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2.
Allergol. immunopatol ; 49(1): 11-16, ene.-feb. 2021. tab, graf
Artigo em Inglês | IBECS | ID: ibc-199220

RESUMO

BACKGROUND: The prevalence of allergic disorders is on the rise, affecting about 10% of the population. In this retrospective cohort, we investigated prevalence of allergic disorders, associated risk factors, and the outcome of food allergies. MATERIAL AND METHODS: We analyzed data from birth cohorts of two university hospitals' well-child outpatient clinics. Factors related to onset and type of allergic diseases were assessed from demographic, socioeconomic, and clinical data. RESULTS: Analyses were performed on 949 (431F/518M) infants at a mean current age of 28 ± 6 months. Any allergic disease was established among 177 cases (22%); atopic dermatitis in 123 (12.8%), respiratory allergies in 55 (5.7%), and food allergy in 41 (4.3%). The risk for allergic disorders was found to be significantly increased for male gender (OR: 2.31, 95% CI; 1.54-3.46), and positive parental atopy (OR: 1.94, 95% CI; 1.31-2.86). The risk of food allergies was significantly higher in the male gender (OR: 2.47, 95% CI; 1.21-5.02), who consumed egg-white between 6 and 12 months (OR: 2.34, 95% CI; 1.22-4.48), and who were formula-fed before 6 months (OR: 2.16, 95% CI; 1.14-4.10). We found no significant association between the rate of food allergy outgrowth or food induced-anaphylaxis with regards to the timing of introducing egg-white into the diet. CONCLUSIONS: Although the introduction of egg-white into infant diet at 6-12 months of life appeared as an independent risk for any food allergy, none of the patients developed anaphylaxis. Age at symptom onset and outgrowing food allergy were similar compared to those introduced egg-white after 12 months. We recommend promoting exclusive breastfeeding during the first 6 months of life, and avoidance of prolonged restrictive diets for children with food allergy


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Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Hipersensibilidade a Ovo/epidemiologia , Hipersensibilidade Alimentar/epidemiologia , Fatores de Risco , Turquia/epidemiologia , Estudos Retrospectivos , Dermatite Atópica/epidemiologia , Dermatite Atópica/terapia , Modelos Logísticos
3.
Curr Opin Allergy Clin Immunol ; 21(2): 159-165, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33534416

RESUMO

PURPOSE OF REVIEW: To summarize the impact of the COVID-19 pandemic on the practice of paediatric allergy. RECENT FINDINGS: Given significant overlap in symptoms, care must be taken to differentiate routine allergic conditions from COVID-19 infection but it appears that most allergic diseases are not risk factors for a severe COVID-19 course. The full impact of restricted allergy/immunology ambulatory services will take months to years to fully understand. One benefit of having to adapt practice style is greater awareness and acceptance of shared decision-making and recognition of preference-sensitive care options in food allergy, in particular for approaches towards allergy prevention, treatment, and anaphylaxis care. Social distancing and masks have helped reduce spread of common respiratory viruses, which may be helping to lower the incidence of viral-associated wheezing episodes, enhancing evidence of the effects of preventing exposure of young children to respiratory viruses on asthma pathogenesis, as well as on allergic rhinitis. There has been a revolution in the rise of telemedicine to increase access to high-quality allergy/immunology specialty care. SUMMARY: Although the field has adapted to remain operational in the face of a significant challenge, it is important to apply lessons learned to evolve patient care and optimize treatment in the aftermath of the pandemic.


Assuntos
Asma/epidemiologia , Dermatite Atópica/epidemiologia , Eczema/epidemiologia , Hipersensibilidade Alimentar/epidemiologia , Pandemias , Rinite Alérgica/epidemiologia , Asma/terapia , Criança , Pré-Escolar , Comorbidade , Dermatite Atópica/terapia , Gerenciamento Clínico , Eczema/terapia , Hipersensibilidade Alimentar/terapia , Humanos , Rinite Alérgica/terapia , Telemedicina
4.
Schweiz Arch Tierheilkd ; 163(1): 67-72, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33528368

RESUMO

INTRODUCTION: In this pilot study, we wished to determine if C-reactive protein (CRP) levels could be a useful severity or treatment biomarker for canine atopic dermatitis (AD). Nine atopic dogs received allergen immunotherapy for 1 year. Blood was collected before and at four re-evaluation visits. At each time point, the skin lesions were graded with the Canine Atopic Dermatitis Extent and Severity Index (CADESI) 4, and the plasma CRP levels were measured by Enzyme-linked Immunosorbent Assay (ELISA). We found a significant yet minimal correlation between the CRP levels and the CADESI4 scores. The CRP levels were not significantly different between dogs with AD of increasing severity. Finally, there was no correlation between the percentage change in CADESI4 and CRP values during immunotherapy. In conclusion, the lack of significant difference in CRP levels between dogs of increasing AD severity and lack of correlation between percentage changes in skin lesion and CRP values suggest that this protein would not be a clinically-useful biomarker in atopic dogs.


Assuntos
Biomarcadores/sangue , Proteína C-Reativa/análise , Dermatite Atópica/veterinária , Dessensibilização Imunológica/veterinária , Doenças do Cão/terapia , Animais , Dermatite Atópica/sangue , Dermatite Atópica/patologia , Dermatite Atópica/terapia , Doenças do Cão/sangue , Doenças do Cão/diagnóstico , Cães , Projetos Piloto , Plasma/química
5.
Nat Med ; 27(4): 700-709, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33619370

RESUMO

Staphylococcus aureus colonizes patients with atopic dermatitis (AD) and exacerbates disease by promoting inflammation. The present study investigated the safety and mechanisms of action of Staphylococcus hominis A9 (ShA9), a bacterium isolated from healthy human skin, as a topical therapy for AD. ShA9 killed S. aureus on the skin of mice and inhibited expression of a toxin from S. aureus (psmα) that promotes inflammation. A first-in-human, phase 1, double-blinded, randomized 1-week trial of topical ShA9 or vehicle on the forearm skin of 54 adults with S. aureus-positive AD (NCT03151148) met its primary endpoint of safety, and participants receiving ShA9 had fewer adverse events associated with AD. Eczema severity was not significantly different when evaluated in all participants treated with ShA9 but a significant decrease in S. aureus and increased ShA9 DNA were seen and met secondary endpoints. Some S. aureus strains on participants were not directly killed by ShA9, but expression of mRNA for psmα was inhibited in all strains. Improvement in local eczema severity was suggested by post-hoc analysis of participants with S. aureus directly killed by ShA9. These observations demonstrate the safety and potential benefits of bacteriotherapy for AD.


Assuntos
Dermatite Atópica/microbiologia , Dermatite Atópica/terapia , Pele/microbiologia , Staphylococcus hominis/fisiologia , Administração Tópica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Proteínas de Bactérias/metabolismo , Bacteriocinas/farmacologia , Contagem de Colônia Microbiana , Humanos , Inflamação/complicações , Inflamação/patologia , Camundongos Endogâmicos BALB C , Testes de Sensibilidade Microbiana , Viabilidade Microbiana/efeitos dos fármacos , Pessoa de Meia-Idade , Peptídeos Cíclicos/metabolismo , Reprodutibilidade dos Testes , Pele/efeitos dos fármacos , Pele/patologia , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/terapia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/crescimento & desenvolvimento , Staphylococcus aureus/fisiologia , Transcrição Genética/efeitos dos fármacos , Resultado do Tratamento , Fatores de Virulência/metabolismo , Adulto Jovem
6.
Curr Allergy Asthma Rep ; 21(2): 8, 2021 02 09.
Artigo em Inglês | MEDLINE | ID: mdl-33560451

RESUMO

PURPOSE OF REVIEW: The coronavirus disease 2019 (COVID-19) has challenged healthcare system capacities and safety for health care workers, reshaping doctor-patient interaction favoring e-Health or telemedicine. The pandemic situation may make difficult to prioritize patients with allergies diseases (AD), face-to-face evaluation, and moreover concern about the possible COVID-19 diagnosis, since COVID-19 shared many symptoms in common with AD. Being COVID-19 a novel disease, everyone is susceptible; there are some advances on vaccine and specific treatment. We evaluate existing literature on allergic diseases (AD): allergic rhinitis, asthma, food allergy, drug allergy, and skin allergy, and potential underlying mechanisms for any interrelationship between AD and COVID-19. RECENT FINDINGS: There is inconclusive and controversial evidence of the association between AD and the risk of adverse clinical outcomes of COVID-19. AD patients should minimize hospital and face-to-face visits, and those who have used biologics and allergen immunotherapy should continue the treatment. It is essential to wear personal protective equipment for the protection of health care workers. Social distancing, rational use of facemasks, eye protection, and hand disinfection for health care workers and patients deserve further attention and promotion. Teleconsultation during COVID-19 times for AD patients is very encouraging and telemedicine platform can provide a reliable service in patient care.


Assuntos
Asma/terapia , Hipersensibilidade Alimentar/terapia , Controle de Infecções/métodos , Rinite Alérgica/terapia , Telemedicina , Asma/imunologia , Produtos Biológicos , Dermatite Alérgica de Contato/imunologia , Dermatite Alérgica de Contato/terapia , Dermatite Atópica/imunologia , Dermatite Atópica/terapia , Dessensibilização Imunológica , Gerenciamento Clínico , Surtos de Doenças , Hipersensibilidade a Drogas/imunologia , Hipersensibilidade a Drogas/terapia , Hipersensibilidade Alimentar/imunologia , Pessoal de Saúde , Humanos , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Rinite Alérgica/imunologia
7.
Rev Med Suisse ; 17(723): 184-187, 2021 Jan 27.
Artigo em Francês | MEDLINE | ID: mdl-33507657

RESUMO

Atopic dermatitis and psoriasis are two diseases that are thought to be distinct from each other, both clinically as well as pathogenetically. Substantial progress has been made in their treatment through the introduction of targeted therapies, blocking key steps in the respective pathogenetic pathways. Interestingly, introduction of a specific therapy for one of these diseases can occasionally trigger onset of the other. This observation helps to better understand the pathophysiology of both diseases and directly impacts their management.


Assuntos
Dermatite Atópica , Psoríase , Dermatite Atópica/epidemiologia , Dermatite Atópica/terapia , Eczema , Humanos , Psoríase/epidemiologia , Psoríase/terapia
8.
Ann Allergy Asthma Immunol ; 126(1): 21-31, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32818591

RESUMO

OBJECTIVE: To discuss the efficacy and safety of novel and emerging topical and systemic therapeutic agents for atopic dermatitis (AD). DATA SOURCES: The review of the published literature was performed using the PubMed database, published abstracts and virtual presentations from scientific meetings, posted results on ClinicalTrials.gov, and data from industry press releases. STUDY SELECTIONS: Primary manuscripts with trial results, case reports, case series, clinical trial data from ClinicalTrials.gov, and articles highlighting expert perspectives on management of AD were selected. RESULTS: Emerging topical and systemic therapies primarily target the type 2 immune pathway. Moreover, 2 newer targeted medications are now approved by the Food and Drug Administration for both children and adults, crisaborole 2% ointment and dupilumab, with several others in the therapeutic pipeline. New directions in developing topical medications include Janus kinase inhibitors, tapinarof (an aryl hydrocarbon receptor agonist), and agents to correct microbial dysbiosis. In addition to the subcutaneously injected monoclonal antibody targeting the interleukin (IL) 4 receptor (dupilumab), other biologics targeting IL-13, IL-31, IL-33, OX40, and thymic stromal lymphopoietin are currently being tested. Oral Janus kinase inhibitors are showing outstanding efficacy and no serious safety signs, but safety concerns remain. CONCLUSION: Given the tremendous burden of AD on physical, mental, and social health, the need is high to develop new, targeted therapies. Advances in our understanding of AD pathogenesis have paved the way toward the development of new therapies that promise to revolutionize our management of AD. Future research will focus on long-term efficacy and safety and creating predictive models for choosing best management options on a personalized basis.


Assuntos
Dermatite Atópica/terapia , Biomarcadores , Terapia Combinada , Dermatite Atópica/etiologia , Dermatite Atópica/metabolismo , Gerenciamento Clínico , Suscetibilidade a Doenças , Humanos , Terapia de Alvo Molecular
9.
Viruses ; 13(1)2020 12 22.
Artigo em Inglês | MEDLINE | ID: mdl-33375201

RESUMO

Atopic dermatitis is accompanied by the abnormal overgrowth of Staphylococcus aureus, a common cause of skin infections and an opportunistic pathogen. Although administration of antibiotics is effective against S. aureus, the resulting reduction in healthy microbiota and the emergence of drug-resistant bacteria are of concern. We propose that phage therapy can be an effective strategy to treat atopic dermatitis without perturbing the microbiota structure. In this study, we examined whether the S. aureus phage SaGU1 could be a tool to counteract the atopic exacerbation induced by S. aureus using an atopic mouse model. Administration of SaGU1 to the back skin of mice reduced both S. aureus counts and the disease exacerbation caused by S. aureus. Furthermore, the S. aureus-mediated exacerbation of atopic dermatitis with respect to IgE plasma concentration and histopathological findings was ameliorated by the application of SaGU1. We also found that Staphylococcus epidermidis, a typical epidermal symbiont in healthy skin, significantly attenuated the emergence of SaGU1-resistant S. aureus under co-culture with S. aureus and S. epidermidis in liquid culture infection experiments. Our results suggest that phage therapy using SaGU1 could be a promising clinical treatment for atopic dermatitis.


Assuntos
Dermatite Atópica/etiologia , Dermatite Atópica/terapia , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/terapia , Fagos de Staphylococcus/fisiologia , Staphylococcus aureus/virologia , Staphylococcus epidermidis/fisiologia , Antibiose , Bacteriólise , Biópsia , Terapia Combinada , Dermatite Atópica/patologia , Resistência à Doença/genética , Interações Hospedeiro-Patógeno , Humanos , Terapia por Fagos , Infecções Estafilocócicas/patologia
10.
Lancet ; 396(10247): 345-360, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32738956

RESUMO

Atopic dermatitis is a common inflammatory skin disorder characterised by recurrent eczematous lesions and intense itch. The disorder affects people of all ages and ethnicities, has a substantial psychosocial impact on patients and relatives, and is the leading cause of the global burden from skin disease. Atopic dermatitis is associated with increased risk of multiple comorbidities, including food allergy, asthma, allergic rhinitis, and mental health disorders. The pathophysiology is complex and involves a strong genetic predisposition, epidermal dysfunction, and T-cell driven inflammation. Although type-2 mechanisms are dominant, there is increasing evidence that the disorder involves multiple immune pathways. Currently, there is no cure, but increasing numbers of innovative and targeted therapies hold promise for achieving disease control, including in patients with recalcitrant disease. We summarise and discuss advances in our understanding of the disease and their implications for prevention, management, and future research.


Assuntos
Dermatite Atópica/epidemiologia , Dermatite Atópica/fisiopatologia , Inflamação/fisiopatologia , Linfócitos T/imunologia , Adolescente , Asma/epidemiologia , Criança , Pré-Escolar , Comorbidade , Dermatite Atópica/prevenção & controle , Dermatite Atópica/terapia , Eczema/patologia , Hipersensibilidade Alimentar/epidemiologia , Predisposição Genética para Doença/genética , Carga Global da Doença , Humanos , Lactente , Transtornos Mentais/epidemiologia , Microbiota/fisiologia , Terapia de Alvo Molecular/métodos , Fototerapia/métodos , Prevalência , Prurido/patologia , Qualidade de Vida , Rinite Alérgica/epidemiologia , Linfócitos T/patologia
11.
PLoS One ; 15(7): e0235500, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614886

RESUMO

INTRODUCTION: Clinical trials often suffer from significant recruitment barriers, poor adherence, and dropouts, which increase costs and negatively affect trial outcomes. The aim of this study was to examine whether making it virtual and reward-based would enable nationwide recruitment, identify patients with variable disease severity, achieve high adherence, and reduce dropouts. METHODS: In a siteless, virtual feasibility study, individuals with atopic dermatitis (AD) were recruited online. During the 8-week study, subjects used their smartphones weekly to photograph target AD lesions, and completed patient-oriented eczema measure (POEM) and treatment use questionnaires. In return, subjects were rewarded every week with personalized lifestyle reports based on their DNA. RESULTS: Over the course of the 11 day recruitment period, 164 (82% women and 18% men) filled in the form to participate, of which 65 fulfilled the inclusion criteria and signed the informed consent. Ten were excluded as they did not complete the mandatory study task of returning the DNA sample. 55 (91% women, 9% men) subjects returned the DNA sample and were enrolled throughout Denmark, the majority outside the Copenhagen capital region in rural areas with relatively low physician coverage. The mean age was 28.5 (SD ±9.5 years, range 18-52 years). The baseline POEM score was 14.5±5.6 (range 6-28). Based on the POEM, 7 individuals had mild, 28 had moderate, 17 had severe, and 3 had very severe eczema. The retention rate was 96% as 53 out of 55 enrolled completed the study. The adherence was very high, and more than 90% of all study tasks were completed. Follow up of 41 subjects showed that 90% would take part again or continue if the study had been longer. CONCLUSION: A virtual trial design enables recruitment with broad geographic reach and throughout the full spectrum of disease severity. Providing personalized genetic reports as a reward seems to contribute to high adherence and retention.


Assuntos
Dermatite Atópica/psicologia , Eczema/patologia , Recompensa , Cooperação e Adesão ao Tratamento , Adolescente , Adulto , DNA/análise , Dermatite Atópica/genética , Dermatite Atópica/patologia , Dermatite Atópica/terapia , Fármacos Dermatológicos/uso terapêutico , Feminino , Estudo de Associação Genômica Ampla , Humanos , Masculino , Pessoa de Meia-Idade , Fototerapia , Índice de Gravidade de Doença , Smartphone , Inquéritos e Questionários , Adulto Jovem
12.
Medicine (Baltimore) ; 99(22): e20329, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481406

RESUMO

Parental knowledge regarding the role of moisturizers in restoring the skin barrier, as well as regular and long-term use of moisturizers, is critical in the treatment of infantile eczema and the prevention of relapse.The parents of children with eczema were enrolled in this study. Their knowledge of the role, use, and effect of moisturizers on their children, as well as their concerns regarding moisturizers were surveyed.A total of 350 parents were enrolled in this study. Two hundred fifty-two parents (72%) knew that eczema requires moisturizers to restore the skin barrier. Among these 252 parents, 175 parents (50.0%) knew that moisturizers can restore the skin barrier. Only 27 parents (27/175, 15.4%) of them knew that moisturizers can improve eczema. Overall, 69.4% used moisturizers; of these, 75.3% used only moisturizers on the face, 87.2% on dry areas of face and other body parts, and only 6.6% on the entire body. Furthermore, 13.2% used topical moisturizers in the long-term; 62.6% used moisturizers 1 to 2 times per day, while 5.4% used moisturizers once every few days. A total of 80.7% discontinued moisturizers immediately after improvement in dryness, and 75.3% reported skin dryness despite moisturizer usage. Among parents of children who used moisturizers, 16.5% were worried about the side effects of moisturizers.Despite a fair level of knowledge about moisturizers, parents of children with eczema are using them inadequately. Pediatrician should be more patient to educate parents the information on the importance of moisturizers for the improvement of eczema and prevention of recurrence.


Assuntos
Dermatite Atópica/terapia , Conhecimentos, Atitudes e Prática em Saúde , Creme para a Pele/uso terapêutico , Dermatite Atópica/patologia , Feminino , Humanos , Lactente , Masculino , Pais , Índice de Gravidade de Doença , Pele/patologia , Creme para a Pele/administração & dosagem
13.
Am Fam Physician ; 101(10): 590-598, 2020 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-32412211

RESUMO

Atopic dermatitis (atopic eczema) is a chronic relapsing and remitting inflammatory skin disease affecting one in 10 people in their lifetime. Atopic dermatitis is caused by a complex interaction of immune dysregulation, epidermal gene mutations, and environmental factors that disrupts the epidermis causing intensely pruritic skin lesions. Repeated scratching triggers a self-perpetuating itch-scratch cycle, which can have a significant impact on the patient's quality of life. The American Academy of Dermatology has created simple diagnostic criteria based on symptoms and physical examination findings. Maintenance therapy consists of liberal use of emollients and daily bathing with soap-free cleansers. Use of topical corticosteroids is the first-line treatment for atopic dermatitis flare-ups. Pimecrolimus and tacrolimus are topical calcineurin inhibitors that can be used in conjunction with topical corticosteroids as first-line treatment. Ultraviolet phototherapy is a safe and effective treatment for moderate to severe atopic dermatitis when first-line treatments are not adequate. Antistaphylococcal antibiotics are effective in treating secondary skin infections. Oral antihistamines are not recommended because they do not reduce pruritus. Evidence is lacking to support the use of integrative medicine in the treatment of atopic dermatitis. Newer medications approved by the U.S Food and Drug Administration, such as crisaborole and dupilumab, are effective in treating atopic dermatitis but are currently cost prohibitive for most patients.


Assuntos
Dermatite Atópica/diagnóstico , Dermatite Atópica/terapia , Administração Tópica , Corticosteroides/administração & dosagem , Banhos/métodos , Inibidores de Calcineurina/administração & dosagem , Dermatite Atópica/complicações , Diagnóstico Diferencial , Emolientes/administração & dosagem , Humanos , Fototerapia/métodos , Prurido/etiologia , Índice de Gravidade de Doença , Dermatopatias Infecciosas/tratamento farmacológico , Dermatopatias Infecciosas/etiologia
15.
Actas dermo-sifiliogr. (Ed. impr.) ; 111(3): 205-221, abr. 2020. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-191523

RESUMO

La dermatitis atópica es la dermatosis inflamatoria más frecuente y hasta un 20% de los casos pueden clasificarse como moderados a graves. En los últimos años se ha producido un avance en el conocimiento de la patogenia, centrada en la vía Th2, pero con una participación marcada de la vía Th22 y de los ejes Th1 y Th17, de la disfunción de la barrera epidérmica, el prurito y la señalización JAK/STAT. Este progreso ha condicionado el desarrollo de nuevas terapias sistémicas, entre las que destacan fármacos biológicos dirigidos frente a la IL-4/13, como dupilumab, tralokinumab y lebrikizumab, pero también moléculas pequeñas, como los inhibidores de JAK, entre los que se incluyen baricitinib, upadicitinib y abrocitinib. Entre las innovaciones en los tratamientos tópicos se incluyen los inhibidores de la PDE4 y de JAK/STAT. Este artículo repasa los principales avances terapéuticos en dermatitis atópica, para los que son esenciales la caracterización de los subtipos clínicos y moleculares clave en su patogénesis


Atopic dermatitis is the most common inflammatory skin disease and up to 20% of cases can be classified as moderate to severe. Our understanding of the pathogenesis of this disease has improved in recent years. The process is primarily driven by the Th2 pathway, but with significant contributions from the Th22 pathway, the Th1 and Th17 axes, epidermal barrier dysfunction, pruritus, and JAK/STAT signaling. Advances in our understanding of the pathogenesis of atopic dermatitis have led to the development of new systemic treatments. Of particular note are biologic agents targeting IL-4 and IL-13 (e. g. , dupilumab, tralokinumab, and lebrikizumab) and small molecules, such as JAK inhibitors (e. g. , baricitinib, upadacitinib, and abrocitinib). Novel topical treatments include phosphodiesterase 4 and JAK/STAT inhibitors. In this article, we review the main advances in the treatment of atopic dermatitis. Characterization of clinical and molecular phenotypes with a key pathogenic role is essential for driving these advances


Assuntos
Humanos , Dermatite Atópica/patologia , Dermatite Atópica/terapia , Administração Tópica , Produtos Biológicos , Anticorpos Monoclonais/uso terapêutico
16.
Complement Ther Med ; 49: 102355, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32147044

RESUMO

OBJECTIVE: Globally, the use of complementary and alternative medicines (CAMs) for children with atopic eczema (AE) is gaining popularity. At present, information on the pattern of CAM use in Malaysia among children with AE is limited. This study aimed to investigate the pattern of CAM use in children with AE and factors associated with its use. METHODS: This was a cross-sectional survey conducted at a tertiary care centre in Kuala Lumpur, Malaysia among parents of children with AE aged ≤ 12 years using validated questionnaires including Beliefs about Medicines Questionnaire (BMQ-General) and Patient-Oriented Eczema Measure (POEM) scale. RESULTS: In total, 173 parents were recruited. The prevalence of CAM use over the last 12-month period was 46.8 %. The most commonly used CAM was Ruqyah (Islamic prayer), followed by Malay herbs, virgin coconut oil, nutritional therapy and homeopathy. AE severity from parental perspective was the major predictor of CAM use based on multiple logistic regression analysis. Parents of children with 'clear or almost clear' (adjusted OR 0.06; 95 % CI 0.01-0.54; p = 0.012) and 'mild' (adjusted OR 0.15; 95 % CI 0.03-0.85; p = 0.032) eczema were less likely to use CAM than those with 'very severe eczema'. CONCLUSION: CAM use was prevalent among children with AE. Its use was significantly associated with AE severity from a parental perspective. Healthcare providers may need to enquire parents about CAM use for their child during routine clinic appointment.


Assuntos
Terapias Complementares/métodos , Dermatite Atópica/terapia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Malásia , Masculino , Inquéritos e Questionários , Centros de Atenção Terciária
17.
Lancet ; 395(10228): 951-961, 2020 03 21.
Artigo em Inglês | MEDLINE | ID: mdl-32087121

RESUMO

BACKGROUND: Skin emollients applied during early infancy could prevent atopic dermatitis, and early complementary food introduction might reduce food allergy in high-risk infants. The study aimed to determine if either regular skin emollients applied from 2 weeks of age, or early complementary feeding introduced between 12 and 16 weeks of age, reduced development of atopic dermatitis by age 12 months in the general infant population. METHODS: This population-based 2×2 factorial, randomised clinical trial was done at Oslo University Hospital and Østfold Hospital Trust, Oslo, Norway; and Karolinska University Hospital, Stockholm, Sweden. Infants of women recruited antenatally at the routine ultrasound pregnancy screening at 18 weeks were cluster-randomised at birth from 2015 to 2017 to the following groups: (1) controls with no specific advice on skin care while advised to follow national guidelines on infant nutrition (no intervention group); (2) skin emollients (bath additives and facial cream; skin intervention group); (3) early complementary feeding of peanut, cow's milk, wheat, and egg (food intervention group); or (4) combined skin and food interventions (combined intervention group). Participants were randomly assigned (1:1:1:1) using computer- generated cluster randomisation based on 92 geographical living area blocks as well as eight 3-month time blocks. Carers were instructed to apply the interventions on at least 4 days per week. Atopic dermatitis by age 12 months was the primary outcome, based on clinical investigations at 3, 6 and 12 months by investigators masked to group allocation. Atopic dermatitis was assessed after completing the 12-month investigations and diagnosed if either of the UK Working Party and Hanifin and Rajka (12 months only) diagnostic criteria were fulfilled. The primary efficacy analyses was done by intention-to-treat analysis on all randomly assigned participants. Food allergy results will be reported once all investigations at age 3 years are completed in 2020. This was a study performed within ORAACLE (the Oslo Research Group of Asthma and Allergy in Childhood; the Lung and Environment). The study is registered at clinicaltrials.gov, NCT02449850. FINDINGS: 2697 women were recruited between Dec 9, 2014, and Oct 31, 2016, from whom 2397 newborn infants were enrolled from April 14, 2015, to April 11, 2017. Atopic dermatitis was observed in 48 (8%) of 596 infants in the no intervention group, 64 (11%) of 575 in the skin intervention group, 58 (9%) of 642 in the food intervention group, and 31 (5%) of 583 in the combined intervention group. Neither skin emollients nor early complementary feeding reduced development of atopic dermatitis, with a risk difference of 3·1% (95% CI -0·3 to 6·5) for skin intervention and 1·0% (-2·1 to 4·1) for food intervention, in favour of control. No safety concerns with the interventions were identified. Reported skin symptoms and signs (including itching, oedema, exanthema, dry skin, and urticaria) were no more frequent in the skin, food, and combined intervention groups than in the no intervention group. INTERPRETATION: Neither early skin emollients nor early complementary feeding reduced development of atopic dermatitis by age 12 months. Our study does not support the use of these interventions to prevent atopic dermatitis by 12 months of age in infants. FUNDING: The study was funded by several public and private funding bodies: The Regional Health Board South East, The Norwegian Research Council, Health and Rehabilitation Norway, The Foundation for Healthcare and Allergy Research in Sweden-Vårdalstiftelsen, Swedish Asthma and Allergy Association's Research Foundation, Swedish Research Council-the Initiative for Clinical Therapy Research, The Swedish Heart-Lung Foundation, SFO-V at the Karolinska Institute, Freemason Child House Foundation in Stockholm, Swedish Research Council for Health, Working Life and Welfare-FORTE, Oslo University Hospital, the University of Oslo, and Østfold Hospital Trust.


Assuntos
Dermatite Atópica/prevenção & controle , Emolientes/uso terapêutico , Hipersensibilidade Alimentar/prevenção & controle , Fenômenos Fisiológicos da Nutrição do Lactente , Administração Tópica , Análise por Conglomerados , Dermatite Atópica/terapia , Fármacos Dermatológicos/uso terapêutico , Feminino , Hospitais Universitários , Humanos , Lactente , Recém-Nascido , Masculino , Noruega , Estudos Prospectivos , Fatores de Risco , Suécia , Resultado do Tratamento
18.
Int J Mol Sci ; 21(4)2020 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-32102344

RESUMO

Allergies are rapidly worsening in recent decades, representing the most common immunological diseases. The mechanism of disorders such as asthma, rhinocongiuntivitis, urticaria, atopic dermatitis, food and drug allergies, and anaphylaxis still remain unclear and consequently treatments is mostly still symptomatic and aspecific while developments of new therapies are limited. A growing amount of data in the literature shows us how the prevalence of allergic diseases is different in both sexes and its changes over the course of life. Genes, hormones, environmental and immunological factors affect sex disparities associated with the development and control of allergic diseases, while they more rarely are considered and reported regarding their differences related to social, psychological, cultural, economic, and employment aspects. This review describes the available knowledge on the role of sex and gender in allergies in an attempt to improve the indispensable gender perspective whose potential is still underestimated while it represents a significant turning point in research and the clinic. It will offer insights to stimulate exploration of the many aspects still unknown in this relationship that could ameliorate the preventive, diagnostic, and therapeutic strategies in allergic diseases.


Assuntos
Alérgenos/imunologia , Anafilaxia/prevenção & controle , Asma/prevenção & controle , Dermatite Atópica/prevenção & controle , Hipersensibilidade Alimentar/prevenção & controle , Hipersensibilidade/prevenção & controle , Anafilaxia/imunologia , Anafilaxia/terapia , Asma/imunologia , Asma/terapia , Dermatite Atópica/imunologia , Dermatite Atópica/terapia , Feminino , Hipersensibilidade Alimentar/imunologia , Hipersensibilidade Alimentar/terapia , Humanos , Hipersensibilidade/imunologia , Hipersensibilidade/terapia , Masculino , Fatores Sexuais
19.
Actas dermo-sifiliogr. (Ed. impr.) ; 111(1): 41-46, ene.-feb. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-191483

RESUMO

INTRODUCCIÓN: La fototerapia se basa en el uso de radiación ultravioleta para el tratamiento de distintas enfermedades dermatológicas. Su eficacia y seguridad está ampliamente establecida en adultos y existen publicaciones que también lo avalan como un tratamiento efectivo y seguro en pacientes pediátricos con afecciones cutáneas recalcitrantes. MATERIAL Y MÉTODOS: Estudio retrospectivo desde 2002 hasta 2017 que incluye a todos los pacientes menores de 17 años que recibieron fototerapia en nuestro servicio. Además, se seleccionaron al azar 122 pacientes adultos que recibieron este tratamiento durante el mismo periodo de tiempo. RESULTADOS: Se realizaron un total de 98 tratamientos pediátricos, 61% en niñas y 39% en niños, con una media de edad de 10,5 años. Las 3 enfermedades más frecuentemente tratadas fueron la psoriasis (48% de pacientes), el vitíligo (17%) y la dermatitis atópica (16%). El 86% de los pacientes recibió fototerapia con radiación ultravioleta B de banda estrecha (UVB-BE), mientras que el 7% recibió fototerapia con radiación ultravioleta A con psoralenos (PUVA). No existían diferencias estadísticamente significativas en cuanto a dosis, duración o número de sesiones con respecto a la población adulta tratada con UVB-BE ni con PUVA. Se alcanzó una respuesta completa en el 35% de los pacientes pediátricos, sin diferencias con respecto a los adultos. Únicamente el 16% de los pacientes mostró efectos adversos, en su mayoría en forma de eritema leve. Encontramos mayor adherencia al tratamiento en los pacientes pediátricos que en los adultos (p < 0,05). CONCLUSIONES: La fototerapia con UVB-BE y/o PUVA parece un tratamiento seguro y eficaz en niños, sin ser necesarios protocolos de tratamiento diferentes a los empleados en adultos. La adherencia al tratamiento es mayor que en los pacientes adultos


INTRODUCTION: Phototherapy involves the use of UV radiation to treat different dermatologic diseases. Its efficacy and safety have been thoroughly established in adults and some publications indicate that it is also an effective and safe treatment in pediatric patients with refractory skin diseases. MATERIAL AND METHODS: Retrospective study that included all patients under 17 years of age and 122 randomly selected adults who received phototherapy in our department between 2002 and 2017. RESULTS: Ninety-eight pediatric patients (61% girls and 39% boys) with a mean age of 10.5 years received phototherapy. The 3 most frequently treated diseases were psoriasis (48% of patients), vitiligo (17%), and atopic dermatitis (16%). Eighty-six percent of the patients received phototherapy with narrowband UV-B, whereas 7% received phototherapy with psoralen and UV-A (PUVA). No statistically significant differences were found in terms of dosage, duration, or number of sessions compared to the adult population treated with narrowband UV-B therapy or PUVA. A complete response was achieved in 35% of the pediatric patients and no differences were found with respect to the adults. Only 16% of the children showed adverse effects, mostly in the form of mild erythema. We found greater adherence to treatment in the pediatric patients than in the adult patients (P < .05). CONCLUSIONS: Narrowband UV-B therapy and PUVA appear to be safe and effective in children and can be administered using the same treatment protocols as those used in adults. Adherence to treatment is greater in children than in adult patients


Assuntos
Humanos , Criança , Adulto , Pessoa de Meia-Idade , Dermatopatias/terapia , Fototerapia/métodos , Resultado do Tratamento , Terapia PUVA/métodos , Estudos Retrospectivos , Terapia Ultravioleta/métodos , Psoríase/terapia , Dermatite Atópica/terapia , Vitiligo/terapia , Cooperação e Adesão ao Tratamento
20.
Int Immunopharmacol ; 80: 106191, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31986325

RESUMO

BACKGROUND: Staphylococcus aureus (S. aureus) accounts for 90% of the microbiome in atopic dermatitis (AD) lesions and plays a role in disease flare-ups and worsens disease outcome. Ozone treatment can improve AD conditions by its bactericidal effect on S. aureus. OBJECTIVE: To study the effects of topical ozone therapy on microbiome diversity in AD lesions and explore potential probiotic pathogens correlated with AD progression. METHODS: Patients with moderate to severe bilateral skin lesions in AD were recruited. Randomized split sides were performed. One side was treated with ozone hydrotherapy followed by ozonated oil; while the contralateral side with tap water and basal oil. Patients' SCORAD scores and modified EASI were recorded before and after treatments. The microbiological compositions in targeting sites were determined using 16S rDNA sequencing. RESULTS: After three-day ozone therapy, patients showed a significant decrease in SCORAD scores and inflammatory cell infiltration in AD lesions. The micro-ecological diversity was higher in the non-lesional as compared with lesional areas (p < 0.05), which was also negatively correlated with the severity of AD (r = -0.499, p < 0.05). The proportion of S. aureus in AD lesions was positively correlated with the severity of AD (r = 0.564, p = 0.010), which was decreased after ozone treatment (p = 0.07). Ozone therapy showed an increase in microbiological diversity with a significant increase in the proportion of Acinetobacter (p < 0.05). CONCLUSION: Topical ozone therapy is highly effective for treatment for AD. It can change the proportional ratio of Staphylococcus and Acinetobacter, thereby restoring the microbiological diversity in AD lesions.


Assuntos
Dermatite Atópica/terapia , Hidroterapia/métodos , Microbiota/imunologia , Ozônio/administração & dosagem , Acinetobacter/genética , Acinetobacter/imunologia , Acinetobacter/isolamento & purificação , Administração Tópica , Adolescente , Adulto , Criança , DNA Bacteriano/isolamento & purificação , Dermatite Atópica/diagnóstico , Dermatite Atópica/imunologia , Dermatite Atópica/microbiologia , Feminino , Humanos , Masculino , Probióticos/isolamento & purificação , RNA Ribossômico 16S/genética , Índice de Gravidade de Doença , Pele/imunologia , Pele/microbiologia , Pele/patologia , Staphylococcus aureus/genética , Staphylococcus aureus/imunologia , Staphylococcus aureus/isolamento & purificação , Resultado do Tratamento , Adulto Jovem
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