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Eichenfield LF, Silverberg JI, Hebert AA, Boguniewicz M. Targeting the aryl hydrocarbon receptor as a strategy to expand the therapeutic armamentarium in atopic dermatitis. J DERMATOL TREAT 2024; 35:2300354. [PMID: 38213229 DOI: 10.1080/09546634.2023.2300354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/23/2023] [Indexed: 01/13/2024]
Affiliation(s)
| | - Jonathan I Silverberg
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Adelaide A Hebert
- UTHealth McGovern School of Medicine and Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Mark Boguniewicz
- National Jewish Health and University of Colorado School of Medicine, Denver, CO, USA
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Silverberg JI, Boguniewicz M, Quintana FJ, Clark RA, Gross L, Hirano I, Tallman AM, Brown PM, Fredericks D, Rubenstein DS, McHale KA. Tapinarof validates the aryl hydrocarbon receptor as a therapeutic target: A clinical review. J Allergy Clin Immunol 2024; 154:1-10. [PMID: 38154665 DOI: 10.1016/j.jaci.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/09/2023] [Accepted: 12/08/2023] [Indexed: 12/30/2023]
Abstract
The aryl hydrocarbon receptor (AhR) is a ligand-dependent transcription factor that has wide-ranging roles, including regulation of inflammation and homeostasis. AhR is not a cell surface receptor; rather, it exists in a cytoplasmic complex that responds to a wide variety of structurally dissimilar endogenous, microbial, and environmental ligands. The ubiquitous expression of AhR, its ability to be activated by a wide range of ligands, and its capacity to act as a master regulator for gene expression and homeostasis make it a promising new therapeutic target. Clinical trials of tapinarof cream have now validated AhR agonism as a therapeutic approach that can deliver significant efficacy for treating inflammatory skin diseases, including psoriasis and atopic dermatitis. Tapinarof 1% cream is a first-in-class, nonsteroidal, topical, AhR agonist with a pharmacokinetic profile that results in localized exposure at sites of disease, avoiding systemic safety concerns, drug interactions, or off-target effects. Psoriasis and atopic dermatitis both involve epidermal inflammation, cellular immune responses, dysregulation of skin barrier protein expression, and oxidative stress. On the basis of the clinical effectiveness of tapinarof cream for treating inflammatory skin diseases, we review how targeting AhR may offer a significant opportunity in other conditions that share key aspects of pathogenesis, including asthma, inflammatory bowel disease, eosinophilic esophagitis, ophthalmic, and nervous system diseases.
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Affiliation(s)
| | - Mark Boguniewicz
- Division of Allergy-Immunology, Department of Pediatrics, National Jewish Health and University of Colorado School of Medicine, Denver, Colo
| | - Francisco J Quintana
- Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | | | - Lara Gross
- Dallas Allergy and Asthma Center, and the Allergy and Immunology Division, Baylor University Medical Center, Dallas, Tex
| | - Ikuo Hirano
- Northwestern University Feinberg School of Medicine, Chicago, Ill
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Kruse LL, Mancini AJ. Atopic Dermatitis in Children. Pediatr Ann 2024; 53:e121-e128. [PMID: 38574071 DOI: 10.3928/19382359-20240205-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Atopic dermatitis (AD) is extremely common in the pediatric population, and most children with AD will first present to their primary care provider (PCP). The PCP can recognize AD by its clinical features, including itch, a chronic relapsing course, and the characteristic eruption. The cornerstone of AD therapy is dry skin care, typically a short daily bath/shower followed by an emollient applied to all skin. Most children with AD will also require topical medications, such as topical corticosteroids and/or topical nonsteroidal therapies. For children with more severe disease, systemic agents, including several novel therapies, may be required. In managing AD, the clinician must monitor for side effects of medications as well as complications of the AD itself, the most common of which is secondary infection. An understanding of the pathogenesis, treatments, and complications of AD is essential for the PCP, as untreated (or undertreated) AD has a significant impact on the quality of life of affected children and their caregivers. [Pediatr Ann. 2024;53(4):e121-e128.].
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Adamson AS. The Economic Impact of Atopic Dermatitis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1447:91-104. [PMID: 38724787 DOI: 10.1007/978-3-031-54513-9_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory disorder that affects over 30 million people in the United States. Given the large and growing prevalence of AD, the associated economic burden is significant. It has been estimated that AD costs over $5 billion dollars annually. These costs include both direct and indirect costs. Direct costs include prescription medicines, visits to health-care providers, hospitalizations, and transportation. Indirect costs include missed days or lost productivity at work or school, career modification, and reduced quality of life. Understanding and measuring these costs can be accomplished through rigorous economic evaluation, which is the organized process of considering inputs and outcomes of various activities. Economic evaluation has been used to contextualize the burden of AD in society. It has also been used to inform patients, providers, and other stakeholders on how to deliver the most evidence-based, efficient way possible. Understanding the economic impact of atopic dermatitis is an important aspect of delivering high-quality care.
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Affiliation(s)
- Adewole S Adamson
- University of North Carolina Hospitals, Department of Dermatology, Chapel Hill, NC, USA
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Golan-Tripto I, Ben Shmuel A, Muallem L, Yahav L, Andre N, Shaki D, Horev A. Pediatricians' confidence level in diagnosing and treating children with atopic dermatitis in Israel, based on a self-efficacy survey. Eur J Pediatr 2023; 182:5223-5230. [PMID: 37718387 DOI: 10.1007/s00431-023-05197-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/19/2023]
Abstract
Atopic dermatitis (AD) is one of childhood's most common skin conditions. Although pediatricians often diagnose and manage it, more than half refer even mild cases to dermatologists. In this study, we aimed to evaluate pediatric residents' and pediatricians' self-confidence regarding their ability to diagnose and manage AD. A cross-sectional questionnaire study was conducted with Israeli pediatric residents and pediatricians in 2022. The questionnaire was designed to distinguish participants with high vs. low self-confidence characteristics regarding their ability to diagnose and treat AD. In total, 171 participants completed the questionnaire (59.4% women; age, 41.1 ± 10.6 years); 39.1% of the participants were residents, while 60.9% were board-certified pediatricians. Overall, 64.4% of the responders reported below or average confidence (score ≤ 3, on a scale of 1-5) in diagnosing and treating AD in children. The group with higher self-confidence was significantly older (44.39 vs. 39.14 years, P = 0.003), had more years of experience in evaluating pediatric AD (P = 0.004), had trained in dermatology during their residency (P = 0.02) with a longer training period (P = 0.01), and with more than three training methods (P = 0.009). Multivariable logistic regression analysis showed that high self-confidence was associated with age older than 40 years and training in dermatology during residency (odds ratios = 5.63 [P = 0.04] and 3.36 [P = 0.05], respectively). Conclusion: Most pediatric residents and pediatricians were not particularly confident in treating children with AD. Those with high self-confidence were older, had been exposed to more patients, and had been trained in dermatology during their residency with various methods and for longer periods. Therefore, we encourage the implementation of a training program in dermatology during pediatric residency programs. What is Known: • Atopic dermatitis (AD) is one of childhood's most common skin conditions and often presents to pediatricians for diagnosis and management. • Many pediatricians refer children with even mild cases of AD to dermatologists. What is New: • Most pediatric residents and pediatricians report low confidence in diagnosing and treating pediatric AD. • Physicians with high self- confidence were older, exposed to more AD patients, and had been trained in dermatology during their residency with various methods and for longer periods. Therefore, the implementation of a training program in dermatology during pediatric residency programs is warranted.
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Affiliation(s)
- Inbal Golan-Tripto
- Pediatrics Department, Soroka University Medical Center, Beer Sheva, Israel.
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Yitzhak Rager Ave, PO Box 151, 8410101, Beer Sheva, Israel.
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer Sheva, Israel.
| | - Atar Ben Shmuel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Yitzhak Rager Ave, PO Box 151, 8410101, Beer Sheva, Israel
- School of Health Profession Education, Maastricht University, Maastricht, the Netherlands
| | - Liezl Muallem
- Pediatrics Department, Soroka University Medical Center, Beer Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Yitzhak Rager Ave, PO Box 151, 8410101, Beer Sheva, Israel
| | - Lior Yahav
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Yitzhak Rager Ave, PO Box 151, 8410101, Beer Sheva, Israel
| | - Nicolas Andre
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Yitzhak Rager Ave, PO Box 151, 8410101, Beer Sheva, Israel
| | - David Shaki
- Pediatrics Department, Soroka University Medical Center, Beer Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Yitzhak Rager Ave, PO Box 151, 8410101, Beer Sheva, Israel
| | - Amir Horev
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Yitzhak Rager Ave, PO Box 151, 8410101, Beer Sheva, Israel
- Pediatric Dermatology Service, Soroka University Medical Center, Beer Sheva, Israel
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Shin JO, Kim K, Kim HS, Ko HC, Kim B, Kim MB, Shin K, Kim YH. Geographische Unterschiede zwischen städtischem und ländlichem Raum beim Risiko für atopische Dermatitis: Systematischer Review und Meta-Analyse. J Dtsch Dermatol Ges 2023; 21:973-984. [PMID: 37700419 DOI: 10.1111/ddg.15135_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/24/2023] [Indexed: 09/14/2023]
Abstract
ZusammenfassungDie atopische Dermatitis ist die häufigste chronisch‐entzündliche Hauterkrankung im Kindesalter. Einige Studien kamen zu dem Ergebnis, das Risiko für diese Erkrankung sei im städtischen Raum höher als im ländlichen. Wir haben die verfügbaren Studien systematisch untersucht und eine Meta‐Analyse durchgeführt, um Unterschiede im Risiko für atopische Dermatitis zwischen städtischem und ländlichem Raum zu erkennen. Die Suche in den Datenbanken Embase und MEDLINE wurde am 19. April 2021 durchgeführt. Einschlusskriterium war das Stichwort “Beobachtungsstudie”. Wir haben außerdem Subgruppenanalysen bezüglich Patientenalter, Publikationsjahr und Land durchgeführt. Insgesamt wurden bei der Datenbanksuche 2115 Studien aufgefunden, von denen letztlich 43 Studien mit insgesamt 1 728 855 Patienten in die Meta‐Analyse eingeschlossen wurden. Ein Wohnsitz im städtischen Raum war mit einem erhöhten Risiko für atopische Dermatitis assoziiert; die Odds Ratio war 1,56 (95 %‐Konfidenzintervall 1,43–1,71). Dieses signifikant erhöhte Risiko war nur bei Kindern zu beobachten (Odds Ratio 1,55, 95 %‐Konfidenzintervall 1,39–1,73), nicht jedoch bei Erwachsenen. Hier betrug die Odds Ratio 1,29 (95 %‐Konfidenzintervall 0,99–1,67). Das Risiko für atopische Dermatitis ist in den letzten Jahrzehnten angestiegen, wobei das Risiko in Entwicklungsländern mit einer Odds Ratio von 1,95 höher liegt als in Industrieländern (Odds Ratio 1,35). Unsere Studie bestätigt die Assoziation zwischen atopischer Dermatitis und dem Wohnsitz im städtischen gegenüber dem ländlichen Raum.
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Affiliation(s)
- Jun-Oh Shin
- Department of Dermatology, College of Medicine, Pusan National University, Busan, South Korea
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, South Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Kihun Kim
- Department of Biomedical Informatics, School of Medicine, Pusan National University, Yangsan, South Korea
- Department of Anatomy, School of Medicine, Pusan National University, Yangsan, South Korea
| | - Hoon-Soo Kim
- Department of Dermatology, College of Medicine, Pusan National University, Busan, South Korea
| | - Hyun-Chang Ko
- Department of Dermatology, College of Medicine, Pusan National University, Busan, South Korea
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Byungsoo Kim
- Department of Dermatology, College of Medicine, Pusan National University, Busan, South Korea
| | - Moon-Bum Kim
- Department of Dermatology, College of Medicine, Pusan National University, Busan, South Korea
| | - Kihyuk Shin
- Department of Dermatology, College of Medicine, Pusan National University, Busan, South Korea
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, South Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Yun Hak Kim
- Department of Biomedical Informatics, School of Medicine, Pusan National University, Yangsan, South Korea
- Department of Anatomy, School of Medicine, Pusan National University, Yangsan, South Korea
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Shin JO, Kim K, Kim HS, Ko HC, Kim B, Kim MB, Shin K, Kim YH. Geographic differences in atopic dermatitis risk between urban and rural area: A systematic review and meta-analysis. J Dtsch Dermatol Ges 2023; 21:973-982. [PMID: 37560937 DOI: 10.1111/ddg.15135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/24/2023] [Indexed: 08/11/2023]
Abstract
Atopic dermatitis is the most common chronic inflammatory skin disease affecting children. Some studies have reported a higher risk of atopic dermatitis in urban areas than in rural areas. We systematically reviewed and carried out a meta-analysis to investigate the differences in the development of atopic dermatitis between urban and rural areas. The search was performed on April 19, 2021, using Embase and MEDLINE databases. Eligible for inclusion were observational studies. Subgroup analyses were performed for age, publication year, and country. We identified 2,115 studies, and 43 studies with 1,728,855 subjects were finally included. Urban residency was associated with an increased risk of atopic dermatitis, with an odds ratio of 1.56 (95% confidence interval, 1.43-1.71). A significantly increased risk was observed only in children, with an odds ratio of 1.55 (95% confidence interval, 1.39-1.73), but not in adults, with an odds ratio of 1.29 (95% confidence interval, 0.99-1.67). The risk has increased in recent decades, with a higher risk in developing countries (odds ratio, 1.95) compared to developed countries (odds ratio, 1.35). Our study provides evidence of an association between atopic dermatitis and urban compared to rural living.
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Affiliation(s)
- Jun-Oh Shin
- Department of Dermatology, College of Medicine, Pusan National University, Busan, South Korea
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, South Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Kihun Kim
- Department of Biomedical Informatics, School of Medicine, Pusan National University, Yangsan, South Korea
- Department of Anatomy, School of Medicine, Pusan National University, Yangsan, South Korea
| | - Hoon-Soo Kim
- Department of Dermatology, College of Medicine, Pusan National University, Busan, South Korea
| | - Hyun-Chang Ko
- Department of Dermatology, College of Medicine, Pusan National University, Busan, South Korea
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Byungsoo Kim
- Department of Dermatology, College of Medicine, Pusan National University, Busan, South Korea
| | - Moon-Bum Kim
- Department of Dermatology, College of Medicine, Pusan National University, Busan, South Korea
| | - Kihyuk Shin
- Department of Dermatology, College of Medicine, Pusan National University, Busan, South Korea
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, South Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Yun Hak Kim
- Department of Biomedical Informatics, School of Medicine, Pusan National University, Yangsan, South Korea
- Department of Anatomy, School of Medicine, Pusan National University, Yangsan, South Korea
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Woo YR, Kim HS. Burden of Disease and Unmet Needs in the Diagnosis and Management of Atopic Dermatitis in Korea. J Clin Med 2023; 12:jcm12113744. [PMID: 37297937 DOI: 10.3390/jcm12113744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/19/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin condition associated with a significant disease burden in Korea. AD is highly prevalent among Korean children, adolescents, and adults, and can cause physical discomfort, psychological distress, and social isolation for those affected. Despite advances in our understanding of AD, there are still many unmet needs in diagnosing and managing the disease in Korea. One of the challenges in diagnosing AD is the lack of a definitive biomarker for AD in Korea, and there is a need for more effective, safe, and cost-effective treatments for AD. Therefore, finding out the current epidemiology, burden of AD, and how AD is currently being diagnosed in Korea and reviewing management options available in Korea will help resolve the unmet needs of AD patients in Korea. Addressing these and other unmet needs in AD management and diagnosis in Korea may improve outcomes for those affected by this challenging condition.
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Affiliation(s)
- Yu Ri Woo
- Department of Dermatology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Hei Sung Kim
- Department of Dermatology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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Santler B, Wimmer L, Schlüter B, Ehrchen J. Anti-DFS70-Antikörper sind mit atopischer Dermatitis assoziiert und können zur Fehldiagnose einer Kollagenose führen. J Dtsch Dermatol Ges 2023; 21:464-472. [PMID: 37183733 DOI: 10.1111/ddg.15022_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 01/23/2023] [Indexed: 05/16/2023]
Affiliation(s)
| | - Louisa Wimmer
- Klinik für Hautkrankheiten, Universitätsklinikum Münster
| | | | - Jan Ehrchen
- Klinik für Hautkrankheiten, Universitätsklinikum Münster
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Santler B, Wimmer L, Schlueter B, Ehrchen J. Anti-DFS70 antibodies are associated with atopic dermatitis and can cause misdiagnosis of connective tissue disease. J Dtsch Dermatol Ges 2023; 21:464-470. [PMID: 36920284 DOI: 10.1111/ddg.15022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 01/23/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND AND OBJECTIVES Antinuclear antibodies (ANA) detected by HEp2 cell immunofluorescence staining are a characteristic finding in patients with connective tissue disease (CTD). However, even detection of highly elevated ANA is not conclusive for CTD and can result in misdiagnosis. Anti-DFS70 antibodies are ANA, which may also be highly elevated in people without CTD. Thus, we wanted to evaluate whether they could cause misdiagnosis of CTD. Since anti-DSF70 antibodies have been associated with atopic dermatitis (AD) in Japan, we wanted to investigate this association and its potential diagnostic relevance in Germany. PATIENTS AND METHODS We retrospectively analyzed data of 40 patients referred for first consultation on CTD and prospectively analyzed the prevalence of anti-DFS70 antibodies in 110 AD patients and 89 controls. RESULTS We could not confirm CTD in 75% of our referred patients, 26% of whom had already received systemic treatments. DFS70-typical fluorescence staining was detected in 35% and definitive anti-DFS70 antibodies in 12.5% of these patients. DFS70-typical fluorescence staining was detected in 22% of AD patients and anti-DFS70 antibodies in 10% (versus 5.6% and 0% in control patients, P < 0.001). CONCLUSIONS Anti-DFS70 antibodies are significantly associated with AD and could be responsible for misdiagnosis of CTD.
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Affiliation(s)
- Bettina Santler
- Department of Dermatology, University Hospital Muenster, Münster, Germany
| | - Louisa Wimmer
- Department of Dermatology, University Hospital Muenster, Münster, Germany
| | | | - Jan Ehrchen
- Department of Dermatology, University Hospital Muenster, Münster, Germany
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Hu X, Zhou Y, Shi J, Qi M, Li X, Yang Y, Zhu C, Wang C, Tang Z, Ma Y, Yu G. Osthole relieves skin damage and inhibits chronic itch through modulation of Akt/ZO-3 pathway in atopic dermatitis. Eur J Pharmacol 2023; 947:175649. [PMID: 36921706 DOI: 10.1016/j.ejphar.2023.175649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023]
Abstract
Atopic dermatitis (AD) is the most prevalent chronic inflammatory skin condition and significantly reduces quality of life. Tight junction (TJ), which is located directly beneath the stratum corneum, maintains skin barrier function and aids in the identification of the cell's "territory". We evaluated seventeen TJ related genes to explore AD related alterations of TJ. Remarkably, we found that the expression of ZO-3, a gene that had not been linked to the development of TJ in AD, was significantly down-regulated in the skin of AD mice and patients. siRNA mediated knock-down of ZO-3 significantly decreased transepithelial electrical resistance in HaCaT cells, demonstrating that ZO-3 is essential to epidermal barrier function. In addition to ZO-3 downregulation, protein kinase B (Akt) phosphorylation was increased in the skin of AD mice. We further confirmed an inverse relationship between Akt phosphorylation and ZO-3 expression in AD using HaCaT cells and mouse model. Finally, we tested the efficacy of osthole as a treatment for AD in mice and HaCaT cells. Osthole inhibits Akt phosphorylation, and thereby enhances ZO-3 expression in mouse models of AD, resulting in greatly lessened AD associated skin damage and chronic itch, and osthole also increased the expression of ZO-3 in HaCaT cells by inhibiting the phosphorylation of Akt. Together, we established that ZO-3 is essential for the development of TJ in AD skin and HaCaT cells, and our findings provide fresh support for osthole's ability to protect ZO-3 expression and the epidermal barrier in AD.
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Affiliation(s)
- Xueqin Hu
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, China; Key Laboratory for Chinese Medicine of Prevention and Treatment in Neurological Diseases, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yuan Zhou
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, China; Key Laboratory for Chinese Medicine of Prevention and Treatment in Neurological Diseases, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jianxin Shi
- Department of Dermatology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Mingxin Qi
- Key Laboratory for Chinese Medicine of Prevention and Treatment in Neurological Diseases, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xue Li
- Key Laboratory for Chinese Medicine of Prevention and Treatment in Neurological Diseases, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yan Yang
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, China; Key Laboratory for Chinese Medicine of Prevention and Treatment in Neurological Diseases, Nanjing University of Chinese Medicine, Nanjing, China
| | - Chan Zhu
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, China; Key Laboratory for Chinese Medicine of Prevention and Treatment in Neurological Diseases, Nanjing University of Chinese Medicine, Nanjing, China
| | - Changming Wang
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, China; Key Laboratory for Chinese Medicine of Prevention and Treatment in Neurological Diseases, Nanjing University of Chinese Medicine, Nanjing, China
| | - Zongxiang Tang
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, China; Key Laboratory for Chinese Medicine of Prevention and Treatment in Neurological Diseases, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yuxiang Ma
- School of Life Science, China Pharmaceutical University, Nanjing, China.
| | - Guang Yu
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, China; Key Laboratory for Chinese Medicine of Prevention and Treatment in Neurological Diseases, Nanjing University of Chinese Medicine, Nanjing, China.
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12
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Nasirzadeh N, Golbabaei F, Omari Shekaftik S. Laboratory activities involving nanomaterials: risk assessment and investigating researchers symptoms. NANOSCALE 2023; 15:2674-2689. [PMID: 36655491 DOI: 10.1039/d2nr06118j] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The increasing use of nanomaterials is a threat to human health and environment that has led to the expansion of risk assessment methods. Thus, the aim of this study was to assess the occupational risks of activities involving nanomaterials in nanomedicine research laboratories by Control Banding (CB) NanoTool and Guidance methods. Further, the symptoms of researchers working in these laboratories were investigated. This cross-sectional study was managed in nanomedicine research laboratories. Risk assessment was performed by the CB NanoTool and Guidance methods. Moreover, a questionnaire was used to assess the prevalence of non-specific symptoms. Finally, data were analyzed using the IBM SPSS software. Descriptive statistics were used for data analysis. Many activities are located on the risk level RL2 and category A based on the CB NanoTool and Guidance methods, respectively. Further, the highest severity of exposure to nanomaterials belonged to the preparation of suspension and emulsion and manufacture of metal nanopolymers, but the highest probability of exposure was in the manufacturing of carbon nanocomposites. In addition, there was a significant relationship between the level of risk in the two methods (P = 0.003). Although, cutaneous symptoms were the most common symptoms among laboratory researchers, chi-square test did not confirm any significant relationship between symptoms and risk levels (p-value >0.05) in these two methods. Since the NanoTool method uses more diverse parameters for risk assessment and is more acceptable, choosing control measures based on its results seems more reasonable. Moreover, Guidance can be used as a method for initial assessments and determine the need for further assessments.
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Affiliation(s)
- Nafiseh Nasirzadeh
- Occupational Health Engineering, Department of Occupational Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Farideh Golbabaei
- Occupational Health Engineering, Department of Occupational Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Soqrat Omari Shekaftik
- Occupational Health Engineering, Department of Occupational Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Gut Microbiome Characteristics in Mothers and Infants According to the Presence of Atopic Dermatitis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8145462. [PMID: 35502335 PMCID: PMC9056221 DOI: 10.1155/2022/8145462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/27/2022] [Accepted: 03/17/2022] [Indexed: 12/18/2022]
Abstract
Objective. The role of the gut microbiome in the onset and development of atopic dermatitis (AD) has been postulated. Thus, we investigated the gut microbial compositions in infants with and without AD and compared the gut bacterial flora of their mothers. Methods. The prospective and cross-sectional study participated in 44 pairs of mothers and children. We selected infants born via full-term normal vaginal delivery and no history of antibiotic or probiotic use and infection during the first three months of life. The 15 pairs, consisting of nine healthy infants and six AD infants, were included in this study. Fecal samples of mothers and infants were analyzed within 30 days of delivery and at 12 months, respectively. Microbes in the fecal samples of mothers and infants were subjected to analysis of 16S rRNA amplicon sequencing. Results. The abundance of specific taxonomic groups was notably different, but microbial diversity and phylogenetic distances were not significantly different in either maternal or infant groups according to the presence of infant AD. A total of 12 species were selected as differential species in infants with AD compared to healthy infants. Six species were significantly different in the mothers of infants with AD compared to the mothers of healthy infants. Akkermansia muciniphila was only detected in healthy infants and their mothers. Conclusion. The presence of Akkermansia muciniphila in mothers and children after vaginal delivery is associated with the onset and development of AD.
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14
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Lu X, Wang H, Zhang J, Jin K, Ma L, Wang Y, Yang S, Wang X, Shen Q, Zhou T, Xu H, Zhang W. Comparison of Gut Viral Communities in Atopic Dermatitis and Healthy Children. Front Med (Lausanne) 2022; 9:835467. [PMID: 35265642 PMCID: PMC8899399 DOI: 10.3389/fmed.2022.835467] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/21/2022] [Indexed: 11/25/2022] Open
Abstract
The immune development and regulation of living individuals are affected by the gut microbiota. The imbalance of gut microbiota is considered to be a key factor that easily induces immune dysregulation and the development of atopic diseases. Atopic dermatitis (AD) is a chronic inflammatory skin disease that affects nearly 20% of children. To date, metagenomics research on AD has mainly focused on the skin and gut microbiome. However, here we assessed the composition of the virome in the gut of AD patients and healthy controls for the first time. This study has obtained possible dominant viruses at different viral classification levels. In terms of diversity, the alpha diversity of the patients group was significantly lower than that of the healthy controls group, and the beta diversity of the two groups was significantly different from phylum to family level. These findings provide a new perspective for us to better understand the effect of the gut microecological environment on AD.
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Affiliation(s)
- Xiang Lu
- Department of Dermatology, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
- Department of Microbiology, School of Medicine, Jiangsu University, Zhenjiang, China
| | - Hao Wang
- Department of Clinical Laboratory, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, China
| | - Jingqi Zhang
- Department of Microbiology, School of Medicine, Jiangsu University, Zhenjiang, China
| | - Kexin Jin
- School of Mathematical Sciences, Soochow University, Suzhou, China
| | - Ling Ma
- Department of Dermatology, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Yan Wang
- Department of Microbiology, School of Medicine, Jiangsu University, Zhenjiang, China
| | - Shixing Yang
- Department of Microbiology, School of Medicine, Jiangsu University, Zhenjiang, China
| | - Xiaochun Wang
- Department of Microbiology, School of Medicine, Jiangsu University, Zhenjiang, China
| | - Quan Shen
- Department of Microbiology, School of Medicine, Jiangsu University, Zhenjiang, China
| | - Tianji Zhou
- Department of Microbiology, School of Medicine, Jiangsu University, Zhenjiang, China
| | - Hui Xu
- Department of Dermatology, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
- *Correspondence: Hui Xu
| | - Wen Zhang
- Department of Microbiology, School of Medicine, Jiangsu University, Zhenjiang, China
- Wen Zhang
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15
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Manjunath J, Silverberg JI. Association between atopic dermatitis and headaches throughout childhood and adolescence-A longitudinal birth cohort study. Pediatr Dermatol 2021; 38:780-786. [PMID: 33931896 DOI: 10.1111/pde.14607] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND/OBJECTIVES Atopic dermatitis (AD) is associated with sleep disturbance, psychosocial distress, anxiety, depression, and atopic comorbidities, which may be associated with increased headaches. Our objective was to understand the association of AD and comorbid asthma, sleep and mental health disturbances with headaches throughout childhood and adolescence. METHODS Data were analyzed from The Fragile Families and Child Wellbeing Study, a longitudinal birth cohort study of 4898 urban children born in 1998-2000. RESULTS AD was associated with headaches at age 5 (adjusted odds ratio [95% confidence interval]: 2.14 [1.27-3.59]), 9 (1.69 [1.27-2.27]) and 15 years (1.71 [1.37-2.14]). AD at age 9 was associated with higher odds of subsequent headaches at age 15 (1.36 [1.05-1.76]). Children with AD at two (1.60 [1.12-2.29]) or all three (1.79 [1.16-2.75]) study-waves had higher odds of headaches at age 15 years. In multivariable repeated measures logistic regression models, significant two-way interactions were found for AD with sleep disturbance (4.59 [3.15-6.69]), attention deficit (hyperactivity) disorder (2.85 [1.87-4.35]), asthma (2.87 [2.18-3.76]), anxiety (2.47 [1.76-3.48]) or depression (2.86 [1.89-4.34]) as predictors of headaches. CONCLUSION Children and adolescents with AD, particularly those with sleep disturbances, atopic and mental health comorbidities, had increased headaches. Persistent childhood AD was associated with headaches in adolescence.
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Affiliation(s)
- Jaya Manjunath
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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16
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Hou A, Silverberg JI. Secular trends of atopic dermatitis and its comorbidities in United States children between 1997 and 2018. Arch Dermatol Res 2021; 314:267-274. [PMID: 33817750 DOI: 10.1007/s00403-021-02219-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/18/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
Previous studies found increased prevalence of childhood atopic dermatitis (AD) in the United States over the past few decades. It is unknown whether the prevalence of AD has plateaued or whether AD comorbidities changed over time. The main objective of this study is to assess the prevalence and secular trends of AD and its comorbidities. We analyzed data on 259,818 children, ages 0 to 17 years, from the National Health Interview Survey, 1997-2018, using logistic regression models. The prevalence (95% confidence interval) of childhood AD steadily increased from 2000 [7.3% (6.8-7.9%)] to 2011 [12.8% (12.1-13.5%)] and remained consistent until 2018 [12.6% (11.6-13.5%)]. In logistic regression models, the odds of AD were significantly increased in all years from 2003 to 2018 compared to 1997. However, the increased odds of AD over time were attenuated when adjusting for socio-demographic factors. AD prevalence increased in most socio-demographic groups, but changed variably by age group, race/ethnicity, and region. There were significant trends of AD comorbidities over time, with increasing prevalence of attention deficit (hyperactivity) disorder, and decreasing prevalence of hay fever and depression/sadness. AD prevalence in US children increased between 1997 and 2011, remaining consistent until 2018 with an overall increase of 59%. Prevalence of comorbid hay fever and sadness/depression decreased, while ADD/ADHD increased. Given divergent trends of AD prevalence by socio-demographic characteristics, future studies are better equipped to identify contributing factors of prevalence change.
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Affiliation(s)
- Alexander Hou
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine, 2150 Pennsylvania Avenue, Suite 2B-425, Washington, DC, 20037, USA.
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17
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Temporal trends of birthweight are not driving trends of atopic dermatitis prevalence in United States children. Arch Dermatol Res 2021; 314:609-611. [PMID: 33492428 DOI: 10.1007/s00403-021-02188-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/20/2020] [Accepted: 01/09/2021] [Indexed: 10/22/2022]
Abstract
Population-based risk-factors for the rising prevalence of childhood atopic dermatitis (AD) in the United States are not well elucidated. We hypothesized that trends of birthweight over the past 2 decades contributed to the increasing prevalence of childhood AD in the United States. We sought to determine whether trends of birthweight were associated with trends of childhood AD prevalence over time in the US. Data were analyzed from the 1997-2018 National Health Interview Survey (N = 238,767 children). The prevalence [95% confidence interval] of childhood AD increased from 1997 (7.9% [7.4-8.5%]) to 2018 (12.6% [11.6-13.5%]). Whereas, mean [95% confidence interval] birthweight decreased from 1997 (3.35 kg [3.34-3.37 kg]) to 2018 (3.30 kg [3.28-3.31 kg]). A 1 kg increase in birthweight was associated with a slightly increased odds of AD (adjusted odds ratio [95% confidence interval] 1.039 [1.009-1.070]). However, there were no significant interactions between low or high birthweight and year as predictors of childhood AD prevalence overall or in any age group. In conclusion, there is a slight association between greater birthweights and AD prevalence. However, temporal trends of birthweight do not account for trends of childhood AD prevalence in the United States.
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18
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Fleming M, McLay JS, Clark D, King A, Mackay DF, Pell JP. Health, educational and employment outcomes among children treated for a skin disorder: Scotland-wide retrospective record linkage cohort study of 766,244 children. PLoS One 2020; 15:e0243383. [PMID: 33306713 PMCID: PMC7732076 DOI: 10.1371/journal.pone.0243383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 11/19/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To compare health, educational and employment outcomes of schoolchildren receiving medication for a skin disorder with peers. METHODS This retrospective population cohort study linked eight Scotland-wide databases, covering dispensed prescriptions, hospital admissions, maternity records, death certificates, annual pupil census, school examinations, school absences/exclusions and unemployment to investigate educational (absence, exclusion, special educational need, academic attainment), employment, and health (admissions and mortality) outcomes of 766,244 children attending local authority run primary, secondary and special schools in Scotland between 2009 and 2013. RESULTS After adjusting for sociodemographic and maternity confounders the 130,087 (17.0%) children treated for a skin disorder had increased hospitalisation, particularly within one year of commencing treatment (IRR 1.38, 95% CI 1.35-1.41, p<0.001) and mortality (HR 1.50, 95% CI 1.18-1.90, p<0.001). They had greater special educational need (OR 1.19, 95% CI 1.17-1.21, p<0.001) and more frequent absences from school (IRR 1.07, 95% CI 1.06-1.08, p<0.001) but did not exhibit poorer exam attainment or increased post-school unemployment. The associations remained after further adjustment for comorbid chronic conditions. CONCLUSIONS Despite increased hospitalisation, school absenteeism, and special educational need, children treated for a skin disorder did not have poorer exam attainment or employment outcomes. Whilst findings relating to educational and employment outcomes are reassuring, the association with increased risk of mortality is alarming and merits further investigation.
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Affiliation(s)
- Michael Fleming
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - James S. McLay
- Department of Child Health, University of Aberdeen, Aberdeen, United Kingdom
| | - David Clark
- Public Health Scotland, Edinburgh, United Kingdom
| | - Albert King
- ScotXed, Scottish Government, Edinburgh, United Kingdom
| | - Daniel F. Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Jill P. Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
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19
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Yahya A. Pattern of pediatric skin disorders in Murtala Muhammad Specialist Hospital Kano, Nigeria. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020184. [PMID: 33525278 PMCID: PMC7927560 DOI: 10.23750/abm.v91i4.8727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/24/2019] [Indexed: 11/23/2022]
Abstract
Background: Skin disorders are very common in children with a wide variety being seen among them. The spectrum of skin disorders seen in children vary from region to region. Aim of the work: The objective of the study was to determine the pattern of skin disorders among children in Pediatric dermatology clinic of Murtala Muhammad Specialist Hospital, Kano, Nigeria. Methods: A descriptive cross-sectional study was employed. Subjects were consecutively recruited. Using a semi-structured questionnaire, demographic history of the subjects and history of skin disorders were obtained from all the subjects and detailed physical examination was carried out with particular emphasis on skin lesion examination. Data obtained was analyzed using SPSS version 24. Results: A total of 338 subjects were recruited. One hundred and seventy-three (51.2%) were males and 165 (48.8%) were females. Thirty-five (35) specific types of skin disorders were observed. the commonest category of skin disorders seen was infection and infestations (47%), followed by inflammatory skin disorders (36.9%) of the subjects. Tinea capitis was the commonest type of skin disorder observed among 15.5% of the subjects followed by atopic eczema (13.0%). Tinea capitis was significantly commoner among male children aged 6-10 years (p<0.01) and Miliaria was significantly commoner among children aged less than 2years (p=0.04). Conclusion: Wide spectrum of skin disorders was seen among children in this environment with infections and infestations being the commonest category of skin disorders observed. (www.actabiomedica.it)
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20
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Hu XQ, Tang Y, Ju Y, Zhang XY, Yan JJ, Wang CM, Yang Y, Zhu C, Tang ZX, Zhou Y, Yu G. Scratching damages tight junctions through the Akt-claudin 1 axis in atopic dermatitis. Clin Exp Dermatol 2020; 46:74-81. [PMID: 32668051 DOI: 10.1111/ced.14380] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/01/2020] [Accepted: 07/09/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is a common, chronic, severely pruritic, eczematous skin disease that seriously deteriorates the quality of life of patients. Scratching is a cardinal symptom of AD. Although the vicious itch-scratch cycle continues and aggravates skin barrier dysfunction in AD, how scratching induces skin barrier dysfunction through tight junctions remains unclear. AIM To study the effect of scratching on tight junctions in the itch-scratch cycle. METHODS Scratching behaviour and skin barrier dysfunction on the neck and back in an AD mouse model were assessed. The expression of tight junction proteins was compared between the neck and back mice, and the mechanisms underlying the involvement of Akt/CLDN1 pathways in this process were explored. RESULTS We used oxazolone to induce AD on the neck or back of mice. There was significantly more scratching behaviour and more pronounced skin barrier dysfunction with the neck than with the back. Downregulation of claudin-1 (CLDN1) and upregulation of Akt phosphorylation in skin were well correlated with scratching behaviour in this AD model. Furthermore, SC79, an agonist of Akt phosphorylation, could downregulate CLDN1 expression in HaCaT cells. An antagonist of Akt phosphorylation (LY294002) was used to treat the AD mice; this treatment rescued CLDN1 expression through inhibiting Akt phosphorylation in skin, and importantly, also inhibited the scratching behaviour induced by AD. CONCLUSION The results reveal the underlying mechanism of tight junction damage promoted by scratching in the itch-scratch cycle of AD, and opens a new avenue to pruritus management in AD, through Akt antagonists.
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Affiliation(s)
- X Q Hu
- School of Medicine and Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, China.,Key Laboratory for Chinese Medicine of Prevention and Treatment in Neurological Diseases, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Y Tang
- School of Medicine and Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, China.,Key Laboratory for Chinese Medicine of Prevention and Treatment in Neurological Diseases, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Y Ju
- School of Medicine and Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, China.,Key Laboratory for Chinese Medicine of Prevention and Treatment in Neurological Diseases, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - X Y Zhang
- School of Medicine and Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, China.,Key Laboratory for Chinese Medicine of Prevention and Treatment in Neurological Diseases, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - J J Yan
- School of Medicine and Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, China.,Key Laboratory for Chinese Medicine of Prevention and Treatment in Neurological Diseases, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - C M Wang
- School of Medicine and Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Y Yang
- Key Laboratory for Chinese Medicine of Prevention and Treatment in Neurological Diseases, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - C Zhu
- Key Laboratory for Chinese Medicine of Prevention and Treatment in Neurological Diseases, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Z X Tang
- Key Laboratory for Chinese Medicine of Prevention and Treatment in Neurological Diseases, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Y Zhou
- School of Medicine and Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, China.,Key Laboratory for Chinese Medicine of Prevention and Treatment in Neurological Diseases, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - G Yu
- School of Medicine and Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, China.,Key Laboratory for Chinese Medicine of Prevention and Treatment in Neurological Diseases, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
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21
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Gabes M, Chamlin S, Lai J, Cella D, Mancini A, Apfelbacher C. Development of a validated short‐form of the Childhood Atopic Dermatitis Impact Scale, the CADIS‐SF15. J Eur Acad Dermatol Venereol 2020; 34:1773-1778. [DOI: 10.1111/jdv.16362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/03/2020] [Indexed: 11/29/2022]
Affiliation(s)
- M. Gabes
- InsStitute of Social Medicine and Health Economics Otto von Guericke University Magdeburg Magdeburg Germany
- Medical Sociology Department of Epidemiology and Preventive Medicine University of Regensburg Regensburg Germany
| | - S.L. Chamlin
- Ann and Robert H. Lurie Children’s Hospital of Chicago and Northwestern Feinberg School of Medicine Chicago IL USA
| | - J.‐S. Lai
- Department of Medical Social Sciences Feinberg School of Medicine Northwestern University Chicago IL USA
| | - D. Cella
- Department of Medical Social Sciences Feinberg School of Medicine Northwestern University Chicago IL USA
| | - A.J. Mancini
- Ann and Robert H. Lurie Children’s Hospital of Chicago and Northwestern Feinberg School of Medicine Chicago IL USA
| | - C.J. Apfelbacher
- InsStitute of Social Medicine and Health Economics Otto von Guericke University Magdeburg Magdeburg Germany
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22
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Park YM, Lee SY, Kang MJ, Kim BS, Lee MJ, Jung SS, Yoon JS, Cho HJ, Lee E, Yang SI, Seo JH, Kim HB, Suh DI, Shin YH, Kim KW, Ahn K, Hong SJ. Imbalance of Gut Streptococcus, Clostridium, and Akkermansia Determines the Natural Course of Atopic Dermatitis in Infant. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2020; 12:322-337. [PMID: 32009325 PMCID: PMC6997289 DOI: 10.4168/aair.2020.12.2.322] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/06/2019] [Accepted: 11/11/2019] [Indexed: 12/30/2022]
Abstract
Purpose The roles of gut microbiota on the natural course of atopic dermatitis (AD) are not yet fully understood. We investigated whether the composition and function of gut microbiota and short-chain fatty acids (SCFAs) at 6 months of age could affect the natural course of AD up to 24 months in early childhood. Methods Fecal samples from 132 infants were analyzed using pyrosequencing, including 84 healthy controls, 22 transient AD and 26 persistent AD subjects from the Cohort for Childhood Origin of Asthma and Allergic Diseases (COCOA) birth cohort. The functional profile of the gut microbiome was analyzed by whole-metagenome sequencing. SCFAs were measured using gas chromatography-mass spectrometry. Results Low levels of Streptococcus and high amounts of Akkermansia were evident in transient AD cases, and low Clostridium, Akkermansia and high Streptococcus were found in children with persistent AD. The relative abundance of Streptococcus positively correlated with scoring of AD (SCORAD) score, whereas that of Clostridium negatively correlated with SCORAD score. The persistent AD group showed decreased gut microbial functional genes related to oxidative phosphorylation compared with healthy controls. Butyrate and valerate levels were lower in transient AD infants compared with healthy and persistent AD infants. Conclusions Compositions, functions and metabolites of the early gut microbiome are related to natural courses of AD in infants.
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Affiliation(s)
- Yoon Mee Park
- Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - So Yeon Lee
- Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi Jin Kang
- Environmental Health Center, Asan Medical Center, Seoul, Korea
| | - Bong Soo Kim
- Department of Life Science, Multidisciplinary Genome Institute, Hallym University, Chuncheon, Korea
| | - Min Jung Lee
- Department of Life Science, Multidisciplinary Genome Institute, Hallym University, Chuncheon, Korea
| | - Sung Su Jung
- Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ji Sun Yoon
- Department of Pediatrics, Mediplex Sejong Hospital, Incheon, Korea
| | - Hyun Ju Cho
- Department of Pediatrics, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Song I Yang
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Ju Hee Seo
- Department of Pediatrics, Dankuk University Hospital, Cheonan, Korea
| | - Hyo Bin Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Youn Ho Shin
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Pediatrics, Yonsei University of Medicine, Seoul, Korea
| | - Kangmo Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Jong Hong
- Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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23
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Giavina Bianchi M, Santos AP, Cordioli E. The majority of skin lesions in pediatric primary care attention could be managed by Teledermatology. PLoS One 2019; 14:e0225479. [PMID: 31790453 PMCID: PMC6886848 DOI: 10.1371/journal.pone.0225479] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 11/05/2019] [Indexed: 11/18/2022] Open
Abstract
Background Teledermatology is a tool that provides accurate diagnosis and has been gaining more emphasis over time. It can be used for triage in primary care attention to address skin conditions improving access and reducing time to treatment for surgical, severe or even lethal diseases. Objectives Our main goal was to evaluate the proportion of pediatric patient’s lesions that could be managed using teledermatology in primary care attention. Secondly, we wanted to assess the ten most frequent skin conditions, the most common treatments and the referrals made by the teledermatologists to biopsy, in-presence dermatologist or kept at primary care attention. Methods A cross-sectional retrospective study involving 6,879 individuals and 10,126 lesions was conducted by store-and-forward teledermatology during one year in the city of Sao Paulo, Brazil. If the photographs taken had enough quality, teledermatologist would diagnose, treat and orient each lesion (if possible), and choose one of three options for referral: direct to biopsy, in-presence dermatologist or kept at primary care attention. Results Teledermatology managed 62% of the lesions to be kept at primary care attention, 37% were referred to dermatologists and 1% to biopsy, reducing the mean waiting time for an in-presence visit in 78%. In patients 0–2 years old, lesions related to eczema and benign congenital lesions predominated. From 3–12 years old, eczema was still a major cause of complaint, as well as warts and molluscum. From 13–19 years old, acne was the most significant problem, followed by atopic dermatitis, nevi and warts. The most frequent treatment was emollient. Conclusion Teletriage addressed 63% of the lesions without the need for an in-presence visit, suggesting that teledermatology can manage common diseases and optimize dermatological appointments for the most serious, surgical or complex skin illnesses, reducing the mean waiting time for them.
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Affiliation(s)
- Mara Giavina Bianchi
- Department of Telemedicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
- * E-mail:
| | - Andre Pires Santos
- Department of Telemedicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Eduardo Cordioli
- Department of Telemedicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
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24
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Simpson EL, Guttman-Yassky E, Margolis DJ, Feldman SR, Qureshi A, Hata T, Mastey V, Wei W, Eckert L, Chao J, Arnold RJG, Yu T, Vekeman F, Suárez-Fariñas M, Gadkari A. Association of Inadequately Controlled Disease and Disease Severity With Patient-Reported Disease Burden in Adults With Atopic Dermatitis. JAMA Dermatol 2019; 154:903-912. [PMID: 29971354 DOI: 10.1001/jamadermatol.2018.1572] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Importance Real-world data are limited on the patient-reported burden of adult atopic dermatitis (AD). Objective To characterize the patient-reported burden of AD with regard to impact of disease severity and inadequate control in adults from clinical settings. Design, Setting, and Participants In this cross-sectional study using data from 6 academic medical centers in the United States collected by a self-administered internet-based questionnaire, 1519 adult patients with AD were stratified by AD severity as mild or moderate/severe using the Patient-Oriented Scoring Atopic Dermatitis (PO-SCORAD). Patients with moderate/severe disease using systemic immunomodulators/phototherapy were further stratified as having adequate or inadequate disease control. Strata were compared for all outcomes. Main Outcomes and Measures Outcomes included validated measures and stand-alone questions assessing itch (pruritus numerical rating scale; PO-SCORAD itch visual analog scale), pain (numerical rating scale), sleep (PO-SCORAD sleep visual analog scale; sleep interference with function), anxiety and depression (Hospital Anxiety and Depression Scale), and health-related quality of life (Dermatology Life Quality Index). Results Among the 1519 adult patients with AD, relative to mild AD (n = 689, 64% women; mean [SD] age, 46.5 [18.0] years), patients with moderate/severe AD (n = 830, 66.8% women; mean [SD] age, 45.1 [16.9] years) reported more severe itching and pain, greater adverse effects on sleep, higher prevalence of anxiety and depression (417 [50.2%] vs 188 [27.3%]), and greater health-related quality-of-life impairment. The 103 patients with moderate/severe AD with inadequate disease control despite treatment with systemic immunomodulators or phototherapy (55.7%) reported higher burdens of itch and sleeping symptoms vs patients with controlled disease including more days per week with itchy skin (5.7 vs 2.7) and higher proportions with itch duration greater than half a day (190 [22.8%] vs 20 [2.9%]). Sleep symptoms included trouble sleeping (3.9 vs 1.1 on the PO-SCORAD VAS), longer sleep latency (38.8 vs 21.6 minutes), more frequent sleep disturbances (2.6 vs 0.4 nights in past week), and greater need for over-the-counter sleep medications (324 [39%] vs 145 [21%]). Conclusions and Relevance Inadequate disease control was common among patients with moderate/severe AD, and was associated with a higher patient-reported burden than patients with controlled disease. Regardless of disease control, the burden of moderate/severe AD was higher than mild AD, suggesting a need for more effective therapies for moderate/severe disease.
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Affiliation(s)
- Eric L Simpson
- Department of Dermatology, Oregon Health & Science University, Portland
| | - Emma Guttman-Yassky
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - David J Margolis
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Steven R Feldman
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Abrar Qureshi
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Tissa Hata
- Department of Dermatology, University of California at San Diego, San Diego
| | | | | | | | | | - Renée J G Arnold
- Quorum Consulting Inc, San Francisco, California.,Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Tiffany Yu
- Quorum Consulting Inc, San Francisco, California
| | | | - Mayte Suárez-Fariñas
- Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, New York
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Giannetti A, Cipriani F, Indio V, Gallucci M, Caffarelli C, Ricci G. Influence of Atopic Dermatitis on Cow's Milk Allergy in Children. ACTA ACUST UNITED AC 2019; 55:medicina55080460. [PMID: 31405131 PMCID: PMC6723735 DOI: 10.3390/medicina55080460] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/25/2019] [Accepted: 08/07/2019] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Cow’s milk protein allergy (CMA) is the most common allergy in children. The natural history of CMA is generally favorable and the majority of children reach tolerance during childhood, even if studies show variable results. Atopic dermatitis (AD) is a complex disease from an immunological point of view. It is characterized by an impaired skin barrier function and is often the first clinical manifestation of the so-called “atopic march”. The aim of our study is to evaluate, in a cohort of children with CMA, if the presence of AD in the first months of life can influence the atopic status of patients, the tolerance acquisition to cow’s milk, the level of specific IgE (sIgE), and the sensitization towards food and/or inhalant allergens. Materials and Methods: We enrolled 100 children with a diagnosis of CMA referred to our Pediatric Allergology Unit, aged 1–24 months at the time of the first visit. Results: 71 children had AD and 29 did not. The mean follow-up was 5.28 years. The CMA manifestations were mainly cutaneous, especially in children with AD (91.6% vs. 51.7%; P < 0.001). Patients with AD showed higher rates of polysensitization to foods and higher levels of both total IgE and sIgE for milk, casein, wheat, peanuts, and cat dander at different ages when compared to patients without AD. We analyzed the presence of IgE sensitization for the main foods and inhalants at various ages in the two groups of patients: a statistically significant difference emerged in the two groups of patients for milk, yolk and egg white, hazelnut, peanuts, soybean, grass pollen and cat dander. Meanwhile, we did not find significant differences in terms of tolerance acquisition toward cow’s milk, which was nonetheless reached around 5 years of age in 61% of patients. The level of cow’s milk sIgE at the age of 5 years was significantly higher in the group of patients who did not acquire tolerance (38.38 vs. 5.22 kU/L; P < 0.0001). Conclusions: An early barrier deficiency appears to promote the development of allergic sensitization, but does not seem to influence the acquisition of tolerance.
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Affiliation(s)
- Arianna Giannetti
- Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Francesca Cipriani
- Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Valentina Indio
- "Giorgio Prodi" Cancer Research Center, University of Bologna, 40138 Bologna, Italy
| | - Marcella Gallucci
- Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Carlo Caffarelli
- Clinica Pediatrica, Department of Medicine and Surgery, University of Parma, 43100 Parma, Italy
| | - Giampaolo Ricci
- Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy.
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Matta SA, Blanchet-Rethore S, Sio YY, Suri BK, Andiappan AK, Anantharaman R, Piketty C, Bourdes V, Chew FT. Different phenotypes and factors associated with atopic dermatitis in the young adult Singaporean Chinese population: A cross-sectional study. World Allergy Organ J 2019; 12:100008. [PMID: 30937133 PMCID: PMC6439406 DOI: 10.1016/j.waojou.2018.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 11/07/2018] [Accepted: 11/28/2018] [Indexed: 10/28/2022] Open
Abstract
Background Atopic dermatitis (AD) is a chronic allergic disease typically accompanied by atopy and thus, a tendency to develop allergic diseases such as allergic rhinitis, asthma or food allergies. Currently, individuals with AD are classified into those presenting with AD alone and those presenting with AD along with other allergic diseases (AD+). It is important to identify the various endophenotypes of AD using anthropometric, environmental, socio-economic, and disease history data in order to improve disease management. To characterize the phenotypic differences among Singaporean Chinese individuals with AD alone and AD+, and identify the socioeconomic, lifestyle, and environmental factors associated with these different presentations. Methods Based on data collected via a standardized/validated questionnaire, 4604 participants (mean age: 22.1 years) were classified into three groups: 1) AD alone group; 2) AD with other allergic diseases group (AD+); and 3) Control group. Results Participants were less sensitized to common inhalant allergens in the AD alone group versus the Control group (67% vs. 72%, respectively; p < 0.05).High Body Mass Index (i.e., BMI > 23) was associated with the disease and the difference was more pronounced in the AD alone group compared to the AD+ group (Odds Ratio: 1.38; 95% Confidence Interval: 1.4-1.67; p < 0.001). No major differences in habits were observed between the AD alone and AD+ groups. Conclusions The two presentations of AD may have different underlying pathogenesis and associated risk factors.
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Affiliation(s)
- Sri Anusha Matta
- Department of Biological Science, National University of Singapore, Singapore
| | | | - Yang Yie Sio
- Department of Biological Science, National University of Singapore, Singapore
| | - Bani Kaur Suri
- Department of Biological Science, National University of Singapore, Singapore
| | - Anand Kumar Andiappan
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (ASTAR), Singapore
| | - Ramani Anantharaman
- Department of Biological Science, National University of Singapore, Singapore
| | | | - Valerie Bourdes
- Nestlé Skin Health-Galderma R&D, Sophia Antipolis, Biot, France
| | - Fook Tim Chew
- Department of Biological Science, National University of Singapore, Singapore
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Wen HJ, Wang SL, Chen PC, Guo YL. Prenatal perfluorooctanoic acid exposure and glutathione s-transferase T1/M1 genotypes and their association with atopic dermatitis at 2 years of age. PLoS One 2019; 14:e0210708. [PMID: 30650146 PMCID: PMC6334968 DOI: 10.1371/journal.pone.0210708] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 12/31/2018] [Indexed: 01/07/2023] Open
Abstract
Background Perfluoroalkyl substance (PFAS) exposure was found associated with atopic diseases. Atopic dermatitis (AD) is a childhood skin disorder. However, the effect of interaction between PFASs and glutathione S-transferase (GST) T1/M1 genotype on AD remains unclear. Objective To investigate the association between gene-environmental interaction and childhood AD using a birth cohort study. Methods From 2001 to 2005, 1,264 mother–newborn pairs were recruited from eight Taiwanese maternity hospitals. PFAS levels and Genotypes were analysed from cord blood. Information on children’s health status including AD occurrence was obtained via phone interviews at 6 months and 2 years. Cord plasma concentrations of nine PFASs were measured via ultra-high performance liquid chromatography/tandem mass spectrometry. GSTT1/M1 was genotyped (null/present) via polymerase chain reaction. Environment-gene interaction effects on AD were assessed using multiple logistic regression analysis. Results Overall, 839 mother–newborn pairs completed all measurements. The prevalence of ever having physician-diagnosed AD by 2 years of age was 5.4%. Among PFASs, perfluorooctanoic acid (PFOA) was positively associated with AD adjusted for potential confounders. After grouping PFOA levels into three groups: undetected, below and above the median in those with detected, children in above the median group who had the GSTT1-null, or GSTM1-null genotype exhibited a higher odds ratio for AD (OR [95%CI] = 3.45 [1.26–9.99] and 2.92 [1.12–7.91], respectively) as compared to the undetected group. Conclusions Our data demonstrated that in-utero PFOA exposure with GSTT1/M1 null genotype were associated with AD. Minimizing early-life PFAS exposure may help against AD development, especially in genetically susceptible individuals.
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Affiliation(s)
- Hui-Ju Wen
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Shu-Li Wang
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
- Department of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Pau-Chung Chen
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
- Department of Environmental and Occupational Medicine, National Taiwan University (NTU) College of Medicine and NTU Hospital, Taipei, Taiwan
- Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Yue Leon Guo
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
- Department of Environmental and Occupational Medicine, National Taiwan University (NTU) College of Medicine and NTU Hospital, Taipei, Taiwan
- * E-mail:
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Yang EJ, Beck KM, Sekhon S, Bhutani T, Koo J. The impact of pediatric atopic dermatitis on families: A review. Pediatr Dermatol 2019; 36:66-71. [PMID: 30556595 DOI: 10.1111/pde.13727] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is an extremely common childhood disease, with considerable impact on the quality of life of affected children and their families. While pruritus is the hallmark symptom of this disease, AD has been well-documented to impact patients beyond physical symptoms, resulting in behavior problems, mood disorders, and sleep disturbance. OBJECTIVE This literature review outlines how atopic dermatitis impacts the quality of life of families of children affected by AD. METHODS A total of 3436 articles were identified via an online search of the MEDLINE health literature database and were screened for relevance to quality of life impacts on families with children affected by AD. RESULTS Caring for children affected by AD can be an extremely time-consuming task that can impair personal relationships, decrease psychosocial functioning, and cause sleep loss among family members of affected patients. Additionally, AD may result in work absence or decreased work productivity for caregivers. Special diets, irritant and allergen avoidance strategies, and alternative therapies are commonly used by patients to manage their disease and require large amounts of family involvement. CONCLUSIONS Atopic dermatitis can greatly decrease quality of life of families of affected children in various domains, including sleep, finances, and relationships. Early intervention and psychotherapy may be needed in some patients to address these quality of life impairments.
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Affiliation(s)
- Eric J Yang
- Department of Dermatology, University of California San Francisco, San Francisco, California.,Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Kristen M Beck
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Sahil Sekhon
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Tina Bhutani
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - John Koo
- Department of Dermatology, University of California San Francisco, San Francisco, California
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29
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Kim Y, Blomberg M, Rifas-Shiman SL, Camargo CA, Gold DR, Thyssen JP, Litonjua AA, Oken E, Asgari MM. Racial/Ethnic Differences in Incidence and Persistence of Childhood Atopic Dermatitis. J Invest Dermatol 2018; 139:827-834. [PMID: 30414911 DOI: 10.1016/j.jid.2018.10.029] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/17/2018] [Accepted: 10/23/2018] [Indexed: 12/25/2022]
Abstract
Although previous studies have explored racial/ethnic differences in incident atopic dermatitis (AD) in childhood, few studies have examined risk factors associated with AD persistence. As such, we sought to examine differences in incidence and persistence of childhood AD by race/ethnicity accounting for sociodemographic characteristics and perinatal vitamin D levels. Using data from Project Viva, a prospective prebirth cohort in eastern Massachusetts, we studied 1,437 mother-child pairs with known AD status to examine the associations of race/ethnicity with maternally reported child AD. We used multivariable logistic regression, adjusting for sociodemographic factors and maternal plasma vitamin D, to estimate adjusted odds ratios (aORs) of AD incidence at early childhood and persistence at mid-childhood. Compared to non-Hispanic whites, non-Hispanic blacks (aOR = 2.71, 95% confidence interval = 1.75-4.19) and other non-Hispanics (aOR = 1.80, 95% confidence interval = 1.16-2.80) were more likely to have incident AD. Non-Hispanic blacks (aOR = 6.26, 95% confidence interval = 2.32-16.88) and Hispanics (aOR = 6.42, 95% CI = 1.93-21.41) with early childhood AD were more likely to have persistent AD. In conclusion, compared with non-Hispanic whites, AD incidence and persistence are higher among certain nonwhite racial/ethnic subgroups. Further research is warranted to identify environmental, socioeconomic, and genetic factors that may be responsible for the observed differences.
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Affiliation(s)
- Yuhree Kim
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Maria Blomberg
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA; Department of Dermatology and Allergy, Herlev-Gentofte University Hospital, Hellerup, Denmark
| | - Sheryl L Rifas-Shiman
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Diane R Gold
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jacob P Thyssen
- Department of Dermatology and Allergy, Herlev-Gentofte University Hospital, Hellerup, Denmark
| | - Augusto A Litonjua
- Division of Pediatric Pulmonology, Department of Pediatrics, Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, New York, USA
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Maryam M Asgari
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.
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30
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Rea CJ, Tran KD, Jorina M, Wenren LM, Hawryluk EB, Toomey SL. Associations of Eczema Severity and Parent Knowledge With Child Quality of Life in a Pediatric Primary Care Population. Clin Pediatr (Phila) 2018; 57:1506-1514. [PMID: 30008244 DOI: 10.1177/0009922818787295] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We investigated factors associated with quality of life (QOL) in children with eczema. We conducted a cross-sectional analysis of survey data from 224 parents of children with eczema attending a large, hospital-based pediatric clinic. Parents completed a validated eczema severity scale (Patient-Oriented Eczema Measure), a QOL scale (Infants' Dermatitis QOL Index or Children's Dermatology Life Quality Index), and a knowledge and understanding questionnaire. In adjusted multivariate analyses, worse eczema severity was associated with worse overall QOL (β = 0.5; 95% confidence interval [CI] = [0.5, 0.6]), while a higher knowledge score was associated with better QOL (β = -3.4; 95% CI = [-6.6, -0.2]). Similarly, even after adjustment for eczema severity, greater understanding of a child's individual treatment plan was associated with better QOL (β = -0.7; 95% CI = [-1.4, -0.08]), while increased frequency of worrying about a child's eczema was associated with worse QOL (β = 0.7; 95% CI = [0.03, 1.1]). These results suggest primary care providers may be able to influence QOL through optimal eczema management and family education.
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Affiliation(s)
- Corinna J Rea
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | | | - Maria Jorina
- 3 Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, MA, USA
| | | | - Elena B Hawryluk
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Sara L Toomey
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
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Ayanlowo O, Puddicombe O, Gold-Olufadi S. Pattern of skin diseases amongst children attending a dermatology clinic in Lagos, Nigeria. Pan Afr Med J 2018; 29:162. [PMID: 30050626 PMCID: PMC6057566 DOI: 10.11604/pamj.2018.29.162.14503] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 02/15/2018] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Skin diseases constitute a major health problem affecting a large proportion of the population including children causing distress and disability. This study aimed to document the spectrum and frequency of skin diseases of children who attended the dermatology outpatient clinic of the Lagos University Teaching Hospital (LUTH) Lagos, Nigeria. METHODS A cross-sectional study of children (18 years old and below) who attended the dermatology clinic between January 2004 and December 2016. Data obtained from the medical records of the patients included age, gender, clinical features, laboratory features and diagnosis. Skin diseases were classified into various groups. RESULTS There were 6373 children included in the study with a male to female ratio of 1:1.13. The most common disease categories were infections 1795 (26.1%), Eczematous conditions 1711 (24.9%), Infestations 936 (13.6%), papulosquamous disorders 547 (8.0%) and Bullous disorders 254 (3.7%). With respect to individual skin diseases, atopic dermatitis (AD) 1042 (15.1%) was the most common skin condition followed by papular urticaria 705 (10.2%) and tinea capitis 554 (8.1%). Infections were most common among infants and adolescents. Acneiform eruptions were common among adolescents while eczematous disorders were most common among children less than 5 years. CONCLUSION The study highlights the common dermatoses seen in children in a specialized dermatology clinic in a developing country such as Nigeria. Most of the skin diseases observed can be controlled by proper environmental sanitation, adequate nutrition, reducing overcrowding, and promoting good health-seeking behavior among parents and caregivers. Information obtained from the study may guide training in dermatology especially among pediatricians.
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Affiliation(s)
- Olusola Ayanlowo
- Department of Medicine, College of Medicine University of Lagos, Idi-araba, Lagos, Nigeria
| | | | - Shakirat Gold-Olufadi
- Department of Medicine, College of Medicine University of Lagos, Idi-araba, Lagos, Nigeria
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Czarnowicki T, Dohlman AB, Malik K, Antonini D, Bissonnette R, Chan TC, Zhou L, Wen HC, Estrada Y, Xu H, Bryson C, Shen J, Lala D, Ma'ayan A, McGeehan G, Gregg R, Guttman-Yassky E. Effect of short-term liver X receptor activation on epidermal barrier features in mild to moderate atopic dermatitis: A randomized controlled trial. Ann Allergy Asthma Immunol 2018; 120:631-640.e11. [PMID: 29567358 DOI: 10.1016/j.anai.2018.03.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 02/27/2018] [Accepted: 03/12/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Liver X receptors (LXRs) are involved in maintaining epidermal barrier and suppressing inflammatory responses in model systems. The LXR agonist VTP-38543 showed promising results in improving barrier function and inflammatory responses in model systems. OBJECTIVE To assess the safety, tolerability, cellular and molecular changes, and clinical efficacy of the topical VTP-38543 in adults with mild to moderate atopic dermatitis (AD). METHODS A total of 104 ambulatory patients with mild to moderate AD were enrolled in this randomized, double-blind, vehicle-controlled trial between December 2015 and September 2016. VTP-38543 cream in 3 concentrations (0.05%, 0.15%, and 1.0%) or placebo was applied twice daily for 28 days. Pretreatment and posttreatment skin biopsy specimens were obtained from a subset of 33 patients. Changes in SCORing of Atopic Dermatitis, Eczema Area and Severity Index, Investigator's Global Assessment, and tissue biomarkers (by real-time polymerase chain reaction and immunostaining) were evaluated. RESULTS Topical VTP-38543 was safe and well tolerated. VTP-38543 significantly increased messenger RNA (mRNA) expression of epidermal barrier differentiation (loricrin and filaggrin, P = .02) and lipid (adenosine triphosphate-binding cassette subfamily G member 1 and sterol regulatory element binding protein 1c, P < .01) measures and reduced epidermal hyperplasia markers (thickness, keratin 16 mRNA). VTP-38543 nonsignificantly suppressed cellular infiltrates and down-regulated mRNA expression of several TH17/TH22-related (phosphatidylinositol 3, S100 calcium-binding protein A12) and innate immunity (interleukin 6) markers. CONCLUSION Topical VTP-38543 is safe and well tolerated. Its application led to improvement in barrier differentiation and lipids. Longer-term studies are needed to clarify whether a barrier-based approach can induce meaningful suppression of immune abnormalities. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02655679.
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Affiliation(s)
- Tali Czarnowicki
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York
| | - Anders B Dohlman
- Department of Pharmacological Sciences, Mount Sinai Center for Bioinformatics, BD2K-LINCS Data Coordination and Integration Center, Icahn School of Medicine at Mount Sinai School, New York, New York
| | - Kunal Malik
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York; College of Medicine, SUNY Downstate, Brooklyn, New York
| | - Diane Antonini
- Vitae Pharmaceuticals Inc, an Allergan affiliate, Irvine, California
| | | | - Tom C Chan
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lisa Zhou
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Huei-Chi Wen
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Yeriel Estrada
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hui Xu
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Catherine Bryson
- Vitae Pharmaceuticals Inc, an Allergan affiliate, Irvine, California
| | - Jie Shen
- Allergan plc, Irvine, California
| | - Deepak Lala
- Vitae Pharmaceuticals Inc, an Allergan affiliate, Irvine, California
| | - Avi Ma'ayan
- Department of Pharmacological Sciences, Mount Sinai Center for Bioinformatics, BD2K-LINCS Data Coordination and Integration Center, Icahn School of Medicine at Mount Sinai School, New York, New York
| | - Gerard McGeehan
- Vitae Pharmaceuticals Inc, an Allergan affiliate, Irvine, California
| | - Richard Gregg
- Vitae Pharmaceuticals Inc, an Allergan affiliate, Irvine, California
| | - Emma Guttman-Yassky
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York.
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Yamaguchi C, Sasaki K, Asano M. The family impact of childhood atopic dermatitis: Scoping review. NURSINGPLUS OPEN 2018. [DOI: 10.1016/j.npls.2017.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kim DH, Han K, Kim SW. Effects of Antibiotics on the Development of Asthma and Other Allergic Diseases in Children and Adolescents. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2018; 10:457-465. [PMID: 30088366 PMCID: PMC6082825 DOI: 10.4168/aair.2018.10.5.457] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 04/17/2018] [Accepted: 05/03/2018] [Indexed: 01/15/2023]
Abstract
Purpose Our aim was to explore whether antibiotic exposure in children and adolescents is associated with the later development of allergic diseases, using nationwide population-based claims data. Methods We collected information from the National Health Insurance Service (2006–2015) database. A total of 5,626,328 children and adolescents were eligible for the study. We explored whether exposure to antibiotics over the prior 7 years affects the later development of allergic diseases. We ran 3 analytical models after adjusting for confounding factors including age, sex, the number of visits to healthcare providers, income, and the place of residence (urban/rural). Results Allergic diseases were most common in male children and those aged < 10 years (atopic dermatitis, asthma and allergic rhinitis; all P < 0.01). Also, urban residents with higher incomes were more likely to develop allergic diseases (all P < 0.01). The annual number of days on which antibiotics were prescribed differed significantly between subjects with each allergic disease studied and a comparison group (all P < 0.01). Multiple logistic regression showed that as the duration of antibiotic exposure increased, the incidences of atopic dermatitis, asthma, and allergic rhinitis trended upward, even after adjusting for confounding factors (P for trend < 0.01). Conclusions Antibiotic use early in life is associated with an increased risk of allergic disease, especially in young children; the risk increases as the duration of antibiotic therapy rises. Moreover, urban residence was more strongly associated with a longer duration of antibiotic use than was rural residence.
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Affiliation(s)
- Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyungdo Han
- Department of Biostatistics, The Catholic University of Korea, Seoul, Korea
| | - Soo Whan Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Cheok S, Yee F, Song Ma JY, Leow R, Ho MSL, Yew YW, Tay YK, Rebello SA, Luo N, Koh MJA. Prevalence and descriptive epidemiology of atopic dermatitis and its impact on quality of life in Singapore. Br J Dermatol 2017; 178:276-277. [PMID: 28415136 DOI: 10.1111/bjd.15587] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S Cheok
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - F Yee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - J Y Song Ma
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - R Leow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Y W Yew
- National Skin Center, Singapore
| | - Y K Tay
- Dermatology Department, Changi General Hospital, Singapore
| | - S A Rebello
- Saw Swee Hock School of Public Health, Singapore
| | - N Luo
- Saw Swee Hock School of Public Health, Singapore
| | - M J A Koh
- Dermatology Service, KK Women's & Children's Hospital, Singapore
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Czarnowicki T, Krueger JG, Guttman-Yassky E. Novel concepts of prevention and treatment of atopic dermatitis through barrier and immune manipulations with implications for the atopic march. J Allergy Clin Immunol 2017; 139:1723-1734. [PMID: 28583445 DOI: 10.1016/j.jaci.2017.04.004] [Citation(s) in RCA: 160] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/07/2017] [Accepted: 04/13/2017] [Indexed: 12/16/2022]
Abstract
Skin barrier abnormalities have been suggested to play an essential role in initiation of early atopic dermatitis (AD). Antigen penetration through a compromised barrier likely leads to increased innate immune responses, antigen-presenting cell stimulation, and priming of overt cutaneous disease. In a TH2-promoting environment, T-cell/B-cell interactions occurring in regional lymph nodes lead to excessive IgE switch. Concurrent redistribution of memory T cells into the circulation not only leads to exacerbation of AD through T-cell skin infiltration but also spreads beyond the skin to initiate the atopic march, which includes food allergy, asthma, and allergic rhinitis. Possible primary interventions to prevent AD are focusing on improving skin barrier integrity, including supplementing barrier function with moisturizers. As for secondary prophylaxis in children with established AD, this can be stratified into prevention of disease exacerbations by using proactive approaches (with either topical corticosteroids or topical calcineurin inhibitors) in mild AD cases or the prevention of other atopic disorders that will probably mandate systemic immunosuppression in severe AD cases.
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Affiliation(s)
- Tali Czarnowicki
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - James G Krueger
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Emma Guttman-Yassky
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Laboratory for Investigative Dermatology, Rockefeller University, New York, NY.
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Silverberg NB, Durán-McKinster C. Special Considerations for Therapy of Pediatric Atopic Dermatitis. Dermatol Clin 2017; 35:351-363. [DOI: 10.1016/j.det.2017.02.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Miyar ME, Brown M, Vivar KL, Jablon K, Boscardin C, Levy ML, Teng JM, Mathes EF. An Atopic Dermatitis Management Algorithm for Primary Care Providers and Assessment of Its Usefulness as a Clinical Tool. Pediatr Dermatol 2017; 34:402-407. [PMID: 28543716 DOI: 10.1111/pde.13157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND/OBJECTIVES There is a lack of primary care provider (PCP) understanding of atopic dermatitis (AD) treatments and topical steroid use. We designed an AD management algorithm for pediatric PCPs. We hypothesized that the algorithm would improve pediatric PCPs' knowledge of AD diagnosis and management. METHODS Pediatric primary care resident and attending physicians at three residency programs were invited to participate in an electronic AD algorithm survey that contained demographic and 19 knowledge-based questions. Participants were randomized to intervention and control groups, with the intervention group receiving a short lecture and copy of our algorithm to use in an inpatient or outpatient setting for 2 months. Changes in scores between preintervention and postintervention surveys were compared. RESULTS Of the 54 participants, those in the intervention group (n = 26) performed significantly better than those in the control group (n = 28) after controlling for pretest scores (β = 1.19 [95% confidence interval 0.07, 2.32], p = 0.04). The intervention group had a higher average score on the posttest knowledge questions (71% correct) than the control group (65% correct) (p = 0.06). The majority of physicians who received the algorithm agreed or strongly agreed that they liked using the algorithm. CONCLUSION The use of a management algorithm improved physician knowledge about the diagnosis and treatment of AD and was well accepted by physicians. Use of this management algorithm may lead to better recognition and management of AD, particularly earlier recognition of and therapy for superinfection, improving treatment outcomes and quality of life for patients and families.
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Affiliation(s)
- Maria E Miyar
- Department of Dermatology, Kaiser Permanente, San Jose, California
| | - Megan Brown
- Department of Dermatology, University of California, San Diego, San Diego, California
| | - Karina L Vivar
- Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, Florida
| | - Kimberly Jablon
- Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Christy Boscardin
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, California
| | - Moise L Levy
- Dell Children's Medical Center, Austin, Texas.,Dell Medical School, University of Texas, Austin, Texas
| | - Joyce M Teng
- Department of Dermatology, Stanford University, Stanford, California.,Department of Pediatrics, Stanford University, Stanford, California
| | - Erin F Mathes
- Department of Pediatrics, University of California, San Francisco, San Francisco, California.,Department of Dermatology, University of California, San Francisco, San Francisco, California
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Adamson AS. The Economics Burden of Atopic Dermatitis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1027:79-92. [DOI: 10.1007/978-3-319-64804-0_8] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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Yamaguchi C, Futamura M, Chamlin SL, Ohya Y, Asano M. Development of a Japanese Culturally Modified Version of the Childhood Atopic Dermatitis Impact Scale (JCMV-CADIS). Allergol Int 2016; 65:312-9. [PMID: 27068767 DOI: 10.1016/j.alit.2016.02.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The Childhood Atopic Dermatitis Impact Scale (CADIS) was developed to measure the impact of AD on QoL in both affected children and their families. However, no scale of this kind exists in Japan. The aims of this study were to validate the Japanese Culturally Modified Version of the CADIS (JCMV-CADIS) and to describe the family impact of children with AD in a Japanese context. METHODS Participants included primary-caregivers for children with AD between 2 and 6 years of age. Interviews were conducted, and new items for the Japanese version were drafted. Reliability and validity were evaluated and compared with the original CADIS, and unique features of the Japanese version were analyzed. RESULTS Exploratory factor analysis revealed the following factors: "Symptoms" and "Activity Limitations and Behavior" in the Child domain, and "Emotions Related to Social Factors," "Emotions Related to the Child's Condition," "Family and Social Function," "Complexity of Care," and "Approaches to Management of AD in Daily Life" in the Parent domain. The latter two factors were unique to the JCMV-CADIS and were not derived from the Original. "Emotion" was split into two independent factors. All factors showed good reliability (internal consistency and stability) and validity (concurrent validity and discriminant validity), except for the concurrent validity of "Approaches to Management of AD in Daily Life." This factor seemed to reflect characteristics similar to the family-related function. CONCLUSIONS The JCMV-CADIS is a QoL scale developed for Japanese children with AD and their families. Further evaluation of clinical applicability is needed.
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Affiliation(s)
- Chikae Yamaguchi
- Department of Community Health Nursing, Nagoya City University School of Nursing, Nagoya, Japan; Department of Nursing, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Masaki Futamura
- Division of Pediatrics, Nagoya Medical Center, Nagoya, Japan
| | - Sarah L Chamlin
- Division of Dermatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Yukihiro Ohya
- Division of Allergy, Department of Medical Specialties, National Center for Child Health and Development, Tokyo, Japan
| | - Midori Asano
- Department of Nursing, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Findlay F, Proudfoot L, Stevens C, Barlow PG. Cationic host defense peptides; novel antimicrobial therapeutics against Category A pathogens and emerging infections. Pathog Glob Health 2016; 110:137-47. [PMID: 27315342 DOI: 10.1080/20477724.2016.1195036] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Cationic Host Defense Peptides (HDP, also known as antimicrobial peptides) are crucial components of the innate immune system and possess broad-spectrum antibacterial, antiviral, and immunomodulatory activities. They can contribute to the rapid clearance of biological agents through direct killing of the organisms, inhibition of pro-inflammatory mediators such as lipopolysaccharide, and by modulating the inflammatory response to infection. Category A biological agents and materials, as classified by the United States National Institutes for Health, the US Centers for Disease Control and Prevention, and the US Department of Homeland Security, carry the most severe threat in terms of human health, transmissibility, and preparedness. As such, there is a pressing need for novel frontline approaches for prevention and treatment of diseases caused by these organisms, and exploiting the broad antimicrobial activity exhibited by cationic host defense peptides represents an exciting priority area for clinical research. This review will summarize what is known about the antimicrobial and antiviral effects of the two main families of cationic host defense peptides, cathelicidins, and defensins in the context of Category A biological agents which include, but are not limited to; anthrax (Bacillus anthracis), plague (Yersinia pestis), smallpox (Variola major), tularemia (Francisella tularensis). In addition, we highlight priority areas, particularly emerging viral infections, where more extensive research is urgently required.
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Affiliation(s)
- Fern Findlay
- a School of Life, Sport and Social Sciences , Edinburgh Napier University , Sighthill Campus, Edinburgh EH11 4BN , UK
| | - Lorna Proudfoot
- a School of Life, Sport and Social Sciences , Edinburgh Napier University , Sighthill Campus, Edinburgh EH11 4BN , UK
| | - Craig Stevens
- a School of Life, Sport and Social Sciences , Edinburgh Napier University , Sighthill Campus, Edinburgh EH11 4BN , UK
| | - Peter G Barlow
- a School of Life, Sport and Social Sciences , Edinburgh Napier University , Sighthill Campus, Edinburgh EH11 4BN , UK
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Roudsari MR, Karimi R, Sohrabvandi S, Mortazavian AM. Health effects of probiotics on the skin. Crit Rev Food Sci Nutr 2016; 55:1219-40. [PMID: 24364369 DOI: 10.1080/10408398.2012.680078] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Skin is the largest organ of the body and is constantly exposed to physical, chemical, bacterial, and fungal challenges. It is well known that probiotics are helpful for specific disorders and different clinical studies have indicated that probiotics have special effects in cutaneous apparatus directly or indirectly that can be considerable from versatile aspects. Probiotic bacteriotherapy can have great potential in preventing and treating the skin diseases including eczema, atopic dermatitis, acne, and allergic inflammation or in skin hypersensitivity, UV-induced skin damage, wound protection, and as a cosmetic product. The current paper comprehensively reviews the different health effects of probiotics on the skin.
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Affiliation(s)
- M Rahmati Roudsari
- a Skin Research Center , Shahid Beheshti University of Medical Sciences , Tehran , Iran
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Filanovsky MG, Pootongkam S, Tamburro JE, Smith MC, Ganocy SJ, Nedorost ST. The Financial and Emotional Impact of Atopic Dermatitis on Children and Their Families. J Pediatr 2016; 169:284-90.e5. [PMID: 26616249 DOI: 10.1016/j.jpeds.2015.10.077] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 09/25/2015] [Accepted: 10/22/2015] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To examine the personal financial impact of atopic dermatitis (AD) and attempt to correlate cost of AD with emotional impact. STUDY DESIGN Between March 2011 and December 2013, 82 caretakers of children 6 months to 12 years of age with moderate-to-severe AD were recruited at the time of dermatology clinic visits in Cleveland, Ohio, to complete surveys. The response rate was >95%. Participants were asked questions about direct expenses (medical visits, medications, and other products) and indirect expenses (time missed from work, childcare costs) related to AD in the past 4 weeks. Emotional impact was measured by the Childhood Atopic Dermatitis Impact Scale. RESULTS The mean monthly personal cost of AD in the month before the office visit was $274 (median $114; IQR $29, $276), with $75 from direct costs (median $45; IQR $20, $110) and $199 from indirect costs (median $0; IQR $0, $208). An average of 34.8% of available monthly money was spent on AD care in the month before the office visit. For patients with Medicaid, there was a significant correlation between monthly adjusted personal cost and Childhood Atopic Dermatitis Impact Scale score (r = 0.548; P < .001); however, this correlation did not exist for patients who had commercial insurance (r = 0.269; P = .166). CONCLUSIONS Our results illustrate the high emotional and financial burden of childhood AD and provide insight into spending patterns. In addition, our study correlate costs with emotional burden of AD for lower-income patients.
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Affiliation(s)
| | - Suwimon Pootongkam
- Department of Dermatology, University Hospitals Case Medical Center, Cleveland, OH
| | - Joan E Tamburro
- Department of Dermatology, University Hospitals Case Medical Center, Cleveland, OH
| | - Mary C Smith
- Department of Dermatology, University Hospitals Case Medical Center, Cleveland, OH
| | - Stephen J Ganocy
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Susan T Nedorost
- Department of Dermatology, University Hospitals Case Medical Center, Cleveland, OH
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Kim HB, Zhou H, Kim JH, Habre R, Bastain TM, Gilliland FD. Lifetime prevalence of childhood eczema and the effect of indoor environmental factors: Analysis in Hispanic and non-Hispanic white children. Allergy Asthma Proc 2016; 37:64-71. [PMID: 26831849 DOI: 10.2500/aap.2016.37.3913] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The prevalence of eczema varies markedly across the globe. It is unclear whether the geographic variation is due to race and/or ethnic differences, environmental exposures, or genetic factors. OBJECTIVE We investigated the effects of ethnicity and environmental exposures on eczema in Hispanic white and non-Hispanic white children who participated in the Southern California Children's Health Study. METHODS We performed a cross-sectional study with sociodemographic predictors and environmental exposures among Hispanic white and non-Hispanic white children ages 4-8 years enrolled in the Children's Health Study, 2002-2003. RESULTS Eczema prevalence differed by ethnicity: Hispanic whites showed lower prevalence (13.8%) compared with non-Hispanic whites (20.2%), and adjustment for sociodemographic factors did not account for the ethnic difference (odds ratio [OR] 0.79 [95% confidence interval {CI}, 0.65-0.95]). Parental history of allergic disease had a larger effect in Hispanic whites than in non-Hispanic whites (p for interaction = 0.005). High maternal education level (OR 1.46 [95% CI, 1.14-1.87]), parental history of allergic disease (OR 2.21 [95% CI, 1.78-2.76]), and maternal smoking during pregnancy (OR 1.44 [95% CI, 1.06-1.95]) increased the risk of eczema. Indoor environmental factors (e.g., mold, water damage, humidifier use) increased the risk of eczema in non-Hispanic whites independent of a parental history of allergic disease, but, in Hispanic whites, increased risks were observed, primarily in children without a parental history of allergic disease. CONCLUSION Hispanic white children in southern California had a lower prevalence of eczema than non-Hispanic whites, and this ethnic difference was not accounted for by sociodemographic differences. The effects of a parental history of allergic disease and indoor environmental exposures on eczema varied by ethnicity, which indicated that the etiology of eczema may differ in Hispanic whites and in non-Hispanic whites.
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Affiliation(s)
- Hyo-Bin Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
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Strom MA, Silverberg JI. Eczema Is Associated with Childhood Speech Disorder: A Retrospective Analysis from the National Survey of Children's Health and the National Health Interview Survey. J Pediatr 2016; 168:185-192.e4. [PMID: 26520915 PMCID: PMC5216176 DOI: 10.1016/j.jpeds.2015.09.066] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/01/2015] [Accepted: 09/25/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine if eczema is associated with an increased risk of a speech disorder. STUDY DESIGN We analyzed data on 354,416 children and adolescents from 19 US population-based cohorts: the 2003-2004 and 2007-2008 National Survey of Children's Health and 1997-2013 National Health Interview Survey, each prospective, questionnaire-based cohorts. RESULTS In multivariate survey logistic regression models adjusting for sociodemographics and comorbid allergic disease, eczema was significantly associated with higher odds of speech disorder in 12 of 19 cohorts (P < .05). The pooled prevalence of speech disorder in children with eczema was 4.7% (95% CI 4.5%-5.0%) compared with 2.2% (95% CI 2.2%-2.3%) in children without eczema. In pooled multivariate analysis, eczema was associated with increased odds of speech disorder (aOR [95% CI] 1.81 [1.57-2.05], P < .001). In a single study assessing eczema severity, mild (1.36 [1.02-1.81], P = .03) and severe eczema (3.56 [1.70-7.48], P < .001) were associated with higher odds of speech disorder. History of eczema was associated with moderate (2.35 [1.34-4.10], P = .003) and severe (2.28 [1.11-4.72], P = .03) speech disorder. Finally, significant interactions were found, such that children with both eczema and attention deficit disorder with or without hyperactivity or sleep disturbance had vastly increased risk of speech disorders than either by itself. CONCLUSIONS Pediatric eczema may be associated with increased risk of speech disorder. Further, prospective studies are needed to characterize the exact nature of this association.
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Affiliation(s)
- Mark A Strom
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL
| | - Jonathan I Silverberg
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL; Department of Preventive Medicine and Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago, IL; Northwestern Medicine Multidisciplinary Eczema Center, Chicago, IL.
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Silverberg JI, Patel N, Immaneni S, Rusniak B, Silverberg NB, Debashis R, Fewkes N, Simpson EL. Assessment of atopic dermatitis using self-report and caregiver report: a multicentre validation study. Br J Dermatol 2015; 173:1400-4. [PMID: 26186170 DOI: 10.1111/bjd.14031] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The epidemiology of atopic dermatitis (AD) in the U.S.A. has been described largely via US population-based questionnaire studies. However, the validity of the questions used for self- and caregiver-reported eczema has not been previously demonstrated. OBJECTIVES To validate the assessment of self- and caregiver-reported eczema. METHODS We performed a prospective multicentre dermatology-practice-based study (three sites) to determine the validity of caregiver- and self-reported ever having eczema and 1-year history of eczema. Questionnaires were administered to unselected patients prior to their encounter. Patients (n = 782) were then evaluated by expert dermatologists trained in utilizing the Hanifin and Rajka criteria for AD. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value were determined. RESULTS Caregiver-reported 1-year history of childhood eczema was found to have a sensitivity (95% confidence interval) of 0·70 (0·59-0·80), specificity of 0·96 (0·93-0·99) and PPV of 0·87 (0·78-0·96) when compared with a physician's diagnosis of AD at that visit. Similarly, self-reported 1-year history of adult eczema was found to have a sensitivity of 0·70 (0·59-0·80), specificity of 0·95 (0·93-0·97) and PPV of 0·76 (0·64-0·85). The specificities and PPVs of a history of ever having caregiver- (0·89, 0·82-0·96 and 0·81, 0·70-0·93) and self-reported eczema (0·97, 0·95-0·99 and 0·91, 0·85-0·97) were high, with a high sensitivity in children (0·83, 0·72-0·95) but not in adults (0·43, 0·37-0·51). CONCLUSIONS Self- and caregiver-reported diagnosis of eczema ever or in the past year based on a single question demonstrates sufficient validity for the epidemiological study of AD.
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Affiliation(s)
- J I Silverberg
- Departments of Dermatology, Preventive Medicine and Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago, IL, U.S.A.,Northwestern Medicine Multidisciplinary Eczema Center, Chicago, IL, U.S.A
| | - N Patel
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, U.S.A
| | - S Immaneni
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, U.S.A
| | - B Rusniak
- Northwestern Medicine Multidisciplinary Eczema Center, Chicago, IL, U.S.A
| | - N B Silverberg
- Department of Dermatology, Mount Sinai St Luke's-Roosevelt Hospital and Beth Israel Medical Centers, New York, NY, U.S.A
| | - R Debashis
- Department of Dermatology, Mount Sinai St Luke's-Roosevelt Hospital and Beth Israel Medical Centers, New York, NY, U.S.A
| | - N Fewkes
- Department of Dermatology, Oregon Health Science University, Portland, OR, U.S.A
| | - E L Simpson
- Department of Dermatology, Oregon Health Science University, Portland, OR, U.S.A
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Li J, Silverberg J. Varicella infection is not associated with increasing prevalence of eczema: a U.S. population-based study. Br J Dermatol 2015; 173:1169-74. [DOI: 10.1111/bjd.14028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2015] [Indexed: 11/28/2022]
Affiliation(s)
- J.C. Li
- Department of Dermatology; Feinberg School of Medicine at Northwestern University; Suite 1600 676 N. St Clair St Chicago IL 60611 U.S.A
| | - J.I. Silverberg
- Departments of Dermatology, Preventive Medicine and Medical Social Sciences; Feinberg School of Medicine at Northwestern University; Chicago IL U.S.A
- Northwestern Medicine Multidisciplinary Eczema Center; Chicago IL U.S.A
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Billeci L, Tonacci A, Tartarisco G, Ruta L, Pioggia G, Gangemi S. Association Between Atopic Dermatitis and Autism Spectrum Disorders: A Systematic Review. Am J Clin Dermatol 2015; 16:371-88. [PMID: 26254000 DOI: 10.1007/s40257-015-0145-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is an allergic disorder caused by both immunological dysregulation and epidermal barrier defect. Several studies have investigated the association between AD and mental health disorders. Autism spectrum disorders (ASD) are a heterogeneous group of neurodevelopmental conditions characterized by impairments in social communication and restricted, stereotyped interests and behaviors. The concurrent increased prevalence of AD and ASD in the last decades has led many scientists to investigate the relationship between the two diseases. OBJECTIVE The aim of this systematic review was to examine the association between AD and ASD. METHODS A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed and ScienceDirect were searched up to March 2015 for all reports examining the association between ASD and AD. Descriptive statistics of the studies are reported. RESULTS The review included 18 studies assessing the association between ASD and AD. Of these studies, two focused on ASD in relation to AD alone, 14 discussed ASD in relation to both AD and other atopic disorders, and two evaluated AD in parents of children with ASD. Most of these studies found a positive association between the two disorders, although there were some studies going in the opposite direction. The entity of the association is somewhat inconsistent among the different studies given that the frequencies of AD in ASD compared with a control group ranged from 7 to 64.2%. In addition, odds ratios (ORs) or hazard ratios (HRs) gave different results as three studies found a weak association with an OR below 2 and a nonsignificant p value, and three other studies found a moderate or strong association with an OR ranging from 1.52 to 7.17 and a significant p value. When all atopic disorders were considered when evaluating the risk of ASD, the association was strong with an HR of 3.4 or an OR of 1.24 and p < 0.001. CONCLUSIONS Overall, the results of this systematic review seem to reveal an association between ASD and AD, suggesting that subjects with ASD have an increased risk of presenting with AD compared with typically developing controls, and vice versa. This association is supported by clinical/epidemiological aspects, shared genetic background and common immunological and autoimmune processes. However, the variability in study population and design, and the presence of other risk factors acting as confounding factors, sometimes contribute to inconsistent results. Further studies are needed to clarify the underlying pathophysiologic mechanism explaining the association between ASD and AD and to explore the causal association between the two conditions.
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Affiliation(s)
- Lucia Billeci
- National Research Council of Italy, Institute of Clinical Physiology, IFC-CNR, Pisa Unit, Pisa, Italy
| | - Alessandro Tonacci
- National Research Council of Italy, Institute of Clinical Physiology, IFC-CNR, Pisa Unit, Pisa, Italy
| | - Gennaro Tartarisco
- National Research Council of Italy, Institute of Clinical Physiology, IFC-CNR, Messina Unit, Via C. Valeria, SNC, 98125, Messina, Italy
| | - Liliana Ruta
- National Research Council of Italy, Institute of Clinical Physiology, IFC-CNR, Messina Unit, Via C. Valeria, SNC, 98125, Messina, Italy
- Department of Developmental Neuroscience, Stella Maris Scientific Institute, Calambrone, Pisa, Italy
| | - Giovanni Pioggia
- National Research Council of Italy, Institute of Clinical Physiology, IFC-CNR, Messina Unit, Via C. Valeria, SNC, 98125, Messina, Italy.
| | - Sebastiano Gangemi
- School and Division of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University Hospital "G. Martino", Messina, Italy
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Payette MJ, Weston G, Humphrey S, Yu J, Holland KE. Lichen planus and other lichenoid dermatoses: Kids are not just little people. Clin Dermatol 2015; 33:631-43. [PMID: 26686015 DOI: 10.1016/j.clindermatol.2015.09.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Lichenoid dermatoses, a group of inflammatory skin conditions with characteristic clinical and histopathologic findings, range from common to rare. Classic lichen planus typically presents as pruritic, polygonal, violaceous flat-topped papules and plaques; many variants in morphology and location also exist. Other lichenoid dermatoses share similar clinical presentations and histopathologic findings. These include lichenoid drug eruption, lichen planus-like keratosis, lichen striatus, lichen nitidus, and keratosis lichenoides chronica. Epidemiologic characteristics vary among each lichenoid disorder. While classic lichen planus is considered a disease of adults, other lichenoid dermatoses may be more common in younger populations. The literature contains an array of reports on the variations in presentation and successful management of lichen planus and lichenoid dermatoses among diverse populations. Familiarity with the characteristics of each lichenoid dermatosis, rare or common within each patient population, is key to accomplishing timely recognition and effective management.
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Affiliation(s)
- Michael J Payette
- Department of Dermatology, University of Connecticut Health Center, 21 South Road, Second Floor, Farmington, CT 06032.
| | - Gillian Weston
- University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030
| | - Stephen Humphrey
- Department of Dermatology, Medical College of Wisconsin, 9200 W. Wisconsin Ave., Wauwatosa, WI 53226
| | - JiaDe Yu
- Department of Dermatology, Medical College of Wisconsin, 9200 W. Wisconsin Ave., Wauwatosa, WI 53226
| | - Kristen E Holland
- Department of Dermatology, Medical College of Wisconsin, 9200 W. Wisconsin Ave., Wauwatosa, WI 53226
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50
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Chan SK, Gelfand EW. Primary Immunodeficiency Masquerading as Allergic Disease. Immunol Allergy Clin North Am 2015; 35:767-78. [PMID: 26454318 DOI: 10.1016/j.iac.2015.07.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Primary immune deficiencies (PIDs) are an uncommon heterogeneous group of diseases that result from fundamental defects in the proteins and cells that enable specific immune responses. Common allergic reactions (eczema, allergic rhinitis, asthma, and food allergies) are exaggerated immune responses that may be manifestations of an underlying PID. Early diagnosis and treatment has significant bearing on outcome. Immune suppression with systemic corticosteroids in these immune compromised individuals can lead to life threatening dissemination of infections.
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Affiliation(s)
- Sanny K Chan
- Division of Allergy and Immunology, Department of Pediatrics, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA.
| | - Erwin W Gelfand
- Division of Allergy and Immunology, Department of Pediatrics, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
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