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İlgün Gürel D, Ünsal H, Soyak Aytekin E, Soyer Ö, Şahiner Ü, Ersoy Evans S, Şekerel BE. The treatment journey of children with moderate to severe atopic dermatitis in Türkiye: unmet needs. Turk J Pediatr 2024; 66:265-274. [PMID: 39024597 DOI: 10.24953/turkjpediatr.2024.4569] [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] [Received: 11/08/2023] [Accepted: 05/22/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Atopic dermatitis (AD) substantially burdens individuals, families, and healthcare systems. We aimed to document the treatment journey of pediatric patients with moderate-to-severe AD in a referral center based in our country. METHODS This retrospective study reviewed patients aged 1-18 years diagnosed with AD, seeking systemic treatment recommendations from the "pediatric allergy and dermatology multidisciplinary team meeting". RESULTS Over the 14-month study period, 30 (12.5%) of 240 AD patients were evaluated in the pediatric dermato-allergy team meetings. The median age of the patients was 13.66 years (Q1-Q3: 7.94-17.27), of whom 60% were male. The median annual healthcare visits for AD were 4 (Q1-Q3: 1.00-8.75). Among the study group, 70% were sensitized to aeroallergens, and admission markers included total IgE (median: 1980 IU/mL, Q1-Q3: 794.50-5446), and eosinophil counts (median: 650, Q1-Q3: 275-1275). All patients utilized intermittent and/or continuous topical corticosteroids (CS), with 56.6% employing short-term/long-term topical tacrolimus. Over the past two years, systemic CSs were utilized in 93.3% of the patients, whereas 57.1% received more than one course. Approximately 43.3% of the patients agreed to receive systemic cyclosporine treatment, with only 30.8% benefiting and 3.3% reporting adverse effects (hypertrichosis and cellulitis). Three patients self-funded dupilumab, all benefiting without adverse effects. Omalizumab, mycophenolate mofetil and narrow-band ultraviolet (UV) treatments were used in one patient each, with limited benefit observed. Health insurance did not grant approval for a Janus kinase inhibitor for one patient. CONCLUSIONS Managing moderate to severe AD is complex and costly, considering disease heterogeneity, comorbidities, care pathways, and health system challenges. Addressing the unmet needs should be a priority in Türkiye's healthcare systems.
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Affiliation(s)
- Deniz İlgün Gürel
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Hilal Ünsal
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Elif Soyak Aytekin
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Özge Soyer
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Ümit Şahiner
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Sibel Ersoy Evans
- Department of Dermatology, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Bülent Enis Şekerel
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Türkiye
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Rijst LPVD, Groot KMDWD, Zuithoff NPA, de Bruin-Weller MS, de Graaf M. Effect of dupilumab on asthma and aeroallergen sensitization in pediatric atopic dermatitis patients: Results of the BioDay registry. Pediatr Allergy Immunol 2024; 35:e14178. [PMID: 38899688 DOI: 10.1111/pai.14178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/31/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Atopic dermatitis (AD) is frequently associated with asthma and allergic rhinitis (AR). Dupilumab is an effective treatment for pediatric AD, although the effect on atopic comorbidities in pediatric AD patients is limited. OBJECTIVE To investigate the prevalence of asthma and AR in pediatric AD patients starting dupilumab treatment and to evaluate the effect of dupilumab on these comorbidities. METHODS This study included pediatric AD patients (aged 3-17 years) treated with dupilumab between 2019 and 2023. Patients were screened at baseline by a pulmonologist for the presence of asthma and AR. Screening included evaluation of medical history and current symptoms, spirometry (including Forced Expiratory Volume in 1 s (FEV1)), Fractional exhaled Nitric Oxide (FeNO), and measurement of aeroallergen-specific IgE levels. In patients diagnosed with comorbid asthma and/or AR, measurements were repeated at weeks 16 and 52. Spirometry measurements, FeNO, and aeroallergen-specific IgE levels during treatment were analyzed using a covariance pattern model. RESULTS Eighty-four patients were included. Asthma was diagnosed in 50 patients (59.5%) and AR in 72 patients (85.7%). Baseline FeNO levels were elevated in both patients with (29.0 ppb (95% CI 22.0-54.0)) and without asthma (26.0 ppb (95% CI 22.0-30.0)). During treatment, FeNO levels decreased (p < .001) and FEV1 scores increased (p < .001) in patients with asthma. In patients with asthma and/or AR, all aeroallergen-specific IgE levels decreased between 61.3% and 89.1% at 52 weeks of treatment. CONCLUSION One year of dupilumab treatment, primarily indicated for AD, resulted in a significant improvement in comorbid asthma and a profound decrease in aeroallergen-specific IgE levels in patients with asthma and/or AR.
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Affiliation(s)
- Lisa P van der Rijst
- Department of Dermatology and Allergology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht University, Utrecht, The Netherlands
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Karin M de Winter-de Groot
- Department of Pediatric Pulmonology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht University, Utrecht, The Netherlands
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marjolein S de Bruin-Weller
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marlies de Graaf
- Department of Dermatology and Allergology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht University, Utrecht, The Netherlands
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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3
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Lee S, Sbihi H, MacIsaac JL, Balshaw R, Ambalavanan A, Subbarao P, Mandhane PJ, Moraes TJ, Turvey SE, Duan Q, Brauer M, Brook JR, Kobor MS, Jones MJ. Persistent DNA Methylation Changes across the First Year of Life and Prenatal NO2 Exposure in a Canadian Prospective Birth Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:47004. [PMID: 38573328 DOI: 10.1289/ehp13034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
BACKGROUND Evidence suggests that prenatal air pollution exposure alters DNA methylation (DNAm), which could go on to affect long-term health. It remains unclear whether DNAm alterations present at birth persist through early life. Identifying persistent DNAm changes would provide greater insight into the molecular mechanisms contributing to the association of prenatal air pollution exposure with atopic diseases. OBJECTIVES This study investigated DNAm differences associated with prenatal nitrogen dioxide (NO 2 ) exposure (a surrogate measure of traffic-related air pollution) at birth and 1 y of age and examined their role in atopic disease. We focused on regions showing persistent DNAm differences from birth to 1 y of age and regions uniquely associated with postnatal NO 2 exposure. METHODS Microarrays measured DNAm at birth and at 1 y of age for an atopy-enriched subset of Canadian Health Infant Longitudinal Development (CHILD) study participants. Individual and regional DNAm differences associated with prenatal NO 2 (n = 128 ) were identified, and their persistence at age 1 y were investigated using linear mixed effects models (n = 124 ). Postnatal-specific DNAm differences (n = 125 ) were isolated, and their association with NO 2 in the first year of life was examined. Causal mediation investigated whether DNAm differences mediated associations between NO 2 and age 1 y atopy or wheeze. Analyses were repeated using biological sex-stratified data. RESULTS At birth (n = 128 ), 18 regions of DNAm were associated with NO 2 , with several annotated to HOX genes. Some of these regions were specifically identified in males (n = 73 ), but not females (n = 55 ). The effect of prenatal NO 2 across CpGs within altered regions persisted at 1 y of age. No significant mediation effects were identified. Sex-stratified analyses identified postnatal-specific DNAm alterations. DISCUSSION Regional cord blood DNAm differences associated with prenatal NO 2 persisted through at least the first year of life in CHILD participants. Some differences may represent sex-specific alterations, but replication in larger cohorts is needed. The early postnatal period remained a sensitive window to DNAm perturbations. https://doi.org/10.1289/EHP13034.
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Affiliation(s)
- Samantha Lee
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
- Biology of Breathing Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Hind Sbihi
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julia L MacIsaac
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Robert Balshaw
- Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Padmaja Subbarao
- Department of Pediatrics & Translational Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Piushkumar J Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Medicine, USCI University, Kuala Lumpur, Malaysia
| | - Theo J Moraes
- Department of Pediatrics & Translational Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Stuart E Turvey
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Qingling Duan
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
- School of Computing, Queen's University, Kingston, Ontario, Canada
| | - Michael Brauer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey R Brook
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Michael S Kobor
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Meaghan J Jones
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
- Biology of Breathing Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
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Li B, Fuxench ZC. Atopic Dermatitis: Disease Background and Risk Factors. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1447:11-19. [PMID: 38724780 DOI: 10.1007/978-3-031-54513-9_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
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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Affiliation(s)
- Becky Li
- Department of Dermatology, Howard University School of Medicine, Washington, DC, USA
| | - Zelma Chiesa Fuxench
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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Sato T, Nikolovski J, Gould R, Lboukili I, Roux P, Al‐Ghalith G, Orie J, Insel R, Stamatas GN. Skin surface biomarkers are associated with future development of atopic dermatitis in children with family history of allergic disease. Skin Res Technol 2023; 29:e13470. [PMID: 37881058 PMCID: PMC10582603 DOI: 10.1111/srt.13470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/06/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is a common childhood chronic inflammatory skin disorder that can significantly impact quality of life and has been linked to the subsequent development of food allergy, asthma, and allergic rhinitis, an association known as the "atopic march." OBJECTIVE The aim of this study was to identify biomarkers collected non-invasively from the skin surface in order to predict AD before diagnosis across a broad age range of children. METHODS Non-invasive skin surface measures and biomarkers were collected from 160 children (3-48 months of age) of three groups: (A) healthy with no family history of allergic disease, (B) healthy with family history of allergic disease, and (C) diagnosed AD. RESULTS Eleven of 101 children in group B reported AD diagnosis in the subsequent 12 months following the measurements. The children who developed AD had increased skin immune markers before disease onset, compared to those who did not develop AD in the same group and to the control group. In those enrolled with AD, lesional skin was characterized by increased concentrations of certain immune markers and transepidermal water loss, and decreased skin surface hydration. CONCLUSIONS Defining risk susceptibility before onset of AD through non-invasive methods may help identify children who may benefit from early preventative interventions.
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Affiliation(s)
- Takahiro Sato
- Janssen Research & Development, LLCRaritanNew JerseyUSA
| | | | - Russell Gould
- Janssen Research & Development, LLCRaritanNew JerseyUSA
| | - Imane Lboukili
- Essential Health Translational ScienceJohnson & Johnson Santé Beauté FranceIssy‐les‐MoulineauxFrance
| | - Pierre‐Francois Roux
- Essential Health Translational ScienceJohnson & Johnson Santé Beauté FranceIssy‐les‐MoulineauxFrance
| | | | - Jeremy Orie
- Janssen Research & Development, LLCRaritanNew JerseyUSA
| | - Richard Insel
- Janssen Research & Development, LLCRaritanNew JerseyUSA
| | - Georgios N. Stamatas
- Essential Health Translational ScienceJohnson & Johnson Santé Beauté FranceIssy‐les‐MoulineauxFrance
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Gulec Koksal Z, Uysal P. Beyond the Skin: Reduced Lung Function Associated With Atopic Dermatitis in Infants. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2839-2847. [PMID: 37406805 DOI: 10.1016/j.jaip.2023.06.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/04/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Very few studies have examined lung function parameters using tidal breath analysis (TBA) in atopic dermatitis (AD) with its high potential for progression to asthma. OBJECTIVE To measure lung functions using TBA in infants with AD and in healthy controls (HCs), and to investigate the effects of disease severity, food sensitivity, and history of recurrent wheezing on TBA parameters in infants with AD. METHODS Two hundred thirty infants were included in this prospective cross-sectional study, including an AD group (n = 150) and an HC group (n = 80). Food sensitivity was assessed by means of food-specific IgE or the skin prick test. The severity of the disease was evaluated using the SCORing Atopic Dermatitis. Lung function was assessed using TBA. RESULTS The following TBA parameters were significantly lower in the AD group than in the HC group (P < .05): time to peak tidal expiratory flow, exhaled volume to peak tidal expiratory flow, ratio of time to peak tidal expiratory flow to expiratory time, ratio of exhaled volume to peak tidal expiratory flow to total expiratory volume, expiratory flow when 25% of tidal volume remains in the lungs, respiratory rate, and minute ventilation. No difference was observed in the AD group when TBA parameters were compared according to disease severity, food sensitivity, and history of recurrent wheezing (P > .05). The receiver-operating characteristic curve demonstrated by the ratio of time to peak tidal expiratory flow to expiratory time yielded an area under the curve of 0.826 (CI, 0.772-0.879), with a cutoff value of 31.65 or higher in differentiating AD, with a sensitivity of 78.7% and a specificity of 77.5%. CONCLUSIONS TBA curves can be a useful tool for demonstrating expiratory airway obstruction in AD and for providing objective information for the clinician. Bronchial obstruction was detected in young children with AD irrespective of the severity of the disease, food sensitivity, and history of recurrent wheezing.
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Affiliation(s)
- Zeynep Gulec Koksal
- Department of Pediatric Allergy and Immunology, Aydin Adnan Menderes University Faculty of Medicine, Aydin, Turkey.
| | - Pinar Uysal
- Department of Pediatric Allergy and Immunology, Aydin Adnan Menderes University Faculty of Medicine, Aydin, Turkey
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Alashkar Alhamwe B, López JF, Zhernov Y, von Strandmann EP, Karaulov A, Kolahian S, Geßner R, Renz H. Impact of local human microbiota on the allergic diseases: Organ-organ interaction. Pediatr Allergy Immunol 2023; 34:e13976. [PMID: 37366206 DOI: 10.1111/pai.13976] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 05/22/2023] [Accepted: 06/02/2023] [Indexed: 06/28/2023]
Abstract
The homogeneous impact of local dysbiosis on the development of allergic diseases in the same organ has been thoroughly studied. However, much less is known about the heterogeneous influence of dysbiosis within one organ on allergic diseases in other organs. A comprehensive analysis of the current scientific literature revealed that most of the relevant publications focus on only three organs: gut, airways, and skin. Moreover, the interactions appear to be mainly unidirectional, that is, dysbiotic conditions of the gut being associated with allergic diseases of the airways and the skin. Similar to homogeneous interactions, early life appears to be not only a crucial period for the formation of the microbiota in one organ but also for the later development of allergic diseases in other organs. In particular, we were able to identify a number of specific bacterial and fungal species/genera in the intestine that were repeatedly associated in the literature with either increased or decreased allergic diseases of the skin, like atopic dermatitis, or the airways, like allergic rhinitis and asthma. The reported studies indicate that in addition to the composition of the microbiome, also the relative abundance of certain microbial species and the overall diversity are associated with allergic diseases of the corresponding organs. As anticipated for human association studies, the underlying mechanisms of the organ-organ crosstalk could not be clearly resolved yet. Thus, further work, in particular experimental animal studies are required to elucidate the mechanisms linking dysbiotic conditions of one organ to allergic diseases in other organs.
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Affiliation(s)
- Bilal Alashkar Alhamwe
- Institute of Laboratory Medicine, Member of the German Center for Lung Research (DZL), and the Universities of Giessen and Marburg Lung Center (UGMLC), Philipps University Marburg, Marburg, Germany
- Institute of Tumor Immunology, Clinic for Hematology, Oncology and Immunology, Center for Tumor Biology and Immunology, Philipps University Marburg, Marburg, Germany
- College of Pharmacy, International University for Science and Technology (IUST), Daraa, Syria
| | - Juan-Felipe López
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia
| | - Yury Zhernov
- Department of General Hygiene, F. Erismann Institute of Public Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Department of Chemistry, Lomonosov Moscow State University, Moscow, Russia
| | - Elke Pogge von Strandmann
- Institute of Tumor Immunology, Clinic for Hematology, Oncology and Immunology, Center for Tumor Biology and Immunology, Philipps University Marburg, Marburg, Germany
| | - Alexander Karaulov
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Saeed Kolahian
- Institute of Laboratory Medicine, Member of the German Center for Lung Research (DZL), and the Universities of Giessen and Marburg Lung Center (UGMLC), Philipps University Marburg, Marburg, Germany
| | - Reinhard Geßner
- Institute of Laboratory Medicine, Member of the German Center for Lung Research (DZL), and the Universities of Giessen and Marburg Lung Center (UGMLC), Philipps University Marburg, Marburg, Germany
| | - Harald Renz
- Institute of Laboratory Medicine, Member of the German Center for Lung Research (DZL), and the Universities of Giessen and Marburg Lung Center (UGMLC), Philipps University Marburg, Marburg, Germany
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Anand P, Schneeweiss S, Mostaghimi A, Schneeweiss MC. Use patterns of systemic immunomodulators in the United States before and after dupilumab approval in adults with atopic dermatitis. Pharmacoepidemiol Drug Saf 2023; 32:567-576. [PMID: 36527432 PMCID: PMC10073264 DOI: 10.1002/pds.5586] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/09/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE The patterns of dupilumab use, the first systemic drug approved for the treatment of atopic dermatitis (AD), is not well understood in the context of off-label systemic medications. OBJECTIVE To describe patterns of prescribing, switching and discontinuing systemic AD drugs, before and after the approval of dupilumab and understand variables associated with dupilumab prescription. METHODS Using longitudinal claims data, we identified patients with AD who initiated a systemic therapy (dupilumab, cyclosporine, methotrexate, azathioprine, mycophenolate) from March 2015 to February 2021, with a washout period of 1 year. We used Sankey plots to visualize longitudinal patterns of use at 3, 6, and 12 months and logistic regression to determine associates of dupilumab prescription. RESULTS The number of patients starting systemic treatment increased from 319 before dupilumab approval to 1358 after. Dupilumab use increased from 72% to 84%. In 2019-2020, 36% of patients discontinued systemic treatment within a year compared to 62% in 2015-2016. 92% of patients who started dupilumab in 2020-2021 had received no other systemic treatment before. Patients <60 years and those who used steroid-sparing topical treatments were more likely to receive dupilumab. CONCLUSION Among new users of a systemic treatment for AD, dupilumab was most used treatment by far.
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Affiliation(s)
- Priyanka Anand
- Division of Pharmacoepidemiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Arash Mostaghimi
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Maria C Schneeweiss
- Division of Pharmacoepidemiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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9
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Msallam R, Redegeld FA. Mast cells-fetal mast cells crosstalk with maternal interfaces during pregnancy: Friend or foe? Pediatr Allergy Immunol 2023; 34:e13943. [PMID: 37102389 DOI: 10.1111/pai.13943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 03/04/2023] [Accepted: 03/08/2023] [Indexed: 04/28/2023]
Abstract
Mast cells (MC) are hematopoietic immune cells that play a major role during allergic reactions in adults by releasing a myriad of vasoactive and inflammatory mediators. MC seed all vascularized tissues and are most prominent in organs with a barrier function such as skin, lungs, and intestines. These secreted molecules cause mild symptoms such as localized itchiness and sneezing to life-threatening symptoms (i.e., anaphylactic shock). Presently, despite the extensive research on Th2-mediated immune responses in allergic diseases in adults, we are still unable to determine the mechanisms of the role of MC in developing pediatric allergic (PA) disorders. In this review, we will summarize the most recent findings on the origin of MC and discuss the underappreciated contribution of MC in the sensitization phase to maternal antibodies during pregnancy in allergic reactions and other diseases such as infectious diseases. Then, we will lay out potential MC-dependent therapeutic strategies to be considered in future investigations to understand the remaining gaps in MC research for a better quality of life for these young patients.
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Affiliation(s)
- Rasha Msallam
- Next Gen of Immunology (NGIg) Consultancy, Dubai, UAE
| | - Frank A Redegeld
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
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Koumaki D, Gregoriou S, Evangelou G, Krasagakis K. Pruritogenic Mediators and New Antipruritic Drugs in Atopic Dermatitis. J Clin Med 2023; 12:2091. [PMID: 36983094 PMCID: PMC10054239 DOI: 10.3390/jcm12062091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/30/2023] Open
Abstract
Atopic dermatitis (AD) is a common highly pruritic chronic inflammatory skin disorder affecting 5-20% of children worldwide, while the prevalence in adults varies from 7 to 10%. Patients with AD experience intense pruritus that could lead to sleep disturbance and impaired quality of life. Here, we analyze the pathophysiology of itchiness in AD. We extensively review the histamine-dependent and histamine-independent pruritogens. Several receptors, substance P, secreted molecules, chemokines, and cytokines are involved as mediators in chronic itch. We also, summarize the new emerging antipruritic drugs in atopic dermatitis.
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Affiliation(s)
- Dimitra Koumaki
- Dermatology Department, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Stamatios Gregoriou
- Department of Dermatology and Venereology, Andreas Sygros Hospital, Medical School of Athens, National and Kapodistrian University of Athens, 16121 Athens, Greece
| | - George Evangelou
- Dermatology Department, University Hospital of Heraklion, 71110 Heraklion, Greece
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11
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Allergy, asthma, and proteomics: opportunities with immediate impact. Allergol Immunopathol (Madr) 2023; 51:16-21. [PMID: 36617817 DOI: 10.15586/aei.v51i1.567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 09/08/2022] [Indexed: 01/03/2023]
Abstract
Allergy is widely discussed by researchers due to its complex mechanism that leads to disorders and injuries, but the reason behind the allergic status remains unclear. Current treatments are insufficient to improve the patient's quality of life significantly. New technologies in scientific and technological development are emerging. For instance, the union between allergy and peptidomics and bioinformatics tools may help fill the gaps in this field, diagnosis, and treatment. In this review, we look at peptidomics and address some findings, such as target proteins or biomarkers that help better understand mechanisms that lead to inflammation, organ damage, and, consequently, poor quality of life or even death.
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12
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Anand P, Schneeweiss S, Mostaghimi A, Schneeweiss MC. Longitudinal utilization of systemic immunomodulators before and after dupilumab approval in children with atopic dermatitis. Pediatr Dermatol 2023; 40:132-134. [PMID: 36403606 PMCID: PMC9868069 DOI: 10.1111/pde.15172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/16/2022] [Indexed: 11/22/2022]
Abstract
In our cohort study, we sought to describe the utilization patterns of systemic immunomodulators in children with atopic dermatitis (AD) and how utilization changed after approval of dupilumab, the first systemic drug approved for the treatment of AD. Using US nationwide claims data, we identified children with AD who initiated a systemic therapy (dupilumab, cyclosporine, methotrexate, azathioprine, and mycophenolate mofetil) from March 2015 to February 2021 and used Sankey plots to describe patterns of starting, switching, and discontinuing these drugs. Dupilumab use among children increased from 19.4% before approval in children to 88.3% after approval in 2019-20. Adherence to dupilumab may suggest better tolerance and improved outcomes in children with AD.
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Affiliation(s)
- Priyanka Anand
- Division of Pharmacoepidemiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Arash Mostaghimi
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Maria C Schneeweiss
- Division of Pharmacoepidemiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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13
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Kumar R, Gaur S, Agarwal M, Menon B, Goel N, Mrigpuri P, Spalgais S, Priya A, Kumar K, Meena R, Sankararaman N, Verma A, Gupta V, Sonal, Prakash A, Safwan MA, Behera D, Singh A, Arora N, Prasad R, Padukudru M, Kant S, Janmeja A, Mohan A, Jain V, Nagendra Prasad K, Nagaraju K, Goyal M. Indian Guidelines for diagnosis of respiratory allergy. INDIAN JOURNAL OF ALLERGY, ASTHMA AND IMMUNOLOGY 2023. [DOI: 10.4103/0972-6691.367373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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14
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Peng Z, Kurz D, Weiss JM, Brenner H, Rothenbacher D, Genuneit J. Latent classes of atopic dermatitis and food allergy development in childhood. Pediatr Allergy Immunol 2022; 33:e13881. [PMID: 36433859 DOI: 10.1111/pai.13881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 10/01/2022] [Accepted: 10/25/2022] [Indexed: 11/14/2022]
Affiliation(s)
- Zhuoxin Peng
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Deborah Kurz
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Johannes M Weiss
- Department of Dermatology and Allergology, University Medical Center Ulm, Ulm, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,German Center of Child and Youth Health (DZKJ), Germany
| | - Jon Genuneit
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany.,Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,German Center of Child and Youth Health (DZKJ), Germany
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15
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Distributing Written Action Plans to Control Eczema Symptoms in Children. JOURNAL OF THE DERMATOLOGY NURSES' ASSOCIATION 2022. [DOI: 10.1097/jdn.0000000000000711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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16
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Singh S, Behl T, Sharma N, Zahoor I, Chigurupati S, Yadav S, Rachamalla M, Sehgal A, Naved T, Arora S, Bhatia S, Al-Harrasi A, Mohan S, Aleya L, Bungau S. Targeting therapeutic approaches and highlighting the potential role of nanotechnology in atopic dermatitis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:32605-32630. [PMID: 35195869 DOI: 10.1007/s11356-021-18429-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/27/2021] [Indexed: 06/14/2023]
Abstract
Atopic dermatitis is a chronic as well as widespread skin disease which has significant influence on the life attributes of affected people and their families. Systemic immunosuppressive drugs can be utilised for effective care of disease, although they are often prescribed for rigorous disruption or disease that is complicated to manage. Therefore, topical applications of corticosteroids are considered the primary pharmacologic therapies for atopic dermatitis, and research recommends that these medications might be helpful in preventing disease flare-ups. However, topical medicine administration to deeper layers of skin is challenging because of the skin anatomic barrier that restricts deeper drug permeation, and also due to barrier function abnormalities in atopic dermatitis skin, which might result in systemic drug absorption, provoking systemic consequences. Hence, effective management of atopic dermatitis needs new, effective, safe and targeted treatments. Therefore, nanotechnology-based topical therapeutics have attracted much interest nowadays because of their tendency to increase drug diffusion and bioavailability along with enormous drug targeting potential to affected cells, and, thereby, reducing the adverse effects of medications. In this review, we mention different symptoms of atopic dermatitis, and provide an overview of the different triggering factors causing atopic dermatitis, with emphasis on its epidemiology, pathophysiology, clinical features and diagnostic, and preventive measures. This review discusses existing therapeutics for treating atopic dermatitis, and the newer approaches as well as the current classical pharmacotherapy of atopic dermatitis against new nanoparticle skin delivery systems. This review has also briefly summarised the recent patents and clinical status of therapeutic modalities for atopic dermatitis.
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Affiliation(s)
- Sukhbir Singh
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Tapan Behl
- Chitkara College of Pharmacy, Chitkara University, Punjab, India.
| | - Neelam Sharma
- Chitkara College of Pharmacy, Chitkara University, Punjab, India.
| | - Ishrat Zahoor
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Sridevi Chigurupati
- Department of Medicine Chemistry and Pharmacognosy, Qassim University, Buraidah, Kingdom of Saudi Arabia
| | - Shivam Yadav
- Yashraj Institute of Pharmacy, Noida, Uttar Pradesh, India
| | - Mahesh Rachamalla
- Department of Biology, University of Saskatchewan, 112 Science Place, Saskatoon, Canada
| | - Aayush Sehgal
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Tanveer Naved
- Amity Institute of Pharmacy, Amity University, Noida, Uttar Pradesh, India
| | - Sandeep Arora
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Saurabh Bhatia
- Natural & Medical Sciences Research Center, University of Nizwa, Nizwa, Oman
- School of Health Science, University of Petroleum and Energy Studies, Dehradun, Uttarakhand, India
| | - Ahmed Al-Harrasi
- Natural & Medical Sciences Research Center, University of Nizwa, Nizwa, Oman
| | - Syam Mohan
- Substance Abuse and Toxicology Research Center, Jazan University, Jazan, Saudi Arabia
| | - Lotfi Aleya
- School of Health Science, University of Petroleum and Energy Studies, Dehradun, Uttarakhand, India
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
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17
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Lopez DJ, Lodge CJ, Bui DS, Waidyatillake NT, Abramson MJ, Perret JL, Su JC, Erbas B, Svanes C, Dharmage SC, Lowe AJ. Establishing subclasses of childhood eczema, their risk factors and prognosis. Clin Exp Allergy 2022; 52:1079-1090. [PMID: 35347774 PMCID: PMC9546228 DOI: 10.1111/cea.14139] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 02/02/2023]
Abstract
Background The heterogeneity of development and progression of eczema suggests multiple underlying subclasses for which aetiology and prognosis may vary. A better understanding may provide a comprehensive overview of eczema development and progression in childhood. Thus, we aimed to determine longitudinal eczema subclasses based on assessments and identify their associations with risk factors and allergic outcomes. Methods A total of 619 participants with a family history of allergic disease were assessed at 24 time‐points from birth to 12 years. At each time, eczema was defined as the report of current rash treated with topical steroid‐based preparations. Longitudinal latent class analysis was used to determine eczema subclasses. Subsequent analyses using regression models assessed the associations between eczema subclasses and potential risk factors and allergic outcomes at 18‐ and 25‐year follow‐ups (eczema, allergic rhinitis, asthma and allergic sensitization). Results We identified five eczema subclasses ‘early‐onset persistent’, ‘early‐onset resolving’, ‘mid‐onset persistent’, ‘mid‐onset resolving’ and ‘minimal eczema’. Filaggrin null mutations were associated with the early‐onset persistent (OR = 2.58 [1.09–6.08]) and mid‐onset persistent class (OR = 2.58 [1.32–5.06]). Compared with ‘minimal eczema’, participants from early‐onset persistent class had higher odds of eczema (OR = 11.8 [5.20–26.6]) and allergic rhinitis (OR = 3.13 [1.43–6.85]) at 18 and at 25 years eczema (OR = 9.37 [3.17–27.65]), allergic rhinitis (OR = 3.26 [1.07–9.93]) and asthma (OR = 2.91 [1.14–7.43]). Likewise, mid‐onset persistent class had higher odds of eczema (OR = 2.59 [1.31–5.14]), allergic rhinitis (OR = 1.70 [1.00–2.89]) and asthma (OR = 2.00 [1.10–3.63]) at 18 and at 25 years eczema (OR = 6.75 [3.11–14–65]), allergic rhinitis (OR = 2.74 [1.28–5.88]) and asthma (OR = 2.50 [1.25–5.00]). Allergic and food sensitization in early life was more common in those in the persistent eczema subclasses. Conclusion We identified five distinct eczema subclasses. These classes were differentially associated with risk factors, suggesting differences in aetiology, and also with the development of allergic outcomes, highlighting their potential to identify high‐risk groups for close monitoring and intervention.
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Affiliation(s)
- Diego J Lopez
- Allergy and Lung Health Unit, The University of Melbourne, Melbourne, Victoria, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dinh S Bui
- Allergy and Lung Health Unit, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nilakshi T Waidyatillake
- Allergy and Lung Health Unit, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Medical Education, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jennifer L Perret
- Allergy and Lung Health Unit, The University of Melbourne, Melbourne, Victoria, Australia
| | - John C Su
- Department of Dermatology, Monash University, Melbourne, Victoria, Australia.,Population allergy group, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Bircan Erbas
- Department of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Cecilie Svanes
- Centre for International Health, University of Bergen, Bergen, Norway.,Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, The University of Melbourne, Melbourne, Victoria, Australia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, The University of Melbourne, Melbourne, Victoria, Australia.,School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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18
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Li Y, Li Q, Cao Z, Wu J. The causal association of polyunsaturated fatty acids with allergic disease: A two-sample Mendelian randomization study. Front Nutr 2022; 9:962787. [PMID: 36159460 PMCID: PMC9500587 DOI: 10.3389/fnut.2022.962787] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/22/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives Previous studies have reported a potential association of polyunsaturated fatty acids (PUFAs) levels with allergic disease risk and the possible benefit of PUFAs supplementation on allergic disease prevention. This study was performed to estimate the genetic association between PUFAs and allergic diseases using the method of both univariable and multivariable two-sample Mendelian randomization (MR). Methods As indicators of the PUFAs levels, we included the omega-3, omega-6, docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), linoleic acid (LA), and the ratio of omega-6 to omega-3 (omega-6:3). Summarized statistics of genome-wide association studies (GWASs) for these PUFAs were obtained from the United Kingdom Biobank and the Twins United Kingdom cohort. Genetic data relating to allergic diseases, including atopic dermatitis (AD), allergic rhinitis (AR), allergic conjunctivitis (AC), allergic urticaria (AU) and asthma, were accessed from the FinnGen biobank analysis. Odds ratios and 95% CIs were used to express the impact. Results The MR results denoted a genetic association between the genetically determined increase in omega-3 levels and the decreased risk of some allergic diseases including AD (OR: 0.863; 95% CI: 0.785 to 0.949; p = 3.86E-03), AC (OR:0.720; 95% CI: 0.547 to 0.947; p = 1.87E-02) and AU (OR:0.821; 95% CI: 0.684 to 0.985; p = 3.42E-02), while omega-6 and DHA level was only found to have negatively correlation with risk of AC with ORs of 0.655 (95% CI: 0.445 to 0.964; p = 3.18E-02) and 0.671 (95% CI 0.490 to 0.918; p = 1.25E-02), respectively. Omega-6:3 were causally significantly associated with the increased risk of AD (OR:1.171; 95% CI: 1.045 to 1.312; p = 6.46E-03) and AC (IVW: OR:1.341; 95% CI: 1.032 to 1.743; p = 2.83E-02). After adjustment of age, economic level, BMI, smoking and alcohol behaviors in the multivariable MR analysis, a direct causal protective effect of omega-3 on AD and AC, as well as a direct causal association between DHA and AD were observed. Omega-6:3 was also found to be directly associated with an increased risk of AD and AC. No association was found of EPA or LA with allergic diseases. Conclusion Higher PUFA concentrations (omega-3, omega-6, DHA) and lower omega-6:3 ratios were genetically associated with a lower risk of some allergic diseases.
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Affiliation(s)
- Yajia Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Qiangxiang Li
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Ningxia Geriatric Disease Clinical Research Center, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China.,Hunan People's Hospital, Department of Hunan Institute of Geriatrics, Changsha, China
| | - Ziqin Cao
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Jianhuang Wu
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
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19
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Potential Role of Omega-3 Polyunsaturated Fatty Acids in Pediatric Food Allergy. Nutrients 2021; 14:nu14010152. [PMID: 35011028 PMCID: PMC8746967 DOI: 10.3390/nu14010152] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/22/2021] [Accepted: 12/24/2021] [Indexed: 02/07/2023] Open
Abstract
Polyunsaturated fatty acids (PUFAs) are involved both in immune system regulation and inflammation. In particular, within the PUFAs category, omega-3 (ω-3) may reduce inflammation, whereas omega-6 (ω-6) PUFAs are generally considered to have a proinflammatory effect. Recent evidence highlights an imbalance in the ω-3:ω-6 ratio with an increased intake of ω-6, as a consequence of the shift towards a westernized diet. In critical age groups such as infants, toddlers and young children, as well as pregnant and lactating women or fish allergic patients, ω-3 intake may be inadequate. This review aims to discuss the potential beneficial effects of PUFAs on pediatric food allergy prevention and treatment, both at prenatal and postnatal ages. Data from preclinical studies with PUFAs supplementation show encouraging effects in suppressing allergic response. Clinical studies results are still conflicting about the best timing and dosages of supplementation and which individuals are most likely to benefit; therefore, it is still not possible to draw firm conclusions. With regard to food-allergic children, it is still debated whether PUFAs could slow disease progression or not, since consistent data are lacking. In conclusion, more data on the effects of ω-3 PUFAs supplementation alone or in combination with other nutrients are warranted, both in the general and food allergic population.
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20
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Dubin C, Del Duca E, Guttman-Yassky E. The IL-4, IL-13 and IL-31 pathways in atopic dermatitis. Expert Rev Clin Immunol 2021; 17:835-852. [PMID: 34106037 DOI: 10.1080/1744666x.2021.1940962] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: Atopic dermatitis (AD) is the most common inflammatory skin disease. It has a complex pathophysiology, with a combination of immune dysregulation and intrinsic barrier defects driving cutaneous inflammation and allergic symptomatology. The IL-4, IL-13 and IL-31 inflammatory pathways have been identified as hallmark features in the pathogenesis of the disease, contributing uniquely and synergistically to immune and barrier abnormalities as well as the key symptoms, such as pruritis. Novel therapeutics that target these pathways have been under development to find treatments for AD.Areas covered: This review discusses the IL-4, IL-13 and IL-31 pathways in AD. We will also detail novel targeted therapeutics that have recently been or are currently in clinical trials for AD. A literature search was conducted by querying Scopus, Google Scholar, PubMed, and Clinicaltrials.gov up to January 2021 using combinations of the search terms 'IL-4' 'IL-13' 'IL-31' 'atopic dermatitis' 'immune pathway' 'biologics' 'novel therapeutics' 'JAK/STAT inhibitors.'Expert opinion: The complex pathophysiology of AD advocates for innovation. Novel minimally invasive sampling modalities such as tape stripping will allow for a broader characterization of the immunomechanisms behind AD pathophysiology. This will allow for the continued development of a personalized medicine approach to treat AD.
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Affiliation(s)
- Celina Dubin
- Department of Dermatology, And Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ester Del Duca
- Department of Dermatology, And Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, USA.,Department of Dermatology, Magna Graecia, Catanzaro, IT, Calabria
| | - Emma Guttman-Yassky
- Department of Dermatology, And Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, USA.,Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York USA
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21
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Gong X, Chen X, Kuligowski ME, Liu X, Liu X, Cimino E, McGee R, Yeleswaram S. Pharmacokinetics of Ruxolitinib in Patients with Atopic Dermatitis Treated With Ruxolitinib Cream: Data from Phase II and III Studies. Am J Clin Dermatol 2021; 22:555-566. [PMID: 33982267 PMCID: PMC8200345 DOI: 10.1007/s40257-021-00610-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Pathogenesis of atopic dermatitis (AD) involves the Janus kinase (JAK)/signal transducer and activator of transcription (STAT) pathway. A cream formulation of ruxolitinib, a potent selective JAK1/JAK2 inhibitor, was developed for topical delivery. METHOD Pharmacokinetic data were obtained from three double-blind, vehicle-controlled studies in patients with AD: a phase II study with ruxolitinib cream 0.15%, 0.5%, or 1.5% once daily or 1.5% twice daily (BID), and two phase III studies with 0.75% or 1.5% BID. Effects of baseline characteristics on pharmacokinetics were examined. Correlations were attempted between plasma concentrations and change in hematological parameters over time. RESULTS Ruxolitinib plasma concentrations at steady-state (Css) increased with cream strength in a less-than-dose-proportional manner. In the phase III studies, overall mean (standard deviation [SD]) Css after ruxolitinib cream 0.75% and 1.5% BID (23.8 [35.0] and 35.7 [55.0] nM) were a fraction of the half-maximal inhibitory concentration for thrombopoietin-stimulated phosphorylated STAT3 inhibition (281 nM), a JAK/STAT signaling marker. Three covariates were identified for Css: dose, percent body surface area (%BSA) treated, and baseline Investigator's Global Assessment score. Mean (SD) bioavailability of ruxolitinib cream 1.5% BID was 6.22% (7.66%). There were no correlations between Css and any hematological changes except for a transient increase in platelets at week 2. CONCLUSIONS Plasma ruxolitinib concentrations after treatment with topical ruxolitinib cream in patients with up to 20% BSA affected by AD are not expected to lead to systemic plasma concentrations that may be associated with adverse effects commonly associated with oral JAK inhibitors. CLINICALTRIALS.GOV: NCT03011892; NCT03745638; NCT03745651.
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Affiliation(s)
| | | | | | - Xing Liu
- Incyte Corporation, Wilmington, DE, USA
| | - Xiang Liu
- Incyte Corporation, Wilmington, DE, USA
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22
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Bawany F, Beck LA, Järvinen KM. Halting the March: Primary Prevention of Atopic Dermatitis and Food Allergies. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:860-875. [PMID: 32147139 DOI: 10.1016/j.jaip.2019.12.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 12/13/2022]
Abstract
Atopic dermatitis (AD) is one of the most common inflammatory skin conditions, affecting 15% to 30% of children and 2% to 10% of adults. Population-based studies suggest that having AD is associated with subsequent development of other atopic diseases, in what is known as the "atopic march." We will provide an overview of studies that investigate primary prevention strategies for the first 2 diseases in the march, namely, AD and food allergies (FA). These strategies include emollients, breastfeeding, microbial exposures, probiotics, vitamin D and UV light, water hardness, and immunotherapy. Some studies, including randomized controlled trials on emollients and microbial supplementation, have found encouraging results; however, the evidence remains limited and contradictory. With regard to breastfeeding, microbial and lifestyle exposures, vitamin D and UV light, water hardness, and immunotherapy, the lack of randomized controlled trials makes it difficult to draw definitive conclusions. Current American Academy of Pediatrics guidelines support the idea that breastfeeding for 3 to 4 months can decrease AD incidence in children less than 2 years old. Recommendations regarding a direct relationship between breastfeeding on FA, however, cannot be made because of insufficient data. Regarding microbial supplementation, most guidelines do not recommend probiotics or prebiotics for the purpose of preventing allergic diseases because of limited evidence. Before definitive conclusions can be made regarding these interventions, more well-designed, longitudinal, and randomized controlled trials, particularly in at-risk populations, are required.
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Affiliation(s)
- Fatima Bawany
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY
| | - Lisa A Beck
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY.
| | - Kirsi M Järvinen
- Department of Pediatrics, Division of Allergy and Immunology & Center for Food Allergy, University of Rochester Medical Center, Rochester, NY
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23
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Liu J, Ting JP, Al-Azzam S, Ding Y, Afshar S. Therapeutic Advances in Diabetes, Autoimmune, and Neurological Diseases. Int J Mol Sci 2021; 22:ijms22062805. [PMID: 33802091 PMCID: PMC8001105 DOI: 10.3390/ijms22062805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/02/2021] [Accepted: 03/06/2021] [Indexed: 02/08/2023] Open
Abstract
Since 2015, 170 small molecules, 60 antibody-based entities, 12 peptides, and 15 gene- or cell-therapies have been approved by FDA for diverse disease indications. Recent advancement in medicine is facilitated by identification of new targets and mechanisms of actions, advancement in discovery and development platforms, and the emergence of novel technologies. Early disease detection, precision intervention, and personalized treatments have revolutionized patient care in the last decade. In this review, we provide a comprehensive overview of current and emerging therapeutic modalities developed in the recent years. We focus on nine diseases in three major therapeutics areas, diabetes, autoimmune, and neurological disorders. The pathogenesis of each disease at physiological and molecular levels is discussed and recently approved drugs as well as drugs in the clinic are presented.
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Affiliation(s)
- Jinsha Liu
- Protein Engineering, Lilly Biotechnology Center, Eli Lilly and Company, San Diego, CA 92121, USA; (J.L.); (J.P.T.); (Y.D.)
| | - Joey Paolo Ting
- Protein Engineering, Lilly Biotechnology Center, Eli Lilly and Company, San Diego, CA 92121, USA; (J.L.); (J.P.T.); (Y.D.)
| | - Shams Al-Azzam
- Professional Scientific Services, Eurofins Lancaster Laboratories, Lancaster, PA 17605, USA;
| | - Yun Ding
- Protein Engineering, Lilly Biotechnology Center, Eli Lilly and Company, San Diego, CA 92121, USA; (J.L.); (J.P.T.); (Y.D.)
| | - Sepideh Afshar
- Protein Engineering, Lilly Biotechnology Center, Eli Lilly and Company, San Diego, CA 92121, USA; (J.L.); (J.P.T.); (Y.D.)
- Correspondence:
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24
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Immunomodulatory Effects of Dietary Polyphenols. Nutrients 2021; 13:nu13030728. [PMID: 33668814 PMCID: PMC7996139 DOI: 10.3390/nu13030728] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 02/08/2023] Open
Abstract
Functional and nutraceutical foods provide an alternative way to improve immune function to aid in the management of various diseases. Traditionally, many medicinal products have been derived from natural compounds with healing properties. With the development of research into nutraceuticals, it is becoming apparent that many of the beneficial properties of these compounds are at least partly due to the presence of polyphenols. There is evidence that dietary polyphenols can influence dendritic cells, have an immunomodulatory effect on macrophages, increase proliferation of B cells, T cells and suppress Type 1 T helper (Th1), Th2, Th17 and Th9 cells. Polyphenols reduce inflammation by suppressing the pro-inflammatory cytokines in inflammatory bowel disease by inducing Treg cells in the intestine, inhibition of tumor necrosis factor-alpha (TNF-α) and induction of apoptosis, decreasing DNA damage. Polyphenols have a potential role in prevention/treatment of auto-immune diseases like type 1 diabetes, rheumatoid arthritis and multiple sclerosis by regulating signaling pathways, suppressing inflammation and limiting demyelination. In addition, polyphenols cause immunomodulatory effects against allergic reaction and autoimmune disease by inhibition of autoimmune T cell proliferation and downregulation of pro-inflammatory cytokines (interleukin-6 (IL-6), IL-1, interferon-γ (IFN-γ)). Herein, we summarize the immunomodulatory effects of polyphenols and the underlying mechanisms involved in the stimulation of immune responses.
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Park JH, Yoo E, Seo MW, Jung HC, Lee JM. Association between Physical Activity and Respiratory Diseases in Adolescents: An Age- and Gender-Matched Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041397. [PMID: 33546335 PMCID: PMC7913582 DOI: 10.3390/ijerph18041397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 12/11/2022]
Abstract
The purpose of the present cross-sectional study was to examine the impacts of allergic respiratory diseases on physical activity (PA), sedentary behaviors (SB), and body mass index (BMI) by matching age and gender with those adolescents without allergic respiratory diseases. This present study analyzed data from the 2019 Korea Youth Risk Behavior Web-based Survey (KYRBWS). Among 57,303 Korean adolescents who responded to the survey, the study divided adolescents into three different groups (i.e., general, asthma, and allergic rhinitis group). Asthma and allergic rhinitis groups included adolescents who checked on asthma- or allergic rhinitis-related questions as ‘yes’ (n = 259, n = 259), but the general group responded to any diseases-related question as ‘no’ (n = 259). The age and gender of participants among the three groups were matched. The results showed weight and BMI were significantly higher in asthma and allergic rhinitis groups compared to the general group (p < 0.001, p < 0.001). Furthermore, age, asthma, and allergic rhinitis were observed to be strong risk factors for predicting obesity in adolescents (BMI, >25.0 kg/m2). In addition, this study found allergic respiratory diseases strong impacts on BMI levels because adolescents with ongoing asthma, or allergic rhinitis symptoms were more likely to have the inevitability of further weight gain compared to the general adolescents. Therefore, not only national interest in adolescents with allergic respiratory disease is essential, but PA should be encouraged to prevent and alleviate these diseases due to obesity.
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Affiliation(s)
- Jeong-Hui Park
- Department of Physical Education, Global Campus, Kyung Hee University, 1732 Deokyoungdaero, Giheung-gu, Yongin-si 17014, Gyeonggi-do, Korea;
| | - Eunhye Yoo
- Department of Physical Education, Seoul National University, 1 Gwanakro, Gwanakgu, Seoul 08826, Korea;
| | - Myong-Won Seo
- Department of Taekwondo, Global Campus, Kyung Hee University, 1732 Deokyoungdaero, Giheung-gu, Yongin-si 17014, Gyeonggi-do, Korea;
| | - Hyun Chul Jung
- Department of Coaching, Global Campus, Kyung Hee University, 1732 Deokyoungdaero, Giheung-gu, Yongin-si 17014, Gyeonggi-do, Korea;
| | - Jung-Min Lee
- Department of Physical Education, Global Campus, Kyung Hee University, 1732 Deokyoungdaero, Giheung-gu, Yongin-si 17014, Gyeonggi-do, Korea;
- Correspondence:
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Zhang M, Miura T, Suzuki S, Chiyotanda M, Tanaka S, Sugiyama K, Kawashima H, Hirano T. Vitamin K2 Suppresses Proliferation and Inflammatory Cytokine Production in Mitogen-Activated Lymphocytes of Atopic Dermatitis Patients through the Inhibition of Mitogen-Activated Protein Kinases. Biol Pharm Bull 2021; 44:7-17. [PMID: 33390552 DOI: 10.1248/bpb.b20-00079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Vitamin K2 is suggested to have a suppressive effect on the peripheral blood mononuclear cells (PBMCs) of pediatric atopic dermatitis patients. We examined the molecular targets of vitamin K2 to suppress proliferation and cytokine production in T-cell mitogen-activated PBMCs of atopic dermatitis patients from the viewpoint of mitogen-activated protein kinase signaling molecules. The study population included 16 pediatric vitamin K2 patients and 21 healthy subjects. The effect of vitamin K2 on concanavalin A-activated PBMC proliferation was evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and cell counting assays. T-helper (Th)1/Th2/Th17 cytokine profiles in plasma and PBMC-culture supernatants were analyzed by a cytometric beads array assay. Mitogen-activated protein kinase signaling molecules in concanavalin A-activated PBMCs were examined by enzyme-linked immunosorbent assay (ELISA) assays. At 10-100 µM, vitamin K2 significantly suppressed the proliferation of mitogen-activated PBMCs derived from atopic dermatitis patients and healthy subjects (p < 0.05). The interleukin (IL)-10 concentrations in plasma and the PBMC culture supernatants of atopic dermatitis patients were significantly higher than those of healthy subjects (p < 0.05). The IL-2 concentrations in the culture supernatants of atopic dermatitis PBMCs were significantly lower than those of healthy PBMCs (p < 0.05). Vitamin K2 significantly inhibited the IL-17A, IL-10, and tumor necrosis factor α (TNF-α) production (p < 0.05), and increased the IL-2 production (p < 0.01) in the culture supernatant of atopic dermatitis PBMCs. At 10-100 µM, vitamin K2 markedly decreased the of Mek1, extracellular signal-regulated kinases (ERK)1/2 mitogen-activated protein kinase, and SAPK/c-Jun N-terminal kinase (JNK) expression in atopic dermatitis PBMCs (p < 0.05). Vitamin K2 is suggested to attenuate activated T-cell immunity in atopic dermatitis patients through the inhibition of mitogen-activated protein kinase-Mek1-ERK1/2 and SAPK/JNK signaling pathways.
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Affiliation(s)
- Meiyu Zhang
- Department of Clinical Pharmacology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences.,Experimental Research Center, China Academy of Chinese Medical Sciences
| | - Taro Miura
- Department of Pediatrics, Tokyo Medical University Hachioji Medical Center
| | - Shunsuke Suzuki
- Department of Pediatrics, Tokyo Medical University Hachioji Medical Center
| | - Masako Chiyotanda
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University
| | - Sachiko Tanaka
- Department of Clinical Pharmacology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences
| | - Kentaro Sugiyama
- Department of Clinical Pharmacology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences
| | - Hisashi Kawashima
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University
| | - Toshihiko Hirano
- Department of Clinical Pharmacology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences
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Custovic A, Custovic D, Kljaić Bukvić B, Fontanella S, Haider S. Atopic phenotypes and their implication in the atopic march. Expert Rev Clin Immunol 2020; 16:873-881. [PMID: 32856959 DOI: 10.1080/1744666x.2020.1816825] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Eczema, allergic rhinitis, and asthma are traditionally considered atopic (or allergic) diseases. They are complex, multifactorial, and are caused by a variety of different mechanisms, which result in multiple heterogeneous clinical phenotypes. Atopic march is usually interpreted as the sequential development of symptoms from eczema in infancy, to asthma, and then allergic rhinitis. Areas covered: The authors reviewed the evidence on the multimorbidity of eczema, asthma, and rhinitis, and the implication of results of data-driven analyses on the concept framework of atopic march. A literature search was conducted in the PubMed and Web of Science for peer-reviewed articles published until July 2020. Application of Bayesian machine learning framework to rich phenotypic data from birth cohorts demonstrated that the postulated linear progression of symptoms (atopic march) does not capture the heterogeneity of allergic phenotypes. Expert opinion: Eczema, wheeze, and rhinitis co-exist more often than would be expected by chance, but their relationship can be best understood in a multimorbidity framework, rather than through atopic march sequence. The observation of their co-occurrence does not imply any specific relationship between them, and certainly not a progressive or causal one. It is unlikely that a sngle mechanism such as allergic sensitization underpins different multimorbidity manifestations.
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Affiliation(s)
- Adnan Custovic
- National Heart and Lung Institute, Imperial College London , London, UK
| | - Darije Custovic
- Department of Brain Sciences, Imperial College London , London, UK
| | - Blazenka Kljaić Bukvić
- Department of Pediatrics, General Hospital Dr Josip Benčević , Slavonski Brod, Croatia.,Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek , Osijek, Croatia.,Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek , Osijek, Croatia
| | - Sara Fontanella
- National Heart and Lung Institute, Imperial College London , London, UK
| | - Sadia Haider
- National Heart and Lung Institute, Imperial College London , London, UK
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van der Lugt T, Opperhuizen A, Bast A, Vrolijk MF. Dietary Advanced Glycation Endproducts and the Gastrointestinal Tract. Nutrients 2020; 12:nu12092814. [PMID: 32937858 PMCID: PMC7551018 DOI: 10.3390/nu12092814] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 12/19/2022] Open
Abstract
The prevalence of inflammatory bowel diseases (IBD) is increasing in the world. The introduction of the Western diet has been suggested as a potential explanation of increased prevalence. The Western diet includes highly processed food products, and often include thermal treatment. During thermal treatment, the Maillard reaction can occur, leading to the formation of dietary advanced glycation endproducts (dAGEs). In this review, different biological effects of dAGEs are discussed, including their digestion, absorption, formation, and degradation in the gastrointestinal tract, with an emphasis on their pro-inflammatory effects. In addition, potential mechanisms in the inflammatory effects of dAGEs are discussed. This review also specifically elaborates on the involvement of the effects of dAGEs in IBD and focuses on evidence regarding the involvement of dAGEs in the symptoms of IBD. Finally, knowledge gaps that still need to be filled are identified.
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Affiliation(s)
- Timme van der Lugt
- Department of Pharmacology and Toxicology, Maastricht University, 6229 ER Maastricht, The Netherlands;
- Office for Risk Assessment and Research, Netherlands Food and Consumer Product Safety Authority (NVWA), 3540 AA Utrecht, The Netherlands
- Correspondence:
| | - Antoon Opperhuizen
- Department of Pharmacology and Toxicology, Maastricht University, 6229 ER Maastricht, The Netherlands;
- Office for Risk Assessment and Research, Netherlands Food and Consumer Product Safety Authority (NVWA), 3540 AA Utrecht, The Netherlands
| | - Aalt Bast
- Department of Pharmacology and Toxicology, Maastricht University, 6229 ER Maastricht, The Netherlands;
- Campus Venlo, Maastricht University, 5911 BV Venlo, The Netherlands; (A.B.); (M.F.V.)
| | - Misha F. Vrolijk
- Campus Venlo, Maastricht University, 5911 BV Venlo, The Netherlands; (A.B.); (M.F.V.)
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Yang L, Fu J, Zhou Y. Research Progress in Atopic March. Front Immunol 2020; 11:1907. [PMID: 32973790 PMCID: PMC7482645 DOI: 10.3389/fimmu.2020.01907] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/15/2020] [Indexed: 12/28/2022] Open
Abstract
The incidence of allergic diseases continues to rise. Cross-sectional and longitudinal studies have indicated that allergic diseases occur in a time-based order: from atopic dermatitis and food allergy in infancy to gradual development into allergic asthma and allergic rhinitis in childhood. This phenomenon is defined as the “atopic march”. Some scholars have suggested that the atopic march does not progress completely in a temporal pattern with genetic and environmental factors. Also, the mechanisms underlying the atopic march are incompletely understood. Nevertheless, the concept of the atopic march provides a new perspective for the mechanistic research, prediction, prevention, and treatment of atopic diseases. Here, we review the epidemiology, related diseases, mechanistic studies, and treatment strategies for the atopic march.
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Affiliation(s)
- Lan Yang
- Institute of Pediatrics, Children's Hospital of Fudan University, The Shanghai Key Laboratory of Medical Epigenetics, International Co-laboratory of Medical Epigenetics and Metabolism, Ministry of Science and Technology, Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Jinrong Fu
- Institute of Pediatrics, Children's Hospital of Fudan University, The Shanghai Key Laboratory of Medical Epigenetics, International Co-laboratory of Medical Epigenetics and Metabolism, Ministry of Science and Technology, Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Yufeng Zhou
- Institute of Pediatrics, Children's Hospital of Fudan University, The Shanghai Key Laboratory of Medical Epigenetics, International Co-laboratory of Medical Epigenetics and Metabolism, Ministry of Science and Technology, Institutes of Biomedical Sciences, Fudan University, Shanghai, China.,National Health Commission (NHC) Key Laboratory of Neonatal Diseases, Fudan University, Shanghai, China
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Badloe FMS, De Vriese S, Coolens K, Schmidt-Weber CB, Ring J, Gutermuth J, Kortekaas Krohn I. IgE autoantibodies and autoreactive T cells and their role in children and adults with atopic dermatitis. Clin Transl Allergy 2020; 10:34. [PMID: 32774842 PMCID: PMC7398196 DOI: 10.1186/s13601-020-00338-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 07/27/2020] [Indexed: 12/14/2022] Open
Abstract
The pathophysiology of atopic dermatitis (AD) is highly complex and understanding of disease endotypes may improve disease management. Immunoglobulins E (IgE) against human skin epitopes (IgE autoantibodies) are thought to play a role in disease progression and prolongation. These antibodies have been described in patients with severe and chronic AD, suggesting a progression from allergic inflammation to severe autoimmune processes against the skin. This review provides a summary of the current knowledge and gaps on IgE autoreactivity and self-reactive T cells in children and adults with AD based on a systematic search. Currently, the clinical relevance and the pathomechanism of IgE autoantibodies in AD needs to be further investigated. Additionally, it is unknown whether the presence of IgE autoantibodies in patients with AD is an epiphenomenon or a disease endotype. However, increased knowledge on the clinical relevance and the pathophysiologic role of IgE autoantibodies and self-reactive T cells in AD can have consequences for diagnosis and treatment. Responses to the current available treatments can be used for better understanding of the pathways and may shed new lights on the treatment options for patients with AD and autoreactivity against skin epitopes. To conclude, IgE autoantibodies and self-reactive T cells can contribute to the pathophysiology of AD based on the body of evidence in literature. However, many questions remain open. Future studies on autoreactivity in AD should especially focus on the clinical relevance, the contribution to the disease progression and chronicity on cellular level, the onset and therapeutic strategies.
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Affiliation(s)
- Fariza Mishaal Saiema Badloe
- Department of Dermatology, SKIN Research Group, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 103, Building D, Room D148, 1090 Brussels, Belgium
| | - Shauni De Vriese
- Department of Dermatology, SKIN Research Group, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 103, Building D, Room D148, 1090 Brussels, Belgium
| | - Katarina Coolens
- Department of Dermatology, SKIN Research Group, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 103, Building D, Room D148, 1090 Brussels, Belgium
| | - Carsten B Schmidt-Weber
- Center of Allergy and Environment (ZAUM), Technical University and Helmholtz Center Munich, Munich, Germany.,Member of the German Center of Lung Research (DZL) and the Helmholtz Initiative for Inflammation and Immunology (I&I), Munich, Germany
| | - Johannes Ring
- Department of Dermatology, SKIN Research Group, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 103, Building D, Room D148, 1090 Brussels, Belgium.,Center of Allergy and Environment (ZAUM), Technical University and Helmholtz Center Munich, Munich, Germany
| | - Jan Gutermuth
- Department of Dermatology, SKIN Research Group, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 103, Building D, Room D148, 1090 Brussels, Belgium
| | - Inge Kortekaas Krohn
- Department of Dermatology, SKIN Research Group, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 103, Building D, Room D148, 1090 Brussels, Belgium
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Guo H, An J, Yu Z. Identifying Shared Risk Genes for Asthma, Hay Fever, and Eczema by Multi-Trait and Multiomic Association Analyses. Front Genet 2020; 11:270. [PMID: 32373153 PMCID: PMC7176997 DOI: 10.3389/fgene.2020.00270] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/05/2020] [Indexed: 12/03/2022] Open
Abstract
Asthma, hay fever and eczema are three comorbid diseases with high prevalence and heritability. Their common genetic architectures have not been well-elucidated. In this study, we first conducted a linkage disequilibrium score regression analysis to confirm the strong genetic correlations between asthma, hay fever and eczema. We then integrated three distinct association analyses (metaCCA multi-trait association analysis, MAGMA genome-wide and MetaXcan transcriptome-wide gene-based tests) to identify shared risk genes based on the large-scale GWAS results in the GeneATLAS database. MetaCCA can detect pleiotropic genes associated with these three diseases jointly. MAGMA and MetaXcan were performed separately to identify candidate risk genes for each of the three diseases. We finally identified 150 shared risk genes, in which 60 genes are novel. Functional enrichment analysis revealed that the shared risk genes are enriched in inflammatory bowel disease, T cells differentiation and other related biological pathways. Our work may provide help on treatment of asthma, hay fever and eczema in clinical applications.
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Affiliation(s)
- Hongping Guo
- Key Laboratory of Intelligent Computing and Information Processing of Ministry of Education and Hunan Key Laboratory for Computation and Simulation in Science and Engineering, Xiangtan University, Hunan, China.,School of Mathematics and Computer Science, Hanjiang Normal University, Hubei, China
| | - Jiyuan An
- Centre for Tropical Crops and Biocommodities, Queensland University of Technology, Brisbane, QLD, Australia
| | - Zuguo Yu
- Key Laboratory of Intelligent Computing and Information Processing of Ministry of Education and Hunan Key Laboratory for Computation and Simulation in Science and Engineering, Xiangtan University, Hunan, China.,School of Electrical Engineering and Computer Science, Queensland University of Technology, Brisbane, QLD, Australia
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Meltzer LJ, Flewelling KD, Jump S, Gyorkos E, White M, Hauk PJ. Impact of atopic dermatitis treatment on child and parent sleep, daytime functioning, and quality of life. Ann Allergy Asthma Immunol 2020; 124:385-392. [PMID: 31923547 DOI: 10.1016/j.anai.2019.12.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/23/2019] [Accepted: 12/27/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is a common childhood disorder that is associated with a variety of negative health outcomes in children and parents, including poor sleep and daytime functioning. Despite this, few studies have examined the impact of treatment for AD on sleep, and even fewer have included validated sleep questionnaires, child report of sleep disturbance, or objective measures of sleep. OBJECTIVE To address limitations in the literature by examining objective and subjective reports of sleep, as well as measures of daytime functioning before and after admission to an intensive treatment program for AD. METHODS Twenty-nine parent-child dyads who presented to an intensive day treatment program participated in this study. Sleep was objectively measured with 1 week of actigraphy both 1 week before admission and 1 month after discharge. Subjective questionnaires of sleep, daytime functioning, and quality of life were completed by children and parents at admission, discharge, 1 month after discharge, and 3 months after discharge. RESULTS Study results highlight the benefit of the treatment program on reducing AD severity, as well as improvements in objectively measured sleep duration and efficiency, self-reported measures of sleep, daytime functioning, and quality of life in children and parents up to 3 months after discharge. CONCLUSION This study highlights the importance of treatment for child AD on both child and parent health outcomes.
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Affiliation(s)
- Lisa J Meltzer
- Department of Pediatrics, National Jewish Health, Denver, Colorado.
| | | | - Stephanie Jump
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | | | - Michael White
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Pia J Hauk
- Department of Pediatrics, National Jewish Health, Denver, Colorado
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Giavina Bianchi M, Santos AP, Cordioli E. The majority of skin lesions in pediatric primary care attention could be managed by Teledermatology. PLoS One 2019; 14:e0225479. [PMID: 31790453 PMCID: PMC6886848 DOI: 10.1371/journal.pone.0225479] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 11/05/2019] [Indexed: 11/18/2022] Open
Abstract
Background Teledermatology is a tool that provides accurate diagnosis and has been gaining more emphasis over time. It can be used for triage in primary care attention to address skin conditions improving access and reducing time to treatment for surgical, severe or even lethal diseases. Objectives Our main goal was to evaluate the proportion of pediatric patient’s lesions that could be managed using teledermatology in primary care attention. Secondly, we wanted to assess the ten most frequent skin conditions, the most common treatments and the referrals made by the teledermatologists to biopsy, in-presence dermatologist or kept at primary care attention. Methods A cross-sectional retrospective study involving 6,879 individuals and 10,126 lesions was conducted by store-and-forward teledermatology during one year in the city of Sao Paulo, Brazil. If the photographs taken had enough quality, teledermatologist would diagnose, treat and orient each lesion (if possible), and choose one of three options for referral: direct to biopsy, in-presence dermatologist or kept at primary care attention. Results Teledermatology managed 62% of the lesions to be kept at primary care attention, 37% were referred to dermatologists and 1% to biopsy, reducing the mean waiting time for an in-presence visit in 78%. In patients 0–2 years old, lesions related to eczema and benign congenital lesions predominated. From 3–12 years old, eczema was still a major cause of complaint, as well as warts and molluscum. From 13–19 years old, acne was the most significant problem, followed by atopic dermatitis, nevi and warts. The most frequent treatment was emollient. Conclusion Teletriage addressed 63% of the lesions without the need for an in-presence visit, suggesting that teledermatology can manage common diseases and optimize dermatological appointments for the most serious, surgical or complex skin illnesses, reducing the mean waiting time for them.
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Affiliation(s)
- Mara Giavina Bianchi
- Department of Telemedicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
- * E-mail:
| | - Andre Pires Santos
- Department of Telemedicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Eduardo Cordioli
- Department of Telemedicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Abstract
Ocular diseases associated with atopic dermatitis (AD) may be sight-threatening. A general understanding of the pathophysiology, diagnosis, and treatment of atopic eye disease may assist dermatologists in knowing when to refer to ophthalmology and in co-managing these diseases with ophthalmologists. Ocular diseases associated with AD include eyelid dermatitis, keratoconjunctivitis, keratoconus, cataract, and retinal detachment. AD patients are also at higher risk for bacterial and viral ocular infections. The objective of this article is to provide a current review of ocular diseases that commonly affect AD patients. The pathogenesis, clinical manifestations, diagnosis, and treatment of ocular co-morbidities of AD will be discussed.
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Astigmatism Associated with Allergic Conjunctivitis in Urban School Children. J Ophthalmol 2019; 2019:9453872. [PMID: 31827915 PMCID: PMC6885257 DOI: 10.1155/2019/9453872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/21/2019] [Indexed: 12/26/2022] Open
Abstract
Introduction We first examined the association of an ocular refractive error with allergic conjunctivitis in school children and then examined this association in children attending a suburban school and an urban school. Methods We enrolled 426 children attending a primary school in a suburban area and 550 children attending a primary school in an urban area which had a higher level of air pollution. Allergic conjunctivitis was defined as the diagnosis of this condition at any time during a child's life. The ophthalmic examinations included measurements of visual acuity and refraction, and a slit lamp examination. Skin prick tests were also performed at each school during 2018. The significance of associations was determined by the calculation of odds ratios (ORs) and 95% confidence intervals (CIs). Results Astigmatism (increase of 1 cylindrical diopter) was associated with allergic conjunctivitis in children overall (OR = 1.287, 95% CI = 1.010 to 1.642) and in children attending the urban school (OR = 1.408, 95% CI = 1.029 to 1.926), but not in children attending the suburban school (OR = 1.040, 95% CI = 0.672 to 1.610). Allergic conjunctivitis also had a higher prevalence among children attending the urban school. The urban school had higher levels of air pollutants than the suburban school. Skin prick tests indicated that the major allergens in children with allergic conjunctivitis were house dust mites and various types of pollen. Conclusion Astigmatism is associated with allergic conjunctivitis in children attending an urban school.
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Irvine A, Mina‐Osorio P. Disease trajectories in childhood atopic dermatitis: an update and practitioner's guide. Br J Dermatol 2019; 181:895-906. [PMID: 30758843 PMCID: PMC6899789 DOI: 10.1111/bjd.17766] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is a heterogeneous disease with a multifactorial aetiology and complex pathophysiology. This heterogeneity translates into different trajectories of disease progression with respect to severity, persistence and risk of development of atopic comorbidities. Determining which possible disease trajectories or comorbidities any individual child might develop is challenging in clinical practice. Tools that help identify paediatric patients at higher risk of disease progression would greatly aid clinicians. METHODS We reviewed recent cohort studies to synthesize and simplify the epidemiological data to try to identify shared clinically relevant characteristics that may help physicians estimate the risk of disease progression in paediatric patients with AD. RESULTS Despite the variability in data collection and methods of analysis and their limitations, there are common patterns of early-childhood AD that may aid in the estimation of risk for disease progression. Factors associated with risk of AD progression include younger age of onset, family history of atopy, greater AD severity, filaggrin mutations, urban environment and polysensitization and/or allergic multimorbidity. Based on these factors, we provide a practitioner's guide for identifying, counselling and/or referring infants and children with AD at potentially higher risk of developing persistent AD and atopic comorbidities. We also present clinical scenarios to illustrate how these data relate to real-life situations. CONCLUSIONS Useful insights are provided for physicians and patients to inform them better about the risk of AD progression and to help guide care pathways for the paediatric population with AD. What's already known about this topic? The complex pathophysiology of atopic dermatitis (AD) translates into a heterogeneous clinical presentation and trajectories of disease progression. Although the consensus is that most paediatric patients with AD will eventually 'outgrow' the disease or follow the longitudinal trajectory known as the 'atopic march', a significant proportion will develop persistent AD and/or other atopic conditions. No known factors conclusively predict the risk of progression or development of comorbidities. What does this study add? Recent analyses of data from large cohorts of paediatric patients with AD have suggested the existence of potentially discrete clusters of patients who present with relatively common AD phenotypes. These studies have shed some light onto the factors associated with risk of progression, which we review in this article. A practitioner's guide with clinical scenarios is provided to help identify patients at high risk of progression to determine whether a patient should be monitored and/or would require specialist referral.
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Affiliation(s)
- A.D. Irvine
- Paediatric DermatologyOur Lady's Children's HospitalCrumlin, Dublin12Ireland
- National Children's Research CentreOur Lady's Children's HospitalCrumlin, Dublin12Ireland
- Clinical MedicineTrinity College DublinDublinIreland
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Wooldridge AL, McMillan M, Kaur M, Giles LC, Marshall HS, Gatford KL. Relationship between birth weight or fetal growth rate and postnatal allergy: A systematic review. J Allergy Clin Immunol 2019; 144:1703-1713. [PMID: 31615640 DOI: 10.1016/j.jaci.2019.08.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/02/2019] [Accepted: 08/22/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Individual susceptibility to allergic diseases is developmentally programmed by early-life exposures. Evidence from preclinical studies suggests that intrauterine growth restriction is protective against later inflammatory responses to allergens. OBJECTIVE We sought to evaluate whether prenatal growth affects susceptibility to allergy in human subjects. METHODS We systematically searched for relevant studies in 11 databases, including Web of Science, ProQuest, EMBASE, and PubMed. We included only studies that corrected for gestational age or were restricted to full-term infants to separate effects of fetal growth from those of prematurity. RESULTS The 42 eligible studies included prospective and retrospective cohort, cross-sectional, and case-control studies. Only 2 studies reported allergic asthma. A birth weight increase of 1 kg was associated with a 44% greater risk of food allergy in children (odds ratio [OR], 1.44; 95% CI, 1.04-1.99; P = .001), a 17% greater risk of ever allergic dermatitis in children (OR, 1.17; 95% CI, 1.04-1.32; P = .008), and a 34% greater risk of ever or current allergic dermatitis in infants up to 2 years of age (OR, 1.34; 95% CI, 1.08-1.68; P = .009). Risks of allergic rhinitis were not associated with birth weight. CONCLUSIONS The results of these meta-analyses suggest that intrauterine growth restriction protects against allergic diseases in human subjects consistent with preclinical evidence but that effects might differ between allergic diseases. The strongest evidence is available for infancy and early childhood, and additional studies in older children and adults are needed to determine whether the effects of prenatal growth on each allergic disease persist or differ between those with severe and mild phenotypes.
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Affiliation(s)
- Amy L Wooldridge
- Robinson Research Institute, University of Adelaide, Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia; School of Human Sciences, University of Western Australia, Perth, Australia
| | - Mark McMillan
- Robinson Research Institute, University of Adelaide, Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia; Vaccinology and Immunology Research Trials Unit (VIRTU), Women's and Children's Hospital, North Adelaide, Australia
| | - Manpreet Kaur
- Robinson Research Institute, University of Adelaide, Adelaide, Australia; School of Medicine, Deakin University, Waurn Ponds, Australia
| | - Lynne C Giles
- Robinson Research Institute, University of Adelaide, Adelaide, Australia; School of Public Health, University of Adelaide, Adelaide, Australia
| | - Helen S Marshall
- Robinson Research Institute, University of Adelaide, Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia; Vaccinology and Immunology Research Trials Unit (VIRTU), Women's and Children's Hospital, North Adelaide, Australia
| | - Kathryn L Gatford
- Robinson Research Institute, University of Adelaide, Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia.
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Akiner U, Yener HM, Gozen ED, Kuzu SB, Canakcioglu S. Helicobacter pylori in allergic and non-allergic rhinitis does play a protective or causative role? Eur Arch Otorhinolaryngol 2019; 277:141-145. [DOI: 10.1007/s00405-019-05659-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/14/2019] [Indexed: 02/07/2023]
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Agón-Banzo PJ, Sanmartin R, García-Malinis AJ, Hernández-Martín Á, Puzo J, Doste D, Pardos C, Gilaberte Y. Body mass index and serum lipid profile: Association with atopic dermatitis in a paediatric population. Australas J Dermatol 2019; 61:e60-e64. [PMID: 31506928 DOI: 10.1111/ajd.13154] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 08/05/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES The association between atopic dermatitis, body weight and serum lipid levels is not well known, and very few studies have examined this relationship in children. METHODS Children (n = 239) under 14 years old participated in this prospective cross-sectional study. The following variables were recorded: age, gender, weight, height, atopic dermatitis severity, serum levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides. RESULTS Mean body mass index was slightly higher in atopic dermatitis patients than healthy controls and significantly higher in atopic dermatitis patients aged 0-2 years (atopic dermatitis, 16.7 ± 4.6; controls, 15.7 ± 1.3; P = 0.04) and 12-14 years (atopic dermatitis, 24.9 ± 5.3; controls, 20.6 ± 3.4; P = 0.03). Among atopic dermatitis patients, body mass index was significantly higher in those with severe atopic dermatitis in the 9-12 (P = 0.03) and 12-14 (P = 0.01) years groups. Mean serum lipid levels were higher in patients with severe atopic dermatitis than in the atopic dermatitis group as a whole. These differences reached statistical significance for total cholesterol (P = 0.04) and triglycerides (P = 0.02). CONCLUSION The prevalence of overweight, obesity and dyslipidemia is greater in children with atopic dermatitis than in age-matched healthy counterparts.
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Affiliation(s)
| | | | | | | | - José Puzo
- Department of Biochemistry, San Jorge Hospital, Huesca, Spain
| | - Divina Doste
- Santo Grial Primary Care Center, San Jorge Hospital, Huesca, Spain
| | | | - Yolanda Gilaberte
- Dermatology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Gür Çetinkaya P, Şahiner ÜM. Childhood atopic dermatitis: current developments, treatment approaches, and future expectations. Turk J Med Sci 2019; 49:963-984. [PMID: 31408293 PMCID: PMC7018348 DOI: 10.3906/sag-1810-105] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Atopic dermatitis (AD) is the most common chronic inflammatory skin disorder of childhood. Underlying factors that contribute to AD are impaired epithelial barrier, alterations in the lipid composition of the skin, immunological imbalance including increased Th2/Th1 ratio, proinflammatory cytokines, decreased T regulatory cells, genetic mutations, and epigenetic alterations. Atopic dermatitis is a multifactorial disease with a particularly complicated pathophysiology. Discoveries to date may be considered the tip of the iceberg, and the increasing number of studies in this field indicate that there are many points to be elucidated in AD pathophysiology. In this review, we aimed to illustrate the current understanding of the underlying pathogenic mechanisms in AD, to evaluate available treatment options with a focus on recently discovered therapeutic agents, and to determine the personal, familial, and economic burdens of the disease, which are frequently neglected issues in AD. Currently available therapies only provide transient solutions and cannot fully cure the disease. However, advances in the understanding of the pathogenic mechanisms of the disease have led to the production of new treatment options, while ongoing drug trials also have had promising results.
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Affiliation(s)
- Pınar Gür Çetinkaya
- Division of Pediatric Allergy and Asthma Unit, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ümit Murat Şahiner
- Division of Pediatric Allergy and Asthma Unit, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Gao X, Yan Y, Zeng G, Sha T, Liu S, He Q, Chen C, Li L, Xiang S, Li H, Tan S, Yan Q. Influence of prenatal and early-life exposures on food allergy and eczema in infancy: a birth cohort study. BMC Pediatr 2019; 19:239. [PMID: 31315604 PMCID: PMC6636159 DOI: 10.1186/s12887-019-1623-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 07/12/2019] [Indexed: 12/30/2022] Open
Abstract
Background Few prospective birth cohort studies are available on the effects of prenatal and early-life exposures on food allergy and eczema among Chinese children. The aim of this study was to evaluate the influence of prenatal and early-life exposures on food allergy and eczema during the first year of life in a prospective birth cohort study. Methods This study was based on a prospective, observational birth cohort of 976 mother-child pairs in three Streets in Changsha, China from January to December 2015. Data on prenatal, early-life exposures and allergic outcomes were obtained from questionnaires collected at birth, and 1, 3, 6, 8, and 12 months of age. Multivariate logistic regression models were performed to estimate the effects of prenatal and early-life exposures on food allergy and eczema. Results Common risk factors for food allergy and eczema in infancy were parental history of allergy, while moderate eggs consumption (3–4 times/week) during pregnancy was protective for both of them compared with low consumption (≤ 2 times/week). Factors only associated with food allergy were maternal aquatic products consumption during pregnancy, number of older siblings and age of solid food introduction, whereas factors only associated with eczema were maternal milk or milk products consumption during pregnancy, maternal antibiotic exposure during pregnancy, season of birth and antibiotic exposure through medication during the first year of life. Conclusion Our study suggests that factors associated with food allergy and eczema are multifaceted, which involving hereditary, environmental and nutritional exposures. Furthermore, differential factors influence the development of food allergy and eczema in infants.
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Affiliation(s)
- Xiao Gao
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, 410078, Hunan Province, China
| | - Yan Yan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, 410078, Hunan Province, China.
| | - Guangyu Zeng
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, 410078, Hunan Province, China
| | - Tingting Sha
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, 410078, Hunan Province, China
| | - Shiping Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, 410078, Hunan Province, China
| | - Qiong He
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, 410078, Hunan Province, China
| | - Cheng Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, 410078, Hunan Province, China
| | - Ling Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, 410078, Hunan Province, China
| | - Shiting Xiang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, 410078, Hunan Province, China
| | - Hongyan Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, 410078, Hunan Province, China
| | - Shan Tan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, 410078, Hunan Province, China
| | - Qiang Yan
- Department of Maternal and Child Health, Kaifu District Health Bureau, Changsha, China
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Cait A, Cardenas E, Dimitriu PA, Amenyogbe N, Dai D, Cait J, Sbihi H, Stiemsma L, Subbarao P, Mandhane PJ, Becker AB, Moraes TJ, Sears MR, Lefebvre DL, Azad MB, Kollmann T, Turvey SE, Mohn WW. Reduced genetic potential for butyrate fermentation in the gut microbiome of infants who develop allergic sensitization. J Allergy Clin Immunol 2019; 144:1638-1647.e3. [PMID: 31279007 DOI: 10.1016/j.jaci.2019.06.029] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 06/06/2019] [Accepted: 06/13/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Allergic disease is the most frequent chronic health issue in children and has been linked to early-life gut microbiome dysbiosis. Many lines of evidence suggest that microbially derived short-chain fatty acids, and particularly butyrate, can promote immune tolerance. OBJECTIVE We sought to determine whether bacterial butyrate production in the gut during early infancy is protective against the development of atopic disease in children. METHODS We used shotgun metagenomic analysis to determine whether dysbiosis in butyrate fermentation could be identified in human infants, before their developing allergic disease. RESULTS We found that the microbiome of infants who went on to develop allergic sensitization later in childhood lacked genes encoding key enzymes for carbohydrate breakdown and butyrate production. CONCLUSIONS Our findings support the importance of microbial carbohydrate metabolism during early infancy in protecting against the development of allergies.
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Affiliation(s)
- Alissa Cait
- Department of Microbiology & Immunology, Life Sciences Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Erick Cardenas
- Department of Microbiology & Immunology, Life Sciences Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pedro A Dimitriu
- Department of Microbiology & Immunology, Life Sciences Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nelly Amenyogbe
- Department of Microbiology & Immunology, Life Sciences Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Darlene Dai
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessica Cait
- Biomedical Research Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hind Sbihi
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Leah Stiemsma
- Department of Microbiology & Immunology, Life Sciences Institute, University of British Columbia, Vancouver, British Columbia, Canada; Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Padmaja Subbarao
- Department of Pediatrics & Physiology, University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children, Toronto, Ontario, Canada
| | - Piush J Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Allen B Becker
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Theo J Moraes
- Department of Pediatrics & Physiology, University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children, Toronto, Ontario, Canada
| | - Malcolm R Sears
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Diana L Lefebvre
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Meghan B Azad
- Developmental Origins of Chronic Diseases in Children Network (DEVOTION), Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tobias Kollmann
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stuart E Turvey
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
| | - William W Mohn
- Department of Microbiology & Immunology, Life Sciences Institute, University of British Columbia, Vancouver, British Columbia, Canada.
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Lee MK, Seo JH, Chu H, Kim H, Jang YH, Jeong JW, Yum HY, Han MY, Yoon HJ, Cho SH, Rha YH, Kim JT, Park YL, Seo SJ, Lee KH, Park CO. Current Status of Patient Education in the Management of Atopic Dermatitis in Korea. Yonsei Med J 2019; 60:694-699. [PMID: 31250584 PMCID: PMC6597467 DOI: 10.3349/ymj.2019.60.7.694] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/13/2019] [Accepted: 05/19/2019] [Indexed: 11/27/2022] Open
Abstract
Patient education is important for successful management of atopic dermatitis; however, due to limited time and resources, patient education remains insufficient. This study aimed to investigate the current state of education provided by Korean dermatologists, pediatric allergists, and allergists to patients with atopic dermatitis. A questionnaire survey consisting of items regarding educational programs for patients with atopic dermatitis was conducted via e-mail. In total, 153 participants responded to the questionnaires, and 26.8% indicated that they have had separate educational programs. The workforce involved in the educational program included nurses, residents or fellows, dieticians, pharmacists, and clinical psychologists. Most education protocols addressed the characteristics and natural course of atopic dermatitis and environmental management. Overall, 96.7% of the participants replied that an additional charge is needed for education; moreover, additional assistance from an academic society or association, in the form of medical staff, organized data, and advertisement, is required to develop and provide a well-structured educational program. A standardized education protocol will effectively provide appropriate education for patients with atopic dermatitis. Arrangement of education fees, covered by the National Health Insurance Service, will lead to the establishment of a structured educational program and participation of an additional medical workforce.
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Affiliation(s)
- Min Kyung Lee
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ju Hee Seo
- Department of Pediatrics, Dankook University Hospital, Cheonan, Korea
| | - Howard Chu
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyunjung Kim
- Department of Dermatology, Atopy Clinic, Seoul Medical Center, Seoul, Korea
| | - Yong Hyun Jang
- Department of Dermatology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jae Won Jeong
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Hye Yung Yum
- Department of Pediatrics, Atopy Clinic, Seoul Medical Center, Seoul, Korea
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Ho Joo Yoon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sang Heon Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yeong Ho Rha
- Department of Pediatrics, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Jin Tack Kim
- Department of Pediatrics, College of Medicine, the Catholic University of Korea, Seoul, Korea
| | - Young Lip Park
- Department of Dermatology, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seong Jun Seo
- Department of Dermatology, Chung-Ang University Hospital, Seoul, Korea
| | - Kwang Hoon Lee
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Ook Park
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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Raciborski F, Bousquet J, Bousqet J, Namysłowski A, Krzych-Fałta E, Tomaszewska A, Piekarska B, Samel-Kowalik P, Białoszewski AZ, Walkiewicz A, Lipiec A, Wojas O, Samoliński K, Szylling A, Zieliński W, Sybilski A, Grąbczewska A, Samoliński B. Dissociating polysensitization and multimorbidity in children and adults from a Polish general population cohort. Clin Transl Allergy 2019; 9:4. [PMID: 30792849 PMCID: PMC6369558 DOI: 10.1186/s13601-019-0246-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/04/2019] [Indexed: 01/13/2023] Open
Abstract
Background Links between multimorbidity of allergic diseases and allergen sensitization are still under debate, especially in adults. This study aimed to establish a relationship between polysensitization and allergic multimorbidity in children and adults and the allergens involved in multimorbidity. Material and method A cross-sectional multicentre study enrolled children aged 6-7 and 13-14 years and adults aged 20-44 years from a Polish national cohort. The diagnosis of allergic diseases was made by a physician. Skin prick tests to 13 allergens and serum IgE levels to 4 allergens were tested. Results Among the 3856 participants, single disease (asthma, allergic rhinitis or atopic dermatitis) was diagnosed in 27.7% subjects and allergic multimorbidity in 9.3%. Allergic multimorbidity occurred more commonly in children than in adults (p < 0.01). Asthma or atopic dermatitis alone were not associated with polysensitization. Rhinitis and multimorbidity were associated with polysensitization. Allergic multimorbidity occurred in 2.2% of participants with negative skin prick tests, 9.8% of those with one positive prick test (SPT ≥ 3 mm) and 20.6% of polysensitized ones (p < 0.001). There was an increasing risk of multimorbidity depending on the number of positive prick tests for both SPT ≥ 3 mm (OR 9.6-16.5) and SPT ≥ 6 mm (OR 5.9-13.7). A statistically significant relationship was found between allergic multimorbidity and sensitization to cat and mite allergens. Conclusions Multimorbidity is associated with polysensitization especially in children compared with adults in Polish population cohort. New insights into single disease patterns were found: bronchial asthma is the strongest risk factor for the development of multimorbidity in comparison with allergic rhinitis and atopic dermatitis.
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Affiliation(s)
- Filip Raciborski
- 1Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | | | - Jean Bousqet
- MACVIA-France and Fondation FMC VI-LR, Montpellier, France.,3Ageing and Chronic Diseases, Epidemiological and Public Health Approaches, U1168, INSERM, VIMA, Paris, France.,UMR-S 1168, Université Versailles St-Quentin-en-Yvelines (UVSQ), Paris, France.,Euforea, Brussels, Belgium.,6Charité, Berlin, Germany
| | - Andrzej Namysłowski
- 1Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland.,7Allergy and Clinical Immunology Department, Central Hospital Medical University of Warsaw, Warsaw, Poland
| | - Edyta Krzych-Fałta
- 1Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland.,7Allergy and Clinical Immunology Department, Central Hospital Medical University of Warsaw, Warsaw, Poland
| | - Aneta Tomaszewska
- 1Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - Barbara Piekarska
- 1Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Samel-Kowalik
- 1Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - Artur Z Białoszewski
- 1Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - Artur Walkiewicz
- 1Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - Agnieszka Lipiec
- 1Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland.,7Allergy and Clinical Immunology Department, Central Hospital Medical University of Warsaw, Warsaw, Poland
| | - Oksana Wojas
- 1Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland.,7Allergy and Clinical Immunology Department, Central Hospital Medical University of Warsaw, Warsaw, Poland
| | | | - Anna Szylling
- 7Allergy and Clinical Immunology Department, Central Hospital Medical University of Warsaw, Warsaw, Poland
| | - Wojciech Zieliński
- 1Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland.,9Department of Econometrics and Statistics, Warsaw University of Life Sciences, Warsaw, Poland
| | - Adam Sybilski
- 1Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - Aleksandra Grąbczewska
- 1Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - Bolesław Samoliński
- 1Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland.,7Allergy and Clinical Immunology Department, Central Hospital Medical University of Warsaw, Warsaw, Poland
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Park A, Park H, Yu J. Development of Aspergillus fumigatus-induced chronic atopic dermatitis mouse model. ALLERGY ASTHMA & RESPIRATORY DISEASE 2019. [DOI: 10.4168/aard.2019.7.3.150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Arum Park
- Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Hyojung Park
- Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Jinho Yu
- Department of Pediatrics, Asan Medical Center, Seoul, Korea
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Celakovská J, Bukac J, Ettler K, Vaneckova J, Krcmova I, Ettlerova K, Krejsek J. The occurrence of food hypersensitivity reactions and the relation to the sensitization to grass and trees in atopic dermatitis patients 14 years of age and older. Indian J Dermatol 2019; 64:346-354. [PMID: 31543527 PMCID: PMC6749770 DOI: 10.4103/ijd.ijd_164_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Methods: Results: Conclusion:
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Arasi S, Porcaro F, Cutrera R, Fiocchi AG. Severe Asthma and Allergy: A Pediatric Perspective. Front Pediatr 2019; 7:28. [PMID: 30805326 PMCID: PMC6378301 DOI: 10.3389/fped.2019.00028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 01/23/2019] [Indexed: 12/17/2022] Open
Abstract
Severe asthma in children is associated with significant morbidity and lung function decline. It represents a highly heterogeneous disorder with multiple clinical phenotypes. As its management is demanding, the social and economic burden are impressive. Several co-morbidities may contribute to worsen asthma control and complicate diagnostic and therapeutic management of severe asthmatic patients. Allergen sensitization and/or allergy symptoms may predict asthma onset and severity. A better framing of "allergen sensitization" and understanding of mechanisms underlying progression of atopic march could improve the management and the long-term outcomes of pediatric severe asthma. This review focuses on the current knowledge about interactions between severe asthma and allergies.
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Affiliation(s)
- Stefania Arasi
- Pediatric Allergology Unit, Bambino Gesù Hospital (IRCCS), Rome, Italy
| | - Federica Porcaro
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Renato Cutrera
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
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Cha KJ, Song CS, Lee JS, Kashif A, Hong MH, Kim G, Kim IS. Chaenomeles sinensis Koehne extract suppresses the development of atopic dermatitis-like lesions by regulating cytokine and filaggrin expression in NC/Nga mice. Int J Med Sci 2019; 16:1604-1613. [PMID: 31839748 PMCID: PMC6909810 DOI: 10.7150/ijms.37854] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/14/2019] [Indexed: 12/16/2022] Open
Abstract
Chaenomeles sinensis Koehne (CS) has been used in a traditional oriental medicine for treating throat diseases, anaphylaxis, viral infection, and inflammation. This study investigated the underlying mechanism of anti-allergic effect of CS. Leaves of CS plants were dried, powdered, and then underwent extraction with DMSO. Both ELISA and western blotting were performed to evaluate cytokine concentration and the expression and activation of filaggrin and JNK. Five-week-old female NC/Nga mice were used as an AD-like mouse model by treating them with 2,4-dinitrochlorobenzene (DNCB). The secretion of TARC, MCP-1, and IL-8 is increased by TNF-α and IFN-γ in HaCaT cells, and CS extract inhibited the increased production of TARC, MCP-1, and IL-8. TNF-α and IFN-γ suppressed filaggrin expression by activating JNK. CS extract recovered the expression of filaggrin decreased by TNF-α and IFN-γ by blocking the activation of JNK. In vivo experiment, CS administration reduced thickening of the epidermis and infiltration of inflammatory cells into the dermis as compared to DNCB treatment. Moreover, the decrease of filaggrin expression due to DNCB treatment was recovered by CS administration. The serum IgE level was decreased by CS treatment. The levels of IL-4, IL-5, IL-13 and eotaxin in mouse splenocytes increased after treatment with concanavalin A, and the secretions of IL-4, IL-5, IL-13 and eotaxin were lower in the CS-treated group than in the DNCB group. These results may contribute to the development of a CS-based drug for the treatment of atopic dermatitis.
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Affiliation(s)
- Kyung-Jae Cha
- Department of Senior Healthcare, BK21 Plus Program, Graduate School, Eulji University, Daejeon 34824
| | - Chang-Seob Song
- Happybio R&D center, Happybio, Cheongju, Chungcheongbuk-do 28101
| | - Ji-Sook Lee
- Department of Clinical Laboratory Science, Wonkwang Health Science University, Iksan, 54538
| | - Ayesha Kashif
- Department of Senior Healthcare, BK21 Plus Program, Graduate School, Eulji University, Daejeon 34824
| | - Min Hwa Hong
- Department of Senior Healthcare, BK21 Plus Program, Graduate School, Eulji University, Daejeon 34824
| | - Geunyeong Kim
- Department of Senior Healthcare, BK21 Plus Program, Graduate School, Eulji University, Daejeon 34824
| | - In Sik Kim
- Department of Senior Healthcare, BK21 Plus Program, Graduate School, Eulji University, Daejeon 34824.,Department of Biomedical Laboratory Science, School of Medicine, Eulji University, Daejeon 34824, Republic of Korea
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Rasheed Z, Zedan K, Saif GB, Salama RH, Salem T, Ahmed AA, El-Moniem AA, Elkholy M, Al Robaee AA, Alzolibani AA. Markers of atopic dermatitis, allergic rhinitis and bronchial asthma in pediatric patients: correlation with filaggrin, eosinophil major basic protein and immunoglobulin E. Clin Mol Allergy 2018; 16:23. [PMID: 30473631 PMCID: PMC6233599 DOI: 10.1186/s12948-018-0102-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 11/03/2018] [Indexed: 01/09/2023] Open
Abstract
Background Allergic reactions have been implicated as contributions in a number of atopic disorders, including atopic dermatitis (AD), allergic rhinitis (AR) and bronchial asthma (BA). However, the potential for filaggrin protein, eosinophil major basic protein (MBP) and immunoglobulin E (IgE) to elicit allergic response or to contribute to atopic disorders remains largely unexplored in pediatric patients. This study was undertaken to investigate the status and contribution of filaggrin protein, eosinophil MBP and total IgE in pediatric patients with AD, AR and BA. Methods Sera from 395 pediatric patients of AD, AR or BA with varying levels of disease activity according to the disease activity index and 410 age-matched non-atopic healthy controls were evaluated for serum levels of atopic markers, including filaggrin, eosinophil MBP and IgE. Results Serum analysis showed that filaggrin levels were remarkably high in pediatric patients with AD, followed by BA and AR, whereas its levels were low in non-atopic pediatric controls. Eosinophil MBP levels in sera of atopic patients were significantly high as compared with their respective controls, but its levels were highest in AR patients, followed by AD and BA. Total IgE in sera of AD patients was markedly high, followed by AR and BA patients, whereas its levels were low in non-atopic pediatric controls. Interestingly, not only was an increased number of subjects positive for filaggrin protein, eosinophil MBP or total IgE, but also their levels were statistically significantly higher among those atopic patients whose disease activity scores were higher as compared with atopic patients with lower disease activity scores. Conclusions These findings strongly support a role of filaggrin protein, eosinophil MBP and IgE in the onset of allergic reactions in pediatric patients with AD, AR and BA. The data suggest that filaggrin, eosinophil MBP or IgE might be useful in evaluating the progression of AD, AR or BA and in elucidating the mechanisms involved in the pathogenesis of these pediatric disorders.
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Affiliation(s)
- Zafar Rasheed
- 1Department of Medical Biochemistry, College of Medicine, Qassim University, P.O. Box 6655, Buraidah, 51452 Saudi Arabia
| | - Khaled Zedan
- 2Department of Pediatrics, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Ghada Bin Saif
- 3Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ragaa H Salama
- 1Department of Medical Biochemistry, College of Medicine, Qassim University, P.O. Box 6655, Buraidah, 51452 Saudi Arabia
| | - Tarek Salem
- 1Department of Medical Biochemistry, College of Medicine, Qassim University, P.O. Box 6655, Buraidah, 51452 Saudi Arabia
| | - Ahmed A Ahmed
- 4Research Center, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Alaa Abd El-Moniem
- 5Department of Medicine, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Maha Elkholy
- 5Department of Medicine, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Ahmad A Al Robaee
- 6Department of Dermatology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
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Ferguson L, Futamura M, Vakirlis E, Kojima R, Sasaki H, Roberts A, Mori R. Leukotriene receptor antagonists for eczema. Cochrane Database Syst Rev 2018; 10:CD011224. [PMID: 30343498 PMCID: PMC6517006 DOI: 10.1002/14651858.cd011224.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Eczema is a common, chronic, inflammatory skin condition that is frequently associated with atopic conditions, including asthma. Leukotriene receptor antagonists (LTRAs) have a corticosteroid-sparing role in asthma, but their role in eczema remains controversial. Currently available topical therapies for eczema are often poorly tolerated, and use of systemic agents is restricted by their adverse effect profile. A review of alternative treatments was therefore warranted. OBJECTIVES To assess the possible benefits and harms of leukotriene receptor antagonists for eczema. SEARCH METHODS We searched the following databases to September 2017: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and the GREAT database. We also searched five trial registries, and handsearched the bibliographies of all extracted studies for further relevant trials. SELECTION CRITERIA Randomised controlled trials of LTRAs alone or in combination with other (topical or systemic) treatments compared with other treatments alone such as topical corticosteroids or placebo for eczema in the acute or chronic (maintenance) phase of eczema in adults and children. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. The primary outcome measures were change in disease severity, long-term symptom control, and adverse effects of treatment. Secondary outcomes were change in corticosteroid requirement, reduction of pruritis, quality of life, and emollient requirement. We used GRADE to assess the quality of the evidence for each outcome. MAIN RESULTS Only five studies (including a total of 202 participants) met the inclusion criteria, all of which assessed oral montelukast; hence, we found no studies assessing other LTRAs. Treatment ranged from four to eight weeks, and outcomes were assessed at the end of treatment; therefore, we could only report short-term measurements (defined as less than three months follow-up from baseline). Montelukast dosing was 10 mg for adults (age 14 years and above) and 5 mg for children (age 6 years to 14 years). One study included children (aged 6 years and above) among their participants, while the remaining studies only included adults (participant age ranged from 16 to 70 years). The participants were diagnosed with moderate-to-severe eczema in four studies and moderate eczema in one study. The study setting was unclear in two studies, multicentre in two studies, and single centre in one study; the studies were conducted in Europe and Bangladesh. Two studies were industry funded. The comparator was placebo in three studies and conventional treatment in two studies. The conventional treatment comparator was a combination of antihistamines and topical corticosteroids (plus oral antibiotics in one study).Four of the studies did not adequately describe their randomisation or allocation concealment method and were considered as at unclear risk of selection bias. Only one study was at low risk of performance and detection bias. However, we judged all studies to be at low risk of attrition and reporting bias.We found no evidence of a difference in disease severity of moderate-to-severe eczema after short-term use of montelukast (10 mg) when compared with placebo. The outcome was assessed using the modified EASI (Eczema Area and Severity Index) score and SASSAD (Six Area, Six Sign Atopic Dermatitis) severity score (standardised mean difference 0.29, with a positive score showing montelukast is favoured, 95% confidence interval (CI) -0.23 to 0.81; 3 studies; n = 131; low-quality evidence).When short-term montelukast (10 mg) treatment was compared with conventional treatment in one study, the mean improvement in severity of moderate-to-severe eczema was greater in the intervention group (measured using SCORAD (SCORing of Atopic Dermatitis) severity index) (mean difference 10.57, 95% CI 4.58 to 16.56; n = 31); however, another study of 32 participants found no significant difference between groups using the same measure (mean improvement was 25.2 points with montelukast versus 23.9 points with conventional treatment; no further numerical data provided). We judged the quality of the evidence as very low for this outcome, meaning the results are uncertain.All studies reported their adverse event rate during treatment. Four studies (136 participants) reported no adverse events. In one study of 58 participants with moderate eczema who received montelukast 10 mg (compared with placebo), there was one case of septicaemia and one case of dizziness reported in the intervention group, both resulting in study withdrawal, although whether these effects were related to the medication is unclear. Mild side effects (e.g. headache and mild gastrointestinal disturbances) were also noted, but these were fairly evenly distributed between the montelukast and placebo groups. The quality of evidence for this outcome was low.No studies specifically evaluated emollient requirement or quality of life. One study that administered treatment for eight weeks specifically evaluated pruritus improvement at the end treatment and topical corticosteroid use during treatment. We found no evidence of a difference between montelukast (10 mg) and placebo for both outcomes (low-quality evidence, n = 58). No other study assessed these outcomes. AUTHORS' CONCLUSIONS The findings of this review are limited to montelukast. There was a lack of evidence addressing the review question, and the quality of the available evidence for most of the measured outcomes was low. Some primary and secondary outcomes were not addressed at all, including long-term control.We found no evidence of a difference between montelukast (10 mg) and placebo on disease severity, pruritus improvement, and topical corticosteroid use. Very low-quality evidence means we are uncertain of the effect of montelukast (10 mg) compared with conventional treatment on disease severity. Participants in only one study reported adverse events, which were mainly mild (low-quality evidence).There is no evidence that LTRA is an effective treatment for eczema. Serious limitations were that all studies focused on montelukast and only included people with moderate-to-severe eczema, who were mainly adults; and that each outcome was evaluated with a small sample size, if at all.Further large randomised controlled trials, with a longer treatment duration, of adults and children who have eczema of all severities may help to evaluate the effect of all types of LTRA, especially on eczema maintenance.
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Affiliation(s)
- Leila Ferguson
- St Helier HospitalDepartment of DermatologyWrythe LaneCarshaltonSurreyUKSM5 1AA
| | - Masaki Futamura
- Nagoya Medical CenterDepartment of Pediatrics4‐1‐1 SannomaruNaka‐kuNagoyaJapan460‐0001
| | - Efstratios Vakirlis
- Aristotle University Medical SchoolA' Department of DermatologyKanari 13ThessalonikiGreece54644
| | - Reiji Kojima
- School of Medicine, University of YamanashiDepartment of Health SciencesYamanashiJapan
| | - Hatoko Sasaki
- National Center for Child Health and DevelopmentDepartment of Health Policy2‐10‐1 Okura, SetagayaTokyoTokyoJapan157‐8535
| | - Amanda Roberts
- Nottingham Support Group for Carers of Children with EczemaNottinghamUKNG5 4FG
| | - Rintaro Mori
- National Center for Child Health and DevelopmentDepartment of Health Policy2‐10‐1 Okura, SetagayaTokyoTokyoJapan157‐8535
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