Sensitization to turnip rape and oilseed rape in children with atopic dermatitis: a case-control study

Turnip rape and oilseed rape 2S albumins are new allergens in children with atopic dermatitis suspected for food allergy. We recently found that 11% (206/1887) of these children had a positive skin prick test to seeds of oilseed rape ( Brassica napus ) and/or turnip rape ( Brassica rapa ). In the present case-control study we examined how the children with atopic dermatitis sensitized to turnip rape and oilseed rape had been breast-fed and whether they had some common sensitization pattern to certain foods or pollens. A total of 64 children with atopic dermatitis and a positive skin prick test to turnip rape and/or oilseed rape (≥5 mm) were examined. Sixty-four age- and sex-matched children with atopic dermatitis but negative skin prick tests to turnip rape and oilseed rape served as case controls. The turnip rape and/or oilseed rape sensitized children with atopic dermatitis had significantly more often positive skin prick tests reactions and IgE antibodies to various foods (cow's milk, egg, wheat, mustard; p < 0.01) and pollens (birch, timothy, mugwort; p < 0.01) than the control children. They had been exclusively breast-fed for a longer period (median 4 months; p < 0.05) and had more often associated asthma (36%) and allergic rhinitis (44%). Children with atopic dermatitis sensitized to oilseed rape and turnip rape had high frequency of associated sensitizations to all foods and pollens tested showing that oilseed plant sensitization affects especially atopic children who have been sensitized to multiple allergens.     

Sensitization to turnip rape and oilseed rape in children with atopic dermatitis: a case-control study.

Turnip rape and oilseed rape 2S albumins are new allergens in children with atopic dermatitis suspected for food allergy. We recently found that 11% (206/1887) of these children had a positive skin prick test to seeds of oilseed rape (Brassica napus) and/or turnip rape (Brassica rapa). In the present case-control study we examined how the children with atopic dermatitis sensitized to turnip rape and oilseed rape had been breast-fed and whether they had some common sensitization pattern to certain foods or pollens. A total of 64 children with atopic dermatitis and a positive skin prick test to turnip rape and/or oilseed rape (>or=5 mm) were examined. Sixty-four age- and sex-matched children with atopic dermatitis but negative skin prick tests to turnip rape and oilseed rape served as case controls. The turnip rape and/or oilseed rape sensitized children with atopic dermatitis had significantly more often positive skin prick tests reactions and IgE antibodies to various foods (cow's milk, egg, wheat, mustard; p < 0.01) and pollens (birch, timothy, mugwort; p < 0.01) than the control children. They had been exclusively breast-fed for a longer period (median 4 months; p < 0.05) and had more often associated asthma (36%) and allergic rhinitis (44%). Children with atopic dermatitis sensitized to oilseed rape and turnip rape had high frequency of associated sensitizations to all foods and pollens tested showing that oilseed plant sensitization affects especially atopic children who have been sensitized to multiple allergens.     

Ass''s milk in children with atopic dermatitis and cow''s milk allergy: Crossover comparison with goat''s milk

Cow milk allergy is a common disease of infancy, often associated with atopic dermatitis (AD). Avoidance of cow milk (CM) implies the use of alternative dietary supports such as mammalian milks. In this study, we assessed the tolerability and clinical effect of ass's milk (AM), when compared with the largely used goat's milk (GM) in a single-blind, controlled, randomized crossover. Twenty-eight children with AD and ascertained allergy to CM were enrolled. The children were randomized to AM or GM for 6 months, then switched to the other milk for further 3 months. The SCORAD index (SI) and a visual analog scale (VAS) were evaluated blindly. After termination of the study, food challenges with GM and AM were performed. An SDS-PAGE analysis of different milks was performed. Two children from the GM group dropped out after randomization and 26 completed the study. Ass milk invariantly led to a significant improvement of SI and VAS of symptoms (p < 0.03 vs. baseline and inter-group), whereas GM had no measurable clinical effect. At the end of the study 23 of 26 children had a positive food challenge with GM and one of 26 with AM. Ass's milk had a protein profile closer to human milk than GM. Ass milk is better tolerated and more effective than GM in reducing symptoms of AD. It may represent a better substitute of CM than the currently used GM.     

Plasma thrombomodulin levels in children with atopic dermatitis

Plasma thrombomodulin (TM) levels were measured in 68 patients with atopic dermatitis (AD) and 35 controls. Plasma TM levels in patients with AD were significantly higher than those of controls (p < 0.01). A significant correlation was observed between plasma TM levels and skin scores of AD or peripheral eosinophil counts (p < 0.01). There was also a positive correlation between plasma TM and vascular cell adhesion molecule-1 levels (p < 0.05). Conclusion: These results suggest that plasma TM levels may reflect a severity of AD and/or endothelial cell activation induced by an allergic inflammation.     

特应性皮炎儿童生活质量调查

目的：特应性皮炎常造成儿童行为、情感、心理发育等方面的异常。本研究旨在调查特应性皮炎幼儿的生活质量。方法：应用儿童特应性皮炎影响量表 (Childhood Atopic Dermatitis Impact Scale,CADIS)调查问卷进行生活质量调查, 并用特应性皮炎评分量表(SCORing Atopic Dermatitis,SCOARD)对特应性皮炎患儿进行临床症状评估。结果：患儿SCORAD评分为56.9±11.1;CADIS评分为38.0±7.9。CADIS与SCORAD存在显著正相关(ρ=0.934,P＜0.05), 其中,与受累面积(ρ=0.581,P＜0.01)、红斑(ρ=0.417,P＜0.01)、糜烂(ρ=0.579,P＜0.01)、水肿丘疹(ρ=0.595,P＜0.01)、渗出结痂(ρ=0.436,P＜0.01)、皮肤干燥(ρ=0.343,P＜0.01)、瘙痒和睡眠减少(ρ=0.0.344,P＜0.05)关系密切。结论：特应性皮炎对患儿生活质量有显著影响, 随着疾病严重程度升高,生活质量逐渐下降。［中国当代儿科杂志,2010,12（5）：351-353］     

Helicobacter pylori seropositivity in children with atopic dermatitis as sole manifestation of food allergy

A positive association between Helicobacter pylori antibodies and food allergy presenting with gastrointestinal symptoms has recently been reported. A subset of a H. pylori strain possesses an antigen, CagA, as a virulence factor. Anti‐ H. pylori and anti‐CagA IgG titre have been determined in children with atopic dermatitis (AD) as the sole clinical manifestation of food allergy. In this study, thirty patients with AD as the sole clinical manifestation of food allergy were examined (group A). For comparative purposes, 30 patients affected by food allergy with gastrointestinal symptoms (group B) and 30 affected by atopic asthma (group C) were studied. Anti‐ H. pylori and anti‐CagA immunoglobulin G (IgG) were determined in all individuals by means of the enzyme‐linked immunosorbent assay. The anti‐ H. pylori IgG titre was significantly higher in group A and group B vs. group C (p < 0.05); no significant difference was detected between group A and group B (p > 0.05). No significant difference in anti‐CagA titre was found between the groups. These data demonstrate a positive association between H. pylori antibodies and AD as the sole manifestation of food allergy. Further investigations are needed to evaluate the cause–effect relationship between H. pylori seropositivity and AD.     

Participation in leisure activities and sensory modulation deficiencies of children with atopic dermatitis

Aim: To examine whether the complexity of atopic dermatitis (AD) symptoms and the sensory modulation deficiencies (SMD) that accompany it may limit child’s preference to participate in leisure activities. Methods: Thirty‐seven children diagnosed with AD and 104 healthy peers aged 6–11 years participated in this study. Disease severity was assessed using SCORAD scores. Both groups were compared in regard to their sensory modulation abilities measured by the ‘Short Sensory Profile’ (SSP) and in regard to their activity preference measured by the ‘Preference for Activities of Children’ (PAC). Results: Children with AD showed lower preference to participate in leisure activities as compared with healthy peers (F = 4.63, p < 0.0001). Among children with AD, significant correlations were found between SMD in several modalities and preference to participate in specific leisure activities. No significant correlations were found between AD severity and the child’s preferred activities. Conclusions: Children with AD may show lower preference to participate in activities in comparison with their typical peers. This lower preference may be impacted by their SMD. Multidisciplinary intervention may be beneficial for children with AD. This intervention should refer to AD symptoms and considers the child’s sensory profile and participation in daily living.     

Proposal for a standardized interpretation of the atopy patch test in children with atopic dermatitis and suspected food allergy

The interpretation of the atopy patch test (APT) to foods is not standardized. This study aimed to validate the reading of the APT in terms of the diagnostic accuracy of individual skin signs. Eighty-seven children (mean age 2.4 +/- 2.5 yr, range 0.5-13.5; 57 male) with atopic dermatitis (AD) and suspected food allergies underwent APT to cow's milk, hen's egg, wheat and soy. Twelve-millimetre Finn chambers were applied for 48 h, and results were read after 48 and 72 h. Skin changes were graded for erythema, induration, papule formation and 'crescendo' phenomenon (increase of skin sign severity from 48 to 72 h). Food allergy was assessed by double blind, placebo-controlled food challenges (DBPCFC). Sensitivity, specificity and predictive values were calculated for each skin signs in relation to challenge outcome. Of 165 DBPCFC children, 75 (45%) were positive. The combination of any skin induration plus papules (seven or more), or of moderate erythema plus any induration plus seven or more papules had a positive predictive value (PPV) and specificity for the challenge outcome of 100%; however, the sensitivity was low (8% and 15%). The best diagnostic accuracy for single signs was found for induration beyond the Finn chamber margin (PPV 88%, specificity 99%, sensitivity 9%) and presence of at least seven papules (PPV 80%, specificity 96% sensitivity 21%). Presence of both induration and of at least seven papules at 72 h were the APT skin signs with the greatest diagnostic accuracy for food allergy in children with AD.     

特应性皮炎婴幼儿IgE介导食物过敏的随访研究

目的探讨IgE介导的食物过敏在特应性皮炎中的作用及其转归。方法对86例深圳地区特应性皮炎患儿进行混合食物组过敏原筛查(fx5E)检测,阳性者进一步检测6种常见食物(鸡蛋白、牛奶、鱼、小麦、花生、大豆)过敏原特异性IgE(sIgE)。对sIgE阳性患儿建议采取过敏食物回避措施,随访6个月和2年。结果 86例患儿中,36例(42%)有IgE介导的食物过敏,牛奶和(或)鸡蛋白为主要过敏原,分别占70%和64%。31例患儿完成了2年随访,食物sIgE检测为1级的13例患儿目前均无过敏症状;13例2级患儿再次进食过敏食物,仍有5例出现症状;7例3级以上过敏患儿,目前再次进食过敏食物,均出现症状。结论 IgE介导的食物过敏是引起婴幼儿特应性皮炎的重要原因,牛奶和(或)鸡蛋白是主要的过敏食物。回避过敏食物可以明显缓解症状,轻度过敏者症状随年龄增长可以消失,过敏程度越高,再次接触过敏食物出现症状的可能性越大。     

Food hypersensitivity in two groups of children and young adults with atopic dermatitis evaluated a decade apart

There is an impression that children today are experiencing allergic reactions to an increasing variety of foods. We compared two separate groups of children and young adults with atopic dermatitis evaluated a decade apart and found no difference in sensitization rates or overall clinical reactivity to a variety of foods. Allergies to egg, milk, wheat, soy, peanut, tree nuts, and seafood continue to account for ≈ 90% of food‐allergic reactions over the past decade.     

Association of food allergy with asthma severity and atopic diseases in Jewish and Arab adolescents

Aim: To investigate the prevalence of reported food allergy and its association with atopic diseases and asthma severity among Jewish and Arab adolescents. Subjects and methods: The self‐report questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC) was administered to adolescents aged 13–14 years from randomly selected junior high schools in Israel. Questions regarding food allergy were added. Results: A total of 11 171 questionnaires were available for analysis. Food allergy was reported by 3.6% of participants: 1.9% milk, 0.6% egg, 0.6% peanut and 0.4% sesame. On multivariate analysis, food allergy was strongly associated with current asthma (OR, 2.5; 95% CI, 1.8–3.3), atopic eczema (OR, 3.2; 95% CI, 2.4–4.3) and allergic rhinitis (OR, 2.4; 95% CI, 1.8–3.1). Arabs were significantly more allergic to peanut (OR, 2.5; 95% CI, 1.5–4.1), egg (OR, 3.5; 95% CI, 2.1–5.9) and sesame (OR, 2.3; 95% CI, 1.2–4.5) than Jews, and less allergic to milk (OR, 0.6; 95% CI, 0.4–0.9). Asthmatic subjects with food allergy had significantly more parameters of severe asthma than those without food allergy (p < 0.001). Conclusions: The prevalence of allergy to specific foods differs between Jews and Arabs. Asthmatic adolescents with food allergy report more severe asthma than those without food allergy.     

Methylprednisolone bolus: a novel therapy for severe atopic dermatitis

Seven children suffering from severe atopic dermatitis, unresponsive to standard therapy, received an iv bolus dose of methylprednisolone (20 mg/kg/day) for three days. Immunological parameters were evaluated before and after treatment. At the end of bolus therapy both skin lesions and itching improved for several months in five of seven patients. No side effects were observed, but a significant and transient lymphopenic response occurred, with lower CD4 + than CD8 + lymphocyte counts. Our data suggest that this therapy may be a novel and safe therapeutic approach in severe atopic dermatitis.     

Food allergy and atopic dermatitis in low birthweight infants during early childhood

The prevalence rates of food allergy and atopic dermatitis in low birthweight infants were evaluated. In Fukuoka City, Japan, between July 1994 and September 1997, sufficient information including birthweight, gestational age, sex, feeding method and a history of food allergy was obtained from questionnaires at the well-baby check-ups of 21766 infants (18 mo of age) and 4378 children (3 y of age). All the children were examined by pediatricians with regard to the existence of atopic dermatitis. The prevalence rate (8.1%) of food allergy in infants with low birthweight (<2,500 g) was significantly lower than that (11.2%) in infants with normal birthweight (> or = 2,500 g) at 18 mo of age (p = 0.0002). Atopic dermatitis was also observed at a lower prevalence rate (1.2%) in infants with low birthweight than in those with normal birthweight (2.3%) at the same age (p = 0.0041). However, this significance was lost at 3 y of age. Other characteristics including male sex and breast-feeding showed independent risks for the development of food allergy and atopic dermatitis at both ages. CONCLUSION: This study found that low birthweight was significantly associated with a lower risk of both food allergy and atopic dermatitis at 18 mo of age.