Advances in pediatric asthma and atopic dermatitis

Immunomodulatory effects of probiotic supplementation in patients with asthma: a randomized, double-blind, placebo-controlled trial

BACKGROUND

Asthma is considered to be a chronic inflammatory disorder of the airways. Probiotics are living microorganisms that are found in the human gut and have protective effects against a wide range of diseases such as allergies. The aim of this study was to investigate the improvement of clinical asthma symptoms and changes in the expression pattern of selective microRNAs in patients with asthma and the changes in IL-4 and IFN-γ plasma levels after receiving probiotics.

MATERIALS AND METHODS

The present study was a randomized, double-blind, placebo-controlled trial that enrolled 40 asthmatic patients. They were treated with probiotics or placebo: 1 capsule/day for 8 weeks. Pulmonary function tests, IL-4 and IFN-γ levels, and expression of microRNAs were assessed at baseline and after treatment.

RESULTS

The results showed that the expression of miR-16, miR146-a and IL-4 levels in patients with asthma after receiving probiotic supplementation was significantly reduced and miR-133b expression was increased. In addition, pulmonary function tests showed a significant improvement in Forced Expiratory Volume in 1 s and Forced Vital Capacity after receiving probiotics.

CONCLUSION

In our study, 8-week treatment with probiotic supplementation led to reduced Th2 cells-associated IL-4 and improved Forced Expiratory Volume and Forced Vital Capacity. It appears probiotics can be used in addition to common asthma treatments.

Asthma, Food Allergy, and How They Relate to Each Other

The association between atopic diseases is well known, and previous research has shown that having one atopic disease can predispose to having another. The link between asthma and food allergy has been well researched, but the exact relationship between the two atopic conditions is not fully understood. Food allergic infants are at increased risk for the development of asthma and are at risk of food-induced asthmatic episodes and also anaphylaxis. Having a diagnosis of both food allergy and asthma has also been shown to have an effect on the severity of a patient's disease including being at greater risk of severe asthmatic episodes. Therefore, understanding the relationship between these two conditions in order to treat and manage these children safely is crucial to clinicians.

Increased risk of major depression subsequent to a first-attack and non-infection caused urticaria in adolescence: a nationwide population-based study

Background

Non-infection caused urticaria is a common ailment in adolescents. Its symptoms (e.g., unusual rash appearance, limitation of daily activities, and recurrent itching) may contribute to the development of depressive stress in adolescents; the potential link has not been well studied. This study aimed to investigate the risk of major depression after a first-attack and non-infection caused urticaria.

Methods

This study used the Taiwan Longitudinal Health Insurance Database. A total of 5,755 adolescents hospitalized for a first-attack and non-infection caused urticaria from 2005 to 2009 were recruited as the study group, together with 17,265 matched non-urticarial enrollees who comprised the control group. Patients who had any history of urticaria or depression prior to the evaluation period were excluded. Each patient was followed for one year to identify the occurrence of depression. Cox proportional hazards models were generated to compute the risk of major depression, adjusting for the subjects’ sociodemographic characteristics. Depression-free survival curves were also analyzed.

Results

Thirty-four (0.6%) adolescents with non-infection caused urticaria and 59 (0.3%) non-urticarial control subjects suffered a new-onset episode of major depression during the study period. The stratified Cox proportional analysis showed that the crude hazard ratio (HR) of depression among adolescents with urticaria was 1.73 times (95% CI, 1.13-2.64) than that of the control subjects without urticaria. Moreover, the HR were higher in physical (HR: 3.39, 95% CI 2.77-11.52) and allergy chronic urticaria (HR: 2.43, 95% CI 3.18-9.78).

Conclusion

Individuals who have a non-infection caused urticaria during adolescence are at a higher risk of developing major depression.

Effect of DHU001, a Polyherbal Formula, on Dinitrofluorobenzene-induced Contact Dermatitis (Type I allergy)

The effect of DHU001, a mixed herbal formula consisted of 7 types aqueous extracts for various respiratory disorders were evaluated on 2,4-dinitrofluorobenzene (DNFB) -induced contact dermatitis, type I allergic model. Contact dermatitis was induced by sensitization with dinitrophenyl-derivatized ovalbumin (DNP-OVA) and DNFB challenge as antigen. Two different dosages of DHU001 (300 and 150 mg/kg) were orally administered to DNP-OVA sensitization mice once a day for 7 days with reference material, dexamethasone (15 mg/kg, intraperitoneal treatment) . End of 7 days oral administration of DHU001 extracts or intraperitoneal treatment of dexamethasone, the changes on the edematous changes and scratching behavior were measured. Immediate after DNFB challenge on ear or paw of DNP-OVA sensitized mice, increases of ear and paw thicknesses and weights were detected with anterior ear skin (dermis to epidermis) thickness and paw scratching behavior increases. However, these contact dermatitis signs induced by DNFB treatment were reduced by treatment of the both different dosages of DHU001 and dexamethasone, respectively. The results obtained in this study suggest that oral treatment of DHU001 extracts also has relatively favorable effects on contact dermatitis.

Children with Atopic Dermatitis Do Not Have More Anxiety or Different Cortisol Levels Compared with Normal Children

Background:

The hypothalamic-pituitary-adrenal axis has an important immunoregulatory role under stress, and stressmediated anxiety has been reported to be associated with alterations in immune functions and attenuated cortisol levels in atopic dermatitis (AD) patients.

Objective:

We investigated serum basal cortisol and anxiety levels in pediatric AD patients and compared them with those of controls.

Methods:

Basal serum cortisol levels were measured in 36 pediatric AD patients (aged 9–16 years) and 36 control subjects (aged 9–15 years). Anxiety was assessed by the trait anxiety subscale (TAI-C) of the State-Trait Anxiety Inventory for Children. The severity of AD was assessed by the objective severity scoring of AD (SCORing Atopic Dermatitis [SCORAD]).

Results:

Data analysis showed no statistical difference for the basal serum cortisol levels ( p = .383) and the TAI-C ( p = .730) between the two groups. No significant correlation was found between the basal cortisol values and the TAI-C scores in the AD group ( p = .290). The SCORAD index was correlated with the TAI-C scores ( p < .05) but not correlated with the basal serum cortisol values in AD patients ( p = .06).

Conclusion:

Children with AD do not have more anxiety or different cortisol levels when compared with normal children, but the severe symptomatology of AD itself may cause anxiety levels to increase in children with AD.

Smad3 Signal Transducer Regulates Skin Inflammation and Specific IgE Response in Murine Model of Atopic Dermatitis

Atopic dermatitis (AD) is a common chronic inflammatory skin disease characterized by itchy, dry, and inflamed skin. Transforming growth factor (TGF)-beta is an important fibrogenic and immunomodulatory factor that regulates cellular processes in the injured and inflamed skin. This study examines the role of the TGF-beta-Smad signaling pathway using Smad3-deficient mice in a murine model of AD. Dermatitis was induced in mice by epicutaneous application of ovalbumin (OVA) applied in a patch to tape-stripped skin. OVA-specific IgE and IgG2a antibody levels were measured by ELISA. Skin biopsies from sensitized skin areas were used for RNA isolation, histology, and immunohistochemical examination. The thickness of dermis was significantly reduced in OVA-sensitized skin of Smad3-/- mice. The defect in the dermal thickness was accompanied by a decrease in the expression of mRNA for proinflammatory cytokines IL-6 and IL-1beta in the OVA-sensitized skin. In contrast, the number of mast cells was significantly increased in OVA-sensitized skin of Smad3-/- mice, which also exhibited elevated levels of OVA-specific IgE. These results demonstrate that the Smad3-pathway regulates allergen-induced skin inflammation and systemic IgE antibody production in a murine model AD. The Smad3 signaling pathway might be a potential target in the therapy of allergic skin diseases.

Atopic dermatitis

Atopic dermatitis is an especially common and frustrating condition, and the prevalence is increasing. The disease can adversely affect the quality of life of patients and caregivers. Significant advances in our understanding of the pathogenesis have led to improvements in therapy. Patient and caregiver education, avoidance of potential triggering factors, optimal skin care, and pharmacotherapy offer the potential for good control for most patients.