靶向药物治疗儿童中重度特应性皮炎的临床研究进展

特应性皮炎(atopic dermatitis,AD)是一种以湿疹和皮肤瘙痒为特征的慢性皮肤病,是儿童最常见的皮肤病之一。AD的治疗目前以药物治疗为主,但儿童患者尤其是中重度AD患者的治疗需求尚未被完全满足,安全、有效的长期治疗方案仍待探索实践。以生物制剂和小分子抑制剂为代表的靶向药物是治疗中重度特应性皮炎的新兴药物,本文检索近年来国内外相关文献,分别从生物制剂和小分子抑制剂两方面进行综述,为儿童中重度特应性皮炎靶向药物的进一步开发与应用提供参考。     

儿童特应性皮炎的新药治疗进展

特应性皮炎是一种常见的慢性、复发性、炎症性皮肤病。目前的治疗方法仍有较多的局限性及不良反应，不能完全满足临床需求。近年来，随着对特应性皮炎复杂发病机制的深入研究，很多新药逐渐应用于治疗特应性皮炎，本文就这些药物在儿童特应性皮炎患者的应用及研究进展进行综述，以便临床医生更好地治疗和管理特应性皮炎患儿。     

儿童湿疹/特应性皮炎药物临床试验评价指标的研究进展

湿疹是儿科临床常见的皮肤病,特应性皮炎是其中最常见的一种.《儿童湿疹/特应性皮炎中药临床试验设计与评价技术指南》已正式发布,其中提到湿疹/特应性皮炎临床试验的核心指标集,包括客观体征、主观症状、生活质量和长期控制4个核心领域,并参考核心指标集所述,制定了疗效评价指标.综述国内外湿疹/特应性皮炎临床试验中关于上述4个核心...     

儿童特应性皮炎中医病因病机探讨

特应性皮炎（Atopic Dermatitis,AD）是一种儿童常见的具有遗传倾向的变态反应性皮肤病,西医发病机制未完全阐释清楚且无特效治疗方法。中医治疗具有独特优势,通过统计分析古籍及现代文献关于特应性皮炎中医病因病机文献,总结归纳特应性皮炎的中医病因病机,为辩证论治提供依据。     

中药三联疗法治疗儿童特应性皮炎78例临床观察

目的 观察妇安消疹洗液、玉屏风颗粒、白及多糖乳膏三联疗法治疗儿童特应性皮炎的临床疗效.方法 选取十堰市太和医院(湖北医药学院附属医院)皮肤病中心2017年1月至2018年12月收治的儿童特应性皮炎156例,采用随机数字表法分为对照组和治疗组,各78例.对照组予玉屏风颗粒口服、白及多糖乳膏和氧化锌糊外涂患处,治疗组予玉屏...     

小儿特应性皮炎居家护理及药物治疗

特应性皮炎(atopic dermatitis,AD)是儿童多发的慢性、复发性、瘙痒性、炎症性皮肤病[1]。常伴有血清IgE水平升高、嗜酸细胞增多、过敏性鼻炎、哮喘以及过敏性家族史。特应性皮炎容易复发,持续的时间比较长,如果护理不当会造成发作的次数增加,延长病程,给患儿带来很大的痛     

儿童抗过敏药物临床应用研究进展

儿童过敏性疾病的发病率在全球范围内呈逐年上升趋势。该病主要临床表现为致敏原引发的哮喘、鼻炎、特应性皮炎、结膜炎、食物过敏及过敏性休克等。但受小儿临床药理学的发展与应用的限制,部分药物无儿童剂型,且因缺乏临床研究依据而导致用药剂量不规范、不统一,本文就儿童抗过敏药物临床应用研究进展作一综述,旨在为临床儿童用药提供理论依据。     

食物干预儿童特应性皮炎50例临床观察

目的:观察食物干预对儿童特应性皮炎患者临床症状改善情况.方法:采用随机对照临床试验,共纳入儿童特应性皮炎患者100例,随机分成食物干预组和对照组,每组50例进行临床对照观察.结果:食物干预组的疗效明显高于对照组.结论:通过特异性IgG的检测,指导干预儿童特应性皮炎的食物结构,能有效地治疗儿童的特应性皮炎.     

我国儿童特应性皮炎药物临床试验分析

目的：基于我国儿童特应性皮炎药物临床试验的登记情况及特应性皮炎治疗药品在我国的上市情况进行分析,为药品研究提供参考。方法：检索国家药品监督管理局“药物临床试验登记与信息公示平台”和“药品查询”数据库(检索时间均为2017年1月1日至2023年4月17日),获得儿童特应性皮炎临床试验注册信息及特应性皮炎治疗药品的上市信息,进行分类统计。结果：平台共登记了40项包含儿童受试者的湿疹/特应性皮炎药物临床试验,目前数据库有36家国内外生产企业的10个品种的特应性皮炎治疗药品在我国获准上市。结论：国内制药企业在儿童特应性皮炎药物研发上多集中于仿制药,目前已有2种治疗用生物制品1类药物,需要继续深耕,进一步开展药物临床试验,同时发挥我国中医药优势,发掘中药品种开展临床试验,为儿童用药添砖加瓦。     

芪血颗粒联合二维亚铁治疗小儿缺铁性贫血的临床研究

《儿童湿疹/特应性皮炎中药临床试验设计与评价技术指南》为中华中医药学会标准化项目《儿科系列常见病中药临床试验设计与评价技术指南》之一。其目的是以临床价值为导向,在病证结合模式下,讨论具有湿疹/特应性皮炎、儿童和中药特点的临床定位、试验设计与实施等相关问题,为中药治疗儿童湿疹/特应性皮炎临床试验设计与评价提供思路和方法。制定过程中先后成立指南工作组、起草专家组和定稿专家组,采用文献研究和共识会议的方法,最终形成指南送审稿定稿。该《指南》的主要内容包括临床定位、试验总体设计、诊断标准与辨证标准、受试者的选择与退出、干预措施、有效性评价、安全性观察、试验流程、试验的质量控制9部分。希望其制定和发布,能为申办者/合同研究组织、研究者在中药治疗湿疹/特应性皮炎的临床试验设计,提供借鉴与参考。     

The allergy march: from food to pollen

There is epidemiological evidence, especially from longitudinal studies, that clinical manifestations of atopy as well as IgE antibodies against food and aeroallergens show a systematic sequence of events. The atopic march begins with food allergy associated gastrointestinal disorders and atopic dermatitis followed by respiratory allergies, i.e. asthma and atopic rhino-conjunctivitis. Detectable food antibodies, especially against egg and milk proteins, usually precede or accompany the early clinical symptoms and signs. Similarly, aeroallergen sensitization, first against indoor allergen antibodies, succeeded by outdoor allergen antibodies, precede the clinical manifestation of respiratory allergy. Early atopic events, either manifestation or sensitization can be used as risk markers or even predictors of atopic disorders to implement preventive measures. Early atopic dermatitis as well as elevated serum IgE antibodies against food allergens in the first two years of life in combination with a family history can be used as a predictor for aeroallergen sensitization.     

Food induced skin diseases

Skin diseases due to an adverse reaction to food are urticaria, atopic dermatitis, oral allergy syndrome, dermatitis herpetiformis and protein induced contact dermatitis. The first three disorders will be discussed in more detail. Urticaria per se is a common skin reaction associated with various external and internal factors. Food as a causative factor is more frequently associated with acute than with chronic urticaria. The relation between food and atopic dermatitis is evident in young children with atopic dermatitis. The course of atopic dermatitis in adults is hardly influenced by food. The mechanism involved in urticaria may be immune-mediated, being IgE-mediated, or non-immune mediated, being pharmacologic or unknown. The mechanism involved in food-induced atopic dermatitis is based on the involvement of IgE antibodies and T lymphocytes. So far, it not known if and how (free or complexed with antibodies) food allergens enter the skin. It has been speculated that cutaneous T cell homing factors are involved.     

Natural history of cow's milk allergy. An eight-year follow-up study in 115 atopic children

BACKGROUND: Cow's milk allergy (CMA) is a disease of infancy and usually appears in the first few months of life. The evaluation of infants for possible CMA is one of the more common problems shared by pediatricians. The role of foods in determining and/or aggravating the clinical features of atopic dermatitis (AD) has been stressed in the last decades. OBJECTIVE: The aim of the present study was to investigate, in children with food related AD, the development of tolerance to the offending food(s), clinical or laboratory data to predict the development of food tolerance, and whether there are clinical or laboratory data to predict the onset of respiratory allergy. MATERIALS AND METHODS: In this prospective study we report on 115 babies, first examined at a median age of 6 months, and followed-up for 8 years. We have investigated several factors as predictive of the outcome, as follows: early onset; widespread or not-typical (reverse pattern) skin lesions, family history positive for atopy; persisting FA, high levels of total and specific IgE antibodies, association with CMA and asthma. RESULTS: All these parameters were significantly predictive of a long-term morbidity of AD children with CMA. The median age for tolerance to cow's milk was 7 years + 11 months, to egg 6 years + 6 months, and to wheat 7 years + 2 months. However a great number of both tolerant and intolerant children developed multiple sensitizations. Only 66 children (57%) acquired food tolerance, but there was the onset of asthma in 54% of cases. CONCLUSION: The natural history of CMA is not well-known, since not many related studies have been done in children. The several predictive factors, all in a negative sense, may be the norm in atopic children. We suggest possible areas of intervention in children at risk due to parental atopy. Preventive measures may induce a dramatic improvement in children with food allergy, but we stress that the long-term prognosis is challenging, since asthma prevalence may increase up to 54% during a long follow-up. Therefore, the natural history of IgE-mediated AD in atopic children sensitized to several allergens may be less optimistic than generally reported.     

儿童特应性皮炎皮肤屏障功能相关蛋白表达情况

目的:了解特应性皮炎患儿皮肤屏障功能相关蛋白的表达情况。方法:应用免疫组化方法检测特应性皮炎患儿和正常儿童的中间丝聚合蛋白、内披蛋白、兜甲蛋白等皮肤屏障功能相关蛋白(表皮终端分化蛋白)的表达差异,采用染色强度(0~5 分)反映相关蛋白的表达水平。结果:正常儿童皮肤的中间丝聚合蛋白、内披蛋白、兜甲蛋白的染色强度分别为(4.49±0.14)分、(4.39±0.14)分、(4.56±0.15)分,特应性皮炎患儿受累部分皮肤分别为(2.19±0.17)分、(2.29±0.11)分、(1.89±0±22)分,两组比较差异均有统计学意义(P均<0.01)。特应性皮炎患儿和正常儿童的中间丝聚合蛋白、兜甲蛋白均主要表达于颗粒层,正常儿童内披蛋白主要表达于棘细胞上层和颗粒层,特应性皮炎患儿内披蛋白主要表达于棘细胞上层。结论:特应性皮炎患儿皮肤屏障功能相关蛋白表达下降,提示存在皮肤屏障功能障碍。     

Chemicals in food and allergy: fact and fiction

The prevalence of the atopic diseases asthma, rhinitis and atopic eczema has increased in the past two to three decades. It is not unusual to read the statement that food additives and other chemicals in food increase the risk of allergy. From a theoretical standpoint chemicals in the diet may influence allergic sensitization and elicitation in different ways: (i) they may directly cause allergy because they are allergens or haptens; (ii) they may act as adjuvants facilitating allergy to other (dietary) components; (iii) they may modulate the immune system by direct immunotoxicity and in theory be able to change the balance from tolerance to IgE production; and (iv) they may trigger non-allergic intolerance reactions. With the present knowledge of chemicals in foods, the human exposure to these chemicals, and the described trends in this exposure, there is no supportive evidence confirming that chemicals in foods are contributing to the reported increase in the prevalence of atopic diseases.     

真菌感染在过敏性皮炎发病机制中的作用

目的探讨真菌感染以及真菌特异性IgE对过敏性皮炎的致病作用。方法采用Bio whittaker变态反应诊断仪检测136例过敏性皮炎患者血清真菌特异性IgE(sIgE),将其分为两组:真菌感染组96例,为合并真菌感染的过敏性皮炎患者,其中荨麻疹45例,湿疹30例,特应性皮炎21例;对照组40例,来自无合并真菌感染的过敏性皮炎患者。结果真菌感染组中,血清真菌sIgE阳性率为87.5%(84/96),显著高于对照组(14/40,阳性率35.0%),血清真菌sIgE检出率在两组病人中差异有显著性意义(χ2=38.08,P<0.005),真菌感染组荨麻疹、湿疹、特应性皮炎患者血清真菌sIgE的阳性检出率差异无显著性意义(χ2=2.24,P>0.05)。结论真菌感染灶中真菌可能成为变应原刺激机体产生特异性IgE,真菌感染在过敏性皮炎的发病机制中占重要地位。     

Effect of lacquering on indoor air carbonyl compound quality and human malondialdehyde levels

Formaldehyde and other organic compounds are known to provoke allergy including asthma and atopid dermatitis by producing IgE antibody when the aldehyde is combined with various proteins in the body such as albumin. To determine if lacquering could reduce the allergic effects of various environmental pollutants, we measured indoor air quality improvement and examined urinary malondialdehyde (MDA) concentration to provide basic data on the use of lacquering as a means of indoor air quality management. Results showed that formaldehyde, acetaldehyde, acetone and benzaldehyde levels before lacquering were found to be 33.25–194.30, 2.24–47.55, 23.78–146.20, and 0.50–6.34 μg/m³, respectively. Formaldehyde, acetaldehyde and acetone levels after lacquering were 20.67–166.54, 0.07–23.24, and 9.13–54.90 μg/m³, respectively. Organic compound levels were found to be lower in indoor air after lacquering. The average MDA level in the urine of atopic dermatitis patients was reduced after lacquering compared to levels before lacquering as levels were recorded at 0.009±0.003 μmol/L and 0.014±0.007 μmol/L, respectively. The change of formaldehyde, acetaldehyde and benzaldehyde levels before and after lacquering was negatively related to the change in MDA level, but the correlation was not statistically significant (p>0.05). In this study, lacquering was shown to modify the indoor environment in the homes of atopic dermatitis patients by reducing formaldehyde, acetaldehyde, acetone, and benzaldehyde levels in indoor air and reducing urine MDA levels. These findings suggest that lacquer tree sap has the possibility to improve atopic dermatitis.     

婴儿早期过敏性疾病的临床研究

目的 探讨早期婴儿过敏性疾病主要表现形式及影响因素。方法 2009年2月至2010年10月对2600例出生后42 d的婴儿进行回访，筛检出有特异性皮炎或有胃肠道过敏症状者，分析婴儿过敏症状与喂养方式、季节、父母过敏史等关系；对120例过敏患儿及110例正常对照儿随访6～12个月，观察发生喘息性支气管炎/急性毛细支气管炎、皮肤过敏等情况，其中部分婴儿随访前后检测血总IgE抗体、吸入过敏原特异抗体(Phadiatop)、食物过敏原特异抗体（Fx5E）、嗜酸粒细胞阳离子蛋白(ECP)，并进行比较。结果 2600例婴儿共检出过敏性疾病婴儿478例，占18.4％，其中特异性皮炎334例、有胃肠道过敏症状患儿453例，分别占12.8、17.4％，二者表现均有的309例，占11.9％。478例过敏婴儿（过敏组）中母乳喂养105例(22.0％)、混合喂养143例(29.9％)，人工喂养230例(48.1％)；母孕期发生过过敏性疾病及父亲有过敏史者分别占31.2％（149例）、15.1％（72例），明显高于无过敏组[分别为10.2％(216/2122)、6.0％(127/2122)，均P＜0.01]；发生在春、夏、秋、冬分别为134例(28.0％)、72例(15.1％)、172例(36.0％)、100例(20.9％)，秋季为高发季节。对120例过敏患儿及110例正常对照儿随访6～ 12个月，过敏患儿中分别有29、24例发生喘息性支气管炎/急性毛细支气管炎、皮肤过敏，发生率为24.2％和20.0％；正常对照儿中分别有16、8例发生喘息性支气管炎/急性毛细支气管炎、皮肤过敏，发生率为14.5％、7.3％，过敏患儿呼吸道过敏性疾病或皮肤过敏的发生率明显高于正常对照儿，差异有统计学意义(P＜0.01)。经家长同意随访前后分别检测50、43例过敏婴儿TIgE、ECP、Phadiatop、Fx5E指标，随访后TIgE、ECP水平有升高趋势，尚无统计学意义，Phadiatop阳性率较前升高，Fx5E阳性率降低，差异有统计学意义(P＜0.01)。结论 特异性皮炎、胃肠道过敏症状是婴儿早期过敏性疾病的常见表现，与喂养方式、家族史、季节有关，人工喂养者、母孕期有过敏史、秋季发病率最高。随着年龄增长过敏表现逐渐由皮肤过敏、胃肠道症状转为呼吸道过敏性疾病，IgE介导的免疫机制增强，对呼吸道过敏原的反应增强，对食物过敏原反应减弱。