Changing perspectives in atopic dermatitis

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

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Basic skin care and topical therapies for atopic dermatitis: essential approaches and beyond

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

Relationship between serum total IgE and disease severity in patients with allergic asthma in Spain

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)

Prevalence and clinical profile of difficult-to-control severe asthma in children: Results from pneumology and allergy hospital units in Spain

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

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Profile of patients treated with omalizumab in routine clinical practice in Spain

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

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Churg-Strauss Syndrome in a Patient Treated With Omalizumab

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