[RECOMMENDATION FOR ITCH ASSESSMENT FROM THE ATOPIC ITCH CONSENSUS MEETING (AICOM)].

BACKGROUND: Itch is the most troublesome symptom of atopic dermatitis, and it is important to assess it appropriately for optimal treatment. We discussed issues regarding itch and the most appropriate methods of assessment at the Atopic Itch Consensus Meeting (AICOM), attended by physicians and researchers with expertise in itch treatment and research. METHODS: The AICOM participants prepared a draft consensus statement that addressed the most appropriate itch assessment methods for age groups <2 years, 2-6 years, 7-14 years, and ≥15 years. Consensus was defined as agreement by ≥80% of the participants. RESULTS: Votes were cast by 20 participants (8 dermatologists, 7 pediatricians, and 5 researchers), and a consensus on the best current methods of itch assessment was reached with 95% agreement. For infants and preschool children, because subjective evaluation is difficult, a checklist for itch assessment was developed for caregivers. CONCLUSION: For itch assessment, we recommend subjective evaluation by the patient using a rating scale. For infants and preschoolers, evaluation should be done by the caregiver using a checklist, combined with objective evaluation (of skin lesions, for example) by a physician. We anticipate that more objective itch assessment indices will be established in the future.

Association of comorbidities and medications with risk of asthma exacerbation in pediatric patients: a retrospective study using Japanese claims data.

Asthma exacerbation impairs the quality of life of pediatric patients and negatively impacts future respiratory function and health economics. Several risk factors associated with exacerbations have been identified; however, most studies report the risk of each factor. Therefore, this study aimed to evaluate the risk of each factor and a combination of factors. We performed a retrospective cohort study using Japanese claims data and extracted factors associated with exacerbations using multivariate Cox proportional hazards regression and stepwise method. Risk scores were then calculated from the extracted factors and validated by tenfold cross validation. Of the 1,748,111 asthma patients in the database, the data of 14,980 were extracted, and 1988 (13.3%) had exacerbation. Factors associated with asthma exacerbation were age of 3-5 years, exacerbation history before cohort entry date, allergic rhinitis, chronic sinusitis, otitis externa, blepharitis, upper respiratory infections, urticaria, LTRA prescription, were determined. A four-level risk score was calculated from 9-factors and the AUC derived from cross validation was 0.700. Most factors extracted in our study are consistent with those of previous studies. We showed that combining each factor is more helpful in assessing the increased risk of asthma exacerbation than assessing each factor alone.

[Actigraphy for the assessment of sleep quality in pediatric atopic dermatitis patients].

BACKGROUND: Good sleep is essential for the growth and the development of children. However, sleep is often impaired in patients with atopic dermatitis (AD). It is important to assess the sleep quality in pediatric AD patients. For that purpose, we utilized actigraphy as an objective method for the assessment of sleep quality. METHODS: Childhood patients with AD (16 cases) and 8 non-allergic volunteers were recruited. Actiwatch (AW-64) was attached to each subject's wrist for 11 days at maximum. Sleep parameters were calculated with Actiware and compared among various patient groups. RESULTS: Results demonstrate that sleep was significantly compromised in patients with AD, according to the severity. Subjective scoring of the sleep quality by parents showed limited correlation with actigraphy. CONCLUSION: Actigraphy is an objective and unobtrusive method to measure the sleep quality in childhood AD patients and can provide useful outcome in clinical trial.

[Immunotherapy by Japanese cedarpollen in atpic dermatitis].

Atopic dermatitis positive to Japanese cedar pollen showed the recurrence or worsening of the symptoms during the pollen season. In 22 cases, 6 children (mean, 11.4 y) and 16 adults (29.5 y) who showed positive to Japanese cedar pollen by RAST, CAST analysis were done by Cry j 1 0.01 approximately 10 micro g/ml and they showed the significant higher simulation indices compared to controls (P<0.01). Randomized analysis of the hyposensitized patients (10 cases) and non-hyposensitized (12 cases) showed significant lower stimulation indices in hyposensitized patients (P<0.01). In six cases stimulation indices were compared after one year of hyposensitization therapy. Four cases to whom hyposensitization were newly introduced showed the significant decreases of stimulation indices: 19.83+/-4.97 (mean+/-SEM) to 6.84+/-6.36 (65.0%) by Cry j 1 0.01 microg/ml, 19.73+/-5.65 to 6.85+/-1.78 (65.3%) by 0.1, 17.88+/-5.11 to 6.36+/-1.53 (64.4%) by 1, and 20.03+/-5.29 to 6.11+/-1.39 (69.5%) by 10, and they showed the significant decreases (P<0.05). By anti-IgE it decreased significantly from 35.08+/-3.42 to 7.00+/-1.77 (79.7%) (P<0.01). In two cases who got hyposensitization therapy for 2 years and 1 1/2 years each, there were no significant decreases of stimulation indices. The symptoms improved significantly and there were little or no recurrence of the symptoms. Symptom scores (Rajka & Langeland) showed significant decreases. Thus, hyposensitization by cedar pollen in atopic dermatitis is a promising treatment.