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Ferry JM, Galera-Martínez R, Campoy C, Sáenz de Pipaón M, Jarocka-Cyrta E, Walkowiak J, Romańczuk B, Escribano J, Gispert M, Grattarola P, Gruszfeld D, Iglesia I, Grote V, Demmelmair H, Handel U, Gallier S, Koletzko B. Effects of infant feeding with goat milk formula or cow milk formula on atopic dermatitis: protocol of the randomised controlled Goat Infant Formula Feeding and Eczema (GIraFFE) trial. BMJ Open 2023; 13:e070533. [PMID: 37055203 PMCID: PMC10106058 DOI: 10.1136/bmjopen-2022-070533] [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] [Indexed: 04/15/2023] Open
Abstract
INTRODUCTION Atopic dermatitis (AD) is a chronic, inflammatory skin condition significantly affecting quality of life. A small randomised trial showed an approximately one-third lower incidence of AD in goat milk formula-fed compared with cow milk formula-fed infants. However, due to limited statistical power, AD incidence difference was not found to be significant. This study aims to explore a potential risk reduction of AD by feeding a formula based on whole goat milk (as a source of protein and fat) compared with a formula based on cow milk proteins and vegetable oils. METHODS AND ANALYSIS This two-arm (1:1 allocation), parallel, randomised, double-blind, controlled nutritional trial shall enrol up to 2296 healthy term-born infants until 3 months of age, if parents choose to start formula feeding. Ten study centres in Spain and Poland are participating. Randomised infants receive investigational infant and follow-on formulas either based on whole goat milk or on cow milk until the age of 12 months. The goat milk formula has a whey:casein ratio of 20:80 and about 50% of the lipids are milk fat from whole goat milk, whereas the cow milk formula, used as control, has a whey:casein ratio of 60:40 and 100% of the lipids are from vegetable oils. The energy and nutrient levels in both goat and cow milk formulas are the same. The primary endpoint is the cumulative incidence of AD until the age of 12 months diagnosed by study personnel based on the UK Working Party Diagnostic Criteria. The secondary endpoints include reported AD diagnosis, measures of AD, blood and stool markers, child growth, sleep, nutrition and quality of life. Participating children are followed until the age of 5 years. ETHICS AND DISSEMINATION Ethical approval was obtained from the ethical committees of all participating institutions. TRIAL REGISTRATION NUMBER NCT04599946.
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Affiliation(s)
- Jill Marie Ferry
- Division of Metabolic and Nutritional Medicine, Department of Paediatrics, Dr von Hauner Children's Hospital, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Rafael Galera-Martínez
- Unit of Pediatric Gastroenterology and Nutrition, Torrecárdenas University Hospital, Almería, Spain
| | - Cristina Campoy
- Department of Paediatrics, EURISTIKOS Excellence Centre for Paediatric Research, School of Medicine, University of Granada, Granada, Spain
- Instituto Biosanitario de Granada (Ibs-Granada), Fundación Parque Tecnológico de Ciencias de la Salud de Granada, Granada, Spain
| | | | - Elzbieta Jarocka-Cyrta
- Department of Pediatrics, Gastroenterology, and Nutrition, Regional Specialized Children's Hospital in Olsztyn, Medical Faculty Collegium Medicum University of Warmia and Mazury, Olsztyn, Poland
| | - Jarosław Walkowiak
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Bartosz Romańczuk
- Department of Pediatrics, Medical College, University of Rzeszów, Rzeszów, Poland
| | - Joaquin Escribano
- IISPV, Pediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, Tarragona, Spain
- Department of Paediatric, Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - Mariona Gispert
- IISPV, Pediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, Tarragona, Spain
| | | | - Dariusz Gruszfeld
- Department of Paediatric, Children's Memorial Health Institute in Warsaw, Warsaw, Poland
| | - Iris Iglesia
- Agrifood Institute of Aragon (IA2), Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS-Aragón), Zaragoza, Spain
| | - Veit Grote
- Division of Metabolic and Nutritional Medicine, Department of Paediatrics, Dr von Hauner Children's Hospital, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Hans Demmelmair
- Division of Metabolic and Nutritional Medicine, Department of Paediatrics, Dr von Hauner Children's Hospital, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Uschi Handel
- Division of Metabolic and Nutritional Medicine, Department of Paediatrics, Dr von Hauner Children's Hospital, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | | | - Berthold Koletzko
- Division of Metabolic and Nutritional Medicine, Department of Paediatrics, Dr von Hauner Children's Hospital, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
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Evaluation of a Modified Version of the United Kingdom Working Party Diagnostic Criteria for Atopic Dermatitis in Tunisia. Dermatitis 2022; 33:S119-S123. [DOI: 10.1097/der.0000000000000966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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3
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Pittet LF, Messina NL, Gardiner K, Freyne B, Abruzzo V, Francis KL, Morrison C, Zufferey C, Vuillermin P, Allen KJ, Ponsonby A, Robins‐Browne R, Shann F, Flanagan KL, Phillips R, Donath S, Casalaz D, Curtis N. Prevention of infant eczema by neonatal Bacillus Calmette-Guérin vaccination: The MIS BAIR randomized controlled trial. Allergy 2022; 77:956-965. [PMID: 34309859 DOI: 10.1111/all.15022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/13/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Bacille Calmette-Guérin (BCG) vaccine could play a role in counteracting the rising prevalence of atopic diseases, through its beneficial off-target effects. We aimed to determine whether neonatal BCG vaccination reduces the incidence of eczema in infants. METHODS Randomized controlled trial with 1272 infants allocated to receive BCG-Denmark or no BCG at birth. The primary outcome was the 12-month incidence of eczema based on 3-monthly questionnaires. Eczema was also assessed at a 12-month clinic visit. ClinicalTrial.gov: NCT01906853. RESULTS The 12-month eczema incidence was 32.2% in the BCG group compared with 36.6% in the control group (adjusted risk difference (aRD) -4.3%, 95% CI -9.9% to 1.3%, multiple imputation model). In addition, comparing infants in the BCG group with the control group, 15.7% vs. 19.2% had eczema lesions at the 12-month visit (aRD -3.5%, 95% CI -8.0% to 1.0%); 35.7% vs. 39.0% reported using topical steroids (aRD -3.3, 95% CI -9.2 to 2.7); and 7.3% vs. 10.2% had severe eczema scores (aRD -3.0%, 95% CI -8.8% to 2.7%). In 344 high-risk infants (two atopic parents), the 12-month eczema incidence was 35.3% in the BCG group compared with 46.8% in the control group (aRD -11.5%, 95% CI -21.9% to -1.2%; number needed to treat 8.7, 95% CI 4.6 to 83.3). CONCLUSION There is insufficient evidence to recommend neonatal BCG vaccination in all infants for the prevention of eczema in the first year of life; however, a modest beneficial effect was observed among high-risk infants. A single dose of BCG-Denmark soon after birth could reduce the incidence of eczema in infants with two atopic parents.
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Affiliation(s)
- Laure F. Pittet
- Infectious Diseases Group Murdoch Children’s Research Institute Parkville Victoria Australia
- Department of Paediatrics The University of Melbourne Parkville Victoria Australia
- Infectious Diseases The Royal Children’s Hospital Melbourne Parkville Victoria Australia
| | - Nicole L. Messina
- Infectious Diseases Group Murdoch Children’s Research Institute Parkville Victoria Australia
- Department of Paediatrics The University of Melbourne Parkville Victoria Australia
| | - Kaya Gardiner
- Infectious Diseases Group Murdoch Children’s Research Institute Parkville Victoria Australia
- Department of Research Operations The Royal Children’s Hospital Melbourne Parkville Victoria Australia
| | - Bridget Freyne
- Infectious Diseases Group Murdoch Children’s Research Institute Parkville Victoria Australia
- Department of Paediatrics College of Medicine University of MalawiQueen Elizabeth Central Hospital Blantyre Malawi
- Institute of Infection, Veterinary and Ecological Sciences University of Liverpool and Malawi‐Liverpool Wellcome Trust Research Programme Blantyre Malawi
| | - Veronica Abruzzo
- Infectious Diseases Group Murdoch Children’s Research Institute Parkville Victoria Australia
| | - Kate L. Francis
- Clinical Epidemiology & Biostatistics Unit Murdoch Children’s Research Institute Parkville Victoria Australia
| | - Clare Morrison
- Infectious Diseases Group Murdoch Children’s Research Institute Parkville Victoria Australia
| | - Christel Zufferey
- Infectious Diseases Group Murdoch Children’s Research Institute Parkville Victoria Australia
| | - Peter Vuillermin
- School of Medicine Deakin University Geelong Victoria Australia
- Child Health Research Unit Barwon Health Geelong Victoria Australia
| | - Katrina J. Allen
- Formerly Centre for Food and Allergy Research Murdoch Children's Research Institute Parkville Victoria Australia
| | - Anne‐Louise Ponsonby
- Population Allergy Murdoch Children's Research Institute Parkville Victoria Australia
- The Florey Institute for Neuroscience and Mental Health University of Melbourne Melbourne Victoria Australia
| | - Roy Robins‐Browne
- Infectious Diseases Group Murdoch Children’s Research Institute Parkville Victoria Australia
- Department of Microbiology and Immunology Peter Doherty Institute for Infection and Immunity The University of Melbourne Melbourne Victoria Australia
| | - Frank Shann
- Department of Paediatrics The University of Melbourne Parkville Victoria Australia
| | - Katie L. Flanagan
- School of Health Sciences University of Tasmania Hobart Tasmania Australia
- School of Health and Biomedical Science RMIT University Melbourne Victoria Australia
- Department of Immunology and Pathology Monash University Melbourne Victoria Australia
| | - Rod Phillips
- Department of Paediatrics The University of Melbourne Parkville Victoria Australia
- Dermatology Unit The Royal Children’s Hospital Melbourne Parkville Victoria Australia
| | - Susan Donath
- Department of Paediatrics The University of Melbourne Parkville Victoria Australia
- Clinical Epidemiology & Biostatistics Unit Murdoch Children’s Research Institute Parkville Victoria Australia
| | - Dan Casalaz
- Neonatal Intensive Care Unit Mercy Hospital for Women Heidelberg Victoria Australia
| | - Nigel Curtis
- Infectious Diseases Group Murdoch Children’s Research Institute Parkville Victoria Australia
- Department of Paediatrics The University of Melbourne Parkville Victoria Australia
- Infectious Diseases The Royal Children’s Hospital Melbourne Parkville Victoria Australia
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Pittet LF, Messina NL, Gardiner K, Freyne B, Abruzzo V, Morrison C, Vuillermin P, Allen KJ, Ponsonby AL, Robins-Browne R, Shann F, Flanagan KL, Donath S, Casalaz D, Phillips R, Curtis N. Discordance Between Diagnosis Tools for Assessing Eczema in Infants: A Challenge for Intervention Trials. Dermatitis 2022; 33:207-214. [PMID: 35170523 DOI: 10.1097/der.0000000000000842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is no standardized definition for infant eczema, and various tools have been used across studies, precluding direct comparison. OBJECTIVE The aim of the study was to assess and to compare the accuracy of diagnostic tools for infant eczema using the extensive data collected in Melbourne Infant Study: BCG for Allergy and Infection Reduction (MIS BAIR), an eczema prevention trial. METHODS Eczema incidence was assessed by 3 questionnaire-based measures: modified UK diagnostic tool, parent-reported medically diagnosed eczema, and parent-reported use of topical corticosteroids. Agreement between the definitions was quantified using κ coefficient. Eczema severity was assessed by 3-monthly Patient-Oriented Eczema Measure (POEM) scores and a SCORing Atopic Dermatitis (SCORAD) clinical assessment at a 12-month visit (ClinicalTrial.gov: NCT01906853). RESULTS Among the 538 participants fulfilling at least 1 of the 3 questionnaire-based eczema definitions, only 197 participants (37%) met all 3 definitions. Agreement between the definitions was poor with κ coefficients ranging from -0.11 to 0.62. The most frequently reported symptoms were generally dry skin (483/538, 90%) and pruritus (400/538, 74%). The face (352/538, 65%) and the trunk (306/538, 57%) were more frequently affected than the creases (257/538, 48%). Participants fulfilling all 3 questionnaire-based definitions of eczema were more likely to have higher severity scores and earlier onset of symptoms. CONCLUSIONS There is poor agreement between currently available tools for assessing infant eczema.
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Affiliation(s)
- Laure F Pittet
- From the Infectious Diseases Group, Murdoch Children's Research Institute Department of Paediatrics, The University of Melbourne Infectious Diseases Department of Research Operations, The Royal Children's Hospital Melbourne, Parkville, Australia Department of Paediatrics, College of Medicine, University of Malawi, Queen Elizabeth Central Hospital Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool and Malawi-Liverpool Wellcome Trust Research Programme, Blantyre School of Medicine, Deakin University Child Health Research Unit, Barwon Health, Geelong Formerly Centre for Food and Allergy Research Population Allergy, Murdoch Children's Research Institute, Melbourne The Florey Institute for Neuroscience and Mental Health Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville School of Medicine, University of Tasmania, Hobart Tasmanian Vaccine Trial Centre, Launceston General Hospital, Launceston School of Health and Biomedical Science, RMIT University Department of Immunology and Pathology, Monash University Clinical Epidemiology & Biostatistics Unit, Murdoch Children's Research Institute, Melbourne Neonatal Intensive Care Unit, Mercy Hospital for Women, Heidelberg Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Australia
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Eczema distribution in girls and boys during infancy: A cohort study on atopic dermatitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3513-3516.e2. [PMID: 33964509 DOI: 10.1016/j.jaip.2021.04.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/07/2021] [Accepted: 04/21/2021] [Indexed: 01/15/2023]
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Pedersen CJ, Uddin MJ, Saha SK, Darmstadt GL. Prevalence and psychosocial impact of atopic dermatitis in Bangladeshi children and families. PLoS One 2021; 16:e0249824. [PMID: 33861780 PMCID: PMC8051797 DOI: 10.1371/journal.pone.0249824] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/25/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Skin conditions are the fourth leading cause of nonfatal disease globally, with atopic dermatitis (AD) a major and rising contributor. Though atopic dermatitis (AD) is rising in prevalence, little is known about its psychosocial effects on children and families in low- and middle-income countries (LMICs). METHODS We conducted a community-based, cross-sectional survey of 2242 under-5 children in rural Bangladesh using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire to measure AD prevalence and severity, the Patient-Oriented Eczema Measure (POEM) to measure severity, and the Infants' Dermatitis Quality of Life index (IDQoL) and Dermatitis Family Index (DFI) to measure quality of life. FINDINGS Overall AD prevalence in under-five children was 11.9% [95% confidence interval (CI) 10.6-13.3%]. Prevalence was highest in children age 30-35 months [16.2% (95% CI 11.4-21.0)]. IDQoL was significantly higher in males (2.67) vs. females (1.95, p = 0.015), the lowest (3.06) vs. highest (1.63) wealth quintile (p<0.001), and among mothers with < primary (2.41) vs. > secondary (1.43) education (p = 0.039). POEM severity was correlated with IDQoL (r = 0.77, p<0.001) and DFI (r = 0.56, p<0.001). Severe disease as rated by caretakers was correlated with POEM (r = 0.73, p<0.001), IDQoL (r = 0.82, p<0.001) and DFI (r = 0.57, p<0.001). CONCLUSIONS Severe AD significantly affects quality of life for children and families in Bangladesh. As access to healthcare expands in LMICs, identification and treatment of both the medical and psychosocial morbidities associated with the disease are needed.
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Affiliation(s)
- Courtney J. Pedersen
- Stanford University School of Medicine, Stanford, California, United States of America
| | | | | | - Gary L. Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States of America
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7
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Endre KMA, Landrø L, LeBlanc M, Gjersvik P, Lødrup Carlsen KC, Haugen G, Hedlin G, Jonassen CM, Nordlund B, Rudi K, Skjerven HO, Staff AC, Söderhäll C, Vettukattil R, Rehbinder EM. Diagnosing atopic dermatitis in infancy using established diagnostic criteria: a cohort study. Br J Dermatol 2021; 186:50-58. [PMID: 33511639 DOI: 10.1111/bjd.19831] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Diagnosing atopic dermatitis (AD) in infants is challenging. OBJECTIVES To determine the incidence and persistence of eczema and AD in infants using the UK Working Party (UKWP) and Hanifin and Rajka (H&R) criteria. METHODS A cohort of 1834 infants was examined clinically at 3, 6 and 12 months of age. AD was diagnosed by UKWP (3, 6 and 12 months) and H&R (12 months) criteria. Logistic regression models were used to assess the relationship between AD and eczema. RESULTS Eczema was observed in 628 (34·2%) infants (n = 240, n = 359 and n = 329 at 3, 6 and 12 months, respectively), with AD diagnosed in 212 (33·7%) infants with any eczema and in 64/78 (82%) infants with eczema at all three visits. The odds of AD were lower with first presentation of eczema at 6 [odds ratio (OR) 0·33, 95% confidence interval (CI) 0·22-0·48] or 12 months (OR 0·49, 95% CI 0·32-0·74) than at 3 months, and higher in infants with eczema at three (OR 23·1, 95% CI 12·3-43·6) or two (OR 6·5, 95% CI 4·3-9·9) visits vs. one visit only. At 12 months, 156/329 (47·4%) fulfilled the UKWP and/or H&R criteria; 27 (8%) fulfilled the UKWP criteria only and 65 (20%) only the H&R criteria. Of the 129 infants who fulfilled the H&R criteria, 44 (34·1%) did not meet the itch criterion. CONCLUSIONS Used in combination and at multiple timepoints, the UKWP and H&R criteria for AD may be useful in clinical research but may have limited value in most other clinical settings.
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Affiliation(s)
- K M A Endre
- Department of Dermatology and Venerology, Oslo University Hospital, Oslo, Norway.,University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
| | - L Landrø
- Department of Dermatology and Venerology, Oslo University Hospital, Oslo, Norway.,University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
| | - M LeBlanc
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - P Gjersvik
- Department of Dermatology and Venerology, Oslo University Hospital, Oslo, Norway.,University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
| | - K C Lødrup Carlsen
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway.,Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - G Haugen
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - G Hedlin
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women´s and Children´s Health, Karolinska Institutet, Stockholm, Sweden
| | - C M Jonassen
- Genetic Unit, Centre for Laboratory Medicine, Østfold Hospital Trust, Kalnes, Norway.,Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway
| | - B Nordlund
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women´s and Children´s Health, Karolinska Institutet, Stockholm, Sweden
| | - K Rudi
- Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway
| | - H O Skjerven
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway.,Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - A C Staff
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - C Söderhäll
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women´s and Children´s Health, Karolinska Institutet, Stockholm, Sweden
| | - R Vettukattil
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway.,Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - E M Rehbinder
- Department of Dermatology and Venerology, Oslo University Hospital, Oslo, Norway.,University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
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Pedersen CJ, Uddin MJ, Saha SK, Darmstadt GL. Prevalence of atopic dermatitis, asthma and rhinitis from infancy through adulthood in rural Bangladesh: a population-based, cross-sectional survey. BMJ Open 2020; 10:e042380. [PMID: 33148768 PMCID: PMC7643529 DOI: 10.1136/bmjopen-2020-042380] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Describe the pattern of atopic disease prevalence from infancy to adulthood. DESIGN Cross-sectional household survey. SETTING Community-based demographic surveillance site, Mirzapur, Bangladesh. PARTICIPANTS 7275 individuals in randomly selected clusters within 156 villages. PRIMARY AND SECONDARY OUTCOME MEASURES The 12-month prevalence of atopic dermatitis (by UK Working Party Criteria (UK criteria) and International Study of Asthma and Allergies in Childhood (ISAAC)), asthma and rhinitis (by ISAAC); disease severity (by ISAAC); history of ever receiving a medical diagnosis. RESULTS Children aged 2 years had the highest prevalence of atopic dermatitis-18.8% (95% CI 15.2% to 22.4%) by UK criteria and 14.9% (95% CI 11.6% to 18.1%) by ISAAC- and asthma (20.1%, 95% CI 16.4% to 23.8%). Prevalence of rhinitis was highest among 25-29 year olds (6.0%, (95% CI% 4.5 to 7.4%). History of a medical diagnosis was lowest for atopic dermatitis (4.0%) and highest for rhinitis (27.3%) and was significantly associated with severe disease compared with those without severe disease for all three conditions (atopic dermatitis: 30.0% vs 11.7%, p=0.015; asthma; 85.0% vs 60.4%, p<0.001; rhinitis: 34.2% vs 7.3%, p<0.001) and having a higher asset-based wealth score for asthma (29.7% (highest quintile) vs 7.5% (lowest quintile), p<0.001) and rhinitis (39.8% vs 12.5%, p=0.003). Prevalence of having >1 condition was highest (36.2%) at 2 years and decreased with age. Having atopic dermatitis (ISAAC) was associated with significantly increased odds ratios (OR) for comorbid asthma (OR 5.56 (95% CI 4.26 to 7.26)] and rhinitis (3.68 (95% CI 2.73 to 4.96)). Asthma and rhinitis were also strongly associated with each other (OR 8.39 (95% CI 6.48 to 10.86)). CONCLUSIONS Atopic disease burden was high in this rural Bangladeshi population. Having one atopic condition was significantly associated with the presence of another. Low incidence of ever obtaining a medical diagnosis highlights an important opportunity to increase availability of affordable diagnosis and treatment options for all age groups.
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Affiliation(s)
- Courtney J Pedersen
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
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El-Heis S, Crozier SR, Healy E, Robinson SM, Harvey NC, Cooper C, Inskip HM, Baird J, Godfrey KM. Faltering of prenatal growth precedes the development of atopic eczema in infancy: cohort study. Clin Epidemiol 2018; 10:1851-1864. [PMID: 30588116 PMCID: PMC6296686 DOI: 10.2147/clep.s175878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Infants with atopic eczema have an increased risk of impaired growth, but the origin of this impairment is unclear. The aim of this study was to examine fetal and infant growth in relation to infantile atopic eczema. Methods Within the UK Southampton Women's Survey, 1,759 infants with known maternal menstrual data had anthropometric measurements at 11, 19, and 34 weeks' gestation, birth, and ages 6 and 12 months, enabling derivation of growth velocity SD scores. Infantile atopic eczema at ages 6 and/or 12 months was ascertained using modified UK Working Party diagnostic criteria. Results Expressed per SD increase, higher femur length and abdominal circumference at 34 weeks' gestation were associated with decreased risks of atopic eczema (eczema OR/SD increase 0.81 [95% CI 0.69-0.96], P=0.017 and 0.78 [95% CI 0.65-0.93], P=0.006, respectively), while every SD increase in head to abdominal circumference ratio (indicating disproportionate growth) was associated with an increase in risk of atopic eczema (1.37 [1.15-1.63], P=0.001). Lower velocities of linear growth from 11 weeks' gestation to birth and birth to age 6 months were associated with atopic eczema (atopic eczema OR/SD increase 0.80 [0.65-0.98], P=0.034 and 0.8 [1 0.66-1.00], P=0.051, respectively). Infants with atopic eczema at age 12 months had a larger head circumference in early gestation and faltering of abdominal growth velocity from 19 to 34 weeks' gestation (atopic eczema OR/SD increase 0.67 [0.51-0.88], P=0.003). Conclusion Infants with atopic eczema demonstrate altered patterns of fetal growth, including faltering of linear growth in utero, prior to the clinical onset of atopic eczema. These findings suggest growth falters prior to the start of clinical atopic eczema and its treatment.
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Affiliation(s)
- Sarah El-Heis
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK,
| | - Sarah R Crozier
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK,
| | - Eugene Healy
- Dermatopharmacology, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Sian M Robinson
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK, .,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK,
| | - Nicholas C Harvey
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK, .,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK,
| | - Cyrus Cooper
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK, .,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK, .,NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - Hazel M Inskip
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK, .,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK,
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK, .,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK,
| | - Keith M Godfrey
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK, .,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK, .,Institute of Developmental Sciences, University of Southampton, Southampton, UK,
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Yew YW, Thyssen JP, Silverberg JI. A systematic review and meta-analysis of the regional and age-related differences in atopic dermatitis clinical characteristics. J Am Acad Dermatol 2018; 80:390-401. [PMID: 30287309 DOI: 10.1016/j.jaad.2018.09.035] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 09/18/2018] [Accepted: 09/20/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Previous studies found conflicting results about the commonality of different atopic dermatitis (AD) signs and symptoms. OBJECTIVE To determine the prevalences of AD characteristics and differences by region and age. METHODS A systematic review was performed of all published studies in MEDLINE, EMBASE, SCOPUS, LILACS, Cochrane, China National Knowledge Infrastructure, Taiwan Electronic Periodical Services, and CiNii that analyzed the proportion of AD characteristics. Two reviewers performed a review study titles and/or abstracts and data abstraction. RESULTS In all, 101 studies reported proportion of AD features with sufficient data for meta-analysis. The most prevalent AD features were pruritus, lichenification, and xerosis. There were differences in AD characteristics by study region. Flexural involvement was less commonly reported in India, the Americas, and Iran. Studies from East Asian reported more erythroderma and truncal, extensor, scalp, and auricular involvement. Studies from Southeast Asia reported more exudative eczema, truncal involvement, lichenification, and prurigo nodularis. Studies from Iran reported more head, face, and neck involvement; pityriasis alba; and xerosis. Studies from Africa reported more papular lichenoid lesions, palmar hyperlinearity, ichthyosis, and orbital darkening. LIMITATIONS Heterogeneity between studies and limited reporting of certain AD clinical characteristics. CONCLUSIONS AD characteristics are heterogeneous and vary by region and age.
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Affiliation(s)
- Yik Weng Yew
- Institute of Dermatology, National Skin Centre, Singapore
| | - Jacob P Thyssen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Jonathan I Silverberg
- Department of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Northwestern Medicine Multidisciplinary Eczema Center, Chicago, Illinois.
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Molloy J, Koplin JJ, Allen KJ, Tang MLK, Collier F, Carlin JB, Saffery R, Burgner D, Ranganathan S, Dwyer T, Ward AC, Moreno-Betancur M, Clarke M, Ponsonby AL, Vuillermin P. Vitamin D insufficiency in the first 6 months of infancy and challenge-proven IgE-mediated food allergy at 1 year of age: a case-cohort study. Allergy 2017; 72:1222-1231. [PMID: 28042676 DOI: 10.1111/all.13122] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ecological evidence suggests vitamin D insufficiency (VDI) due to lower ambient ultraviolet radiation (UVR) exposure may be a risk factor for IgE-mediated food allergy. However, there are no studies relating directly measured VDI during early infancy to subsequent challenge-proven food allergy. OBJECTIVE To prospectively investigate the association between VDI during infancy and challenge-proven food allergy at 1 year. METHODS In a birth cohort (n = 1074), we used a case-cohort design to compare 25-hydroxyvitamin D3 (25(OH)D3 ) levels among infants with food allergy vs a random subcohort (n = 274). The primary exposures were VDI (25(OH)D3 <50 nM) at birth and 6 months of age. Ambient UVR and time in the sun were combined to estimate UVR exposure dose. IgE-mediated food allergy status at 1 year was determined by formal challenge. Binomial regression was used to examine associations between VDI, UVR exposure dose and food allergy and investigate potential confounding. RESULTS Within the random subcohort, VDI was present in 45% (105/233) of newborns and 24% (55/227) of infants at 6 months. Food allergy prevalence at 1 year was 7.7% (61/786), and 6.5% (53/808) were egg-allergic. There was no evidence of an association between VDI at either birth (aRR 1.25, 95% CI 0.70-2.22) or 6 months (aRR 0.93, 95% CI 0.41-2.14) and food allergy at 1 year. CONCLUSIONS There was no evidence that VDI during the first 6 months of infancy is a risk factor for food allergy at 1 year of age. These findings primarily relate to egg allergy, and larger studies are required.
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Affiliation(s)
- J. Molloy
- School of Medicine; Deakin University; Waurn Ponds VIC Australia
- Child Health Research Unit; Barwon Health; Geelong VIC Australia
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Food and Allergy Research; Parkville VIC Australia
| | - J. J. Koplin
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Food and Allergy Research; Parkville VIC Australia
- Centre for Epidemiology and Biostatistics; The University of Melbourne; Carlton VIC Australia
| | - K. J. Allen
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Food and Allergy Research; Parkville VIC Australia
- Department of Paediatrics; University of Melbourne; Parkville VIC Australia
- Department of Allergy and Immunology; Royal Children's Hospital; Parkville VIC Australia
| | - M. L. K. Tang
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Food and Allergy Research; Parkville VIC Australia
- Department of Paediatrics; University of Melbourne; Parkville VIC Australia
- Department of Allergy and Immunology; Royal Children's Hospital; Parkville VIC Australia
| | - F. Collier
- School of Medicine; Deakin University; Waurn Ponds VIC Australia
- Child Health Research Unit; Barwon Health; Geelong VIC Australia
- Murdoch Childrens Research Institute; Parkville VIC Australia
| | - J. B. Carlin
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Epidemiology and Biostatistics; The University of Melbourne; Carlton VIC Australia
- Department of Paediatrics; University of Melbourne; Parkville VIC Australia
| | - R. Saffery
- Murdoch Childrens Research Institute; Parkville VIC Australia
| | - D. Burgner
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Department of Paediatrics; University of Melbourne; Parkville VIC Australia
- Department of Paediatrics; Monash University; Clayton VIC Australia
| | - S. Ranganathan
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Department of Paediatrics; University of Melbourne; Parkville VIC Australia
- Department of Respiratory Medicine; Royal Children's Hospital; Parkville VIC Australia
| | - T. Dwyer
- The George Institute for Global Health; University of Oxford; Oxford UK
| | - A. C. Ward
- School of Medicine; Deakin University; Waurn Ponds VIC Australia
| | - M. Moreno-Betancur
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne VIC Australia
| | - M. Clarke
- Biological and Molecular Mass Spectrometry Facility; Centre for Microscopy, Characterisation and Analysis; University of Western Australia; Perth Western Australia 6009
| | - A. L. Ponsonby
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Food and Allergy Research; Parkville VIC Australia
| | - P. Vuillermin
- School of Medicine; Deakin University; Waurn Ponds VIC Australia
- Child Health Research Unit; Barwon Health; Geelong VIC Australia
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Food and Allergy Research; Parkville VIC Australia
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12
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Leitenberger S, Hajar T, Simpson EL, von Kobyletzki L, Hanifin JM. Validation of a Parent-Reported Diagnostic Instrument in a U.S. Referral Population: The Childhood Eczema Questionnaire. Pediatr Dermatol 2017; 34:398-401. [PMID: 28523849 DOI: 10.1111/pde.13139] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES There is a paucity of validated tools for diagnosing atopic dermatitis (AD) in very young children that do not rely on clinical evaluation. The Childhood Eczema Questionnaire (CEQ)-a diagnostic tool for AD in children younger than 2 years that a caretaker can complete-was recently validated in Sweden. The objective of this study was to validate the tool in a U.S. POPULATION As a substudy, we added an additional question that was independently assessed. METHODS Children younger than 2 years old were recruited from a dermatology clinic. Their caretakers completed a questionnaire containing the original tool's three questions as well as a fourth question that increased the time frame measured from 1 week to 6 months. Questionnaires with all "yes" answers were considered positive and were compared with a dermatologist diagnosis of AD. RESULTS A total of 283 subjects were recruited. The first three questions (the original CEQ) predicted a positive diagnosis of AD with a sensitivity of 0.72 (95% confidence interval [CI] 0.58, 0.82) and a specificity of 0.93 (95% CI 0.87, 0.95). In a separate analysis we included the first two questions and the fourth question and found that the sensitivity increased to 0.82 (95% CI 0.69, 0.90) with a specificity of 0.89 (95% CI 0.83, 0.93). CONCLUSION This study validates a novel parental questionnaire for the diagnosis of AD in children younger than 2 years in a U.S. clinic population.
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Affiliation(s)
- Sabra Leitenberger
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Tamar Hajar
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Laura von Kobyletzki
- Department of Dermatology, Skane University Hospital, Lund University, Malmo, Sweden
| | - Jon M Hanifin
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
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13
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Prevalence of Atopic Dermatitis in Chinese Children aged 1-7 ys. Sci Rep 2016; 6:29751. [PMID: 27432148 PMCID: PMC4949439 DOI: 10.1038/srep29751] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 06/23/2016] [Indexed: 11/08/2022] Open
Abstract
Prevalence of atopic dermatitis (AD) is increasing worldwide. Up to date, there has been no face-to-face nation-wide study in China. We aim to explore the prevalence of clinical diagnosed AD in children aged 1-7 ys in China. Twelve metropolises were chosen from different areas of China. In each region, we selected 4-10 kindergartens and 2-5 vaccination clinics randomly. A complete history-taking and skin examination were performed by dermatologists. The definite diagnosis of AD and the severity were determined by two or three dermatologists. All criteria concerned in UK diagnosis criteria, characteristic presentation of AD and atypical manifestations were recorded in detail. A total of 13998 children from 84 kindergartens and 40 vaccination clinics were included. The prevalence of AD was 12.94% by clinical diagnosis of dermatologists overall, with 74.6% of mild AD. Comparatively, prevalence of AD based on UK diagnostic criteria was 4.76%. This is the first face-to-face nation-wide study in Chinese children aged 1-7 ys, revealing that the prevalence of AD in children is closer to that of wealthier nations.
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14
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Lee SC. Various diagnostic criteria for atopic dermatitis (AD): A proposal of Reliable Estimation of Atopic Dermatitis in Childhood (REACH) criteria, a novel questionnaire-based diagnostic tool for AD. J Dermatol 2016; 43:376-84. [PMID: 26813749 DOI: 10.1111/1346-8138.13264] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 11/15/2015] [Indexed: 12/24/2022]
Abstract
Atopic dermatitis (AD) is a heterogeneous disease that manifests with a wide variety of clinical symptoms and signs. Due to the lack of definitive biomarkers for AD, it is very difficult to set up standard diagnostic criteria for AD which cover the entire spectrum of AD patients. Various instruments have been proposed for AD diagnosis, and they can be classified into a hospital setting or a community setting. From the preventive medicine viewpoint, questionnaire-based diagnostic criteria in a community setting are important to detect and manage childhood AD patients properly. In this article, various diagnostic criteria for AD in hospital and community settings will be reviewed. Additionally, the Reliable Estimation of Atopic Dermatitis in Childhood (REACH), a new full questionnaire-based diagnostic tool for childhood AD, will be reviewed.
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Affiliation(s)
- Seung-Chul Lee
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
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15
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Minasyan A, Babajanyan A, Campbell DE, Nanan R. Validation of a Comprehensive Early Childhood Allergy Questionnaire. Pediatr Allergy Immunol 2015; 26:522-9. [PMID: 26031325 DOI: 10.1111/pai.12415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Parental questionnaires to assess incidence of pediatric allergic disease have been validated for use in school-aged children. Currently, there is no validated questionnaire-based assessment of food allergy, atopic dermatitis (AD), and asthma for infants and young children. METHODS The Comprehensive Early Childhood Allergy Questionnaire was designed for detecting AD, asthma, and IgE-mediated food allergies in children aged 1-5 years. A nested case-control design was applied. Parents of 150 children attending pediatric outpatient clinics completed the questionnaire before being clinically assessed by a pediatrician for allergies. Sensitivity, specificity, and reproducibility of the questionnaire were assessed. RESULTS Seventy-seven children were diagnosed with one or more current allergic diseases. The questionnaire demonstrated high overall sensitivity of 0.93 (95% CI 0.86-0.98) with a specificity of 0.79 (95% CI 0.68-0.88). Questionnaire reproducibility was good with a kappa agreement rate for symptom-related questions of 0.45-0.90. CONCLUSIONS Comprehensive Early Childhood Allergy Questionnaire accurately and reliably reflects the presence of allergies in children aged 1-5 years. Its use is warranted as a tool for determining prevalence of allergies in this pediatric age group.
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Affiliation(s)
- Anna Minasyan
- Sydney Medical School Nepean, The University of Sydney, Sydney, NSW, Australia
| | - Arman Babajanyan
- Sydney Medical School Nepean, The University of Sydney, Sydney, NSW, Australia.,Department of Paediatrics, Blue Mountains ANZAC Memorial Hospital, Katoomba, NSW, Australia
| | - Dianne E Campbell
- Sydney Medical School Nepean, The University of Sydney, Sydney, NSW, Australia.,Department of Allergy and Immunology, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Ralph Nanan
- Sydney Medical School Nepean, The University of Sydney, Sydney, NSW, Australia
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16
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Eviston DP, Minasyan A, Mann KP, Campbell DE, Nanan RK. In utero Head Circumference is Associated with Childhood Allergy. Front Pediatr 2015; 3:73. [PMID: 26442233 PMCID: PMC4561811 DOI: 10.3389/fped.2015.00073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 08/10/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Altered fetal growth is known to be associated with allergic disease. Specifically, increased head circumference at birth has been linked to asthma and elevated IgE. However, few studies have examined a link between early fetal anthropometry and allergic disease. The aim of this study was to examine head circumference at mid-gestation in children diagnosed with allergy. METHODS This was a retrospective cohort study, comprising pregnancies delivered between 10/2006 and 9/2010 at Nepean Hospital, Australia. Exclusion criteria were illegal drug use, alcohol consumption, gestation <35 weeks, and gestational hypertension. Pregnancy data were sourced from the Nepean Obstetric Database. Atopic diseases (asthma, atopic dermatitis, and IgE-mediated food allergy) were assessed by questionnaire at age 1-5 years. Infants from pregnancies with completed questionnaires, who also had a mid-gestation ultrasound scan, were included (N = 121). Multiple logistic regression techniques were used to model head circumference against the development of allergies. RESULTS Smaller head circumference at mid-gestation was associated with increased odds of allergic disease in children aged 1-5 years. A 1 mm smaller head circumference was associated with a 7% increased chance of allergies being later diagnosed, adjusted for gestation (95% CI: 1-14%, p = 0.036). Head circumference at mid-gestation was also inversely correlated with the presence of multiple atopic disease. CONCLUSION Smaller mid-gestational head circumference is associated with early childhood allergic disease, which suggests that fetal programing of allergic disease occurs before mid-gestation. This suggests that mediators such as brain-derived neurotrophic factor may be dysregulated early in utero in a milieu, which also predisposes to atopic disease.
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Affiliation(s)
- David P Eviston
- Discipline of Obstetrics, Gynaecology and Neonatology, Charles Perkins Centre Nepean, Sydney Medical School Nepean, The University of Sydney , Penrith, NSW , Australia
| | - Anna Minasyan
- Discipline of Paediatrics and Child Health, Charles Perkins Centre Nepean, Sydney Medical School Nepean, The University of Sydney , Penrith, NSW , Australia
| | - Kristy P Mann
- NHMRC Clinical Trials Centre, The University of Sydney , Camperdown, NSW , Australia
| | - Dianne E Campbell
- Department of Allergy and Immunology, The Children's Hospital at Westmead, The University of Sydney , Westmeabd, NSW , Australia ; Discipline of Paediatrics and Child Health, The University of Sydney , Penrith, NSW , Australia
| | - Ralph K Nanan
- Discipline of Obstetrics, Gynaecology and Neonatology, Charles Perkins Centre Nepean, Sydney Medical School Nepean, The University of Sydney , Penrith, NSW , Australia ; Discipline of Paediatrics and Child Health, The University of Sydney , Penrith, NSW , Australia
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17
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Barbarot S, Gras-Leguen C, Colas H, Garrot E, Darmaun D, Larroque B, Roze J, Ancel P. Lower risk of atopic dermatitis among infants born extremely preterm compared with higher gestational age. Br J Dermatol 2013; 169:1257-64. [DOI: 10.1111/bjd.12581] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2013] [Indexed: 11/27/2022]
Affiliation(s)
- S. Barbarot
- Department of Pediatric Dermatology; UMR 1280 Nantes University Hospital; Nantes France
| | - C. Gras-Leguen
- Department of Neonatal Medicine and INSERM CIC 004; UMR 1280 Nantes University Hospital; Nantes France
| | - H. Colas
- Department of Neonatal Medicine and INSERM CIC 004; UMR 1280 Nantes University Hospital; Nantes France
| | - E. Garrot
- Department of Neonatal Medicine and INSERM CIC 004; UMR 1280 Nantes University Hospital; Nantes France
| | - D. Darmaun
- French National Institute for Agricultural Research; UMR 1280 Nantes University Hospital; Nantes France
| | - B. Larroque
- INSERM; UMR S953; IFR 69; Epidemiological Research on Perinatal Health and Women's and Children's Health; Paris France
- UPMC University Paris 06; UMR S953; Paris France
| | - J.C. Roze
- Department of Neonatal Medicine and INSERM CIC 004; UMR 1280 Nantes University Hospital; Nantes France
| | - P.Y. Ancel
- INSERM; UMR S953; IFR 69; Epidemiological Research on Perinatal Health and Women's and Children's Health; Paris France
- UPMC University Paris 06; UMR S953; Paris France
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18
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Boyle RJ, Ismail IH, Kivivuori S, Licciardi PV, Robins-Browne RM, Mah LJ, Axelrad C, Moore S, Donath S, Carlin JB, Lahtinen SJ, Tang MLK. Lactobacillus GG treatment during pregnancy for the prevention of eczema: a randomized controlled trial. Allergy 2011; 66:509-16. [PMID: 21121927 DOI: 10.1111/j.1398-9995.2010.02507.x] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Probiotic supplementation in early life may be effective for preventing eczema. Previous studies have suggested that prenatal administration may be particularly important for beneficial effects. OBJECTIVE We examined whether prenatal treatment with the probiotic Lactobacillus rhamnosus GG (LGG) can influence the risk of eczema during infancy. METHODS We recruited 250 pregnant women carrying infants at high risk of allergic disease to a randomized controlled trial of probiotic supplementation (LGG 1.8 × 10(10) cfu/day) from 36 weeks gestation until delivery. Infants were assessed during their first year for eczema or allergic sensitization. Immunological investigations were performed in a subgroup. Umbilical cord blood was examined for dendritic cell and regulatory T cell numbers and production of TGFβ, IL-10, IL-12, IL-13, IFN-γ and TNFα. Maternal breast milk was examined for total IgA, soluble CD14 and TGFβ. RESULTS Prenatal probiotic treatment was not associated with reduced risk of eczema (34% probiotic, 39% placebo; RR 0.88; 95% CI 0.63, 1.22) or IgE-associated eczema (18% probiotic, 19% placebo; RR 0.94; 95% CI 0.53, 1.68). Prenatal probiotic treatment was not associated with any change in cord blood immune markers, but was associated with decreased breast milk soluble CD14 and IgA levels. CONCLUSIONS Prenatal treatment with Lactobacillus rhamnosus GG was not sufficient for preventing eczema. If probiotics are effective for preventing eczema, then a postnatal component to treatment or possibly an alternative probiotic strain is necessary.
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Affiliation(s)
- R J Boyle
- Allergy and Immune Disorders, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
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19
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Schram ME, Leeflang MMG, DEN Ottolander JPS, Spuls PI, Bos JD. Validation and refinement of the Millennium Criteria for atopic dermatitis. J Dermatol 2011; 38:850-8. [PMID: 21453318 DOI: 10.1111/j.1346-8138.2011.01202.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There is no gold standard for a definite diagnosis of atopic dermatitis. For the time being, several lists of diagnostic criteria have been proposed, some of them in actual use. The Millennium Criteria have been proposed to diagnose atopic dermatitis and to differentiate it from atopiform dermatitis. Our aim was to further refine the Millennium Criteria into a manageable set that can differentiate between atopic and atopiform dermatitis and other entities. The hereby refined Millennium Criteria will be compared with the UK Working Party Criteria and the Hanifin & Rajka Criteria. Data of 210 included patients were used. After multiple logistic regression, a minimum set of five criteria was identified as best discriminators: (i) typical morphology; (ii) early age of onset; (iii) Dennie-Morgan fold; (iv) historical and (v) actual flexural involvement. The refined Millennium Criteria were constituted from these criteria. When comparing the different list for validity in diagnosing atopic dermatitis, the refined Millennium Criteria showed a sensitivity of 81.8% and a specificity of 98.8% compared to a sensitivity of 97.7% and specificity of 72.9% of the UK Criteria and a sensitivity of 100% and specificity of 48.8% of the Hanifin & Rajka Criteria. This refinement and validity study shows that the refined Millennium Criteria are a valid tool to diagnose atopic and atopiform dermatitis in a hospital-based setting and therefore could be incorporated in clinical practice and trials.
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Affiliation(s)
- Mandy E Schram
- Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
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20
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Notenboom ML, Mommers M, Jansen EHJM, Penders J, Thijs C. Maternal fatty acid status in pregnancy and childhood atopic manifestations: KOALA Birth Cohort Study. Clin Exp Allergy 2011; 41:407-16. [PMID: 21255139 DOI: 10.1111/j.1365-2222.2010.03672.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prevalence of atopic disorders has increased rapidly, but aetiological factors responsible for this increase are still largely unknown. Prenatal exposure to a pro-inflammatory fatty acid status is hypothesized although little research has been carried out. OBJECTIVE To investigate whether prenatal fatty acid exposures are associated with atopy in childhood. METHODS In the KOALA Birth Cohort Study, maternal blood samples (n=1275) at 34-36 weeks of pregnancy were assayed for n-6 and n-3 long-chain polyunsaturated fatty acids (LCPs). The full spectrum of offspring atopic manifestations (wheeze, asthma, allergic rhinoconjunctivitis, eczema, atopic dermatitis, allergic sensitization, and high total IgE) until the age of 6-7 years was assessed by repeated parental questionnaires and measurements of total and specific IgE. Associations of maternal fatty acid status with child atopic outcomes were analysed using multivariable logistic regression and generalized estimating equations for repeated measurements. RESULTS High ratio of maternal n-6 vs. n-3 LCPs was associated with a lower risk of eczema in the child (P for trend 0.012). More specifically, we found a decreased risk of eczema in the first 7 months of life with increasing arachidonic acid levels (P for trend 0.013). No associations were found between maternal fatty acids and offspring airway-related atopic manifestations, sensitization, or high total IgE. CONCLUSION AND CLINICAL RELEVANCE The development of atopic disorders in early childhood is associated with prenatal exposure to n-6 vs. n-3 fatty acids, but with inconsistencies between different manifestations. Further exploration of associations with maternal diet and genetic variants in genes regulating fatty acid metabolism are required. This study shows that the influence of prenatal exposure to fatty acids on the risk of eczema in the child is limited to the first year of life.
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Affiliation(s)
- M L Notenboom
- Department of Epidemiology, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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21
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Arana A, Wentworth CE, Fernández-Vidaurre C, Schlienger RG, Conde E, Arellano FM. Incidence of cancer in the general population and in patients with or without atopic dermatitis in the U.K. Br J Dermatol 2011; 163:1036-43. [PMID: 20545690 DOI: 10.1111/j.1365-2133.2010.09887.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) affects approximately 20% of children and 1-3% of adults in developed countries. OBJECTIVE To study the incidence of cancer in patients with AD in the U.K. general population. METHODS We conducted a follow-up study in the U.K. using The Health Improvement Network (THIN) database. We calculated the incidence rate (IR) of the first occurrence of overall cancer, lymphoma, melanoma and nonmelanoma skin cancer (NMSC) in the general population, in patients with AD and in individuals without AD. In addition we calculated the IR ratio (IRR) of overall cancer and subtypes of cancer in patients with AD vs. those without. RESULTS The study population included 4,518,131 patients [2,336,230 (51·7%) female]. There were 129,972 subjects [68,688 (52·8%) female] with a diagnosis of cancer (excluding NMSC). The IR (per 10,000 person-years) of cancer (excluding NMSC) was 42·41 [95% confidence interval (CI) 42·18-42·64]; of lymphoma 1·70 (95% CI 1·65-1·74); of skin melanoma 1·71 (95% CI 1·67-1·76) and of NMSC 11·76 (95% CI 11·64-11·88). The age- and sex-adjusted IRR for cancer (excluding NMSC) was 1·49 (95% CI 1·39-1·61); for lymphoma 2·21 (95% CI 1·65-2·98); for melanoma 1·74 (95% CI 1·25-2·41); and for NMSC 1·46 (95% CI 1·27-1·69). CONCLUSIONS Our results indicate an increased incidence of cancer overall as well as of specific cancer subtypes, including lymphoma, in patients with AD. Further studies are needed to disentangle the effects of treatment for AD from AD itself.
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Affiliation(s)
- A Arana
- Risk Management Resources, Pharmacovigilance Services SL, 50001 Zaragoza, Spain.
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22
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Brenninkmeijer EEA, Schram ME, Leeflang MMG, Bos JD, Spuls PI. Diagnostic criteria for atopic dermatitis: a systematic review. Br J Dermatol 2008; 158:754-65. [PMID: 18241277 DOI: 10.1111/j.1365-2133.2007.08412.x] [Citation(s) in RCA: 150] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) has a wide spectrum of dermatological manifestations and despite various validated sets of diagnostic criteria that have been developed over the past decades, there is disagreement about its definition. Nevertheless, clinical studies require valid diagnostic criteria for reliable and reproducible results. OBJECTIVE To summarize the evidence concerning the validity of diagnostic criteria for AD. METHODS All data sources were identified through searches on Medline, Embase and Cochrane databases. The Quality Assessment of Diagnostic Accuracy tool (QUADAS) was used. Results are presented in a receiver operating characteristic (ROC) plot. RESULTS Out of the 20 articles that met the criteria, 27 validation studies were identified. In two studies concerning Hanifin and Rajka diagnostic criteria sensitivity and specificity ranged from 87.9% to 96.0% and from 77.6% to 93.8%, respectively. Nineteen validation studies of the U.K. diagnostic criteria showed sensitivity and specificity ranging from 10% to 100% and 89.3% to 99.1%, respectively. Three validation studies concerning the Schultz-Larsen criteria showed sensitivity from 88% to 94.4% and specificity from 77.6% to 95.9%. In one article concerning the criteria of Diepgen, the sensitivity ranged from 83.0% to 87.7% and the specificity from 83.9% to 87.0%. One article studied the Kang and Tian criteria and reported 95.5% sensitivity and 100% specificity. One article validating the International Study of Asthma and Allergies in Childhood (ISAAC) criteria showed a positive and negative predictive value of 48.8% and 91.1%, respectively. CONCLUSION With this systematic review of the existing sets of diagnostic criteria for AD a varying number of validation studies with varying methodological quality was found. The U.K. diagnostic criteria are the most extensively validated. However, improvement of methodological design for validation studies and uniformity in well-validated and applicable diagnostic criteria are needed to improve future intervention studies and to compare study results.
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Affiliation(s)
- E E A Brenninkmeijer
- Department of Dermatology, Academic Medical Center A0-251, University of Amsterdam, Amsterdam, The Netherlands.
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Harding NJ, Birch JM, Hepworth SJ, McKinney PA. Atopic dysfunction and risk of central nervous system tumours in children. Eur J Cancer 2007; 44:92-9. [PMID: 18042376 DOI: 10.1016/j.ejca.2007.10.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Revised: 09/20/2007] [Accepted: 10/09/2007] [Indexed: 02/01/2023]
Abstract
Risk factors for central nervous system (CNS) tumours in children remain largely unknown. Evidence of an inverse relationship between atopy and tumour development exists in adults but little is known about childhood tumours. This study aims to examine the risk of childhood CNS tumours given a history of eczema and asthma. Cases of children diagnosed with CNS tumours (n=575) and controls (n=6292) from the UK Childhood Cancer Study (UKCCS) were analysed using conditional logistic regression comparing reported histories of allergic disease. Asthma was statistically significantly and negatively associated with all CNS tumours (odds ratios, OR 0.75, confidence of interval, CI(95%): 0.58-0.97), though this was not observed for eczema (OR 0.94, CI(95%): 0.74-1.18). Individuals who had suffered both asthma and eczema showed the most significant reduction in risk (OR 0.48, CI(95%): 0.28-0.81). Analysis by tumour subtype showed the strongest effect for the medulloblastoma/PNET group. These results may have a biological explanation with raised immunosurveillance in atopic individuals protecting against the development of brain tumours. Alternative explanations might include bias, reverse causality or confounding.
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Affiliation(s)
- N J Harding
- Paediatric Epidemiology Group, Centre for Epidemiology and Biostatistics, University of Leeds, UK
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Wallaert B, Kouzan S, Leroyer C, Delacourt C, Roguedas AB. Quelle est la place de l’examen clinique chez l’asthmatique allergique ? Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)73300-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hughes AM, Lightfoot T, Simpson J, Ansell P, McKinney PA, Kinsey SE, Mitchell CD, Eden TOB, Greaves M, Roman E. Allergy and risk of childhood leukaemia: results from the UKCCS. Int J Cancer 2007; 121:819-24. [PMID: 17390373 DOI: 10.1002/ijc.22702] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We investigated the relationship between childhood leukaemia and preceding history of allergy. A nationwide case-control study of childhood cancers was conducted in the United Kingdom with population-based sampling of cases (n = 839) and controls (n = 1,337), matched on age, sex and region of residence. Information about clinically diagnosed allergies was obtained from primary care records. More than a third of subjects had at least one allergy diagnosed prior to leukaemia diagnosis (cases) or pseudo-diagnosis (controls). For both total acute lymphoblastic leukaemia (ALL) and common-ALL/precursor B-cell ALL (c-ALL), a history of eczema was associated with a 30% significant reduction in risk: the odds ratios (OR) and 95% confidence intervals (CI) were 0.70 (0.51-0.97) and 0.68 (0.48-0.98), respectively. Similar associations were observed for hayfever (OR = 0.47; 95% CI: 0.26-0.85 and OR = 0.62; 95% CI: 0.33-1.16 for ALL and c-ALL, respectively). No such patterns were seen either for asthma and ALL, or for any allergy and acute myeloid leukaemia. A comparative analysis of primary care records with parents recall of allergy revealed only moderate agreement with contemporaneous clinical diagnoses for both cases and controls--confirming the unreliability of parental report at interview. Our finding of a reciprocal relationship between allergy and ALL in children is compatible with the hypothesis that a dysregulated immune response is a critical determinant of childhood ALL.
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Affiliation(s)
- Ann M Hughes
- Epidemiology and Genetics Unit, Department of Health Sciences, University of York, York, United Kingdom
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Margolis DJ, Hoffstad O, Bilker W. Lack of Association between Exposure to Topical Calcineurin Inhibitors and Skin Cancer in Adults. Dermatology 2007; 214:289-95. [PMID: 17460399 DOI: 10.1159/000100879] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2006] [Accepted: 12/08/2006] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Two topical calcineurin inhibitors (TCI) are available for the treatment of atopic dermatitis and there has been concern that their use could be associated with an increased risk of nonmelanoma skin cancer (NMSC). OBJECTIVE To determine if TCI exposure is associated with an increased risk of NMSC in adults. METHODS A case-control study using a questionnaire mailed to 5,000 adults with dermatitis. RESULTS We received responses from 70.7% of those surveyed by mail. Overall, 25.7% reported exposure to TCI. TCI exposure was 14.4% for the cases and 30.7% for the controls. Our primary analysis was a comparison between those with NMSC and those without. The unadjusted odds ratio was 0.38 (0.31-0.47) and the adjusted (age, gender, previous NMSC, history of atopic dermatitis) was 0.54 (0.41-0.69). The odds ratio of association for NMSC decreased as the number of tubes used and the potency of the agent increased. CONCLUSION This early study shows that TCI use is not associated with an increased risk of NMSC in adults.
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Affiliation(s)
- David J Margolis
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Arellano FM, Wentworth CE, Arana A, Fernández C, Paul CF. Risk of Lymphoma Following Exposure to Calcineurin Inhibitors and Topical Steroids in Patients with Atopic Dermatitis. J Invest Dermatol 2007; 127:808-16. [PMID: 17096020 DOI: 10.1038/sj.jid.5700622] [Citation(s) in RCA: 168] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Systemic use of immunosuppressant agents increases the risk of lymphoma in transplantation. We performed a nested case-control study in the PharMetrics database to evaluate the association between topical immunosuppressants and lymphoma in a cohort of patients with atopic dermatitis. We identified cases of lymphoma and randomly selected four controls for each case, matched by length of follow-up. We used conditional logistic regression to calculate odds ratio (OR) and 95% confidence intervals (CIs) of the association between topical immunosuppressants and lymphoma. Two hundred and ninety-four cases of lymphoma occurred in 293,253 patients, 81 in patients younger than 20 years. The adjusted analysis yielded the following OR (95%CI) for: severity (OR 2.4; 95% CI 1.5-3.8), oral steroids 1.5 (1.0-2.4), "super potent" topical steroids 1.2 (0.8-1.8) , "low potency" topical steroids OR 1.1 (0.7-1.6); pimecrolimus 0.8(0.4-1.6), tacrolimus OR 0.8 (0.4-1.7), and concomitant topical steroids, pimecrolimus, and tacrolimus 1.0 (0.3-4.1). We did not find an increased risk of lymphoma in patients treated with topical calcineurin inhibitors. It is difficult to disentangle the effects of severity of disease on outcome versus the true effects of drugs. However, in the adjusted analysis, severity of AD was the main factor associated with an increased risk of lymphoma.
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Affiliation(s)
- Felix M Arellano
- Risk Management Resources, 726 Route 202 South, Suite 320-361, Bridgewater, New Jersey, USA.
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Haileamlak A, Lewis SA, Britton J, Venn AJ, Woldemariam D, Hubbard R, Williams HC. Validation of the International Study of Asthma and Allergies in Children (ISAAC) and U.K. criteria for atopic eczema in Ethiopian children. Br J Dermatol 2005; 152:735-41. [PMID: 15840106 DOI: 10.1111/j.1365-2133.2005.06511.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reliable diagnostic criteria for atopic eczema (AE) are essential in order to make international comparisons and to identify possible disease risk factors. Little is known about the prevalence of atopic eczema and validity of diagnostic criteria for AE in developing countries where English is not the first language. OBJECTIVES We sought to determine the prevalence of AE in an area of urban and rural Ethiopia, and to compare the predictive values of different questionnaire and examination methods for diagnosing AE in this population. METHODS We conducted a cross-sectional survey of 7915 children aged 1-5 years living in and around the town of Jimma in southwest Ethiopia. AE prevalence was assessed in two ways: (i) by using the International Study for Asthma and Allergies in Childhood (ISAAC) questionnaire, and (ii) using the U.K. refinement of Hanifin and Rajka's diagnostic criteria. All possible cases identified by screening questions and random samples of controls were then examined by an experienced local paediatrician, who acted as a reference standard to determine the predictive value of the criteria used to diagnose AE. RESULTS The overall 1-year period prevalence of AE according to ISAAC and U.K. criteria was 4.4%[95% confidence interval (CI) 3.95-4.85] and 1.8% (95% CI 1.5-2.1), respectively. Corresponding point prevalence estimates (symptoms in the last week) were 1.8% for ISAAC and 1.3% for the U.K. criteria. The positive predictive values of the ISAAC and U.K. criteria questions for AE symptoms still reported to be present (in the last week) at the doctor's examination were 48.8% and 55.5%, respectively. Corresponding negative predictive values were 90.5% and 90.1%, respectively. The sign of visible flexural dermatitis (a component of the U.K. criteria) when used alone had positive and negative predictive values of 57% and 91%, respectively. CONCLUSIONS Neither the ISAAC nor U.K. criteria performed especially well in predicting cases of AE in this survey. Possible reasons include problems with questionnaire translation, cultural conceptions of terminology, asking parents rather than the child about symptoms, the transient nature of AE signs, and differences in what a doctor perceives to constitute a typical case of AE. The results do not preclude the use of standardized diagnostic criteria alongside a doctor's examination in future surveys of Ethiopian children, and knowledge of the criteria's limited predictive value should help to interpret study findings that have employed such criteria. Consideration should be given to adopting the sign of visible flexural dermatitis as a standard for estimating the point prevalence of AE throughout the world because it is less susceptible to problems with translation and interpretation.
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Affiliation(s)
- A Haileamlak
- Department of Paediatrics and Child Health, Jimma University, Ethiopia
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Texte des recommandations. Ann Dermatol Venereol 2005. [DOI: 10.1016/s0151-9638(05)86136-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Dermatite atopique : épidémiologie en France, définitions, histoire naturelle, association aux autres manifestations atopiques, scores de gravité, qualité de vie. Ann Dermatol Venereol 2005. [DOI: 10.1016/s0151-9638(05)86150-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Martindale S, McNeill G, Devereux G, Campbell D, Russell G, Seaton A. Antioxidant intake in pregnancy in relation to wheeze and eczema in the first two years of life. Am J Respir Crit Care Med 2004; 171:121-8. [PMID: 15531754 DOI: 10.1164/rccm.200402-220oc] [Citation(s) in RCA: 176] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Two thousand women were recruited for a prospective investigation of the influence of maternal antioxidant intake in pregnancy on the development of asthma and eczema in children. A food frequency questionnaire was used to characterize diet during pregnancy and blood antioxidant levels were measured. Postal questionnaires were used to follow up the 1,924 singleton children born to the cohort at 6, 12, and 24 months of age. There were no associations between maternal antioxidant intake and wheezing symptoms and eczema in the children's first year. In the children's second year, maternal vitamin E intake during pregnancy was negatively associated with wheeze in the absence of a "cold" (p for trend 0.010) and, in children whose mothers were atopic, there was a negative association between maternal vitamin E intake and childhood eczema (p for trend 0.024). Maternal vitamin C intake during pregnancy was positively associated with "ever wheeze" and eczema during the children's second year. This study suggests that maternal dietary antioxidant intakes during pregnancy may modify the risks of developing wheeze and eczema during early childhood. Further follow up of the cohort will determine whether maternal diet during pregnancy is associated with asthma and atopic disease in later childhood.
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Affiliation(s)
- Sheelagh Martindale
- Department of Environmental and Occupational Medicine, University of Aberdeen, Aberdeen, Scotland, United Kingdom.
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Wadonda-Kabondo N, Sterne JAC, Golding J, Kennedy CTC, Archer CB, Dunnill MGS. Association of parental eczema, hayfever, and asthma with atopic dermatitis in infancy: birth cohort study. Arch Dis Child 2004; 89:917-21. [PMID: 15383434 PMCID: PMC1719677 DOI: 10.1136/adc.2003.034033] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the association of parental history of atopic disease with childhood atopic dermatitis, and to examine the relative strength of associations with maternal and paternal disease. DESIGN Mothers were recruited to the Avon longitudinal study of parents and children (ALSPAC) from the eighth week of pregnancy. Before parturition, both parents were asked, separately, to report their lifetime history of eczema, asthma, and hayfever. Parents reported symptoms of atopic dermatitis in their children at ages 6, 18, 30, and 42 months. RESULTS Of 8530 children with complete information on rash at ages 6, 18, 30, and 42 months, 7969 had complete information on maternal atopic disease and 5658 on maternal and paternal atopic disease. There was a strong association between parental eczema and childhood atopic dermatitis: odds ratio 1.69 (95% confidence interval, 1.47 to 1.95) for maternal eczema only, 1.74 (1.44 to 2.09) for paternal eczema only, and 2.72 (2.09 to 3.53) for eczema in both parents. Associations with parental asthma or hayfever were attenuated after controlling for parental eczema. There was no evidence that associations with maternal atopy were stronger than with paternal. CONCLUSIONS Associations between parents' atopic disease and the risk of atopic dermatitis in offspring vary according to the type of atopic disease in the parents, but not according to parental sex. These results are at variance with previous studies reporting stronger associations with maternal than paternal atopy, and suggest that there is no "parent-of-origin" effect in atopic dermatitis. Parental eczema may be a better marker than parental asthma/hayfever in predisposing to childhood eczema.
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Ming ME, Levy R, Hoffstad O, Filip J, Abrams BB, Fernández C, Margolis DJ. The lack of a relationship between atopic dermatitis and nonmelanoma skin cancers. J Am Acad Dermatol 2004; 50:357-62. [PMID: 14988675 DOI: 10.1016/j.jaad.2003.09.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Very little has been published on whether a relationship exists between atopic dermatitis (AD) and skin cancer. OBJECTIVE The goal of this study was to investigate whether individuals with AD are more likely than other patients with dermatologic conditions to develop nonmelanoma skin cancer. METHODS This was a case-control, mailed-survey study. RESULTS Of those contacted, 69.8% (3207 of 4591) filled out the survey. Of the control patients, 18.4% (254) had a history of AD as defined by the United Kingdom Working Party diagnosis criteria and composed 13.7% (210) of the cases. The unadjusted odds ratio of AD to nonmelanoma skin cancer was 0.70 (95% confidence interval 0.57-0.85). After fully adjusting for age, sex, ethnicity, and topical steroid use the odds ratio was 0.78 (0.61, 0.98). Using different definitions of AD had little effect on this result. CONCLUSIONS It does not appear that patients with a history of AD are more likely to develop nonmelanoma skin cancers than other patients with dermatologic conditions.
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Affiliation(s)
- Michael E Ming
- Department of Dermatology, University of Pennsylvania School of Medicine, 423 Guardian Drive, Philadelphia, PA 19104, USA
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Roguedas AM, Machet L, Fontes V, Lorette G. Dermatite atopique : quels sont les critères diagnostiques utilisés dans les articles scientifiques ? Ann Dermatol Venereol 2004; 131:161-4. [PMID: 15026743 DOI: 10.1016/s0151-9638(04)93564-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Diagnosis of atopic dermatitis currently relies on diagnostic criteria scales developed by Hanifin and Rafka in 1980 and by the "United Kingdom Working party" in 1994. Some authors have proposed: "AEDS" [sM1] and "Atopiform Dermatitis", which has led to the distinction between different sub-populations and the exclusion of certain diseases from the diagnosis of atopic dermatitis. The aim of our study was to collect the criteria retained in the scientific medical literature during the year 2002 for the definition of atopic dermatitis and to try to understand not only the interest but also the questions that the various definitions lead to. METHOD A PubMed research was launched with the key word "atopic dermatitis" from January to September of 2002. All the scientific articles either in French or in English were studied. RESULTS Hanifin and Rafka's criteria were selected in 44 p. 100 of the scientific articles, and the "United Kingdom Working Party" criteria in 12 p. 100. Personal definitions were used in 21 p. 100 of the articles; these were based on the level of total and specific IgE or on personal clinical criteria. For twenty-three p. 100 of the authors, the definition of atopic dermatitis was not specified. DISCUSSION There was not just one definition of atopic dermatitis. This may affect the interpretation of diagnostic or therapeutic papers concerning the disease, because there has been no proof that these definitions cover the same population of patients.
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Affiliation(s)
- A-M Roguedas
- Département Peau et Morphologie, Service de Dermatologie, CHU Trousseau Tours
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Wadonda-Kabondo N, Sterne JAC, Golding J, Kennedy CTC, Archer CB, Dunnill MGS. A prospective study of the prevalence and incidence of atopic dermatitis in children aged 0-42 months. Br J Dermatol 2003; 149:1023-8. [PMID: 14632809 DOI: 10.1111/j.1365-2133.2003.05605.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND There is strong evidence that the incidence and prevalence of atopic diseases is increasing. However, estimates of the prevalence of atopic dermatitis (AD) have varied greatly in the U.K. and most parts of the developed world. OBJECTIVES The aim of the study was to estimate the prevalence and incidence of AD between the ages of 0 and 42 months in children born in the 1990s in a defined population in the U.K. DESIGN We used data from the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC), a large population-based study in the U.K. that enrolled all pregnant mothers who were resident in Avon and had their delivery date falling between 1 April 1991 and 31 December 1992. Since then ALSPAC has collected a wide range of data from the newborns and their parents. Data reported here were collected at 6, 18, 30 and 42 months using parental reports in a postal questionnaire. Of the 14 009 children originally enrolled 8530 provided information on AD in each of the four follow-up questionnaires. We defined AD as a report of rash in at least two of the four questionnaires. Incidence risk was defined as the percentage of new cases of AD between follow-up questionnaires, out of the total number of children whose parents had not reported that they had AD by the time of the previous follow-up. RESULTS Period prevalence of 21.0%, 25.6%, 23.2% and 19.9% were observed at ages 0-6, 6-18, 18-30 and 30-42 months, respectively. The corresponding incidence risks were 21.0%, 11.2% and 3.8%, at 0-6, 6-18 and 18-30 months, respectively. There were no gender differences in either the incidence or prevalence of the disease. CONCLUSIONS Results from this large, prospective study are consistent with recent reports of increased incidence and prevalence of AD. Health planners can use our estimates of incidence and prevalence to project the number of children likely to suffer from AD during infancy and early childhood, and thus to determine the human and financial resources required.
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Kawamoto N, Yamada A, Ohkouchi S, Maeda T, Tanaka S, Hashimoto T, Saijo Y, Saijo S, Nukiwa T, Shichijo S, Aizawa H, Itoh K. IgG reactive to CTL-directed epitopes of self-antigens is either lacking or unbalanced in atopic dermatitis patients. TISSUE ANTIGENS 2003; 61:352-61. [PMID: 12753654 DOI: 10.1034/j.1399-0039.2003.00046.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We previously demonstrated that CTL-directed epitopes derived from non-mutated self-antigens elicit a type-I allergy in the majority of healthy donors (HD) as did the presence of IgE and IgG reactive to these peptides in the sera of the donors. We investigated in this study whether Igs reactive to eight types of CTL-directed peptides were elevated in the sera of 40 patients with atopic dermatitis (AD). Total IgE levels in the sera of AD patients were significantly higher than those of HD, however, no significant differences between the AD patients and the HD were observed in either the serum levels or the positive rates of IgE reactive to seven of the eight peptides. Total IgG levels were not different from each other, however, IgG reactive to the two peptides with no sequence similarity to other species and one peptide that had similarity to DNA helicase II of enterobacteria were not detectable in the sera of the AD patients. Although IgG reactive to the remaining five peptides, which had sequence similarity to other species, were detectable in both the AD patients and the HD, ratios of peptide-specific IgG1/IgG2 were mostly lower in the AD patients than in the HD. These results indicate that IgG reactive to CTL-directed epitopes of self-antigens is either lacking or unbalanced in AD patients. This information may provide new insight into the immune-mechanisms of elevated auto-reactivity of AD patients.
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Affiliation(s)
- N Kawamoto
- Cancer Vaccine Development Division, Kurume University Research Center for Innovative Cancer Therapy, Kurume, Japan
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Girolomoni G, Abeni D, Masini C, Sera F, Ayala F, Belloni-Fortina A, Bonifazi E, Fabbri P, Gelmetti C, Monfrecola G, Peserico A, Seidenari S, Giannetti A. The epidemiology of atopic dermatitis in Italian schoolchildren. Allergy 2003; 58:420-5. [PMID: 12752329 DOI: 10.1034/j.1398-9995.2003.00112.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is common in children in industrialized countries. Only one large population study on its prevalence has been conducted in Italy, based on self-report questionnaire. The present study was designed to estimate the prevalence of AD in schoolchildren in Italy by dermatologists' assessment and by UK Working Party criteria, and to investigate associated symptoms and factors. METHODS Cross-sectional survey on a random sample of 9-year-old schoolchildren from seven Italian cities. Children were examined by experienced dermatologists. Parents and teachers answered standardized questionnaires. RESULTS Of the 1369 children examined, 88 had a diagnosis of AD, with an estimated point prevalence of 5.8% (95% CI 4.5-7.1) in the reference population. The reported lifetime prevalence was 15.2 (95% CI 12.2-18.2) for AD, 11.9% (95% CI 9.0-14.8) for asthma, and 17.6% (95% CI 14.6-20.7) for rhino-conjunctivitis. The strongest associated factor was the presence of AD in at least one parent. No association of AD with maternal smoking during pregnancy, birth weight, maternal age at the time of the child birth and breast-feeding was observed. The environmental characteristics of the house and the school did not correlate with the prevalence of AD. Episodes of lower respiratory tract infections were associated with asthma, and to a lower extent also with AD and rhinitis. CONCLUSIONS The prevalence of doctor-diagnosed AD in Italian schoolchildren is comparable to those reported for other developed countries. Family history of atopy was the single most important associated factor, while the complex interplay of environmental factors remains to be elucidated.
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Affiliation(s)
- G Girolomoni
- Istituto Dermopatico dell'Immacolata, IRCCS, Roma, Italy
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