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Gelato F, Mastorino L, Stepkina E, Cavaliere G, Ribero S, Quaglino P, Ortoncelli M. Is Dupilumab as Effective in Intrinsic Atopic Dermatitis as It Is in Extrinsic Atopic Dermatitis? J Clin Med 2023; 12:jcm12062189. [PMID: 36983191 PMCID: PMC10058810 DOI: 10.3390/jcm12062189] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/13/2023] [Accepted: 03/09/2023] [Indexed: 03/16/2023] Open
Abstract
Atopic dermatitis (AD) can be subclassified into the more frequent extrinsic type (EAD), with elevated serum IgE levels and frequent association with other atopic conditions, and the less frequent intrinsic type (IAD), with normal IgE levels and no history of atopy. This retrospective study has the objective to compare the efficacy of dupilumab therapy in patients with IAD versus EAD in a real-life setting. We studied a group of 360 patients treated with dupilumab for moderate-to-severe AD of whom 49 had IAD (IgE < 200 kU/L and no history of other atopic conditions) and 311 had EAD (IgE ≥ 200 kU/L and/or history of atopy). There were no statistically significant differences in the achievement of EASI75 between IAD and EAD patients either at 16, 32, or 48 weeks (61% vs. 50%; 66% vs. 60%; and 53% vs. 65%, respectively). Similarly, there were no statistically significant differences in the achievement of EASI90 or the reduction in NRSpp, NRSsd, and DLQI at each timepoint. Additionally, mean absolute eosinophils and IgE values were significantly higher in the EAD group at all timepoints. This study confirms that dupilumab, targeting the Th2 pathway, which is known to be overexpressed in all AD phenotypes, appears to be equally effective in the two populations regardless of IgE levels.
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Imamura S, Washio K, Mizuno M, Oda Y, Fukunaga A, Nishigori C. Activated steady status and distinctive FcεRI-mediated responsiveness in basophils of atopic dermatitis. Allergol Int 2021; 70:327-334. [PMID: 33674191 DOI: 10.1016/j.alit.2021.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/17/2020] [Accepted: 01/06/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Although basophils are considered to play an important role for maintenance of type 2 inflammation in atopic dermatitis (AD), studies on basophils in AD patients are limited. Some studies have reported the activation status, including CD203c and CD63, of peripheral blood basophils in AD patients. METHODS We examined the features of circulating basophils in AD patients, assessed cell surface marker expressions and total serum IgE, and compared basophil responsiveness to stimulation between AD patients and healthy controls (HCs). In addition, the correlations among AD severity, laboratory factors, and features of basophils were examined. Blood samples from 38 AD patients and 21 HCs were analyzed. Basophil response markers CD203c and CD63, and expression of surface-bound IgE and FcεRI on basophils were measured. CD203c and CD63 expressions induced by stimulation with anti-IgE and anti-FcεRI antibodies were measured. Clinical/laboratory factors including total serum IgE were examined for correlations with these basophil parameters. RESULTS Baseline CD203c and CD63 expression on basophils were significantly higher in AD patients compared with HCs. The CD203c/CD63 response ratio to anti-FcεRI stimulation was higher than that to anti-IgE stimulation in AD patients, but not HCs. FcεRI expression on basophils was higher in AD patients than in HCs, although surface-bound IgE on basophils was equivalent. Total serum IgE had negative correlations with surface-bound IgE and CD63 responsiveness to anti-IgE stimulation. CONCLUSIONS Basophils were spontaneously activated under steady-state conditions in AD patients and responsiveness to anti-IgE stimulation was lower than in HCs. Despite high serum IgE and high basophil FcεRI expression, surface-bound IgE on basophils remained relatively low. Basophils might be suppressed or exhausted regarding FcεRI signaling via IgE in severe AD.
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Choi DW, Jung SY, Lee SY, Shon DH, Shin HS. Rosae multiflorae Fructus Extract Improves Trimellitic Anhydride-Induced Atopic Dermatitis-Like Symptoms. J Med Food 2020; 23:1287-1295. [PMID: 33185498 DOI: 10.1089/jmf.2020.4767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Allergic disorders, including atopic dermatitis (AD), are closely linked to the activation of type 2 helper T (Th2) cells. The aim of this study was to investigate the possibility of using Rosae multiflorae fructus extract (RMFE) for AD treatment in the AD-like mouse model induced by treatment with trimellitic anhydride (TMA). Oral treatment of RMFE reduced the increase in ear thickness and suppressed inflammatory cytokine expression (interleukin [IL]-1β and tumor necrosis factor [TNF]-α) and Th2-associated immune responses (immunoglobulin [Ig] E and IL-4) in mouse ears. Furthermore, messenger RNA (mRNA) expression levels such as IL-4, IL-5, and IL-13, in draining lymph nodes were decreased by RMFE. Furthermore, we found that RMFE increased the level of heme oxygenase-1 (HO-1) through ERK and p38 pathways, reducing IL-2 production and CD4+ T cell proliferation, and inhibited STAT6 phosphorylation. Therefore, this study suggested that RMFE could be an effective treatment of AD induced by Th2-mediated immune responses by suppressing proliferation of CD4+ T cells via increased HO-1.
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Affiliation(s)
- Dae Woon Choi
- Food Biotechnology Program, KFRI School, Korea University of Science and Technology, Daejeon, Korea.,Division of Functional Food Research, Korea Food Research Institute, Wanju-gun, Korea
| | - Sun Young Jung
- Food Biotechnology Program, KFRI School, Korea University of Science and Technology, Daejeon, Korea.,Division of Functional Food Research, Korea Food Research Institute, Wanju-gun, Korea
| | - So-Young Lee
- Food Biotechnology Program, KFRI School, Korea University of Science and Technology, Daejeon, Korea.,Division of Functional Food Research, Korea Food Research Institute, Wanju-gun, Korea
| | - Dong-Hwa Shon
- Department of Food Processing and Distribution, Gangneung-Wonju National University, Gangneung, Korea
| | - Hee Soon Shin
- Food Biotechnology Program, KFRI School, Korea University of Science and Technology, Daejeon, Korea.,Division of Functional Food Research, Korea Food Research Institute, Wanju-gun, Korea
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Misery L, Huet F, Gouin O, Ständer S, Deleuran M. Current pharmaceutical developments in atopic dermatitis. Curr Opin Pharmacol 2019; 46:7-13. [PMID: 30611103 DOI: 10.1016/j.coph.2018.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/27/2018] [Accepted: 12/08/2018] [Indexed: 12/20/2022]
Abstract
Atopic dermatitis (AD) is an inflammatory, pruritic, chronic or chronically relapsing skin disease that typically begins in early childhood and is occurring frequently in families with other atopic diseases (bronchial asthma and/or allergic rhino-conjunctivitis). Thanks to immunological and neurobiological research, the era of new treatments is coming as well as it occurred with psoriasis 15 years ago. Many treatments targeting cytokines (IL-4, IL-13, IL-31, TSLP) or neurotransmitters (substance P, opioids) or their respective receptors as well as phosphodiesterase-4 or the Jak/Stat pathways are under development. Antagonists of cytokines and anti-jak have promising effects on pruritus while it is more difficult to discriminate the effects of other drugs from the placebo effect on itch, which is known to be high.
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Affiliation(s)
- Laurent Misery
- University of Brest, LIEN, F-29200 Brest, France; University Hospital of Brest, Department of Dermatology, Brest, France.
| | - Flavien Huet
- University of Brest, LIEN, F-29200 Brest, France; University Hospital of Brest, Department of Dermatology, Brest, France
| | - Olivier Gouin
- University Paris Descartes, Imagine Institute, INSERM U1163, Paris, France
| | - Sonja Ständer
- Center for Chronic Pruritus, Department of Dermatology, University Hospital of Münster, Münster, Germany
| | - Mette Deleuran
- Aarhus University Hospital, Department of Dermatology, Aarhus, Denmark
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Botoni LS, Torres SMF, Koch SN, Heinemann MB, Costa‐Val AP. Comparison of demographic data, disease severity and response to treatment, between dogs with atopic dermatitis and atopic‐like dermatitis: a retrospective study. Vet Dermatol 2018; 30:10-e4. [DOI: 10.1111/vde.12708] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Larissa S. Botoni
- Department of Veterinary Clinical Sciences and Surgery Universidade Federal de Minas Gerais 6627 Antônio Carlos Ave Belo Horizonte 31270‐901 Brazil
| | - Sheila M. F. Torres
- Department of Veterinary Clinical Sciences University of Minnesota 1365 Gortner Avenue Saint Paul MN 55108 USA
| | - Sandra N. Koch
- Department of Veterinary Clinical Sciences University of Minnesota 1365 Gortner Avenue Saint Paul MN 55108 USA
| | - Marcos B. Heinemann
- Department of Preventive Veterinary Medicine and Animal Health Universidade de São Paulo 87 Prof. Dr. Orlando Marques de Paiva Ave São Paulo 05508‐270 Brazil
| | - Adriane P. Costa‐Val
- Department of Veterinary Clinical Sciences and Surgery Universidade Federal de Minas Gerais 6627 Antônio Carlos Ave Belo Horizonte 31270‐901 Brazil
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Nomura T, Honda T, Kabashima K. Multipolarity of cytokine axes in the pathogenesis of atopic dermatitis in terms of age, race, species, disease stage and biomarkers. Int Immunol 2018. [DOI: 10.1093/intimm/dxy015] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Takashi Nomura
- Department of Dermatology, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto 606-8326, Japan
| | - Tetsuya Honda
- Department of Dermatology, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto 606-8326, Japan
| | - Kenji Kabashima
- Department of Dermatology, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto 606-8326, Japan
- Singapore Immunology Network (SIgN) and Institute of Medical Biology (IMB), Agency for Science, Technology and Research (A*STAR), Biopolis, Singapore
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Vinnik T, Kirby M, Bairachnaya M, Koman I, Tarkina T, Sadykova G, Abildinova G, Batpenova G, Pinhasov A. Seasonality and BDNF polymorphism influences depression outcome in patients with atopic dermatitis and psoriasis. World J Biol Psychiatry 2017; 18:604-614. [PMID: 27409526 DOI: 10.1080/15622975.2016.1212171] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To examine the effect of seasonality and rs6265 genotype on depression outcome and brain-derived neurotrophic factor (BDNF) level with dermatitis patients from onset through remission. METHODS Atopic dermatitis (AD, 56) and psoriasis (PS, 33) patients and healthy controls (HC, 49) were recruited over the 2014 calendar year. Patients were subdivided by immunoglobulin E (IgE) sensitivity (AD only), season and rs6265 genotype. Assessments were performed at onset and week 10 (Hamilton Depression Rating Scale [HAM-D], SCORAD/PASI, IgE, BDNF). Patients received standard corticosteroid and antihistamine interventions. RESULTS All patients responded to corticosteroid treatment. Seasonally differential outcomes were observed in all groups. HAM-D was elevated at onset and improved over 10 weeks: AD cohort 1 (autumn/winter, AD-1) patients improved and AD cohort 2 (spring/summer, AD-2) patients remained elevated. BDNF levels were elevated in AD and seasonal differential: AD-2 declined at 10 weeks, whereas AD-1 remained high (intrinsic AD) or elevated further (extrinsic AD). PS cohort 2 declined to below control at 10 weeks. AD Val/Val had persistently elevated HAM-D and AD Val/Met were either normal (AD-1) or persistently elevated (AD-2). CONCLUSIONS Findings presented here suggest a strong influence of seasonality on depression outcome and BDNF expression in AD and PS and likely reflect separate patient populations which differentially respond to environment-based stressors.
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Affiliation(s)
- Tatyana Vinnik
- a Department of Dermatovenereology , Astana Medical University , Astana , Kazakhstan
| | - Michael Kirby
- b Department of Molecular Biology , Ariel University , Ariel , Israel
| | | | - Igor Koman
- b Department of Molecular Biology , Ariel University , Ariel , Israel
| | - Tatyana Tarkina
- a Department of Dermatovenereology , Astana Medical University , Astana , Kazakhstan
| | - Gulnaz Sadykova
- a Department of Dermatovenereology , Astana Medical University , Astana , Kazakhstan
| | - Gulshara Abildinova
- c National Research Centre of Maternal and Child Health , Astana , Kazakhstan
| | - Gulnara Batpenova
- a Department of Dermatovenereology , Astana Medical University , Astana , Kazakhstan
| | - Albert Pinhasov
- b Department of Molecular Biology , Ariel University , Ariel , Israel
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Celakovska J, Bukač J, Ettler K, Ettlerova K, Krcmova I. Atopic dermatitis in adolescents and adults – the evaluation of association with other allergic diseases and parameters. FOOD AGR IMMUNOL 2017. [DOI: 10.1080/09540105.2017.1320358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Jarmila Celakovska
- Department of Dermatology and Venereology, Charles University, Hradec Králové, Czech Republic
| | - Josef Bukač
- Department of Medical Biophysics, Charles University, Hradec Králové, Czech Republic
| | - Karel Ettler
- Department of Dermatology and Venereology, University Hospital, Charles University, Hradec Králové, Czech Republic
| | - Květuše Ettlerova
- Department of Allergy and Clinical Immunology, Outpatient Clinic, Hradec Králové, Czech Republic
| | - Irena Krcmova
- Department of Clinical Immunology and Allergology, Faculty Hospital and Medical Faculty of Charles University, Hradec Králové, Czech Republic
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Čelakovská J, Bukač J. Severity of atopic dermatitis in relation to food and inhalant allergy in adults and adolescents. FOOD AGR IMMUNOL 2016. [DOI: 10.1080/09540105.2016.1228838] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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Čelakovská J, Bukač J. Eosinophils in patients suffering from atopic dermatitis and the relation to the occurrence of food allergy and other atopic diseases. FOOD AGR IMMUNOL 2016. [DOI: 10.1080/09540105.2016.1148669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- J. Čelakovská
- Department of Dermatology and Venereology Faculty Hospital and Medical Faculty of Charles University, Hradec Králové, Czech Republic
| | - J. Bukač
- Department of Medical Biophysic, Medical Faculty of Charles University, Hradec Králové, Czech republic
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Pucheu-Haston CM, Eisenschenk MNC, Bizikova P, Marsella R, Nuttall T, Santoro D. Introduction to the review articles by ICADA on the pathogenesis of atopic dermatitis in dogs. Vet Dermatol 2015; 26:77-8. [PMID: 25808534 DOI: 10.1111/vde.12207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Cherie M Pucheu-Haston
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, 1909 Skip Bertman Drive, Baton Rouge, LA, 70803, USA.
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Pucheu-Haston CM, Bizikova P, Eisenschenk MNC, Santoro D, Nuttall T, Marsella R. Review: The role of antibodies, autoantigens and food allergens in canine atopic dermatitis. Vet Dermatol 2015; 26:115-e30. [DOI: 10.1111/vde.12201] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Cherie M. Pucheu-Haston
- Department of Veterinary Clinical Sciences; School of Veterinary Medicine; Louisiana State University; 1909 Skip Bertman Drive Baton Rouge LA 70803 USA
| | - Petra Bizikova
- Department of Clinical Sciences; College of Veterinary Medicine; North Carolina State University; 1060 William Moore Drive Raleigh NC 27606 USA
| | | | - Domenico Santoro
- Department of Small Animal Clinical Sciences; College of Veterinary Medicine; University of Florida; 2015 SW 16th Avenue Gainesville FL 32610 USA
| | - Tim Nuttall
- Royal (Dick) School of Veterinary Studies; Easter Bush Veterinary Centre; University of Edinburgh; Roslin EH25 9RG UK
| | - Rosanna Marsella
- Department of Small Animal Clinical Sciences; College of Veterinary Medicine; University of Florida; 2015 SW 16th Avenue Gainesville FL 32610 USA
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Čelakovská J, Ettlerová K, Ettler K, Bukač J. Food allergy, asthma bronchiale, and rhinitis in atopic dermatitis patients with total immunoglobulin E under and above 200 IU/ml. FOOD AGR IMMUNOL 2015. [DOI: 10.1080/09540105.2015.1007447] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease with specific genetic and immunological mechanisms. The rapid development of new techniques in molecular biology had ushered in new discoveries on the role of cytokines, chemokines, and immune cells in the pathogenesis of AD. New polymorphisms of AD are continually being reported in different populations. The physical and immunological barrier of normal intact skin is an important part of the innate immune system that protects the host against microbials and allergens that are associated with AD. Defects in the filaggrin gene FLG may play a role in facilitating exposure to allergens and microbial pathogens, which may induce Th2 polarization. Meanwhile, Th22 cells also play roles in skin barrier impairment through IL-22, and AD is often considered to be a Th2/Th22-dominant allergic disease. Mast cells and eosinophils are also involved in the inflammation via Th2 cytokines. Release of pruritogenic substances by mast cells induces scratching that further disrupts the skin barrier. Th1 and Th17 cells are mainly involved in chronic phase of AD. Keratinocytes also produce proinflammatory cytokines such as thymic stromal lymphopoietin (TSLP), which can further affect Th cells balance. The immunological characteristics of AD may differ for various endotypes and phenotypes. Due to the heterogeneity of the disease, and the redundancies of these mechanisms, our knowledge of the pathophysiology of the disease is still incomplete, which is reflected by the absence of a cure for the disease.
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Affiliation(s)
- Zhanglei Mu
- Department of Dermatology, Peking University People's Hospital, No11, Xizhimen South Street, Beijing, 100044, China
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Pathogenic intracellular and autoimmune mechanisms in urticaria and angioedema. Clin Rev Allergy Immunol 2014; 45:47-62. [PMID: 22674016 DOI: 10.1007/s12016-012-8326-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Urticaria and angioedema are common disorders. Chronic urticaria is defined as lasting longer than 6 weeks. Causes of chronic urticaria fall into the following categories: physical, allergic, hereditary, autoimmune, and idiopathic. Basophils and mast cells are the primary effector cells responsible for clinical symptoms and signs. These cells produce and secrete a variety of mediators including histamine, leukotrienes, prostaglandins, cytokines, chemokines, and other pro-inflammatory mediators. This leads to vasodilation, fluid exudation, increased vascular permeability, and accumulation of additional secondary inflammatory cells. Two mechanisms have been investigated as possibly contributing to the pathogenesis of chronic urticaria. One is the development of autoantibodies to FcεRI or IgE on mast cells and basophils. This appears to be responsible for 30-50 % of cases. The other is dysregulation of intracellular signaling pathways involving Syk, SHIP-1, or SHIP-2 in basophils and mast cells. The primary treatment for chronic urticaria is to treat the underlying pathology, if any can be identified. Otherwise, in idiopathic cases, H1 antihistamines, H2 antihistamines, antileukotrienes, and corticosteroids constitute the main pharmacologic treatment modalities. In severe and recalcitrant cases of chronic and autoimmune urticaria, immunosuppressive drugs have been used, most commonly cyclosporin. More recent experimental studies have also suggested that omalizumab, an anti-IgE therapy, may be of benefit. Currently, inhibitors of Syk are also being developed and tested in the laboratory and in animal models. As our understanding of the pathogenesis of idiopathic urticaria increases, development of additional drugs targeting these pathways may provide relief for the significant physical and psychological morbidity experienced by patients with this disorder.
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Abstract
Atopic dermatitis (AD) continues to present significant therapeutic challenges, especially in severe cases. Navigating the line between risk and benefit can be difficult for more powerful medications such as immunosuppressants, but non-pharmacologic treatments are often overlooked and underutilized. Creative application of these more physical therapies can serve to minimize the pharmacologic treatments and their side effects, and possibly even create synergy between modalities, to maximize benefit to the patient.
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Affiliation(s)
- Peter A Lio
- Clinical Dermatology & Pediatrics, Northwestern University Feinberg School of Medicine, 1455 N. Milwaukee Ave, 2nd Floor, Chicago, IL, 60622, USA,
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Abstract
Asthma is a syndrome which is seen by physicians in nearly every specialty and affects millions of people throughout the world. Although the geoepidemiology with respect to prevalence and incidence of asthma does vary, even under the most mild of circumstance, asthma is among the leading causes of school absenteeism, work loss, and physician visits. In the past, it was considered primarily a disorder of childhood. Hence, the adage that children outgrow their asthma. We now realize that children really only outgrow their pediatrician and the genetic predisposition to asthma and bronchial hyperactivity persists throughout life. This issue is devoted to key papers that focus on important clinical problems in allergies and asthma. This issue is dedicated to helping the many sufferers of asthma with the hope that this topic will eventually become a medical anachronism.
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Marsella R. An update on the treatment of canine atopic dermatitis. VETERINARY MEDICINE (AUCKLAND, N.Z.) 2012; 3:85-91. [PMID: 30101088 PMCID: PMC6067670 DOI: 10.2147/vmrr.s28488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Remarkable progress has been made in recent years concerning our understanding of the pathogenesis of canine atopic dermatitis (AD). As our understanding improves, the therapeutic approach evolves. Of utmost importance is the documentation of skin barrier impairment in canine AD: ceramides deficiency leads to increased permeability and increased allergen penetration and sensitization. It is currently unknown whether this dysfunction is primary and genetically inherited or secondary to inflammation but it is accepted that skin barrier deficiency plays an important role in either starting or minimally exacerbating canine AD. Thus, the therapeutic approach has changed from focusing on the control of the inflammation to a combined approach that includes therapies aimed at skin barrier repair. The issue of skin barrier repair has been addressed both with oral administration of essential fatty acids and the topical application of products containing a combination of ceramides and fatty acids. These strategies are most helpful as adjunctive treatments and would be best used in young patients that have not developed chronic skin changes. Importantly, treatment for canine AD is multimodal and tailored to the individual patient, the age, and the duration of the disease. Client education plays an important role in explaining the importance of a long-term approach to minimize flare-ups and, in this context, topical therapy to correct skin barrier can be of great benefit. This is an area still in infancy and much work is needed to identify the best formulation. In human medicine, long-term use of moisturizers can have a profound effect on skin barrier and gene expression of proteins involved in skin barrier. This effect is variable depending on the formulation used. It is reasonable to speculate that the same may be true in dogs; thus, it is very important to identify the correct ingredients and formulation to use.
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Affiliation(s)
- Rosanna Marsella
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida Gainesville, FL, USA,
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Affiliation(s)
- Laurent Misery
- Laboratory of Skin Neurobiology, Department of Dermatology, University Hospital, University of Brest, France.
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