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van Dalen M, Pasmans SGMA, Aendekerk EWC, Mathijssen IMJ, Koudstaal MJ, Williamson H, Hillegers MHJ, Utens EMWJ, Okkerse JME. Acceptability and feasibility of an online psychosocial intervention for Dutch adolescents with a visible difference: A mixed-methods study. Body Image 2022; 41:298-307. [PMID: 35378339 DOI: 10.1016/j.bodyim.2022.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
Abstract
Adolescents with a visible difference can experience difficult social situations, (e.g., people staring or making unwanted comments) and are at risk for mental health problems. Unfortunately, interventions for adolescents with a visible difference experiencing appearance-related distress are scarce and lack an evidence-base. This study tests the acceptability and feasibility of YP Face IT, an innovative online psychological intervention using social skills training and cognitive behavioural therapy, to Dutch adolescents. Adolescents aged 12-17 with a visible difference and access to an internet-enabled computer or tablet participated. They completed YP Face IT (eight sessions) and questionnaires were administered pre- and post-intervention. After completing YP Face IT, participants were interviewed to assess the acceptability and feasibility of YP Face IT and study procedures. Overall, 15 adolescents consented to participation, one person dropped out after one session. Most adolescents appreciated the intervention and all would recommend it to other adolescents experiencing appearance-related distress. Everyone reported learning experiences after following the sessions. Some struggled with motivation, but reminders by the website and research team were helpful. The Dutch YP Face IT intervention may be acceptable and the current study design is feasible to use. An RCT should be conducted to assess the effectiveness of the intervention.
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Affiliation(s)
- M van Dalen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, The Netherlands
| | - S G M A Pasmans
- Department of Dermatology, Erasmus MC Sophia Children's Hospital, The Netherlands
| | - E W C Aendekerk
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, The Netherlands
| | - I M J Mathijssen
- Department of Plastic and Reconstructive Surgery and Hand Surgery, The Dutch Craniofacial Centre, Erasmus MC Sophia Children's Hospital, The Netherlands
| | - M J Koudstaal
- Department of Oral and Maxillofacial Surgery, The Dutch Craniofacial Centre, Erasmus MC Sophia Children's Hospital, The Netherlands
| | - H Williamson
- Department of Social Sciences, University of the West of England, United Kingdom
| | - M H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, The Netherlands
| | - E M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, The Netherlands; Research Institute of Child Development and Education, University of Amsterdam, The Netherlands; Academic Center for Child Psychiatry Levvel/Department of Child and Adolescent Psychiatry, Academic University Medical Center, The Netherlands
| | - J M E Okkerse
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, The Netherlands.
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Cuperus E, Bygum A, Boeckmann L, Bodemer C, Bolling MC, Caproni M, Diociaiuti A, Emmert S, Fischer J, Gostynski A, Guez S, van Gijn ME, Hannulla-Jouppi K, Has C, Hernández-Martín A, Martinez AE, Mazereeuw-Hautier J, Medvecz M, Neri I, Sigurdsson V, Suessmuth K, Traupe H, Oji V, Pasmans SGMA. Proposal for a 6-step-approach for differential diagnosis of neonatal erythroderma. J Eur Acad Dermatol Venereol 2022; 36:973-986. [PMID: 35238435 PMCID: PMC9310754 DOI: 10.1111/jdv.18043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 12/15/2021] [Accepted: 02/03/2022] [Indexed: 11/28/2022]
Abstract
The broad differential diagnosis of neonatal erythroderma often poses a diagnostic challenge. Mortality of neonatal erythroderma is high due to complications of the erythroderma itself and the occasionally severe and life-threatening underlying disease. Early correct recognition of the underlying cause leads to better treatment and prognosis. Currently, neonatal erythroderma is approached by a case by case basis. The purpose of this scoping review was to develop a diagnostic approach in neonatal erythroderma. After a systematic literature search in Embase (January 1990 - May 2020, 74 cases of neonatal erythroderma were identified, and 50+ diagnoses could be extracted. Main causes were the ichthyoses (40%) and primary immunodeficiencies (35%). Congenital erythroderma was present in 64% (47/74) of the cases, predominantly with congenital ichthyosis (11/11; 100%), Netherton syndrome (12/14, 86%), and Omenn syndrome (11/23, 48%). Time until diagnosis ranged from 102 days to 116 days for cases of non-congenital erythroderma and congenital erythroderma respectively. Among the 74 identified cases a total of 17 patients (23%) died within a mean of 158 days and were related to Omenn syndrome (35%), graft versus host disease (67%), and Netherton syndrome (18%). Disease history and physical examination are summarized in this paper. Age of onset and a collodion membrane can help to narrow the differential diagnoses. Investigations of blood, histology, hair analysis, genetic analysis and clinical imaging are summarized and discussed. A standard blood investigation is proposed and the need for skin biopsies with Lympho-Epithelial Kazal-Type related Inhibitor-staining is highlighted. Overall, this review shows that diagnostic procedures narrow the differential diagnosis in neonatal erythroderma. A 6-step flowchart for the diagnostic approach for neonatal erythroderma during the first month of life is proposed. The approach was made with the support of expert leaders from international multidisciplinary collaborations in the European Reference Network Skin-subthematic group Ichthyosis.
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Affiliation(s)
- E Cuperus
- Erasmus MC University Medical Center Rotterdam-Sophia Children's Hospital, Department of Dermatology, Center of Pediatric Dermatology, The Netherlands
| | - A Bygum
- University of Southern Denmark, Clinical Institute, Denmark & Odense University Hospital, Department of Clinical Genetics, Denmark
| | - L Boeckmann
- University Medical Center Rostock. Clinic and Policlinic for Dermatology and Venereology. Rostock, Germany
| | - C Bodemer
- Department of Dermatology, Reference Center for Genodermatoses (MAGEC), Necker-Enfants Malades Hospital (AP-HP5), Paris-Centre University, Imagine Institute, INSERM, Paris, France
| | - M C Bolling
- University of Groningen, University Medical Center Groningen, Department of Dermatology, Groningen, the Netherlands
| | - M Caproni
- Department of Health Sciences, Section of Dermatology, USL Toscana Centro, Rare Diseases Unit, University of Florence, Florence, Italy
| | - A Diociaiuti
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - S Emmert
- University Medical Center Rostock. Clinic and Policlinic for Dermatology and Venereology. Rostock, Germany
| | - J Fischer
- Institute of Human Genetics, Medical Faculty and Medical Center, University of Freiburg, Freiburg, Germany
| | - A Gostynski
- Department of Dermatology, Maastricht University Medical Center, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S Guez
- Pediatrics Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - M E van Gijn
- University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, the Netherlands
| | - K Hannulla-Jouppi
- Department of Dermatology and Allergology, University of Helsinki and Helsinki University Central Hospital, HUS, Helsinki, Finland
| | - C Has
- Department of Dermatology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - A E Martinez
- Pediatric Dermatology, NHS Foundation Trust, Great Ormond Street, London, UK
| | - J Mazereeuw-Hautier
- Dermatology Department, Reference Center for Rare Skin Diseases, Toulouse, France
| | - M Medvecz
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - I Neri
- Dermatology - IRCCS Policlinico di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES) Alma Mater, Studiorum University of Bologna, Bologna, Italy
| | - V Sigurdsson
- University Medical Center Utrecht and Utrecht University, Department of Dermatology, Utrecht, The Netherlands
| | - K Suessmuth
- Department of Dermatology, University Hospital of Münster, Münster, Germany
| | - H Traupe
- Department of Dermatology, University Hospital of Münster, Münster, Germany
| | - V Oji
- Department of Dermatology, University Hospital of Münster, Münster, Germany
| | - S G M A Pasmans
- Erasmus MC University Medical Center Rotterdam-Sophia Children's Hospital, Department of Dermatology, Center of Pediatric Dermatology, The Netherlands
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Fledderus AC, Pasmans SGMA, Wolkerstorfer A, Oei W, Etchevers HC, van Kessel MS, van der Horst CMAM, Spuls PI. Domains and outcomes of the core outcome set of congenital melanocytic naevi for clinical practice and research (the OCOMEN project): part 2. Br J Dermatol 2021; 185:970-977. [PMID: 33959942 PMCID: PMC9290785 DOI: 10.1111/bjd.20437] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 11/30/2022]
Abstract
Background Congenital melanocytic naevi (CMN) can have a great impact on patients’ lives owing to perceived stigmatization, and the risk of melanoma development and neurological complications. Development of a core outcome set (COS) for care and research in CMN will allow standard reporting of outcomes. This will enable comparison of outcomes, allowing professionals to offer advice about the best management options. In previous research, stakeholders (patients, parents and professionals) reached consensus on the core domains of the COS. To select the appropriate measurement instruments, the domains should be specified by outcomes. Objectives To reach consensus on the specific core outcomes describing the core domains pertaining to clinical care and research in CMN. Methods A list of provisional outcomes (obtained earlier) was critically reviewed by the Outcomes for COngenital MElanocytic Naevi (OCOMEN) research team and by relevant stakeholders through an online questionnaire, to refine this list and provide clear definitions for every outcome. When needed, discussion with individual participants was undertaken over the telephone or by email. During an online consensus meeting, stakeholders discussed the inclusion of potential outcomes. After the meeting, participants voted in two rounds for the inclusion of outcomes. Results Forty‐four stakeholders from 19 countries participated. Nine core outcomes were included in the COS relative to clinical care and 10 core outcomes for research. Conclusions These core outcomes will enable standard reporting in future care and research of CMN. This study facilitates the next step of COS development: selecting the appropriate measurement instruments for every outcome. What is already known about this topic?Congenital melanocytic naevi (CMN) can be associated with psychosocial burden and increased risk of melanoma and/or neurological complications. Outcomes measured for research and care in CMN are heterogeneous, impeding comparison. A core outcome set (COS) may enhance standardized use and reporting, and reduce selective reporting bias. In previous research, relevant stakeholders reached consensus on what domains should be included in the core domain set (CDS).
What does this study add?To select the appropriate measurement instruments for the domains included in the CDS, the domains should be further specified by outcomes. We reached consensus on what outcomes should describe the domains of the CDS of CMN care and research. Through a consensus procedure, including online discussions, online consensus meeting and voting, relevant stakeholders reached consensus on a limited number of core outcomes describing the core domains.
What are the clinical implications of this work?Development of a COS will allow standard reporting of outcomes in future care and research of CMN. This will enable pooling and comparison of outcomes, allowing guideline development of optimal management policy.
Linked Comment: M.V. Heppt et al. Br J Dermatol 2021; 185:881–882. Plain language summary available online
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Affiliation(s)
- A C Fledderus
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, the Netherlands.,Department of Dermatology, Amsterdam Public Health, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, the Netherlands
| | - S G M A Pasmans
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Sophia Children's Hospital, Doctor Molewaterplein 40, Rotterdam, 3015GD, the Netherlands
| | - A Wolkerstorfer
- Department of Dermatology, Amsterdam Public Health, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, the Netherlands
| | - W Oei
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Sophia Children's Hospital, Doctor Molewaterplein 40, Rotterdam, 3015GD, the Netherlands
| | - H C Etchevers
- Aix Marseille Univ, INSERM, MMG, Faculté de Médecine AMU, 27 boulevard Jean Moulin, Marseille, 13005, France
| | - M S van Kessel
- Patient representative, Naevus International, the Netherlands
| | - C M A M van der Horst
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, the Netherlands
| | - P I Spuls
- Department of Dermatology, Amsterdam Public Health, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, the Netherlands
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van Dalen M, Leemreis WH, Kraaij V, De Laat PCJ, Pasmans SGMA, Versnel SL, Koudstaal MJ, Hillegers MHJ, Utens EMWJ, Okkerse JME. Parenting Children With a Cleft Lip With or Without Palate or a Visible Infantile Hemangioma: A Cross-Sectional Study of Distress and Parenting Stress. Cleft Palate Craniofac J 2021; 58:1536-1546. [PMID: 33583213 PMCID: PMC8586175 DOI: 10.1177/1055665621993298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective: Parents of children with a medical condition and a visible difference can experience challenging situations. We evaluated distress and parenting stress in parents of children with a cleft lip with or without cleft palate (CL±P) or a visible infantile hemangioma (IH). Setting: This cross-sectional study took place in an academic medical hospital in Rotterdam, the Netherlands. Participants: Three-hundred nine parents (mean age = 40.30, 56.00% mothers) of children with CL±P and 91 parents (mean age = 36.40, 58.24% mothers) of children with IH. Main Outcome Measures: The Dutch version of the Parenting Stress Index – Short Form and the subscales Anxiety, Depression, and Hostility of the Symptom Checklist – 90. Results: One sample t tests and mixed linear modeling were used. On average, parents of children with CL±P and of children with IH showed significantly lower parenting stress compared to normative data. Anxiety was significantly lower in parents of children with CL±P than that in the norm group. Visibility of the condition was not related to distress or parenting stress. Child behavioral problems were positively related to parenting stress, depression, and hostility. Conclusions: Parents of children with CL±P and IH report less distress and parenting stress compared to the norm. On average, these parents seem well adjusted. A practical implication is to monitor parents of children with behavioral problems.
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Affiliation(s)
- M van Dalen
- Department of Child and Adolescent Psychiatry/Psychology, 97759Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - W H Leemreis
- Department of Child and Adolescent Psychiatry/Psychology, 97759Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - V Kraaij
- Department of Clinical Psychology, 4496Leiden University, the Netherlands
| | - P C J De Laat
- Department of Pediatrics, 97759Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - S G M A Pasmans
- Department of Dermatology, Centre of Pediatric Dermatology, 97759Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - S L Versnel
- Department of Plastic and Reconstructive Surgery and Hand Surgery, The Dutch Craniofacial Centre, 97759Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - M J Koudstaal
- Department of Oral and Maxillofacial Surgery, The Dutch Craniofacial Centre, 97759Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - M H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, 97759Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - E M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, 97759Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.,Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands.,Department of Child and Adolescent Psychiatry, Academic Center for Child Psychiatry Levvel, Amsterdam, the Netherlands
| | - J M E Okkerse
- Department of Child and Adolescent Psychiatry/Psychology, 97759Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
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van Dalen M, Dierckx B, Pasmans SGMA, Aendekerk EWC, Mathijssen IMJ, Koudstaal MJ, Timman R, Williamson H, Hillegers MHJ, Utens EMWJ, Okkerse JME. Anxiety and depression in adolescents with a visible difference: A systematic review and meta-analysis. Body Image 2020; 33:38-46. [PMID: 32092507 DOI: 10.1016/j.bodyim.2020.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 12/24/2022]
Abstract
Living with a visible difference can entail challenging social situations, associated with psychosocial symptoms. However, it is not clear whether adolescents with a visible difference experience more anxiety and depression than unaffected peers. We aim to determine whether adolescents with a visible difference experience more symptoms of anxiety and depression than unaffected peers. A literature search was conducted in Embase, Medline Ovid, Web of Science, Cochrane CENTRAL, PsycINFO Ovid, and Google Scholar. Meta-analyses were done using random-effects models to calculate a standardised mean difference. Analyses for subgroups were used to study causes of visible difference. Eleven studies were identified (n = 1075, weighted mean age = 15.80). Compared to unaffected peers, adolescents with a visible difference experience more symptoms of anxiety (SMD = 0.253, 95 % CI [0.024, 0.482], p = .030), but not depression (SMD = 0.236, 95 % CI [-0.126, 0.599], p = .202). Adolescents with a skin condition did not experience more symptoms of anxiety (SMD = 0.149, 95 % CI [-0.070, 0.369], p = .182) or depression (SMD = 0.090, 95 % CI [-0.082, 0.262], p = .305) when compared to unaffected peers. Overall, more symptoms of anxiety are found in adolescents with a visible difference compared to peers. No differences in anxiety or depression were found for skin differences. Screening for anxiety is recommended.
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Affiliation(s)
- M van Dalen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, the Netherlands
| | - B Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, the Netherlands
| | - S G M A Pasmans
- Department of Dermatology, Erasmus MC - Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, the Netherlands
| | - E W C Aendekerk
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, the Netherlands
| | - I M J Mathijssen
- Department of Plastic and Reconstructive Surgery and Hand Surgery, The Dutch Craniofacial Centre, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, the Netherlands
| | - M J Koudstaal
- Department of Oral and Maxillofacial Surgery, The Dutch Craniofacial Centre, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, the Netherlands
| | - R Timman
- Department of Psychiatry, Unit of Medical Psychology and Psychotherapy, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - H Williamson
- Department of Health and Social Sciences, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom
| | - M H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, the Netherlands
| | - E M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, the Netherlands; Research Institute of Child Development and Education, University of Amsterdam, P.O. Box 15780, 1001 NG, Amsterdam, the Netherlands; Academic Center for Child Psychiatry the Bascule/Department of Child and Adolescent Psychiatry, Academic Medical Center, P.O. Box 303, 1115 ZG, Duivendrecht, the Netherlands
| | - J M E Okkerse
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, the Netherlands.
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Hu C, Nijsten T, Pasmans SGMA, de Jongste JC, Jansen PW, Duijts L. Associations of eczema phenotypes with emotional and behavioural problems from birth until school age. The Generation R Study. Br J Dermatol 2019; 183:311-320. [PMID: 31730242 PMCID: PMC7496612 DOI: 10.1111/bjd.18705] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2019] [Indexed: 01/04/2023]
Abstract
Background Eczema phenotypes and emotional and behavioural problems are highly prevalent in childhood, but their mutual relationship is not fully clear. Objectives To examine the associations of eczema phenotypes with school‐age emotional and behavioural problems, and the bidirectional associations of eczema and emotional and behavioural problems from birth until 10 years. Methods This study among 5265 individuals was embedded in a prospective population‐based cohort study. Never, early transient, mid‐transient, late transient and persistent eczema phenotypes were identified based on parent‐reported, physician‐diagnosed eczema from age 6 months until 10 years. Emotional (internalizing) and behavioural (externalizing) problems were measured repeatedly using the Child Behavior Checklist from age 1·5 to 10 years. Cross‐lagged models were applied for bidirectional analyses. Results All eczema phenotypes were associated with more internalizing problems and attention problems at age 10 years, compared with never having eczema: range of Z‐score differences 0·14 [95% confidence interval (CI) 0·01–0·27] to 0·39 (95% CI 0·18–0·60). Children with early transient eczema had more aggressive behaviour symptoms at age 10 years (Z = 0·16, 95% CI 0·05–0·27). Bidirectional analysis showed that eczema at 0–2 years was associated with more internalizing and externalizing problems at ages 3–6 and 10 years, while, inversely, only internalizing problems at 0–2 years were associated with an increased risk of eczema at age 10 years. Conclusions Eczema phenotypes are very modestly associated with more somatic symptoms and attention problems at school age. Early transient eczema is associated with more aggressive behaviour symptoms. Directional effects seem to occur from early‐life eczema to later‐life internalizing and externalizing problems, rather than the reverse. What's already known about this topic? Previous cohort studies using non‐data‐driven methods to define eczema phenotypes observed that children with early‐onset and persistent eczema had a higher risk of emotional and behavioural problems in preadolescence. Alternatively, previous cohort studies showed that children with emotional and behavioural problems had more severe eczema and eczema exacerbations in childhood. The direction of effects between eczema and emotional and behavioural problems is not fully clear.
What does this study add? Taking the variability of eczema onset and persistence within and between children over time into account, all identified eczema phenotypes were very modestly associated with more somatic symptoms and attention problems at school age. Directional effects seem to occur from eczema leading to emotional and behavioural problems, rather than the reverse. Future research should focus on the effect of early optimal eczema management on mental health disorders in children later in life.
Plain language summary available online
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Affiliation(s)
- C Hu
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - T Nijsten
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - S G M A Pasmans
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J C de Jongste
- Department of Paediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - P W Jansen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - L Duijts
- Department of Paediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Paediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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7
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Hu C, Duijts L, Erler NS, Elbert NJ, Piketty C, Bourdès V, Blanchet-Réthoré S, de Jongste JC, Pasmans SGMA, Felix JF, Nijsten T. Most associations of early-life environmental exposures and genetic risk factors poorly differentiate between eczema phenotypes: the Generation R Study. Br J Dermatol 2019; 181:1190-1197. [PMID: 30869802 PMCID: PMC6916296 DOI: 10.1111/bjd.17879] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2019] [Indexed: 12/23/2022]
Abstract
Background Childhood eczema is variable in onset and persistence. Objectives To identify eczema phenotypes during childhood, and their associations with early‐life environmental and genetic factors. Methods In this study of 5297 children from a multiethnic population‐based prospective cohort study, phenotypes based on parent‐reported physician‐diagnosed eczema from age 6 months to 10 years were identified using latent class growth analysis. Information on environmental factors was obtained using postal questionnaires. Four filaggrin mutations were genotyped and a risk score was calculated based on 30 genetic variants. Weighted adjusted multinomial models were used for association analyses. Results We identified the following five eczema phenotypes: never (76%), early transient (8%), mid‐transient (6%) and late transient (8%) and persistent eczema (2%). Early transient and persistent eczema were most common in first‐born children, those with a parental history of eczema, allergy or asthma and those with persistent wheezing [range of odds ratio (OR): 1.37, 95% confidence interval (CI) 1.07–1.74 and OR 3.38, 95%CI 1.95–5.85]. Early transient eczema was most common in male children only (OR 1·49, 95% CI 1·18–1·89). Children with late transient or persistent eczema were more often of Asian ethnicity (OR 2·04, 95% CI 1·14–3·65 and OR 3·08, 95% CI 1·34–7·10, respectively). Children with early, late transient and persistent eczema more often had a filaggrin mutation or additional risk alleles (range OR: 1.07, 95%CI 1.02–1.12 and OR 2.21, 95%CI 1.39–3.50). Eczema phenotypes were not associated with maternal education, breastfeeding, day care attendance and pet exposure. Conclusions Five eczema phenotypes were identified in a multiethnic paediatric population with limited differences in risk profiles, except for sex and ethnicity. What's already known about this topic? Two previous studies in longitudinal birth cohorts identified four and six different eczema phenotypes, predominantly in children of European ethnicity.
What does this study add? Five eczema phenotypes were identified in a multiethnic paediatric population using latent class growth analysis. Children with early transient and persistent eczema were most often first‐born children and had persistent wheezing, filaggrin mutation or additional risk alleles. Previously known eczema risk factors had limited differentiating capabilities for eczema phenotypes, except for the association of early transient eczema with male children, and late transient and persistent eczema with Asian ethnicity.
https://doi.org/10.1111/bjd.18575 available online https://www.bjdonline.com/article/most-associations-of-early-life-environmental-exposures-and-genetic-risk-factors-poorly-differentiate-between-eczema-phenotypes-the-generation-r-study/
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Affiliation(s)
- C Hu
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - L Duijts
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - N S Erler
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - N J Elbert
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - C Piketty
- CUTIS (Clinical Unit for Tests and Imaging of Skin), Evaluation Department, Nestlé Skin Health/Galderma Research and Development, Sophia-Antipolis, France
| | - V Bourdès
- CUTIS (Clinical Unit for Tests and Imaging of Skin), Evaluation Department, Nestlé Skin Health/Galderma Research and Development, Sophia-Antipolis, France
| | - S Blanchet-Réthoré
- CUTIS (Clinical Unit for Tests and Imaging of Skin), Evaluation Department, Nestlé Skin Health/Galderma Research and Development, Sophia-Antipolis, France
| | - J C de Jongste
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - S G M A Pasmans
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J F Felix
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - T Nijsten
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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8
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Totté JEE, Pardo LM, Fieten KB, Vos MC, van den Broek TJ, Schuren FHJ, Pasmans SGMA. Nasal and skin microbiomes are associated with disease severity in paediatric atopic dermatitis. Br J Dermatol 2019; 181:796-804. [PMID: 30737999 DOI: 10.1111/bjd.17755] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Alterations of the skin microbiome have been associated with atopic dermatitis (AD) and its severity. The nasal microbiome in relation to AD severity is less well studied. OBJECTIVES We aimed to characterize the nasal and skin microbiomes in children with AD in relation to disease severity. In addition, we explored the differences and correlations between the nasal and skin communities. METHODS We characterized the microbial composition of 90 nasal and 108 lesional skin samples cross-sectionally from patients with AD, using 16S-rRNA sequencing. In addition, a quantitative polymerase chain reaction was performed for Staphylococcus aureus and Staphylococcus epidermidis on the skin samples, and AD severity was estimated using the self-administered Eczema Area and Severity Index. RESULTS We found an association between the microbial composition and AD severity in both the nose and skin samples (R2 = 2·6%; P = 0·017 and R2 = 7·0%; P = 0·004), strongly driven by staphylococci. However, other species also contributed, such as Moraxella in the nose. Skin lesions were positive for S. aureus in 50% of the children, and the presence and the load of S. aureus were not associated with AD severity. Although the nose and skin harbour distinct microbial communities (n = 48 paired samples; P < 0·001), we found that correlations exist between species in the nose and (other) species on the skin. CONCLUSIONS Our results indicate that both the nasal and the skin microbiomes are associated with AD severity in children and that, next to staphylococci, other species contribute to this association.
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Affiliation(s)
- J E E Totté
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - L M Pardo
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - K B Fieten
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands.,Swiss Institute of Allergy and Asthma Research (SIAF), University of Zürich, Davos, Switzerland
| | - M C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - F H J Schuren
- Microbiology and Systems Biology Group, TNO, Zeist, the Netherlands
| | - S G M A Pasmans
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of (Pediatric) Dermatology, Erasmus MC University Medical Center Rotterdam, Sophia Children's Hospital, Rotterdam, the Netherlands
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9
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Fieten KB, Schappin R, Zijlstra WT, Rijssenbeek-Nouwens L, Meijer Y, Pasmans SGMA. Predictors of treatment success in children with difficult to treat atopic dermatitis using a personalized integrative multidisciplinary (PIM) treatment programme. J Eur Acad Dermatol Venereol 2018; 33:376-383. [PMID: 30198582 DOI: 10.1111/jdv.15244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 08/27/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND A 6-week personalized integrative multidisciplinary treatment programme (PIM) was developed for children with difficult to treat AD who appeared unresponsive to treatment according to current guidelines. OBJECTIVE The aim of the present study was to identify clinical and psychosocial characteristics that predict long-term treatment success after PIM. METHODS Treatment was considered successful when there was a 75% reduction on the Self-Administered Eczema Area and Severity Index and/or little impact of AD on daily life, measured with the Children's Dermatology Life Quality Index (score ≤ 6), 6 months after the end of PIM. PIM is a personalized, integrative, multidisciplinary treatment programme with clearly defined goals and strategies, addressing atopic, paediatric, mental health comorbidities and general well-being, for children and adolescents aged 8- to 18 years. Multivariate logistic regression models were constructed using a backward selection procedure. Questionnaires were used to assess psychosocial characteristics; clinical data was extracted from medical records. RESULTS In total, 79 children/adolescents with difficult to treat AD completed PIM and long-term treatment results were available for 74 children/adolescents. The majority (77%) of children/adolescents demonstrated long-term treatment success with PIM. Predictors of long-term treatment success (adjusted ORs) included maternal disease acceptance OR (95% CI) 1.84 (1.15-2.94). A group (23%) of mostly females OR (95% CI) 0.10 (0.02-0.54) with multiple somatic complaints OR (95% CI) 0.88(0.80-0.97), from families where the mother has anxiety for the use of topical corticosteroids OR (95% CI) 0.62(0.40-0.94), is less likely to obtain long-term treatment success. CONCLUSION Most children and adolescents with difficult to treat AD, seemingly unresponsive to conventional treatment according to current guidelines, are able to improve with PIM. Psychosocial and family but not clinical variables, predicted long-term treatment success after participating in PIM.
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Affiliation(s)
- K B Fieten
- Department of (Pediatric) Dermatology/Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,Merem Dutch Asthma Center Davos, Davos, Switzerland.,Swiss Institute of Allergy and Asthma Research (SIAF), University of Zürich, Davos, Switzerland
| | - R Schappin
- Department of Pediatric Psychology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W T Zijlstra
- Department of (Pediatric) Dermatology/Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Y Meijer
- Department of Pediatric Pulmonology/Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S G M A Pasmans
- Department of (Pediatric) Dermatology/Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of (Pediatric) Dermatology, Sophia Children's Hospital, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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10
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Masthoff LJN, Pasmans SGMA, Doorn H, Hartog Jager CF, Geneugelijk K, Knol EF, Bruijnzeel‐Koomen CAFM, Lidholm J, Knulst AC, Hoffen E. Major hazelnut and peanut allergens are potent in basophil activation and cross-react at T-cell level. Allergy 2018; 73:2080-2082. [PMID: 29885257 DOI: 10.1111/all.13498] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- L. J. N. Masthoff
- Department of Dermatology/Allergology University Medical Center Utrecht Utrecht The Netherlands
| | - S. G. M. A. Pasmans
- Department of Dermatology/Allergology University Medical Center Utrecht Utrecht The Netherlands
| | - H. Doorn
- Department of Dermatology/Allergology University Medical Center Utrecht Utrecht The Netherlands
| | - C. F. Hartog Jager
- Department of Dermatology/Allergology University Medical Center Utrecht Utrecht The Netherlands
| | - K. Geneugelijk
- Department of Dermatology/Allergology University Medical Center Utrecht Utrecht The Netherlands
| | - E. F. Knol
- Department of Dermatology/Allergology University Medical Center Utrecht Utrecht The Netherlands
- Department of Immunology University Medical Center Utrecht Utrecht The Netherlands
| | | | | | - A. C. Knulst
- Department of Dermatology/Allergology University Medical Center Utrecht Utrecht The Netherlands
| | - E. Hoffen
- Department of Dermatology/Allergology University Medical Center Utrecht Utrecht The Netherlands
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11
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Totté JEE, Pardo LM, Fieten KB, de Wit J, de Boer DV, van Wamel WJ, Pasmans SGMA. IgG response against Staphylococcus aureus is associated with severe atopic dermatitis in children. Br J Dermatol 2018; 179:118-126. [PMID: 29194572 DOI: 10.1111/bjd.16153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND An altered immune response against Staphylococcus aureus might contribute to inflammation and barrier damage in atopic dermatitis (AD). OBJECTIVES To profile IgG antibodies against 55 S. aureus antigens in sera of children with mild-to-severe AD and to evaluate the association between IgG levels and disease severity. METHODS In this cross-sectional study, we included children with AD from two interventional study cohorts, the Shared Medical Appointment (SMA) cohort (n = 131) and the older DAVOS cohort (n = 76). AD severity was assessed using the Self-Administered Eczema Area and Severity Index (SA-EASI) and levels of thymus and activation-regulated chemokine (TARC) in serum. IgG antibody levels against 55 S. aureus antigens were quantified simultaneously using a Luminex assay. Pair-wise correlations were calculated between the 55 IgG levels using the Spearman rank correlation test. Linear regression analysis was performed to test for associations between 55 IgG levels and SA-EASI and TARC, adjusting for age, sex and S. aureus colonization. RESULTS In the SMA cohort, 16 antigens were associated with SA-EASI and 12 with TARC (10 overlapping antigens; P-values 0·001-0·044). The associated IgG antibodies targeted mainly secreted proteins with immunomodulatory functions. In the DAVOS study, IgG levels against only four and one S. aureus antigen(s) were associated with SA-EASI and TARC, respectively (no overlap). CONCLUSIONS In young children, severity of AD is associated with an IgG response directed against S. aureus antigens with mainly immunomodulatory functions. These findings encourage further evaluation of the role of S. aureus in the pathogenesis of AD.
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Affiliation(s)
- J E E Totté
- Department of Dermatology, Sophia Children's Hospital, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - L M Pardo
- Department of Dermatology, Sophia Children's Hospital, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - K B Fieten
- Department of Dermatology and Allergology, University Medical Centre Utrecht, Utrecht, The Netherlands.,Swiss Institute of Allergy and Asthma Research (SIAF), University of Zürich, Davos, Switzerland
| | - J de Wit
- Department of Dermatology, Sophia Children's Hospital, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - D V de Boer
- Department of Dermatology, Sophia Children's Hospital, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - W J van Wamel
- Department of Medical Microbiology and Infectious Diseases, Sophia Children's Hospital, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - S G M A Pasmans
- Department of Dermatology, Sophia Children's Hospital, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Paediatric Dermatology, Sophia Children's Hospital, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
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12
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Heeringa JJ, Fieten KB, Bruins FM, van Hoffen E, Knol EF, Pasmans SGMA, van Zelm MC. Treatment for moderate to severe atopic dermatitis in alpine and moderate maritime climates differentially affects helper T cells and memory B cells in children. Clin Exp Allergy 2018; 48:679-690. [PMID: 29575251 DOI: 10.1111/cea.13136] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 02/13/2018] [Accepted: 02/25/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Treatment of atopic dermatitis (AD) is focused on topical anti-inflammatory therapy, epidermal barrier repair and trigger avoidance. Multidisciplinary treatment in both moderate maritime and alpine climates can successfully reduce disease activity in children with AD. However, it remains unclear whether abnormalities in B cell and T cell memory normalize and whether this differs between treatment strategies. OBJECTIVE To determine whether successful treatment in maritime and alpine climates normalizes B- and T lymphocytes in children with moderate to severe AD. METHODS The study was performed in the context of a trial (DAVOS trial, registered at Current Controlled Trials ISCRTN88136485) in which eighty-eight children with moderate to severe AD were randomized to 6 weeks of treatment in moderate maritime climate (outpatient setting) or in the alpine climate (inpatient setting). Before and directly after treatment, disease activity was determined with SA-EASI and serum TARC, and T cell and B cell subsets were quantified in blood. RESULTS Both treatment protocols achieved a significant decrease in disease activity, which was accompanied by a reduction in circulating memory Treg, transitional B cell and plasmablast numbers. Alpine climate treatment had a significantly greater effect on disease activity and was accompanied by a reduction in blood eosinophils and increases in memory B cells, CD8+ TemRO, CD4+ Tcm and CCR7+ Th2 subsets. CONCLUSIONS AND CLINICAL RELEVANCE Clinically successful treatment of AD induces changes in blood B- and T cell subsets reflecting reduced chronic inflammation. In addition, multidisciplinary inpatient treatment in the alpine climate specifically affects memory B cells, CD8+ T cells and Th2 cells. These cell types could represent good markers for treatment efficacy.
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Affiliation(s)
- J J Heeringa
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - K B Fieten
- Department of Dermatology and Allergology, University Medical Center, Utrecht, The Netherlands.,Merem Dutch Asthma Center Davos, Davos, Switzerland.,Swiss Institute of Allergy and Asthma Research (SIAF), University of Zürich, Davos, Switzerland
| | - F M Bruins
- Department of Dermatology and Allergology, University Medical Center, Utrecht, The Netherlands
| | - E van Hoffen
- Department of Dermatology and Allergology, University Medical Center, Utrecht, The Netherlands
| | - E F Knol
- Department of Dermatology and Allergology, University Medical Center, Utrecht, The Netherlands.,Department of Immunology, University Medical Center, Utrecht, The Netherlands
| | - S G M A Pasmans
- Department of Dermatology and Allergology, University Medical Center, Utrecht, The Netherlands
| | - M C van Zelm
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Immunology and Pathology, Central clinical school, Monash University, Melbourne, VIC, Australia.,Department of Allergy, Immunology & Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia
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13
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Fieten KB, Bruins FM, Zijlstra WT, Schappin R, Figee L, de Bruijn M, Russel IMB, van Os-Medendorp H, Pasmans SGMA. Parental treatment management skills in paediatric atopic dermatitis. Clin Exp Dermatol 2017; 43:461-463. [DOI: 10.1111/ced.13336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2017] [Indexed: 11/29/2022]
Affiliation(s)
- K. B. Fieten
- Department of (Pediatric) Dermatology and Allergology; Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht the Netherlands
| | - F. M. Bruins
- Department of (Pediatric) Dermatology and Allergology; Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht the Netherlands
| | - W. T. Zijlstra
- Department of (Pediatric) Dermatology and Allergology; Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht the Netherlands
| | - R. Schappin
- Department of (Pediatric) Dermatology and Allergology; Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht the Netherlands
| | - L. Figee
- Department of (Pediatric) Dermatology and Allergology; Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht the Netherlands
| | - M. de Bruijn
- Department of (Pediatric) Dermatology and Allergology; Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht the Netherlands
| | - I. M. B. Russel
- Department of (Pediatric) Dermatology and Allergology; Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht the Netherlands
| | - H. van Os-Medendorp
- Department of (Pediatric) Dermatology and Allergology; Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht the Netherlands
| | - S. G. M. A. Pasmans
- Department of (Pediatric) Dermatology and Allergology; Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht the Netherlands
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14
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Fieten KB, Schappin R, Zijlstra WT, Figee L, Beutler J, Raymakers F, van Os-Medendorp H, Stellato R, Vandewall M, Winkelhof J, Uniken Venema M, Bruijnzeel-Koomen CAFM, Rijssenbeek-Nouwens L, van der Ent CK, van Hoffen E, Meijer Y, Pasmans SGMA. Effectiveness of alpine climate treatment for children with difficult to treat atopic dermatitis: Results of a pragmatic randomized controlled trial (DAVOS trial). Clin Exp Allergy 2017; 48:186-195. [PMID: 29121432 DOI: 10.1111/cea.13058] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 11/02/2017] [Accepted: 11/05/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Alpine climate treatment has historically been used in Europe to treat atopic dermatitis (AD), but no randomized trials have been conducted to provide evidence for its effectiveness. OBJECTIVE To investigate the long-term effectiveness of alpine climate treatment for children with difficult to treat AD. MATERIALS & METHODS A pragmatic, open, randomized controlled trial was conducted. Children diagnosed with AD that was considered difficult to treat, aged between 8 and 18 years and willing to be treated in Switzerland were randomized to a six-week personalized integrative multidisciplinary treatment period in a clinical setting in the alpine climate (Switzerland) or an outpatient setting in moderate maritime climate (Netherlands). Study assessments were conducted at the Wilhelmina Children's Hospital; an electronic portal was used for the collection of questionnaire data. Primary outcomes were disease activity (SAEASI), quality of life (CDLQI) and catastrophizing thoughts (JUCKKI/JU) 6 months after intervention. Other assessments were immediately and 6 weeks after intervention. Subgroup analyses concerned asthma-related outcomes. Children were randomly assigned to either the intervention or control group using a covariate adaptive randomization method, taking age and asthma diagnosis into account. Children, parents and healthcare professionals involved in treatment were not blinded to group assignment. Data were analysed according to intention-to-treat with linear mixed-effects models for continuous outcomes. The trial is registered at Current Controlled Trials ISCRTN88136485. RESULTS Between 14 September 2010 and 30 September 2014, 88 children were enrolled in the trial, 84 children were randomized (41 assigned to intervention, 43 to control) of whom 77 completed the intervention (38 of 41 (93%) intervention, 39 of 43 (91%) control) and 74 completed follow-up (38 of 41 (93%) intervention, 36 of 43 (84%) control). Six months after intervention there were no significant differences between the groups on disease activity (SAEASI mean difference -3.4 (95%CI -8.5 to 1.7)), quality of life (CDLQI mean difference -0.3 (95%CI -2.0 to 1.4)) and catastrophizing thoughts (JUCCKI/JU subscale mean difference -0.7 (95%CI -1.4 to -0.0)). Immediately and 6 weeks after intervention, disease activity and quality of life were significantly different in favour of alpine climate treatment. Mean differences on SAEASI were -10.1 (95%CI -14.5 to -5.8) and -8.4 (95%CI -12.2 to -4.6) and on CDLQI -1.9 (95%CI -3.3 to -0.5) and -1.5 (95%CI -2.8 to -0.3) immediately and 6 weeks after the intervention, respectively. There were no long-term differences on asthma-related outcomes. Five serious adverse events occurred during the study period, which were not thought to be related to the treatment. CONCLUSIONS & CLINICAL RELEVANCE For children with difficult to treat AD, there was no additional long-term benefit of alpine climate treatment, in contrast to the short-term, compared to an outpatient treatment programme in moderate maritime climate, using a personalized integrative multidisciplinary treatment approach.
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Affiliation(s)
- K B Fieten
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.,Merem Dutch Asthma Center Davos, Davos, Switzerland.,Swiss Institute of Allergy and Asthma Research (SIAF), University of Zürich, Davos, Switzerland
| | - R Schappin
- Department of Pediatric Psychology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W T Zijlstra
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Figee
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Beutler
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F Raymakers
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H van Os-Medendorp
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R Stellato
- Department of Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Vandewall
- Merem Dutch Asthma Center Davos, Davos, Switzerland
| | - J Winkelhof
- Merem Dutch Asthma Center Davos, Davos, Switzerland
| | - M Uniken Venema
- Department of Pediatric Psychology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C A F M Bruijnzeel-Koomen
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - C K van der Ent
- Department of Pediatric Pulmonology/Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E van Hoffen
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Y Meijer
- Department of Pediatric Pulmonology/Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S G M A Pasmans
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of (Pediatric) Dermatology, Sophia Children's Hospital, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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15
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Elbert NJ, van Meel ER, den Dekker HT, de Jong NW, Nijsten TEC, Jaddoe VWV, de Jongste JC, Pasmans SGMA, Duijts L. Duration and exclusiveness of breastfeeding and risk of childhood atopic diseases. Allergy 2017; 72:1936-1943. [PMID: 28449362 DOI: 10.1111/all.13195] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Breastfeeding may have immune modulatory effects that influence the development of childhood allergic sensitization and atopic diseases. We aimed to examine the associations of breastfeeding with childhood allergic sensitization, inhalant or food allergy and eczema, and whether any association was affected by disease-related modification of the exposure or modified by maternal history of allergy, eczema, or asthma. METHODS This study among 5828 children was performed in a population-based prospective cohort from fetal life onwards. We collected information on duration (<2 months, 2-4 months, 4-6 months, and ≥6 months) and exclusiveness (nonexclusive vs exclusive for 4 months) of breastfeeding in infancy by postal questionnaires. At age 10 years, inhalant allergic sensitization and food-allergic sensitization were measured by skin prick tests, and physician-diagnosed inhalant and food allergy by a postal questionnaire. Data on parental-reported eczema were available from birth until age 10 years. RESULTS We observed no association of breastfeeding with any allergic sensitization, physician-diagnosed allergy, or combination of these outcomes. Shorter breastfeeding duration was associated with an overall increased risk of eczema (P-value for trend <.05). Nonexclusively breastfed children had an overall increased risk of eczema (adjusted odds ratio [95% confidence interval]: 1.11 [1.01, 1.23]), compared with children exclusively breastfed for 4 months. Risk period-specific sensitivity analyses, additional adjustment for ointment use for eczema at age 2 months, and cross-lagged modeling showed no consistent results for disease-related modification of the exposure. Results were not modified by maternal history of allergy, eczema, or asthma (lowest P-value for interaction=.13). CONCLUSION Shorter duration or nonexclusiveness of breastfeeding is associated with a weak overall increased risk of eczema but not allergic sensitization or physician-diagnosed allergy at age 10 years.
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Affiliation(s)
- N. J. Elbert
- The Generation R Study Group; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
- Department of Dermatology; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
| | - E. R. van Meel
- The Generation R Study Group; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
- Division of Respiratory Medicine and Allergology; Department of Pediatrics; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
- Department of Epidemiology; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
| | - H. T. den Dekker
- The Generation R Study Group; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
- Division of Respiratory Medicine and Allergology; Department of Pediatrics; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
- Department of Epidemiology; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
| | - N. W. de Jong
- Division of Allergology; Department of Internal Medicine; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
| | - T. E. C. Nijsten
- Department of Dermatology; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
| | - V. W. V. Jaddoe
- The Generation R Study Group; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
- Department of Epidemiology; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
- Department of Pediatrics; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
| | - J. C. de Jongste
- Division of Respiratory Medicine and Allergology; Department of Pediatrics; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
| | - S. G. M. A. Pasmans
- Department of Dermatology; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
| | - L. Duijts
- Division of Respiratory Medicine and Allergology; Department of Pediatrics; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
- Division of Neonatology; Department of Pediatrics; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
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16
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Elbert NJ, Duijts L, den Dekker HT, de Jong NW, Nijsten TEC, Jaddoe VWV, de Jongste JC, van Wijk RG, Tiemeier H, Pasmans SGMA. Maternal psychiatric symptoms during pregnancy and risk of childhood atopic diseases. Clin Exp Allergy 2017; 47:509-519. [PMID: 28109169 DOI: 10.1111/cea.12889] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/29/2016] [Accepted: 12/22/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Maternal psychiatric symptoms during pregnancy might affect the developing immune system and subsequent risk of childhood atopic diseases. OBJECTIVE Our aim was to examine the associations of maternal psychiatric symptoms during pregnancy with allergic sensitization, allergy and eczema in children until age 10 years. METHODS This study among 5205 children was performed in a population-based prospective cohort from foetal life onwards. We assessed maternal and paternal psychiatric symptoms (overall, depressive, anxiety) during pregnancy and at 36 months after delivery, and maternal psychiatric symptoms at 2 and 6 months after delivery using the Brief Symptom Inventory. Inhalant and food allergic sensitization were measured by skin prick tests, and physician-diagnosed inhalant and food allergy or eczema by questionnaires from birth until age 10 years. We used multivariate logistic regression, multinomial logistic regression or generalized estimating equation models where appropriate. RESULTS We observed no association of maternal psychiatric symptoms during pregnancy with allergic sensitization. Maternal overall psychiatric, depressive and anxiety symptoms during pregnancy were associated with an increased risk of inhalant allergy only (adjusted odds ratio (95% confidence interval) 1.96 (1.44, 2.65), 1.58 (1.25, 1.98) and 1.61 (1.27, 2.03), respectively, per 1-unit increase). Maternal overall psychiatric and anxiety symptoms during pregnancy were associated with an increased risk of eczema (1.21 (1.05, 1.39) and 1.15 (1.02, 1.29), respectively, per 1-unit increase). Effect estimates did not materially change when maternal psychiatric symptoms after delivery, or paternal psychiatric symptoms during pregnancy and after delivery were taken into account. CONCLUSIONS AND CLINICAL RELEVANCE Maternal psychiatric symptoms during pregnancy were associated with increased risks of childhood inhalant allergy and eczema, independent of maternal psychiatric symptoms after delivery and of paternal psychiatric symptoms.
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Affiliation(s)
- N J Elbert
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - L Duijts
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - H T den Dekker
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - N W de Jong
- Department of Internal Medicine, Division of Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - T E C Nijsten
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - V W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J C de Jongste
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - R Gerth van Wijk
- Department of Internal Medicine, Division of Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - H Tiemeier
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - S G M A Pasmans
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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17
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Ruitenberg G, Young-Afat DA, de Graaf M, Pasmans SGMA, Breugem CC. Ulcerated infantile haemangiomas: the effect of the selective beta-blocker atenolol on wound healing. Br J Dermatol 2016; 175:1357-1360. [PMID: 27105937 DOI: 10.1111/bjd.14687] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- G Ruitenberg
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre Utrecht, PO Box 85090, 3508, AB Utrecht, the Netherlands
| | - D A Young-Afat
- Department of Clinical Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - M de Graaf
- Department of Pediatric Dermatology and Allergology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, PO Box 85090, 3508, AB Utrecht, the Netherlands
| | - S G M A Pasmans
- Department of Pediatric Dermatology and Allergology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, PO Box 85090, 3508, AB Utrecht, the Netherlands.,Department of Pediatric Dermatology, Erasmus University Medical Centre Rotterdam, Sophia's Children Hospital, Rotterdam, the Netherlands
| | - C C Breugem
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre Utrecht, PO Box 85090, 3508, AB Utrecht, the Netherlands
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18
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Totté JEE, van der Feltz WT, Hennekam M, van Belkum A, van Zuuren EJ, Pasmans SGMA. Prevalence and odds of Staphylococcus aureus carriage in atopic dermatitis: a systematic review and meta-analysis. Br J Dermatol 2016; 175:687-95. [PMID: 26994362 DOI: 10.1111/bjd.14566] [Citation(s) in RCA: 235] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Staphylococcus aureus is increasingly implicated as a possible causal factor in the pathogenesis of atopic dermatitis (AD). However, the reported prevalence rates of skin and nasal colonization in the literature vary widely. OBJECTIVES This study evaluates the prevalence and odds of skin and nasal colonization with S. aureus in patients with AD. METHODS A systematic literature search was conducted. Odds ratios (ORs) for colonization in patients vs. controls and the prevalence of colonization in patients were pooled using the random-effects model. RESULTS Overall, 95 observational studies were included, of which 30 had a control group. The Newcastle-Ottawa Scale was used to assess study quality, with the majority of studies being of fair to poor quality. Patients with AD were more likely to be colonized with S. aureus than healthy controls [OR 19·74, 95% confidence interval (CI) 10·88-35·81]. Differences were smaller in nonlesional skin (OR 7·77, 95% CI 3·82-15·82) and in the nose (OR 4·50, 95% CI 3·00-6·75). The pooled prevalence of S. aureus colonization among patients was 70% for lesional skin, 39% for nonlesional skin and 62% for the nose. In lesional skin, meta-regression showed that the prevalence of colonization increased with disease severity. Study heterogeneity should be taken into consideration when interpreting the results. CONCLUSIONS These results demonstrate the importance of colonization with S. aureus in AD. Further evaluation of the mechanisms by which S. aureus influences inflammation is required in addition to the development of targeted strategies to decrease skin and nasal S. aureus load.
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Affiliation(s)
- J E E Totté
- Department of Dermatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.
| | - W T van der Feltz
- Molecular and Cellular Life Sciences, Utrecht University, Utrecht, the Netherlands
| | - M Hennekam
- Department of Dermatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - A van Belkum
- bioMérieux, Microbiology, La Balme Les Grottes, France.,Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - E J van Zuuren
- Department of Dermatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - S G M A Pasmans
- Department of Dermatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
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19
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Totté JEE, van der Feltz WT, Bode LGM, van Belkum A, van Zuuren EJ, Pasmans SGMA. A systematic review and meta-analysis on Staphylococcus aureus carriage in psoriasis, acne and rosacea. Eur J Clin Microbiol Infect Dis 2016; 35:1069-77. [PMID: 27151386 PMCID: PMC4902839 DOI: 10.1007/s10096-016-2647-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 04/09/2016] [Indexed: 10/28/2022]
Abstract
Staphylococcus aureus might amplify symptoms in chronic inflammatory skin diseases. This study evaluates skin and mucosal colonization with S. aureus in patients with psoriasis, acne and rosacea. A systematic literature search was conducted. Both odds ratios (OR) for colonization in patients versus controls and the prevalence of colonization in patients are reported. Fifteen articles about psoriasis and 13 about acne (12 having a control group) were included. No study in rosacea met our inclusion criteria. For psoriasis, one study out of three controlled studies showed increased skin colonization (OR 18.86; 95 % confidence interval [CI] 2.20-161.99). Three out of the five studies that reported on nasal colonization showed significant ORs varying from 1.73 (95 % CI 1.16-2.58) to 14.64 (95 % CI 2.82-75.95). For acne one of the three studies that evaluated skin colonization reported a significant OR of 4.16 (95 % CI 1.74-9.94). A relation between nasal colonization and acne was not found. Limitations in study design and low sample sizes should be taken into consideration when interpreting the results. Colonisation with S. aureus seems to be increased in patients with psoriasis. This bacterial species, known for its potential to induce long-lasting inflammation, might be involved in psoriasis pathogenesis. Information on acne is limited. Prospective controlled studies should further investigate the role of S. aureus in chronic inflammatory skin diseases.
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Affiliation(s)
- J E E Totté
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - W T van der Feltz
- Molecular and Cellular Life Sciences, Utrecht University, Utrecht, The Netherlands
| | - L G M Bode
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A van Belkum
- bioMérieux, Scientific Office, La Balme Les Grottes, France
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - E J van Zuuren
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - S G M A Pasmans
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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20
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Hermans MAW, Verburg M, van Laar JAM, van Hagen PM, Pasmans SGMA, van Daele PLA. [Systemic mastocytosis: a heterogeneous disease]. Ned Tijdschr Geneeskd 2016; 160:A9340. [PMID: 27229688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Systemic mastocytosis (SM) is an acquired myeloproliferative disease, which is caused by an uncontrolled proliferation of aberrant mast cells. SM patients can have very different clinical phenotypes and may therefore initially present to different specialties. Diagnosis is often delayed because many physicians are unfamiliar with this illness. This can lead to substantial morbidity and puts patients at risk of complications such as severe anaphylaxis. Measurement of serum tryptase levels is always a sensible first step in the diagnostic work-up, but a normal serum tryptase does not rule out SM completely, and a bone marrow biopsy is essential for a conclusive diagnosis. Here, we describe two patient cases to illustrate the heterogeneous nature of this disease, and provide an overview of the symptoms, diagnostic work-up and current treatments options for SM.
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21
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Verburg M, Oldhoff JM, Klemans RJB, Lahey-de Boer A, de Bruin-Weller MS, Röckmann H, Sanders C, Bruijnzeel-Koomen CAFM, Pasmans SGMA, Knulst AC. Rush immunotherapy for wasp venom allergy seems safe and effective in patients with mastocytosis. Eur Ann Allergy Clin Immunol 2015; 47:192-196. [PMID: 26549336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Patients with mastocytosis and wasp venom allergy (WA) may benefit from venom immunotherapy (VIT). However, fatal insect sting reactions have been described in mastocytosis patients despite previous immunotherapy. We investigated the safety and efficacy of (rush) VIT in patients with mastocytosis and WA. OBJECTIVE To investigate the safety and efficacy of (rush) VIT in patients with mastocytosis and WA. METHODS We describe nine patients with cutaneous mastocytosis and WA who received VIT. Cutaneous mastocytosis was confirmed by histopathology and systemic mastocytosis was diagnosed according to World Health Organization criteria. VIT was given according to a rush protocol. Given the difference in safety and efficacy of VIT in patients with WA and honeybee venom allergy, we reviewed the literature for VIT with the focus on WA patients with mastocytosis and addressed the difference between patients with cutaneous versus systemic mastocytosis. RESULTS Nine patients had WA and mastocytosis, of whom six had cutaneous mastocytosis, two combined cutaneous and systemic mastocytosis and one systemic mastocytosis. All patients received rush IT with wasp venom. Most patients had only mild local side effects, with no systemic side effects during the course of VIT. One patient had a systemic reaction upon injection on one occasion, during the updosing phase, with dyspnoea and hypotension, but responded well to treatment. Immunotherapy was continued after temporary dose adjustment without problems. Two patients with a previous anaphylactic reaction were re-stung, without any systemic effects. CONCLUSIONS VIT is safe in cutaneous mastocytosis patients with WA, while caution has to be made in case of systemic mastocytosis. VIT was effective in the patients who were re-stung.
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Affiliation(s)
- M Verburg
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J M Oldhoff
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R J B Klemans
- Department of Dermatology/Allergology University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands. Phone: +31 88 7553 235 E-mail:
| | - A Lahey-de Boer
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M S de Bruin-Weller
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H Röckmann
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C Sanders
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - S G M A Pasmans
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A C Knulst
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
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22
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Klemans RJB, Blom WM, van Erp FC, Masthoff LJN, Rubingh CM, van der Ent CK, Bruijnzeel-Koomen CAFM, Houben GF, Pasmans SGMA, Meijer Y, Knulst AC. Objective eliciting doses of peanut-allergic adults and children can be combined for risk assessment purposes. Clin Exp Allergy 2015; 45:1237-44. [DOI: 10.1111/cea.12558] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 03/23/2015] [Accepted: 03/24/2015] [Indexed: 11/29/2022]
Affiliation(s)
- R. J. B. Klemans
- Department of Dermatology and Allergology; University Medical Center Utrecht; Utrecht The Netherlands
| | - W. M. Blom
- The Netherlands Organisation for Applied Scientific Research (TNO); Zeist The Netherlands
| | - F. C. van Erp
- Department of Pediatric Pulmonology and Allergology; Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht The Netherlands
| | - L. J. N. Masthoff
- Department of Dermatology and Allergology; University Medical Center Utrecht; Utrecht The Netherlands
| | - C. M. Rubingh
- The Netherlands Organisation for Applied Scientific Research (TNO); Zeist The Netherlands
| | - C. K. van der Ent
- Department of Pediatric Pulmonology and Allergology; Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht The Netherlands
| | | | - G. F. Houben
- The Netherlands Organisation for Applied Scientific Research (TNO); Zeist The Netherlands
| | - S. G. M. A. Pasmans
- Department of Dermatology and Allergology; University Medical Center Utrecht; Utrecht The Netherlands
- Department of Pediatric Dermatology and Allergology; Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht The Netherlands
| | - Y. Meijer
- Department of Pediatric Pulmonology and Allergology; Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht The Netherlands
| | - A. C. Knulst
- Department of Dermatology and Allergology; University Medical Center Utrecht; Utrecht The Netherlands
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23
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Fieten KB, Weststrate ACG, van Zuuren EJ, Bruijnzeel-Koomen CA, Pasmans SGMA. Alpine climate treatment of atopic dermatitis: a systematic review. Allergy 2015; 70:12-25. [PMID: 25130620 DOI: 10.1111/all.12514] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2014] [Indexed: 11/28/2022]
Abstract
Climate therapy has been used for decades in the treatment of atopic dermatitis (AD), but evidence of its effectiveness has not yet been assessed systematically. A systematic literature search in Medline, Embase, and the Cochrane library was performed to identify all original studies concerning alpine climate treatment. The risk of bias of individual studies was assessed following the Cochrane Handbook, and level of evidence was rated using GRADE guidelines. Fifteen observational studies were included concerning 40 148 patients. Four studies concerning 2670 patients presented follow-up data over a period of 1 year. Disease activity decreased in the majority of patients during treatment (96% of n = 39 006) and 12-month follow-up (64% of n = 2670). Topical corticosteroid use could often be reduced or stopped during treatment (82% of n = 1178) and during 12-month follow-up (72% of n = 3008). Quality assessment showed serious study limitations, therefore resulting in a very low level of evidence for the described outcomes. Randomized controlled trials designed with a follow-up period including well-defined patient populations, detailed description and measurement of applied interventions during climate therapy and using validated outcomes including cost-effectiveness parameters, are required to improve the evidence for alpine climate therapy as an effective treatment for patients with AD.
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Affiliation(s)
- K. B. Fieten
- Department of (Pediatric) Dermatology and Allergology; University Medical Center Utrecht; Utrecht the Netherlands
- High Altitude Clinic Merem Dutch Asthma Center Davos; Davos Switzerland
| | - A. C. G. Weststrate
- Department of (Pediatric) Dermatology and Allergology; University Medical Center Utrecht; Utrecht the Netherlands
| | - E. J. van Zuuren
- Department of Dermatology; Leiden University Medical Center; Leiden The Netherlands
| | - C. A. Bruijnzeel-Koomen
- Department of (Pediatric) Dermatology and Allergology; University Medical Center Utrecht; Utrecht the Netherlands
| | - S. G. M. A. Pasmans
- Department of (Pediatric) Dermatology and Allergology; University Medical Center Utrecht; Utrecht the Netherlands
- Department of Pediatric Dermatology; Sophia Children's Hospital; Erasmus MC University Medical Center Rotterdam; Rotterdam the Netherlands
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24
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Klemans RJB, Liu X, Knulst AC, Knol MJ, Gmelig-Meyling F, Borst E, Pasmans SGMA, Knol EF. IgE binding to peanut components by four different techniques: Ara h 2 is the most relevant in peanut allergic children and adults. Clin Exp Allergy 2014; 43:967-74. [PMID: 23889250 DOI: 10.1111/cea.12136] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 04/16/2013] [Accepted: 04/19/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several studies have analysed the diagnostic value of specific IgE (sIgE) for individual peanut allergens. However, little is known about the concordance between different techniques available in both children and adults. OBJECTIVE To evaluate the value of individual peanut allergens by different techniques, i.e. multi-plexed microarray, single-plexed IgE assay, skin prick test (SPT) and immunoblot in both peanut allergic adults and children. METHODS Sensitization patterns to peanut allergens Ara h 1, 2, 3, and 8 were evaluated using four different techniques: multi-plexed microarray immunoassay, single-plexed IgE assay, SPT and immunoblot. Twenty-two peanut allergic adults and 15 children scored on clinical severity according to double-blind, placebo-controlled food challenges and 27 atopic control patients were included. RESULTS Comparable sensitivity values were found between all four techniques in adults, with the highest sensitivity for Ara h 2 (76.2-95.5%, compared to 100% with all techniques in children). The multi-plexed assay to Ara h 1 (93.3%) demonstrated a higher sensitivity compared with the other three techniques (P = 0.04) in children, but absolute values were perfectly correlated. There were no differences between adults and children. The area under the receiver operating characteristic curve (AUC) of sIgE to Ara h 1 was higher with the multi-plexed assay compared with the single-plexed assay (0.91 vs. 0.75). In adults, sIgE to Ara h 1, 2, and 3 was correlated with clinical severity. No such correlation was found in children. CONCLUSION AND CLINICAL RELEVANCE In conclusion, the single- and multi-plexed assay, SPT and immunoblot perform equally in both peanut allergic adults and children, with Ara h 2 being most often recognized with all techniques. Specific IgE to Ara h 1, 2, and 3 in adults was correlated with severity.
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Affiliation(s)
- R J B Klemans
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
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25
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Klemans RJB, Knol EF, Michelsen-Huisman A, Pasmans SGMA, de Kruijf-Broekman W, Bruijnzeel-Koomen CAFM, van Hoffen E, Knulst AC. Components in soy allergy diagnostics: Gly m 2S albumin has the best diagnostic value in adults. Allergy 2013; 68:1396-402. [PMID: 24117462 DOI: 10.1111/all.12259] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Thus far, four soy allergens have been characterized. Their diagnostic value was assessed only using a case-control design with controls not suspected of soy allergy or in a soy-allergic population without controls. Our objective was to analyze the diagnostic value of specific immunoglobulin E (sIgE) to Gly m 2S albumin, Gly m 4, 5, and 6, and their possible relation with severity or culprit soy product. METHODS Adult patients suspected of soy allergy were included (n = 46). Allergy was confirmed by challenge (n = 19) or history (n = 16) and excluded by challenge in 11 patients. Soy components were analyzed by ImmunoCAP. Diagnostic value was assessed in the challenged patient group by an area under receiver operating characteristic (ROC) curve (AUC). RESULTS Specific immunoglobulin E to Gly m 2S albumin had the highest AUC (0.79), comparable to skin prick test (SPT) and sIgE to soy extract (0.76 and 0.77, respectively). All patients were sensitized to either soy extract or Gly m 4 (sIgE ≥ 0.35 kU/l). sIgE to soy extract, Gly m 5, and Gly m 6 was significantly higher in patients with mild symptoms (P = 0.04, 0.02 and 0.02, respectively). Patients only reacting to soy milk had higher sIgE levels to Gly m 4 (median 9.8 vs 1.1 kU/l, P = 0.01). CONCLUSION Specific immunoglobulin E to Gly m 2S albumin had the best accuracy in diagnosing soy allergy. Gly m 5 and 6 were related to mild symptoms. Higher levels of Gly m 4 were related to allergy to soy milk.
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Affiliation(s)
- R J B Klemans
- Department of (Paediatric) Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
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van Os-Medendorp H, Koffijberg H, Eland-de Kok PCM, van der Zalm A, de Bruin-Weller MS, Pasmans SGMA, Ros WJG, Thio HB, Knol MJ, Bruijnzeel-Koomen CAFM. E-health in caring for patients with atopic dermatitis: a randomized controlled cost-effectiveness study of internet-guided monitoring and online self-management training. Br J Dermatol 2012; 166:1060-8. [PMID: 22268960 DOI: 10.1111/j.1365-2133.2012.10829.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Dermatology Department of the University Medical Centre Utrecht, the Netherlands, developed an e-health portal for patients with atopic dermatitis (AD), consisting of e-consultation, a patient-tailored website, monitoring and self-management training. OBJECTIVES To determine the cost-effectiveness of individualized e-health compared with usual face-to-face care for children and adults with AD. METHODS A randomized controlled cost-effectiveness study from a societal perspective in adults and parents of children with moderate AD. Outcomes were quality of life, severity of AD, itching and direct and indirect costs. Data were collected at baseline and at 3 and 12 months after randomization. Linear mixed models were used to analyse clinical outcomes. After multiple imputation of missing data, costs and differences in costs were calculated over a period of 1 year. RESULTS In total, 199 patients were included. There were no significant differences in disease-specific quality of life, severity of AD and intensity of itching between both groups at the three time points. The difference in direct costs between the intervention and control groups was €24 [95% confidence interval (CI) -360 to 383], whereas this difference was -€618 (95% CI -2502 to 1143) for indirect costs. Overall, individual e-health was expected to save €594 (95% CI -2545 to 1227) per patient in the first year of treatment, mainly through a reduction in work absenteeism. Uncertainty analyses revealed that the probability of e-health reducing costs was estimated to be ≥ 73%. CONCLUSIONS E-health during follow-up of patients with AD is, after initial diagnosis and treatment during face-to-face contact, just as effective as usual face-to-face care with regard to quality of life and severity of disease. However, when costs are considered, e-health is likely to result in substantial cost savings. Therefore, e-health is a valuable service for patients with AD.
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Affiliation(s)
- H van Os-Medendorp
- Department of Dermatology and Allergology, University Medical Centre Utrecht, Utrecht, the Netherlands.
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Schimmel RJ, Pasmans SGMA, Xu M, Stadhouders-Keet SAE, Shore EM, Kaplan FS, Wulffraat NM. GNAS-associated disorders of cutaneous ossification: two different clinical presentations. Bone 2010; 46:868-72. [PMID: 19900597 PMCID: PMC3501213 DOI: 10.1016/j.bone.2009.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 11/02/2009] [Accepted: 11/02/2009] [Indexed: 11/23/2022]
Abstract
Progressive osseous heteroplasia (POH) is a rare genetic disorder characterized by dermal ossification during infancy and progressive ossification into deep connective tissue during childhood. POH is at the severe end of a spectrum of GNAS-associated ossification disorders that include osteoma cutis and Albright Hereditary Osteodystrophy (AHO). Here we describe two girls who have different clinical presentations that reflect the variable expression of GNAS-associated disorders of cutaneous ossification. Each girl had a novel heterozygous inactivating mutation in the GNAS gene. One girl had POH limited to the left arm with severe contractures and growth retardation resulting from progressive heterotopic ossification in the deep connective tissues. The other girl had AHO with widespread, superficial heterotopic ossification but with little functional impairment. While there is presently no treatment or prevention for GNAS-associated ossification disorders, early diagnosis is important for genetic counselling and for prevention of iatrogenic harm.
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Affiliation(s)
- R J Schimmel
- Department of Paediatric Dermatology and Allergology, Wilhelmina's Children Hospital, University Medical Center Utrecht, 3508 AB Utrecht, The Netherlands
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Flinterman AE, Pasmans SGMA, den Hartog Jager CF, Hoekstra MO, Bruijnzeel-Koomen CAFM, Knol EF, van Hoffen E. T cell responses to major peanut allergens in children with and without peanut allergy. Clin Exp Allergy 2010; 40:590-7. [PMID: 20067479 DOI: 10.1111/j.1365-2222.2009.03431.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND T cell responses involved in peanut allergy are poorly understood. OBJECTIVE To investigate T cell responses towards major peanut allergens in peanut-allergic (PA) subjects compared with peanut-sensitized (PS) non-allergic children and non-atopic (NA) controls. METHODS Eighteen PA children, seven non-allergic PS children and 11 NA adults were included. Peripheral blood mononuclear cells were stimulated with a crude peanut extract (CPE). Short-term T cell lines were generated and subsequently stimulated with CPE and purified Ara h 1, Ara h 2, Ara h 3 and Ara h 6. The proliferation and production of IL-13, IFN-gamma, IL-10 and TNF-alpha were analysed. RESULTS Proliferation to CPE and major allergens was enhanced in PA subjects. The primary response to CPE was comparable with PS subjects, with increased production of IL-13 and IFN-gamma compared with NA. Production of IL-10 was not observed. In short-term T cell lines, the response to CPE was stronger in PA than in PS and NA subjects. Only PA children had a detectable response to major peanut allergens, characterized by IL-13 production. The response was the highest after Ara h 3 stimulation, and the lowest after Ara h 2 stimulation. No significant correlation was observed between peanut-specific IgE levels and T cell responses to CPE. CONCLUSION T cell responses to CPE in PA and PS children were characterized by Th1 and Th2 cytokines. Only PA children showed enhanced Th2 responses to Ara h 1, Ara h 3 and Ara h 6.
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Affiliation(s)
- A E Flinterman
- Departments of Dermatology/Allergology, UMC Utrecht, The Netherlands
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Schimmel RJ, Van Tuyll Van Serooskerke AM, Bladergroen RS, Van Steensel AM, van Geel M, Pasmans SGMA, Frank J. Exclusion of ferrochelatase gene mutations in patients with seasonal palmoplantar keratoderma. Cell Mol Biol (Noisy-le-grand) 2009; 55:111-117. [PMID: 19656459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Accepted: 05/20/2009] [Indexed: 05/28/2023]
Abstract
Erythropoietic protoporphyria (EPP) is an autosomal dominant disorder that results from a deficiency of ferrochelatase (FECH), the last enzyme in the heme biosynthetic pathway. The characteristic clinical symptoms usually manifest in early childhood on the sun-exposed areas of the body. They are due to protoporphyrin-induced photosensitivity and include pain, burning and stinging of the skin, followed by erythema and edema. Recently, the occurrence of predominantly seasonal palmar and palmoplantar keratoderma in patients with homozygous mutations in the FECH gene has been reported. These data suggested that palmoplantar keratoderma might be a clinical sign of EPP. Palmoplantar keratodermas (PPKs) are a heterogeneous group of genetic skin diseases and include a seasonal variant, erythrokeratolysis hiemalis et estivalis (EH), also known as keratolytic winter erythema. Because the skin symptoms in the latter disorder are similar to those reported for recessive EPP we examined the FECH gene in three unrelated Dutch Caucasian patients with a previous diagnosis of EH in whom mutations in several other genes had been excluded. However, sequencing analysis of the entire coding regions and the adjacent splice sites of the FECH gene in these individuals revealed absence of mutations. Hence, our data largely exclude the possibility that FECH mutations might be responsible for the palmoplantar skin phenotype observed in EH.
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Affiliation(s)
- R J Schimmel
- University Medical Center, Utrecht Medical School, The Netherlands
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Abstract
In Sweet's syndrome, the essential features are the characteristic morphology of the lesions, their histologic appearance, the dramatic response to corticosteroids and the absence of scarring. We report an 8-month-old infant in whom Sweet's syndrome was diagnosed and who developed acquired cutis laxa in the skin lesions.
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Affiliation(s)
- L Timmer-DE Mik
- Department of Dermatology and Allergology, University Medical Center, Utrecht, The Netherlands
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Flinterman AE, Knol EF, van Ieperen-van Dijk AG, Timmerman HM, Knulst AC, Bruijnzeel-Koomen CAFM, Pasmans SGMA, van Hoffen E. Probiotics have a different immunomodulatory potential in vitro versus ex vivo upon oral administration in children with food allergy. Int Arch Allergy Immunol 2007; 143:237-44. [PMID: 17290150 DOI: 10.1159/000099467] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2006] [Accepted: 11/24/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Previous studies suggest that administration of probiotics in vitro can stimulate regulatory and Th1 immune responses. We studied both the in vitro immunological effects of probiotics and the ex vivo immunological effects after oral administration of probiotics in children with food allergy, a Th2-mediated disease. METHODS Thirteen children were enrolled. Probiotics (n = 7) or placebo (n = 6) were orally administered during 3 months. At baseline and after 1 and 3 months, peripheral blood mononuclear cells were stimulated with crude peanut extract, anti-CD3, or anti-CD40 and IL-4 in the presence (in vitro response) or absence (ex vivo response) of probiotics. The proliferation and production of IFN-gamma, IL-5, IL-13, IL-10, TNF-alpha, IL-6 and IgE were analyzed. Sensitization to peanut, cow's milk and hen's egg was determined before and after treatment. RESULTS The in vitro addition of probiotics to peripheral blood mononuclear cell cultures resulted in enhanced proliferation and production of IFN-gamma, IL-10 and TNF-alpha. After oral treatment, proliferation in the presence of probiotics increased, whereas in vitro IgE production decreased in the probiotics group compared to baseline. The ex vivo production of IL-10, TNF-alpha and IL-6 tended to decrease. Th1 and Th2 cytokines were not altered. Sensitization remained unchanged. CONCLUSION Probiotics enhanced the production of Th1 and regulatory cytokines in vitro. Oral administration of probiotics resulted in a slightly decreased ex vivo production of IL-10, TNF-alpha and IL-6. This indicates that probiotics have a different potential to modulate the immune response in vitro versus ex vivo.
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Affiliation(s)
- A E Flinterman
- Department of Dermatology and Allergology, UMC Utrecht, Utrecht, The Netherlands
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Hoekstra MO, Meijer Y, Pasmans SGMA, Knulst AC. [Double-blind placebo-controlled cow's milk challenge for children in general hospitals]. Ned Tijdschr Geneeskd 2006; 150:1278-80. [PMID: 16821450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Every child with possible food allergies has the right to a double-blind, placebo-controlled cow's milk challenge. This test can be performed in the paediatric ward of a non-academic hospital. Challenge with other foodstuffs can lead to more serious side effects and therefore should be considered in a general hospital setting only after extensive experience with double-blind, placebo-controlled challenge for cow's milk has been obtained. Other items of international discussion on double-blind, placebo-controlled challenge in children are: the natural development of tolerance for cow's milk, IgE- versus non-IgE-mediated cow's milk allergy, and the exacerbation of pre-existing eczema during and after double-blind, placebo-controlled challenge.
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Affiliation(s)
- M O Hoekstra
- Afd. Dermatologie, Universitair Medisch Centrum Utrecht, Wilhelmina Kinderziekenhuis, Centrum voor Kinderallergologie, Postbus 85.090, 3508 AB Utrecht.
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Flinterman AE, Knulst AC, Meijer Y, Bruijnzeel-Koomen CAFM, Pasmans SGMA. Acute allergic reactions in children with AEDS after prolonged cow's milk elimination diets. Allergy 2006; 61:370-4. [PMID: 16436148 DOI: 10.1111/j.1398-9995.2006.01018.x] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Food allergy is not always correctly diagnosed in children with atopic eczema dermatitis syndrome (AEDS) and treatment with an avoidance diet is not without danger. METHODS After admission to our clinic, 11 children with a prolonged cow's milk (CM) elimination diet because of AEDS and sensitization underwent double-blind placebo-controlled food challenge (DBPCFC). Retrospectively, the exposure to CM, sensitization and reactions to accidental ingestion were carefully documented. The DBPCFC was used to evaluate the childrens' current status. RESULTS Before the elimination period (median 2.3 years; started before the admission) all 11 children with AEDS were sensitized and had ingested CM (four bottle-fed; seven breast-fed without CM diet of the mother) without the development of acute reactions. The diagnosis of CM allergy was not confirmed by DBPCFC previously. After elimination the AEDS had not improved, but nevertheless the diet was continued. During the elimination period, eight of 11 children developed severe acute allergic reactions to CM after accidental ingestion. In evaluation, in our clinic all 11 children experienced acute allergic reactions to CM during DBPCFC. CONCLUSION There is a considerable chance of developing acute allergic reactions to CM after elimination in children with AEDS without previous problems after CM intake.
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Affiliation(s)
- A E Flinterman
- Department of Dermatology/Allergology, University Medical Centre, Utrecht, Utrecht, the Netherlands
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Affiliation(s)
- J M Deckers-Kocken
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Huispost KE01.147.0, PO Box 85090, 3508 AB Utrecht, Netherlands.
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Schade RP, Meijer Y, Pasmans SGMA, Knulst AC, Kimpen JLL, Bruijnzeel-Koomen CAFM. [Double blind placebo controlled cow's milk provocation for the diagnosis of cow's milk allergy in infants and children]. Ned Tijdschr Geneeskd 2002; 146:1739-42. [PMID: 12357876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
OBJECTIVE To test a protocol for a double-blind placebo-controlled cow's milk provocation for the diagnosis of acute allergic reactions to milk in an outpatient setting. DESIGN Prospective, descriptive. METHOD During the period from June 1, 1999 to February 28, 2001 the protocol was tested on all infants and children who were referred to the Paediatric outpatient clinic of the University Medical Centre on Utrecht with symptoms indicative of cow's milk allergy. The protocol comprised of a phased administration of two test meals, one with a true feed and one with placebo, during the course of one day. In case of allergic symptoms the test was discontinued and the code was broken. A diagnosis of 'cow's milk allergy' was made if the symptoms appeared during the provocation with true feeding. RESULTS The test group (n = 154) consisted of 85 boys and 69 girls with ages ranging from 0.25 to 14 years (median 1.5). Acute type reactions to cow's milk occurred in 21 of the children who underwent the provocation. These reactions mainly consisted of cutaneous symptoms (erythema and urticaria). In none of these cases the symptoms were severe enough to require a prolonged stay in the hospital. There were no reactions on placebo meals nor acute reactions during the reintroduction of milk at home. CONCLUSION It is possible to perform double-blind placebo-controlled provocations routinely in the diagnostic work-up of children with a suspicion of cow's milk allergy.
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Affiliation(s)
- R P Schade
- Universitair Medisch Centrum Utrecht (UMCU), Postbus 85.090, 3508 AB Utrecht.
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