Atopic Dermatitis and Celiac Disease: A Cross-Sectional Study of 116,816 Patients

Background

Both atopic dermatitis and celiac disease are often accompanied by other immune-mediated disorders.

Objective

The objective of this study was to evaluate the potential association between atopic dermatitis and celiac disease in a broad community-based population.

Methods

A cross-sectional observational design was used. Demographic and clinical data were collected for patients enrolled in a large health management organization who were diagnosed with atopic dermatitis by a dermatologist in 2002–17. The presence of celiac disease/celiac disease-related morbidities was recorded for the whole group, for adults (age > 18 years), and for adults with moderate-to-severe atopic dermatitis. Findings were compared with a matched control group without atopic dermatitis.

Results

The study group included 116,816 patients of whom 45,157 were adults; 1909 adult patients had moderate-to-severe atopic dermatitis. Compared to the respective control subjects, the prevalence rate of celiac disease in the whole group was 0.6% vs. 0.4%; in the adults, 0.6% vs. 0.3%; and in the adults with moderate-to-severe atopic dermatitis, 0.8% vs. 0.3% (p < 0.001 for all). On multivariate analysis, atopic dermatitis was associated with a significantly higher prevalence of celiac disease (odds ratio = 1.609, 95% confidence interval 1.42–1.82, p < 0.001) in the entire study population and each subgroup.

Conclusions

We observed a significant association between atopic dermatitis and celiac disease. This association emphasizes the need for timely screening of gastrointestinal morbidities in individuals with atopic dermatitis to prevent long-term complications.

     

Topical Therapy in Atopic Dermatitis in Children

Atopic dermatitis (AD) is a common, chronic childhood skin disorder caused by complex genetic, immunological, and environmental interactions. It significantly impairs quality of life for both child and family. Treatment is complex and must be tailored to the individual taking into account personal, social, and emotional factors, as well as disease severity. This review covers the management of AD in children with topical treatments, focusing on: education and empowerment of patients and caregivers, avoidance of trigger factors, repair and maintenance of the skin barrier by correct use of emollients, control of inflammation with topical corticosteroids and calcineurin inhibitors, minimizing infection, and the use of bandages and body suits.     

Significance of Food Hypersensitivity in Children with Atopic Dermatitis

Abstract: Some of us are old enough to recall reading Lewis Webb Hill's monograph entitled The Treatment of Eczema in Infants and Children (St. Louis: CV Mosby, 1956). Its epilogue is a quotation from Claude Bernard's Introduction to Experimental Medicine , words that seem most fitting as a prologue to this symposium:

It happens quite naturally that men who believe too firmly in their theories do not believe enough in the theories of others. We must disregard our own opinion quite as much as the opinion of others, when faced with the decisions of experience. When two physiologists, or doctors quarrel, each to maintain his own ideas or theories, in the midst of their contradictory arguments, only one thing is absolutely certain; that both theories are insufficient, and neither of them corresponds to the truth.… We really know very little, and we are all fallible when facing the immense difficulties presented by investigation of natural phenomena.

Nancy Burton Esterly, M.D.     

特应性皮炎患儿过敏原检测及分析

目的了解延边地区特应性皮炎患儿过敏原种类,为制定预防措施提供依据。方法采用免疫印迹法检测200例特应性皮炎患儿血清特异性IgE(sIgE)和IgE,并对朝鲜族和汉族患儿的检测结果进行比较。结果婴幼儿组59例(朝鲜族26例,汉族33例)和小儿组55例(朝鲜族28例,汉族27例)血清总IgE升高,婴幼儿组血清特异性IgE阳性53例(朝鲜族24例,汉族29例),小儿组有58例(朝鲜族30例,汉族28例),两年龄组间及两民族间差异均无统计学意义(P均>0.05)。两组患儿阳性率较高的过敏原依次为牛奶、牛肉和羊肉。结论延边地区婴幼儿组和小儿组特应性皮炎患儿血清总IgE水平和血清特异性IgE阳性率差异不显著,且朝鲜族和汉族患儿也无差异,特异性过敏原主要为牛奶、牛肉和羊肉。     

Advances in Nondietary Management of Children with Atopic Dermatitis

This paper discusses recent advances in therapy of atopic dermatitis (AD), excluding those that include dietary management. Some of these therapies are anecdotal, experimental, or somewhat controversial. It is important to emphasize that physicians should not try what is new without first having given standard therapy a long and reasonable chance to succeed. This is important because AD does not last forever, and in many patients, mild disease heals spontaneously.     

Knemometry in Children with Atopic Dermatitis Treated with Topical Glucocorticoids

Abstract: Recently the knemometer, a lower leg length measuring device, has been introduced for sensitive assessment of systemic activity of exogeneous glucocorticoids in children. The aim of this study was to assess by means of knemometry whether the topical glucocorticoid budesonide affects short-term growth in children with atopic dermatitis. Fourteen children 5 to 12 years old were studied in an open longitudinal trial with three periods of 2 weeks duration. In periods 1 (run-in) and 3 (run-out), the children were treated with emollient. In period 2, budesonide cream 0.025% was followed by emollient twice daily to all of the body except the face. Eczema was evaluated according to a score based on extent and activity. Knemometry was performed twice weekly. Compared to the run-in and run-out periods the mean growth rate during budesonide treatment was reduced by 0.11 mm/wk (p > .05) and 0.40 mm/wk (p < .05), respectively. The mean growth rate during run-out was increased by 0.29 mm/wk as compared to run-in (p < .05). Compared to run-in the mean severity indices during budesonide treatment and runout were reduced by 1.55 (p < .05) and 1.55 points (p <.05), respectively. The concomittant variations in lower leg growth rate and disease activity suggest that short-term treatment with topical glucocorticoids may provide a better growth potential during the weeks after withdrawal of the treatment. Whether this is due to improved disease control needs further study. Being a noninvasive method, knemometry may be useful for comparing different topical glucocorticoids and administration regimens in children in whom vasoconstrictor assays are difficult.     

Probiotic Supplement Reduces Atopic Dermatitis in Preschool Children

Background: The role of probiotics in the treatment of atopic dermatitis (AD) remains controversial. A recent systematic review of the available evidence called for further clinical trials with new probiotic formulations. Objective: To assess the clinical efficacy and impact of Lactobacillus acidophilus DDS-1, Bifidobacterium lactis UABLA-12 with fructo-oligosaccharide on peripheral blood lymphocyte subsets in preschool children with moderate-to-severe AD. Method: Randomized, double-blind, placebo-controlled, prospective trial of 90 children aged 1–3 years with moderate-to-severe AD who were treated with a mixture of L. acidophilus DDS-1, B. lactis UABLA-12 with fructo-oligosaccharide at a dosage of 5 billion colony-forming units twice daily for 8 weeks versus placebo. The primary outcome measure was the percentage change in Scoring of Atopic Dermatitis (SCORAD) value. Other outcome measures were changes in Infant Dermatitis Quality Of Life (IDQOL) and Dermatitis Family Impact (DFI) scores, frequency and amount of topical corticosteroid used, and lymphocyte subsets in peripheral blood measured by laser flow cytometry. Results: At the final visit, the percentage decrease in SCORAD was 33.7% in the probiotic group compared with 19.4% in the placebo group (p = 0.001). Children receiving probiotic showed a greater decrease in the mean [SD] SCORAD score than did children from the placebo group at week 8 (?14.2 [9.9] vs ?7.8 [7.7], respectively; p = 0.001). IDQOL and DFI scores decreased significantly from baseline by 33.0% and 35.2% in the probiotic group and by 19.0% and 23.8% in the placebo group, respectively (p = 0.013, p = 0.010). Use of topical corticosteroids during the 8-week trial period averaged 7.7 g less in probiotic patients (p = 0.006). CD3, CD16, and CD22 lymphocyte subsets remained unchanged, whereas the percentage of CD4, and the percentage and absolute count of CD25 decreased, and the percentage and absolute count of CD8 increased in the probiotic group at week 8 (p < 0.007 vs placebo). There was a significant correlation between CD4 percentage, CD25 percentage, CD25 absolute count, and SCORAD values (r = 0.642, r = 0.746, r = 0.733, respectively; p < 0.05) in the probiotic group at week 8. Conclusion: The administration of a probiotic mixture containing L. acidophilus DDS-1, B. lactis UABLA- 12, and fructo-oligosaccharide was associated with significant clinical improvement in children with AD, with corresponding lymphocyte subset changes in peripheral blood. The efficacy of probiotic therapy in adults with AD requires further investigation.     

Salivary Cortisol Response to Stress in Young Children with Atopic Dermatitis

Abstract: Poor responsiveness of the hypothalamic–pituitary–adrenal (HPA) axis under stress may be one explanation for stress‐induced exacerbation of atopic dermatitis (AD) symptoms. In previous studies, children and adults with AD showed attenuated salivary cortisol responses to psychosocial stress, suggesting hyporesponsiveness of the HPA axis, but few studies have been conducted in young children, who are vulnerable to systemic side effects of topical corticosteroid (TCS) therapy. We evaluated whether salivary cortisol responses to the stress of venipuncture in young children with AD were related to the severity of AD or performance of TCS therapy. We studied 38 young children with AD (median age 16.5 mos, range 3–66 mos) being treated at our outpatient unit. Patients were divided into three groups according to the scoring of atopic dermatitis index: mild (n = 12), moderate (n = 14), and severe (n = 12). To evaluate the responsiveness of the HPA axis to stress, salivary cortisol was determined before and after venipuncture. Salivary cortisol responsiveness to stress correlated negatively with severity of AD (p = 0.048) but not with previous use of TCS (p = 0.43) in young children with AD. Our findings suggest that the disease activity of AD, rather than TCS use, is responsible for HPA axis dysfunction in children with AD.     

Factors Associated with Steroid Phobia in Caregivers of Children with Atopic Dermatitis

Abstract: Topical corticosteroids (TCS) are first‐line therapeutic agents for atopic dermatitis (AD). Some patients express irrational fear and anxiety about using TCS, which leads to poor outcomes for AD. Although it is important to understand the factors underlying steroid phobia so that its effects can be minimized, few studies have addressed this subject. Here, we used a questionnaire to investigate predictive factors for steroid phobia in the caregivers (usually mothers) of children with AD. We studied 436 children with AD (mean age 47.6 mos, range 2–236 mos) who newly visited our AD outpatient unit. The caregivers were asked to complete a medical history questionnaire regarding AD. Steroid phobia was analyzed for correlations with other patient and caregiver variables. Overall, 38.3% of the caregivers were reluctant to use TCS on their children’s skin. Patient characteristics female sex (odds ratio [OR] = 1.85 vs male; p = 0.005), child’s paternal history of AD (OR = 1.94; p = 0.03), and frequent changing of clinics (OR = 1.25; p = 0.03) were predictive factors for steroid phobia. AD severity did not correlate with steroid phobia. Our findings suggest that greater attention to the patient’s sex and clinical background of patients with AD is important to the success of AD therapy, regardless of AD severity.     

Atopic Dermatitis Symptoms Decreased in Children Following Massage Therapy

Abstract: Young children with atopic dermatitis were treated with standard topical care and massaged by their parents for 20 minutes daily for a 1 month period. A control group received standard topical care only. The children's affect and activity level significantly improved, and their parent's anxiety decreased immediately after the massage therapy sessions. Over the 1 month period, parents of massaged children reported lower anxiety levels in their children, and the children improved significantly on all clinical measures including redness, scaling, lichenification, excoriation, and pruritus. The control group only improved significantly on the scaling measure. These data suggest that massage therapy may be a cost-effective adjunct treatment for atopic dermatitis, since there is a one-time expense of $30 for the child to receive the massage and the parent to learn the technique.     

Eczematous Skin Reaction from Patch Testing with Aeroallergens in Atopic Children With and Without Atopic Dermatitis

Abstract: To determine whether aeroaltergens could induce eczematous lesions, 30 patients with atopic dermatitis were studied in comparison with 30 patients with respiratory atopy without atopic dermatitis. All patients were between 2 end 14 years of age. Patch testing with five aeroallergens—housedust, mite, cockroach, mold mix, and grass mixwas done on skin that was stripped by 10 applications of adhesive tape. Intradermal tests with the same antigens were done on the forearm. In 27 (90%) children with staple dermatitis, patch testing with aeroallergens Induced eczematous lesions at one or more sites. Mite, cockroach, house dust, mold mix, and grass mix caused reactions In 21 (70%), 21 (70%), 19 (63%), 15 (50%), and 13 (43%) patients, respectively. Three patients had a dermatitis flare at the antecubital and popliteal fossae during testing. Only three (10%) atopic children without atopic dermatitis had eczematous lesions, which was significantly different from children with atopic dermatitis ( P < 10⁻⁵). Intradermai skin tests in both groups were not significantly different This study supports previous reports that aeroallergens play an Important role in causing eczamatous skin lesions.     

Atopic Dermatitis

These hundred seventy-two Chinese patients with atopic dermatitis were compared with a Caucasian population for the basic features. Significant findings occurred: personal or family history of atopy, early age of onset, xerosis, ichthyosis, palmar hyperlinearity, and facial pallor. Laboratory findings of immunologic alteration and altered pharmacologic reactivity are relatively more important features for the diagnosis of atopic dermatitis.     

Atopic Dermatitis

Atopic dermatitis is a common, chronic, relapsing cutaneous disease with typical cellular and humoral immunologic abnormalities that can result in significant physical and psychological morbidity to the patient. Atopic dermatitis typically begins in childhood and can often persist through adolescence into adulthood. Although there are a variety of treatments for atopic dermatitis, many patients' symptoms do not improve or they have adverse reactions to medications, requiring the search for other, effective therapeutic agents. A number of inflammatory and immunological abnormalities have long been noted in patients with atopic dermatitis. Although great strides have been made in understanding the causes, the complex pathophysiology of atopic dermatitis is still not completely understood. Most notably, patients with atopic dermatitis often have an elevation of serum immunoglobulin (Ig) E levels, depressed cellular immunity, elevated blood eosinophilia, and increased interleukin (IL)-4 production. In addition, peripheral blood mononuclear cells of patients with atopic dermatitis produce reduced levels of interferon-gamma spontaneously and in response to stimuli. Due to this constellation of features, atopic dermatitis was initially viewed as a prototypical type 2 helper T lymphocyte (T(h2)) disease. These immunological findings led to a number of clinical trials with recombinant interferon-gamma in patients who had severe, unremitting atopic dermatitis. Treatment with recombinant interferon-gamma was postulated to be able to correct the immunological imbalances in patients with atopic dermatitis by decreasing serum IgE levels, IL-4 levels, restoring immune balance, and thereby leading to clinical improvement. Initial open-label studies, a double-blind placebo trial, and long-term open-label studies have demonstrated the clinical efficacy and tolerability of recombinant interferon-gamma in a subset of patients with severe, unremitting atopic dermatitis. Patients receiving treatment often had marked decreases in severity of clinical parameters: erythema, edema/indurations, pruritus, excoriations, dryness, lichenification and associated reduction in total body surface area involvement. Surprisingly, treatment with recombinant interferon-gamma did not lower serum IgE levels refuting the hypothesized mechanism by which interferon-gamma would bring about clinical improvement in patients with atopic dermatitis. Instead, decreases were noted in absolute white blood cell and eosinophil counts that tended to correlate with clinical improvement. Although the exact mechanism by which recombinant interferon-gamma brings about clinical changes in patients with atopic dermatitis is unknown, recombinant interferon-gamma should be considered a possible therapy for patients with atopic dermatitis.     

Atopic Dermatitis

Atopic dermatitis (AD) is a chronic and relapsing disease affecting an increasing number of patients. Usually starting in early childhood, AD can be the initial step of the so-called atopic march, i.e. followed by allergic rhinitis and allergic asthma. AD is a paradigmatic genetically complex disease involving gene-gene and gene-environment interactions. Genetic linkage analysis as well as association studies have identified several candidate genes linked to either the epidermal barrier function or to the immune system. Stress, bacterial or viral infections, the exposure to aero- or food-allergens as well as hygienic factors are discussed to aggravate symptoms of AD. Athough generalized Th2-deviated immune response is closely linked to the condition of AD, the skin disease itself is a biphasic inflammation with an initial Th2 phase and while chronic lesions harbour Th0/Th1 cells. Regulatory T cells have been shown to be altered in AD as well as the innate immune system in the skin. The main treatment-goals include the elimination of inflammation and infection, preserving and restoring the barrier function and controlling exacerbating factors. The overall future strategy in AD will be aimed to control skin inflammation by a more proactive management in order to potentially prevent the emergence of sensitization as well as to design customized management based on genetic and pathophysiologic information.     

Atopic Dermatitis

<正>0001 Atopic dermatitis特应性皮炎Weidinger S,Novak N./Lancet.2015 Sep 11.doi:10.1016/S0140-6736(15)00149-X.[Epub ahead of print]Review.PMID:263771420002 Pathogenesis of atopic dermatitis特应性皮炎的发病机制Peng W,Novak N.Clin Exp Allergy./2015 Mar;45(3):566574.doi:10.1111/cea.12495.Review.PMID:25610977     

Effect of Probiotics on the Treatment of Children with Atopic Dermatitis

Background

Atopic dermatitis, a chronic recurrent disease, is frequently encountered in clinical practice. In the last 30 years, the prevalence of atopic dermatitis has rapidly increased due to industrialization. Therefore, there have been attempts in recent years to find new ways of treating and preventing atopic dermatitis.

Objective

In this double-blind, randomized, placebo-controlled study, a combination of Bifidobacterium bifidum, Lactobacillus acidophilus, Lactobacillus casei, and Lactobacillus salivarius strains were evaluated in the treatment of atopic dermatitis in pediatric patients.

Methods

Forty pediatric patients (23 males and 17 females) aged 1~13 years were enrolled. One eligible individual who was approached declined to participate. The probiotic group was administered a probiotic complex containing B. bifidum, L. acidophilus, L. casei, and L. salivarius for 8 weeks. The placebo group, on the other hand, was administered skim milk powder and dextrose. All of the parameters including serum cytokines, eosinophil cationic protein), SCORing Atopic Dermatitis (SCORAD) index, and total serum immunoglobulin E (IgE) were measured in both the probiotic group and the placebo group at the end of 8 weeks.

Results

Probiotic intervention in pediatric atopic dermatitis patients effectively reduced the SCORAD index and serum cytokines interleukin (IL)-5, IL-6, interferon (IFN)-γ, and total serum IgE levels, but did not reduce levels of serum cytokines IL-2, IL-4, IL-10, ECP, or tumor necrosis factor-α (TNF-α) compared to the placebo group.

Conclusion

Our study found probiotics to be effective in reducing atopic dermatitis patients'' SCORAD index, serum IL-5, IL-6, IFN-γ, and total serum IgE levels but not effective in reducing serum IL-2, IL-4, IL-10, ECP, or TNF-α levels.     

丁酸氢化可的松软膏治疗儿童异位性皮炎临床疗效观察

目的:评价丁酸氢化可的松软膏治疗儿童异位性皮炎的临床疗效。方法:采用自身对照,治疗侧用丁酸氢化可的松软膏;对照侧用0.1％糠酸莫米松霜。结果:共观察了46例异位性皮炎患儿,丁酸氢化可的松软膏的有效率为84.78%,0.1％糠酸莫米松霜的有效率为91.30％,二者差异无显著性(x2=0.93,P>0.05)。二组均未观察到明显的不良反应。结论:丁酸氢化可的松软膏是一种高效、安全的外用皮质类固醇激素制剂,可以应用于治疗儿童异位性皮炎。