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Trzeciak M, Rudnicka L, Arenberger P, Engin B, L'vov A, Alper S, Alpsoy E, Benáková N, Bobko S, Borlu M, Czarnecka-Operacz M, Elisyutina O, Ergun T, Ertam I, Fedenko E, Filipovská O, Fomina D, Gadzhigoroeva A, Kojanová M, Lesiak A, Michenko A, Murashkin N, Owczarek W, Özkaya E, Plzáková Z, Reich A, Selerova M, Gurbuz BA. Disease burden, clinical management and unmet treatment need of patients with moderate to severe atopic dermatitis; consensus statements, insights and practices from CERTADE (Central/Eastern EU, Russia, Turkiye AD Experts) Delphi panel. Front Med (Lausanne) 2024; 11:1402493. [PMID: 38962737 PMCID: PMC11220254 DOI: 10.3389/fmed.2024.1402493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 05/27/2024] [Indexed: 07/05/2024] Open
Abstract
Background There is limited insight into the current disease burden and everyday clinical management of moderate-to- severe AD in Poland, Czechia, Russia, and Turkiye. Therefore, this study aimed to get information-driven insights regarding the current disease burden and clinical management of patients with moderate-to-severe AD with common and differentiating aspects of the patient journey and establish a consensus. Methods In this modified 2-round Delphi panel, 133 questions were asked in total to 27 dermatologists. A consensus was achieved when 70% of the panel members strongly agreed or agreed (or strongly disagreed or disagreed) with an item. Statements with <40% agreement dropped from the Delphi rounds and were not repeated. Results The results state that AD has a significant impact on the quality of life for both patients and their families with social and economic consequences in these countries. While there were significant dissimilarities regarding the current treatment approach by preference order and treatment duration among participants, there was also a high percentage of consensus on literature and guideline-based statements. Current topical therapies and the immune response modifiers were not found to be sufficient by panelists to cover the therapeutic needs of patients with moderate-to-severe AD. Moreover, panelists highlighted the significant burden of adverse events with the off-label use of currently available immunosuppressants. Conclusions These results underlined that there is a significant disease burden with an unmet treatment need for patients with moderate-to-severe AD in Poland, Czechia, Russia, and Turkiye.
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Affiliation(s)
- Magdalena Trzeciak
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Petr Arenberger
- Department of Dermatovenerology, Third Faculty of Medicine, Charles University of Prague, Prague, Czechia
| | - Burhan Engin
- Department of Dermatology and Venerology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, İstanbul, Türkiye
| | - Andrey L'vov
- Department of Dermatology, Federal State Budgetary Institution of Continuing Professional Education “Central State Medical Academy”, Moscow, Russia
- Department of Dermatology, Medical Research and Educational Center, Lomonosov Moscow State University, Moscow, Russia
| | - Sibel Alper
- Department of Dermatology and Venereology, Koç University, İstanbul, Türkiye
| | - Erkan Alpsoy
- Department of Dermatology and Venereology, Akdeniz University, Antalya, Türkiye
| | - Nina Benáková
- Department of Dermatovenereology, 1st Medical Faculty, Charles University, Prague, Czechia
| | - Svetlana Bobko
- Moscow Scientific and Practical Centre of Dermatovenereology and Cosmetology, Moscow, Russia
| | - Murat Borlu
- Department of Dermatology and Venereology, Erciyes University, Kayseri, Türkiye
| | | | | | - Tulin Ergun
- Department of Dermatology, Marmara University, İstanbul, Türkiye
| | - Ilgen Ertam
- Department of Dermatology, Ege University, İzmir, Türkiye
| | - Elena Fedenko
- NRC Institute of Immunology FMBA of Russia, Moscow, Russia
| | - Olga Filipovská
- Department of Dermatology, Hospital in Ústí nad Labem, Ústí nad Labem, Czechia
| | - Daria Fomina
- Centre of Allergy and Immunology, Clinical State Hospital 52, Moscow Ministry of Healthcare, Moscow, Russia
- Department of Dermatology, I. M. Sechenov Moscow Medical University, Moscow, Russia
| | - Aida Gadzhigoroeva
- Moscow Scientific and Practical Centre of Dermatovenereology and Cosmetology, Moscow, Russia
| | - Martina Kojanová
- Department of Dermatovenereology, 1st Medical Faculty, Charles University, Prague, Czechia
| | - Aleksandra Lesiak
- Dermatology and Venereology Clinic, Medical University, Łodź, Poland
| | - Anna Michenko
- Department of Dermatology, Federal State Budgetary Institution of Continuing Professional Education “Central State Medical Academy”, Moscow, Russia
- Department of Dermatology, Medical Research and Educational Center, Lomonosov Moscow State University, Moscow, Russia
| | - Nikolay Murashkin
- Department of Dermatology, Federal State Autonomous Institution, Scientific Centre of Children's Health of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Witold Owczarek
- Department of Dermatology, Military Institute of Medicine, Warsaw, Poland
| | - Esen Özkaya
- Istanbul Faculty of Medicine, Department of Dermatology and Venereology, Istanbul University, İstanbul, Türkiye
| | - Zuzana Plzáková
- Department of Dermatovenereology, 1st Medical Faculty, Charles University, Prague, Czechia
| | - Adam Reich
- Department of Dermatology, University of Rzeszow, Rzeszów, Poland
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Chen PL, Hung SI, Chung WH, Chen CB, Kuo CN, Lin YK, Chiu CY. T-cell receptor diversity and allergen sensitivity in childhood asthma and atopic dermatitis. Pediatr Allergy Immunol 2024; 35:e14143. [PMID: 38745384 DOI: 10.1111/pai.14143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Childhood allergies of asthma and atopic dermatitis (AD) involve an overactive T-cell immune response triggered by allergens. However, the impact of T-cell receptor (TCR) repertoires on allergen sensitization and their role in mediating different phenotypes of asthma and AD in early childhood remains unclear. METHODS A total of 78 children, comprising 26 with asthma alone, 26 with AD alone, and 26 healthy controls (HC), were enrolled. TCR repertoire profiles were determined using a unique molecular identifier system for next-generation sequencing. Integrative analyses of their associations with allergen-specific IgE levels and allergies were performed. RESULTS The diversity in TCR alpha variable region (TRAV) genes of TCR repertoires and complementarity determining region 3 (CDR3) clonality in TRAV/TRBV (beta) genes were significantly higher in children with AD compared with those with asthma and HC (p < .05). Compared with HC, the expression of TRAV13-1 and TRAV4 genes was significantly higher in both asthma and AD (p < .05), with a significant positive correlation with mite-specific IgE levels (p < .01). In contrast, TRBV7-9 gene expression was significantly lower in both asthma and AD (p < .01), with this gene showing a significant negative correlation with mite-specific IgE levels (p < .01). Furthermore, significantly higher TRAV8-3 gene expression, positively correlated with food-specific IgE levels, was found in children with AD compared with those with asthma (p < .05). CONCLUSION Integrated TCR repertoires analysis provides clinical insights into the diverse TCR genes linked to antigen specificity, offering potential for precision immunotherapy in childhood allergies.
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Affiliation(s)
- Pei-Ling Chen
- Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, and Chang Gung University, Taoyuan, Taiwan
| | - Shuen-Iu Hung
- Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Hung Chung
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei and Keelung, Taiwan
| | - Chun-Bing Chen
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei and Keelung, Taiwan
| | - Chieh-Ni Kuo
- Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, and Chang Gung University, Taoyuan, Taiwan
| | - Yin-Ku Lin
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital at Keelung, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Yung Chiu
- Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, and Chang Gung University, Taoyuan, Taiwan
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Piontek K, Arnold A, Ewert R, Stubbe B, Bremert T, Krüger M, Fietze I, Völzke H, Apfelbacher C. Polysomnographic characteristics of sleep in adults with and without physician-diagnosed atopic dermatitis: results from the Study of Health in Pomerania. Sleep Breath 2024; 28:967-974. [PMID: 37889457 PMCID: PMC11136841 DOI: 10.1007/s11325-023-02937-7] [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: 05/22/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE To analyze sleep characteristics as measured with polysomnography (PSG) in adults from the general population with and without physician-diagnosed atopic dermatitis (AD). METHODS We analyzed data from participants from the German population-based Study of Health in Pomerania (SHIP) TREND-0. AD was diagnosed in a standardized skin examination. The following polysomnographic parameters were measured: total sleep duration (min), sleep latency (min), wake after sleep onset (WASO; min), rapid eye movement (REM) latency (min), sleep efficiency (%), total number of wakefulness and movement episodes, stages of sleep (%), and apnea-hypopnea index (AHI). Additionally, the subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). We compared sleep characteristics of participants with and without AD. RESULTS Among 1187 participants, 47 (4.0%) had AD. We found no differences between participants with and without AD in any of the analyzed PSG parameters except for the total number of wakefulness and movement episodes and the percentage of REM sleep. Participants with AD had a higher number of wakefulness and movement episodes, and a lower proportion of REM sleep compared to those without AD. Regarding subjective sleep parameters, no significant differences were found between participants with and without AD. CONCLUSION Our data do not provide evidence for poor sleep quality in individuals with AD. Major limitations of the study include the unavailability of data on AD severity and the small number of participants with AD. Larger-scaled longitudinal studies considering disease severity and specific AD symptoms with an effect on sleep are required.
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Affiliation(s)
- Katharina Piontek
- Institute of Social Medicine and Health Systems Research, Medical Faculty Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Andreas Arnold
- Department of Dermatology, University Medicine Greifswald, Greifswald, Germany
| | - Ralf Ewert
- Department of Internal Medicine B - Cardiology, Pneumology, Weaning, Infectious Diseases, Intensive Care Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Beate Stubbe
- Department of Internal Medicine B - Cardiology, Pneumology, Weaning, Infectious Diseases, Intensive Care Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Thomas Bremert
- Department of Oto-Rhino-Laryngology, Phoniatrics and Pedaudiology Division, University Medicine Greifswald, Greifswald, Germany
| | - Markus Krüger
- Department of Prosthetic Dentistry, Gerodontology and Biomaterials, University Medicine Greifswald, Greifswald, Germany
| | - Ingo Fietze
- Center of Interdisciplinary Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Medical Faculty Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
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Xing Y, Wang MH, Leung TF, Wong CK, Roponen M, Schaub B, Li J, Wong GWK. Poultry exposure and environmental protection against asthma in rural children. Allergy 2022; 77:2949-2960. [PMID: 35531632 DOI: 10.1111/all.15365] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 03/17/2022] [Accepted: 04/02/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Asthma is one of the most common chronic diseases in childhood, and the prevalence has been increasing over the past few decades. One of the most consistent epidemiological findings is that children living in a farming or rural environment are protected from development of asthma and allergies, but the protective factors in rural China are not clear. METHODS A community-based, cross-sectional epidemiological study was performed in a total of 17,587 children aged 5-8 years, 3435 from Hong Kong (urban) and 14,152 from Conghua (rural county in southern China). Asthma and allergic symptoms as well as environmental exposures were ascertained by using a standardized and validated questionnaire. RESULTS The prevalence of current wheeze was significantly lower in rural Conghua than that of urban Hong Kong (1.7% vs. 7.7%, p < 0.001). A lower rate of asthma ever was also reported in rural children compared with their urban counterparts (2.5% vs. 5.3%, p < 0.001). After adjusting for confounding factors, exposure to agricultural farming (adjusted odds ratio 0.74, 95% confidence interval: 0.56-0.97) and poultry (0.75, 0.59-0.96) were the most important factors associated with the asthma-protective effect in the rural area. Further propensity score-adjusted analysis indicated that such protection conferred by living in the rural environment was mainly attributable to poultry exposure. CONCLUSIONS We confirmed that the prevalence of asthma and atopic disorders was significantly lower in rural children when compared with their urban peers. Exposure to poultry and agricultural farming are the most important factors associated with asthma protection in the rural area.
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Affiliation(s)
- Yuhan Xing
- Department of Paediatrics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Maggie H Wang
- Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
| | - Ting-Fan Leung
- Department of Paediatrics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Chun-Kwok Wong
- Department of Chemical Pathology, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Marjut Roponen
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
| | - Bianca Schaub
- Pediatric Allergology, Department of Pediatrics, Dr von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Jing Li
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Gary W K Wong
- Department of Paediatrics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
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Neonatal Bacillus Calmette-Guérin Vaccination to Prevent Early-Life Eczema: A Systematic Review and Meta-analysis. Dermatitis 2022; 33:S3-S16. [PMID: 36125788 DOI: 10.1097/der.0000000000000945] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Increasing evidence suggests that early-life bacillus Calmette-Guérin (BCG) vaccine could prevent atopic eczema through its beneficial off-target effects. In this meta-analysis, 3 randomized control trials with similar methods were included and enabled robust estimations with low heterogeneity, involving a total of 5655 children randomized to early-life BCG Denmark (n = 2832) or no BCG (n = 2823). Meta-analyses suggest a beneficial effect of BCG to prevent eczema (risk ratio [RR], 0.89; 95% confidence interval [CI], 0.82-0.98). In subgroup analyses, BCG was more beneficial in boys (RR, 0.84; 95% CI, 0.74-0.95) and in children born to 2 atopic parents (RR, 0.81; 95% CI, 0.68-0.97). The NNT to prevent one case of eczema among children of 1 or 2 atopic parent was 20 (95% CI, 12-50). Bacillus Calmette-Guérin Denmark leads to an 11% reduction in the risk of eczema in early life. A greater effect was observed with increasing predisposition. Given its well-established safety profile, neonatal BCG vaccination should be considered for children of atopic parents.
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Piontek K, Ittermann T, Wiesmann U, Arnold A, Grabe HJ, Völzke H, Apfelbacher C. Childhood maltreatment is not associated with atopic dermatitis in adults: results from a cross-sectional population-based cohort study. J Eur Acad Dermatol Venereol 2022; 36:2430-2437. [PMID: 35920760 DOI: 10.1111/jdv.18480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/12/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Childhood maltreatment (CM) is related to poor physical and mental health outcomes in adults. Knowledge on the impact of CM on skin diseases is limited, and no study has previously addressed the association of CM with atopic dermatitis (AD) in adult age. OBJECTIVES To analyze the prevalence of CM in individuals with physician-diagnosed AD, and to examine the relationship between different types of CM with physician-diagnosed AD in a general population sample of German adults. METHODS Data from 2973 participants from the cross-sectional population-based Study of Health in Pomerania (SHIP) TREND-0 were analyzed (aged 20 to 83 years; 51.4% female). We administered the Childhood Trauma Questionnaire (CTQ) assessing emotional, physical and sexual abuse, and emotional and physical neglect. AD was diagnosed by dermatologists in a standardized clinical examination. We conducted logistic regression analyses adjusted for age, sex and school education to investigate the association of CM types with AD. RESULTS Among all individuals with AD, 20.6% reported to have experienced at least one type of moderate or severe CM. Emotional and physical neglect were the most frequently reported CM types. Overall, the prevalence of CM types among individuals with AD did not differ from those among individuals without AD. We found no association of CM type with AD. CONCLUSIONS This is the first study investigating the association of CM with AD in adults. CM was common in the present general population sample, emphasizing that CM is an important public health problem. Our findings suggest that CM is not a risk factor for AD. It might be hypothesized that AD severity is a crucial outcome, and that CM history is a factor with impact on disease severity and course rather than a risk factor for the development of AD. Longitudinal studies are required to address this question.
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Affiliation(s)
- K Piontek
- Institute of Social Medicine and Health Systems Research, Medical Faculty Magdeburg, Magdeburg, Germany
| | - T Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - U Wiesmann
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
| | - A Arnold
- Department of Dermatology, University Medicine Greifswald, Greifswald, Germany
| | - H J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - H Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - C Apfelbacher
- Institute of Social Medicine and Health Systems Research, Medical Faculty Magdeburg, Magdeburg, Germany
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Galiniak S, Rachel M. Fractional Exhaled Nitric Oxide in Teenagers and Adults with Atopic Dermatitis. Adv Respir Med 2022; 90:237-245. [PMID: 35892744 PMCID: PMC9717323 DOI: 10.3390/arm90040033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022]
Abstract
Fractional exhaled nitric oxide (FeNO) is a non-invasive biomarker of eosinophilic airway inflammation and therapeutic response to corticosteroid treatment of respiratory diseases. Atopic dermatitis (AD), one of the most common allergic conditions of the skin, is a factor influencing the increase of FeNO. The main aim of this study was to determine differences between levels of FeNO in patients with AD and healthy controls as measured by an electrochemical analyzer. In total, 54 teenagers and adults with AD were recruited and compared with 34 healthy volunteers. The measurements of FeNO were taken using the Hyp’Air FeNO in participants. FeNO was statistically significantly higher in patients with AD than in healthy controls (60.5 ± 35.1 vs. 14.8 ± 5.1 ppb, p < 0.001). We found a strong positive significant correlation between FeNO and the number of positive skin prick tests among AD patients (R = 0.754, p < 0.001). There was no correlation between FeNO and duration of disease as well as SCORAD index among patients. Moreover, we also found no FeNO difference between the mild and moderate forms of AD. The presence of AD and the increasing number of positive skin prick tests increase FeNO, so the results of this measurement should be interpreted with caution in patients with respiratory diseases suffering from AD.
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Affiliation(s)
- Sabina Galiniak
- Institute of Medical Sciences, Medical College, Rzeszów University, Warzywna 1a, 35-310 Rzeszów, Poland;
- Correspondence: ; Tel.: +48-17-851-68-38
| | - Marta Rachel
- Institute of Medical Sciences, Medical College, Rzeszów University, Warzywna 1a, 35-310 Rzeszów, Poland;
- Department of Allergology and Cystic Fibrosis, State Hospital 2 in Rzeszów, Lwowska 60, 35-301 Rzeszów, Poland
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Piontek K, Ittermann T, Arnold A, Völzke H, Baumeister S, Apfelbacher C. Prevalence, atopic and psychological comorbidity of physician-diagnosed atopic dermatitis in an adult general population sample: A cross-sectional study. Allergy 2022; 77:1915-1917. [PMID: 35332565 DOI: 10.1111/all.15288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/21/2022] [Accepted: 03/20/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Katharina Piontek
- Institute of Social Medicine and Health Systems Research Medical Faculty Magdeburg Magdeburg Germany
| | - Till Ittermann
- Institute for Community Medicine University Medicine Greifswald Greifswald Germany
| | - Andreas Arnold
- Department of Dermatology University Medicine Greifswald Greifswald Germany
| | - Henry Völzke
- Institute for Community Medicine University Medicine Greifswald Greifswald Germany
| | | | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research Medical Faculty Magdeburg Magdeburg Germany
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Pittet LF, Messina NL, Gardiner K, Freyne B, Abruzzo V, Morrison C, Vuillermin P, Allen KJ, Ponsonby AL, Robins-Browne R, Shann F, Flanagan KL, Donath S, Casalaz D, Phillips R, Curtis N. Discordance Between Diagnosis Tools for Assessing Eczema in Infants: A Challenge for Intervention Trials. Dermatitis 2022; 33:207-214. [PMID: 35170523 DOI: 10.1097/der.0000000000000842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is no standardized definition for infant eczema, and various tools have been used across studies, precluding direct comparison. OBJECTIVE The aim of the study was to assess and to compare the accuracy of diagnostic tools for infant eczema using the extensive data collected in Melbourne Infant Study: BCG for Allergy and Infection Reduction (MIS BAIR), an eczema prevention trial. METHODS Eczema incidence was assessed by 3 questionnaire-based measures: modified UK diagnostic tool, parent-reported medically diagnosed eczema, and parent-reported use of topical corticosteroids. Agreement between the definitions was quantified using κ coefficient. Eczema severity was assessed by 3-monthly Patient-Oriented Eczema Measure (POEM) scores and a SCORing Atopic Dermatitis (SCORAD) clinical assessment at a 12-month visit (ClinicalTrial.gov: NCT01906853). RESULTS Among the 538 participants fulfilling at least 1 of the 3 questionnaire-based eczema definitions, only 197 participants (37%) met all 3 definitions. Agreement between the definitions was poor with κ coefficients ranging from -0.11 to 0.62. The most frequently reported symptoms were generally dry skin (483/538, 90%) and pruritus (400/538, 74%). The face (352/538, 65%) and the trunk (306/538, 57%) were more frequently affected than the creases (257/538, 48%). Participants fulfilling all 3 questionnaire-based definitions of eczema were more likely to have higher severity scores and earlier onset of symptoms. CONCLUSIONS There is poor agreement between currently available tools for assessing infant eczema.
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Affiliation(s)
- Laure F Pittet
- From the Infectious Diseases Group, Murdoch Children's Research Institute Department of Paediatrics, The University of Melbourne Infectious Diseases Department of Research Operations, The Royal Children's Hospital Melbourne, Parkville, Australia Department of Paediatrics, College of Medicine, University of Malawi, Queen Elizabeth Central Hospital Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool and Malawi-Liverpool Wellcome Trust Research Programme, Blantyre School of Medicine, Deakin University Child Health Research Unit, Barwon Health, Geelong Formerly Centre for Food and Allergy Research Population Allergy, Murdoch Children's Research Institute, Melbourne The Florey Institute for Neuroscience and Mental Health Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville School of Medicine, University of Tasmania, Hobart Tasmanian Vaccine Trial Centre, Launceston General Hospital, Launceston School of Health and Biomedical Science, RMIT University Department of Immunology and Pathology, Monash University Clinical Epidemiology & Biostatistics Unit, Murdoch Children's Research Institute, Melbourne Neonatal Intensive Care Unit, Mercy Hospital for Women, Heidelberg Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Australia
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Chiu CY, Lin G, Wang CJ, Hung SI, Chung WH. Metabolomics reveals microbial-derived metabolites associated with immunoglobulin E responses in filaggrin-related atopic dermatitis. Pediatr Allergy Immunol 2021; 32:1709-1717. [PMID: 34087019 DOI: 10.1111/pai.13570] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/23/2021] [Accepted: 05/31/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Filaggrin (FLG) gene mutation and immunoglobulin E (IgE)-mediated sensitization are the most important predictors of atopic dermatitis (AD). However, a metabolomics-based approach to address the metabolic impact of FLG mutations on allergic IgE responses for AD is still lacking. We, though, determine the relationships of metabolic profiles in AD with FLG mutations and allergic responses. METHODS Eighty-one children with adolescent AD (n = 58) and healthy controls (n = 23) were prospectively enrolled. Mutations in the filaggrin gene were identified using whole-exome sequencing, and plasma metabolic profiles were determined using 1 H-nuclear magnetic resonance (NMR) spectroscopy. Integrative analyses of their associations related to total serum IgE levels were performed, and further metabolic functional pathways for AD were also assessed. RESULTS Metabolites contributed to the separation between AD and controls were identified using the supervised partial least squares discriminant analysis (Q2 /R2 = 0.90, Ppermutation <0.001). Nitrogen and amino acid metabolisms for energy production, and microbe-related methane and propanoate metabolisms were significantly associated with AD compared with healthy controls (FDR-adjusted p < .05). Five of fifteen metabolites related to FLG mutations were positively correlated with total serum IgE levels. Among them, dimethylamine and isopropanol were strongly associated with methane metabolism and propanoate metabolism, respectively, in AD with FLG mutations (FDR-adjusted p < .01). CONCLUSION A strong correlation of microbial-derived metabolites, dimethylamine and isopropanol, with FLG mutations and IgE allergic reactions provides the influence of host genetics on the microbiome to regulate susceptibility to allergic responses in the pathogenesis of AD.
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Affiliation(s)
- Chih-Yung Chiu
- Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan.,Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Gigin Lin
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Jung Wang
- Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Shuen-Iu Hung
- Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Hung Chung
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan
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Qurashi TA, Bhat GA, Khan MS, Rasool R, Sameen F, Hassan I, Mudassar S. Interleukin 4 and Interleukin 4 receptor alpha gene variants and risk of atopy - A case control study based assessment. Clin Immunol 2021; 229:108783. [PMID: 34129931 DOI: 10.1016/j.clim.2021.108783] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/12/2021] [Accepted: 06/08/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION IL4 pathway is known to upregulate IgE mediated immune responses and responsible for the manifestation of Atopic disorders. The current study was aimed to elucidate the genetic variations of Interleukin 4 (IL4) and Interleukin 4 receptor alpha (IL4R) genes and their possible association with atopic subjects. METHODS The well-designed questionnaire was used to collect the subject demographic and clinical details. Biochemical parameters were analysed using Chemiluminescent Immunoassay (CLIA) technique. The genotyping was performed using Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP). RESULTS We observed a statistically significant difference of serum Immunoglobulin-E (IgE) levels among cases and controls (P<0.05). Subjects harbouring the variant genotypes of I50V and Q576R single nucleotide polymorphisms (SNPs) in IL4R gene showed statistically differential risk towards atopic disorders. However, the variants genotype of 70 bp VNTR polymorphism in IL4 gene showed a protective role towards in predisposition to Atopy. On stratification, the above genetic variants had a significant impact on modifiable and non-modifiable factors associated with the disease. CONCLUSION Our study demonstrates that increased IgE levels and IL4 gene variants (I50V and Q576R) are significantly associated towards predisposition to allergic disorders in this study population.
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Affiliation(s)
- Taha Ashraf Qurashi
- Department of Clinical Biochemistry, Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Soura, 190011, J&K, India
| | - Gulzar Ahmad Bhat
- Department of Clinical Biochemistry, Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Soura, 190011, J&K, India
| | - Mosin Saleem Khan
- Department of Clinical Biochemistry, Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Soura, 190011, J&K, India
| | - Roohi Rasool
- Department of Immunology and Molecular Medicine, Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Soura, 190011, J&K, India
| | - Farah Sameen
- Department of Dermatology, SKIMS Medical College, Bemina, 190018, J&K, India
| | - Iffat Hassan
- Department of Dermatology & Venereal Diseases, Govt. Medical College Srinagar and Associated Hospitals, Karan Nagar, 190010, J&K, India
| | - Syed Mudassar
- Department of Clinical Biochemistry, Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Soura, 190011, J&K, India.
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12
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Calzavara-Pinton P, Belloni Fortina A, Bonamonte D, Marseglia GL, Miraglia Del Giudice M, Musarra A, Nettis E, Neri I, Patruno C, Stingeni L, Peris K. Diagnosis and management of moderate to severe atopic dermatitis in adolescents. A Consensus by the Italian Society of Dermatology and Venereology (SIDeMaST), the Italian Association of Hospital Dermatologists and Public Health (ADOI), the Italian Association of Hospital and Territorial Allergists and Immunologists (AAIITO), the Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC), the Italian Society of Pediatric Allergy and Immunology (SIAIP), the Italian Society of Allergological, Occupational and Environmental Dermatology (SIDAPA), and the Italian Society of Pediatric Dermatology (SIDerP). Ital J Dermatol Venerol 2020; 156:184-197. [PMID: 32438781 DOI: 10.23736/s2784-8671.20.06654-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory disease with increasing global incidence, which has a multifactorial pathogenesis and a variable expressivity. Clinical features of AD are different in adults compared to children, but it is well recognized the substantial impact of the disease on patients' quality of life at any age. Indeed, little is known about AD in adolescence, a period of life generally associated with high psychological burden and vulnerability to depression. Guidelines for the management of AD are available for both children and adults but specific guidelines for the diagnosis and treatment of AD in adolescents are lacking. Seven Italian scientific societies of dermatologists, allergists, and pediatric allergists joined in a specific meeting to provide practical guidance for the diagnosis and management of moderate-to-severe adolescent AD suitable for the Italian clinical practice. Through a modified Delphi procedure, consensus was reached by 59 Italian experts in the management of AD on 20 statements covering five areas of interest about adolescent AD, including disease complexity, burden and social impact, diagnosis and definition of severity, current treatments, and new biologic therapies. This paper reports recommendations for the diagnosis and management of AD specifically in adolescents, pointing out some peculiar clinical features and focusing on the choice of medications. Dupilumab, the first biologic approved for the treatment of adolescents with AD, represents a useful treatment option due to its efficacy and reassuring safety profile.
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Affiliation(s)
| | | | - Domenico Bonamonte
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Gian L Marseglia
- Department of Pediatrics, IRCCS San Matteo Polyclinic Foundation, University of Pavia, Pavia, Italy
| | - Michele Miraglia Del Giudice
- Department of Woman and Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Antonino Musarra
- Unit of Allergy, National Healthcare System, Reggio Calabria, Italy
| | - Eustachio Nettis
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, Aldo Moro University, Bari, Italy
| | - Iria Neri
- Unit of Dermatology, Department of Specialistic, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
| | - Cataldo Patruno
- Unit of Dermatology, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Luca Stingeni
- Section of Clinical Allergological Venereological Dermatology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Ketty Peris
- Unit of Dermatology, Sacred Heart Catholic University, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
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13
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Zhang T, Lee TK, Lui H, Dutz J, Dawes M, Lee A, Kalia S. Health insurance claim- and prescription record-based algorithms as a population-based method for eczema ascertainment. J Eur Acad Dermatol Venereol 2020; 34:e466-e468. [PMID: 32103573 DOI: 10.1111/jdv.16315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- T Zhang
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.,Photomedicine Institute, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - T K Lee
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.,Photomedicine Institute, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Departments of Cancer Control Research Program and Integrative Oncology - Imaging Unit, BC Cancer, Vancouver, BC, Canada
| | - H Lui
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.,Photomedicine Institute, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Departments of Cancer Control Research Program and Integrative Oncology - Imaging Unit, BC Cancer, Vancouver, BC, Canada
| | - J Dutz
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.,Division of Dermatology, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - M Dawes
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - A Lee
- Cross Roads Clinics, Vancouver, BC, Canada
| | - S Kalia
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.,Photomedicine Institute, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Departments of Cancer Control Research Program and Integrative Oncology - Imaging Unit, BC Cancer, Vancouver, BC, Canada.,Division of Dermatology, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
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14
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Kim J, Kim S, Woo SY, Chung JY, Hong YS, Oh SY, Choi SJ, Oh SY, Kim KW, Shin YH, Won HS, Lee KJ, Kim SH, Kwon JY, Lee SH, Hong SJ, Ahn K. Prenatal Exposure to Lead and Chromium is Associated with IL-13 Levels in Umbilical Cord Blood and Severity of Atopic Dermatitis: COCOA Study. Immune Netw 2019; 19:e42. [PMID: 31921472 PMCID: PMC6943175 DOI: 10.4110/in.2019.19.e42] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/05/2019] [Accepted: 11/10/2019] [Indexed: 01/13/2023] Open
Abstract
There have been few studies investigating the association between atopic dermatitis (AD) and prenatal exposure to heavy metals. We aimed to evaluate whether prenatal exposure to heavy metals is associated with the development or severity of AD in a birth cohort study. A total of 331 subjects were followed from birth for a median duration of 60.0 months. The presence and severity of AD were evaluated at ages 6 and 12 months, and regularly once a year thereafter. The concentrations of lead, mercury, chromium, and cadmium in umbilical cord blood were measured by inductively coupled plasma mass spectrometry. Cord blood mononuclear cells (CBMCs) were isolated and stimulated for analysis of cytokine production using ELISA. Heavy metal levels in cord blood were not associated with the development of AD until 24 months of age. However, a positive correlation was observed between the duration of AD and lead levels in cord blood (p=0.002). AD severity was also positively associated with chromium concentrations in cord blood (p=0.037), while cord blood levels of lead, mercury, and cadmium were not significantly associated with AD severity (p=0.562, p=0.054, and p=0.055, respectively). Interleukin-13 production in CBMCs was positively related with lead and chromium levels in cord blood (p=0.021 and p=0.015, respectively). Prenatal exposure to lead and chromium is associated with the persistence and severity of AD, and the immune reaction toward a Th2 polarization.
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Affiliation(s)
- Jihyun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
| | - Seonwoo Kim
- Statistics and Data Center, Samsung Medical Center, Seoul, Korea
| | - Sook-Young Woo
- Statistics and Data Center, Samsung Medical Center, Seoul, Korea
| | - Jin-Yong Chung
- Heavy Metal Exposure Environmental Health Center, Dong-A University, Busan, Korea
| | - Young-Seoub Hong
- Heavy Metal Exposure Environmental Health Center, Dong-A University, Busan, Korea.,Department of Preventive Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Se-Young Oh
- Department of Food and Nutrition, College of Human Ecology, Kyung Hee University, Seoul, Korea
| | - Suk-Joo Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Youn Ho Shin
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University College of Medicine, Seoul, Korea
| | - Hye-Sung Won
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung-Ju Lee
- Department of Obstetrics and Gynecology, Integrative Medicine Center, Korea University Medical College, Seoul, Korea
| | - Soo Hyun Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University College of Medicine, Seoul, Korea
| | - Ja Young Kwon
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Si Hyeon Lee
- Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College 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
| | - Kangmo Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
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15
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Cheng R, Zhang H, Zong W, Tang J, Han X, Zhang L, Zhang X, Gu H, Shu Y, Peng G, Huang L, Liu Q, Gao X, Guo Y, Yao Z. Development and validation of new diagnostic criteria for atopic dermatitis in children of China. J Eur Acad Dermatol Venereol 2019; 34:542-548. [PMID: 31568595 DOI: 10.1111/jdv.15979] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/05/2019] [Indexed: 11/30/2022]
Affiliation(s)
- R. Cheng
- Department of Dermatology Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine Shanghai China
- Institute of Dermatology Shanghai Jiao Tong University School of Medicine Shanghai China
| | - H. Zhang
- Department of Dermatology Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine Shanghai China
- Institute of Dermatology Shanghai Jiao Tong University School of Medicine Shanghai China
| | - W. Zong
- Institute of Dermatology Chinese Academy of Medical Sciences and Peking Union Medical College Nanjing Jiangsu China
| | - J. Tang
- Department of Dermatology Hunan Children's Hospital Changsha Hunan China
| | - X. Han
- Department of Dermatology Shengjing Hospital of China Medical University Shenyang Liaoning China
| | - L. Zhang
- Department of Dermatology China Medical University First Hospital Shenyang Liaoning China
| | - X. Zhang
- Department of Dermatology Children's Hospital of Shanxi Taiyuan Shanxi China
| | - H. Gu
- Institute of Dermatology Chinese Academy of Medical Sciences and Peking Union Medical College Nanjing Jiangsu China
| | - Y. Shu
- Department of Dermatology Hunan Children's Hospital Changsha Hunan China
| | - G. Peng
- Department of Dermatology Shengjing Hospital of China Medical University Shenyang Liaoning China
| | - L. Huang
- Clinical Research Center Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine Shanghai China
- Department of Pediatrics Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Q. Liu
- Department of Dermatology Children's Hospital of Shanxi Taiyuan Shanxi China
| | - X. Gao
- Department of Dermatology China Medical University First Hospital Shenyang Liaoning China
| | - Y. Guo
- Department of Dermatology Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine Shanghai China
- Institute of Dermatology Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Z. Yao
- Department of Dermatology Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine Shanghai China
- Institute of Dermatology Shanghai Jiao Tong University School of Medicine Shanghai China
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16
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Gür Çetinkaya P, Şahiner ÜM. Childhood atopic dermatitis: current developments, treatment approaches, and future expectations. Turk J Med Sci 2019; 49:963-984. [PMID: 31408293 PMCID: PMC7018348 DOI: 10.3906/sag-1810-105] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Atopic dermatitis (AD) is the most common chronic inflammatory skin disorder of childhood. Underlying factors that contribute to AD are impaired epithelial barrier, alterations in the lipid composition of the skin, immunological imbalance including increased Th2/Th1 ratio, proinflammatory cytokines, decreased T regulatory cells, genetic mutations, and epigenetic alterations. Atopic dermatitis is a multifactorial disease with a particularly complicated pathophysiology. Discoveries to date may be considered the tip of the iceberg, and the increasing number of studies in this field indicate that there are many points to be elucidated in AD pathophysiology. In this review, we aimed to illustrate the current understanding of the underlying pathogenic mechanisms in AD, to evaluate available treatment options with a focus on recently discovered therapeutic agents, and to determine the personal, familial, and economic burdens of the disease, which are frequently neglected issues in AD. Currently available therapies only provide transient solutions and cannot fully cure the disease. However, advances in the understanding of the pathogenic mechanisms of the disease have led to the production of new treatment options, while ongoing drug trials also have had promising results.
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Affiliation(s)
- Pınar Gür Çetinkaya
- Division of Pediatric Allergy and Asthma Unit, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ümit Murat Şahiner
- Division of Pediatric Allergy and Asthma Unit, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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17
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Furue M. T helper type 2 signatures in atopic dermatitis. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2018. [DOI: 10.1002/cia2.12023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Masutaka Furue
- Department of Dermatology; Kyushu University; Fukuoka Japan
- Division of Skin Surface Sensing; Department of Dermatology; Kyushu University; Fukuoka Japan
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18
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Furue M, Kadono T, Tsuji G, Nakahara T. Topical E6005/RVT-501, a novel phosphodiesterase 4 inhibitor, for the treatment of atopic dermatitis. Expert Opin Investig Drugs 2017; 26:1403-1408. [PMID: 29068253 DOI: 10.1080/13543784.2017.1397626] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Local adverse effects of steroid use and the burning sensation of calcineurin inhibitors impair patients' adherence to treatment and decrease the treatment response in atopic dermatitis (AD). Steroid phobia appears to be a psychological problem in patients with AD. Topical non-steroidal remedies are in demand. Areas covered: This manuscript reviews the current literature on preclinical and clinical studies regarding topical E6005/RVT-501, a novel phosphodiesterase 4 inhibitor. We also discuss the mechanistic background of E6005/RVT-501 in the treatment of AD. Expert opinion: Topical E6005/RVT-501 improves skin eruption and pruritus of pediatric and adult AD patients without any serious side effects. It is useful for mild to moderate lesions of AD in pediatric and adult patients. Topical E6005/RVT-501 is non-steroidal agent but its potency is equal to that of mild rank topical steroid, therefore, it may fit the demand of patients with steroid phobia. Its steroid-sparing effects may also be investigated in future clinical trials and may minimize the dose and frequency of topical steroids.
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Affiliation(s)
- Masutaka Furue
- a Department of Dermatology , Kyushu University , Fukuoka , Japan.,b Division of Skin Surface Sensing, Department of Dermatology , Kyushu University , Fukuoka , Japan.,c Research and Clinical Center for Yusho and Dioxin , Kyushu University , Fukuoka , Japan
| | - Takafumi Kadono
- d Department of Dermatology , St Marianna University School of Medicine , Kawasaki , Japan
| | - Gaku Tsuji
- a Department of Dermatology , Kyushu University , Fukuoka , Japan
| | - Takeshi Nakahara
- c Research and Clinical Center for Yusho and Dioxin , Kyushu University , Fukuoka , Japan
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19
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Huang A, Cho C, Leung DYM, Brar K. Atopic Dermatitis: Early Treatment in Children. CURRENT TREATMENT OPTIONS IN ALLERGY 2017; 4:355-369. [PMID: 29868331 DOI: 10.1007/s40521-017-0140-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Therapeutic regimens for the treatment and long-term management of AD traditionally had a two-fold objective of decreasing skin inflammation and repairing the defective skin barrier. Essential treatments for AD in children should include topical moisturizers for skin hydration and prevention of flares, topical anti-inflammatory medications (e.g. corticosteroids, calcineurin inhibitors, PDE4 inhibitor), allergen/irritant avoidance, and treatment of skin infections. Treatment regimens should be severity-based, and implemented in a stepwise approach tailored to the individual patient. This stepwise approach includes initial use of emollients, gentle skin care, and escalating to more potent anti-inflammatory treatments as the disease severity increases. Currently available systemic medications should be reserved for the presence of recalcitrance to topical therapies due to associated toxicities. We believe that early treatment of AD is not only essential in treating the skin disease, but also in preventing the development of additional atopic diseases, such as food allergy, asthma and allergic rhinitis. The defective skin barrier of AD permits a route of entry for food and environmental allergens, and upon exposure, keratinocytes secrete TSLP, which activates the TH2 pathway. This TH2 differentiation sets off the atopic march and the subsequent diseases that are seen. This review highlights treatment options and strategies in pediatric AD therapy with an emphasis on early therapy. Supporting evidence on the efficacy and safety of each intervention will be discussed.
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Affiliation(s)
- Amy Huang
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, NY
| | - Christine Cho
- Department of Pediatrics, National Jewish Health, Denver, CO
| | | | - Kanwaljit Brar
- Department of Pediatrics, National Jewish Health, Denver, CO
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20
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Furue M, Chiba T, Tsuji G, Ulzii D, Kido-Nakahara M, Nakahara T, Kadono T. Atopic dermatitis: immune deviation, barrier dysfunction, IgE autoreactivity and new therapies. Allergol Int 2017; 66:398-403. [PMID: 28057434 DOI: 10.1016/j.alit.2016.12.002] [Citation(s) in RCA: 173] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 11/16/2016] [Indexed: 12/24/2022] Open
Abstract
Atopic dermatitis (AD) is a chronic or chronically relapsing, eczematous, severely pruritic skin disorder mostly associated with IgE elevation and skin barrier dysfunction due to decreased filaggrin expression. The lesional skin of AD exhibits Th2- and Th22-deviated immune reactions that are progressive during disease chronicity. Th2 and Th22 cytokines further deteriorate the skin barrier by inhibiting filaggrin expression. Some IgEs are reactive to self-antigens. The IgE autoreactivity may precipitate the chronicity of AD. Upon activation of the ORAI1 calcium channel, atopic epidermis releases large amounts of thymic stromal lymphopoietin (TSLP), which initiates the Th2 and Th22 immune response. Th2-derived interleukin-31 and TSLP induce an itch sensation. Taken together, TSLP/Th2/Th22 pathway is a promising target for developing new therapeutics for AD. Enhancing filaggrin expression using ligands for the aryl hydrocarbon receptor may also be an adjunctive measure to restore the disrupted barrier function specifically for AD.
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Abstract
BACKGROUND Comorbidities of cardiovascular diseases (CVDs), metabolic syndrome and autoimmune diseases with systemic inflammation are recent topics in medicine. Inflammatory skin diseases such as atopic dermatitis and psoriasis are an active source of diverse proinflammatory cytokines and chemokines, which are readily detectable in the circulation and are likely to be involved in developing comorbidities. EVIDENCE Both atopic dermatitis and psoriasis are frequently comorbid with CVD, metabolic syndrome and autoimmune diseases, the consequence of which is called "inflammatory skin march", "psoriatic march" or "march of psoriasis". CONCLUSION In this review, we summarize the epidemiological evidence and pathogenetic concepts regarding inflammatory skin march in atopic dermatitis and psoriasis.
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Affiliation(s)
- Masutaka Furue
- Department of Dermatology, Kyushu University, Maidashi 3-1-1, Higashiku, Fukuoka, 812-8582, Japan.
| | - Takafumi Kadono
- Department of Dermatology, St. Marianna University School of Medicine, Kawasaki, Japan
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22
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Abstract
Although atopic dermatitis (AD) is the most common skin disorder, there remains an ongoing debate on this denomination, its definition and the binary view based on immunoglobulin E measurement. The wide spectrum of the clinical phenotype of AD reflects the complex genetic and pathophysiologic mechanisms underlying the disease. The diagnostic criteria have to be reconsidered and adapted to different ethnic populations. There is an urgent need for biomarker discovery further supporting the clinical diagnostic criteria as well as the precision medicine approach on a global level.
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Affiliation(s)
- Thomas Bieber
- Department of Dermatology and Allergy, Christine Kühne-Center for Allergy Research and Education, University Medical Center, Sigmund-Freud-Street 25, Bonn 53127, Germany.
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