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Sun P, Zhao X, Zhao W, Chen L, Liu X, Zhan Z, Wang J. Sophora flavescens-Angelica sinensis in the treatment of eczema by inhibiting TLR4/MyD88/NF-κB pathway. JOURNAL OF ETHNOPHARMACOLOGY 2024; 322:117626. [PMID: 38154523 DOI: 10.1016/j.jep.2023.117626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/05/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Sophora flavescens Ait.-Angelica sinensis(Oliv.) Diels drug pairing (SA) is a transformed drug pairing from Shengui pill, a traditional Chinese medicine prescription in the ninth volume of Traditional Chinese Medicine classic "Gu Jin Yi Jian", which is famous for clearing heat, moistening dryness, and promoting blood circulation. It is commonly used in the treatment of eczema, a skin condition that causes itching and inflammation. Despite its widespread use, there is still limited research on the mechanism of how SA treats eczema. This paper aims to fill this gap by conducting animal experiments to uncover the mechanism behind SA's therapeutic effects on eczema. Our findings provide a solid foundation for the clinical use of this TCM prescription. AIM OF THE STUDY The basic purpose of this study is to clarify the therapeutic mechanism of Sophora flavescens-Angelica sinensis (SA) in the treatment and control of eczema. MATERIALS AND METHODS The chemical compositions of SA were analyzed using HPLC-Q-Orbitrap-MS. In vivo, a mouse model of eczema was created, and the serum levels of TNF-α and IL-1β were quantified using an enzyme-linked immunosorbent assay (ELISA). Hematoxylin and eosin (HE) staining was performed to assess the pathological state of the mouse skin, and immunohistochemical technique (IHC) was employed to estimate the contents of TNF-α, TLR4, and NF-κB semi-quantitatively. The expression levels of TLR4, MyD88, and NF-κB mRNA were determined through real-time quantitative polymerase chain reaction (qRT-PCR). Western Blotting was utilized to identify the protein levels of TLR4, MyD88, and NF-κB in mouse skin tissue. RESULTS SA identified 18 active chemicals, some of which were shown in vivo to inhibit the TLR4/MyD88/NF-κB signaling pathway while reducing serum levels of TNF-α and IL-1β, making them ideal agents for the treatment of eczema. CONCLUSIONS SA's anti-inflammatory properties are attributed to its ability to reduce serum levels of TNF-α and IL-1β, likewise inhibit the TLR4/MyD88/NF-κB signaling pathway.
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Affiliation(s)
- Peng Sun
- College of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Ji'nan, 250355, China
| | - Xiangfeng Zhao
- College of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Ji'nan, 250355, China
| | - Wenjie Zhao
- Innovation Research Institute of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China
| | - Lele Chen
- College of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Ji'nan, 250355, China
| | - Xinyue Liu
- College of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Ji'nan, 250355, China
| | - Zhaoshuang Zhan
- College of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Ji'nan, 250355, China.
| | - Jiafeng Wang
- College of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Ji'nan, 250355, China.
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Hua L, Chen Q, Liu QH, Guo YF, Cheng RH, Zhang J, Zhang JH, Wang LW, Ji RX. Interaction between antibiotic use and MS4A2 gene polymorphism on childhood eczema: a prospective birth cohort study. BMC Pediatr 2021; 21:314. [PMID: 34261469 PMCID: PMC8278718 DOI: 10.1186/s12887-021-02786-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background Eczema is usually the first allergic manifestation to appear in life attributed to gene–environment interactions. IL13, IL4, MS4A2 and ILR4A are four key inflammatory genes associated with atopy. This study aimed to explore gene-environment interactions on eczema in early life among the above four genes and environmental factors in Chinese Han children. Methods Five hundred ninety-seven children from a birth cohort who completed two-year follow-up were enrolled and their cord blood was collected. Subjects were genotyped for six polymorphisms in the aforementioned four genes. The children were followed at 6, 12 and 24 months, with epidemiologic information and medical history of eczema collected by questionnaire and eczema assessed by dermatologists. Results Among the 597 children, 168 were diagnosed with eczema and the others were not after 2 years of follow-up. MS4A2 rs569108 GG genotype (P = 1.68E-02, odds ratio (OR) = 4.66) and antibiotic use (P = 3.75E-4, OR = 2.02) were found independently associated with development of childhood eczema. Children with both antibiotic use and MS4A2 rs569108 GG genotype were more likely to develop eczema than those with only antibiotic use or GG homozygote (OR = 6.24 VS. 2.04 or 4.68). Conclusions MS4A2 rs569108 polymorphism and antibiotic use were solely associated with eczema, and they interacted with each other to increase the risk of developing the disease in Chinese Han toddlers. Long-term follow-up along with functional and replication studies are still needed.
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Affiliation(s)
- Li Hua
- Department of Pediatric Pulmonology, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Qian Chen
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Quan-Hua Liu
- Department of Pediatric Pulmonology, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Yi-Feng Guo
- Department of Dermatology, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Ru-Hong Cheng
- Department of Dermatology, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Jun Zhang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Jian-Hua Zhang
- Department of Pediatric Pulmonology, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Li-Wei Wang
- Department of Pediatric Pulmonology, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
| | - Ruo-Xu Ji
- Department of Pediatric Pulmonology, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
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Osinka K, Dumycz K, Kwiek B, Feleszko W. Novel Therapeutic Approaches to Atopic Dermatitis. Arch Immunol Ther Exp (Warsz) 2017; 66:171-181. [PMID: 28861617 DOI: 10.1007/s00005-017-0487-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 07/11/2017] [Indexed: 12/20/2022]
Abstract
Atopic dermatitis (AD) is one of the most common inflammatory skin diseases. The number of people affected by AD is relatively high and seems to be rising. Although mild and moderate forms of the disease can be well controlled by the use of emollients, topical corticosteroids, and topical calcineurin inhibitors, treatment of severe is still a huge challenge. The new hope is biologic drugs, magic bullets in allergy, targeted at different points of the complex pathomechanism of inflammation in AD. In this review, novel biologic therapies are discussed, including recombinant monoclonal antibodies directed against various interleukin pathways (such as IL-4, IL-13, TSLP, IL-31, and IL-12/23), on immunoglobulin E, molecules acting as T cells, B cells, etc. Of biological drugs, the most promising seems to be anti-IL-4/IL-13 therapy (dupilumab-the biological agent) and phosphodiesterase-4 inhibitor (crisaborole-a small molecule). A deep understanding of the AD pathomechanism provides a new perspective for tailor-made treatment of severe atopic dermatitis.
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Affiliation(s)
- Katarzyna Osinka
- Department of Pediatric Respiratory Diseases and Allergy, Medical University of Warsaw, Żwirki i Wigury 63A, 02-091, Warsaw, Poland
| | - Karolina Dumycz
- Department of Pediatric Respiratory Diseases and Allergy, Medical University of Warsaw, Żwirki i Wigury 63A, 02-091, Warsaw, Poland
| | - Bartłomiej Kwiek
- Department of Dermatology and Immunodermatology, Medical University of Warsaw, Warsaw, Poland
| | - Wojciech Feleszko
- Department of Pediatric Respiratory Diseases and Allergy, Medical University of Warsaw, Żwirki i Wigury 63A, 02-091, Warsaw, Poland.
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Probiotics as an adjunct for the treatment of recurrent wheezing in infants and effects on expression of T-helper 1 and regulatory T cytokines. J Funct Foods 2017. [DOI: 10.1016/j.jff.2017.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Environmental Risk Factors for Development of Atopic Dermatitis: a Systematic Review. CURRENT DERMATOLOGY REPORTS 2017. [DOI: 10.1007/s13671-017-0189-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Genuneit J, Seibold AM, Apfelbacher CJ, Konstantinou GN, Koplin JJ, La Grutta S, Logan K, Perkin MR, Flohr C. Overview of systematic reviews in allergy epidemiology. Allergy 2017; 72:849-856. [PMID: 28052339 DOI: 10.1111/all.13123] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is a substantial body of evidence on the epidemiology of allergic conditions, which has advanced the understanding of these conditions. We aimed to systematically identify systematic reviews and meta-analyses on the epidemiology of allergic diseases to assess what has been studied comprehensively and what areas might benefit from further research. METHODS We searched PubMed and EMBASE up to 12/2014 for systematic reviews on epidemiological research on allergic diseases. We indexed diseases and topics covered and extracted data on the search characteristics of each systematic review. RESULTS The search resulted in 3991 entries after removing duplicates, plus 20 other items found via references and conference abstracts; 421 systematic reviews were relevant and included in this overview. The majority contained some evidence on asthma (72.9%). Allergic rhinitis, atopic eczema and food hypersensitivity were covered in 15.7%, 24.5% and 9.0%, respectively. Commonly studied risk factors for atopic eczema included dietary and microbial factors, while for asthma, pollution and genetic factors were often investigated in systematic reviews. There was some indication of differing search characteristics across topics. CONCLUSION We present a comprehensive overview with an indexed database of published systematic reviews in allergy epidemiology. We believe that this clarifies where most research interest has focussed and which areas could benefit from further research. We propose that this effort is updated every few years to include the most recently published evidence and to extend the search to an even broader list of hypersensitivity/allergic disorders.
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Affiliation(s)
- J. Genuneit
- Institute of Epidemiology and Medical Biometry; Ulm University; Ulm Germany
| | - A. M. Seibold
- Institute of Epidemiology and Medical Biometry; Ulm University; Ulm Germany
| | - C. J. Apfelbacher
- Institute of Epidemiology and Preventive Medicine; University of Regensburg; Regensburg Germany
| | - G. N. Konstantinou
- Department of Allergy and Clinical Immunology; 424 General Military Training Hospital; Thessaloniki Greece
| | - J. J. Koplin
- Murdoch Children's Research Institute; University of Melbourne; Melbourne VIC Australia
| | - S. La Grutta
- National Research Council of Italy; Institute of Biomedicine and Molecular Immunology; Palermo Italy
| | - K. Logan
- Children's Allergies Department; Division of Asthma, Allergy and Lung Biology; King's College London; London UK
| | - M. R. Perkin
- Population Health Research Institute; St George's, University of London; London UK
| | - C. Flohr
- Unit for Population-Based Dermatology Research; St John's Institute of Dermatology; King's College London and Guy's and St Thomas’ NHS Foundation; London UK
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Lloyd-Lavery A, Rogers NK, Hatfield SJ, Grindlay D, Barnett R, Thomas KS. What's new in atopic eczema? An analysis of systematic reviews published in 2014. Part 2. Treatment and prevention. Clin Exp Dermatol 2016; 42:3-7. [DOI: 10.1111/ced.12967] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2016] [Indexed: 12/16/2022]
Affiliation(s)
- A. Lloyd-Lavery
- Department of Dermatology; Churchill Hospital; Oxford University Hospitals NHS Foundation Trust; Oxford UK
| | - N. K. Rogers
- Centre of Evidence Based Dermatology; University of Nottingham; Nottingham UK
| | | | - D. Grindlay
- Centre of Evidence Based Dermatology; University of Nottingham; Nottingham UK
| | - R. Barnett
- Department of Dermatology; Churchill Hospital; Oxford University Hospitals NHS Foundation Trust; Oxford UK
| | - K. S. Thomas
- Centre of Evidence Based Dermatology; University of Nottingham; Nottingham UK
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Mathew JL, Ghosh G, Patel A. Does Early Exposure to Animals Alter Risk of Childhood Asthma? Indian Pediatr 2016; 53:59-63. [PMID: 26840676 DOI: 10.1007/s13312-016-0793-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | - Gautam Ghosh
- Department of Pediatrics, B R Singh Hospital for Medical Education and Reaserch, Kolkata, India.
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Vaneckova J, Bukač J. The severity of atopic dermatitis and the relation to the level of total IgE, onset of atopic dermatitis and family history about atopy. FOOD AGR IMMUNOL 2016. [DOI: 10.1080/09540105.2016.1183598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- J. Vaneckova
- Department of Dermatology and Venereology, Faculty Hospital and Medical Faculty of Charles University, Hradec Králové, Czech Republic
| | - J. Bukač
- Department of Medical Biophysics, Medical Faculty of Charles University, Hradec Králové, Czech Republic
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Abstract
BACKGROUND Recognizing the whole spectrum of comorbidities related to atopic dermatitis (AD) is prerequisite for adequate, patient-centered care. OBJECTIVES Based on systematic reviews (SRs) and published case-control studies, the current evidence on nonallergic comorbidities of AD is summarized. MATERIALS AND METHODS A comprehensive systematic literature search was performed in Medline and Embase (Search period: through 15 November 2014). RESULTS In total, nine systematic reviews were included. Six reviews investigating the association between AD and cancer suggested a decreased risk of glioma, meningioma, and acute lymphoblastic leukemia in patients with current or previous AD. One SR reported a consistent positive association of AD with attention deficit hyperactivity disorder. In comparison, two SRs focusing on the relationship between AD and diabetes mellitus type 1 and multiple sclerosis showed that there is no evidence supporting an association. A further screening of individual observational studies concerning immunological and psychiatric diseases pointed out that AD seems to be a significant risk factor for Crohn's disease, affective, schizophrenic, and behavior disorders. CONCLUSION Further longitudinal studies are needed to verify the existence of causal relationships. Interdisciplinary working groups are desirable to investigate explanations for genetic and physiologic mechanisms of described associations between AD and nonallergic comorbidities.
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Affiliation(s)
- S Deckert
- Zentrum für Evidenzbasierte Gesundheitsversorgung (ZEGV), Medizinische Fakultät Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
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11
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Čelakovská J. Atopic march, food allergy and food hypersensitivity in children and adolescents suffering from atopic dermatitis. FOOD AGR IMMUNOL 2015. [DOI: 10.1080/09540105.2014.998636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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12
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Hon KL, Tsang YCK, Pong NH, Luk DCK, Lee VW, Woo WM, Lam CYJ, Yeung YTE, Chau YSS, Chui KKK, Li KHG, Leung TF. Correlations among steroid fear, acceptability, usage frequency, quality of life and disease severity in childhood eczema. J DERMATOL TREAT 2015; 26:418-25. [PMID: 25895012 DOI: 10.3109/09546634.2015.1025030] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Topical corticosteroids (CSs) are the mainstay of treatment for eczema but CS phobia and fears are prevalent and influence therapeutic efficacy. AIM To quantify if CS acceptability and fear affect patients' quality-of-life (QoL). METHODS Patients with eczema managed in the pediatric dermatology outpatient clinic of a university hospital were surveyed. Nottingham Eczema Severity Score (NESS) for severity, Children's Dermatology Life Quality Index (CDLQI) for QoL, CS fear, acceptability and reported frequency of CS use were measured with quantified questions. RESULTS CS fears were prevalent among parents and caregivers of patients with eczema. Fifty-eight percent of parents reported general acceptability of CS as being very good or good, and many applied CS to their child regularly every week. However, >40% of parents reported CS fear "always" or "often", 41% reported that they "always" or "often" apply CS only when eczema got worse, 57% would discuss CS fear with their doctors, 30% would request CS-sparing medications and 14% "always" or "often" use traditional Chinese herbal medicine. Fears were predominantly interpersonal and less often iatrogenic in nature. Skin problems were the most concerned side effects of CS. CS acceptability, frequency of CS usage, CS fear and usage of alternative medications were independent domains in eczema management: CS fears correlated with CDLQI; CS usage frequency correlated with NESS and negatively with parental education; and CS acceptability correlated with parental education. Ordinal logistic regressions showed worse QoL was associated with more CS fear (odds ratio: 1.092 [95% CI: 1.023-1.165], p = 0.008). CONCLUSIONS The extent of CS fears is independent of CS acceptability, but correlates with patients' QoL. Desensitization of parental CS fears should be integral part of eczema education and therapeutics in order to improve therapeutic efficacy and patients' QoL.
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Affiliation(s)
- Kam Lun Hon
- a Department of Paediatrics , The Chinese University of Hong Kong , Hong Kong , Hong Kong SAR , China
| | - Yin Ching K Tsang
- a Department of Paediatrics , The Chinese University of Hong Kong , Hong Kong , Hong Kong SAR , China
| | - Nga Hin Pong
- a Department of Paediatrics , The Chinese University of Hong Kong , Hong Kong , Hong Kong SAR , China
| | - David C K Luk
- b Department of Paediatrics & Adolescent Medicine , United Christian Hospital , Kwun Tong , Hong Kong SAR , China
| | - Vivian W Lee
- c School of Pharmacy, The Chinese University of Hong Kong , Hong Kong , Hong Kong SAR , China , and
| | - Wing Man Woo
- d Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , Hong Kong SAR , China
| | - Chak Yiu Justin Lam
- d Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , Hong Kong SAR , China
| | - Yun Ting Eunice Yeung
- d Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , Hong Kong SAR , China
| | - Yiu Shing Sunny Chau
- d Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , Hong Kong SAR , China
| | - Ka Kam Kenneth Chui
- d Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , Hong Kong SAR , China
| | - Ka Hin Gabriel Li
- d Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , Hong Kong SAR , China
| | - Ting Fan Leung
- a Department of Paediatrics , The Chinese University of Hong Kong , Hong Kong , Hong Kong SAR , China
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13
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Sokolova A, Smith SD. Factors contributing to poor treatment outcomes in childhood atopic dermatitis. Australas J Dermatol 2015; 56:252-7. [DOI: 10.1111/ajd.12331] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 02/17/2015] [Indexed: 11/28/2022]
Affiliation(s)
| | - Saxon D Smith
- Department of Dermatology; Royal North Shore Hospital; St Leonards Sydney Australia
- Discipline of Dermatology, Northern Clinical School; University of Sydney; Sydney Australia
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Madhok V, Futamura M, Thomas KS, Barbarot S. What's new in atopic eczema? An analysis of systematic reviews published in 2012 and 2013. Part 2. Treatment and prevention. Clin Exp Dermatol 2015; 40:349-54; quiz 354-5. [PMID: 25622761 DOI: 10.1111/ced.12591] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2014] [Indexed: 11/29/2022]
Abstract
This review provides a summary of key findings from 22 systematic reviews on atopic eczema (AE) published over the 2-year period from January 2012 to 31 December 2013, focusing on prevention and treatment of AE. For an update of systematic reviews on the epidemiology, mechanisms of disease and methodological issues, see Part 1 of this update. Based on current systematic review evidence, the most promising intervention for the prevention of AE is the use of probiotics (and possibly prebiotics) during the late stages of pregnancy and early life. Exposure to household pets, especially dogs, may also be protective, but exclusive breastfeeding for up to 7 months does not confer benefit. The role of vitamin D in preventing AE is currently unclear. Very few of the systematic reviews provided additional evidence for the use of specific treatments for AE. Further research is required to establish the role of desensitization, Chinese herbal medicines, homeopathy and specialist clothing. Nevertheless, there is now clear evidence that evening primrose oil and borage oil are not effective for the treatment of AE. There have been no randomized controlled trials on the use of H1 anti-histamines as monotherapy for the treatment of AE.
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Affiliation(s)
- V Madhok
- Division of Population Health Sciences, University of Dundee, Dundee, UK
| | - M Futamura
- Division of Allergy, National Center for Child Health and Development, Tokyo, Japan
| | - K S Thomas
- Centre of Evidence Based Dermatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - S Barbarot
- Centre of Evidence Based Dermatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK.,Dermatology Department, Nantes University Hospital, Nantes, France
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15
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Madhok V, Futamura M, Thomas KS, Barbarot S. What's new in atopic eczema? An analysis of systematic reviews published in 2012 and 2013. Part 1. Epidemiology, mechanisms of disease and methodological issues. Clin Exp Dermatol 2015; 40:238-42. [DOI: 10.1111/ced.12578] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2014] [Indexed: 12/14/2022]
Affiliation(s)
- V. Madhok
- Division of Population Health Sciences; University of Dundee; Dundee UK
| | - M. Futamura
- Division of Allergy; National Center for Child Health and Development; Tokyo Japan
| | - K. S. Thomas
- Centre of Evidence Based Dermatology; Division of Rheumatology, Orthopaedics and Dermatology; School of Medicine; University of Nottingham; Nottingham UK
| | - S. Barbarot
- Centre of Evidence Based Dermatology; Division of Rheumatology, Orthopaedics and Dermatology; School of Medicine; University of Nottingham; Nottingham UK
- Dermatology Department; Nantes University Hospital; Nantes France
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Abstract
Atopic dermatitis (AD) is a common childhood inflammatory disease that, in a small percentage of cases, can become severe enough to require potent systemic treatment. Many trials have been conducted with systemic agents for the treatment of severe pediatric AD; we review the evidence here. Although corticosteroids are widely used in practice, they are not generally recommended as a systemic treatment option for AD in children. Most patients experience a relatively rapid and robust response to cyclosporine. Treating children with cyclosporine long term is troubling; however, azathioprine, mycophenolate mofetil, and methotrexate are all reasonable alternatives for maintenance therapy in recalcitrant cases. Several additional options are available for the most refractory cases, including interferon-γ, intravenous immunoglobulin, and various biologics. Phototherapy is another modality that can be effective in treating severe AD. Ultimately the choice of agent is individualized. Systemic therapy options are associated with potentially severe adverse effects and require careful monitoring. Nonsystemic approaches toward prevention of flares and long-term control of atopic dermatitis in pediatric patients should be continued in conjunction with systemic therapy. In the future, more targeted systemic treatments hold the potential for effective control of disease with fewer side effects than broadly immunosuppressive agents.
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Affiliation(s)
- Nathaniel A Slater
- Department of Dermatology, School of Medicine, University of North Carolina-Chapel Hill, 410 Market Street, Suite 400 Chapel Hill, NC, 27516
| | - Dean S Morrell
- Department of Dermatology, School of Medicine, University of North Carolina-Chapel Hill, 410 Market Street, Suite 400 Chapel Hill, NC, 27516.
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Therapeutic Patient Education. CURRENT TREATMENT OPTIONS IN ALLERGY 2014. [DOI: 10.1007/s40521-014-0033-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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19
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Celakovská J, Bukač J. Analysis of food allergy in atopic dermatitis patients - association with concomitant allergic diseases. Indian J Dermatol 2014; 59:445-50. [PMID: 25284847 PMCID: PMC4171910 DOI: 10.4103/0019-5154.139867] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A few reports demonstrate the comorbidity of food allergy and allergic march in adult patients. AIMS AND OBJECTIVES To evaluate, if there is some relation in atopic dermatitis patients at the age 14 years and older who suffer from food allergy to common food allergens to other allergic diseases and parameters as bronchial asthma, allergic rhinitis, duration of atopic dermatitis, family history and onset of atopic dermatitis. MATERIALS AND METHODS Complete dermatological and allergological examination was performed; these parameters were examined: food allergy (to wheat flour, cow milk, egg, peanuts and soy), the occurrence of bronchial asthma, allergic rhinitis, duration of atopic dermatitis, family history and onset of atopic dermatitis. The statistical evaluation of the relations among individual parameters monitored was performed. RESULTS Food allergy was altogether confirmed in 65 patients (29%) and these patients suffer significantly more often from bronchial asthma and allergic rhinitis. Persistent atopic dermatitis lesions and positive data in family history about atopy are recorded significantly more often in patients with confirmed food allergy to examined foods as well. On the other hand, the onset of atopic dermatitis under 5 year of age is not recorded significantly more often in patients suffering from allergy to examined foods. CONCLUSION Atopic dermatitis patients suffering from food allergy suffer significantly more often from allergic rhinitis, bronchial asthma, persistent eczematous lesions and have positive data about atopy in their family history.
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Affiliation(s)
- Jarmila Celakovská
- Department of Dermatology and Venereology, Medical Faculty of Charles University, Hradec Králové, Czech Republic
| | - Josef Bukač
- Department of Medical Biophysic, Medical Faculty of Charles University, Hradec Králové, Czech Republic
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Abstract
BACKGROUND Atopic dermatitis (AD) is a common inflammatory disorder of skin with significant comorbidities. AD care often requires a combination of treatment approaches, including emollients, topical steroids, systemic immunosuppressants and/or phototherapy. PURPOSE Our purpose was to review recent randomized controlled trials (RCT) and systematic reviews of AD treatments. METHODS A MEDLINE search was performed focusing on RCTs of AD treatments, with a sample size ≥ 15, and systematic reviews published from 2011 to 2013, limited to the English language. A total of 53 manuscripts met the inclusion/exclusion criteria, including 44 RCTs and nine systematic reviews. RESULTS Investigator-initiated RCTs support the use of the systemic agents cyclosporine, methotrexate, azathioprine and mycophenolate mofetil. In one RCT, petrolatum was found to be as effective as creams containing ceramides or glycyrrhetinic acid. Additional therapeutic approaches supported by RCTs include balneotherapy, oral and/or topical probiotics, nutritional interventions, vitamin D with or without vitamin E supplementation, as well as several new topical and complementary medicines. CONCLUSIONS Advances have been made with respect to AD treatment in the past few years through the use of well designed RCTs and comparative efficacy studies. However, more well designed RCTs and investigator-initiated studies are needed in order to improve the care of AD patients.
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Affiliation(s)
- Jonathan I Silverberg
- Departments of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University, Suite 1400, 680 Lake Shore Drive, Chicago, IL, 60611, USA,
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Jadotte YT, Santer M, Vakirlis E, Schwartz RA, Bauer A, Gundersen DA, Mossman K, Lewith G. Complementary and alternative medicine treatments for atopic eczema. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd010938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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