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The Influence of Antioxidant Plant Extracts on the Oxidation of O/W Emulsions. COSMETICS 2023. [DOI: 10.3390/cosmetics10020040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
The demand for natural cosmetics has steadily increased in recent years. However, challenges occur especially in quality preservation regarding oxidative spoilage of natural cosmetic products, as the use of synthetic preservatives and antioxidants is limited. Therefore, it is important to find nature-based ingredients to ensure shelf life in natural cosmetic formulations. As a result, potential is seen in the use of plant-based antioxidant extracts. The aim of this work was to determine the suitability of the method combination by measuring the antioxidant activity, oxygen concentration, and volatile oxidation products via gas chromatography (hexanal) for the characterization of the influence of some plant extracts on the oxidative stability of natural cosmetic emulsions. Plant extracts of Riesling (Vitis vinifera) pomace, apple (Malus domestica) pomace, coffee (Coffea arabica) grounds, cocoa (Theobroma cacao) husk, and coffee (Coffea arabica) powder extract were incorporated in stable O/W emulsion formulations, while an emulsion without extract functioned as blank. Afterwards, the emulsions were subjected to 3-month accelerated storage tests with and without light exposure. Their oxygen uptake was investigated, and headspace gas chromatography measurements were performed to detect the fatty acid oxidation products formed during oxidative processes in the samples. The results showed that all emulsion samples under light exposure had a higher oxygen uptake and an increase in the characteristic fatty acid oxidation products compared with those stored under light exclusion. However, differences in oxygen uptake under light exposure were observed depending on the plant extract. Therefore, for O/W emulsions, the daily oxygen consumption rate correlated exponentially with the antioxidant activity, and the hexanal concentration correlated linearly with the daily oxygen consumption rate.
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Labib A, Golpanian RS, Aickara D, Smith P, Yosipovitch G. The effect of fatty acids, vitamins, and minerals on pediatric atopic dermatitis: A systematic review. Pediatr Dermatol 2023; 40:44-49. [PMID: 36263777 DOI: 10.1111/pde.15143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/04/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND A body of research has examined the role of fatty acid (FA), vitamin, and mineral supplementation as adjunctive treatment for atopic dermatitis (AD); however, results are conflicting and concrete recommendations are lacking. The objective of this study is to highlight the role of these nutrients in alleviating AD severity and provide the clinician with consolidated information that can be used to make recommendations to the pediatric patient and caretaker, where this topic is of high interest. METHODS A review of the PubMed and Embase databases was conducted to identify and qualitatively analyze all randomized controlled trials, systematic reviews, and meta-analyses conducted within the last 21 years regarding use of these nutrients to alleviate symptoms of AD. Inclusion criteria include AD diagnosis, non-infant age groups, and AD severity outcomes; exclusion criteria include preventative studies, predominantly maternal or infant demographics, or nonclinical outcomes. RESULTS Sixty-nine studies were included. Evidence regarding FA supplementation is inconclusive; however, targeting an ideal omega-3:omega-6 FA ratio may play a small role in alleviating AD symptoms. Studies results regarding vitamin/mineral supplementation are inconsistent and supplementation should not be advised unless the patient has a documented deficiency. CONCLUSION Pediatric AD patients should lead a healthy lifestyle with an emphasis on consumption of wholesome foods. Nutritional supplementation can play a role in improving AD symptoms; however, this should be evaluated on a case-by-case basis. Limitations include heterogeneity of studies.
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Affiliation(s)
- Angelina Labib
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rachel S Golpanian
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Divya Aickara
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Peter Smith
- Clinical Medicine, Griffith University, Southport, Queensland, Australia
| | - Gil Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, University of Miami Miller School of Medicine, Miami, Florida, USA
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Abstract
Atopic dermatitis, a common chronic and pruritic inflammatory skin disorder, can create significant disruptions in sleep and quality of life. Atopic dermatitis is especially common in infants and children; therefore, safe and natural therapeutic options have considerable appeal. Over the past several decades, there has been an increase in the prevalence of atopic dermatitis in industrialized nations. Also, there is variability in the prevalence of atopic dermatitis in the United States, both across and within states. Environmental factors including diet are believed to be associated with this increased risk. Dietary interventions continue to be an area of keen interest and have been studied extensively, albeit with variable results. Maternal dietary restrictions during pregnancy and lactation, hydrolyzed or partially hydrolyzed formulas, delaying the introduction of solid foods, and omega-3 or omega-6 fatty acids supplementation do not appear to have a beneficial effect on the treatment and prevention of atopic dermatitis. Exclusive breastfeeding for 3 to 4 months, a diet high in fruits and vegetables, and prebiotics might have a beneficial effect. Because environmental triggers, including dietary exposures, are thought to play a role in the pathogenesis of atopic dermatitis, we herein review the current literature on the role of dietary habits, vitamin and mineral supplementation, and probiotics on the treatment and prevention of atopic dermatitis.
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Appay M. Dermatite atopique de l’enfant, un traitement strictement symptomatique. ACTUALITES PHARMACEUTIQUES 2020. [DOI: 10.1016/s0515-3700(20)30265-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Sergeant S, Hallmark B, Mathias RA, Mustin TL, Ivester P, Bohannon ML, Ruczinski I, Johnstone L, Seeds MC, Chilton FH. Prospective clinical trial examining the impact of genetic variation in FADS1 on the metabolism of linoleic acid- and ɣ-linolenic acid-containing botanical oils. Am J Clin Nutr 2020; 111:1068-1078. [PMID: 32167131 PMCID: PMC7198310 DOI: 10.1093/ajcn/nqaa023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 01/30/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Unexplained heterogeneity in clinical trials has resulted in questions regarding the effectiveness of ɣ-linolenic acid (GLA)-containing botanical oil supplements. This heterogeneity may be explained by genetic variation within the fatty acid desaturase (FADS) gene cluster that is associated with circulating and tissue concentrations of arachidonic acid (ARA) and dihomo-ɣ-linolenic acid (DGLA), both of which may be synthesized from GLA and result in proinflammatory and anti-inflammatory metabolites, respectively. OBJECTIVES The objective of this study was to prospectively compare the capacity of a non-Hispanic white cohort, stratified by FADS genotype at the key single-nucleotide polymorphism (SNP) rs174537, to metabolize 18-carbon omega-6 (n-6) PUFAs in borage oil (BO) and soybean oil (SO) to GLA, DGLA, and ARA. METHODS Healthy adults (n = 64) participated in a randomized, double-blind, crossover intervention. Individuals received encapsulated BO (Borago officinalis L.; 37% LA and 23% GLA) or SO [Glycine max (L.) Merr.; 50% LA and 0% GLA] for 4 wk, followed by an 8-wk washout period, before consuming the opposite oil for 4 wk. Serum lipids and markers of inflammation (C-reactive protein) were assessed for both oil types at baseline and during weeks 2 and 4 of the intervention. RESULTS SO supplementation failed to alter circulating concentrations of any n-6 long-chain PUFAs. In contrast, a modest daily dose of BO elevated serum concentrations of GLA and DGLA in an rs174537 genotype-dependent manner. In particular, DGLA increased by 57% (95% CI: 0.38, 0.79) in GG genotype individuals, but by 141% (95% CI: 1.03, 2.85) in TT individuals. For ARA, baseline concentrations varied substantially by genotype and increased modestly with BO supplementation, suggesting a key role for FADS variation in the balance of DGLA and ARA. CONCLUSIONS The results of this study clearly suggest that personalized and population-based approaches considering FADS genetic variation may be necessary to optimize the design of future clinical studies with GLA-containing oils. This trial was registered at clinicaltrials.gov as NCT02337231.
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Affiliation(s)
- Susan Sergeant
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA,Center for Botanical Lipids and Inflammatory Disease Prevention, Wake Forest School of Medicine,Winston-Salem, NC, USA
| | | | - Rasika A Mathias
- Center for Botanical Lipids and Inflammatory Disease Prevention, Wake Forest School of Medicine,Winston-Salem, NC, USA,Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Tammy L Mustin
- Center for Botanical Lipids and Inflammatory Disease Prevention, Wake Forest School of Medicine,Winston-Salem, NC, USA,Department of Physiology/Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Priscilla Ivester
- Center for Botanical Lipids and Inflammatory Disease Prevention, Wake Forest School of Medicine,Winston-Salem, NC, USA,Department of Physiology/Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Maggie L Bohannon
- Center for Botanical Lipids and Inflammatory Disease Prevention, Wake Forest School of Medicine,Winston-Salem, NC, USA,Department of Physiology/Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ingo Ruczinski
- Center for Botanical Lipids and Inflammatory Disease Prevention, Wake Forest School of Medicine,Winston-Salem, NC, USA,Johns HopkinsBloomberg School of Public Health, Department of Biostatistics, Baltimore, MD, USA
| | | | - Michael C Seeds
- Center for Botanical Lipids and Inflammatory Disease Prevention, Wake Forest School of Medicine,Winston-Salem, NC, USA,Department of Internal Medicine, Section on Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Floyd H Chilton
- Center for Botanical Lipids and Inflammatory Disease Prevention, Wake Forest School of Medicine,Winston-Salem, NC, USA,BIO5 Institute, University of Arizona, Tucson, AZ, USA,Address correspondence to FHC (e-mail: )
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Balić A, Vlašić D, Žužul K, Marinović B, Bukvić Mokos Z. Omega-3 Versus Omega-6 Polyunsaturated Fatty Acids in the Prevention and Treatment of Inflammatory Skin Diseases. Int J Mol Sci 2020; 21:E741. [PMID: 31979308 PMCID: PMC7037798 DOI: 10.3390/ijms21030741] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 12/19/2022] Open
Abstract
Omega-3 (ω-3) and omega-6 (ω-6) polyunsaturated fatty acids (PUFAs) are nowadays desirable components of oils with special dietary and functional properties. Their therapeutic and health-promoting effects have already been established in various chronic inflammatory and autoimmune diseases through various mechanisms, including modifications in cell membrane lipid composition, gene expression, cellular metabolism, and signal transduction. The application of ω-3 and ω-6 PUFAs in most common skin diseases has been examined in numerous studies, but their results and conclusions were mostly opposing and inconclusive. It seems that combined ω-6, gamma-linolenic acid (GLA), and ω-3 long-chain PUFAs supplementation exhibits the highest potential in diminishing inflammatory processes, which could be beneficial for the management of inflammatory skin diseases, such as atopic dermatitis, psoriasis, and acne. Due to significant population and individually-based genetic variations that impact PUFAs metabolism and associated metabolites, gene expression, and subsequent inflammatory responses, at this point, we could not recommend strict dietary and supplementation strategies for disease prevention and treatment that will be appropriate for all. Well-balanced nutrition and additional anti-inflammatory PUFA-based supplementation should be encouraged in a targeted manner for individuals in need to provide better management of skin diseases but, most importantly, to maintain and improve overall skin health.
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Affiliation(s)
- Anamaria Balić
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, School of Medicine University of Zagreb, Šalata 4, 10 000 Zagreb, Croatia; (A.B.); (B.M.)
| | - Domagoj Vlašić
- Department of Ophtalmology and Optometry, General Hospital Dubrovnik, Ulica dr. Roka Mišetića 2, 20000 Dubrovnik, Croatia;
| | - Kristina Žužul
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia;
| | - Branka Marinović
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, School of Medicine University of Zagreb, Šalata 4, 10 000 Zagreb, Croatia; (A.B.); (B.M.)
| | - Zrinka Bukvić Mokos
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, School of Medicine University of Zagreb, Šalata 4, 10 000 Zagreb, Croatia; (A.B.); (B.M.)
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Reynolds KA, Juhasz MLW, Mesinkovska NA. The role of oral vitamins and supplements in the management of atopic dermatitis: a systematic review. Int J Dermatol 2019; 58:1371-1376. [DOI: 10.1111/ijd.14404] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/28/2018] [Accepted: 01/17/2019] [Indexed: 12/20/2022]
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Nosrati A, Afifi L, Danesh MJ, Lee K, Yan D, Beroukhim K, Ahn R, Liao W. Dietary modifications in atopic dermatitis: patient-reported outcomes. J DERMATOL TREAT 2017; 28:523-538. [PMID: 28043181 DOI: 10.1080/09546634.2016.1278071] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patients with atopic dermatitis (AD) commonly turn to dietary modifications to manage their skin condition. OBJECTIVES To investigate patient-reported outcomes and perceptions regarding the role of diet in AD. METHODS One hundred and sixty nine AD patients were surveyed in this cross-sectional study. The 61-question survey asked about dietary modifications, perceptions and outcomes. RESULTS Eighty seven percent of participants reported a trial of dietary exclusion. The most common were junk foods (68%), dairy (49.7%) and gluten (49%). The best improvement in skin was reported when removing white flour products (37 of 69, 53.6%), gluten (37 of 72, 51.4%) and nightshades (18 of 35, 51.4%). 79.9% of participants reported adding items to their diet. The most common were vegetables (62.2%), fish oil (59.3%) and fruits (57.8%). The best improvement in skin was noted when adding vegetables (40 of 84, 47.6%), organic foods (17 of 43, 39.5%) and fish oil (28 of 80, 35%). Although 93.5% of patients believed it was important that physicians discuss with them the role of diet in managing skin disease, only 32.5% had consulted their dermatologist. CONCLUSIONS Since dietary modifications are extremely common, the role of diet in AD and potential nutritional benefits and risks need to be properly discussed with patients.
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Affiliation(s)
- Adi Nosrati
- a Department of Dermatology , University of California San Francisco , San Francisco , CA , USA
| | - Ladan Afifi
- a Department of Dermatology , University of California San Francisco , San Francisco , CA , USA
| | - Melissa J Danesh
- a Department of Dermatology , University of California San Francisco , San Francisco , CA , USA
| | - Kristina Lee
- a Department of Dermatology , University of California San Francisco , San Francisco , CA , USA
| | - Di Yan
- a Department of Dermatology , University of California San Francisco , San Francisco , CA , USA
| | - Kourosh Beroukhim
- a Department of Dermatology , University of California San Francisco , San Francisco , CA , USA
| | - Richard Ahn
- a Department of Dermatology , University of California San Francisco , San Francisco , CA , USA
| | - Wilson Liao
- a Department of Dermatology , University of California San Francisco , San Francisco , CA , USA
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Reese I, Werfel T. Do long-chain omega-3 fatty acids protect from atopic dermatitis? J Dtsch Dermatol Ges 2016; 13:879-85. [PMID: 26882378 DOI: 10.1111/ddg.12780] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Long-chain polyunsaturated fatty acids are essential for human nutrition. The number of double bonds determines whether a given fatty acid is termed two, three, or x times unsaturated. Depending on the distance of the first double bond from the fatty acid's methyl group, one distinguishes omega-3 fatty acids from omega-6 fatty acids. While the use of gamma linolenic acid, a long-chain fatty acid of the omega-6 family, has proven unsuccessful in the prevention or treatment of atopic dermatitis, supplementation of long-chain omega-3 fatty acids may represent a promising approach in the prevention of allergic disorders, especially atopic dermatitis. Whether the concept of long-chain omega-3 fatty acid administration will also become established in a therapeutic setting, depends on whether the beneficial effects observed so far can be substantiated in randomized controlled intervention studies.
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Affiliation(s)
- Imke Reese
- Nutrition Counseling and Therapy with Special Focus on Allergology, Munich, Germany
| | - Thomas Werfel
- Division of Immunodermatology and Experimental Allergology, Department of Dermatology, Allergology, and Venereology, Medical University Hanover, Hanover, Germany
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10
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Improvement in the Safety of Use of Hand Dishwashing Liquids Through the Addition of Hydrophobic Plant Extracts. J SURFACTANTS DETERG 2016; 19:1315-1326. [PMID: 27795665 PMCID: PMC5055909 DOI: 10.1007/s11743-016-1868-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/18/2016] [Indexed: 11/18/2022]
Abstract
We investigated the effect of hydrophobic extract concentration on the safety of using hand dishwashing liquids (HDL). A series of formulations was prepared, differing in the concentration of the hydrophobic chamomile extract obtained in supercritical CO2 conditions (from 0 to 0.7 %). We found that an increase in the concentration of the extract led to a decrease in the zein number, and reduced changes in the pH level of bovine serum albumin solution (i.e., two parameters determining the irritant activity of the formulations). It was also found that the additives reduced transepidermal water loss and improved the skin hydration level. Based on the findings of the study, a mechanism has been proposed, according to which hydrophobic plant extracts form aggregates in the volume phase of the washing bath. The surface of the aggregates is the adsorption area for surfactant monomers responsible for the irritant effect. Increasing the addition of the extract was shown to reduce the negative impact of the formulations on the skin of the hands, thus contributing to a greater safety of use of HDL.
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Abstract
Nutrition has long been associated with skin health, including all of its possible aspects from beauty to its integrity and even the aging process. Multiple pathways within skin biology are associated with the onset and clinical course of various common skin diseases, such as acne, atopic dermatitis, aging, or even photoprotection. These conditions have been shown to be critically affected by nutritional patterns and dietary interventions where well-documented studies have demonstrated beneficial effects of essential nutrients on impaired skin structural and functional integrity and have restored skin appearance and health. Although the subject could be vast, the intention of this review is to provide the most relevant and the most well-documented information on the role of nutrition in common skin conditions and its impact on skin biology.
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Affiliation(s)
- Apostolos Pappas
- Johnson & Johnson Consumer, Inc., 199 Grandview Road, Skillman, NJ, 08558, USA.
| | - Aikaterini Liakou
- Second Department of Dermatology and Venereology, 'Attikon' Hospital, Athens, Greece
| | - Christos C Zouboulis
- Department of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany
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Sergeant S, Rahbar E, Chilton FH. Gamma-linolenic acid, Dihommo-gamma linolenic, Eicosanoids and Inflammatory Processes. Eur J Pharmacol 2016; 785:77-86. [PMID: 27083549 PMCID: PMC4975646 DOI: 10.1016/j.ejphar.2016.04.020] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 03/25/2016] [Accepted: 04/11/2016] [Indexed: 12/13/2022]
Abstract
Gamma-linolenic acid (GLA, 18:3n-6) is an omega-6 (n-6), 18 carbon (18C-) polyunsaturated fatty acid (PUFA) found in human milk and several botanical seed oils and is typically consumed as part of a dietary supplement. While there have been numerous in vitro and in vivo animal models which illustrate that GLA-supplemented diets attenuate inflammatory responses, clinical studies utilizing GLA or GLA in combination with omega-3 (n-3) PUFAs have been much less conclusive. A central premise of this review is that there are critical metabolic and genetic factors that affect the conversion of GLA to dihommo-gamma linolenic acid (DGLA, 20:3n-6) and arachidonic acid (AA, 20:4n-6), which consequently affects the balance of DGLA- and AA- derived metabolites. As a result, these factors impact the clinical effectiveness of GLA or GLA/(n-3) PUFA supplementations in treating inflammatory conditions. Specifically, these factors include: 1) the capacity for different human cells and tissues to convert GLA to DGLA and AA and to metabolize DGLA and AA to bioactive metabolites; 2) the opposing effects of DGLA and AA metabolites on inflammatory processes and diseases; and 3) the impact of genetic variations within the fatty acid desaturase (FADS) gene cluster, in particular, on AA/DGLA ratios and bioactive metabolites. We postulate that these factors influence the heterogeneity of results observed in GLA supplement-based clinical trials and suggest that "one-size fits all" approaches utilizing PUFA-based supplements may no longer be appropriate for the prevention and treatment of complex human diseases.
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Affiliation(s)
- Susan Sergeant
- Department of Biochemistry; Wake Forest School of Medicine, One Medical Center Blvd, Winston-Salem, NC 27157, USA.
| | - Elaheh Rahbar
- Department of Biomedical Engineering; Wake Forest School of Medicine, One Medical Center Blvd, Winston-Salem, NC 27157, USA.
| | - Floyd H Chilton
- Department of Physiology/Pharmacology, Wake Forest School of Medicine, One Medical Center Blvd, Winston-Salem, NC 27157, USA.
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Nankervis H, Thomas KS, Delamere FM, Barbarot S, Rogers NK, Williams HC. Scoping systematic review of treatments for eczema. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04070] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BackgroundEczema is a very common chronic inflammatory skin condition.ObjectivesTo update the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) systematic review of treatments for atopic eczema, published in 2000, and to inform health-care professionals, commissioners and patients about key treatment developments and research gaps.Data sourcesElectronic databases including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Skin Group Specialised Register, Latin American and Caribbean Health Sciences Literature (LILACS), Allied and Complementary Medicine Database (AMED) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from the end of 2000 to 31 August 2013. Retrieved articles were used to identify further randomised controlled trials (RCTs).Review methodsStudies were filtered according to inclusion criteria and agreed by consensus in cases of uncertainty. Abstracts were excluded and non-English-language papers were screened by international colleagues and data were extracted. Only RCTs of treatments for eczema were included, as other forms of evidence are associated with higher risks of bias. Inclusion criteria for studies included availability of data relevant to the therapeutic management of eczema; mention of randomisation; comparison of two or more treatments; and prospective data collection. Participants of all ages were included. Eczema diagnosis was determined by a clinician or according to published diagnostic criteria. The risk of bias was assessed using the Cochrane Collaboration risk-of-bias tool. We used a standardised approach to summarising the data and the assessment of risk of bias and we made a clear distinction between what the studies found and our own interpretation of study findings.ResultsOf 7198 references screened, 287 new trials were identified spanning 92 treatments. Trial reporting was generally poor (randomisation method: 2% high, 36% low, 62% unclear risk of bias; allocation concealment: 3% high, 15% low, 82% unclear risk of bias; blinding of the intervention: 15% high, 28% low, 57% unclear risk of bias). Only 22 (8%) trials were considered to be at low risk of bias for all three criteria. There was reasonable evidence of benefit for the topical medications tacrolimus, pimecrolimus and various corticosteroids (with tacrolimus superior to pimecrolimus and corticosteroids) for both treatment and flare prevention; oral ciclosporin; oral azathioprine; narrow band ultraviolet B (UVB) light; Atopiclair™ and education. There was reasonable evidence to suggest no clinically useful benefit for twice-daily compared with once-daily topical corticosteroids; corticosteroids containing antibiotics for non-infected eczema; probiotics; evening primrose and borage oil; ion-exchange water softeners; protease inhibitor SRD441 (Serentis Ltd); furfuryl palmitate in emollient; cipamfylline cream; andMycobacterium vaccaevaccine. Additional research evidence is needed for emollients, bath additives, antibacterials, specialist clothing and complementary and alternative therapies. There was no RCT evidence for topical corticosteroid dilution, impregnated bandages, soap avoidance, bathing frequency or allergy testing.LimitationsThe large scope of the review coupled with the heterogeneity of outcomes precluded formal meta-analyses. Our conclusions are still limited by a profusion of small, poorly reported studies.ConclusionsAlthough the evidence base of RCTs has increased considerably since the last NIHR HTA systematic review, the field is still severely hampered by poor design and reporting problems including failure to register trials and declare primary outcomes, small sample size, short follow-up duration and poor reporting of risk of bias. Key areas for further research identified by the review include the optimum use of emollients, bathing frequency, wash products, allergy testing and antiseptic treatments. Perhaps the greatest benefit identified is the use of twice weekly anti-inflammatory treatment to maintain disease remission. More studies need to be conducted in a primary care setting where most people with eczema are seen in the UK. Future studies need to use the same core set of outcomes that capture patient symptoms, clinical signs, quality of life and the chronic nature of the disease.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Helen Nankervis
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Finola M Delamere
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Sébastien Barbarot
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Natasha K Rogers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Hywel C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
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Reese I, Werfel T. Schützen langkettige Omega-3-Fettsäuren vor atopischer Dermatitis? J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.20_12780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Imke Reese
- Ernährungsberatung und -therapie Schwerpunkt Allergologie; München
| | - Thomas Werfel
- Abteilung Immundermatologie und experimentelle Allergologie, Klinik für Dermatologie; Allergologie und Venerologie, Medizinische Hochschule Hannover
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15
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Harlina PW, Shahzad R, Ma M, Geng F, Wang Q, He L, Ding S, Qiu N. Effect of Garlic Oil on Lipid Oxidation, Fatty Acid Profiles and Microstructure of Salted Duck Eggs. J FOOD PROCESS PRES 2015. [DOI: 10.1111/jfpp.12541] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Putri Widyanti Harlina
- National Research and Development Center for Egg Processing; College of Food Science and Technology; Wuhan Hubei 430070 China
| | - Raheel Shahzad
- College of Life Science and Technology; Huazhong Agricultural University; Wuhan Hubei China
| | - Meihu Ma
- National Research and Development Center for Egg Processing; College of Food Science and Technology; Wuhan Hubei 430070 China
| | - Fang Geng
- National Research and Development Center for Egg Processing; College of Food Science and Technology; Wuhan Hubei 430070 China
| | - Qingling Wang
- National Research and Development Center for Egg Processing; College of Food Science and Technology; Wuhan Hubei 430070 China
| | - Liyuan He
- National Research and Development Center for Egg Processing; College of Food Science and Technology; Wuhan Hubei 430070 China
| | - Shuqi Ding
- National Research and Development Center for Egg Processing; College of Food Science and Technology; Wuhan Hubei 430070 China
| | - Ning Qiu
- National Research and Development Center for Egg Processing; College of Food Science and Technology; Wuhan Hubei 430070 China
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Amagai Y, Oida K, Matsuda A, Jung K, Kakutani S, Tanaka T, Matsuda K, Jang H, Ahn G, Xia Y, Kawashima H, Shibata H, Matsuda H, Tanaka A. Dihomo-γ-linolenic acid prevents the development of atopic dermatitis through prostaglandin D1 production in NC/Tnd mice. J Dermatol Sci 2015; 79:30-7. [PMID: 25907057 DOI: 10.1016/j.jdermsci.2015.03.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 03/18/2015] [Accepted: 03/19/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic and relapsing skin disorder with pruritic skin symptoms. We previously reported that dihomo-γ-linolenic acid (DGLA) prevented the development of AD in NC/Tnd mice, though the mechanism remained unclear. OBJECTIVE We attempted to investigate the mechanism of preventive effect of DGLA on AD development in NC/Tnd mice. METHODS The clinical outcomes of NC/Tnd mice that were given diets containing DGLA, arachidonic acid, or eicosapentaenoic acid were compared. Lipid mediator contents in the skin in each group were also quantified. In addition, release of lipid mediators from RBL-2H3 mast cells treated with either DGLA or prostaglandin D1 (PGD1) was measured. Furthermore, effect of PGD1 on gene expression of thymic stromal lymphopoietin (TSLP) in PAM212 keratinocyte cells was determined. RESULTS Only DGLA containing diet suppressed the development of dermatitis in vivo. By quantifying the 20-carbon fatty acid-derived eicosanoids in the skin, the application of DGLA was found to upregulate PGD1, which correlated with a better outcome in NC/Tnd mice. Moreover, we confirmed that mast cells produced PGD1 after DGLA exposure, thereby exerting a suppressive effect on immunoglobulin E-mediated degranulation. PGD1 also suppressed gene expression of TSLP in keratinocytes. CONCLUSION These results suggest that oral administration of DGLA causes preventive effects on AD development in NC/Tnd mice by regulating the PGD1 supply.
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Affiliation(s)
- Yosuke Amagai
- Cooperative Major in Advanced Health Science, Graduate School of Bio-Applications and System Engineering, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Kumiko Oida
- Cooperative Major in Advanced Health Science, Graduate School of Bio-Applications and System Engineering, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Akira Matsuda
- Laboratory of Veterinary Molecular Pathology and Therapeutics, Division of Animal Life Science, Institute of Agriculture, Tokyo, Japan
| | - Kyungsook Jung
- Laboratory of Comparative Animal Medicine, Division of Animal Life Science, Institute of Agriculture, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Saki Kakutani
- Institute for Health Care Science, Suntory Wellness Ltd., Osaka, Japan
| | - Takao Tanaka
- Institute for Health Care Science, Suntory Wellness Ltd., Osaka, Japan
| | - Kenshiro Matsuda
- Cooperative Major in Advanced Health Science, Graduate School of Bio-Applications and System Engineering, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Hyosun Jang
- Cooperative Major in Advanced Health Science, Graduate School of Bio-Applications and System Engineering, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Ginae Ahn
- Cooperative Major in Advanced Health Science, Graduate School of Bio-Applications and System Engineering, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Yan Xia
- Cooperative Major in Advanced Health Science, Graduate School of Bio-Applications and System Engineering, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Hiroshi Kawashima
- Institute for Health Care Science, Suntory Wellness Ltd., Osaka, Japan
| | - Hiroshi Shibata
- Institute for Health Care Science, Suntory Wellness Ltd., Osaka, Japan
| | - Hiroshi Matsuda
- Cooperative Major in Advanced Health Science, Graduate School of Bio-Applications and System Engineering, Tokyo University of Agriculture and Technology, Tokyo, Japan; Laboratory of Veterinary Molecular Pathology and Therapeutics, Division of Animal Life Science, Institute of Agriculture, Tokyo, Japan.
| | - Akane Tanaka
- Cooperative Major in Advanced Health Science, Graduate School of Bio-Applications and System Engineering, Tokyo University of Agriculture and Technology, Tokyo, Japan; Laboratory of Comparative Animal Medicine, Division of Animal Life Science, Institute of Agriculture, Tokyo University of Agriculture and Technology, Tokyo, Japan.
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Guidelines of care for the management of atopic dermatitis: Section 4. Prevention of disease flares and use of adjunctive therapies and approaches. J Am Acad Dermatol 2014; 71:1218-33. [PMID: 25264237 DOI: 10.1016/j.jaad.2014.08.038] [Citation(s) in RCA: 202] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 08/06/2014] [Accepted: 08/22/2014] [Indexed: 01/27/2023]
Abstract
Atopic dermatitis is a common, chronic inflammatory dermatosis that can affect all age groups. This evidence-based guideline addresses important clinical questions that arise in its management. In this final section, treatments for flare prevention and adjunctive and complementary therapies and approaches are reviewed. Suggestions on use are given based on available evidence.
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Two-Dimensional High Performance Liquid Chromatography-Mass Spectrometry for Phosphatidylcholine Analysis in Egg Yolk. FOOD ANAL METHOD 2014. [DOI: 10.1007/s12161-014-9942-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Place des thérapeutiques complémentaires et alternatives dans les dermatites atopiques. ACTUALITES PHARMACEUTIQUES 2014. [DOI: 10.1016/j.actpha.2013.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Landis ET, Davis SA, Feldman SR, Taylor S. Complementary and alternative medicine use in dermatology in the United States. J Altern Complement Med 2014; 20:392-8. [PMID: 24517329 DOI: 10.1089/acm.2013.0327] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Complementary and alternative medicine (CAM) has an increasing presence in dermatology. Complementary therapies have been studied in many skin diseases, including atopic dermatitis and psoriasis. OBJECTIVES This study sought to assess oral CAM use in dermatology relative to medicine as a whole in the United States, using the National Ambulatory Medical Care Survey. DESIGN Variables studied include patient demographic characteristics, diagnoses, and CAM documented at the visits. A brief literature review of the top 5 CAM treatments unique to dermatology visits was performed. RESULTS Most CAM users in both dermatology and medicine as a whole were female and white and were insured with private insurance or Medicare. Fish oil, glucosamine, glucosamine chondroitin, and omega-3 were the most common complementary supplements used in both samples. CONCLUSIONS CAM use in dermatology appears to be part of a larger trend in medicine. Knowledge of common complementary therapies can help dermatologists navigate this expanding field.
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Affiliation(s)
- Erin T Landis
- 1 Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine , Winston-Salem, NC
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21
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Gamma-linolenic acid levels correlate with clinical efficacy of evening primrose oil in patients with atopic dermatitis. Adv Ther 2014; 31:180-8. [PMID: 24435467 PMCID: PMC3930832 DOI: 10.1007/s12325-014-0093-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Indexed: 12/02/2022]
Abstract
Introduction Atopic dermatitis (AD) has been related to a deficiency of delta-6-desaturase, an enzyme responsible for the conversion of linoleic acid to gamma-linolenic acid (GLA). Evening primrose oil (EPO) contains high amounts of GLA. Therefore, this study investigated whether EPO supplementation results in an increase in plasma GLA and its metabolite dihomo-gamma-linolenic acid (DGLA) correlating with clinical improvement of AD, assessed by the SCORing Atopic Dermatitis (SCORAD) index. Methods The open study included 21 patients with AD. EPO (4–6 g) was administered daily for 12 weeks. Before treatment, and 4 and 12 weeks after initiation of EPO supplementation, objective SCORAD was assessed and plasma concentrations of GLA and DGLA were determined by gas chromatography. Results A significant increase in plasma GLA and DGLA levels and a decrease in the objective SCORAD were observed 4 and 12 weeks after initiation of EPO treatment. In the per-protocol population (n = 14), a significant inverse correlation between the changes in plasma GLA levels and SCORAD was found (P = 0.008). Conclusion The clinical disease activity under EPO treatment correlates with the individual increase in plasma GLA levels. Thus, the results of this pilot study indicate that an increase in plasma GLA might be used as predictive parameter for responsiveness of AD to EPO therapy. Electronic supplementary material The online version of this article (doi:10.1007/s12325-014-0093-0) contains supplementary material, which is available to authorized users.
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DiNicola C, Kekevian A, Chang C. Integrative medicine as adjunct therapy in the treatment of atopic dermatitis--the role of traditional Chinese medicine, dietary supplements, and other modalities. Clin Rev Allergy Immunol 2013; 44:242-53. [PMID: 22661238 DOI: 10.1007/s12016-012-8315-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Atopic dermatitis (AD) is becoming increasingly prevalent in the pediatric population, with rates reportedly as high as 18-25 %. Westernized medicine has traditionally used a combination of emollients, antihistamines, corticosteroids, and immunomodulating agents to combat this often frustrating disease. Of late, integrative medicine has become the subject of more research as concerns grow regarding prolonged use of corticosteroids and their side effects in pediatric patients. Probiotics have been extensively studied to define their role in the treatment and prevention of AD in children. Unfortunately, results are varying showing significant improvement in some patients but not all. With regard to prevention, studies show that the use of probiotics during pregnancy does decrease the incidence of AD in children. Prebiotics and synbiotics are also a conceivable option for prevention of AD. A number of studies on Chinese herbal medicine have been performed, with a collective result of symptom improvement and decreased levels of inflammatory cytokines. However, there were reports of asymptomatic transaminitis in a few patients that warrant further testing. While the herbs tested in more recent randomized clinical trials were free from corticosteroids, a previous study showed high levels of dexamethasone in unlabeled herbal eczema creams. Vitamins and minerals have also been suggested as an alternative treatment of AD. Studies however have not yet demonstrated improvement of AD with vitamin or mineral supplementation. Topical vitamin B(12) is the exception to this; however, no topical vitamin B(12) preparation is available for use. Finally, relaxation techniques are also being investigated as adjunctive methods of treatment, but well-designed scientific studies are lacking.
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Affiliation(s)
- C DiNicola
- Division of Allergy, Asthma and Immunology, Thomas Jefferson University, Wilmington, DE, USA
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Chung BY, Kim JH, Cho SI, Ahn IS, Kim HO, Park CW, Lee CH. Dose-dependent effects of evening primrose oil in children and adolescents with atopic dermatitis. Ann Dermatol 2013; 25:285-91. [PMID: 24003269 PMCID: PMC3756191 DOI: 10.5021/ad.2013.25.3.285] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 06/07/2012] [Accepted: 06/09/2012] [Indexed: 11/28/2022] Open
Abstract
Background Previous clinical trials with evening primrose oil in atopic dermatitis (AD) treatment have shown different results. In addition, the optimal dose and duration of treatment with evening primrose oil have not yet been determined. Objective The aim of this study is to investigate the dose-response treatment effects of evening primrose oil on clinical symptoms of AD and serum concentrations of polyunsaturated fatty acids. Methods Forty AD patients were enrolled for the study and randomly divided into 2 groups: those who received evening primrose oil 160 mg daily for 8 weeks and those who received 320 mg of evening primrose oil twice daily for 8 weeks. We evaluated the Eczema Area Severity Index (EASI) scores of all AD patients at weeks 0, 2, 4 and 8. In addition, we measured the levels of serum fatty acids, including C16 : 0 (palmitic), C18 : 2n (linoleic), C18 : 3n (linolenic) and C20 : 4 (arachidonic acid) using gas chromatography. Results The serum fatty acid levels C18 : 3n and C20 : 4 were higher in the 320 mg group than in the 160 mg group, with statistical significance. After evening primrose oil treatment, EASI scores were reduced in the 2 groups. The improvement in EASI scores was greater in the 320 mg group than in the 160 mg group. There were no side effects seen in either group during the study in the 2 groups. Conclusion The results of this study suggest that the 320 mg and 160 mg groups may be equally effective in treating AD patients and show dose-dependent effects on serum fatty acid levels and EASI scores.
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Affiliation(s)
- Bo Young Chung
- Department of Dermatology, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
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Medicinal plants used in treatment of inflammatory skin diseases. Postepy Dermatol Alergol 2013; 30:170-7. [PMID: 24278070 PMCID: PMC3834722 DOI: 10.5114/pdia.2013.35620] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 12/12/2012] [Accepted: 02/10/2013] [Indexed: 01/19/2023] Open
Abstract
Skin is an organ providing contact with the environment and protecting the human body from unfavourable external factors. Skin inflammation, reflected adversely in its functioning and appearance, also unfavourably affects the psyche, the condition of which is important during treatment of chronic skin diseases. The use of plants in treatment of inflammatory skin diseases results from their influence on different stages of inflammation. The paper presents results of the study regarding the anti-inflammatory activity of the plant raw material related to its influence on skin. The mechanism of action, therapeutic indications and side effects of medicinal plants used for treatment of inflammatory diseases of the skin are described.
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Supplementation with long chain polyunsaturated fatty acids in treatment of atopic dermatitis in children. Postepy Dermatol Alergol 2013; 30:103-7. [PMID: 24278056 PMCID: PMC3834680 DOI: 10.5114/pdia.2013.34160] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 09/03/2012] [Accepted: 04/24/2013] [Indexed: 11/17/2022] Open
Abstract
Some recent studies indicate that unsaturated fatty acids, components of cellular membranes and precursors of immunomodulators, play a significant role in the pathogenesis of some symptoms of atopic dermatitis. Since they cannot be synthesized by the human body, they must be provided with nutrition as the so called exogenous fatty acids: linoleic (a precursor of arachidonic acid) and α-linolenic acid (a precursor of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)). Their deficiency facilitates the development of some disorders, e.g. of the cardiovascular system or of the nervous system, or becomes the cause of intensification of ailments in their course e.g. pruritus and dryness in atopic dermatitis. Though clinical examinations to date confirm the efficacy of fatty acid supplementation in treatment of atopic dermatitis, their results are not explicit.
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Ellis CN, Mancini AJ, Paller AS, Simpson EL, Eichenfield LF. Understanding and managing atopic dermatitis in adult patients. ACTA ACUST UNITED AC 2013; 31:S18-22. [PMID: 23021781 DOI: 10.1016/j.sder.2012.07.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Atopic dermatitis (AD) in adults is an important dermatologic disease. Even in patients in whom the clinical presentation is mild, the burden of disease can be considerable. Relatively little has been published on adult AD compared to the body of literature devoted to AD in children, although adults with severe AD are greatly affected by the disease. Even when AD is a mild clinical disease in adults, the psychosocial and economic burden of the disease can be profound. Patients are likely to find it useful if these nondermatologic comorbidities of AD are addressed by health care providers in clinical encounters. The treatment options for AD in adults are the same as those for children with AD, with some modifications.
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Affiliation(s)
- Charles N Ellis
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI 48109-5314, USA.
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Fujii M, Nakashima H, Tomozawa J, Shimazaki Y, Ohyanagi C, Kawaguchi N, Ohya S, Kohno S, Nabe T. Deficiency of n-6 polyunsaturated fatty acids is mainly responsible for atopic dermatitis-like pruritic skin inflammation in special diet-fed hairless mice. Exp Dermatol 2013; 22:272-7. [DOI: 10.1111/exd.12120] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2013] [Indexed: 12/24/2022]
Affiliation(s)
- Masanori Fujii
- Department of Pharmacology; Division of Pathological Sciences; Kyoto Pharmaceutical University; Kyoto; Japan
| | - Hiroyuki Nakashima
- Department of Pharmacology; Division of Pathological Sciences; Kyoto Pharmaceutical University; Kyoto; Japan
| | - Junko Tomozawa
- Department of Pharmacology; Division of Pathological Sciences; Kyoto Pharmaceutical University; Kyoto; Japan
| | - Yuki Shimazaki
- Department of Pharmacology; Division of Pathological Sciences; Kyoto Pharmaceutical University; Kyoto; Japan
| | - Chie Ohyanagi
- Department of Pharmacology; Division of Pathological Sciences; Kyoto Pharmaceutical University; Kyoto; Japan
| | - Naomi Kawaguchi
- Department of Pharmacology; Division of Pathological Sciences; Kyoto Pharmaceutical University; Kyoto; Japan
| | - Susumu Ohya
- Department of Pharmacology; Division of Pathological Sciences; Kyoto Pharmaceutical University; Kyoto; Japan
| | - Shigekatsu Kohno
- Department of Pharmacology; Division of Pathological Sciences; Kyoto Pharmaceutical University; Kyoto; Japan
| | - Takeshi Nabe
- Department of Pharmacology; Division of Pathological Sciences; Kyoto Pharmaceutical University; Kyoto; Japan
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Fatty acid composition of egg yolk phospholipid fractions following feed supplementation of Lohmann Brown hens with humic-fat preparations. Food Chem 2011. [DOI: 10.1016/j.foodchem.2010.11.112] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Foster RH, Hardy G, Alany RG. Borage oil in the treatment of atopic dermatitis. Nutrition 2010; 26:708-18. [DOI: 10.1016/j.nut.2009.10.014] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 09/16/2009] [Accepted: 10/28/2009] [Indexed: 11/28/2022]
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Linnamaa P, Savolainen J, Koulu L, Tuomasjukka S, Kallio H, Yang B, Vahlberg T, Tahvonen R. Blackcurrant seed oil for prevention of atopic dermatitis in newborns: a randomized, double-blind, placebo-controlled trial. Clin Exp Allergy 2010; 40:1247-55. [DOI: 10.1111/j.1365-2222.2010.03540.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Boneberger S, Rupec RA, Ruzicka T. Complementary therapy for atopic dermatitis and other allergic skin diseases: facts and controversies. Clin Dermatol 2010; 28:57-61. [DOI: 10.1016/j.clindermatol.2009.03.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Callaway J, Schwab U, Harvima I, Halonen P, Mykkänen O, Hyvönen P, Järvinen T. Efficacy of dietary hempseed oil in patients with atopic dermatitis. J DERMATOL TREAT 2009; 16:87-94. [PMID: 16019622 DOI: 10.1080/09546630510035832] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Hempseed oil is a rich and balanced source of omega-6 and omega-3 polyunsaturated fatty acids (PUFAs). Anecdotal evidence indicated that dietary hempseed oil might be useful in treating symptoms of atopic dermatitis. PATIENTS AND METHODS Dietary hempseed oil and olive oil were compared in a 20-week randomized, single-blind crossover study with atopic patients. Fatty acid profiles were measured in plasma triglyceride, cholesteryl and phospholipid fractions. A patient questionnaire provided additional information on skin dryness, itchiness and usage of dermal medications. Skin transepidermal water loss (TEWL) was also measured. RESULTS Levels of both essential fatty acids (EFAs), linoleic acid (18:2n6) and alpha-linolenic acid (18:3n3), and gamma-linolenic acid (GLA; 18:3n6) increased in all lipid fractions after hempseed oil, with no significant increases of arachidonic acid (20:4n6) in any lipid fractions after either oil. Intra-group TEWL values decreased (p=0.074), qualities of both skin dryness and itchiness improved (p=0.027) and dermal medication usage decreased (p=0.024) after hempseed oil intervention. CONCLUSIONS Dietary hempseed oil caused significant changes in plasma fatty acid profiles and improved clinical symptoms of atopic dermatitis. It is suggested that these improvements resulted from the balanced and abundant supply of PUFAs in this hempseed oil.
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Affiliation(s)
- James Callaway
- Department of Pharmaceutical Chemistry, University of Kuopio, Finland.
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Borchard KLA, Orchard D. Systemic therapy of paediatric atopic dermatitis: An update. Australas J Dermatol 2008; 49:123-34; quiz 135-6. [DOI: 10.1111/j.1440-0960.2008.00451_1.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Koch C, Dölle S, Metzger M, Rasche C, Jungclas H, Rühl R, Renz H, Worm M. Docosahexaenoic acid (DHA) supplementation in atopic eczema: a randomized, double-blind, controlled trial. Br J Dermatol 2008; 158:786-92. [DOI: 10.1111/j.1365-2133.2007.08430.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Immunological and metabolic effects of cis-9, trans-11-conjugated linoleic acid in subjects with birch pollen allergy. Br J Nutr 2008; 100:112-9. [PMID: 18167173 DOI: 10.1017/s0007114507886326] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Animal studies suggest that conjugated linoleic acid (CLA) may modulate the immune response, while studies in healthy human subjects have shown little effect and results are controversial. However, the effects of CLA may be more prominent in situations of immune imbalance, such as allergy. We studied the effects of the natural CLA isomer, cis-9, trans-11-CLA, on allergy symptoms and immunological parameters in subjects with birch pollen allergy. In a randomised, placebo-controlled study, forty subjects (20-46 years) with diagnosed birch pollen allergy received 2 g CLA/d in capsules, which contained 65.3 % cis-9, trans-11-CLA and 8.5 % trans-10, cis-12-CLA (n 20), or placebo (high-oleic acid sunflower-seed oil) (n 20) for 12 weeks. The supplementation began 8 weeks before the birch pollen season and continued throughout the season. Allergy symptoms and use of medication were recorded daily. Lymphocyte subsets, cytokine production, immunoglobulins, C-reactive protein, lipid and glucose metabolism and lipid peroxidation were assessed before and after supplementation. The CLA group reported a better overall feeling of wellbeing (P < 0.05) and less sneezing (P < 0.05) during the pollen season. CLA supplementation decreased the in vitro production of TNF-alpha (P < 0.01), interferon-gamma (P < 0.05) and IL-5 (P < 0.05). Total plasma IgE and birch-specific IgE concentrations did not differ between groups, whereas plasma IgA (P < 0.05), granulocyte macrophage colony-stimulating factor (P < 0.05) and eosinophil-derived neurotoxin (P < 0.05) concentrations were lower after CLA supplementation. Urinary excretion of 8-iso-PGF2alpha, a major F2-isoprostane (P < 0.01), and 15-keto-dihydro-PGF2alpha, a primary PGF2alpha metabolite (P < 0.05), increased in the CLA group. The results suggest that cis-9, trans-11-CLA has modest anti-inflammatory effects in allergic subjects.
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Bukutu C, Deol J, Shamseer L, Vohra S. Complementary, holistic, and integrative medicine: atopic dermatitis. Pediatr Rev 2007; 28:e87-94. [PMID: 18055641 DOI: 10.1542/pir.28-12-e87] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Cecilia Bukutu
- Complementary and Alternative Research and Education (CARE) Program, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Abstract
Many pediatric patients and their families use dietary supplements and homeopathy. They do not always disclose this information to their health care practitioners. It is important that health care practitioners are aware of the research available in these areas and discuss the use of these products openly with their patients. As part of that dialogue, clinicians need to consider what level of effectiveness is acceptable to support the use of these products by their patients. This risk-benefit appraisal should consider safety, effectiveness, the medical condition being treated, and the personal beliefs and preferences of patients and their families.
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Affiliation(s)
- Paula Gardiner
- Department of Family Medicine, Boston University Medical Center, 1 Boston Medical Center Place, Dowling 5 South, Boston, MA 02118, USA.
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Hwang I, Cha A, Lee H, Yoon H, Yoon T, Cho B, Lee S, Park Y. N-3 polyunsaturated fatty acids and atopy in Korean preschoolers. Lipids 2007; 42:345-9. [PMID: 17406929 DOI: 10.1007/s11745-007-3033-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2006] [Accepted: 02/05/2007] [Indexed: 12/12/2022]
Abstract
Atopy is a growing problem for Korean children. Since eicosapentaenoic acid is a precursor of less active inflammatory eicosanoids, n-3 polyunsaturated fatty acids (PUFA) may have a protective effect on atopy. This study was undertaken to determine whether n-3 PUFA in red blood cells (RBC) is lower in atopic than in non-atopic preschoolers. Three hundred and eight Korean children aged 4-6 years were enrolled. Total RBC fatty acid composition was measured by gas chromatography. The prevalence of atopic dermatitis, allergic rhinitis, or asthma was 29%. Total RBC n-3 PUFA were lower in preschoolers with atopy than controls (9.8 +/- 1.2 vs. 11.4 +/- 1.6%; P<0.05), while n-6 PUFA (33.0 +/- 1.4 vs. 32.2 +/- 1.0%; P<0.05) and n-6/n-3 PUFA ratio (3.4 +/- 0.6 vs. 2.8 +/- 0.5; P<0.05) were greater. The following factors were also associated with an increase in atopy: higher saturated fatty acids (39.6 +/- 1.4 vs. 40.6 +/- 1.9; P<0.05) and arachidonic acid (15.3 +/- 1.6 vs. 16.0 +/- 2.9; P<0.05), and lower total PUFA (43.8 +/- 0.7 vs. 42.8 +/- 1.4; P<0.05) and omega-3 index (EPA + DHA; 9.1 +/- 0.8 vs. 7.8 +/- 0.5; P<0.05) in RBC. Maternal history of atopy was a significant (P<0.05) risk factor, while lactation was not. The results suggest that a reduced content of n-3 PUFA in the RBC membrane could play a role in early children atopy.
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Affiliation(s)
- Inkyung Hwang
- Department of Preventive and Occupational Medicine, College of Medicine, Pusan National University, Pusan, South Korea
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Tricon S, Willers S, Smit HA, Burney PG, Devereux G, Frew AJ, Halken S, Host A, Nelson M, Shaheen S, Warner JO, Calder PC. Nutrition and allergic disease. ACTA ACUST UNITED AC 2006. [DOI: 10.1111/j.1365-2222.2006.00114.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Proksch E, Fölster-Holst R, Jensen JM. Skin barrier function, epidermal proliferation and differentiation in eczema. J Dermatol Sci 2006; 43:159-69. [PMID: 16887338 DOI: 10.1016/j.jdermsci.2006.06.003] [Citation(s) in RCA: 259] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2006] [Accepted: 06/15/2006] [Indexed: 11/17/2022]
Abstract
Skin permeability barrier function is impaired in eczema, particularly in contact and atopic dermatitis (AD). In contact dermatitis disruption of the barrier by irritants and allergens is the primary event, followed by sensitization, inflammation, increased epidermal proliferation and changes in differentiation. Genetically impaired skin barrier function is already present in non-lesional and more pronounced in lesional skin in AD. Increased epidermal proliferation and disturbed differentiation, including changes in lipid composition, cause impaired barrier function in AD. Defective permeability barrier function enables the enhanced penetration of environmental allergens into the skin and initiates immunological reactions and inflammation. Barrier dysfunction is therefore crucially involved in the pathogenesis of AD. The atopic syndrome represents a genetically impaired skin barrier function as well as impaired nasal, bronchial, and intestinal mucous membranes leading to AD, allergic rhinitis, bronchial asthma or aggravation of AD. Common treatment strategies for eczema include the application of lipid-based creams and ointments, which aim toward the restoration of the defective permeability barrier, thus helping to normalize proliferation and differentiation.
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Affiliation(s)
- Ehrhardt Proksch
- Department of Dermatology, University of Kiel, Schittenhelmstr. 7, 24105 Kiel, Germany.
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Lauritzen L, Halkjaer LB, Mikkelsen TB, Olsen SF, Michaelsen KF, Loland L, Bisgaard H. Fatty acid composition of human milk in atopic Danish mothers. Am J Clin Nutr 2006; 84:190-6. [PMID: 16825695 DOI: 10.1093/ajcn/84.1.190] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Atopic dermatitis has been related to a disturbed metabolism of polyunsaturated fatty acids (PUFAs). OBJECTIVE We tested whether the PUFA composition of breast milk differs significantly between mothers with atopic dermatitis, mothers with other types of atopy, and nonatopic mothers. We also investigated whether differences in diet can explain possible observed differences. DESIGN Mothers with current or previous asthma (n = 396) were divided into 3 groups according to history of atopic dermatitis and allergic rhinitis. Breast-milk samples were collected from 314 women approximately 3 wk after delivery. The habitual diet of the women was assessed with food-frequency questionnaires in the 25th week of gestation (n = 207). Breast-milk samples and simultaneous dietary data from 14 nonatopic mothers were used for comparison. RESULTS Compared with the milk of nonatopic mothers, that of atopic mothers had significantly higher concentrations of 22:5n-6 and lower concentrations of 20:5n-3; moreover, 20:4n-6/20:5n-3, 22:5n-6/22:6n-3, and long-chain n-3 PUFA/18:3n-3 were shifted toward n-6 PUFA and 18:3n-3 in nonatopic and atopic mothers, respectively. No differences in breast-milk PUFA composition were evident between the subject groups. The diets of the groups differed only slightly with respect to protein intake. However, the PUFA composition of the breast milk was associated with diet and time of milk sampling, and the above difference in milk PUFAs disappeared when those factors were taken into account. CONCLUSION Our data do not support the possibility that the fatty acid composition of breast milk is affected by atopic dermatitis or atopy in general, because most differences in breast-milk PUFA composition appear to be explained by the diet.
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Affiliation(s)
- Lotte Lauritzen
- Department of Human Nutrition, Center for Advanced Food Studies, The Royal Veterinary and Agricultural University, Frederiksberg, Denmark.
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Laitinen K, Hoppu U, Hämäläinen M, Linderborg K, Moilanen E, Isolauri E. Breast milk fatty acids may link innate and adaptive immune regulation: analysis of soluble CD14, prostaglandin E2, and fatty acids. Pediatr Res 2006; 59:723-7. [PMID: 16627889 DOI: 10.1203/01.pdr.0000203158.31452.9e] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In addition to its role in sensing intraluminal microbial antigens, soluble (s)CD14 may regulate immune responses by its lesser known function as a lipid carrier with possible influences in the production of fatty acid-derived eicosanoids. We investigated the interrelations of fatty acids, prostaglandin E2 (PGE2), and sCD14 and their role in infant atopic eczema during the first year of life. Serum and breast milk samples from mothers and serum samples from their infants were collected at infant's age 3 mo and analyzed for sCD14 and PGE2 concentrations and for fatty acid compositions. The main correlation of sCD14 was with arachidonic acid (20:4n-6) (AA). Dihomo-gamma-linolenic acid (20:3n-6) (DHGLA) and the ratio of n-6 to n-3 fatty acids correlated positively and docosahexaenoic acid (22:6n-3) (DHA) and sum of n-3 fatty acid negatively with PGE2 in mother's serum and linoleic acid (LA) negatively with PGE2 in breast milk. Soluble CD14 tended to be higher and LA, total polyunsaturated fatty acid (PUFA), and sum of n-6 fatty acids were lower in breast milk received by infants with atopic eczema compared with those without. These results suggest that fatty acids contribute to the regulation of innate and adaptive immune responses and link intraluminal exposures, mother's diet, and microbes.
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Affiliation(s)
- Kirsi Laitinen
- Department of Paediatrics, Turku University Central Hospital, 20521 Turku, Finland.
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Kitz R, Rose MA, Schönborn H, Zielen S, Böhles HJ. Impact of early dietary gamma-linolenic acid supplementation on atopic eczema in infancy. Pediatr Allergy Immunol 2006; 17:112-7. [PMID: 16618360 DOI: 10.1111/j.1399-3038.2005.00369.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Polyunsaturated fatty acids (PUFAs) are components of cell membranes and may play an immunomodulating role in the pathogenesis of atopic dermatitis (AD). The goal was to determine the impact of PUFAs on AD by dietary supplementation of infants. Based on the parents' decision on their babies' primary feeding, mothers and newborns were randomized to the supplementation with gamma-linolenic acid (GLA) or placebo for up to 6 months. Breastfed infants received GLA by supplementing their mothers. Formula diet was commercial whey hydrolysate unsupplemented with PUFAs. Of 131 eligible infants, 24 developed AD within the first year of life. Of these, nine belonged to the exclusively breastfed group (n = 58), 14 to the combined-fed group (n = 53), and one to the never breastfed group (n = 20). We could not find an influence of GLA on the development of AD. In subjects with AD, at 1 yr of age the serum-immunoglobulin E (IgE) was the lowest in the GLA-supplemented group A-subjects. In the GLA-supplemented group, GLA-levels in breast milk were similar in atopic and non-atopic infants. In the non-supplemented group the GLA-content of breast milk was 0.07% of total fatty acids in atopic infants vs. 0.17% in non-atopic infants (p < 0.01). Dietary GLA-supplementation could not prevent AD. Interestingly, the number of infants developing AD was the lowest in never breastfed children. In infants suffering from AD, GLA-supplementation seemed to reduce total IgE in the first year of life.
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Affiliation(s)
- Richard Kitz
- Department of Allergology and Pulmonology, Children's Hospital, Goethe University, Frankfurt, Germany
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Abstract
The dietary approach to allergic disease in infancy is evolving from passive allergen avoidance to active stimulation of the immature immune system, the aim of which is to support the establishment of tolerance. This may include probiotics providing maturational signals for the gut-associated lymphoid tissue and by balancing the generation of pro and anti-inflammatory cytokines in addition to their capacity to reduce the dietary antigen load by degrading and modifying macromolecules. Probiotics have also been shown to reverse the increased intestinal permeability characteristic of children with food allergy and to enhance specific IgA responses frequently defective in children with food allergy. The promotion of gut barrier functions by probiotics also includes the normalization of the gut microecology, alterations in which have been demonstrated in allergic individuals. Dietary lipids, especially long-chain polyunsaturated fatty acids, regulate immune function and may modify the adherence of microbes in the mucosa thereby contributing to host-microbe interactions. The properties of specific dietary compounds in optimal combinations and the joint effects of nutrients can be exploited in the development of specific prophylactic and therapeutic interventions. To meet these targets, rigorous scientific effort is required to elucidate how the food matrix and the dietary content impacts on the complex cascade of interrelated immunological mechanisms in food allergy.
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Affiliation(s)
- Kirsi Laitinen
- Department of Paediatrics, University of Turku and Turku University Central Hospital, Finland
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Guillet G, Guillet-Oyhenart MH. Coordination du traitement de la dermatite atopique de l'enfant. Arch Pediatr 2005; 12:909-11. [PMID: 15904847 DOI: 10.1016/j.arcped.2005.04.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- G Guillet
- Dermatologie et allergologie, CHU de la Milétrie, rue de la Milétrie, BP 577, 86021 Poitiers, France
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Dunstan JA, Prescott SL. Does fish oil supplementation in pregnancy reduce the risk of allergic disease in infants? Curr Opin Allergy Clin Immunol 2005; 5:215-21. [PMID: 15864078 DOI: 10.1097/01.all.0000168784.74582.32] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Parallel increases in many inflammatory diseases over the last 40 years suggest that common environmental changes are promoting inflammatory immune responses and/or inhibiting the processes that normally keep these in check. One key change during this period has been declining intakes of anti-inflammatory dietary factors, including omega-3 polyunsaturated fatty acids (n-3 PUFA). As allergic diseases often first manifest in early infancy, prevention strategies need to be targeted early, even in utero. This review will examine recent evidence for the use of fish oil during this early period as a primary prevention strategy for allergic disease. RECENT FINDINGS N-3 PUFA have well documented anti-inflammatory effects in vitro and have also been demonstrated to have health benefits in a range of chronic inflammatory diseases, including cardiovascular disease, rheumatoid arthritis and diabetes, supporting their role in modulating inflammation in vivo. Although the effects of fish oil supplementation in established allergic disease are less convincing, there is accumulating evidence that dietary n-3 PUFA may have greater effects before allergic responses are established. SUMMARY Supplementation of the maternal diet in pregnancy with n-3 PUFA may provide a non-invasive intervention with significant potential to prevent the development of allergic and possibly other immune-mediated diseases.
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Affiliation(s)
- Janet A Dunstan
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia.
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Current World Literature. Curr Opin Allergy Clin Immunol 2005. [DOI: 10.1097/01.all.0000168798.22110.c9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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50
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Current World Literature. Curr Opin Allergy Clin Immunol 2005. [DOI: 10.1097/01.all.0000162314.10050.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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