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3.
Dermatol Res Pract ; 2020: 1524293, 2020.
Article in English | MEDLINE | ID: mdl-32318104

ABSTRACT

BACKGROUND: The purpose of this study was to gather information on the current assessment and management of patients with moderate-to-severe AD in routine daily practice. METHODS: A cross-sectional two-round Delphi survey with the participation of dermatologists and allergologists throughout Spain was conducted. They completed a 46-item questionnaire, and consensus was defined when responses of ≥80% of participants coincided in the categories of a 5-point Likert scale for that item. RESULTS: A total of 105 specialists (aged 40-59 years) completed the two rounds. Participants agreed regarding the consideration of AD as a multifaceted disease and the differences in clinical presentation of AD according to the patient's age. It is recommendable to perform a skin biopsy to exclude early stage T-cell cutaneous lymphoma, psoriasis, or dermatitis herpetiformis, among others (99.1%). Also, consensus was reached regarding the use of the SCORAD index to quantify the severity of the disease (86.7%), the use of wet wraps to increase the effect of topical corticosteroids (90.4%), the usefulness of proactive treatment during follow-up (85.6%) and tacrolimus ointment (91.2%) to reduce new flares, and the fact that crisaborole is not the treatment of choice for severe AD (92.4%). AD was not considered a contraindication for immunotherapy in patients with allergic respiratory diseases (92.4%). In patients with severe AD, the use of immune response modifier drugs (97.6%) or phototherapy (92.8%) does not sufficiently cover their treatment needs. Consensus was also obtained regarding the role of the new biologic drugs (93.6%) targeting cytokines involved in the Th2 inflammatory pathway (92.0%) and the potential role of dupilumab as first-line treatment (90.4%) in moderate-to-severe AD patients. CONCLUSION: This study contributes a reference framework to the care of AD patients. There is no diagnostic test or biomarkers to direct treatment or to assess the severity of the disease, and many therapeutic challenges remain.

4.
Allergol. immunopatol ; 46(4): 397-412, jul.-ago. 2018. tab
Article in English | IBECS | ID: ibc-177873

ABSTRACT

Atopic dermatitis (AD) is a multifaceted disease that involves a complex interplay between the skin and the immune system. The course of the disease depends strongly on the genetic background of the patient and on yet poorly-defined environmental factors. Changes in lifestyle could be behind the dramatic rise in the prevalence of AD across continents; including hygienic conditions, food, social habits, skin microbiome or exposure to a number of allergens. Although AD typically develops in childhood and disappears after a few years, in a relatively large number of patients it continues into adulthood. Adult AD can also appear de novo but it is often underdiagnosed and its treatment can be challenging. New, highly effective drugs are being developed to manage moderate and severe forms of the disease in adults. In this review, we highlight the most recent developments in diagnostic tools, current insights into the mechanistic basis of this disease, and therapeutic innovations


No disponible


Subject(s)
Humans , Dermatitis, Atopic/diagnosis , Dermatitis, Atopic/therapy , Dermatitis, Atopic/etiology
5.
J Investig Allergol Clin Immunol ; 28(6): 379-391, 2018 Dec.
Article in English | MEDLINE | ID: mdl-30004024

ABSTRACT

Atopic dermatitis (AD) is a recurrent and chronic skin disease characterized by dysfunction of the epithelial barrier, skin inflammation, and immune dysregulation, with changes in the skin microbiota and colonization by Staphylococcus aureus being common. For this reason, the therapeutic approach to AD is complex and should be directed at restoring skin barrier function, reducing dehydration, maintaining acidic pH, and avoiding superinfection and exposure to possible allergens. There is no curative treatment for AD. However, a series of measures are recommended to alleviate the disease and enable patients to improve their quality of life. These include adequate skin hydration and restoration of the skin barrier with the use of emollients, antibacterial measures, specific approaches to reduce pruritus and scratching, wet wrap applications, avoidance of typical AD triggers, and topical anti-inflammatory drugs. Anti-inflammatory treatment is generally recommended during acute flares or, more recently, for preventive management. Nevertheless, the selection of the pharmacologic agent, as well as its potency, duration, and frequency of application must be in accordance with the severity of the disease and the distribution and type of the lesion. The objectives of this review are to emphasize the importance of basic skin care and to describe current and novel topical therapies for AD.


Subject(s)
Dermatitis, Atopic/drug therapy , Skin/drug effects , Animals , Humans , Quality of Life , Skin Care/methods
6.
Allergol Immunopathol (Madr) ; 46(4): 397-412, 2018.
Article in English | MEDLINE | ID: mdl-29031890

ABSTRACT

Atopic dermatitis (AD) is a multifaceted disease that involves a complex interplay between the skin and the immune system. The course of the disease depends strongly on the genetic background of the patient and on yet poorly-defined environmental factors. Changes in lifestyle could be behind the dramatic rise in the prevalence of AD across continents; including hygienic conditions, food, social habits, skin microbiome or exposure to a number of allergens. Although AD typically develops in childhood and disappears after a few years, in a relatively large number of patients it continues into adulthood. Adult AD can also appear de novo but it is often underdiagnosed and its treatment can be challenging. New, highly effective drugs are being developed to manage moderate and severe forms of the disease in adults. In this review, we highlight the most recent developments in diagnostic tools, current insights into the mechanistic basis of this disease, and therapeutic innovations.


Subject(s)
Dermatitis, Atopic/diagnosis , Dermatitis, Atopic/therapy , Dermatitis, Atopic/etiology , Humans
7.
J. investig. allergol. clin. immunol ; 28(6): 379-391, 2018. ilus, tab
Article in English | IBECS | ID: ibc-174551

ABSTRACT

Atopic dermatitis (AD) is a recurrent and chronic skin disease characterized by dysfunction of the epithelial barrier, skin inflammation, and immune dysregulation, with changes in the skin microbiota and colonization by Staphylococcus aureus being common. For this reason, the therapeutic approach to AD is complex and should be directed at restoring skin barrier function, reducing dehydration, maintaining acidic pH, and avoiding superinfection and exposure to possible allergens. There is no curative treatment for AD. However, a series of measures are recommended to alleviate the disease and enable patients to improve their quality of life. These include adequate skin hydration and restoration of the skin barrier with the use of emollients, antibacterial measures, specific approaches to reduce pruritus and scratching, wet wrap applications, avoidance of typical AD triggers, and topical anti-inflammatory drugs. Anti-inflammatory treatment is generally recommended during acute flares or, more recently, for preventive management. Nevertheless, the selection of the pharmacologic agent, as well as its potency, duration, and frequency of application must be in accordance with the severity of the disease and the distribution and type of the lesion. The objectives of this review are to emphasize the importance of basic skin care and to describe current and novel topical therapies for AD


La dermatitis atópica (DA) es una enfermedad cutánea crónica y recurrente que se caracteriza por la existencia de una disfunción de la barrera epitelial, un proceso inflamatorio cutáneo, una alteración del sistema inmune y posibles cambios en la microbiota cutánea, siendo frecuente una posible colonización por Estafilococo aureus. Por ello, el abordaje terapéutico de la DA es complejo y debe de estar enfocado principalmente hacia la restauración de la barrera cutánea, la reducción de la deshidratación, el mantenimiento del PH ácido y la evitación de posibles sobreinfecciones y exposiciones a diferentes fuentes alergénicas. Actualmente no existe tratamientos curativos para la DA. Sin embargo, con el fin de aliviar la enfermedad y que mejore la calidad de vida de los pacientes, se recomiendan una serie de medidas que incluyen una adecuada hidratación y restauración de la barrera cutánea gracias a la aplicación de emolientes, medidas antibacterianas, reducción del picor y del rascado mediante determinados abordajes específicos, la aplicación de vendajes húmedos, la evitación de los desencadenantes de la DA y una terapia tópica antiinflamatoria adecuada. Los tratamientos anti-inflamatorios se recomiendan habitualmente durante las reagudizaciones y, más recientemente, como tratamiento preventivo. Sin embargo, dependiendo de la gravedad de la enfermedad, la distribución o el tipo de lesión, se seleccionará el agente farmacológico, su potencia, la duración y frecuencia necesaria de aplicación. El objetivo principal de esta revisión es resaltar la importancia del cuidado básico de la piel, además de describir los tratamientos tópicos, tanto actuales como emergentes, que existen para el abordaje de la dermatitis atópica


Subject(s)
Humans , Dermatitis, Atopic/therapy , Skin Care/methods , Dermatitis, Allergic Contact/therapy , Pruritus/therapy , Emollients/administration & dosage , Sanitizing Products , Wetting Agents/therapeutic use , Anti-Infective Agents, Local/therapeutic use
8.
Article in English | MEDLINE | ID: mdl-25997305

ABSTRACT

OBJECTIVES: To evaluate the association between serum total IgE levels and disease severity in adult patients with persistent allergic asthma and to explore the main predictors of IgE levels. METHODS: We performed a multicenter, retrospective, observational study including adult patients diagnosed ≥ 1 year previously with persistent allergic asthma who were positive to ≥ 1 allergen. Patients also had serum total IgE and spirometry results available from the previous 12 months. Inclusion was stratified by asthma severity according to the GEMA 2009 criteria. RESULTS: We included 383 patients with allergic asthma (129 mild, 82 moderate, and 172 severe). Mean (SD) age was 38 (15), 46 (16), and 45 (15) years, respectively (P < 0.001). Serum total IgE levels varied markedly (coefficient of variation, 147%). No association was observed with forced expiratory volume in 1 second (FEV1) or asthma severity: mean (SD)/median (IQR) of 403 (616)/214 (108-409), 361 (516)/204 (126-361), and 473 (676)/211 (98-545) IU/mL in the mild, moderate, and severe subgroups, respectively (P = .951). The severe subgroup had a higher percentage of patients with > 400 IU/mL (36% vs 26.4% [mild] and 18.3% [moderate], P = .010). In a multivariate multiple regression model, the independent predictors of higher IgE were younger age (P = .004), sensitization to ≥ 2 allergens (P = .009), male gender (P = .025), and family history of asthma (P = .122). CONCLUSION: Serum total IgE levels in adult patients with persistent allergic asthma were high (two-thirds with levels > 150 IU/mL) and extremely variable. We did not find a significant association between serum total IgE levels and asthma severity or airflow limitation, except for a higher percentage of patients with IgE > 400 IU/mL in the severe subgroup.


Subject(s)
Allergens/immunology , Asthma/immunology , Immunoglobulin E/blood , Lung/immunology , Adult , Asthma/blood , Asthma/diagnosis , Biomarkers/blood , Female , Humans , Inflammation Mediators/blood , Intradermal Tests , Lung/physiopathology , Male , Middle Aged , Predictive Value of Tests , Retrospective Studies , Risk Factors , Severity of Illness Index , Spain , Spirometry , Up-Regulation , Young Adult
9.
J. investig. allergol. clin. immunol ; 25(2): 120-127, 2015. tab, graf
Article in English | IBECS | ID: ibc-135501

ABSTRACT

Objectives: To evaluate the association between serum total IgE levels and disease severity in adult patients with persistent allergic asthma and to explore the main predictors of IgE levels. Methods: We performed a multicenter, retrospective, observational study including adult patients diagnosed ≥1 year previously with persistent allergic asthma who were positive to ≥1 allergen. Patients also had serum total IgE and spirometry results available from the previous 12 months. Inclusion was stratified by asthma severity according to the GEMA 2009 criteria. Results: We included 383 patients with allergic asthma (129 mild, 82 moderate, and 172 severe). Mean (SD) age was 38 (15), 46 (16), and 45 (15) years, respectively (P400 IU/mL (36% vs 26.4% [mild] and 18.3% [moderate], P=.010). In a multivariate multiple regression model, the independent predictors of higher IgE were younger age (P=.004), sensitization to ≥2 allergens (P=.009), male gender (P=.025), and family history of asthma (P=.122). Conclusion: Serum total IgE levels in adult patients with persistent allergic asthma were high (two-thirds with levels >150 IU/mL) and extremely variable. We did not find a significant association between serum total IgE levels and asthma severity or airflow limitation, except for a higher percentage of patients with IgE >400 IU/mL in the severe subgroup (AU)


Objetivos: Evaluar la asociación entre los niveles séricos de IgE total y la gravedad de la enfermedad en adultos con asma alérgica persistente, y explorar los principales factores predictores de los niveles de IgE total. Métodos: Estudio multicéntrico, observacional, retrospectivo que incluyó pacientes adultos diagnosticados de asma alérgica persistente al menos de un año de evolución, con positividad para ≥1 alérgeno, y que dispusieran de resultados de IgE sérica total y espirometría de los últimos 12 meses. Se estratificó la inclusión según la gravedad del asma, de acuerdo a los criterios GEMA 2009. Resultados: Se incluyeron 383 pacientes con asma alérgica, 129 leve, 82 moderada y 172 grave, con una edad media (DE) de 38 (15), 46 (16) y 45 (15) años, respectivamente (p400 UI/mL (36% frente a 26,4% (leve ) y 18,3% (moderada) ,P=0,010). En un modelo de regresión múltiple multivariante, los predictores independientes de niveles más elevados de IgE fueron: una menor edad (P=0,004); la sensibilización a ≥2 alérgenos (P=0,009); el sexo masculino (P=0,025) y los antecedentes familiares de asma (P=0,122). Conclusión: Los niveles séricos de IgE total en pacientes adultos con asma alérgica persistente fueron elevados (dos tercios con niveles >150 UI/mL) y extremadamente variables, y no se asociaron a la gravedad del asma ni a la limitación del flujo aéreo, a excepción de un mayor porcentaje de pacientes con IgE>400 UI/mL en el asma grave (AU)


Subject(s)
Humans , Hypersensitivity, Immediate/immunology , Asthma/immunology , Immunoglobulin E/blood , Severity of Illness Index , Airway Obstruction/immunology
10.
Allergol. immunopatol ; 42(6): 510-517, nov.-dic. 2014. tab
Article in English | IBECS | ID: ibc-130139

ABSTRACT

BACKGROUND: Severe asthma is often poorly controlled and its prevalence in Spanish children is unknown. The aim was to determine the prevalence of difficult-to-control severe asthma in children, the agreement of asthma control between physicians and Spanish Guidelines for Asthma Management (GEMA), and the health-related quality of life (HRQoL) for children and parents. METHODS: Observational, cross-sectional, two-phase, multicentre study. In the first phase, all children who attended pneumology and allergy units during a three-month period were classified according to physicians' criteria as patients with: asthma, severe asthma, or difficult-to-control severe asthma. Patients aged 6-14 years with severe asthma (difficult-to-control or controlled) were included in the second phase. RESULTS: 12,376 asthmatic children were screened in the first phase. According to physicians' criteria, 8.8% (95% CI 8.3-9.3%) had severe asthma. Of these, 24.2% (95% CI, 21.7-26.8%) had difficult-to-control severe asthma. 207 patients with severe asthma (mean age 10.8 ± 2.3 years; 61.4% male; mean of 5.5 ± 3.4 years since asthma diagnosis) were included in the second phase. Compared to the patients with controlled asthma, children with difficult-to-control asthma had a higher number of exacerbations, emergency room or unscheduled primary care visits in the previous year (p < 0.0001, all) and poor HRQoL (p < 0.0001, both children and caregivers). 33.3% of patients with controlled asthma according to physicians' criteria were poorly controlled according to GEMA. CONCLUSIONS: Around one in four asthmatic children with severe disease had difficult-to-control asthma, although one third was underestimated by physicians. Children with difficult-to-control severe asthma had a poor HRQoL that also affected their parents


No disponible


Subject(s)
Humans , Asthma/epidemiology , Anti-Asthmatic Agents/therapeutic use , Hospital Units/organization & administration , Quality of Life , Sickness Impact Profile
11.
Allergol Immunopathol (Madr) ; 42(6): 510-7, 2014.
Article in English | MEDLINE | ID: mdl-24948187

ABSTRACT

BACKGROUND: Severe asthma is often poorly controlled and its prevalence in Spanish children is unknown. The aim was to determine the prevalence of difficult-to-control severe asthma in children, the agreement of asthma control between physicians and Spanish Guidelines for Asthma Management (GEMA), and the health-related quality of life (HRQoL) for children and parents. METHODS: Observational, cross-sectional, two-phase, multicentre study. In the first phase, all children who attended pneumology and allergy units during a three-month period were classified according to physicians' criteria as patients with: asthma, severe asthma, or difficult-to-control severe asthma. Patients aged 6-14 years with severe asthma (difficult-to-control or controlled) were included in the second phase. RESULTS: 12,376 asthmatic children were screened in the first phase. According to physicians' criteria, 8.8% (95% CI 8.3-9.3%) had severe asthma. Of these, 24.2% (95% CI, 21.7-26.8%) had difficult-to-control severe asthma. 207 patients with severe asthma (mean age 10.8 ± 2.3 years; 61.4% male; mean of 5.5 ± 3.4 years since asthma diagnosis) were included in the second phase. Compared to the patients with controlled asthma, children with difficult-to-control asthma had a higher number of exacerbations, emergency room or unscheduled primary care visits in the previous year (p<0.0001, all) and poor HRQoL (p<0.0001, both children and caregivers). 33.3% of patients with controlled asthma according to physicians' criteria were poorly controlled according to GEMA. CONCLUSIONS: Around one in four asthmatic children with severe disease had difficult-to-control asthma, although one third was underestimated by physicians. Children with difficult-to-control severe asthma had a poor HRQoL that also affected their parents.


Subject(s)
Asthma/drug therapy , Asthma/epidemiology , Adolescent , Allergy and Immunology , Anti-Asthmatic Agents/therapeutic use , Child , Cross-Sectional Studies , Disease Progression , Female , Hospital Units/statistics & numerical data , Humans , Male , Parents , Practice Guidelines as Topic , Prevalence , Pulmonary Medicine , Quality of Life , Spain/epidemiology
12.
Allergol. immunopatol ; 42(2): 102-108, mar.-abr. 2014. tab, graf
Article in English | IBECS | ID: ibc-121007

ABSTRACT

BACKGROUND: Omalizumab is indicated in patients with severe allergic asthma not controlled by high-dose inhaled glucocorticoids and long-acting beta-agonists. Few data are available on the profile of patients treated with this drug in routine clinical practice in Spain. OBJECTIVE:To describe the profile of patients with severe allergic asthma treated with omalizumab and the course of the disease after a period of treatment. METHODS: Retrospective, multicentre study, recording the data on patients of either sex and ≥12 years with uncontrolled severe allergic asthma, previously treated with omalizumab. Data were evaluated in relation to pulmonary function, symptoms, quality of life, and concomitant anti-asthma treatment before the prescription of omalizumab and at the time of the study visit. RESULTS: 214 patients were evaluable (mean age = 48.2 ± 17.7 years; mean age at the time of diagnosis = 26.6 ± 16.5 years). 90.7% had experienced exacerbations the year before receiving omalizumab, and the mean total IgE level was 273 ± 205.4 IU/ml. The mean monthly dose was 380.5 ± 185.4 mg. Compared with the baseline situation, differences were observed after treatment with omalizumab in mean FEV1 (62.7 ± 15.9% vs. 70.8 ± 18.7%), in the proportion of patients requiring oral corticosteroids (47.7% vs. 14.0%), and in the ACQ and AQLQ scores. 32.7% of the patients received doses not recommended by the Summary of Product Characteristics (SPC). CONCLUSIONS: Profile of asthmatic patients treated with omalizumab predominantly corresponds to uncontrolled severe asthma cases, in accordance with SPC's indications. The results of the study suggest a favourable clinical course similar to that observed in other studies


No disponible


Subject(s)
Humans , Antibodies, Monoclonal/therapeutic use , Asthma/drug therapy , Hypersensitivity, Immediate/drug therapy , Glucocorticoids/therapeutic use , Observational Studies as Topic , Effectiveness , Receptors, IgE/antagonists & inhibitors
13.
Allergol Immunopathol (Madr) ; 42(2): 102-8, 2014.
Article in English | MEDLINE | ID: mdl-23267505

ABSTRACT

BACKGROUND: Omalizumab is indicated in patients with severe allergic asthma not controlled by high-dose inhaled glucocorticoids and long-acting beta-agonists. Few data are available on the profile of patients treated with this drug in routine clinical practice in Spain. OBJECTIVE: To describe the profile of patients with severe allergic asthma treated with omalizumab and the course of the disease after a period of treatment. METHODS: Retrospective, multicentre study, recording the data on patients of either sex and ≥12 years with uncontrolled severe allergic asthma, previously treated with omalizumab. Data were evaluated in relation to pulmonary function, symptoms, quality of life, and concomitant anti-asthma treatment before the prescription of omalizumab and at the time of the study visit. RESULTS: 214 patients were evaluable (mean age=48.2±17.7 years; mean age at the time of diagnosis=26.6±16.5 years). 90.7% had experienced exacerbations the year before receiving omalizumab, and the mean total IgE level was 273±205.4IU/ml. The mean monthly dose was 380.5±185.4mg. Compared with the baseline situation, differences were observed after treatment with omalizumab in mean FEV1 (62.7±15.9% vs. 70.8±18.7%), in the proportion of patients requiring oral corticosteroids (47.7% vs. 14.0%), and in the ACQ and AQLQ scores. 32.7% of the patients received doses not recommended by the Summary of Product Characteristics (SPC). CONCLUSIONS: Profile of asthmatic patients treated with omalizumab predominantly corresponds to uncontrolled severe asthma cases, in accordance with SPC's indications. The results of the study suggest a favourable clinical course similar to that observed in other studies.


Subject(s)
Anti-Asthmatic Agents/therapeutic use , Antibodies, Anti-Idiotypic/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Asthma/prevention & control , Hypersensitivity/drug therapy , Asthma/etiology , Female , Humans , Hypersensitivity/complications , Male , Middle Aged , Omalizumab , Retrospective Studies , Spain , Treatment Outcome
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