Oral Disodium Cromoglycate Treatment of A topic Dermatitis

Fourteen adults and 10 children with active atopic dermatitis entered this double blind cross-over study of oral disodium cromoglycate (DSCG) (adults 200 mg qid, children 100 mg qid) compared with placebo. Oral DSCG and placebo were given for 6 weeks in random order. According to the investigators' assessments of eczema, significant differences between active and placebo were found after 6 weeks' treatment, DSCG being favoured (P less than 0.05). No differences were detected in the investigators' assessment of lichenization and overall disease. No significant differences between the two treatments were demonstrated in the patients' assessments. Results from food allergic patients were similar to those from non-food allergic patients. Two patients reported possible side effects of arthralgia and urticaria respectively. There were no treatment effects on serum IgE values or any other laboratory data.     

Topical Sodium Cromoglycate in Atopic Dermatitis A Disappointing but Informative Trial

Forty children with atopic eczema requiring topical steroids entered a double-blind group comparative study over 12 weeks and were randomized to either 4% sodium cromoglycate (SCG) in an oil-in-water cream or matching placebo cream. The eczema was evaluated on area charts for 20 parts of the body at five clinic visits. In addition, the families kept diaries on symptoms and treatment. After 3 weeks there were small but statistically significant decreases in severity scores recorded at the clinical visits in the SCG group compared with small increases in the placebo group. However, there were no statistically significant differences in the diary card data during the first 3 weeks of treatment or in any other period, nor were significant differences found in any efficacy data collected during the other 9 weeks of the trial. There were no marked differences in treatment opinions, unusual symptoms, skin infections, use of topical steroids or drugs, or acceptability data between the groups. Staphylococcus aureus was found once or twice in cultures from eczema lesions in 31 of 40 children with no marked group difference. The trial showed that there is great need for improved information, family support and topical as well as general treatment in childhood atopic eczema, but topical SCG did not relieve the patients' eczema.     

Disodium Cromoglycate and Food Allergy

In a food allergic patient challenge evoked a dual asthmatic response. These reactions could be partly or completely blocked by pretreatment with disodium cromoglycate (Intal, Lomudal) orally, depending on the doses given. Pretreatment with inhalations of disodium cromoglycate gave no protection.     

Oral and Inhaled Sodium Cromoglycate in Challenge Test with Food Allergens or Acetylsalicylic Acid

The prophylactic effect of oral and inhaled sodium cromoglycate (SCG) in challenge tests of patients with IgE-mediated food allergy or sensitivity towards acetylsalicylic acid (ASA) was investigated. In food allergic patients SCG administered orally protected against an asthmatic reaction whereas inhaled SCG was without effect. In ASA sensitivity neither oral nor inhaled SCG protected the patients against bronchospasms. SCG seems to act on mucosal surfaces and may inhibit uptake of macromolecular antigens but not affect the absorption of ASA.     

Atopic Dermatitis With Coexisting Food Allergy in Early Life Is Associated With Childhood Asthma

PurposeAtopic dermatitis (AD) and food allergy (FA) are associated with respiratory comorbidities, in the concept of ‘atopic march.’ However, children with AD and a coexisting FA have various disease courses, and the mechanism of atopic march remains unclear. In this study, we investigated whether the phenotype of AD with coexisting FA in early life affected asthma or allergic rhinitis (AR) in school children.MethodsA total of 1,579 children from the Panel Study on Korean Children (PSKC) cohort were followed-up in 2013. The participants diagnosed with AD in this cohort were classified by the age of AD onset and persistence as well as FA history. We compared the presence of comorbidities—asthma and rhinitis—among different AD phenotypes.ResultsAsthma and AR with current symptoms within 12 months at age 6–8 years were associated with early-onset persistent AD phenotype, regardless of coexisting FA. AD with FA conferred a higher risk of recent wheezing at 8 years of age than AD without FA (adjusted odds ratio, 8.09; 95% confidence interval, 2.54–25.76). Children with early-onset persistent AD with FA manifested a distinctive trajectory with a higher prevalence of wheezing and AR at age 5–8 years than those without AD.ConclusionsAD with FA in early life is strongly associated with asthma and AR in school children, and the early-onset persistent AD with FA had a strong additive effect on the risk of asthma at school age. Classifying AD phenotypes regarding FA in early life will help predict and prevent asthma and AR in school children.     

Oral Sodium Cromoglycate in Chronic Urticaria

Fifteen patients were included in a double-blind cross-over trial to investigate the efficacy of oral sodium cromoglycate in the treatment of chronic urticaria. Only patients with positive oral provocation tests were entered into the study. The challenging agents were food additives or antirheumatic agents. Treatments were taken for 4 weeks and the dose of sodium cromoglycate was 200 mg four times daily. No significant differences were found between active and placebo treatment periods for diary card symptom scores. Six patients preferred the active treatment, two preferred placebo and seven had no preference. The clinician showed no preference for either treatment.     

Double-Blind Crossover Trial Comparing Systemic Chromone-Carboxylic Acid with Placebo in Patients with Atopic Dermatitis

35 adult patients with atopic dermatitis were included in a double-blind crossover trial comparing chromone-2-carboxylic acid, FPL 57787 18 mg × 4, with placebo. Each treatment period lasted for 6 weeks with clinical assessment every 3 weeks, 28 patients completed 3 weeks of each period. Significant differences at the 5 % level in favour of FPL 57787 were seen in the group starting on placebo. 17 patients completed the study. After 6 weeks there were no significant differences. 10 patients experienced dyspeptic side-effects. Further studies are warranted on clearly allergic sub-groups of atopic dermatitis patients.     

Effect of Oral and Inhaled Sodium Cromoglycate in Exercise–Induced Asthma

Ten patients with bronchial asthma reacting with bronchoconstriction after exercise were studied to compare the effect of oral sodium cromoglycate against sodium cromoglycate inhalation and placebo. Only sodium cromoglycate inhalations protected against exercise-induced asthma. The effect of sodium cromoglycate seems to be a local action of mucosal surfaces.     

Nebulisead Sodium Cromoglycate in the Treatment of Wheezy Bronchitis A Multicentre Double-Blind Placebo Controlled Study

The efficacy of nebulised sodium cromoglycate (SCG) used as a prophylactic treatment of wheezy bronchitis in children aged 1 to 4 years was evaluated in a multicentre double-blind placebo controlled, group comparative study. Fifty-four patients completed the 10-week trial (29 treated with SCG and 25 treated with placebo), preceded by 4-8 weeks baseline. Nebulised SCG did not prove significantly superior to placebo in reducing day wheezing, day coughing, or sleep disturbance due to wheezing or coughing at night. Neither was there significant difference in the use of supportive medicine (beta 2-agonist and theophylline) between the groups. Extra doctor visits, hospital admissions, and parental preference did not show significant difference either.     

Correlation Between Serum Vitamin D Level and the Severity of Atopic Dermatitis Associated With Food Sensitization

Purpose

A growing body of literature has linked vitamin D deficiency with allergic diseases, particularly atopic dermatitis (AD). In this study, we investigated the association between serum vitamin D status and the clinical manifestation of AD. We also developed an analytical method for the simultaneous determination of 25-hydroxy vitamin D₃ (25(OH)D₃), using liquid chromatography (LC) coupled with tandem mass spectrometry (MS/MS).

Methods

This study included 157 patients (79 males and 78 females) with AD, aged 4 months to 56 years. We evaluated disease severity using the SCORing Atopic Dermatitis (SCORAD) index. Serum levels of 25(OH)D₃ were determined by LC coupled with MS/MS. Total IgE and specific IgE levels were assayed using the immunoCAP system. ANOVA was used for statistical evaluation.

Results

We found mild, moderate, and severe AD in 30 (11.1%), 87 (55.4%), and 40 (25.5%) patients, respectively. There was no significant correlation between serum levels of 25(OH)D₃ and AD severity. However, among the 36 patients with food sensitization, the mean±SD serum levels of 25(OH)D₃ were significantly higher (P<0.05) in patients with mild disease (21.2±5.18 ng/mL) compared with the levels in patients with moderate (17.9±4.02 ng/mL) or severe AD (13.3±5.11 ng/mL) disease.

Conclusions

These results suggest that vitamin D deficiency is related to the severity of AD associated with food sensitization. Thus, these data suggest a role for vitamin D in a select group of AD patients.     

The Role of Cow Milk Allergy in Increasing the Severity of Atopic Dermatitis

Previous studies have shown that up to 33% of children with atopic dermatitis have experienced food hypersensitivity and among different kinds of food allergens Cow Milk (CM) has almost always been one of the most common food allergens in children. The aim of this study is to evaluate the cow milk allergy (CMA) as an increasing factor of severity of atopic dermatitis. One hundred and nineteen children (between 1.5 months and 12 years of age) with atopic dermatitis in the sense of Hanifin and Rajka's criteria entered this study and the severity of atopic dermatitis was identified via the SCORAD index. In order to make the diagnosis of cow milk allergy, a careful history, and a familial history of allergy was taken and the results of skin prick test (SPT) with CM and 4 other food allergen extracts, Radioallergosorbent test (RAST) with CM allergens and a food challenge test with cow milk (fresh or dried) were used. Also a total serum IgE determination and an eosinophil count (with a stool exam) were accomplished. The clinical manifestations of atopic dermatitis in patients was started from their first day of life up to 10 years of age. The family history in 83% of the patients was positive. Positive skin prick test and RAST with CM allergens were positive in 37.9% and 29.3% of cases respectively and the response to challenge test with cow milk was positive in 35 out of 40 patients and in total 44.5% had CMA according to a positive history of cow milk allergy and a positive outcome of the IgE tests (SPT and/or RAST) or a positive challenge test with CM allergens. The results showed that the most common food allergens in patients with atopic dermatitis are certainly cow milk allergens (44.5%) whereas other food allergens are tomato (29.41%), egg (28.57%), nuts (9.24%) and wheat (3.36%) according to the skin prick test. The mean total serum IgE was 307.11 ± 6.56 IU/ml (range = 6–5000) in children with CMA and 81.04 ± 5.97 IU/ml (range = 1–5000) in children without CMA while the mean eosinophil count was 569.52 ± 3.02 count/ml (range = 67–8500) and 314.22 ± 2.94 count/ml (range = 5–5000) respectively. The mean severity of atopic dermatitis according to the SCORAD index was 60.76 in children with CMA and 44.29 in children without CMA. The severity of atopic dermatitis in patients with CMA was significantly higher than patients without CMA (p < 0.0001). Also the mean total serum IgE and mean eosionophil counts in children with CMA were significantly higher than in children without CMA (P < 0.01 and p < 0.0001, respectively). It shows the important role of CM allergen proteins in the induction and in increasing the severity of AD in children.     

Atopic march,food allergy and food hypersensitivity in children and adolescents suffering from atopic dermatitis

Increases in allergic diseases have been well documented worldwide. Approximately one-third of children with severe atopic dermatitis (AD) were reported to suffer from IgE-mediated food allergy as well. Data sources concerning the food allergy, AD, and atopic march were accessed from Pubmed/MEDLINE. This review provides a summary of findings concerning the food allergy, food hypersensitivity reactions, and atopic march in children and adolescents. Food allergy that developed at a young age increased the risk for AD, asthma bronchiale, and allergic rhinitis; new research identifies the skin barrier as not only an important initiator of AD but it may even be a site for allergic sensitization to protein antigens. Early childhood is thought to be a key period for the prevention of allergic march and adolescence is another key period for the prevention of recurrence. The prevention of recurrence would decrease allergic disease in adulthood.     

A New Aerosol Formulation of Sodium Cromoglycate Compared with Conventional Powder in the Treatment of Asthma

Sodium cromoglycate formulated as a pressurised aerosol was compared with the conventional powder for a period of 12 weeks in a double-blind group comparison trial involving 48 patients. A double dummy technique was used; the dose of sodium cromoglycate was 2 mg four times daily by aerosol, and 20 mg four times daily by Spinhaler. Patients were able to use the correct technique for both aerosol and dry powder inhalation. Patients recorded the severity of their asthma symptoms, their morning and evening peak flow rate, and the amount of other asthma therapy used, on a daily diary card. They also attended the clinic every 4 weeks for assessment. A statistical comparison of the efficacy of the powder and aerosol forms found no significant differences in clinical assessment of severity, diary card symptom scores, morning and evening peak flow readings, or aerosol bronchodilator usage. Thirty-four patients considered that the aerosol was more convenient and easier to use than the dry powder inhaler.     

Long-term Efficacy of Intravenous Immunoglobulin Therapy for Moderate to Severe Childhood Atopic Dermatitis

Purpose

The present study investigates the long-term effects of intravenous immunoglobulin (IVIg) therapy for the treatment of moderate to severe childhood atopic dermatitis (AD). Previous research indicates that IVIg can treat severe AD; however, the effectiveness of IVIg has not been confirmed in prospective, blinded clinical trials.

Methods

Forty eligible children with moderate to severe AD, as defined by the criteria of Hanifin and Rajka, were enrolled in a randomized, placebo-controlled study. After the completion of an initial screening visit (V0), the patients were randomly allocated into therapy (n=30) and control (n=10) groups (V1). Thirty children were each treated with three injections of 2.0 g/kg IVIg at 1-month intervals over a 12-week period. Ten children were treated with placebo. Assessments were conducted after each injection (V2, V3, and V4) and at 3 (V5) and 6 months (V6) after completed treatment.

Results

The disease severity index was significantly decreased at V5 compared with the value at V1 (P<0.05). There were no significant changes in the total IgE level or total eosinophil count in peripheral blood at the last injection (V4) compared with the value at V1. The interleukin (IL)-5/interferon (IFN)-γ ratio was assessed in T-helper 1 (Th1) and Th2 cells. The ratio significantly decreased between V1 and V5, after which it increased, such that the ratio at V6 was not significantly different from that at V1. Compared with the level at V1, the intercellular cell adhesion molecule-1 level at V4 did not differ significantly, but the level at V5 was lower.

Conclusions

This study suggests that IVIg therapy may clinically improve AD in patients after 3 months of therapy, but the improvement may decline by 6 months after therapy.     

Humoral Immunity to Dietary Antigens in Atopic Dermatitis

Enzyme-linked immunosorbent assays (ELISA) employing a biotin-avidin amplification step are described for the quantification of human serum IgG antibodies to the dietary antigens ovalbumin (OA) and beta-lactoglobulin (BLG). The analytical quality of these assays was acceptable. Antibodies were measured in 16 patients with mild or moderate atopic dermatitis (AD), in 31 patients with a history of AD, and in closely matched controls. Levels of serum anti-OA antibodies did not differ in patients and controls, whereas anti-BLG antibodies tended to be higher in patients with mild or moderate AD than in controls (P less than 0.05).