonathan Silverberg
- Departments of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Lee SH, Lee SH, Lee SH, Park YL. Cataract, Glaucoma, and Dry Eye Disease in Adults with Atopic Dermatitis: A Nationwide Cross-Sectional Study from the Republic of Korea. Ann Dermatol 2019; 31:37-43. [PMID: 33911537 PMCID: PMC7992703 DOI: 10.5021/ad.2019.31.1.37] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/02/2018] [Accepted: 08/14/2018] [Indexed: 01/19/2023] Open
Abstract
Background Atopic dermatitis (AD) is an inflammatory skin disorder characterized by relapsing eczema with intractable itching. Ocular diseases in patients with AD, including cataract, retinal detachment, blepharitis, glaucoma, keratoconjunctivitis, and keratoconus, have frequently been reported worldwide. However, only a few studies using a large-sample, population-based study design have been reported so far. Objective We investigated the association between cataract, glaucoma, and dry eye disease and AD in an adult population in the Republic of Korea. Methods A total of 14,900 adults who participated in the Korean National Health and Nutrition Examination Survey, a nationwide, population-based, cross-sectional survey, between 2010 and 2012 were included in the study. Multiple logistic regression analyses identified the possible association between cataract, glaucoma, and dry eye disease and AD relative to matched controls. Results After we adjusted for confounding factors in patients with AD, cataract and glaucoma were significantly associated with AD. Moreover, patients with AD had a higher prevalence of ophthalmic surgery compared to those without AD. Conclusion Dermatologists should therefore be aware of possible ocular disorders in patients with AD and should recommend regular ophthalmic screening for early detection.
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Affiliation(s)
- Sul Hee Lee
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Sang-Hoon Lee
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Si Hyung Lee
- Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Young Lip Park
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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208
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Strategies for Successful Management of Severe Atopic Dermatitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:1-16. [DOI: 10.1016/j.jaip.2018.10.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/18/2018] [Accepted: 10/22/2018] [Indexed: 12/21/2022]
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209
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Czarnowicki T, He H, Krueger JG, Guttman-Yassky E. Atopic dermatitis endotypes and implications for targeted therapeutics. J Allergy Clin Immunol 2019; 143:1-11. [DOI: 10.1016/j.jaci.2018.10.032] [Citation(s) in RCA: 238] [Impact Index Per Article: 47.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/02/2018] [Accepted: 10/11/2018] [Indexed: 01/28/2023]
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210
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Hu Y, Zhu Y, Lian N, Chen M, Bartke A, Yuan R. Metabolic Syndrome and Skin Diseases. Front Endocrinol (Lausanne) 2019; 10:788. [PMID: 31824416 PMCID: PMC6880611 DOI: 10.3389/fendo.2019.00788] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/29/2019] [Indexed: 12/13/2022] Open
Abstract
The increasing prevalence of Metabolic syndrome (MetS) is a worldwide health problem, and the association between MetS and skin diseases has recently attracted growing attention. In this review, we summarize the associations between MetS and skin diseases, such as psoriasis, acne vulgaris, hidradenitis suppurativa, androgenetic alopecia, acanthosis nigricans, and atopic dermatitis. To discuss the potential common mechanisms underlying MetS and skin diseases, we focus on insulin signaling and insulin resistance, as well as chronic inflammation including adipokines and proinflammatory cytokines related to molecular mechanisms. A better understanding of the relationship between MetS and skin diseases contributes to early diagnosis and prevention, as well as providing clues for developing novel therapeutic strategies.
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Affiliation(s)
- Yu Hu
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, United States
| | - Yun Zhu
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, United States
| | - Ni Lian
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Min Chen
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- *Correspondence: Min Chen
| | - Andrzej Bartke
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, United States
| | - Rong Yuan
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, United States
- Rong Yuan
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211
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Parental and child factors associated with inhalant and food allergy in a population-based prospective cohort study: the Generation R Study. Eur J Pediatr 2019; 178:1507-1517. [PMID: 31414213 PMCID: PMC6733817 DOI: 10.1007/s00431-019-03441-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 07/09/2019] [Accepted: 08/06/2019] [Indexed: 12/27/2022]
Abstract
The prevalence of allergic diseases in children is markedly increasing to epidemic proportions. The aim of this study is to describe the presence and examine associated parental and child characteristics of allergic sensitization and physician-diagnosed allergy in Dutch children at age 10 years. This study among 5471 children was performed in a population-based prospective cohort from fetal life onwards. Allergic sensitization was measured by skin prick tests. Physician-diagnosed allergy and parental and child characteristics were collected by questionnaires. In children aged 10 years, inhalant and food allergic sensitization was present in 32.2% and 7.1%, and physician-diagnosed inhalant and food allergy in 12.4% and 2.3%. Maternal and paternal history of allergy, eczema or asthma was associated with increased risks of physician-diagnosed inhalant allergy (aOR (95% CI) 1.44 (1.23-1.70) and 1.59 (1.30-1.94), respectively), but not with food allergy. Asthma and eczema ever at age 10 years were associated with increased risks of physician-diagnosed inhalant allergy (4.60 (3.55-5.96) and 2.42 (1.94-3.03), respectively). Eczema ever at age 10 years was associated with an increased risk of physician-diagnosed food allergy (5.78, 3.04-9.52), with the highest risk of cashew (7.36, 3.20-16.94) and peanut (5.58, 3.08-10.10) food allergy.Conclusions: We found strong effects of parental history of allergy, eczema or asthma on the presence of physician-diagnosed inhalant allergy in children at age 10 years. Eczema ever at age 10 years was a strong risk factor for the development of physician-diagnosed inhalant and food allergy. What is Known: • The prevalence of allergic diseases in children has markedly increased. • Early-life influences are critically important in the development of allergic diseases. What is New: • Maternal and paternal history of allergy, eczema or asthma is associated with increased risks of physician-diagnosed inhalant allergy but not with food allergy. • Eczema ever at age 10 years is associated with an increased risk of physician-diagnosed food allergy, with the highest risk for cashew and peanut food allergy.
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212
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Brunner PM, Pavel AB, Khattri S, Leonard A, Malik K, Rose S, Jim On S, Vekaria AS, Traidl-Hoffmann C, Singer GK, Baum D, Gilleaudeau P, Sullivan-Whalen M, Fuentes-Duculan J, Li X, Zheng X, Estrada Y, Garcet S, Wen HC, Gonzalez J, Coats I, Cueto I, Neumann AU, Lebwohl MG, Krueger JG, Guttman-Yassky E. Baseline IL-22 expression in patients with atopic dermatitis stratifies tissue responses to fezakinumab. J Allergy Clin Immunol 2019; 143:142-154. [PMID: 30121291 DOI: 10.1016/j.jaci.2018.07.028] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 07/06/2018] [Accepted: 07/27/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND IL-22 is potentially a pathogenic cytokine in patients with atopic dermatitis (AD), but the molecular effects of IL-22 antagonism have not been defined in human subjects. OBJECTIVE We sought to evaluate the cellular and molecular effects of IL-22 blockade in tissues from patients with moderate-to-severe AD. METHODS We assessed lesional and nonlesional skin from 59 patients with moderate-to-severe AD treated with anti-IL-22 (fezakinumab) versus placebo (2:1) using transcriptomic and immunohistochemistry analyses. RESULTS Greater reversal of the AD genomic profile was seen with fezakinumab versus placebo, namely 25.3% versus 10.5% at 4 weeks (P = 1.7 × 10-5) and 65.5% versus 13.9% at 12 weeks (P = 9.5 × 10-19), respectively. Because IL-22 blockade showed clinical efficacy only in patients with severe AD, we used baseline median IL-22 mRNA expression to stratify for high (n = 30) and low (n = 29) IL-22 expression groups. Much stronger mean transcriptomic improvements were seen with fezakinumab in the IL-22-high drug-treated group (82.8% and 139.4% at 4 and 12 weeks, respectively) than in the respective IL-22-high placebo-treated group (39.6% and 56.3% at 4 and 12 weeks) or the IL-22-low groups. Significant downregulations of multiple immune pathways, including TH1/CXCL9, TH2/CCL18/CCL22, TH17/CCL20/DEFB4A, and TH22/IL22/S100A's, were restricted to the IL-22-high drug group (P < .05). Consistently, tissue predictors of clinical response were mostly genes involved in T-cell and dendritic cell activation and differentiation. CONCLUSIONS This is the first report showing a profound effect of IL-22 blockade on multiple inflammatory pathways in AD. These data, supported by robust effects in patients with high IL-22 baseline expression, suggest a central role for IL-22 in AD, indicating the need for a precision medicine approach for improving therapeutic outcomes in patients with AD.
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Affiliation(s)
- Patrick M Brunner
- Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Ana B Pavel
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Saakshi Khattri
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alexandra Leonard
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kunal Malik
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sharon Rose
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shelbi Jim On
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Anjali S Vekaria
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Claudia Traidl-Hoffmann
- Institute of Environmental Medicine, University Center for Health Sciences at the Klinikum Augsburg, Technical University Munich and Helmholtz Zentrum München-German Research Center for Environmental Health, Augsburg, Germany; Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
| | - Giselle K Singer
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Danielle Baum
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | | | - Xuan Li
- Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Xiuzhong Zheng
- Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Yeriel Estrada
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sandra Garcet
- Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Huei-Chi Wen
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Juana Gonzalez
- Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Israel Coats
- Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Inna Cueto
- Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Avidan U Neumann
- Institute of Environmental Medicine, University Center for Health Sciences at the Klinikum Augsburg, Technical University Munich and Helmholtz Zentrum München-German Research Center for Environmental Health, Augsburg, Germany
| | - Mark G Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - James G Krueger
- Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Emma Guttman-Yassky
- Laboratory for Investigative Dermatology, Rockefeller University, New York, NY; Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY.
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Jaworek AK, Szafraniec K, Jaworek M, Doniec Z, Zalewski A, Kurzawa R, Wojas-Pelc A, Pokorski M. Cat Allergy as a Source Intensification of Atopic Dermatitis in Adult Patients. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1251:39-47. [PMID: 31749134 DOI: 10.1007/5584_2019_451] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Atopic dermatitis (AD) is characterized by exacerbations and remissions of eczematous skin, underlain by impaired skin barrier and aberrant Th2-type and Th-22 cytokine production. A number of allergens, in particular contact with fur animals, may aggravate the disease. This study seeks to define the influence of having a regular contact with a pet cat at home on the severity of symptoms and signs of AD. We addressed the issue using the SCORing Atopic Dermatitis (SCORAD) and visual analog (VAS) scores to assess the intensity of pruritus and by measuring the blood content of specific IgE and IL-4, IL-13, and IL-22 cytokines. The study group consisted of 47 adult patients suffering from AD since childhood, 18 of whom declared having regular contact with a cat and the remaining 29 who denied it. There also was a control group consisted of 16 healthy volunteers with no AD signs. The SCORAD and VAS scores were significantly higher in patients in contact with a cat than in those without it (median SCORAD 61.0 vs. 50.4 and VAS 9.0 vs. 4.0 points, respectively). The sIgE of a majority of patients (94.4%) in contact with a cat was in Class V-VI, compared with just a few patients (3.4%) with no such contact, having sIgE in the same classes (p < 0.001). Significant correlations were revealed between SCORAD and VAS scores and the class level of serum sIgE value. In addition, IL-22 was a single elevated cytokine, only in the patients in contact with a cat, and it correlated with pruritus severity. The results of the study underline the need to beware of the cat fur allergen, and they stress forethought and caution in acquiring and keeping a pet cat by patients suffering from AD.
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Affiliation(s)
| | - Krystyna Szafraniec
- Department of Epidemiology and Population Studies, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Cracow, Poland
| | - Magdalena Jaworek
- Department of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, Cracow, Poland
| | - Zbigniew Doniec
- Department of Pneumology, Institute of Tuberculosis and Lung Disorders, Rabka, Poland
| | - Adam Zalewski
- Student Scientific Group, Department of Dermatology, Jagiellonian University Medical College, Cracow, Poland
| | - Ryszard Kurzawa
- Department of Allergology and Pneumology, Institute of Tuberculosis and Lung Disorders, Rabka, Poland
| | - Anna Wojas-Pelc
- Department of Dermatology, Jagiellonian University Medical College, Cracow, Poland
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214
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Taghavi Ardakani A, Farrehi M, Sharif MR, Ostadmohammadi V, Mirhosseini N, Kheirkhah D, Moosavi SGA, Behnejad M, Reiter RJ, Asemi Z. The effects of melatonin administration on disease severity and sleep quality in children with atopic dermatitis: A randomized, double-blinded, placebo-controlled trial. Pediatr Allergy Immunol 2018; 29:834-840. [PMID: 30160043 DOI: 10.1111/pai.12978] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/07/2018] [Accepted: 08/16/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND The aim of this clinical trial was to determine the effects of melatonin administration on disease severity and sleep quality in children diagnosed with atopic dermatitis (AD). METHODS This randomized, double-blinded, placebo-controlled trial was conducted by recruiting 70 patients, aged 6-12 years, who had been diagnosed with AD. Study participants were randomly allocated into two intervention groups to receive either 6 mg/d melatonin supplements or placebo (n = 35 each group) for 6 weeks. Severity of disease was assessed using the scoring atopic dermatitis (SCORAD) and objective SCORAD indices. Sleep quality was evaluated by completing the Children's Sleep Habits Questionnaire (CSHQ). RESULTS Following 6 weeks of intervention, melatonin supplementation significantly improved SCORAD index (β -3.55; 95% CI, -6.11, -0.98; P = 0.007), objective SCORAD index (β -3.23; 95% CI, -5.08, -1.38; P = 0.001), serum total IgE levels (β -153.94 ku/L; 95% CI, -260.39, -47.49; P = 0.005), and CSHQ scores (β -2.55; 95% CI, -4.34, -0.75; P = 0.006). However, melatonin had no significant impact on pruritus scores, high-sensitivity C-reactive protein (hs-CRP), sleep-onset latency, total sleep time, weight, and BMI compared with placebo. CONCLUSIONS Overall, melatonin supplementation had beneficial effects on disease severity, serum total IgE levels, and CSHQ among children diagnosed with AD.
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Affiliation(s)
- Abbas Taghavi Ardakani
- Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran.,Department of Pediatrics, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Maryam Farrehi
- Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran.,Department of Pediatrics, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohammad Reza Sharif
- Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran.,Department of Pediatrics, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Vahidreza Ostadmohammadi
- Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran.,Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Davood Kheirkhah
- Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran.,Department of Pediatrics, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Seyed Gholam Abbas Moosavi
- Department of Statistics and Public Health, Faculty of Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Milad Behnejad
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | - Russel J Reiter
- Department of Cellular and Structural Biology, UT Health Science Center, San Antonio, TX, USA
| | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
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215
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Paller A, Jaworski JC, Simpson EL, Boguniewicz M, Russell JJ, Block JK, Tofte S, Dunn JD, Feldman SR, Clark AR, Schwartz G, Eichenfield LF. Major Comorbidities of Atopic Dermatitis: Beyond Allergic Disorders. Am J Clin Dermatol 2018; 19:821-838. [PMID: 30168085 DOI: 10.1007/s40257-018-0383-4] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The consequences of atopic dermatitis reach beyond the skin and past childhood. Patients with atopic dermatitis are at risk of developing allergic comorbidities, but less is known about the associations between atopic dermatitis and non-allergic conditions. Understanding these non-allergic comorbidities has the potential to improve patient outcomes and to help mitigate the cost and burdens associated with these conditions. Atopic dermatitis is associated with cutaneous bacterial infections, more severe forms/courses of cutaneous viral infections, and extra-cutaneous infections. Atopic dermatitis is also associated with several mental health comorbidities particularly attention-deficit hyperactivity disorder, anxiety, and depression. Data are largely inconsistent for specific cancers, but atopic dermatitis appears to protect against malignancy overall; severe long-term atopic dermatitis is associated with adult lymphomas. Atopic dermatitis may also be associated with obesity, cardiovascular disease, and autoimmune disease, particularly alopecia areata and gastrointestinal immune-mediated disorders. Although the causative mechanisms underlying these associations are poorly understood, treating physicians should be aware of associations in seeking to alleviate the burden for patients with atopic dermatitis.
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216
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Human and computational models of atopic dermatitis: A review and perspectives by an expert panel of the International Eczema Council. J Allergy Clin Immunol 2018; 143:36-45. [PMID: 30414395 PMCID: PMC6626639 DOI: 10.1016/j.jaci.2018.10.033] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/10/2018] [Accepted: 10/30/2018] [Indexed: 12/14/2022]
Abstract
Atopic dermatitis (AD) is a prevalent disease worldwide and is associated with systemic comorbidities representing a significant burden on patients, their families, and society. Therapeutic options for AD remain limited, in part because of a lack of well-characterized animal models. There has been increasing interest in developing experimental approaches to study the pathogenesis of human AD in vivo, in vitro, and in silico to better define pathophysiologic mechanisms and identify novel therapeutic targets and biomarkers that predict therapeutic response. This review critically appraises a range of models, including genetic mutations relevant to AD, experimental challenge of human skin in vivo, tissue culture models, integration of “omics” data sets, and development of predictive computational models. Although no one individual model recapitulates the complex AD pathophysiology, our review highlights insights gained into key elements of cutaneous biology, molecular pathways, and therapeutic target identification through each approach. Recent developments in computational analysis, including application of machine learning and a systems approach to data integration and predictive modeling, highlight the applicability of these methods to AD subclassification (endotyping), therapy development, and precision medicine. Such predictive modeling will highlight knowledge gaps, further inform refinement of biological models, and support new experimental and systems approaches to AD. (J Allergy Clin Immunol 2019;143:36–45.)
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217
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Narla S, Silverberg JI. Association between atopic dermatitis and autoimmune disorders in US adults and children: A cross-sectional study. J Am Acad Dermatol 2018; 80:382-389. [PMID: 30287311 DOI: 10.1016/j.jaad.2018.09.025] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/06/2018] [Accepted: 09/04/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Little is known about the risk and predictors of autoimmune diseases in children and adults. OBJECTIVE To determine the prevalence, predictors, and excess costs of autoimmune disease in atopic dermatitis (AD) patients. METHODS Cross-sectional study of the 2002-2012 National Inpatient Sample, which includes a ∼20% sample of all US hospitalizations (n = 87,053,155 adults and children). RESULTS The prevalence of autoimmune disease was higher in adults with AD (7.9%, 95% confidence interval [95% CI] 7.3-8.5%) than without AD (5.7%, 95% CI 5.7%-5.8%) and higher in children with AD (2.0%, 95% CI 1.7%-2.3%) than without AD (1.0%, 95% CI 0.9%-1.1%). In multivariable logistic regression models controlling for sociodemographics, adult (adjusted odds ratio 1.45, 95% CI 1.32-1.58) and pediatric (adjusted odds ratio 2.08, 95% CI 1.73-2.50) AD were associated with any autoimmune disorder. In particular, AD was associated with 18 of 32 autoimmune disorders examined in adults and 13 of 24 examined in children, including disorders of the skin, endocrine, gastrointestinal, hematologic, and musculoskeletal systems. AD patients hospitalized with any autoimmune disorder had a higher cost of inpatient care, with $2.5-$50 million excess annual costs. CONCLUSIONS Adults and children with AD had increased cutaneous and extracutaneous autoimmune disorders, which were associated with a considerable cost burden.
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Affiliation(s)
- Shanthi Narla
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jonathan I Silverberg
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Northwestern Medicine Multidisciplinary Eczema Center, Chicago, Illinois.
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218
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Guttman-Yassky E, Bissonnette R, Ungar B, Suárez-Fariñas M, Ardeleanu M, Esaki H, Suprun M, Estrada Y, Xu H, Peng X, Silverberg JI, Menter A, Krueger JG, Zhang R, Chaudhry U, Swanson B, Graham NMH, Pirozzi G, Yancopoulos GD, D Hamilton JD. Dupilumab progressively improves systemic and cutaneous abnormalities in patients with atopic dermatitis. J Allergy Clin Immunol 2018; 143:155-172. [PMID: 30194992 DOI: 10.1016/j.jaci.2018.08.022] [Citation(s) in RCA: 377] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 07/19/2018] [Accepted: 08/14/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Dupilumab is an IL-4 receptor α mAb inhibiting signaling of IL-4 and IL-13, key drivers of type 2-driven inflammation, as demonstrated by its efficacy in patients with atopic/allergic diseases. OBJECTIVE This placebo-controlled, double-blind trial (NCT01979016) evaluated the efficacy, safety, and effects of dupilumab on molecular/cellular lesional and nonlesional skin phenotypes and systemic type 2 biomarkers of patients with moderate-to-severe atopic dermatitis (AD). METHODS Skin biopsy specimens and blood were evaluated from 54 patients randomized 1:1 to weekly subcutaneous doses of 200 mg of dupilumab or placebo for 16 weeks. RESULTS Dupilumab (vs placebo) significantly improved clinical signs and symptoms of AD, was well tolerated, and progressively shifted the lesional transcriptome toward a nonlesional phenotype (weeks 4-16). Mean improvements in a meta-analysis-derived AD transcriptome (genes differentially expressed between lesional and nonlesional skin) were 68.8% and 110.8% with dupilumab and -10.5% and 55.0% with placebo (weeks 4 and 16, respectively; P < .001). Dupilumab significantly reduced expression of genes involved in type 2 inflammation (IL13, IL31, CCL17, CCL18, and CCL26), epidermal hyperplasia (keratin 16 [K16] and MKi67), T cells, dendritic cells (ICOS, CD11c, and CTLA4), and TH17/TH22 activity (IL17A, IL-22, and S100As) and concurrently increased expression of epidermal differentiation, barrier, and lipid metabolism genes (filaggrin [FLG], loricrin [LOR], claudins, and ELOVL3). Dupilumab reduced lesional epidermal thickness versus placebo (week 4, P = .001; week 16, P = .0002). Improvements in clinical and histologic measures correlated significantly with modulation of gene expression. Dupilumab also significantly suppressed type 2 serum biomarkers, including CCL17, CCL18, periostin, and total and allergen-specific IgEs. CONCLUSION Dupilumab-mediated inhibition of IL-4/IL-13 signaling through IL-4 receptor α blockade significantly and progressively improved disease activity, suppressed cellular/molecular cutaneous markers of inflammation and systemic measures of type 2 inflammation, and reversed AD-associated epidermal abnormalities.
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Affiliation(s)
- Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY; Laboratory for Investigative Dermatology, Rockefeller University, New York, NY.
| | | | - Benjamin Ungar
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY; Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Mayte Suárez-Fariñas
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY; Laboratory for Investigative Dermatology, Rockefeller University, New York, NY; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Hitokazu Esaki
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Maria Suprun
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yeriel Estrada
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hui Xu
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Xiangyu Peng
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jonathan I Silverberg
- Department of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Alan Menter
- Department of Dermatology, Baylor University Medical Center, Dallas, Tex
| | - James G Krueger
- Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Rick Zhang
- Regeneron Pharmaceuticals, Tarrytown, NY
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219
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Type I Immune Response Induces Keratinocyte Necroptosis and Is Associated with Interface Dermatitis. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.02.034] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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220
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Simpson EL, Reynolds NJ, Flohr C, Paller AS, Silverberg JI, Cork MJ, Guttman-Yassky E, Irvine AD. Response to "Comment on: 'When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council'". J Am Acad Dermatol 2018; 79:e25-e26. [PMID: 30012284 DOI: 10.1016/j.jaad.2018.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Eric L Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon.
| | - Nick J Reynolds
- Newcastle National Institute for Health Research Biomedical Research Centre and Medical Research Council/Engineering and Physical Sciences Research Council Molecular Pathology Node, Newcastle University and Royal Victoria Infirmary, Newcastle upon Tyne, Newcastle, United Kingdom
| | - Carsten Flohr
- Unit for Population-Based Dermatology Research, St. John's Institute of Dermatology, King's College London and Guy's & St. Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Jonathan I Silverberg
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michel J Cork
- Sheffield Dermatology Research Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
| | | | - Alan D Irvine
- Trinity College Dublin, National Children's Research Centre, Paediatric Dermatology, Our Lady's Children's Hospital, Dublin, Republic of Ireland
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221
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Silverberg JI, Gelfand JM, Margolis DJ, Boguniewicz M, Fonacier L, Grayson MH, Simpson EL, Ong PY, Chiesa Fuxench ZC. Patient burden and quality of life in atopic dermatitis in US adults: A population-based cross-sectional study. Ann Allergy Asthma Immunol 2018; 121:340-347. [PMID: 30025911 DOI: 10.1016/j.anai.2018.07.006] [Citation(s) in RCA: 334] [Impact Index Per Article: 55.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/01/2018] [Accepted: 07/04/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND The patient burden and quality of life (QOL) impact of atopic dermatitis (AD) in the United States population is not well established. OBJECTIVE To elucidate the patient burden of AD in the US population. METHODS A cross-sectional, population-based study of 602 adults was performed. Atopic dermatitis was determined using modified UK Diagnostic Criteria for AD. Its severity was assessed using self-reported global AD severity, Patient-Oriented Eczema Measure (POEM), Patient-Oriented Scoring AD (PO-SCORAD), PO-SCORAD-itch, and sleep. Quality of life was assessed using short-form (SF-)12 mental and physical health scores and Dermatology Life Quality Index (DLQI). RESULTS Adults with AD reported higher proportions of having only fair/poor overall health (25.8% vs. 15.8%), being somewhat/very dissatisfied with life (16.7% vs 11.4%), lower weighted mean (standard deviation [SD]) SF-12 mental (45.9 [9.9] vs 50.9 [9.2]) and physical health subscores (53.0 [2.5] vs 53.5 [2.3]) and higher DLQI (4.9 [6.5] vs 1.1 [2.8]). In multivariable regression models adjusting for sociodemographics and multiple comorbid health disorders, significant stepwise decreases by AD severity (self-reported, POEM, PO-SCORAD) of overall health, life satisfaction, SF-12 mental health, and increases of DLQI scores were seen. The SF-12 physical health scores were only associated with moderate AD. Concurrently, severe PO-SCORAD, POEM, or PO-SCORAD-itch was associated with very low mean SF-12 mental health (34.7) and high DLQI scores (24.7). Atopic dermatitis commonly limited lifestyle (51.3%), led to avoidance of social interaction (39.1%), and impacted activities (43.3%). The most burdensome AD symptoms were itch (54.4%), excessive dryness/scaling (19.6%), and red/inflamed skin (7.2%). CONCLUSION These data support the heavy burden that AD places on patients, particularly those with moderate and severe AD.
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Affiliation(s)
| | - Joel M Gelfand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - David J Margolis
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Mark Boguniewicz
- National Jewish Health and University of Colorado School of Medicine, Denver, Colorado
| | | | - Mitchell H Grayson
- Nationwide Children's Hospital-The Ohio State University College of Medicine, Columbus, Ohio
| | | | - Peck Y Ong
- Children's Hospital Los Angeles, University of Southern California, Keck School of Medicine, Los Angeles, California
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222
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Boguniewicz M. Biologic Therapy for Atopic Dermatitis: Moving Beyond the Practice Parameter and Guidelines. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 5:1477-1487. [PMID: 29122151 DOI: 10.1016/j.jaip.2017.08.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/21/2017] [Accepted: 08/28/2017] [Indexed: 02/07/2023]
Abstract
Atopic dermatitis (AD), a common chronic pruritic inflammatory skin disease, impacts the quality of life of patients and caregivers and has become a global health problem. It is increasingly recognized as a disease not only of children but also of adults who may have a persistent or relapsing course from childhood or who develop new-onset adult disease. Besides well-established atopic comorbidities, associations with a number of nonatopic comorbidities have been reported. AD is characterized by both immune dysregulation and epidermal barrier dysfunction. The findings that nonlesional skin in AD has both terminal keratinocyte differentiation defects and immune abnormalities as well as multiple markers of immune and inflammatory activation in the circulation point to the systemic nature of the disease and have important translational implications. Although AD is predominantly associated with type 2 immune responses, activation of other cytokine pathways including TH1, TH22, and TH17/IL-23 has been reported, suggesting potential therapeutic targets and provide a rationale for treatment with novel biologics. Dupilumab, a fully human mAb targeting the IL-4 Rα subunit, blocks signaling of both IL-4 and IL-13 and is the first biologic to be approved for the treatment of moderate-to-severe AD in adult patients. Other biologics in current trials for AD are targeting the IL-31 receptor, IL-13, and the common p40 subunit of IL-12/IL-23.
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Affiliation(s)
- Mark Boguniewicz
- Division of Allergy-Immunology, Department of Pediatrics, National Jewish Health and University of Colorado School of Medicine, Denver, Colo.
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223
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Dizon M, Yu A, Singh R, Wan J, Chren M, Flohr C, Silverberg J, Margolis D, Langan S, Abuabara K. Systematic review of atopic dermatitis disease definition in studies using routinely collected health data. Br J Dermatol 2018; 178:1280-1287. [PMID: 29336013 PMCID: PMC6033033 DOI: 10.1111/bjd.16340] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Routinely collected electronic health data obtained for administrative and clinical purposes are increasingly used to study atopic dermatitis (AD). Methods for identifying AD patients in routinely collected electronic health data differ, and it is unknown how this might affect study results. OBJECTIVES To evaluate how patients with AD have been identified in studies using routinely collected electronic health data, to determine whether these methods were validated and to estimate how the method for identifying patients with AD affected variability in prevalence estimates. METHODS We systematically searched PubMed, Embase and Web of Science for studies using routinely collected electronic health data that reported on AD as a primary outcome. Studies of localized AD and other types of dermatitis were excluded. The protocol for this review was registered in PROSPERO (CRD42016037968). RESULTS In total, 59 studies met eligibility criteria. Medical diagnosis codes for inclusion and exclusion, number of occasions of a code, type of provider associated with a code and prescription data were used to identify patients with AD. Only two studies described validation of their methods and no study reported on disease severity. Prevalence estimates ranged from 0·18% to 38·33% (median 4·91%) and up to threefold variation in prevalence was introduced by differences in the method for identifying patients with AD. CONCLUSIONS This systematic review highlights the need for clear reporting of methods for identifying patients with AD in routinely collected electronic health data to allow for meaningful interpretation and comparison of results.
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Affiliation(s)
- M.P. Dizon
- Program for Clinical ResearchDepartment of DermatologyUniversity of CaliforniaSan Francisco School of MedicineSan FranciscoCAU.S.A.
| | - A.M. Yu
- Faculty of MedicineUniversity of OttawaOttawaOntarioCanada
| | - R.K. Singh
- University of California, Los AngelesDavid Geffen School of Medicine at UCLALos AngelesCAU.S.A.
| | - J. Wan
- Department of DermatologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAU.S.A.
| | - M.‐M. Chren
- Department of DermatologyVanderbilt University Medical CenterNashvilleTN 37204U.S.A.
| | - C. Flohr
- Unit for Population‐Based Dermatology ResearchSt John's Institute of DermatologyGuy's & St Thomas' NHS Foundation Trust and King's College LondonChicagoILU.S.A.
| | - J.I. Silverberg
- Departments of Dermatology, Preventive Medicine and Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoILU.S.A.
| | - D.J. Margolis
- Department of DermatologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAU.S.A.
- Department of Biostatistics, Epidemiology and InformaticsUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAU.S.A.
| | - S.M. Langan
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonU.K.
| | - K. Abuabara
- Program for Clinical ResearchDepartment of DermatologyUniversity of CaliforniaSan Francisco School of MedicineSan FranciscoCAU.S.A.
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Barbarot S, Auziere S, Gadkari A, Girolomoni G, Puig L, Simpson EL, Margolis DJ, Bruin‐Weller M, Eckert L. Epidemiology of atopic dermatitis in adults: Results from an international survey. Allergy 2018; 73:1284-1293. [PMID: 29319189 DOI: 10.1111/all.13401] [Citation(s) in RCA: 477] [Impact Index Per Article: 79.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND There are gaps in our knowledge of the prevalence of adult atopic dermatitis (AD). OBJECTIVE To estimate the prevalence of AD in adults and by disease severity. METHODS This international, cross-sectional, web-based survey was performed in the United States, Canada, France, Germany, Italy, Spain, United Kingdom, and Japan. Adult members of online respondent panels were sent a questionnaire for AD identification and severity assessment; demographic quotas ensured population representativeness for each country. A diagnosis of AD required subjects to be positive on the modified UK Working Party/ISAAC criteria and self-report of ever having an AD diagnosis by a physician. The proportion of subjects with AD who reported being treated for their condition was determined and also used to estimate prevalence. Severity scales were Patient-Oriented SCORAD, Patient-Orientated Eczema Measure, and Patient Global Assessment. RESULTS Among participants by region, the point prevalence of adult AD in the overall/treated populations was 4.9%/3.9% in the US, 3.5%/2.6% in Canada, 4.4%/3.5% in the EU, and 2.1%/1.5% in Japan. The prevalence was generally lower for males vs females, and decreased with age. Regional variability was observed within countries. Severity varied by scale and region; however, regardless of the scale or region, proportion of subjects reporting severe disease was lower than mild or moderate disease. CONCLUSIONS Prevalence of adult AD ranged from 2.1% to 4.9% across countries. Severe AD represented a small proportion of the overall AD population regardless of measure or region.
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Affiliation(s)
- S. Barbarot
- Department of Dermatology CHU Nantes Nantes France
| | | | | | - G. Girolomoni
- Department of Medicine Section of Dermatology University of Verona Verona Italy
| | - L. Puig
- Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
| | - E. L. Simpson
- Department of Dermatology Oregon Health & Science University Portland OR USA
| | - D. J. Margolis
- Department of Dermatology University of Pennsylvania Perelman School of Medicine Philadelphia PA USA
| | - M. Bruin‐Weller
- Department of Dermatology & Allergology University Medical Center Utrecht Utrecht The Netherlands
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225
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The Unique Molecular Signatures of Contact Dermatitis and Implications for Treatment. Clin Rev Allergy Immunol 2018; 56:1-8. [DOI: 10.1007/s12016-018-8685-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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226
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Kabashima K, Biedermann T. A new era for translational atopic dermatitis research and management. Exp Dermatol 2018; 27:313-317. [DOI: 10.1111/exd.13546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Kenji Kabashima
- Faculty of Medicine; Department of Dermatology; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Tilo Biedermann
- Department of Dermatology and Allergy; Technical University of Munich; Munich Germany
- Clinical Unit Allergology; Helmholtz Zentrum München; German Research Center for Environmental Health (GmbH); Germany
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227
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Siegfried EC, Jaworski JC, Eichenfield LF, Paller A, Hebert AA, Simpson EL, Altman E, Arena C, Blauvelt A, Block J, Boguniewicz M, Chen S, Cordoro K, Hanna D, Horii K, Hultsch T, Lee J, Leung DY, Lio P, Milner J, Omachi T, Schneider C, Schneider L, Sidbury R, Smith T, Sugarman J, Taha S, Tofte S, Tollefson M, Tom WL, West DP, Whitney L, Zane L. Developing drugs for treatment of atopic dermatitis in children (≥3 months to <18 years of age): Draft guidance for industry. Pediatr Dermatol 2018; 35:303-322. [PMID: 29600515 DOI: 10.1111/pde.13452] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Atopic dermatitis is the most common chronic skin disease, and it primarily affects children. Although atopic dermatitis (AD) has the highest effect on burden of skin disease, no high-level studies have defined optimal therapy for severe disease. Corticosteroids have been used to treat AD since the 1950s and remain the only systemic medication with Food and Drug Administration approval for this indication in children, despite published guidelines of care that recommend against this option. Several clinical trials with level 1 evidence have supported the use of topical treatments for mild to moderate atopic dermatitis in adults and children, but these trials have had little consistency in protocol design. Consensus recommendations will help standardize clinical development and trial design for children. The Food and Drug Administration issues guidance documents for industry as a source for "the Agency's current thinking on a particular subject." Although they are nonbinding, industry considers these documents to be the standard for clinical development and trial design. Our consensus group is the first to specifically address clinical trial design in this population. We developed a draft guidance document for industry, Developing Drugs for Treatment of Atopic Dermatitis in Children (≥3 months to <18 years of age). This draft guidance has been submitted to the Food and Drug Administration based on a provision in the Federal Register (Good Guidance Practices).
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Affiliation(s)
- Elaine C Siegfried
- Department of Pediatrics, Saint Louis University and Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | | | - Lawrence F Eichenfield
- Department of Dermatology, School of Medicine, University of California, and Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital-San Diego, San Diego, CA, USA
| | - Amy Paller
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Division of Dermatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Adelaide A Hebert
- Department of Dermatology, UTHealth McGovern Medical School at Houston, Houston, TX, USA
| | - Eric L Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | | | - Charles Arena
- Clinical Development & Medical Affairs, Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | | | - Julie Block
- National Eczema Association, San Rafael, CA, USA
| | - Mark Boguniewicz
- Department of Pediatrics, National Jewish Health and Division of Pediatric Allergy-Immunology, University of Colorado School of Medicine, Denver, CO, USA
| | - Suephy Chen
- Department of Dermatology, Emory University, and Division of Dermatology, Atlanta Veterans Affairs Medical Center, Atlanta, GA, USA
| | - Kelly Cordoro
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Diane Hanna
- Medical Affairs, Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - Kimberly Horii
- Division of Dermatology, Children's Mercy and University of Missouri, Kansas City, MO, USA
| | - Thomas Hultsch
- Translational Medicine, Sanofi-Genzyme, Cambridge, MA, USA
| | - James Lee
- Dermavant Sciences, Raleigh-Durham, NC, USA
| | - Donald Y Leung
- Department of Pediatrics, National Jewish Health and Division of Pediatric Allergy-Immunology, University of Colorado School of Medicine, Denver, CO, USA
| | - Peter Lio
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joshua Milner
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - Theodore Omachi
- Immunology/Respiratory, Genentech, Inc., San Francisco, CA, USA
| | | | - Lynda Schneider
- Department of Pediatrics, Harvard Medical School and Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA
| | - Robert Sidbury
- Division of Dermatology, Seattle Children's Hospital and Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Jeffrey Sugarman
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Sharif Taha
- National Eczema Association, San Rafael, CA, USA
| | - Susan Tofte
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | | | - Wynnis L Tom
- Department of Dermatology, School of Medicine, University of California, and Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital-San Diego, San Diego, CA, USA
| | - Dennis P West
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lucinda Whitney
- School of Nursing, University of Kansas Medical Center, Kansas City, KS, USA
| | - Lee Zane
- Anacor Pharmaceuticals, Palo Alto, CA, USA
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228
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Thyssen JP, Halling-Overgaard AS, Andersen YMF, Gislason G, Skov L, Egeberg A. The association with cardiovascular disease and type 2 diabetes in adults with atopic dermatitis: a systematic review and meta-analysis. Br J Dermatol 2018; 178:1272-1279. [PMID: 29210061 DOI: 10.1111/bjd.16215] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Recent studies examining the association between atopic dermatitis (AD) and cardiovascular disease (CVD) and type 2 diabetes have shown inconsistent results. OBJECTIVES To carry out a systematic review and meta-analysis that examines the association with cardiovascular disease and type 2 diabetes in adults with AD. METHODS We compared the risk of CVD and diabetes for adult patients with and without AD by searching the PubMed, Embase and Web of Science databases. Data extraction was carried out by two independent reviewers. We found a total of 2855 citations, of which 53 were considered relevant based on title and abstract. Overall, 16 publications were included in the qualitative analysis, of which 13 were also included in a quantitative meta-analysis of crude data. RESULTS No association was observed between AD and unspecified but suspected type 2 diabetes [pooled odds ratio (OR) 1·11; 95% confidence interval (CI) 0·87-1·42], hypertension (pooled OR 1·16; 95% CI 0·98-1·37), stroke (pooled OR 1·15; 95% CI 0·95-1·39) or myocardial infarction (pooled OR 1·14; 95% CI 0·83-1·56), but a positive association was observed with angina pectoris (OR 1·73; 95% CI 1·27-2·37). Meta-analysis of adjusted data gave similar results. CONCLUSIONS While adults with AD in some populations have an increased prevalence of cardiovascular risk factors, such as obesity and smoking, it is unlikely that AD represents an independent and clinically relevant risk factor for cardiometabolic disease.
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Affiliation(s)
- J P Thyssen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, DK-2900, Hellerup, Denmark
| | - A-S Halling-Overgaard
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, DK-2900, Hellerup, Denmark
| | - Y M F Andersen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, DK-2900, Hellerup, Denmark
| | - G Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, DK-2900, Hellerup, Denmark.,The Danish Heart Foundation, DK-1120, Copenhagen, Denmark.,The National Institute of Public Health, University of Southern Denmark, DK-1353, Copenhagen, Denmark
| | - L Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, DK-2900, Hellerup, Denmark
| | - A Egeberg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, DK-2900, Hellerup, Denmark
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229
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Narla S, Silverberg J. Association between childhood atopic dermatitis and cutaneous, extracutaneous and systemic infections. Br J Dermatol 2018; 178:1467-1468. [DOI: 10.1111/bjd.16482] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- S. Narla
- Department of Dermatology; Northwestern University Feinberg School of Medicine; Suite 1600, 676 N. St Clair St, 312-503-4985 Chicago IL 60611 U.S.A
| | - J.I. Silverberg
- Department of Dermatology; Northwestern University Feinberg School of Medicine; Suite 1600, 676 N. St Clair St, 312-503-4985 Chicago IL 60611 U.S.A
- Department of Preventive Medicine; Northwestern University Feinberg School of Medicine; Suite 1600, 676 N. St Clair St, 312-503-4985 Chicago IL 60611 U.S.A
- Department of Medical Social Sciences; Northwestern University Feinberg School of Medicine; Suite 1600, 676 N. St Clair St, 312-503-4985 Chicago IL 60611 U.S.A
- Northwestern Medicine Multidisciplinary Eczema Center; Chicago IL 60611 U.S.A
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230
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Atopic Dermatitis: Disease Background and Risk Factors. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1027:11-19. [PMID: 29063427 DOI: 10.1007/978-3-319-64804-0_2] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Multiple risk factors have been associated with the development of atopic dermatitis (AD). Recent advances in understanding the role of genetics in this disease have been made, with discovery of the filaggrin (FLG) gene as the most notable so far. In addition to FLG gene mutations as a risk factor for AD, a positive family history of atopic or allergic disease in either parent, has been shown to confer a greater risk of developing AD. Atopic dermatitis usually presents early in life and is thought to represent the initial-step in the "atopic march" which is characterized by the development of other atopic diseases later in life such as asthma, allergic rhinitis and/or rhinoconjunctivitis, food allergies and hay fever. Other comorbid diseases that have been associated with AD include increase risk of viral and bacterial skin infections, neuropsychiatric diseases such as attention-deficit hyperactivity disorders (ADHD) and autistic spectrum disorder (ASD). Patients with AD, have also been found to have worse sleep quality overall compared to patients without AD. In this chapter, we will discuss the risk factors associated with development of atopic dermatitis as well as the most commonly reported comorbidities in patients with this disease.
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231
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Dupilumab for the Treatment of Atopic Dermatitis. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.02.019] [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
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232
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Blocking TGF-β type 1 receptor partially reversed skin tissue damage in experimentally induced atopic dermatitis in mice. Cytokine 2018; 106:45-53. [PMID: 29549723 DOI: 10.1016/j.cyto.2018.02.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 02/01/2018] [Accepted: 02/26/2018] [Indexed: 01/08/2023]
Abstract
Animals with impaired transforming growth factor (TGF)-β1 signaling developed spontaneous lethal autoimmune inflammationand autoimmune diseases. Moreover, evidence for modified TGF-β signaling in atopic dermatitis (AD) exists. Therefore, the goal of this study was to determine whether SB-431542, a potent and selective inhibitor of the TGF-β type 1 receptor (TGF-βR1), could attenuate such a severe reaction in mice. In addition, the molecular underpinnings the possible protective effects were also investigated. Repeated epicutaneous application of DNCB was performed on the ear and shaved dorsal skin of miceto induce AD-like symptoms and skin lesions. SB-431542 (1 mg/kg) was given by intra-peritoneal injection three times weekly for 3 weeks to assess the anti-pruritic effects. Serum levels of TGF-β1, TGF-βR1, latency-associated peptide (LAP), tumor necrosis factor (TNF)-α, interleukin (IL)-1β and IL-6 were assessed by ELISA. Moreover, the gene expression of TNF-α, IL-1β and IL-6 were determined. Apoptotic pathway was evaluated by measuring the activity of caspase-3 and by staining skin sections with anti-caspase-3 antibodies. We found that SB-431542 alleviated DNCB-induced AD-like symptoms as quantified by skin lesion,dermatitisscore, ear thickness and scratching behavior. In parallel, SB-431542 blocked DNCB-induced elevation in serum levels of TNF-α, TGF-β1, TGF-βR1, LAP, IL-1β, IL-6 and IgE. The collective results indicate that SB-431542 partially suppresses DNCB-induced AD in micevia reduction of TGF-β1 signaling pathway associated with inhibition of inflammation and apoptosis.
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233
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Abstract
Atopic dermatitis is a heterogeneous, chronic, and inflammatory skin disease that is associated with a profound symptom burden. Recent studies have demonstrated associations between atopic dermatitis and a number of multi-organ and systemic disorders. The origin of these comorbid conditions is likely multifactorial, with combined effects of skin-barrier disruption, immune dysregulation, intense symptoms, and iatrogenic complications. Some of these comorbid conditions appear to be related to the underlying severity of atopic dermatitis and inadequate disease control. This review will summarize recent developments in the understanding of the comorbid health disorders associated with atopic dermatitis, particularly infections, sleep disturbances, and cardiovascular disease.
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Affiliation(s)
- Jonathan I Silverberg
- Departments of Dermatology, Preventive Medicine, and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Arkes building, 676 N Saint Clair St, Suite 1600, Chicago, IL, 60611, USA
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234
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Schmitt J, Buske-Kirschbaum A, Tesch F, Trikojat K, Stephan V, Abraham S, Bauer A, Nemat K, Plessow F, Roessner V. Increased attention-deficit/hyperactivity symptoms in atopic dermatitis are associated with history of antihistamine use. Allergy 2018; 73:615-626. [PMID: 28975640 DOI: 10.1111/all.13326] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Epidemiologic evidence indicates a relevant association between atopic dermatitis (AD) and attention-deficit/hyperactivity disorder (ADHD). Underlying mechanisms and ways to best identify subgroups of AD patients at risk for ADHD are poorly understood. AIMS OF THE STUDY To compare sociodemographic, clinical and psychosocial characteristics of children with AD, ADHD, comorbid AD/ADHD and age-matched healthy controls and to investigate aspects of AD related to ADHD symptoms. METHODS Applying a factorial design, we investigated 4 groups of children aged 6-12 years: AD-only (ie, without ADHD), ADHD-only (ie, without AD), AD + ADHD and healthy controls (HC; ie, no AD/no ADHD). Using validated instruments, ADHD symptoms and other behavioural problems, quality of life, parenting stress and sleeping problems were compared between groups. In children with AD-only, clinical signs (objective SCORAD), symptoms (POEM, VAS pruritus, VAS sleeping problems) and previous treatment of AD were assessed to investigate disease patterns related to ADHD symptoms. RESULTS Compared to HC (n = 47), children with AD-only (n = 42), ADHD-only (n = 34) and comorbid AD + ADHD (n = 31) had significantly increased behavioural problems and decreased quality of life. Children with AD-only had significantly higher levels of ADHD symptoms than HC. In children with AD-only, previous use of antihistamines was significantly associated with increased ADHD symptoms (OR 1.88; 95% CI 1.04-3.39). Current clinical signs and AD symptoms were unrelated to the level of ADHD symptoms. CONCLUSIONS Even if the clinical diagnosis of ADHD is excluded, children with AD show increased levels of ADHD symptoms. Further investigations need to determine whether early antihistamine exposure is a major risk factor for ADHD or a surrogate for previous AD severity and/or associated sleeping problems.
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Affiliation(s)
- J. Schmitt
- Center for Evidence-based Healthcare; Medizinische Fakultät Carl Gustav Carus; TU Dresden; Dresden Germany
- University Allergy Center; University Hospital Carl Gustav Carus; TU Dresden; Dresden Germany
| | | | - F. Tesch
- Center for Evidence-based Healthcare; Medizinische Fakultät Carl Gustav Carus; TU Dresden; Dresden Germany
| | - K. Trikojat
- Department of Biopsychology; TU Dresden; Dresden Germany
| | - V. Stephan
- Center for Evidence-based Healthcare; Medizinische Fakultät Carl Gustav Carus; TU Dresden; Dresden Germany
| | - S. Abraham
- University Allergy Center; University Hospital Carl Gustav Carus; TU Dresden; Dresden Germany
- Department of Dermatology; University Hospital Carl Gustav Carus; TU Dresden; Dresden Germany
| | - A. Bauer
- University Allergy Center; University Hospital Carl Gustav Carus; TU Dresden; Dresden Germany
- Department of Dermatology; University Hospital Carl Gustav Carus; TU Dresden; Dresden Germany
| | - K. Nemat
- University Allergy Center; University Hospital Carl Gustav Carus; TU Dresden; Dresden Germany
| | - F. Plessow
- Neuroendocrine Unit; Massachusetts General Hospital; Boston MA USA
- Department of Medicine; Harvard Medical School; Boston MA USA
| | - V. Roessner
- Child and Adolescent Psychiatry; University Hospital Carl Gustav Carus; TU Dresden; Dresden Germany
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235
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Ferreira S, Torres T. Dupilumab for the Treatment of Atopic Dermatitis. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:230-240. [PMID: 29422431 DOI: 10.1016/j.ad.2017.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/25/2017] [Accepted: 10/25/2017] [Indexed: 12/12/2022] Open
Abstract
Atopic dermatitis (AD) is a common, chronic, inflammatory skin disorder with high physical and emotional burden. AD usually starts in early childhood and has a heterogeneous course. Emerging evidence suggests that IL-4 and IL-13 are key cytokines in the immunopathogenesis of AD. Dupilumab is a monoclonal antibody directed against IL-4 receptor α subunit, that blocks both IL-4 and IL-13 signaling. Data from Phase I-III studies revealed that dupilumab, administered as monotherapy or with topical corticosteroids, is effective and well tolerated in the treatment of adult patients with moderate-to-severe AD. A large proportion of patients receiving dupilumab had significant improvements in multiple efficacy indexes, including Eczema Area and Severity Index, Investigator's Global Assessment and SCORing Atopic Dermatitis scores. These results introduce a new era of targeted therapies in the management of AD.
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Affiliation(s)
- S Ferreira
- Unidad de Dermatología, Centro Hospitalar Universitário do Porto, Oporto, Portugal
| | - T Torres
- Unidad de Dermatología, Centro Hospitalar Universitário do Porto, Oporto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Oporto, Portugal.
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236
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Thijs JL, Strickland I, Bruijnzeel-Koomen CAFM, Nierkens S, Giovannone B, Knol EF, Csomor E, Sellman BR, Mustelin T, Sleeman MA, de Bruin-Weller MS, Herath A, Drylewicz J, May RD, Hijnen D. Serum biomarker profiles suggest that atopic dermatitis is a systemic disease. J Allergy Clin Immunol 2018; 141:1523-1526. [PMID: 29410314 DOI: 10.1016/j.jaci.2017.12.991] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/27/2017] [Accepted: 12/06/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Judith L Thijs
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Stefan Nierkens
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Barbara Giovannone
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Edward F Knol
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | | | | | | | | - Julia Drylewicz
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - DirkJan Hijnen
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.
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237
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Egawa G, Kabashima K. Barrier dysfunction in the skin allergy. Allergol Int 2018; 67:3-11. [PMID: 29153780 DOI: 10.1016/j.alit.2017.10.002] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 09/30/2017] [Accepted: 10/04/2017] [Indexed: 12/14/2022] Open
Abstract
The skin is continuously exposed to external pathogens, and its barrier function is critical for skin homeostasis. Previous studies have shown that the barrier dysfunction is one of the most predisposing factors for the development of skin allergic diseases such as atopic dermatitis. In this article, we summarize how the physical barrier of the skin is organized and review its link to the pathomechanism of skin allergic diseases. We describe the formation of the SC barrier in terms of the following five categories: 1) filaggrin metabolism; 2) cornified envelope; 3) intercellular lipids; 4) corneodesmosome; and 5) corneocyte desquamation. New approaches to restoring the skin barrier function are also discussed.
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238
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Brunner PM, Leung DYM, Guttman-Yassky E. Immunologic, microbial, and epithelial interactions in atopic dermatitis. Ann Allergy Asthma Immunol 2018; 120:34-41. [PMID: 29126710 PMCID: PMC8715858 DOI: 10.1016/j.anai.2017.09.055] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 08/31/2017] [Accepted: 09/11/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To provide an overview of studies contributing to the understanding of immunologic, microbial, and epithelial interactions in atopic dermatitis. DATA SOURCES PubMed literature review (2000-2017) and meeting abstracts from recent international dermatology conferences. STUDY SELECTIONS Articles discussing primarily human disease. RESULTS Clinical studies showed that atopic dermatitis is a type 2 immune-centered disease with a systemic inflammatory component but with heterogeneous treatment responses. This suggests that other factors are likely involved in shaping the skin disease phenotype, including microbial dysbiosis and epidermal barrier dysfunction. CONCLUSION Recent clinical investigation has significantly expanded our knowledge on disease pathogenesis in atopic dermatitis, and current and future clinical trials will most likely further help to elucidate this complex, heterogeneous skin disease.
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Affiliation(s)
- Patrick M Brunner
- The Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Emma Guttman-Yassky
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York.
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239
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Petit A. [What's new in clinical dermatology?]. Ann Dermatol Venereol 2017; 144 Suppl 4:IVS1-IVS9. [PMID: 29249246 DOI: 10.1016/s0151-9638(17)31059-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In addition to continuous medical education, medical journals offer to dermatologists a huge variety of news that differ by their content, validity, originality and clinical relevance. I collected here various articles relative to clinical dermatology that have been published between September, 2016 and September, 2017. These papers have been chosen in the aim of reflecting such diversity. I just excluded, as far as possible, articles dealing with other issues that the reader will find further in this booklet (such as research, pediatric, instrumental, oncologic or therapeutic dermatology, or dermatology and internal medicine). Space restriction required to skip some commentaries while keeping the references to the selected papers, which the reader will be able to read carefully in its original form.
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Affiliation(s)
- A Petit
- Service de dermatologie, AP-HP hôpital Saint-Louis, Paris, France.
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240
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Chiaverini C. Quoi de neuf en dermatologie pédiatrique ? Ann Dermatol Venereol 2017; 144 Suppl 4:IVS29-IVS39. [DOI: 10.1016/s0151-9638(17)31063-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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241
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242
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Dermatite atopique de l’adulte : présentation clinique, complications et comorbidités. Ann Dermatol Venereol 2017; 144 Suppl 5:VS15-VS22. [DOI: 10.1016/s0151-9638(18)30087-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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243
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Ottas A, Fishman D, Okas TL, Püssa T, Toomik P, Märtson A, Kingo K, Soomets U. Blood serum metabolome of atopic dermatitis: Altered energy cycle and the markers of systemic inflammation. PLoS One 2017; 12:e0188580. [PMID: 29176763 PMCID: PMC5703555 DOI: 10.1371/journal.pone.0188580] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 11/09/2017] [Indexed: 12/19/2022] Open
Abstract
Atopic dermatitis is a chronic inflammatory disease which usually starts in the early childhood and ends before adulthood. However up to 3% of adults remain affected by the disease. The onset and course of the disease is influenced by various genetic and environmental factors. Although the immune system has a great effect on the outcome of the disease, metabolic markers can also try to explain the background of atopic dermatitis. In this study we analyzed the serum of patients with atopic dermatitis using both targeted and untargeted metabolomics approaches. We found the most significant changes to be related to phosphatidylcholines, acylcarnitines and their ratios and a cleavage peptide of Fibrinogen A-α. These findings that have not been reported before will further help to understand this complex disease.
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Affiliation(s)
- Aigar Ottas
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
- * E-mail:
| | - Dmytro Fishman
- Faculty of Science and Technology, Institute of Computer Science, University of Tartu, Tartu, Estonia
- Quretec OÜ, Tartu, Estonia
| | | | - Tõnu Püssa
- Department of Food Hygiene, Estonian University of Life Sciences, Tartu, Estonia
| | - Peeter Toomik
- Department of Food Hygiene, Estonian University of Life Sciences, Tartu, Estonia
| | - Aare Märtson
- Clinic of Traumatology and Orthopedics, Tartu University Hospital, Tartu, Estonia
| | - Külli Kingo
- Department of Dermatology, University of Tartu; Clinic of Dermatology, Tartu University Hospital, Tartu, Estonia
| | - Ursel Soomets
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
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244
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Traidl S, Kienlin P, Begemann G, Jing L, Koelle DM, Werfel T, Roesner LM. Patients with atopic dermatitis and history of eczema herpeticum elicit herpes simplex virus-specific type 2 immune responses. J Allergy Clin Immunol 2017; 141:1144-1147.e5. [PMID: 29155096 DOI: 10.1016/j.jaci.2017.09.048] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 09/15/2017] [Accepted: 09/27/2017] [Indexed: 01/22/2023]
Affiliation(s)
- Stephan Traidl
- Department of Dermatology and Allergy, Division of Immunodermatology and Allergy Research, Hannover Medical School, Hannover, Germany
| | - Petra Kienlin
- Department of Dermatology and Allergy, Division of Immunodermatology and Allergy Research, Hannover Medical School, Hannover, Germany
| | - Gabriele Begemann
- Department of Dermatology and Allergy, Division of Immunodermatology and Allergy Research, Hannover Medical School, Hannover, Germany
| | - Lichen Jing
- Department of Medicine, University of Washington, Seattle, Wash
| | - David M Koelle
- Departments of Medicine, Global Health, and Laboratory Medicine, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, Wash; Benaroya Research Institute, Seattle, Wash
| | - Thomas Werfel
- Department of Dermatology and Allergy, Division of Immunodermatology and Allergy Research, Hannover Medical School, Hannover, Germany
| | - Lennart M Roesner
- Department of Dermatology and Allergy, Division of Immunodermatology and Allergy Research, Hannover Medical School, Hannover, Germany.
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245
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Malik K, Ungar B, Garcet S, Dutt R, Dickstein D, Zheng X, Xu H, Estrada YD, Suárez-Fariñas M, Shemer A, Krueger JG, Guttman-Yassky E. Dust mite induces multiple polar T cell axes in human skin. Clin Exp Allergy 2017; 47:1648-1660. [DOI: 10.1111/cea.13040] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/11/2017] [Accepted: 08/18/2017] [Indexed: 12/18/2022]
Affiliation(s)
- K. Malik
- Department of Dermatology; Icahn School of Medicine at Mount Sinai; New York NY USA
- Laboratory for Investigative Dermatology; The Rockefeller University; New York NY USA
| | - B. Ungar
- Department of Dermatology; Icahn School of Medicine at Mount Sinai; New York NY USA
- Laboratory for Investigative Dermatology; The Rockefeller University; New York NY USA
| | - S. Garcet
- Laboratory for Investigative Dermatology; The Rockefeller University; New York NY USA
| | - R. Dutt
- Department of Dermatology; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - D. Dickstein
- Department of Dermatology; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - X. Zheng
- Laboratory for Investigative Dermatology; The Rockefeller University; New York NY USA
| | - H. Xu
- Department of Dermatology; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Y. D. Estrada
- Department of Dermatology; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - M. Suárez-Fariñas
- Laboratory for Investigative Dermatology; The Rockefeller University; New York NY USA
- Department of Population Health Science and Policy; Icahn School of Medicine at Mount Sinai; New York NY USA
- Department of Genetics and Genomics Science; Icahn School of Medicine at Mount Sinai; New York NY USA
- Icahn Institute for Genomics and Multiscale Biology; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - A. Shemer
- The Department of Dermatology; Tel-Hashomer; Tel-Aviv Israel
| | - J. G. Krueger
- Laboratory for Investigative Dermatology; The Rockefeller University; New York NY USA
| | - E. Guttman-Yassky
- Department of Dermatology; Icahn School of Medicine at Mount Sinai; New York NY USA
- Laboratory for Investigative Dermatology; The Rockefeller University; New York NY USA
- Department of Genetics and Genomics Science; Icahn School of Medicine at Mount Sinai; New York NY USA
- The Immunology Institute; Icahn School of Medicine at Mount Sinai; New York NY USA
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246
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Thyssen JP, Skov L, Egeberg A. Cause-specific mortality in adults with atopic dermatitis. J Am Acad Dermatol 2017; 78:506-510. [PMID: 29102489 DOI: 10.1016/j.jaad.2017.10.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/19/2017] [Accepted: 10/22/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Adult atopic dermatitis (AD) has been associated with several comorbidities, but cause-specific mortality risk is unknown. OBJECTIVE To examine cause-specific death rates and risk in adults with AD. METHODS We performed cross-linkage of nationwide health care and cause of death registers. Adult patients with AD were matched with 10 controls per study subject. We calculated incidence rates per 1000 person-years and hazard ratios (HRs) of cause-specific death with 95% confidence intervals (95% CIs) using Cox proportional hazards models. RESULTS A total of 8686 patients and 86,860 matched controls were studied. The risk for death due to any cause was significantly increased in patients with AD (HR 1.27, 95%CI 1.11-1.45). Significant causes included cardiovascular (HR 1.45; 95% CI 1.07-1.96), infectious (HR 3.71; 95% CI 1.43-9.60), and urogenital diseases (HR 5.51; 95% CI 1.54-19.80). No increased risk for death due to cancer, endocrine, neurologic, psychiatric, respiratory, or gastroenterologic disease was observed. LIMITATIONS The results might not be generalizable to patients seen exclusively by primary care physicians. CONCLUSION Adults with atopic dermatitis had slightly increased risk for death during follow-up. While the risk for death from cardiovascular, urogenital, and infectious diseases was slightly elevated among patients with AD, the absolute risk was very low.
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Affiliation(s)
- Jacob P Thyssen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; National Allergy Research Centre, Gentofte, Denmark.
| | - Lone Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Alexander Egeberg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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247
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Effect of isoliquiritigenin for the treatment of atopic dermatitis-like skin lesions in mice. Arch Dermatol Res 2017; 309:805-813. [PMID: 29026975 DOI: 10.1007/s00403-017-1787-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/20/2017] [Accepted: 10/04/2017] [Indexed: 10/18/2022]
Abstract
Atopic dermatitis (AD) is a common chronic inflammatory skin disease characterized with high heterogeneity. Recent studies have suggested that it is driven by both terminal keratinocyte differentiation defects and type 2 immune responses. The mainstay steroid topical therapy has severe side effect and new treatment is in demand. Isoliquiritigenin (ISLG) is a small phenolic bioactive molecule from licorice that has shown multiple pharmacological effects against cancer, inflammatory disorder, and cardiovascular diseases. ISLG was evaluated in AD-like lesion model induced by the repetitive application of 2,4-dinitrochlorobenzene (DNCB) in BALB/c mice. Overall symptom score, serological and molecular changes of the skin lesions were evaluated. ISLG could ameliorate the overall manifestation of AD-like symptoms including scratching behavior incidence and skin lesion severity. At blood level, ISLG significantly suppressed the DNCB-induced IgE and Th2 cytokines up-regulation. At skin lesion site, ISLG also inhibited DNCB-induced pro-inflammatory cytokines like TNF-α, IL-6 as well as IL-4 expressions. In a human monocyte model THP-1, ISLG suppressed the up-regulation of CD86 and CD54 and abolished the DNCB-induced p38-α and ERK activation, suggesting a molecular mechanism for ISLG therapy. This study indicated that ISLG could be a potential therapeutic agent for the treatment of AD.
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248
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Boguniewicz M, Alexis AF, Beck LA, Block J, Eichenfield LF, Fonacier L, Guttman-Yassky E, Paller AS, Pariser D, Silverberg JI, Lebwohl M. Expert Perspectives on Management of Moderate-to-Severe Atopic Dermatitis: A Multidisciplinary Consensus Addressing Current and Emerging Therapies. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:1519-1531. [PMID: 28970084 DOI: 10.1016/j.jaip.2017.08.005] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/24/2017] [Accepted: 08/07/2017] [Indexed: 12/17/2022]
Abstract
Atopic dermatitis (AD) is a common, chronic, relapsing, inflammatory skin disease that affects children and adults. Until recently, the only Food and Drug Administration-approved systemic treatment option for patients with moderate-to-severe AD was systemic steroids, which are not recommended by current guidelines and are commonly associated with disease rebound. Instead, clinicians choose from several off-label immunosuppressants, which can have serious adverse effects. A significant number of these patients go untreated. Research on the immunopathogenesis of AD has paved the way for new, targeted, systemic therapies for moderate-to-severe AD. In early 2017, the Food and Drug Administration approved dupilumab for adults with moderate-to-severe AD whose disease is not adequately controlled with topical therapies. Although the national guidelines can be very helpful to clinicians, the process for updating them does not allow for timely incorporation of novel therapies. A steering committee of AD experts, including dermatologists, allergists, and a patient advocacy group representative, developed recommendations on the basis of a literature review and expert opinion to help clinicians understand how new therapies fit into the current treatment paradigm and to provide practical recommendations for assessing AD severity, treatment response, and treatment failure.
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Affiliation(s)
- Mark Boguniewicz
- Division of Allergy-Immunology, Department of Pediatrics, National Jewish Health and University of Colorado School of Medicine, Denver, Colo.
| | - Andrew F Alexis
- Department of Dermatology, Skin of Color Center, Mount Sinai St Luke's and Mount Sinai West, New York, NY
| | - Lisa A Beck
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY
| | - Julie Block
- National Eczema Association, San Rafael, Calif
| | - Lawrence F Eichenfield
- Departments of Dermatology and Pediatrics, University of California, San Diego, Calif; Rady Children's Hospital San Diego, San Diego, Calif
| | - Luz Fonacier
- Section of Allergy and Clinical Immunology, Department of Medicine, NYU Winthrop-University Hospital, Mineola, NY
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - David Pariser
- Department of Dermatology, Eastern Virginia Medical School and Virginia Clinical Research, Inc, Norfolk, Va
| | - Jonathan I Silverberg
- Departments of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
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249
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Vekaria AS, Brunner PM, Aleisa AI, Bonomo L, Lebwohl MG, Israel A, Guttman-Yassky E. Moderate-to-severe atopic dermatitis patients show increases in serum C-reactive protein levels, correlating with skin disease activity. F1000Res 2017; 6:1712. [PMID: 29188018 PMCID: PMC5698919 DOI: 10.12688/f1000research.12422.2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2017] [Indexed: 12/30/2022] Open
Abstract
Background: Atopic dermatitis (AD), the most common chronic inflammatory skin disease, is evolving as a systemic disease, and associated systemic inflammation is possibly linked to increases in cardiovascular disease. Methods: We assessed levels of the inflammatory marker CRP in 59 patients with moderate-to-severe AD compared to matched healthy controls, and to determine correlation with skin disease severity. Clinical severity was measured using SCORing of Atopic Dermatitis (SCORAD) and body surface area (BSA). Control subjects (n=118), matched by age, gender, smoking status and ethnicity, were obtained from the National Health and Nutrition Survey (NHANES). Results: AD patients had significantly increased serum CRP levels compared to controls (0.7±1.0 vs. 0.4±0.7mg/dl; p=0.001), and 52.5% of them showed CRP levels >0.3mg/dl, predicting high cardiovascular risk. CRP levels were significantly correlated with both SCORAD (r=0.427, p=0.0008) and BSA (r=0.407, p=0.0015). IgE levels in AD were highly elevated (median 2903U/ml, IQR [234,10655]), but only weakly correlated with SCORAD (r=0.282, p=0.0427) and BSA (r=0.382, p=0.0052), but not with CRP levels. AD patients also showed increased LDH levels, but without significant correlations with disease severity (SCORAD, BSA) or CRP. Conclusions: Our study strongly supports CRP as a marker for disease severity in moderate-to-severe AD patients, further demonstrating its chronic systemic nature.
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Affiliation(s)
- Anjali S Vekaria
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Patrick M Brunner
- The Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, 10065, USA
| | - Ahmad I Aleisa
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Lauren Bonomo
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Mark G Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Ariel Israel
- Department of Family Medicine, Clalit Health Services, Jerusalem, 954323, Israel
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.,The Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, 10065, USA
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250
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Treudler R, Zeynalova S, Walther F, Engel C, Simon JC. Atopic dermatitis is associated with autoimmune but not with cardiovascular comorbidities in a random sample of the general population in Leipzig, Germany. J Eur Acad Dermatol Venereol 2017; 32:e44-e46. [PMID: 28758257 DOI: 10.1111/jdv.14495] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- R Treudler
- Department of Dermatology, Venerology and Allergology, Universität Leipzig, Leipzig, Germany.,Leipzig Interdisciplinary Allergy Center (LICA) - Comprehensive Allergy Center, Leipzig, Germany.,Leipzig Research Center for Civilization Disease - LIFE, Universität Leipzig, Germany
| | - S Zeynalova
- Leipzig Research Center for Civilization Disease - LIFE, Universität Leipzig, Germany.,Institute for Medical Informatics, Statistics and Epidemiology (IMISE) Leipzig, Universität Leipzig, Germany
| | - F Walther
- Department of Dermatology, Venerology and Allergology, Universität Leipzig, Leipzig, Germany.,Leipzig Research Center for Civilization Disease - LIFE, Universität Leipzig, Germany
| | - C Engel
- Leipzig Research Center for Civilization Disease - LIFE, Universität Leipzig, Germany.,Institute for Medical Informatics, Statistics and Epidemiology (IMISE) Leipzig, Universität Leipzig, Germany
| | - J C Simon
- Department of Dermatology, Venerology and Allergology, Universität Leipzig, Leipzig, Germany.,Leipzig Interdisciplinary Allergy Center (LICA) - Comprehensive Allergy Center, Leipzig, Germany.,Leipzig Research Center for Civilization Disease - LIFE, Universität Leipzig, Germany
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