1
|
Vassilopoulou E, Comotti A, Douladiris N, Konstantinou GΝ, Zuberbier T, Alberti I, Agostoni C, Berni Canani R, Bocsan IC, Corsello A, De Cosmi V, Feketea G, Laitinen K, Mazzocchi A, Monzani NA, Papadopoulos NG, Peroni DG, Pitsios C, Roth-Walter F, Skypala I, Tsabouri S, Baldeh AK, O'Mahony L, Venter C, Milani GP. A systematic review and meta-analysis of nutritional and dietary interventions in randomized controlled trials for skin symptoms in children with atopic dermatitis and without food allergy: An EAACI task force report. Allergy 2024; 79:1708-1724. [PMID: 38783644 DOI: 10.1111/all.16160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/09/2024] [Accepted: 04/30/2024] [Indexed: 05/25/2024]
Abstract
This systematic review and meta-analysis aimed to consolidate evidence on dietary interventions for atopic eczema/dermatitis (AD) skin symptoms in children without food allergies, following PRISMA 2020 guidelines. Systematic review updates were conducted in May 2022 and June 2023, focusing on randomized placebo-controlled trials (RCTs) involving children with AD but without food allergies. Specific diets or supplements, such as vitamins, minerals, probiotics, prebiotics, symbiotics, or postbiotics, were explored in these trials. Exclusions comprised descriptive studies, systematic reviews, meta-analyses, letters, case reports, studies involving elimination diets, and those reporting on food allergens in children and adolescents. Additionally, studies assessing exacerbation of AD due to food allergy/sensitization and those evaluating elimination diets' effects on AD were excluded. Nutritional supplementation studies were eligible regardless of sensitization profile. Evaluation of their impact on AD clinical expression was performed using SCORAD scores, and a meta-analysis of SCORAD outcomes was conducted using random-effect models (CRD42022328702). The review encompassed 27 RCTs examining prebiotics, Vitamin D, evening primrose oil, and substituting cow's milk formula with partially hydrolyzed whey milk formula. A meta-analysis of 20 RCTs assessing probiotics, alone or combined with prebiotics, revealed a significant reduction in SCORAD scores, suggesting a consistent trend in alleviating AD symptoms in children without food allergies. Nonetheless, evidence for other dietary interventions remains limited, underscoring the necessity for well-designed intervention studies targeting multiple factors to understand etiological interactions and propose reliable manipulation strategies.
Collapse
Affiliation(s)
- Emilia Vassilopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
- Pediatric Area, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Comotti
- Occupational Medicine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nikolaos Douladiris
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - George Ν Konstantinou
- Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, Thessaloniki, Greece
| | - Torsten Zuberbier
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Ilaria Alberti
- Pediatric Area, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Agostoni
- Pediatric Area, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
| | - Roberto Berni Canani
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | - Ioana Corina Bocsan
- Department of Pharmacology, Toxicology and Clinical Pharmacology, "luliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Antonio Corsello
- Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
| | - Valentina De Cosmi
- Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Gavriela Feketea
- Department of Pharmacology, Toxicology and Clinical Pharmacology, "luliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Pediatrics, "Karamandaneio" Children's Hospital of Patra, Patras, Greece
| | - Kirsi Laitinen
- Faculty of Medicine, Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology and Nutrition and Food Research Center, University of Turku, Turku, Finland
| | - Alessandra Mazzocchi
- Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
| | - Nicola A Monzani
- Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
| | | | - Diego G Peroni
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
| | | | - Franziska Roth-Walter
- Department of Interdisciplinary Life Sciences, Messerli Research Institute, University of Veterinary Medicine, Vienna, Austria
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Isabel Skypala
- Royal Brompton & Harefield Hospitals, Part of Guys & St Thomas NHS Foundation Trust, London, UK
- Department of Inflammation & Repaid, Imperial College of London, London, UK
| | - Sophia Tsabouri
- Child Health Department, University of Ioannina School of Medicine, Ioannina, Greece
| | - Abdoulie K Baldeh
- Department of Public Health and Community Medicine, Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Liam O'Mahony
- APC Microbiome Ireland, Department of Medicine, School of Microbiology, University College Cork, Cork, Ireland
| | - Carina Venter
- Pediatric Allergy and Clinical Immunology, Children's Hospital Colorado/University of Colorado, Aurora, Colorado, USA
| | - Gregorio Paolo Milani
- Pediatric Area, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
| |
Collapse
|
2
|
Çiçek F, Köle MT. Evaluation of the Impact of Serum Vitamin D Levels on the Scoring Atopic Dermatitis Index in Pediatric Atopic Dermatitis. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1522. [PMID: 37761483 PMCID: PMC10529228 DOI: 10.3390/children10091522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023]
Abstract
Atopic dermatitis (AD) is a chronic and recurrent inflammatory skin condition characterized by itching, eczematous plaques, and dry skin. Despite ongoing research, its exact cause remains elusive. In this study, we aimed to explore the factors that influence the severity of AD in children and assess the relationship between serum vitamin D levels and the disease's severity. We enrolled 96 AD patients in our investigation, evaluated their clinical condition using the Scoring Atopic Dermatitis (SCORAD) index, and compared them to a group of 90 healthy controls. Our analysis revealed that serum vitamin D levels and eosinophil counts significantly impacted the SCORAD index (p < 0.001). According to standardized regression coefficients, for each incremental unit in serum vitamin D levels, the SCORAD index exhibited a decrease of 0.449 units. Similarly, a one-unit increase in eosinophil count resulted in a 0.009 unit increase in the SCORAD index. It is worth noting that the influence of serum vitamin D levels on disease severity surpasses that of eosinophil counts and atopic conditions. In our patient cohort, we uncovered a negative correlation (r = -0.419, p < 0.001) between serum vitamin D levels and the SCORAD index. Our findings suggest that low serum vitamin D levels may have a more substantial impact on AD severity than atopic conditions and eosinophilia. Furthermore, we observed a negative association between the severity of AD and serum 25(OH)D3 levels.
Collapse
Affiliation(s)
- Fatih Çiçek
- Department of Pediatric Allergy and Immunology, Kartal Dr. Lütfi Kırdar City Hospital, University of Health Sciences, Istanbul 34870, Turkey
| | - Mehmet Tolga Köle
- Department of Pediatrics, Kartal Dr. Lütfi Kırdar City Hospital, University of Health Sciences, Istanbul 34870, Turkey;
| |
Collapse
|
3
|
Ziyab AH, Al-Taiar A, Al-Sabah R, Shaban L, Almousa Z, AlBaloul AH, Karmaus W. Sex and obesity status modify the association between vitamin D and eczema among adolescents. Pediatr Res 2023; 94:1235-1242. [PMID: 37173405 DOI: 10.1038/s41390-023-02641-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Epidemiologic studies have reported inconsistent associations between vitamin D and eczema. This study sought to assess whether sex and obesity status could modify the association between vitamin D and eczema. METHODS A cross-sectional study enrolled 763 adolescents in Kuwait. 25-hydroxyvitamin D (25(OH)D) was measured in venous blood. Current eczema was defined according to clinical history and characteristic morphology and distribution. RESULTS In sex-stratified analysis, decreased 25(OH)D levels were associated with increased current eczema prevalence among males (adjusted odds ratio (aOR)tertile 1 vs. tertile 3: 2.14, 95% confidence intervals (CI): 1.07-4.56), but not among females (aORtertile 1 vs. tertile 3: 1.08, 95% CI: 0.71-1.66). Further stratification by obesity status showed that lower 25(OH)D levels were associated with increased current eczema prevalence among overweight/obese males (per 10-unit decrease in 25(OH)D levels: aOR: 1.70, 95% CI: 1.17-2.46). Such an association was weaker and statistically non-significant among overweight/obese females (per 10-unit decrease in 25(OH)D levels: aOR: 1.26, 95% CI: 0.93-1.70). CONCLUSIONS Sex and obesity status modified the association between vitamin D levels and eczema, with an inverse association observed among overweight/obese males, but not among overweight/obese females. These results suggest that preventive and clinical management strategies could vary by sex and obesity status. IMPACT The current study showed that sex and obesity modify the association between vitamin D and eczema among adolescents. An inverse association between vitamin D and eczema was observed among overweight/obese males, but this association was not as pronounced among overweight/obese females. Vitamin D was not associated with eczema among underweight/normal weight males and females. The identification of effect modification by sex and obesity status add to the current scientific knowledge and further highlight the complexity of the association between vitamin D and eczema. These results may promote a more individualized approach to the future prevention and clinical management of eczema.
Collapse
Affiliation(s)
- Ali H Ziyab
- Department of Community Medicine and Behavioral Sciences, College of Medicine, Kuwait University, Safat, Kuwait.
| | - Abdullah Al-Taiar
- School of Community and Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, VA, USA.
| | - Reem Al-Sabah
- Department of Community Medicine and Behavioral Sciences, College of Medicine, Kuwait University, Safat, Kuwait
| | - Lemia Shaban
- Department of Food Science and Nutrition, College of Life Sciences, Kuwait University, Safat, Kuwait
| | - Zainab Almousa
- Department of Community Medicine and Behavioral Sciences, College of Medicine, Kuwait University, Safat, Kuwait
| | - Anwar H AlBaloul
- Department of Community Medicine and Behavioral Sciences, College of Medicine, Kuwait University, Safat, Kuwait
| | - Wilfried Karmaus
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| |
Collapse
|
4
|
Kashinskaya TS, Shakhova NV, Lobanov YF, Kamaltynova EM. Prevalence of Vitamin D Insufficiency/Deficiency and Their Role in Atopic Dermatitis Development and Course in Children. CURRENT PEDIATRICS 2022. [DOI: 10.15690/vsp.v21i4.2435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Various conclusive evidence on the role of vitamin D in the pathogenesis of atopic dermatitis (AD) has been obtained in recent decades. Many studies have shown that patients with AD have low concentration of 25(OH)D in blood associated with high concentration of allergen specific IgE (according to several reports). The analysis of low 25(OH)D concentration prevalence, association of vitamin D deficiency with AD severity and sensitization to allergens, and association of vitamin D disorders with risk of AD development is presented.
Collapse
|
5
|
Lugović-Mihić L, Mandušić N, Dasović M, Pondeljak N, Kuna M, Pozderac I. Vitamin D supplementation in patients with atopic dermatitis, chronic urticaria and contact irritant and allergic dermatitis - possible improvement without risk. Folia Med (Plovdiv) 2022; 64:467-477. [PMID: 35856109 DOI: 10.3897/folmed.64.e66166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/22/2021] [Indexed: 11/12/2022] Open
Abstract
Abstract.
Collapse
Affiliation(s)
| | | | - Marina Dasović
- Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Nives Pondeljak
- Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Matea Kuna
- Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Iva Pozderac
- Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| |
Collapse
|
6
|
Herrmann N, Nümm TJ, Iwamoto K, Leib N, Koch S, Majlesain Y, Maintz L, Kirins H, Schnautz S, Bieber T. Vitamin D 3-Induced Promotor Dissociation of PU.1 and YY1 Results in FcεRI Reduction on Dendritic Cells in Atopic Dermatitis. THE JOURNAL OF IMMUNOLOGY 2021; 206:531-539. [PMID: 33443066 DOI: 10.4049/jimmunol.2000667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/23/2020] [Indexed: 12/12/2022]
Abstract
Atopic dermatitis (AD) is a severe inflammatory skin disease. Langerhans cells and inflammatory dendritic epidermal cells (IDEC) are located in the epidermis of AD patients and contribute to the inflammatory processes. Both express robustly the high-affinity receptor for IgE, FcεRI, and thereby sense allergens. A beneficial role of vitamin D3 in AD is discussed to be important especially in patients with allergic sensitization. We hypothesized that vitamin D3 impacts FcεRI expression and addressed this in human ex vivo skin, in vitro Langerhans cells, and IDEC models generated from primary human precursor cells. We show in this article that biologically active vitamin D3 [1,25(OH)2-D3] significantly downregulated FcεRI at the protein and mRNA levels of the receptor's α-chain, analyzed by flow cytometry and quantitative RT-PCR. We also describe the expression of a functional vitamin D receptor in IDEC. 1,25(OH)2-D3-mediated FcεRI reduction was direct and resulted in impaired activation of IDEC upon FcεRI engagement as monitored by CD83 expression. FcεRI regulation by 1,25(OH)2-D3 was independent of maturation and expression levels of microRNA-155 and PU.1 (as upstream regulatory axis of FcεRI) and transcription factors Elf-1 and YY1. However, 1,25(OH)2-D3 induced dissociation of PU.1 and YY1 from the FCER1A promotor, evaluated by chromatin immunoprecipitation. We show that vitamin D3 directly reduces FcεRI expression on dendritic cells by inhibiting transcription factor binding to its promotor and subsequently impairs IgE-mediated signaling. Thus, vitamin D3 as an individualized therapeutic supplement for those AD patients with allergic sensitization interferes with IgE-mediated inflammatory processes in AD patients.
Collapse
Affiliation(s)
- Nadine Herrmann
- Department of Dermatology and Allergy, University Hospital of Bonn, D-53127 Bonn, Germany; and .,Christine Kühne-Center for Allergy Research and Education, CH-7265 Davos, Switzerland
| | - Tim J Nümm
- Department of Dermatology and Allergy, University Hospital of Bonn, D-53127 Bonn, Germany; and.,Christine Kühne-Center for Allergy Research and Education, CH-7265 Davos, Switzerland
| | - Kazumasa Iwamoto
- Department of Dermatology and Allergy, University Hospital of Bonn, D-53127 Bonn, Germany; and
| | - Nicole Leib
- Department of Dermatology and Allergy, University Hospital of Bonn, D-53127 Bonn, Germany; and.,Christine Kühne-Center for Allergy Research and Education, CH-7265 Davos, Switzerland
| | - Susanne Koch
- Department of Dermatology and Allergy, University Hospital of Bonn, D-53127 Bonn, Germany; and
| | - Yasmin Majlesain
- Department of Dermatology and Allergy, University Hospital of Bonn, D-53127 Bonn, Germany; and
| | - Laura Maintz
- Department of Dermatology and Allergy, University Hospital of Bonn, D-53127 Bonn, Germany; and.,Christine Kühne-Center for Allergy Research and Education, CH-7265 Davos, Switzerland
| | - Helene Kirins
- Department of Dermatology and Allergy, University Hospital of Bonn, D-53127 Bonn, Germany; and
| | - Sylvia Schnautz
- Department of Dermatology and Allergy, University Hospital of Bonn, D-53127 Bonn, Germany; and
| | - Thomas Bieber
- Department of Dermatology and Allergy, University Hospital of Bonn, D-53127 Bonn, Germany; and.,Christine Kühne-Center for Allergy Research and Education, CH-7265 Davos, Switzerland
| |
Collapse
|
7
|
Ibrahim HM, El-Taieb MA, Hassan MH, Mohamed AAE, Kotop EA, Abd-Ellah OH, Hegazy EM. Relations between vitamin D3, total and specific IgE for house dust mites in atopic dermatitis patients. Sci Rep 2020; 10:21000. [PMID: 33268802 PMCID: PMC7710713 DOI: 10.1038/s41598-020-77968-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/28/2020] [Indexed: 01/12/2023] Open
Abstract
Atopic dermatitis (AD) is a chronic recurrent inflammatory skin disease. There are a lot of evidences on the importance of vitamin D and house dust mite (HDM) allergens in the etiology and course of AD. The objectives of this study are to evaluate the relation between vitamin D3 level and house dust mites (HDM) Dermatophagoidspecies sensitization in pathogenesis of atopic dermatitis. Cross-sectional design study was conducted on 50 atopic dermatitis patients. Blood analysis were done to determine level of vitamin D3, total IgE by fluorescent immunoassay & specific IgE for HDM (d1, d2) & other inhalant allergens by ELISA test. There was significant high negative correlation with the specific IgE for HDM (r = −0. 62, p < 0.001) and vitamin D3. & there was non-significant minimal negative correlation with the specific IgE and other inhalant allergens (r = − 0.10, p > 0.05). There was a statistically significant relation between level of vitamin D3 and atopic dermatitis severity and sensitization to HDM and other allergens.
Collapse
Affiliation(s)
- Hassan M Ibrahim
- Dermatology, Andrology and Venereology, Qena Faculty of Medicine, South Valley University, Qena, 83523, Egypt.
| | - Moustafa A El-Taieb
- Department of Dermatology, Andrology and Venereology, Aswan Faculty of Medicine, Aswan University, Tingar, Egypt
| | - Mohammed H Hassan
- Department of Medical Biochemistry, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | - Abd Allah E Mohamed
- Clinical Pathology, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | - Ebtihal A Kotop
- Dermatology, Venereology and Andrology, Qena University Hospital, South Valley University, Qena, Egypt
| | - Osama H Abd-Ellah
- Parasitology Department, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | - Eisa M Hegazy
- Department of Dermatology, Andrology and Venereology, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| |
Collapse
|
8
|
Sanmartin R, Pardos C, Doste D, Aguilera J, Alijarde R, Jesús Agón-Banzo P, García-Malinis AJ, Puzo J, Hernández-Martín Á, Gilaberte Y. The association between atopic dermatitis and serum 25-hydroxyvitamin D in children: Influence of sun exposure, diet, and atopy features-A cross-sectional study. Pediatr Dermatol 2020; 37:294-300. [PMID: 31997408 DOI: 10.1111/pde.14049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Previous studies have linked low serum vitamin D (VD) or 25-hydroxyvitamin D (25(OH)D) levels with increased severity of atopic dermatitis (AD) in children. OBJECTIVE To investigate the association between serum VD (25(OH)D) levels and AD and AD severity, considering the influence of diet and sun exposure. METHODS We performed a prospective cross-sectional study of healthy controls and children diagnosed with AD. Participants were recruited between January 2011 and December 2012, and the following parameters were assessed: age, sex, body mass index (BMI), AD severity, Fitzpatrick skin type, asthma and rhinitis history, dietary VD intake, daily potential sun-induced VD production, sunscreen use, 25(OH)D and IgE serum levels, and results of the ImmunoCAP Phadiatop Infant test. RESULTS The study population consisted of 105 healthy controls and 134 AD patients. Serum 25(OH)D levels were significantly lower in moderate and severe AD than in mild AD, although this association was only significant for patients with light Fitzpatrick skin type (mean(SD) 36.7 (11.9) ng/mL; moderate 28.8 [11.5] ng/mL; and severe 27.6 [12.1] ng/mL, P = .045). Logistic regression analysis revealed a positive association between severe AD and both positive ImmunoCAP Phadiatop test and BMI. CONCLUSION Our data support an association between VD deficiency and AD severity only in patients with light complexion.
Collapse
Affiliation(s)
| | - Carlos Pardos
- Perpetuo Socorro, Primary Care Center, Huesca, Spain
| | | | - Jose Aguilera
- Photobiological Dermatology Laboratory, Department of Dermatology and Medicine, Medical Research Center, Faculty of Medicine, University of Málaga, Málaga, Spain
| | | | | | | | - José Puzo
- Department of Biochemistry, San Jorge Hospital, Huesca, Spain
| | | | - Yolanda Gilaberte
- Department of Dermatology, University Hospital Miguel Servet, IIS Aragón, Zaragoza, Spain
| |
Collapse
|
9
|
Ahmed Mohamed A, Salah Ahmed EM, Farag YMK, Bedair NI, Nassar NA, Ghanem AIM. Dose-response association between vitamin D deficiency and atopic dermatitis in children, and effect modification by gender: a case-control study. J DERMATOL TREAT 2019; 32:174-179. [PMID: 31296076 DOI: 10.1080/09546634.2019.1643447] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Vitamin D is a regulatory factor for immunity and skin barrier functions. It is hypothesized to be linked to atopic dermatitis (AD) which is characterized by interaction between epidermal barrier dysfunction and dysregulation of skin immune functions. METHODS One hundred AD patients and one hundred and one normal controls were collected from outpatient clinic based on their clinical condition, both had measurement of 25-hydroxyvitamin D [25(OH)D]. We assessed the relationship between 25(OH)D deficiency and AD prevalence using adjusted Poisson regression model. RESULTS Serum 25(OH)D levels were significantly lower in cases than controls (mean 35.1 versus 22.6 ng/mL, p < .001). The unadjusted prevalence ratios (PRs) (95% CI) for AD for comparing participants with intermediate and deficient vitamin D levels to those with optimal levels were 3.11 (1.91, 5.06) and 4.77 (2.99, 7.60), respectively. The association did not materially change after adjusting for potential confounders. In the fully adjusted analysis stratified by gender, PRs for AD for comparing male participants with intermediate and deficient vitamin D levels to those with optimal levels were 3.38 (1.21, 9.40) and 5.20 (1.91, 14.13), respectively, whereas in the female participants were 1.32 (0.96, 1.83) and 1.49 (1.04, 2.14), respectively (p-interaction <.001). CONCLUSION In this case-control study in children, we found a statistically significant dose-response association between vitamin D deficiency and AD. We also observed a statistically significant effect modification of this association by gender. Further research is recommended to study this association longitudinally, and to examine whether treating vitamin D deficiency may potentially improve AD. Key points Question: Can atopic dermatitis be associated with vitamin D deficiency? Finding: Serum 25(OH)D levels were significantly lower in cases with AD than in controls. Prevalence ratios for comparing male participants with intermediate and deficient vitamin D levels to those with optimal levels were 3.38 (1.21, 9.40) and 5.20 (1.91, 14.13), respectively, whereas in the female participants were 1.32 (0.96, 1.83) and 1.49 (1.04, 2.14), respectively (p-interaction <.001). Meaning: vitamin D deficiency is associated with AD in children, effect modification of this association by gender was also observed.
Collapse
Affiliation(s)
- Amal Ahmed Mohamed
- Biochemistry Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Eman Mohamed Salah Ahmed
- Department of Dermatology, Andrology, Sexual Medicine and STDs, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Youssef M K Farag
- Welch Center for Prevention, Epidemiology, and Clinical Research and Clinical Research and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nermeen Ibrahim Bedair
- Department of Dermatology, Andrology, Sexual Medicine and STDs, Faculty of Medicine, Helwan University, Cairo, Egypt
| | | | | |
Collapse
|
10
|
Daniluk U, Filimoniuk A, Kowalczuk‐Krystoń M, Alifier M, Karpińska J, Kaczmarski MG, Lebensztejn DM. Association of antioxidants and vitamin D level with inflammation in children with atopic dermatitis. Int J Dermatol 2019; 58:1056-1061. [DOI: 10.1111/ijd.14438] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/25/2019] [Accepted: 02/28/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Urszula Daniluk
- Department of Pediatrics, Gastroenterology, Hepatology, Nutrition and Allergology Medical University of Bialystok Bialystok Poland
| | - Aleksandra Filimoniuk
- Department of Pediatrics, Gastroenterology, Hepatology, Nutrition and Allergology Medical University of Bialystok Bialystok Poland
| | - Monika Kowalczuk‐Krystoń
- Department of Pediatrics, Gastroenterology, Hepatology, Nutrition and Allergology Medical University of Bialystok Bialystok Poland
| | - Marek Alifier
- Department of Clinical Immunology Medical University of Bialystok Bialystok Poland
| | | | - Maciej G. Kaczmarski
- Department of Pediatrics, Gastroenterology, Hepatology, Nutrition and Allergology Medical University of Bialystok Bialystok Poland
| | - Dariusz M. Lebensztejn
- Department of Pediatrics, Gastroenterology, Hepatology, Nutrition and Allergology Medical University of Bialystok Bialystok Poland
| |
Collapse
|
11
|
Vaughn AR, Foolad N, Maarouf M, Tran KA, Shi VY. Micronutrients in Atopic Dermatitis: A Systematic Review. J Altern Complement Med 2019; 25:567-577. [PMID: 30912673 DOI: 10.1089/acm.2018.0363] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objective: The pathophysiology of atopic dermatitis (AD) involves a complex interplay between immune system dysfunction, genetics, and environmental factors. It is well known that nutritional status is essential to a proper functioning immune system, leading to a highly debated question regarding the role of dietary factors in the pathogenesis of AD. Food allergies and elimination diets have been broadly studied in atopy; however, less consideration has been given to how vitamins, minerals, and other micronutrients influence the risk for AD and severity of symptoms. This systematic review discusses evidence on how various micronutrients, including vitamins (C, E, and D) and trace minerals (zinc, selenium, iron, copper, magnesium, and strontium) are associated with AD, and how supplementation influence disease severity. Design: A systematic search was conducted to identify the role that oral micronutrients have on AD. The authors reviewed 49 studies herein. Results: While there are weak associations between vitamins C or E and AD, there is sufficient evidence to suggest that vitamin D supplementation provides benefit in AD patients. Deficiency of selenium and zinc may exacerbate AD. Current reports are not sufficient to confidently discern the role of other vitamins and trace minerals on AD. Conclusions: Though oral micronutrients may play a role in AD, the current literature is limited, and there is a need for more comprehensive randomized controlled trials (RCTs) to truly decipher the role between oral micronutrients and AD.
Collapse
Affiliation(s)
- Alexandra R Vaughn
- 1 Department of Dermatology, University of California-Davis, Sacramento, CA
| | - Negar Foolad
- 2 School of Medicine, University of California-Davis, Sacramento, CA
| | - Melody Maarouf
- 3 College of Medicine, University of Arizona-Tucson, Tucson, AZ
| | - Khiem A Tran
- 3 College of Medicine, University of Arizona-Tucson, Tucson, AZ
| | - Vivian Y Shi
- 4 Division of Dermatology, Department of Medicine, University of Arizona-Tucson, Tucson, AZ
| |
Collapse
|
12
|
Droitcourt C, Barbarot S, Maruani A, Darrieux L, Misery L, Brenaut E, Adamski H, Chabbert C, Vermersch A, Weiborn M, Seneschal J, Taïeb A, Plantin P, Maillard H, Phan A, Skowron F, Viguier M, Staumont-Salle D, Nosbaum A, Soria A, Barbaud A, Oger E, Dupuy A. A new phototherapy regimen during winter as an add-on therapy, coupled with oral vitamin D supplementation, for the long-term control of atopic dermatitis: study protocol for a multicentre, randomized, crossover, pragmatic trial - the PRADA trial. Trials 2019; 20:184. [PMID: 30909923 PMCID: PMC6434814 DOI: 10.1186/s13063-019-3276-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 03/01/2019] [Indexed: 12/05/2022] Open
Abstract
Background Atopic dermatitis is a highly prevalent, chronic, relapsing disease in both adults and children. On the severity spectrum, lower-end patients benefit from small amounts of topical anti-inflammatory treatments (TAT), whereas higher-end patients need systemic immunosuppressants; in-between patients are treated with TAT and phototherapy. The major therapeutic challenge in this population is the long-term control of disease activity, and the current TAT-based pro-active strategy does not meet all their needs. Immunosuppressants are used as long-term control add-on treatments, but they are restricted to the most severely affected patients because of safety concerns. In addition, neither immunosuppressants nor other strategies have been properly evaluated in the long term despite long-term control having been acknowledged as one of the most important core outcome domains to be targeted in atopic dermatitis trials. Safe add-on therapies, rigorously evaluated for long-term control of the disease, are therefore needed. Phototherapy and vitamin D supplementation are both good candidates. Methods This is a multicenter, national, randomized, superiority, crossover trial testing add-on phototherapy (one winter under spaced sessions of phototherapy and one winter under observation) among subjects receiving standard care (i.e., TAT). On the same population, we will test the long-term control provided by oral supplementation of vitamin D versus placebo in a randomized, superiority, double-blind, parallel-group trial. The primary outcomes are (1) repeat measures of the PO-SCORAD severity score over 1 year and (2) cumulate consumption of TAT (number of tubes) during the winter. They will be tested following a hierarchical testing procedure. The secondary outcomes will be measures repeated over 2 years of investigator-based severity scores, patient-reported severity and quality of life scores, serum vitamin D levels, weeks during which the disease is well-controlled, inter-visit cumulate consumption of TAT, and synthetic patient-reported satisfaction at the end of each winter. Discussion This study includes two separate 2-year pragmatic trials designed to evaluate the efficacy of vitamin D supplementation and pro-active phototherapy for primary care atopic dermatitis patients receiving TAT on long-term control of disease activity. The experimental design enables the study of both interventions and exploration of the interaction between vitamin D and phototherapy. A pragmatic trial is particularly suited to the assessment of long-term control. This study explores the possibility of new and safe therapeutic strategies for the control of long-term atopic dermatitis, and is an example of efficacy research that is unlikely to be sponsored by industrialists. A potentially effective low-cost therapeutic strategy for long-term control is essential for patients and public health. Trial registration ClinicalTrials.gov Identifier: NCT02537509, first received: 1 September 2015. Electronic supplementary material The online version of this article (10.1186/s13063-019-3276-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Catherine Droitcourt
- Univ Rennes, Rennes, France. .,Department of Dermatology, University Hospital Center of Rennes, Pontchaillou Hospital, 2 rue Henri le Guilloux, 35000, Rennes, France. .,INSERM, CIC 1414, 35000, Rennes, France. .,EA 7449 REPERES "Pharmaco-epidemiology and Health Services Research", Univ Rennes, 35000, Rennes, France.
| | - Sébastien Barbarot
- Department of Dermatology, University Hospital Center of Nantes, 44000, Nantes, France
| | - Annabel Maruani
- Department of Dermatology, University Hospital Center of Tours, 37000, Tours, France
| | - Laure Darrieux
- Department of Dermatology, Hospital Center of Saint-Brieuc, 22000, Saint-Brieuc, France
| | - Laurent Misery
- Department of Dermatology, University Hospital Center of Brest, 29000, Brest, France
| | - Emilie Brenaut
- Department of Dermatology, University Hospital Center of Brest, 29000, Brest, France
| | - Henri Adamski
- Department of Dermatology, University Hospital Center of Rennes, Pontchaillou Hospital, 2 rue Henri le Guilloux, 35000, Rennes, France
| | - Cécile Chabbert
- Department of Dermatology, Hospital Center of Perigueux, 24000, Perigueux, France
| | - Annie Vermersch
- Department of Dermatology, Hospital Center of Valenciennes, 62000, Valenciennes, France
| | - Marie Weiborn
- Department of Dermatology, Hospital Center of Valenciennes, 62000, Valenciennes, France
| | - Julien Seneschal
- Department of Dermatology, University Hospital Center of Bordeaux, 33000, Bordeaux, France
| | - Alain Taïeb
- Department of Dermatology, University Hospital Center of Bordeaux, 33000, Bordeaux, France
| | - Patrice Plantin
- Department of Dermatology, Hospital Center of Quimper, 29000, Quimper, France
| | - Hervé Maillard
- Department of Dermatology, Hospital Center of Le Mans, 72000, Angers, France
| | - Alice Phan
- Department of Dermatology, University Hospital Center of Lyon, 69000, Lyon-Bron, France
| | - François Skowron
- Department of Dermatology, Hospital Center of Valence, 26000, Valence, France
| | - Manuelle Viguier
- Department of Dermatology, University Hospital Center of Reims, 51000, Reims, France
| | | | - Audrey Nosbaum
- Department of Dermatology, University Hospital Center of Lyon, 69000, Lyon Sud, France
| | - Angèle Soria
- Department of Dermatology and Allergology, University Hospital Center of Paris-Tenon, 75020, Paris, France
| | - Annick Barbaud
- Department of Dermatology and Allergology, University Hospital Center of Paris-Tenon, 75020, Paris, France
| | - Emmanuel Oger
- Univ Rennes, Rennes, France.,EA 7449 REPERES "Pharmaco-epidemiology and Health Services Research", Univ Rennes, 35000, Rennes, France
| | - Alain Dupuy
- Univ Rennes, Rennes, France.,Department of Dermatology, University Hospital Center of Rennes, Pontchaillou Hospital, 2 rue Henri le Guilloux, 35000, Rennes, France.,EA 7449 REPERES "Pharmaco-epidemiology and Health Services Research", Univ Rennes, 35000, Rennes, France
| | | |
Collapse
|
13
|
Xiang J, Wang H, Li T. Comorbidity of Vitamin A and Vitamin D Deficiency Exacerbates the Severity of Atopic Dermatitis in Children. Dermatology 2019; 235:196-204. [DOI: 10.1159/000496603] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
<b><i>Background:</i></b> Several studies have suggested that vitamin D (VD) deficiency (VDD) is associated with atopic dermatitis (AD). However, little is known about the relationship between AD and vitamin A (VA). The interaction between VA and VD on AD requires further study. <b><i>Objective:</i></b> We detected serum levels of VA and VD in children with AD to explore how VA deficiency (VAD) and VDD affect AD severity. <b><i>Methods:</i></b> We assessed the SCORing Atopic Dermatitis (SCORAD) index, total immunoglobin E levels and peripheral blood eosinophil counts. VA and VD levels were determined with high-performance liquid chromatography. Correlations among variables were investigated with Pearson’s correlation analysis. <b><i>Results:</i></b> The VD and VA levels were significantly lower in children with AD than in normal children (p < 0.001, p = 0.0423). Both VD and VA levels were negatively correlated with SCORAD scores. The SCORAD scores were significantly higher in AD patients with both VDD and VAD (co-deficiency) than in other AD patients. Significant inverse correlations were observed between peripheral blood eosinophil counts and serum VA and VD levels. <b><i>Conclusions:</i></b> VA and VD co-deficiency may exacerbate AD symptoms in children, but the specific mechanism underlying this relationship requires further study. These findings may indicate the need for studies evaluating the use of VD and VA as potential treatments for AD patients.
Collapse
|
14
|
Dogru M. Is vitamin D level associated with the natural course of atopic dermatitis? Allergol Immunopathol (Madr) 2018; 46:546-551. [PMID: 29559281 DOI: 10.1016/j.aller.2017.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 11/24/2017] [Accepted: 12/02/2017] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND OBJECTIVES Atopic dermatitis (AD) is a chronic inflammatory disease of the skin. Apart from its well-known role on calcium metabolism, vitamin D is reported to affect skin functions. The study aims were to: compare the vitamin D levels of children with AD and healthy children; investigate the relationship between the severity of AD and vitamin D levels; and investigate the effect of vitamin D on the natural course of AD. PATIENTS OR MATERIALS AND METHODS Sixty-nine patients with AD were enrolled. Seventy healthy children were assigned as control group. Clinical and demographic features of groups were recorded. The skin prick test, eosinophil counts, immunoglobulin (Ig) E levels and serum 25 OH cholecalciferol (25OHD3) levels were measured. After at least 4 years of follow-up, patients were re-evaluated for natural course of AD. RESULTS Mean 25OHD3 level was lower in patient group vs. control group; 19.86±6.7ng/mL (min-max: 6.8-40) vs. 24.07±9.08ng/mL, respectively, (p=0.002). Mean 25OHD3 levels, and vitamin D status were significantly different between AD severity groups. (p<0.05). In terms of vitamin D status in the pairwise comparison, vitamin D deficiency was greater in children with severe and moderate AD groups (respectively, p=0.005, p=0.018). In Tukey's post hoc analysis for 25OHD3 level, the 25OHD3 levels of severe AD are significantly lower than mild or moderate AD (respectively, p=0.001, p=0.026). There was a negative correlation between 25OHD3 levels and severity of AD (r=-0.480; p=0.001). In patients reassessed after 4 years: age, the age of AD onset, vitamin D deficiency, SCORAD level and severe AD were higher in the persistent group vs. remission group, 25OHD3 levels were higher in the remission group vs. persistent group (p<0.05). CONCLUSIONS Mean vitamin D levels were lower in patients with AD. A negative correlation between vitamin D levels and disease severity was documented. Vitamin D may affect the natural course of atopic dermatitis. There is a need for more comprehensive studies in this regard.
Collapse
Affiliation(s)
- M Dogru
- Health Sciences University, Zeynep Kamil Woman and Children Health Practice and Research Center, Department of Pediatrics, Istanbul, Turkey.
| |
Collapse
|
15
|
Huang CM, Lara-Corrales I, Pope E. Effects of Vitamin D levels and supplementation on atopic dermatitis: A systematic review. Pediatr Dermatol 2018; 35:754-760. [PMID: 30284328 DOI: 10.1111/pde.13639] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic inflammatory skin condition affecting 5%-20% of children worldwide. Studies suggested both a correlation between serum vitamin D (VD) levels and AD severity and a therapeutic potential role for VD supplementation. OBJECTIVES To determine whether serum VD levels correlate with AD severity and the effects of supplementation for disease improvement in children. DATA SOURCES Ovid MEDLINE, EMBASE, and Cochrane Library databases were searched. STUDY SELECTION Publications with children 0-18 years old with AD and data evaluating effects of VD levels or supplementation on AD severity were included. DATA EXTRACTION Author, year, inclusion criteria, study design, location, age, VD levels, VD supplementation regimens, and baseline and final disease severities were extracted. RESULTS Of the 21 included publications, 15, 5, and 1 evaluated VD level, VD supplementation, and both factors with disease severity, respectively. There were 4 randomized control trials (RCTs), 5 cohort, 6 case-control, and 6 cross-sectional studies. A significant inverse correlation between VD level and severity was described in 62.5% (10/16) of studies. There were 67% (4/6) that reported a significant improvement in AD severity with supplementation. LIMITATIONS Studies meeting inclusion criteria were limited. Furthermore, papers were heterogeneous in terms of location, season, and VD supplementation regimen. Language and publication bias was another potential limitation. CONCLUSION In children, the majority of existing literature confirmed a link between serum VD levels and AD severity. Weak evidence was found supporting improvement of AD with VD supplementation. Future large-scale studies are needed to support our findings.
Collapse
Affiliation(s)
| | - Irene Lara-Corrales
- Section of Dermatology, Division of Pediatric Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Elena Pope
- Section of Dermatology, Division of Pediatric Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
16
|
Lara-Corrales I, Huang CM, Parkin PC, Rubio-Gomez GA, Posso-De Los Rios CJ, Maguire J, Pope E. Vitamin D Level and Supplementation in Pediatric Atopic Dermatitis: A Randomized Controlled Trial. J Cutan Med Surg 2018; 23:44-49. [PMID: 30336685 DOI: 10.1177/1203475418805744] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND: Atopic dermatitis (AD) is a chronic inflammatory skin condition characterized by a pruritic eczematous rash. Evidence surrounding the role of serum vitamin D (VD) in modifying disease severity is inconsistent. OBJECTIVES: To determine whether VD levels are correlated with AD severity and the effects of VD supplementation on disease modification. METHODS: This was a 2-phase study, using a cross-sectional design to evaluate the relationship between VD level and severity, as well as a double-blinded, randomized control trial to elucidate the effects of VD supplementation. Patients aged 0 to 18 years with AD were included in phase 1, and disease severity and serum VD levels were determined. Those with renal, liver, or other dermatologic conditions were excluded. Patients with abnormal (<72.7 nmol/L) VD levels were eligible for phase 2 and to be randomized to either VD supplementation of 2000 IU/d or placebo. VD level and severity were assessed at baseline and 3 months. RESULTS: The 77 patients included in phase 1 had a mean (SD) age of 7.4 (4.5) years, and 45.5% (33/77) were female. Increased severity was significantly correlated with lower VD levels ( P = .015). Of the 45 patients included in phase 2, 21 and 24 were assigned to the supplementation and placebo arm, respectively. The mean (SD) change in severity did not differ significantly between the supplementation (15.35 [9.71]) and placebo (15.13 [8.97]) groups after 3 months of intervention ( P = .7). CONCLUSION: Although VD levels correlated with AD severity, VD supplementation did not significantly improve disease severity.
Collapse
Affiliation(s)
- Irene Lara-Corrales
- 1 Section of Dermatology, Division of Pediatric Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Patricia C Parkin
- 3 Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | | | - Jonathon Maguire
- 3 Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Elena Pope
- 1 Section of Dermatology, Division of Pediatric Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
17
|
Interleukin 1-β, interleukin-1 receptor antagonist and vitamin D levels in children with atopic dermatitis. Cent Eur J Immunol 2018; 43:180-185. [PMID: 30135631 PMCID: PMC6102616 DOI: 10.5114/ceji.2018.77388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 01/16/2017] [Indexed: 11/28/2022] Open
Abstract
Introduction Among the broad spectrum of cytokines, interleukin 1-β (IL-1β) has been implicated in induction and subsequent aggravation of skin lesions in atopic dermatitis (AD). A considerable body of evidence suggests that vitamin D status also influences the risk and/or severity of AD. Material and methods Fifty-seven children suffering from mild to severe AD were enrolled in the study. The control group consisted of 33 matched healthy children. In all the children serum concentrations of IL-1β/IL-1F2 and the interleukin-1 receptor antagonist IL-Ra/1F3 were measured. Serum 25(OH)D concentration was obtained for 49 patients with AD and all healthy children. Results In children with AD 59.2% of children had insufficiency, 24.5% had deficiency and 16.3% had a sufficient serum 25(OH)D level. In the control group 26.5%, 52.9% and 20% of participants had insufficiency/deficiency/sufficiency of 25(OH)D, respectively. The severity of AD was positively correlated with total IgE level, percentage and absolute count of eosinophils and IL-1Ra. IL-1β correlated with IL-1Ra. Conclusions In children with AD the serum vitamin D level was lower than in healthy children. The correlation between severity of AD and IL-1Ra may prove that inflammasome-dependent IL-1β is involved in immunopathogenesis of the disease. Further studies are needed on a larger population of children to confirm the role of this cytokine in development of AD.
Collapse
|
18
|
Asthma and Allergy "Epidemic" and the Role of Vitamin D Deficiency. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 996:169-183. [PMID: 29124699 DOI: 10.1007/978-3-319-56017-5_14] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The increase in asthma and allergies prevalence that has been recorded in many countries during the last decades, and the reemergence of vitamin D (VD) deficiency in many populations worldwide, renders fairly plausible the assumption of an underlying association between these two conditions and justifies the research effort invented in this issue. Indeed, there is growing body of evidence from epidemiological, laboratory, and clinical studies, suggesting that such an association does exist. The hypothesis of low levels of VD leading to compromised fetal programming and impairment of various immune functions involved in asthma and allergic disorders, stands as the most credible explanation of this presumed association. However, the evidence is not yet definite and there are some conflicting results among studies. As a consequence, no safe conclusions can be drawn yet, and more research is required in order to fully clarify the involvement of VD deficiency in the pathogenesis of asthma and allergies, and decide if VD has a role to play in the prevention and therapy of these disorders.
Collapse
|
19
|
Amon U, Baier L, Yaguboglu R, Ennis M, Holick MF, Amon J. Serum 25-hydroxyvitamin D levels in patients with skin diseases including psoriasis, infections, and atopic dermatitis. DERMATO-ENDOCRINOLOGY 2018; 10:e1442159. [PMID: 29904567 PMCID: PMC5997090 DOI: 10.1080/19381980.2018.1442159] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/13/2018] [Indexed: 02/07/2023]
Abstract
The pathogenetic role of vitamin D as well as its clinical correlation in inflammatory skin diseases is still uncertain. This study aimed to compare serum levels of 25(OH) vitamin D (calcidiol) in outpatients suffering from different skin diseases using the same laboratory method in one study. In routine serum samples of 1,532 patients from the previous 12 months we identified retrospectively 180 (mean age 49.4 years, 80 female, 100 male) and 205 (mean age 36.3 years, 116 female, 89 male) patients with psoriasis (PSO) and atopic dermatitis (AD), respectively. Clinical disease activity and quality of life was evaluated using Physicians Global Assessment Scores (PGA), Dermatology Life Quality Index (DLQI), and a Visual Analog Scale for pruritus in AD, respectively. The median 25(OH)D serum level of all patients (22.97 ng/mL, range 2.61–96.0, n = 1,461) was significantly lower in comparison to healthy controls (41.6 ng/mL, range 16.9–77.57, p < 0.0001, n = 71). In PSO and AD we measured 21.05 ng/mL (44% < 20 ng/mL) and 22.7 ng/mL (39% < 20 ng/mL), respectively (p = 0.152). Among all subgroups, patients with severe acute or chronic infectious skin diseases had the lowest median 25(OH)D serum levels (17.11 ng/mL, n = 94, 66% <20 ng/mL, p < 0,001 vs. AD, p = 0,007 vs. PSO). For PSO and AD there was no significant correlation between 25(OH)D levels and PGA scores and DLQI values, respectively, or the extent of pruritus in AD. 25(OH)D serum levels in inflammatory skin diseases might correlate more with the type of disease and the degree of inflammation than with clinical activity itself.
Collapse
Affiliation(s)
- Ulrich Amon
- International Centre for Skin Diseases DermAllegra, Am Markgrafenpark 6, Pommelsbrunn-Hohenstadt, Germany
| | - Laura Baier
- International Centre for Skin Diseases DermAllegra, Am Markgrafenpark 6, Pommelsbrunn-Hohenstadt, Germany
| | - Raul Yaguboglu
- International Centre for Skin Diseases DermAllegra, Am Markgrafenpark 6, Pommelsbrunn-Hohenstadt, Germany
| | - Madeleine Ennis
- Centre for Experimental Medicine, Queens University of Belfast, University Road, Belfast, Northern Ireland, United Kingdom
| | - Michael F Holick
- Endocrinology, Nutrition and Diabetes, Department of Medicine, Heliotherapy, Light, and Skin Research Center, Boston University Medical Center, 801 Massachusetts Ave, Boston, MA, USA
| | - Julian Amon
- International Centre for Skin Diseases DermAllegra, Am Markgrafenpark 6, Pommelsbrunn-Hohenstadt, Germany
| |
Collapse
|
20
|
Serum vitamin D level in Egyptian children with atopic dermatitis and efficacy of vitamin D supplementation. JOURNAL OF THE EGYPTIAN WOMEN’S DERMATOLOGIC SOCIETY 2017. [DOI: 10.1097/01.ewx.0000516170.33041.a5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
21
|
Sharma S, Kaur T, Malhotra SK, Rai J, Chaudhari S. Correlation of Vitamin D3 Levels and SCORAD Index in Atopic Dermatits: A Case Control Study. J Clin Diagn Res 2017; 11:WC01-WC03. [PMID: 28893022 PMCID: PMC5583930 DOI: 10.7860/jcdr/2017/27188.10223] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 04/17/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Atopic Dermatitis (AD) is a common chronic inflammatory condition characterized clinically by pruritus and eczematous lesions. An inverse relationship has been suggested between serum 25-hydroxyvitamin D concentration and severity of atopic dermatitis. AIM We carried out this controlled cross-sectional study to evaluate the association between the serum vitamin D3 levels and SCORAD index. MATERIALS AND METHODS For this study, 40 patients with clinical diagnosis of AD based on UK diagnostic criteria were enrolled and 40 patients with minor ailments like superficial bacterial, fungal or viral infections and not suffering from atopic dermatitis were taken as controls. Salient presentations were recorded in a pre-set proforma. Serum 25-hydroxyvitamin D levels were determined through Sandwich-ELISA technique. SCORAD (Scoring AD) index was used to evaluate the severity of the disease. RESULTS Mean value of serum 25-hydroxyvitamin D levels in cases was 30.38 nmol/l whereas in controls, it was 53.46 nmol/l. The decrease in serum levels in cases was statistically highly significant (p-value <0.001). Mean±S.D of serum vitamin D levels in mild disease was 33.29±5.89 nmol/l, in moderate disease was 31.52±6.04 nmol/l and in severe form of disease was 21.24±3.17nmol/l. The correlation between SCORAD and serum 25-hydroxyvitamin D levels was also statistically significant. CONCLUSION The data suggests an inverse relationship between serum levels of vitamin D3 and the SCORAD Index.
Collapse
Affiliation(s)
- Saurabh Sharma
- Junior Resident, Department of Dermatology, Venereology and Leprosy, Govt. Medical College, Amritsar, Punjab, India
| | - Tejinder Kaur
- Associate Professor, Department of Dermatology, Venereology and Leprosy, Govt. Medical College, Amritsar, Punjab, India
| | - Suresh Kumar Malhotra
- Professor and Head, Department of Dermatology, Venereology and Leprosy, Govt. Medical College, Amritsar, Punjab, India
| | - Jaswant Rai
- Professor and Head, Department of Pharnacology, Govt. Medical College, Amritsar, Punjab, India
| | - Sunil Chaudhari
- Junior Resident, Department of Dermatology, Venereology and Leprosy, Govt. Medical College, Amritsar, Punjab, India
| |
Collapse
|
22
|
Jang YH, Sim HB, Moon SY, Lee WJ, Lee SJ, Jin M, Kim SH, Kim DW. House Dust Mite Sensitization Is Inversely Associated with Plasma 25-Hydroxyvitamin D3 Levels in Patients with Severe Atopic Dermatitis. Ann Dermatol 2017; 29:400-406. [PMID: 28761286 PMCID: PMC5500703 DOI: 10.5021/ad.2017.29.4.400] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 08/31/2016] [Indexed: 12/23/2022] Open
Abstract
Background The relationship between atopic dermatitis (AD) and low vitamin D levels has been studied. Emerging evidence has implicated vitamin D as a critical regulator of immunity, playing a role in both the innate and cell-mediated immune systems. However, the effect of vitamin D on house dust mite (HDM) sensitization in patients with AD has not been established. Objective We investigated the association between vitamin D levels and HDM sensitization according to AD severity. Methods In total, 80 patients (43 men and 37 women) with AD were included. We classified AD severity using Rajka and Langeland scores. Laboratory tests included serum 25-hydroxyvitamin D3, total immunoglobulin E (IgE), and specific IgE antibody titer against Dermatophagoides farinae and D. pteronyssinus. Results There were no differences in vitamin D levels between the mild or moderate AD and severe AD groups. In the severe AD group, high HDM sensitization group had lower serum vitamin D levels compared to low HDM sensitization group with statistical significance. In addition, a significant negative correlation was found between vitamin D levels and HDM sensitization in the severe AD group. Conclusion Our results demonstrate that low vitamin D levels may link to high HDM sensitization in patients with the severe AD. Further elucidation of the role of vitamin D in HDM sensitization may hold profound implications for the prevention and treatment of AD.
Collapse
Affiliation(s)
- Yong Hyun Jang
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hyun Bo Sim
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sun Young Moon
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Weon Ju Lee
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seok-Jong Lee
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Meiling Jin
- Department of Pharmacology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sang-Hyun Kim
- Department of Pharmacology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Do Won Kim
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
| |
Collapse
|
23
|
D'Auria E, Barberi S, Cerri A, Boccardi D, Turati F, Sortino S, Banderali G, Ciprandi G. Vitamin D status and body mass index in children with atopic dermatitis: A pilot study in Italian children. Immunol Lett 2017; 181:31-35. [PMID: 27838470 DOI: 10.1016/j.imlet.2016.11.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/27/2016] [Accepted: 11/08/2016] [Indexed: 12/24/2022]
|
24
|
Schlichte MJ, Vandersall A, Katta R. Diet and eczema: a review of dietary supplements for the treatment of atopic dermatitis. Dermatol Pract Concept 2016. [PMID: 27648380 DOI: 10.5826/dpc.0603a06.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2022] Open
Abstract
In the context of increasing popularity of "natural" alternatives to conventional medicine, several dietary supplements have gained the attention of researchers and consumers alike in the treatment of atopic dermatitis (AD). Readily available without a prescription and frequently perceived to have fewer side effects than traditional medications, these "natural" remedies may be featured in discussions with patients, and clinicians should therefore be familiar with their efficacy and safety. Based on trials to date, no dietary supplements can be recommended for routine use in the treatment of AD. However, some promising results have been noted from the use of probiotics and prebiotics taken in combination. Given significant differences in study design to date, however, further studies would be needed to clarify dose and strains of probiotics. Studies of vitamin D have been limited and have produced conflicting results, although further trials in selected subsets of patients may be indicated. Very limited data is available on fish oil supplements, while future studies on Chinese herbal medicine would require evaluation of comparable herbs and formulations. Finally, multiple trials of evening primrose oil and borage seed oil have shown improvement similar to placebo, and neither is currently recommended in eczema therapy.
Collapse
Affiliation(s)
- Megan J Schlichte
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Abbey Vandersall
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Rajani Katta
- Division of Dermatology, Houston Methodist Hospital, Houston, TX, USA
| |
Collapse
|
25
|
Schlichte MJ, Vandersall A, Katta R. Diet and eczema: a review of dietary supplements for the treatment of atopic dermatitis. Dermatol Pract Concept 2016; 6:23-9. [PMID: 27648380 PMCID: PMC5006549 DOI: 10.5826/dpc.0603a06] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 06/23/2016] [Indexed: 10/31/2022] Open
Abstract
In the context of increasing popularity of "natural" alternatives to conventional medicine, several dietary supplements have gained the attention of researchers and consumers alike in the treatment of atopic dermatitis (AD). Readily available without a prescription and frequently perceived to have fewer side effects than traditional medications, these "natural" remedies may be featured in discussions with patients, and clinicians should therefore be familiar with their efficacy and safety. Based on trials to date, no dietary supplements can be recommended for routine use in the treatment of AD. However, some promising results have been noted from the use of probiotics and prebiotics taken in combination. Given significant differences in study design to date, however, further studies would be needed to clarify dose and strains of probiotics. Studies of vitamin D have been limited and have produced conflicting results, although further trials in selected subsets of patients may be indicated. Very limited data is available on fish oil supplements, while future studies on Chinese herbal medicine would require evaluation of comparable herbs and formulations. Finally, multiple trials of evening primrose oil and borage seed oil have shown improvement similar to placebo, and neither is currently recommended in eczema therapy.
Collapse
Affiliation(s)
- Megan J Schlichte
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Abbey Vandersall
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Rajani Katta
- Division of Dermatology, Houston Methodist Hospital, Houston, TX, USA
| |
Collapse
|
26
|
Abstract
There has been a surge of new data regarding the pathophysiology of skin diseases. We are appreciating the sophisticated interplay among the skin, the immune system, and the environment. More elegant and highly specific medicines have been designed to target certain immune mediators of the adaptive immune system. In parallel fashion, we are learning more about the elegance of the innate immune system and how nutrition as early as the prenatal period can affect the priming of other immune cells. Concerns about the long-term impact of new immune-modulating medicines-especially in the pediatric population-have patients asking their dermatologists for nutritional alternatives to medical therapies. Nutrients and nutritional therapies appear to play a role at different ages for different dermatoses. Probiotics are showing promise as a therapeutic option for patients older than 1 year for atopic dermatitis. Systemic contact allergens appear to be a bigger burden on the adult population with atopic dermatitis. Obesity is a growing concern for both children and adults with psoriasis. Milk and high glycemic foods have a strong impact on the teenage acne population. Vitamins A and D are addressed as piece of the alopecia areata puzzle. Zinc and homeopathy are presented finally as possible treatments to the everlasting wart.
Collapse
Affiliation(s)
- Meagen McCusker
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT.
| | - Robert Sidbury
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| |
Collapse
|
27
|
Hwang JM, Oh SH, Shin MY. The relationships among birth season, sunlight exposure during infancy, and allergic disease. KOREAN JOURNAL OF PEDIATRICS 2016; 59:218-25. [PMID: 27279886 PMCID: PMC4897157 DOI: 10.3345/kjp.2016.59.5.218] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 10/22/2015] [Accepted: 11/09/2015] [Indexed: 01/04/2023]
Abstract
Purpose The recent increase in the prevalence of allergic diseases is hypothetically attributed to immune dysregulation in turn caused by a reduction in exposure to sunlight. We explored relationships between birth season, sunlight exposure, exercise duration, and an allergic disease. Methods We performed a questionnaire-based survey on allergic diseases among elementary school students. Birth time was categorized according to the season (summer and winter). Results The prevalence of atopic dermatitis (AD) "symptoms ever" was higher in the children born in winter than in those born in summer (adjusted odds ratio [aOR], 1.24; 95% confidence interval [CI], 1.03-1.49; P=0.024). Birth in winter was associated with an increase in the "symptoms in the past 12 months" prevalence of food allergy (FA) (aOR, 1.56; 95% CI, 1.09-2.24; P=0.015). The lifetime prevalence of allergic diseases except FA was higher in the children whose parents considered their sunlight exposure prior to 24 months of ageas inadequate than those who considered their exposure as adequate ("diagnosis ever" asthma: aOR, 1.4; 95% CI, 1.17-1.67; P<0.001; allergic rhinitis [AR]: aOR, 1.4; 95% CI, 1.17-1.67; P<0.001; AD: aOR, 1.26; 95% CI, 1.06-1.51; P=0.01). Neither recent sunlight exposure nor exercise duration was associated with the prevalence of an allergic disease. Conclusion Birth in winter may be associated with development of AD and FA. Inadequate sunlight exposure before the age of 24 months might possibly increase the risks of development of asthma, AR, and AD.
Collapse
Affiliation(s)
- Jung Min Hwang
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Se Hyun Oh
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Mee Yong Shin
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| |
Collapse
|
28
|
Robl R, Uber M, Abagge KT, Lima MN, Carvalho VO. Serum Vitamin D Levels Not Associated with Atopic Dermatitis Severity. Pediatr Dermatol 2016; 33:283-8. [PMID: 26862046 DOI: 10.1111/pde.12795] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGOUND/OBJECTIVES The objective of the current study was to determine the relationship between serum vitamin D levels and the severity of atopic dermatitis (AD) in a Brazilian population. METHODS This was a cross-sectional study of patients younger than 14 years of age seen from April to November 2013. All patients fulfilled the Hanifin and Rajka Diagnostic Criteria for AD diagnosis. Disease severity was determined using the SCORing Atopic Dermatitis index and classified as mild (<25), moderate (25-50), or severe (>50). Serum vitamin D levels were classified as sufficient (≥30 ng/mL), insufficient (29-21 ng/mL), or deficient (≤20 ng/mL). RESULTS A total of 105 patients met the inclusion criteria. Mild AD was diagnosed in 58 (55.2%) children, moderate in 24 (22.8%), and severe in 23 (21.9%). Vitamin D deficiency was observed in 45 individuals (42.9%). Of these, 24 (53.3%) had mild AD, 13 (28.9%) moderate, and 8 (17.7%) severe. Insufficient vitamin D levels were found in 45 (42.9%) individuals; 24 (53.3%) had mild AD, 9 (20.0%) moderate, and 12 (26.7%) severe. Of the 15 individuals (14.2%) with sufficient vitamin D levels, 10 (60.7%) had mild AD, 2 (13.3%) moderate, and 3 (20.0%) severe. The mean vitamin D level was 22.1 ± 7.3 ng/mL in individuals with mild AD, 20.8 ± 6.5 ng/mL in those with moderate AD, and 21.9 ± 9.3 ng/mL in those with severe AD. Variables such as sex, age, skin phototype, season of the year, and bacterial infection were not significantly associated with vitamin D levels. CONCLUSION Levels of 25-hydroxyvitamin D were deficient or insufficient in 85% of the children, but serum vitamin D concentrations were not significantly related to AD severity.
Collapse
Affiliation(s)
- Renata Robl
- Division of Pediatric Dermatology, Department of Pediatrics, Federal University of Paraná, Hospital de Clínicas da UFPR, Curitiba, Parana, Brazil
| | - Marjorie Uber
- Division of Pediatric Dermatology, Department of Pediatrics, Federal University of Paraná, Hospital de Clínicas da UFPR, Curitiba, Parana, Brazil
| | - Kerstin Taniguchi Abagge
- Division of Pediatric Dermatology, Department of Pediatrics, Federal University of Paraná, Hospital de Clínicas da UFPR, Curitiba, Parana, Brazil
| | - Monica Nunes Lima
- Division of Pediatric Dermatology, Department of Pediatrics, Federal University of Paraná, Hospital de Clínicas da UFPR, Curitiba, Parana, Brazil
| | - Vânia Oliveira Carvalho
- Division of Pediatric Dermatology, Department of Pediatrics, Federal University of Paraná, Hospital de Clínicas da UFPR, Curitiba, Parana, Brazil
| |
Collapse
|
29
|
Abstract
Vitamin D has been suggested to have an important impact on a much wider aspects on human health than calcium homeostasis and mineral metabolism, specifically in the field of human immunology. It has been reported that vitamin D influences the regulation of both innate and adaptive immune systems, which makes the association between vitamin D and allergic diseases a field of interest. Although many studies have sought to determine whether vitamin D has an influence on progression of allergic disease, the impact of vitamin D on atopic dermatitis development and severity remains unclear. In this review, we summarize recent studies relating vitamin D to atopic dermatitis and discuss its possible role in the pathogenesis of allergic skin diseases, emphasizing the need for well-designed, prospective trials on vitamin D supplementation in the context of prevention and treatment for allergic conditions.
Collapse
|
30
|
Quirk SK, Rainwater E, Shure AK, Agrawal DK. Vitamin D in atopic dermatitis, chronic urticaria and allergic contact dermatitis. Expert Rev Clin Immunol 2016; 12:839-47. [PMID: 27014952 DOI: 10.1586/1744666x.2016.1171143] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Vitamin D influences allergen-induced pathways in the innate and adaptive immune system, and its potential immunomodulatory role in allergic skin disorders has been explored. This comprehensive review article provides an overview of the role of vitamin D in three common dermatologic conditions: atopic dermatitis (AD), chronic urticaria, and allergic contact dermatitis (ACD). Whereas the literature regarding vitamin D and AD has resulted in mixed findings, several studies have described an inverse relationship between vitamin D levels and AD severity, and improvement in AD with vitamin D supplementation. Similarly, several studies report an inverse relationship between vitamin D levels and severity of chronic urticaria. Although current research in humans remains limited, an increased likelihood of ACD has been demonstrated in vitamin D-deficient mice. Additional well-designed clinical trials will be necessary to determine whether vitamin D supplementation should be recommended for prevention or adjuvant treatment of these common dermatologic conditions.
Collapse
Affiliation(s)
- Shannon K Quirk
- a Department of Clinical & Translational Science , Creighton University School of Medicine , Omaha , NE , USA
| | - Ellecia Rainwater
- a Department of Clinical & Translational Science , Creighton University School of Medicine , Omaha , NE , USA
| | - Anna K Shure
- a Department of Clinical & Translational Science , Creighton University School of Medicine , Omaha , NE , USA
| | - Devendra K Agrawal
- a Department of Clinical & Translational Science , Creighton University School of Medicine , Omaha , NE , USA
| |
Collapse
|
31
|
Abstract
Atopic dermatitis (AD), or eczema, is a chronic inflammatory skin condition characterized by relapsing pruritic, scaly, erythematous papules and plaques frequently associated with superinfection. The lifelong prevalence of AD is over 20 % in affluent countries. When a child with severe AD is not responding to optimized topical therapy including phototherapy, and relevant triggers cannot be identified or avoided, systemic therapy should be considered. If studies show early aggressive intervention can prevent one from advancing along the atopic march, and relevant triggers such as food allergies cannot be either identified or avoided, systemic therapy may also play a prophylactic role. Though the majority of evidence exists in adult populations, four systemic non-specific immunosuppressive or immunomodulatory drugs have demonstrated efficacy in AD and are used in most patients requiring this level of intervention regardless of age: cyclosporine, mycophenolate mofetil, methotrexate, and azathioprine. This article reviews the use of these medications as well as several promising targeted therapies currently in development including dupilumab and apremilast. We briefly cover several other systemic interventions that have been studied in children with atopic dermatitis.
Collapse
Affiliation(s)
- Eliza R Notaro
- Dermatology Division, Seattle Children's Hospital, University of Washington School of Medicine, 2480 Birch Ave N #1105, Seattle, WA, 98109, USA.
| | - Robert Sidbury
- Dermatology Division, Seattle Children's Hospital, OC.9.835-Dermatology, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| |
Collapse
|
32
|
Tamašauskienė L, Gasiūnienė E, Lavinskienė S, Sakalauskas R, Šitkauskienė B. Evaluation of vitamin D levels in allergic and non-allergic asthma. MEDICINA-LITHUANIA 2015; 51:321-7. [PMID: 26739673 DOI: 10.1016/j.medici.2015.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 09/23/2015] [Accepted: 11/10/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVE Some researches show that low vitamin D may play a role in asthma pathogenesis. The aim of this study was to evaluate the serum vitamin D level in asthmatics with different phenotypes and to determine its associations with lung function, IgE, eosinophil count and body mass index (BMI). MATERIALS AND METHODS The study population comprised 85 patients with asthma and 73 healthy persons. Patients with asthma were divided into groups according to phenotypes. Allergy was assessed using a skin prick test and measuring eosinophil count in peripheral blood and total IgE in serum. Lung function was evaluated by spirometry. Concentration of vitamin D (25(OH)D3) was measured using a commercial ELISA kit. Smoking history was assessed and BMI was calculated for all individuals. RESULTS The vitamin D level was lower in asthmatics than in the control group (14.36±0.57 vs. 22.13±0.84 ng/mL, P<0.01). There were no significant differences in the vitamin D level between the groups with allergic and non-allergic asthma (14.36±0.77 vs. 14.35±0.74 ng/mL). The low vitamin D level increased the risk of asthma 1.2 times (OR, 1.194; 95% CI, 1.109-1.286, P<0.01). The vitamin D level did not correlate with lung function and markers of allergy in asthmatic patients. The vitamin D level correlated with FEV1/FVC (rs=0.72, P<0.05) in smoking patients with asthma. Correlation between the vitamin D level and BMI was found in all studied subjects (rs=-0.18, P<0.05). CONCLUSIONS The vitamin D level was lower in asthmatic patients than in healthy individuals despite their hypersensitivity and increase risk of asthma. There was no relation between the vitamin D level and lung function, eosinophil count and total IgE level, whereas the lower vitamin D level was associated with higher BMI.
Collapse
Affiliation(s)
- Laura Tamašauskienė
- Department of Pulmonology and Immunology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Edita Gasiūnienė
- Department of Pulmonology and Immunology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Simona Lavinskienė
- Department of Pulmonology and Immunology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Raimundas Sakalauskas
- Department of Pulmonology and Immunology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Brigita Šitkauskienė
- Department of Pulmonology and Immunology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| |
Collapse
|
33
|
Gilaberte Y, Sanmartín R, Aspiroz C, Hernandez-Martin A, Benito D, Sanz-Puertolas P, Alonso M, Torrelo A, Torres C. Correlation Between Serum 25-Hydroxyvitamin D and Virulence Genes of Staphylococcus aureus Isolates Colonizing Children with Atopic Dermatitis. Pediatr Dermatol 2015; 32:506-13. [PMID: 25491017 DOI: 10.1111/pde.12436] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The skin of children with atopic dermatitis (AD) is colonized with Staphylococcus aureus more frequently than that of their peers. We investigated the prevalence of skin and nares colonization by S. aureus in children with AD, the virulence genes of the isolates, and their association with allergy, AD severity, and serum vitamin D (25(OH)D). This was an observational, cross-sectional study in a sample of children diagnosed with AD in two settings in Spain. The samples were collected in 2012. Swabs from affected skin and nares were taken for microbiologic culture. The prevalence of S. aureus and presence of 17 staphylococcal virulence genes were studied using polymerase chain reaction. A total of 114 patients with a mean age of 5.7 ± 4.1 (range 3 mos to 14 yrs) were included in the study. Swabs were taken from the skin of 113 individuals with AD and from the nares of 85; 28.3% had S. aureus on the skin, which was significantly associated with positive allergen-specific immunoglobulin E antibodies and higher Scoring Atopic Dermatitis (SCORAD) scores in the multivariate analysis. The presence of virulence factors tsst-1, eta, cna, aur, and sec in cutaneous S. aureus isolates was associated with lower serum levels of 25(OH)D. S. aureus on nasal swabs correlated with its presence on the skin and was associated with lower 25(OH)D levels. In conclusion, S. aureus colonization is associated with allergy and severity in AD, whereas certain virulence genes are associated with lower serum 25(OH)D levels.
Collapse
Affiliation(s)
- Yolanda Gilaberte
- Department of Dermatology, Hospital San Jorge, Huesca, Spain.,Aragon Health Sciences Institute, Zaragoza, Spain
| | | | - Carmen Aspiroz
- Department of Microbiology, Hospital Royo Villanova, Zaragoza, Spain
| | | | - Daniel Benito
- Area of Biochemistry and Molecular Biology, University of La Rioja, Logroño, Spain
| | | | - Mercedes Alonso
- Department of Microbiology, Hospital Infantil del Niño Jesús, Madrid, Spain
| | - Antonio Torrelo
- Department of Dermatology, Hospital Infantil Universitario del Niño Jesús, Madrid, Spain
| | - Carmen Torres
- Area of Biochemistry and Molecular Biology, University of La Rioja, Logroño, Spain
| |
Collapse
|
34
|
Palmer DJ. Vitamin D and the Development of Atopic Eczema. J Clin Med 2015; 4:1036-50. [PMID: 26239464 PMCID: PMC4470215 DOI: 10.3390/jcm4051036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 05/07/2015] [Indexed: 01/14/2023] Open
Abstract
A “vitamin D hypothesis” has been proposed to explain the increased prevalence of eczema in regions with higher latitude. This review focuses on the current available evidence with regard to the possible effect of vitamin D on the development of atopic eczema. Observational studies have indicated a link between vitamin D status and eczema outcomes, including lower serum vitamin D levels associated with increased incidence and severity of eczema symptoms. Vitamin D is known to have a regulatory influence on both the immune system and skin barrier function, both critical in the pathogenesis of eczema. However heterogeneous results have been found in studies to date investigating the effect of vitamin D status during pregnancy and infancy on the prevention of eczema outcomes. Well-designed, adequately powered, randomised controlled trials are needed. The study design of any new intervention trials should measure vitamin D levels at multiple time points during the intervention, ultraviolet (UV) radiation exposure via the use of individual UV dosimeters, and investigate the role of individual genetic polymorphisms. In conclusion, the current available evidence does not allow firm conclusions to be made on whether vitamin D status affects the development of atopic eczema.
Collapse
Affiliation(s)
- Debra J Palmer
- School of Paediatrics and Child Health, The University of Western Australia, PO Box D184, Princess Margaret Hospital, Perth WA 6001, Australia.
| |
Collapse
|
35
|
Vitamin D and atopic dermatitis in childhood. J Immunol Res 2015; 2015:257879. [PMID: 25973433 PMCID: PMC4417995 DOI: 10.1155/2015/257879] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 01/09/2015] [Indexed: 12/26/2022] Open
Abstract
Vitamin D features immunomodulatory effects on both the innate and adaptive immune systems, which may explain the growing evidence connecting vitamin D to allergic diseases. A wealth of studies describing a beneficial effect of vitamin D on atopic dermatitis (AD) prevalence and severity are known. However, observations linking high vitamin D levels to an increased risk of developing AD have also been published, effectively creating a controversy. In this paper, we review the existing literature on the association between AD and vitamin D levels, focusing on childhood. As of today, the role of vitamin D in AD is far from clear; additional studies are particularly needed in order to confirm the promising therapeutic role of vitamin D supplementation in childhood AD.
Collapse
|
36
|
Cheon BR, Shin JE, Kim YJ, Shim JW, Kim DS, Jung HL, Park MS, Shim JY. Relationship between serum 25-hydroxyvitamin D and interleukin-31 levels, and the severity of atopic dermatitis in children. KOREAN JOURNAL OF PEDIATRICS 2015; 58:96-101. [PMID: 25861332 PMCID: PMC4388977 DOI: 10.3345/kjp.2015.58.3.96] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 08/29/2014] [Accepted: 09/25/2014] [Indexed: 01/22/2023]
Abstract
PURPOSE Atopic dermatitis (AD) is a chronic inflammatory relapsing skin disorder. Vitamin D plays a pivotal role in the development of AD, and interleukin (IL) 31 is known to be related to pruritus in AD. The aim of our study was to determine whether 25-hydroxyvitamin D (25(OH)D) levels are related to IL-31 levels or to the severity of AD. METHODS We enrolled 91 children with AD and 32 control subjects without history or symptoms of allergic diseases. Blood was drawn to evaluate complete blood cell count, total eosinophil count (TEC), and total IgE, specific IgE to common allergens, 25(OH)D, and IL-31 levels. Serum 25(OH)D and IL-31 levels were measured using high-performance liquid chromatography and enzyme-linked immunosorbent assay, respectively. The scoring atopic dermatitis (SCORAD) index was used to evaluate the severity of AD. RESULTS The mean 25(OH)D level was significantly lower in the AD group than in the control group; 25(OH)D decreased greatly in the moderate and severe AD groups compared with the mild AD group. Children with atopic sensitization showed significantly lower 25(OH)D levels than nonatopic children. However, serum IL-31 levels were not related to AD group, SCORAD index, or 25(OH)D levels. The SCORAD index was inversely correlated with serum 25(OH)D level and positively correlated with TECs and total IgE levels. Children with moderate and severe AD had significantly higher TECs than children with mild AD. CONCLUSION Vitamin D is related to the severity of AD independently of IL-31.
Collapse
Affiliation(s)
- Bo Ram Cheon
- Department of Pediatrics, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Eun Shin
- Department of Pediatrics, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun Ji Kim
- Department of Pediatrics, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Won Shim
- Department of Pediatrics, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Deok Soo Kim
- Department of Pediatrics, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Lim Jung
- Department of Pediatrics, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Moon Soo Park
- Department of Pediatrics, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Yeon Shim
- Department of Pediatrics, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
37
|
Meyer R, De Koker C, Dziubak R, Skrapac AK, Godwin H, Reeve K, Chebar-Lozinsky A, Shah N. A practical approach to vitamin and mineral supplementation in food allergic children. Clin Transl Allergy 2015; 5:11. [PMID: 25780558 PMCID: PMC4361144 DOI: 10.1186/s13601-015-0054-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/23/2015] [Indexed: 01/05/2023] Open
Abstract
Background The management of food allergy in children requires elimination of the offending allergens, which significantly contribute to micronutrient intake. Vitamin and mineral supplementation are commonly suggested as part of dietary management. However a targeted supplementation regime requires a complete nutritional assessment, which includes food diaries. Ideally these should be analysed using a computerised program, but are very time consuming. We therefore set out to evaluate current practice of vitamin and mineral supplementation in a cohort of children with non-Immunoglobulin E (IgE) mediated food allergies. Methods This prospective, observational study recruited children aged 4 weeks – 16 years, who required to follow an elimination diet for non-IgE mediated allergies. Only children that improved according to a symptom score and were on a vitamin and/or mineral supplement were included. A 3-day food diary including vitamin and mineral supplementation was recorded and analysed using Dietplan computer program. We assessed dietary adequacy with/without the supplement using the Dietary Reference Values. Results One hundred-and-ten children had completed food diaries and of these 29% (32/110) were taking vitamin and/or mineral supplements. Children on hypoallergenic formulas were significantly (p = 0.007) less likely to be on supplements than those on alternative over-the-counter milks. Seventy-one percent had prescribable supplements, suggested by a dietitian/physician. Sixty percent of those without a vitamin supplement had a low vitamin D intake, but low zinc, calcium and selenium was also common. Of the supplemented cohort many continued to be either under or over-supplemented. Conclusion This study has raised the question for the first time, whether clinicians dealing with paediatric food allergies should consider routine vitamin and/or mineral supplements in the light of deficient intake being so common in addition to being so difficult to predict.
Collapse
Affiliation(s)
- Rosan Meyer
- Department Gastroenterology, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK
| | - Claire De Koker
- Department Nutrition and Dietetics, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Robert Dziubak
- Department Gastroenterology, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK
| | - Ana-Kristina Skrapac
- Department Nutrition and Dietetics, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Heather Godwin
- Department Gastroenterology, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK
| | - Kate Reeve
- Department Gastroenterology, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK
| | - Adriana Chebar-Lozinsky
- Department Gastroenterology, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK
| | - Neil Shah
- Department Gastroenterology, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK ; Institute of Child Health, University College London, London, UK
| |
Collapse
|
38
|
Silverberg JI. Association between childhood atopic dermatitis, malnutrition, and low bone mineral density: a US population-based study. Pediatr Allergy Immunol 2015; 26:54-61. [PMID: 25443466 DOI: 10.1111/pai.12315] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Children with atopic dermatitis (AD) have multiple risk factors for low bone mineral density (BMD). METHODS We analyzed data from 3049 children and adolescents aged 8-19 yrs from the 2005-2006 National Health and Nutrition Examination Survey, including a cross-sectional questionnaire, dual energy X-ray absorptiometry, and blood samples. RESULTS In multivariate models that controlled for age, sex, race/ethnicity, level of education and household income, body mass index (BMI), and smoking in the household, AD was associated with lower BMD z-score for the total femur (survey linear regression; adjusted β [95% CI]: -0.42 [0.68, -0.16]), including trochanter (-0.29 [-0.54, -0.05]) and femoral neck (-0.29 [-0.53, -0.05]) and total lumbar spine (-0.31 [-0.52, -0.11]). Children with AD had higher median levels of serum IgE (110.0 vs. 53.0 kU/l), peripheral lymphocyte (2.9 vs. 2.5 × 10(3) cells/μl), and eosinophil counts (0.3 vs. 0.2 × 10(3) cells/μl) (Mann-Whitney U-test, p ≤ 0.003 for all), but not CRP levels (0.03 vs. 0.04 mg/dl) and higher odds of 25-OH vitamin D deficiency (survey logistic regression; odds ratio [OR] [95% CI]: 4.81 [1.21, 20.81]), low calcium (2.56 [1.24, 5.28]), low alkaline phosphatase (2.56 [1.20, 5.44]), and higher tertiles of LDH (tertile 2: 6.36 [1.75, 23.18]; tertile-3: 4.57 [1.32, 15.85]), but not parathyroid hormone (PTH) or albumin. Finally, children with AD had higher rates of low BMD, that is, BMD z-score <-2, of the femur (23.4% vs. 18.4%) and spine (35.3% vs. 24.5%). In multivariate logistic regression models of low BMD of femur and/or spine using stepwise selection of the 30 sociodemographic and clinical factors, laboratory values, and medications used, AD remained a significant covariate (1.33 [1.32-1.34]). The covariates with the largest effects on low BMD were low PTH and albumin, higher basophil count, Hispanic ethnicity, and BMI <5th percentile. Among children with AD, 56.2% of those with Hispanic origin, 52.8% with BMI <5th percentile, 75.0% with low albumin, and 54.0% with low PTH had low BMD. CONCLUSIONS Children with AD have lower BMD, particularly those with malnutrition and Hispanic ethnicity.
Collapse
Affiliation(s)
- Jonathan I Silverberg
- Departments of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
39
|
Hwang YJ, Choi JW, Kim SW, Choi KH, Sung MS. Correlation between serum 25-hydroxyvitamin D 3and the severity of atopic dermatitis in children with allergic or nonallergenic sensitization. ALLERGY ASTHMA & RESPIRATORY DISEASE 2015. [DOI: 10.4168/aard.2015.3.3.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Yong Jin Hwang
- Department of Pediatrics, Busan St. Mary's Hospital, Busan, Korea
| | - Jin Wook Choi
- Department of Pediatrics, Busan St. Mary's Hospital, Busan, Korea
| | - Sung Woon Kim
- Department of Pediatrics, Busan St. Mary's Hospital, Busan, Korea
| | - Kwang Hae Choi
- Department of Pediatrics, Yeungnam University Medical Center, Daegu, Korea
| | - Myong Soon Sung
- Department of Pediatrics, CHA Gumi Medical Center, CHA University, Gumi, Korea
| |
Collapse
|
40
|
Della Giustina A, Landi M, Bellini F, Bosoni M, Ferrante G, Onorari M, Travaglini A, Pingitore G, Passalacqua G, Tripodi S. Vitamin D, allergies and asthma: focus on pediatric patients. World Allergy Organ J 2014; 7:27. [PMID: 25829979 PMCID: PMC4363348 DOI: 10.1186/1939-4551-7-27] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 09/11/2014] [Indexed: 11/10/2022] Open
Abstract
In recent years, the interest of the scientific world towards vitamin D gradually increased, and several studies have been conducted to dissect its possible role in modulating the development/course of allergic diseases. Also, Vitamin D supplementation has been assessed as a beneficial approach for treating allergies in some, but not all studies. We reviewed herein the available and relevant literature concerning the possible links between Vitamin D, its supplementation and allergic diseases. A literature search was made independently by the Authors, identifying articles for a narrative review. As per literature, Vitamin D plays a key role in calcium and phosphate metabolism, and it is essential for bone health in infants, children and adolescents. However, there is presently insufficient evidence to support vitamin D supplementation for prevention or treatment of allergic diseases in infants, children and adolescents, concerning allergic rhinitis, asthma, food allergy and atopic dermatitis.
Collapse
Affiliation(s)
| | - Massimo Landi
- Department of Pediatrics, National Healthcare System ASL TO1, Turin, Italy
| | - Federica Bellini
- Pediatric Unit Department of Gynecologic, Obstetric and Pediatric Sciences, University of Bologna, Bologna, Italy
| | | | - Giuliana Ferrante
- Department of Sciences for Health Promotion and mother and child, University of Palermo, Palermo, Italy
| | - Marzia Onorari
- Department of Prato, Environmental Protection Agency of Tuscany (ARPAT), Prato, Italy
| | | | | | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS San Martino-Ist-University of Genoa, Pad. Maragliano, L.go R Benzi 10, 16133 Genoa, Italy
| | - Salvatore Tripodi
- Department of Pediatrics and Allergy Unit Sandro Pertini Hospital, Rome, Italy
| |
Collapse
|
41
|
Cipriani F, Dondi A, Ricci G. Recent advances in epidemiology and prevention of atopic eczema. Pediatr Allergy Immunol 2014; 25:630-8. [PMID: 25406640 DOI: 10.1111/pai.12309] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2014] [Indexed: 12/22/2022]
Abstract
Atopic dermatitis (AD), named also atopic eczema, is a chronic relapsing inflammatory skin disease with a considerable social and economic burden. The primum movens of AD is in most cases a genetic and/or immune-supported defect of the skin barrier, facilitating penetration and sensitization to food or airborne allergens, as well as infections by Staphylococcus aureus, herpes simplex virus, or other microbes. New pathogenetic concepts have generated new approaches to prevention and therapy of AD. In particular, the daily use of emollients in newborns at high risk of AD has shown interesting results, with a reduction in the cumulative incidence of AD ranging from 32% to 50% of the treated infants. On the other hand, the AD preventive efficacy of food and/or inhalant allergen avoidance has been questioned, and supplementation strategies (vitamin D, probiotics, or other compounds) need to be further investigated.
Collapse
Affiliation(s)
- Francesca Cipriani
- Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | | |
Collapse
|
42
|
Yu SJ, Liao EC, Tsai JJ. House dust mite allergy: environment evaluation and disease prevention. Asia Pac Allergy 2014; 4:241-52. [PMID: 25379484 PMCID: PMC4215436 DOI: 10.5415/apallergy.2014.4.4.241] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 10/14/2014] [Indexed: 02/05/2023] Open
Abstract
There are two groups of dust mites, house dust mites (HDMs) and storage mites (SMs), that have been identified in the household environment. Both could induce airway inflammation through activation of innate and adaptive immunity and lead to asthma. In order to monitor environmental dust mite infestation, different methods can be used to detect their presence, such as the use of floating methods, monoclonal antibodies, and nanostructured biosensor. SM could be identified in the storage room, mainly in contaminated food such as mushrooms and corn starch. In HDM-sensitive subjects and mice that were challenged with HDM or SM after sensitization, these mites could up-regulate IgE levels, T helper 2 associated cytokine production and airway hypersensitivity. Different age groups of subjects were sensitized by different species of mites. More subjects above 70 years were sensitized by SM and more subjects below the age of 40 years were sensitized to HDM. Different allergenic components of dust mite extracts, such as Der p 1, Der p 2, could activate innate immunity through activating pattern recognition receptor (PRR) and then lead to allergic inflammation. The best modality to treat HDM allergy is immunomodulation through Treg cells and IgA production. In the recent years, many studies indicated probiotics could increase IgA secretion and the number of Treg cells. However, some studies conducted in adults have contradictory effects in reducing allergic symptoms. Therefore, probiotics confer inconclusive benefits on the allergic symptoms.
Collapse
Affiliation(s)
- Sheng-Jie Yu
- Institute of Biomedical Sciences, National Chung Hsing University, Taichung 40705, Taiwan. ; Section of Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - En-Chih Liao
- Center for Translational Medicine, Department of Medical Research, Taichung Veterans General Hospital, Taichung 40705, Taiwan. ; Department of BioIndustry Technology, Da Yeh University, Changhua 51591, Taiwan. ; Department of Medical Technology, Jen Ten College of Medicine, Nursing and Management, Miaoli 35664, Taiwan
| | - Jaw-Ji Tsai
- Institute of Biomedical Sciences, National Chung Hsing University, Taichung 40705, Taiwan. ; Section of Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan. ; Institute of Clinical Medicine, National Yang Ming University, Taipei 11221, Taiwan
| |
Collapse
|
43
|
Meyer R, De Koker C, Dziubak R, Godwin H, Dominguez-Ortega G, Shah N. Dietary elimination of children with food protein induced gastrointestinal allergy - micronutrient adequacy with and without a hypoallergenic formula? Clin Transl Allergy 2014; 4:31. [PMID: 25328667 PMCID: PMC4201676 DOI: 10.1186/2045-7022-4-31] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 09/18/2014] [Indexed: 12/19/2022] Open
Abstract
Background The cornerstone for management of Food protein-induced gastrointestinal allergy (FPGIA) is dietary exclusion; however the micronutrient intake of this population has been poorly studied. We set out to determine the dietary intake of children on an elimination diet for this food allergy and hypothesised that the type of elimination diet and the presence of a hypoallergenic formula (HF) significantly impacts on micronutrient intake. Method A prospective observational study was conducted on children diagnosed with FPIGA on an exclusion diet who completed a 3 day semi-quantitative food diary 4 weeks after commencing the diet. Nutritional intake where HF was used was compared to those without HF, with or without a vitamin and mineral supplement (VMS). Results One-hundred-and-five food diaries were included in the data analysis: 70 boys (66.7%) with median age of 21.8 months [IQR: 10 - 67.7]. Fifty-three children (50.5%) consumed a HF and the volume of consumption was correlated to micronutrient intake. Significantly (p <0.05) more children reached their micronutrient requirements if a HF was consumed. In those without a HF, some continued not to achieve requirements in particular for vitamin D and zinc, in spite of VMS. Conclusion This study points towards the important micronutrient contribution of a HF in children with FPIGA. Children, who are not on a HF and without a VMS, are at increased risk of low intakes in particular vitamin D and zinc. Further studies need to be performed, to assess whether dietary intake translates into actual biological deficiencies.
Collapse
Affiliation(s)
- Rosan Meyer
- Gastroenterology Department, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK
| | - Claire De Koker
- Gastroenterology Department, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK ; Department of Nutrition and Dietetics, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Robert Dziubak
- Gastroenterology Department, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK
| | - Heather Godwin
- Gastroenterology Department, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK
| | - Gloria Dominguez-Ortega
- Gastroenterology and Nutrition Department, Niño Jesús Children University Hospital, Madrid, Spain
| | - Neil Shah
- Gastroenterology Department, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK ; Katholic University Hospital, TARGID, Leuven, Belgium
| |
Collapse
|
44
|
Ronceray S, Benkalfate L, Saillard C, Ezzedine K, Adamski H, Dupuy A, Droitcourt C. Sévérité de la dermatite atopique et taux de vitamine D : étude transversale. Ann Dermatol Venereol 2014; 141:265-71. [DOI: 10.1016/j.annder.2014.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 10/28/2013] [Accepted: 01/10/2014] [Indexed: 01/16/2023]
|
45
|
Borzutzky A, Camargo CA. Role of vitamin D in the pathogenesis and treatment of atopic dermatitis. Expert Rev Clin Immunol 2014; 9:751-60. [DOI: 10.1586/1744666x.2013.816493] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
46
|
|