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1.
Int J Mol Sci ; 20(17)2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31470652

RESUMO

Atopic dermatitis (AD) is the most common inflammatory skin disease worldwide. It is a chronic, relapsing and pruritic skin disorder which results from epidermal barrier abnormalities and immune dysregulation, both modulated by environmental factors. AD is strongly associated with asthma and allergic rhinitis in the so-called 'atopic march.' Xenobiotic receptors and their mates are ligand-activated transcription factors expressed in the skin where they control cellular detoxification pathways. Moreover, they regulate the expression of genes in pathways involved in AD in epithelial cells and immune cells. Activation or overexpression of xenobiotic receptors in the skin can be deleterious or beneficial, depending on context, ligand and activation duration. Moreover, their impact on skin might be amplified by crosstalk among xenobiotic receptors and their mates. Because they are activated by a broad range of endogenous molecules, drugs and pollutants owing to their promiscuous ligand affinity, they have recently crystalized the attention of researchers, including in dermatology and especially in the AD field. This review examines the putative roles of these receptors in AD by critically evaluating the conditions under which the proteins and their ligands have been studied. This information should provide new insights into AD pathogenesis and ways to develop new therapeutic interventions.


Assuntos
Dermatite Atópica/metabolismo , Receptores Citoplasmáticos e Nucleares/metabolismo , Pele/metabolismo , Xenobióticos/metabolismo , Asma/genética , Asma/imunologia , Asma/metabolismo , Dermatite Atópica/genética , Dermatite Atópica/imunologia , Eczema/genética , Eczema/imunologia , Eczema/metabolismo , Epiderme/imunologia , Epiderme/metabolismo , Epiderme/patologia , Regulação da Expressão Gênica/imunologia , Ligantes , Receptores Citoplasmáticos e Nucleares/genética , Rinite Alérgica/genética , Rinite Alérgica/imunologia , Rinite Alérgica/metabolismo , Pele/imunologia , Pele/patologia
2.
Clin Rev Allergy Immunol ; 57(2): 286-293, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31309394

RESUMO

Eczema is increasing worldwide with associated increases in health costs and decreases in quality of life. There are many factors that are speculated to interact in the development of eczema including genetics and environmental exposures. Prevention of the development of eczema may prevent the further development of food allergies and asthma. This concept has prompted a variety of research into the area of primary prevention of eczema in infants. This exploration includes a growing body of research examining infants supplemented with probiotics, prebiotics, or both (synbiotics) often compared with their breastfed counterparts. The goal of this paper is to examine the evidence for manipulating the microbiome in the prevention of eczema. Several strains of probiotics, compositions of prebiotics, and varied combinations of both are commercially available. Evidence supports altering the microbiome in infants at high risk of atopy who are not able to breastfeed with Lactobacillus strains when given both prenatally followed by prolonged use (greater than 6 months) postnatally for the primary prevention of eczema. Prebiotics have also been shown beneficial for primary prevention of eczema in formula-fed infants with prolonged use greater than 6 months. These findings are in keeping with the World Allergy Organization (WAO) recommendations that support interventions to manipulate the microbiome with both probiotics and prebiotics.


Assuntos
Eczema/dietoterapia , Eczema/prevenção & controle , Microbiota/imunologia , Prebióticos , Probióticos , Simbióticos , Bifidobacterium/fisiologia , Aleitamento Materno , Eczema/imunologia , Humanos , Lactente , Lactobacillus/fisiologia , Qualidade de Vida
3.
J Dermatol ; 46(8): 680-685, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31187925

RESUMO

Systemic treatment options for chronic hand eczema are limited. Dupilumab is used in atopic dermatitis (AD) but is not licensed for (isolated) hand eczema. In this observational prospective study we aimed to determine the response of hand eczema to dupilumab in patients with AD. Adult patients with hand eczema and AD received dupilumab s.c. at a 600 mg loading dose, followed by 300 mg every 2 weeks. Primary outcome was a minimum improvement of 75% on the Hand Eczema Severity Index after 16 weeks (HECSI-75). Secondary outcomes were severity, measured using the Photographic guide; quality of life improvement as patient-reported outcome, measured using the Dermatology Life Quality Index (DLQI); and AD severity, measured using the Eczema Area and Severity Index (EASI). Forty-seven patients were included (32 males; mean age, 45 years). HECSI-75 was achieved by 28 (60%). Mean HECSI score reduction was 49.2 points (range, 0-164; 95% within-subject confidence interval, 46.4-52.0), which was already significantly decreased after 4 weeks (P < 0.001). DLQI score mean improvement was 8.8 points (standard deviation [SD], 6.0) or 70.0% decrease (SD, 26.4) (P < 0.001). Eighteen patients (38%) were classified as responders on the Photographic guide. There was no difference in response between chronic fissured and recurrent vesicular clinical subtypes. Similar percentages of patients achieving EASI-75 and HECSI-75 were seen after 16 weeks. In conclusion, this study shows a favorable response of hand eczema to dupilumab in patients with AD. This raises the question whether a response will also be seen in isolated hand eczema.


Assuntos
Anticorpos Monoclonais/administração & dosagem , Dermatite Atópica/tratamento farmacológico , Eczema/tratamento farmacológico , Adulto , Idoso , Anticorpos Monoclonais Humanizados , Doença Crônica/tratamento farmacológico , Dermatite Atópica/complicações , Método Duplo-Cego , Esquema de Medicação , Eczema/complicações , Eczema/diagnóstico por imagem , Eczema/imunologia , Feminino , Mãos , Humanos , Injeções Subcutâneas , Subunidade alfa de Receptor de Interleucina-4/antagonistas & inibidores , Subunidade alfa de Receptor de Interleucina-4/imunologia , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Fotografação , Estudos Prospectivos , Qualidade de Vida , Recidiva , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
4.
Immun Inflamm Dis ; 7(3): 170-182, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31207167

RESUMO

BACKGROUND: Heredity and environmental parameters jointly affect allergy development. Here, we used a Swedish prospective cohort to study the influence of heredity and factors usually associated with allergic disease and the development of allergic manifestations in combination with immunoglobulin E (IgE) sensitization at four different time points until 10 years of age. METHODS: Parents-to-be were characterized concerning allergy and their children (n = 281) were divided based on allergic heredity and followed from birth and clinically examined for IgE-associated allergic symptoms until 10 years of age. The relation between allergy and early-life parameters was analyzed by logistic regression. Group-wise comparisons were made by nonparametrical tests. RESULTS: Early life eczema and/or asthma in combination with IgE sensitization, was a strong indicator of allergy at a later time point. Further, the early occurrence of multiple allergic symptoms among IgE-sensitized children predisposed for a more complex allergic phenotype at later ages, independently of allergic heredity. At 10 years of age, allergic children had higher fractional exhaled nitrogen oxide (FeNO) levels, regardless of asthma, and FeNO levels were also influenced by heredity. Birth season was strongly associated with allergy development, but only in children with two allergic parents. CONCLUSION: Allergic eczema/asthma in early life, being born during the autumn/winter, having multiple allergic symptoms and two allergic parents were all strong predictors for having allergic diseases at 5 and 10 years of age. However, the allergic march seems to be independent of heredity, as IgE-mediated allergies follow the same trajectories in children with and without allergic heredity.


Assuntos
Asma/imunologia , Eczema/imunologia , Hipersensibilidade/imunologia , Imunoglobulina E/imunologia , Fatores Etários , Asma/diagnóstico , Criança , Pré-Escolar , Eczema/diagnóstico , Expiração , Feminino , Humanos , Hipersensibilidade/diagnóstico , Lactente , Recém-Nascido , Masculino , Óxido Nítrico/imunologia , Óxido Nítrico/metabolismo , Pais , Fenótipo , Estudos Prospectivos
5.
Eur J Dermatol ; 29(3): 250-258, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31122909

RESUMO

Atopic dermatitis is a worldwide prevalent chronic inflammatory skin disease. Although primarily recognized as a disease of children, there is increasing evidence suggesting that it is more common in adults than previously thought. Both immune dysregulation and cutaneous barrier dysfunction are involved in the pathogenesis of the disease, although the exact mechanisms are still unclear. The concept of atopic dermatitis as a biphasic Th1-Th2 disease is changing, as recent evidence supports systemic activation of other multiple Th-cell subsets. Atopic dermatitis has been associated with an increasing number of comorbidities, possibly sharing some common pathological mechanisms. The atopic march is well known and represents the natural progression of atopic diseases in a considerable number of patients, usually starting with the development of atopic dermatitis followed by other atopic conditions, such as asthma and allergic rhinitis. Association of atopic dermatitis with cardiovascular disease, autoimmune diseases, as well as cutaneous and extracutaneous infections have been increasingly reported, although the link is not yet clear. Furthermore, the association between atopic dermatitis and neuropsychiatric conditions has also been widely studied, with an increased risk of mental health disorders strongly influenced by sleep disorders. Altogether, these associations contribute to the burden of atopic dermatitis, which increases the need for a more focused therapeutic approach that includes prevention or early diagnosis and treatment of comorbidities that may arise. This review explores the recent associations with atopic dermatitis and the possible underlying mechanisms involved, which supports the concept of atopic dermatitis as a systemic disease.


Assuntos
Asma/epidemiologia , Doenças Autoimunes/diagnóstico , Dermatite Atópica/epidemiologia , Dermatite Atópica/imunologia , Eczema/epidemiologia , Rinite Alérgica/epidemiologia , Adulto , Fatores Etários , Asma/imunologia , Doenças Autoimunes/epidemiologia , Criança , Comorbidade , Dermatite Atópica/diagnóstico , Progressão da Doença , Eczema/imunologia , Feminino , Humanos , Incidência , Masculino , Prognóstico , Rinite Alérgica/imunologia , Medição de Risco , Fatores Sexuais
6.
Sci Transl Med ; 11(481)2019 02 27.
Artigo em Inglês | MEDLINE | ID: mdl-30814336

RESUMO

Antigenic exposures at epithelial sites in infancy and early childhood are thought to influence the maturation of humoral immunity and modulate the risk of developing immunoglobulin E (IgE)-mediated allergic disease. How different kinds of environmental exposures influence B cell isotype switching to IgE, IgG, or IgA, and the somatic mutation maturation of these antibody pools, is not fully understood. We sequenced antibody repertoires in longitudinal blood samples in a birth cohort from infancy through the first 3 years of life and found that, whereas IgG and IgA show linear increases in mutational maturation with age, IgM and IgD mutations are more closely tied to pathogen exposure. IgE mutation frequencies are primarily increased in children with impaired skin barrier conditions such as eczema, suggesting that IgE affinity maturation could provide a mechanistic link between epithelial barrier failure and allergy development.


Assuntos
Doenças Transmissíveis/imunologia , Meio Ambiente , Receptores de Antígenos de Linfócitos B/metabolismo , Adulto , Envelhecimento , Anticorpos/genética , Antígenos/imunologia , Linfócitos B/imunologia , Carbanilidas , Pré-Escolar , Células Clonais , Eczema/imunologia , Características da Família , Feminino , Humanos , Hipersensibilidade/imunologia , Switching de Imunoglobulina , Imunoglobulina E/metabolismo , Cadeias Pesadas de Imunoglobulinas/genética , Região Variável de Imunoglobulina/genética , Lactente , Masculino , Hipermutação Somática de Imunoglobulina , Vacinas/imunologia
7.
Immun Inflamm Dis ; 7(2): 74-85, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30859748

RESUMO

INTRODUCTION: Allergen-specific immunoglobulin isotype formation associated with immunoglobulin class-switching during the lactation period is the immunological background for food allergy in infants. We analyzed the serial changes in the production of feeding type-related egg- and milk-specific immunoglobulin isotypes from birth to 6 months of age with or without eczema in 84 infants. METHODS: Allergen-specific immunoglobulin G1 (IgG1), IgG2, IgG3, IgG4, IgA, and IgE levels of hen's egg and bovine milk were measured in cord blood and blood samples from infants at 2, 4, and 6 months of age by the densely carboxylated protein microarray. RESULTS: Formula and mixed feeding were associated with a rapid increase in cow's milk allergen-specific immunoglobulins and feeding type-related significant differences in casein-specific immunoglobulin levels were detected. Breast and mixed feeding were associated with slow but significant increase in ovalbumin-specific IgG1 and IgE levels, but not other immunoglobulins. We found two different immunoglobulin isotype formation at 6 months of age with low- or high-affinity IgE against ovalbumin. One isotype formation pattern had relatively high ovalbumin-specific IgG1 levels, detectable IgG2, and low-affinity IgE, while the other had low ovalbumin-specific IgG1 levels, undetectable IgG2, and high levels of high-affinity IgE. The incidence of eczema was significantly higher in the latter pattern (84.6%), compared with the remaining infants (42.2%). CONCLUSIONS: Feeding practice-related allergen sensitization and immunoglobulin isotype formation were identified during the lactation period. The development of eczema during the lactation period could potentially modify the immunoglobulin isotype formation with high levels of high-affinity IgE.


Assuntos
Alérgenos/imunologia , Eczema/imunologia , Hipersensibilidade a Ovo/imunologia , Ovos/efeitos adversos , Switching de Imunoglobulina/imunologia , Imunoglobulina E/imunologia , Hipersensibilidade a Leite/imunologia , Leite/efeitos adversos , Fatores Etários , Animais , Afinidade de Anticorpos/imunologia , Formação de Anticorpos/imunologia , Especificidade de Anticorpos/imunologia , Bovinos , Galinhas , Eczema/complicações , Hipersensibilidade a Ovo/complicações , Hipersensibilidade a Ovo/genética , Feminino , Humanos , Isotipos de Imunoglobulinas/genética , Isotipos de Imunoglobulinas/imunologia , Lactente , Recém-Nascido , Masculino , Hipersensibilidade a Leite/complicações , Hipersensibilidade a Leite/genética , Gravidez
8.
Environ Sci Pollut Res Int ; 26(7): 6290-6300, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30666578

RESUMO

The statistics from Europe and the USA have proven a high risk for skin diseases associated with plant contact. Therefore, plant-induced dermatitis is of increasing attention in dermatology. The focus of this paper was to present the current knowledge on aspects of contact allergy related to Asteraceae (Compositae) species. The Asteraceae family is one of the largest in the world with members across all continents. The PubMed/Medline databases have been searched. The Asteraceae representatives consist of diverse secondary metabolites, which exhibit various advantageous effects in humans. In particular, sesquiterpene lactones (SLs) may cause sensitization resulting in skin irritation and inflammation. In this study, we tried to reveal the allergenic potential of several Asteraceae species. The Asteraceae-related allergy symptoms involve eczema, hay fever, asthma, or even anaphylaxis. Furthermore, the evidence of severe cross-reactivity with food and pollen allergens (PFS) in patients sensitive to Asteraceae allergens have been announced. Further identification and characterization of secondary metabolites and possible allergens in Asteraceae are necessary for the better understanding of Asteraceae-related immune response. The Asteraceae allergy screening panel (the SL mix and the Compositae mix of five plant species) is a promising tool to improve allergy diagnostics and therapy.


Assuntos
Alérgenos/imunologia , Asteraceae/imunologia , Hipersensibilidade/imunologia , Asma/imunologia , Dermatite Alérgica de Contato/imunologia , Eczema/imunologia , Europa (Continente) , Humanos , Inflamação , Dermatopatias
9.
J Allergy Clin Immunol ; 143(1): 378-385.e9, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30336226

RESUMO

BACKGROUND: Although many risk factors have been described for atopic eczema in children, little is known about the eczema phenotype in middle-aged or elderly adults. OBJECTIVE: We sought to examine the association between air pollution, atopy, and eczema in adulthood. METHODS: This analysis was based on 834 women from the Study on the influence of Air pollution on Lung Function, Inflammation and Ageing cohort in Germany. Incident symptoms of eczema after age 55 years and prevalent symptoms of eczema 12 months or less before investigation were assessed by means of questionnaire at the second follow-up (2007-2010). Total serum IgE levels were measured at baseline (1985-1994) and in 2007-2010. Exposure to air pollution was assessed by using land-use regression. Adjusted logistic regression models were applied to estimate the association between air pollution and incident and prevalent symptoms of eczema. Weighted genetic risk scores were used to investigate the effect of atopic eczema-related risk alleles on this association. RESULTS: Exposures to oxides of nitrogen (nitrogen dioxide and nitrogen oxides) and particulate matter (fine particulate matter with an aerodynamic diameter of ≤2.5 µm [PM2.5] and particulate matter with an aerodynamic diameter of <10 µm) were significantly associated with increased odds of incident eczema (eg, with PM2.5 per 4.7 µg/m3; odds ratio, 1.45; 95% CI, 1.06-1.99). These associations were slightly more pronounced with nonatopic eczema (eg, with PM2.5; odds ratio of 1.65 and 95% CI of 1.15-2.34 for participants without hay fever or increased IgE levels). Associations with air pollution were stronger in carriers of fewer risk alleles for atopic eczema. CONCLUSION: Nonatopic eczema in the elderly is associated with traffic-related air pollutants, and this phenotype differs from genetically driven atopic eczema.


Assuntos
Poluição do Ar/efeitos adversos , Alelos , Eczema , Exposição Ambiental/efeitos adversos , Frequência do Gene , Eczema/induzido quimicamente , Eczema/epidemiologia , Eczema/genética , Eczema/imunologia , Feminino , Seguimentos , Humanos , Incidência , Pessoa de Meia-Idade , Prevalência , Fatores de Risco
10.
G Ital Dermatol Venereol ; 154(4): 425-434, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30428660

RESUMO

Atopic dermatitis is a multifactorial disease that can concomitantly occur with irritant or allergic contact dermatitis. The colloquial use of atopic dermatitis and eczema interchangeably has created confusion among patients and providers alike. Atopic skin is a complex entity that involves a defective barrier and biome, an aberrant immune response, and abnormal neural activation, while eczema is a generalized term denoting a particular appearance common to multiple diagnoses including atopic dermatitis and contact dermatitis. The conventional paradigm that simplifies atopic dermatitis and allergic contact dermatitis into distinct Th2 and Th1 processes, respectively, fails to acknowledge potential immunologic intersection points and contributes to impaired disease management. This article will review the complex interplay of atopic dermatitis and contact dermatitis and discuss treatment strategies for recalcitrant cases.


Assuntos
Dermatite Alérgica de Contato/patologia , Dermatite Atópica/patologia , Dermatite Irritante/patologia , Dermatite Alérgica de Contato/diagnóstico , Dermatite Alérgica de Contato/imunologia , Dermatite Atópica/diagnóstico , Dermatite Atópica/imunologia , Dermatite Irritante/diagnóstico , Dermatite Irritante/imunologia , Eczema/diagnóstico , Eczema/imunologia , Eczema/patologia , Humanos , Células Th1/imunologia , Células Th2/imunologia
12.
Clin Immunol ; 197: 219-223, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30368009

RESUMO

Early onset multisystem autoimmunity is commonly the defining feature of IPEX. Recurrent sinopulmonary infections and CVID-like phenotype were not previously recognized as a presentation in IPEX. Herein, we describe three extended family members with IPEX. In addition to autoimmunity, all three had a CVID-like presentation consisting of recurrent sinopulmonary infections, hypogammaglobulinemia and B-cell class switching defect. In vitro studies have shown that the B cell class switching defect is not B cell intrinsic. Additionally, a marked increase in circulating T follicular helper (cTFH) cells with high IFN-γ and IL-17 secretion on stimulation was noted in our patients. The dysregulated cTFH cells could contribute to a decreased B cell class switching. However, the exact mechanism of how expanded and dysregulated cTFH lead to B cell class switching defect and hypogammaglobulinemia in our patients is not clear. Our study could extend the clinical spectrum of IPEX to include a CVID-like presentation.


Assuntos
Agamaglobulinemia/imunologia , Autoimunidade/imunologia , Linfócitos B/imunologia , Diabetes Mellitus Tipo 1/congênito , Diarreia/imunologia , Doenças Genéticas Ligadas ao Cromossomo X/imunologia , Doenças do Sistema Imunitário/congênito , Linfócitos T Auxiliares-Indutores/imunologia , Adulto , Agamaglobulinemia/terapia , Anemia Hemolítica Autoimune/imunologia , Diabetes Mellitus Tipo 1/genética , Diabetes Mellitus Tipo 1/imunologia , Diabetes Mellitus Tipo 1/terapia , Diarreia/genética , Diarreia/terapia , Eczema/imunologia , Família , Feminino , Fatores de Transcrição Forkhead/genética , Doenças Genéticas Ligadas ao Cromossomo X/genética , Doenças Genéticas Ligadas ao Cromossomo X/terapia , Heterozigoto , Humanos , Doenças do Sistema Imunitário/genética , Doenças do Sistema Imunitário/imunologia , Doenças do Sistema Imunitário/terapia , Switching de Imunoglobulina/imunologia , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Enteropatias/imunologia , Masculino , Pessoa de Meia-Idade , Linhagem , Pneumonia/imunologia , Recidiva , Sinusite/imunologia , Adulto Jovem
14.
Allergol. immunopatol ; 46(3): 281-290, mayo-jun. 2018.
Artigo em Inglês | IBECS | ID: ibc-172948

RESUMO

Eczema is one of the most common inflammatory diseases, often constituting a lifelong burden for afflicted individuals. The complex interaction of host genetic and multiple environmental factors contribute to its pathogenesis. A relationship between maladjustment of gut microbiota and eczema has been brought into the light of day in most previous studies. In eczema preclinical models, specific intestinal microbial species have been demonstrated to prohibit or dwindle immune responsiveness, indicating that these strains among commensal gut bacteria may exert either a morbific or phylactic function in eczema progression. As such, oral probiotics can serve as a medicinal approach for eczema therapy. Given that relative scientific work is still at the early stage, only limited data are available in the field. New sequencing techniques have been fortunately performed to gain access to an extended research on the relationship between gut bacterial flora and human diseases. In the current review, we identified the role of intestinal microbiota in the development of eczema and how specific bacterial strains adjust the immune responsiveness in the midst of disease progression. Probiotics as an applicable treatment for eczema were evaluated in other threads as well (AU)


No disponible


Assuntos
Humanos , Eczema/imunologia , Eczema/microbiologia , Microbioma Gastrointestinal/imunologia , Inflamação/imunologia , Clostridium difficile/imunologia , Clostridium difficile/isolamento & purificação , Escherichia coli/imunologia , Escherichia coli/isolamento & purificação
15.
An. pediatr. (2003. Ed. impr.) ; 88(6): 309-314, jun. 2018. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-176954

RESUMO

Introducción: El eccema de manos es una forma frecuente de eccema en adultos. Su diagnóstico en ocasiones es complejo debido a la existencia de diferentes clasificaciones diagnósticas. Existen pocos trabajos que estudien el eccema de manos y su clasificación en niños. Material y método: Se ha identificado a 389 niños entre 0 y 16 años remitidos a la Unidad de Alergia Cutánea de nuestro servicio para estudio con pruebas epicutáneas en el periodo 1996-2016. De entre todos los casos se han seleccionado 42 casos con dermatitis localizada exclusivamente en la mano (10,8% de todos los niños remitidos). En todos los casos se realizaron pruebas epicutáneas parchando la batería estándar, así como baterías adicionales en función de la sospecha clínica. Se recogieron datos epidemiológicos (edad, sexo, antecedentes de dermatitis atópica…), así como clínicos (localización de las lesiones). Resultados: De los 42 niños remitidos con dermatitis de la mano, 25 (60,5%) eran niñas y 17 (40,5%) niños. La edad media de los pacientes con dermatitis de la mano fue de 10,6 ± 3,9 años. El diagnóstico definitivo tras la realización de pruebas epicutáneas fue dermatitis atópica en 15 casos, dermatitis alérgica de contacto en 14 pacientes, eccema endógeno vesiculoso en 6 casos, eccema endógeno hiperqueratósico en 5 casos y dermatitis irritativa de contacto en 2 casos. Los alérgenos detectados más frecuentes fueron tiomersal (9 casos), niquel (5 casos), mercurio (5 casos) y cobalto (4 casos). Conclusión: El eccema de manos es una entidad frecuente en niños. La causa más frecuente es la dermatitis atópica, aunque no son infrecuentes los casos de dermatitis alérgica de contacto que se manifiestan como eccema de manos. Todo niño con eccema de manos en el que se sospeche una causa alérgica debe ser remitido para realización de pruebas epicutáneas


Introduction: Hand eczema is a frequent disease in adults. Diagnosing the cause of hand eczema is difficult due to different classifications. There is lack of evidence on hand eczema and its causes in children. Material and method: A total of 389 children between 0 and 16 years were identified between 1996 and 2016, from whom 42 (10.8%) with exclusively hand eczema were selected. In all cases a standard battery of epicutaneous patch tests was performed, as well as additional batteries depending on the clinical suspicion. The clinical and epidemiological features of these children were recorded and compared against children with eczema in other locations. Results: The 42 children with hand eczema included 25 (60.5%) girls, and 17 (40.5%) boys, with a mean age of 10.6 +- 3.9 years, and did not differ from that of children with eczema in other locations. The definitive diagnosis after patch-testing was Atopic Dermatitis in 15 cases, Allergic Contact Dermatitis in 14 patients, Endogenous Vesiculous Eczema in 6 cases, Endogenous Hyperkeratotic Eczema in 5 cases, and Irritant Contact Dermatitis in 2 cases. The most frequent allergens detected were thiomersal (9 cases), nickel (5 cases), mercury (5 cases), and cobalt (4 cases). Conclusion: Hand eczema is a common condition in children. The most common cause is atopic dermatitis, although cases of allergic contact dermatitis manifesting as hand eczema are not uncommon. Any child with eczema of hands in whom an allergic cause is suspected should be referred for patch- testing


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Eczema/diagnóstico , Eczema/epidemiologia , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/epidemiologia , Estudo Observacional , Eczema/imunologia , Estudos Epidemiológicos , Dermatoses da Mão/imunologia , Testes do Emplastro , Estudos Retrospectivos , Centros de Atenção Terciária , Testes Cutâneos
17.
Medicine (Baltimore) ; 97(14): e0215, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29620631

RESUMO

Hyperimmunoglobulin E syndromes (HIES) are rare primary immunodeficiency diseases characterized by markedly elevated serum immunoglobulin (Ig) E, recurrent pneumonia, and chronic eczema. To date, information about pediatric HIES is limited. We aimed to evaluate the spectrum of clinical and immunological features in pediatric patients with HIES in China.We retrospectively reviewed the cases of 4 pediatric patients with HIES followed at the Guangzhou Women and Children's Medical Center from May 2013 to September 2017. We analyzed clinical presentation, laboratory data, immunological evaluations, imagenological characteristics, treatment, response to therapy, genetic and bronchoalveolar lavage fluid (BALF) findings, and prognosis.The common clinical features of the patients were recurrent respiratory and mucocutaneous infections and eczematoid skin lesions. In 3 of 4 patients, BALF and transbronchial lung biopsy (TBLB) demonstrated fungal pneumonia with organisms including invasive Aspergillus and Penicillium marneffei. Elevated serum IgG and IgM were detected in 3 and 2 cases, respectively, while CD4+ T and CD19+ B cells were slightly reduced in only 1 patient. Nitroblue tetrazolium tests (NBTs) were normal in all patients, and reduced natural killer cell counts were identified in 3 patients. A novel missense mutation in exon 17 (c.1593A>T, p.K531N) was identified in the signal transducer and activator of transcription 3 (STAT3) gene that has not been reported previously. One patient had 3 homozygous nonsynonymous variations of the complement receptor 2 (CR2) gene distributed in exons 10 (c.1916G>A, p.S639N) and 11 (c.1987T>C, p.S663P and c.2012G>A, p.R671H) with high frequency.This case series suggests that fungi are important respiratory pathogens in children with HIES and should be considered in cases of pneumonia in this population. The NIH scoring system does not allow diagnostic certainty, particularly in infants, because some of the common manifestations of HIES may not develop until the patient matures. Pulmonary complications must be identified in the early stage of the disease to treat them effectively. In addition, we report a mutation in STAT3 that has not been identified previously.


Assuntos
Síndrome de Job , Adolescente , Criança , Pré-Escolar , China , Eczema/imunologia , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Síndrome de Job/genética , Síndrome de Job/imunologia , Síndrome de Job/microbiologia , Pneumopatias Fúngicas/imunologia , Pneumopatias Fúngicas/microbiologia , Masculino , Pneumonia/imunologia , Pneumonia/microbiologia , Estudos Retrospectivos
18.
Ann Allergy Asthma Immunol ; 120(6): 620-625, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29524559

RESUMO

BACKGROUND: Recent guidelines recommend early peanut introduction (EPI) beginning around 4 to 6 months of age in infants with severe eczema and/or egg allergy and around 6 months for all other infants. Caregiver preferences for such practices are unknown. OBJECTIVE: To determine levels of support for early allergenic solid food recommendations among new and expecting caregivers of infants at risk for peanut allergy. METHODS: We explored preferences for EPI and in-office allergy risk assessment (IRA) through a nationally representative survey of expecting (n = 1,000) and new caregivers of infants younger than 1 year (n = 1,000). RESULTS: Among a primarily female (99.7%), married (80.3%), and white (74.4%) sample, 29% had no or vague awareness of the new guidelines, 61% had no or minimal concern for their child developing food allergy, but 54% felt timing of food introduction has moderate to strong importance for developing food allergy. Only 31% expressed willingness for EPI before or around 6 months of age, with 40% reporting willingness to introduce peanut after 11 months of age, similar to tree nuts and seafood. However, 60% reported willingness to introduce egg before 8 months of age. A total of 51% and 56.8% were unwilling to allow IRA methods, such as skin testing and oral challenge, before 11 months of age, respectively. Odds of willingness to delay peanut introduction (odds ratio, 0.79; 95% confidence interval, 0.65-0.96) and undergo challenge (odds ratio, 0.67; 95% confidence interval, 0.54-0.82) after 6 months of age were lower among expecting caregivers. CONCLUSION: Among new and expecting caregivers, there is poor current willingness and questionable support for early allergenic solid food recommendations, including IRA before introduction. Willingness was better among expecting vs current caregivers. These trends underscore a need for broader formal implementation planning to facilitate early allergen introduction and maximize its preventive benefits.


Assuntos
Alérgenos/administração & dosagem , Arachis/imunologia , Cuidadores/psicologia , Eczema/prevenção & controle , Hipersensibilidade a Ovo/prevenção & controle , Ovos/análise , Hipersensibilidade a Amendoim/prevenção & controle , Arachis/química , Criança , Eczema/imunologia , Eczema/fisiopatologia , Hipersensibilidade a Ovo/imunologia , Hipersensibilidade a Ovo/fisiopatologia , Feminino , Humanos , Lactente , Masculino , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Hipersensibilidade a Amendoim/imunologia , Hipersensibilidade a Amendoim/fisiopatologia , Guias de Prática Clínica como Assunto , Medição de Risco , Testes Cutâneos , Fatores de Tempo
20.
Microb Pathog ; 117: 27-31, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29428424

RESUMO

Parvovirus B19 (PVB19) is a virus found in the skin that causes asymptomatic infections and can exist in the host for long periods to time. The virus induces a local inflammatory response and is associated with the development of arthritis and other autoimmunes diseases. Parvovirus B19 DNA was investigated by PCR in the skin of 20 patients with psoriasis and 20 patients with eczema. Additionally, immunohistochemistry was used to characterize the expression of cytokines in these lesions. The sociodemographic variables were similar in the two groups studied. Psoriasis vulgaris was the most common clinical type in men (50%) and women (80%) (p = 0.0106). Comorbidities were observed in most patients with psoriasis (75%), with an OR of 14 (p = 0.0068). Another important finding was the high prevalence (50%) of psychiatric disorders in patients with psoriasis (OR = 16, p = 0.0218). Only two patients (10%) with psoriasis were positive for PVB19. Comparison of cytokine expression showed the same cytokine profile in the two groups (p > 0.05). However, expression of TNF-α tended to be higher in psoriasis patients. There was no significant positivity for PVB19 in the two groups studied. Immunohistochemistry showed higher expression of TNF-α in psoriasis lesions compared to the eczema group.


Assuntos
Eczema/imunologia , Infecções por Parvoviridae/imunologia , Parvovirus B19 Humano/patogenicidade , Psoríase/imunologia , Dermatopatias/imunologia , Dermatopatias/virologia , Pele/imunologia , Pele/virologia , Infecções Assintomáticas , Brasil , Citocinas/metabolismo , DNA Viral/análise , Eczema/complicações , Eczema/epidemiologia , Eczema/virologia , Feminino , Humanos , Imuno-Histoquímica , Interferon gama/metabolismo , Interleucina-2/metabolismo , Interleucina-4/metabolismo , Masculino , Pessoa de Meia-Idade , Infecções por Parvoviridae/complicações , Infecções por Parvoviridae/epidemiologia , Infecções por Parvoviridae/virologia , Parvovirus B19 Humano/genética , Parvovirus B19 Humano/imunologia , Parvovirus B19 Humano/isolamento & purificação , Prevalência , Psoríase/complicações , Psoríase/epidemiologia , Psoríase/virologia , Pele/patologia , Dermatopatias/epidemiologia , Dermatopatias/patologia , Fator de Necrose Tumoral alfa/metabolismo
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