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1.
Systematic review about 10 interventions in dermatitis. A document from the Latin American Society of Allergy, Asthma, and Immunology.
Sánchez, J, Sánchez, MR, Macías-Weinmann, A, Barreto, B, Ensina, LF, Uriarte-Obando, SA, Castro-Almarales, RL, Adorni, R, Lázaro, M, Callero-Viera, A, et al
Revista alergia Mexico (Tecamachalco, Puebla, Mexico : 1993). 2019;(4):426-455
Abstract
The Latin American Society of Allergy, Asthma, and Immunology (SLAAI) conducted a systematic search in the Medline and LILACS' database in order to get articles linked to 10 current questions about dermatitis. The assessment of the quality of the evidence and the strength of the recommendations was made through the GRADE system. The completeness and transparency of the recommendations for this clinical guide were assessed with the AGREE Reports Verification Checklist. The final document was shared with physicians, allergists, dermatologists, and pediatricians, and with patients and academic institutions such as universities and medical scientific societies for external assessment. According to the review, clinical scales should be used to measure the severity of the dermatitis, and some interventions such as the use of probiotics may benefit the patient; nevertheless, more studies are required before this management option can be used in the everyday practice. Other interventions such as dietary restrictions and the use of antihistamines seem to be well-founded only in particular cases and they should not be a general recommendation for all patients. This practical guide presents recommendations for the treatment of atopic dermatitis; these recommendations can be helpful for medical staff, patients, and health systems.
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Epidemiologic studies about food allergy and food sensitization in tropical countries. Results and limitations.
Sánchez, J, Sánchez, A
Allergologia et immunopathologia. 2019;(4):401-408
Abstract
The variety of foods and methods of preparation are part of the cultural identity of each population, and thus the main foods that cause symptoms vary among different regions. Due to their increasing frequency, Adverse Reactions to Food (AFR) have been the subject of extensive study, especially in North America and Europe but few studies have been conducted in other areas, especially in populations located in the tropics and subtropics. In this article, we review available information on the epidemiology of food sensitization and food allergies in tropical regions and explore the different epidemiological data considering the major food involved, the underlying immune mechanism and clinical symptoms partners. In addition, we identify the possible limitations and questions that arise from studies conducted in tropical countries, which helps to generate objectives for future research.
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3.
Topical probiotics: the unknowns behind their rising popularity.
Lee, GR, Maarouf, M, Hendricks, AJ, Lee, DE, Shi, VY
Dermatology online journal. 2019;(5)
Abstract
OBJECTIVE Topical probiotics have been used for skin care and treatment since the early 20th century. Over the past decade, there has been a dramatic surge of commercially-available topical probiotic products. We conducted a systematic search of clinical data relating to the use of topical probiotics and identified relevant clinical and regulatory gaps. METHODS PubMed and Google Scholar searches were conducted for trials and reviews of probiotics. FDA definitions of cosmetics, drugs, and regulation of topical probiotics were reviewed. RESULTS Topical probiotics have shown efficacy in a number of limited trials, particularly those involving the treatment of acne, atopic dermatitis, and rosacea. However, there is a paucity of literature on the safety profiles, mechanistic action, and therapeutic potential of topical probiotic products. Several regulatory gaps exist, including approval and classification of topical probiotic products by the FDA; currently there are no topical probiotic products the FDA has approved as drugs. CONCLUSION With increasing popularity among the general public, but insufficient clinical data to demonstrate large-scale effectiveness and a thorough understanding of side effects, there is a need for further mechanistic and clinical investigation, as well as improved regulation and standardization of topical probiotic products.
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4.
Adjunctive dexamethasone implant in patients with atopic dermatitis and retinal detachment undergoing vitrectomy and silicone oil tamponade: an interventional case series.
Cho, AR, Yoon, YH
BMC ophthalmology. 2019;(1):86
Abstract
BACKGROUND To report the clinical course and outcomes of adjunctive dexamethasone implants in patients with atopic dermatitis (AD) and retinal detachment (RD) undergoing vitrectomy and silicone oil tamponade. METHODS This retrospective, interventional case series included AD patients with RD and various degrees of proliferative vitreoretinopathy (PVR) who were scheduled to undergo vitrectomy. Following total vitrectomy and retinopexy, silicone oil tamponade was performed. Finally, an intraocular dexamethasone implant was injected intravitreally. Anatomical and functional outcomes were assessed at 12 months, and extended follow-up data were also collected. RESULTS Seven eyes from six patients (five male, one female) were included. The median age was 29 (range, 20-38) years. Preoperatively, six eyes were pseudophakic, two eyes had a history of previous vitreoretinal surgery, and one had uveitis. Postoperatively, best-corrected visual acuity improved in two eyes, worsened in one, and remained similar in four. Retinal attachment was maintained in all eyes at 12 months. The major complication was an increase in postoperative intraocular pressure in six eyes, requiring either medical or surgical treatment. During the extended follow-up period (15-37 months), retinas remained attached in all eyes and stable visual acuity was maintained in five. CONCLUSIONS Injection of an intraoperative dexamethasone implant to silicone oil-filled eyes appears tolerable and may be beneficial in the surgical management of AD patients with RD and PVR.
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Skin Care and Synbiotics for Prevention of Atopic Dermatitis or Food Allergy in Newborn Infants: A 2 × 2 Factorial, Randomized, Non-Treatment Controlled Trial.
Dissanayake, E, Tani, Y, Nagai, K, Sahara, M, Mitsuishi, C, Togawa, Y, Suzuki, Y, Nakano, T, Yamaide, F, Ohno, H, et al
International archives of allergy and immunology. 2019;(3):202-211
Abstract
BACKGROUND Atopic dermatitis (AD) and food allergy (FA) are common childhood diseases, which may either be interrelated or be the result of skin barrier disruption and gut mucosal dysbiosis. Although some evidence suggests the efficacy of emollients and synbiotics, there is no conclusive evidence on the use of these interventions alone or in combination. OBJECTIVES This study is aimed at identifying the efficacy of emollients and synbiotics in preventing AD and FA in children during the first year of life. METHODS The babies of mothers recruited prenatally received either an emollient, synbiotic, both or neither. The intervention was carried out from birth up to 6 months of age. The age of occurrence of AD and FA were reported in multiple questionnaires at 1, 6, and 9 months and at 1 year of age. AD was diagnosed by a pediatrician at 9 months of age. RESULTS A -total of 459 babies qualified for the outcome assessment at 1 year of age. Neither the emollient nor the synbiotic showed any effect on reducing the development of AD and FA at 1 year of age. CONCLUSIONS This study did not provide any evidence to show that emollients and synbiotics, alone or in combination are sufficient to prevent the occurrence of AD or FA in children up to 1 year of age.
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Protocol for an outcome assessor-blinded pilot randomised controlled trial of an ion-exchange water softener for the prevention of atopic eczema in neonates, with an embedded mechanistic study: the Softened Water for Eczema Prevention (SOFTER) trial.
Jabbar-Lopez, ZK, Gurung, N, Greenblatt, D, Briley, A, Chalmers, JR, Thomas, KS, Frost, T, Kezic, S, Common, JEA, Kong, HH, et al
BMJ open. 2019;(8):e027168
Abstract
INTRODUCTION Atopic eczema affects 20% of UK children, and environmental factors are important in its aetiology. Several observational studies suggest an increased risk of atopic eczema in children living in hard water areas. The Softened Water for Eczema Prevention pilot trial tests the feasibility of installing domestic ion-exchange water softeners around the time of birth to reduce the risk of atopic eczema in children with a family history of atopy. A further aim is to explore the pathophysiological mechanisms for this in an embedded mechanistic study. METHODS AND ANALYSIS Multicentre parallel group assessor-blinded randomised controlled pilot trial. Participants are newborn babies (n=80) living in a hard water (>250 mg/L calcium carbonate) area at risk of developing atopic eczema because of a family history of atopy. Participants will be randomised prior to birth in a 1:1 ratio. The intervention group will have an ion-exchange water softener installed prior to birth. The control group will receive their usual domestic hard water supply. Follow-up will be until 6 months of age. Data will be collected at birth (baseline), 1, 3 and 6 months of age. The main outcome is the proportion of eligible families screened who are willing and able to be randomised. Several secondary feasibility and clinical endpoints will also be evaluated, alongside mechanistic outcomes. Data will be analysed on an intention-to-treat basis. There will be no hypothesis testing for the clinical outcomes. Study acceptability will be evaluated through semistructured interviews. ETHICS AND DISSEMINATION This study has been reviewed and given a favourable opinion by the North West-Liverpool East Research Ethics Committee (Ref: 17/NW/0661). The results of the study will be reported at international conferences and in peer-reviewed scientific journals. We will send participating families a summary of the pilot trial results. TRIAL REGISTRATION NUMBER NCT03270566.
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Tripterygium agents for the treatment of atopic eczema: A Bayesian analysis of randomized controlled trials.
Liu, L, Luo, Y, Zhou, M, Lu, Y, Xing, M, Ru, Y, Sun, X, Chen, X, Li, S, Hong, S, et al
Phytomedicine : international journal of phytotherapy and phytopharmacology. 2019;:152914
Abstract
BACKGROUND Atopic eczema is a common and recrudescent skin disorder. Tripterygium agents (TA), extracted from Tripterygium wilfordii hook F, a traditional Chinese medicine, have been used as a supplemental therapy for treating eczema empirically in recent years. PURPOSE To investigate the efficacy and safety of TA for treating atopic eczema. STUDY DESIGN Systematic review and Bayesian analysis. METHODS PubMed, Embase, Cochrane Central Register of Controlled Trials, CNKI, Chinese Scientific Journals Database, the Wan Fang Database, and Chinese Biomedicine databases were systematically searched from their respective inception dates to October 2, 2018. Randomized controlled trials (RCTs) related to TA used alone or in combination with other drugs were included. Meta-analysis was conducted by RevMan 5.3 software, and Bayesian analysis was performed in Stata 15.0 and R (V.3.4.0) package gemtc software. The Cochrane risk-of-bias tool and Jadad score were applied to assess the quality of all trials. RESULTS Thirteen trials involving 1385 patients were analyzed. Meta-analysis showed that, when treating atopic eczema patients, TA combined with other drugs were strongly synergistic (p < 0.00001). Among all combinations, the efficacy of TA combined with Diyin tablet (DYP) and topical glucocorticoids (TG) (RR: 0.06, 95%CI [0.01, 0.53]), as well as with compound glycyrrhizin (CG) (RR: 0.36, 95%CI [0.14,0.94]) was superior. Among the different combined medications, the best curative effect was achieved with TA combined with DYP and TG (98.2%), followed by TA combined with CG (85.3%), with TG (51.0%), or with Fuyang granule (FG) (49.9%). Reproductive system dysfunction was the main adverse events in patients treated with TA (RR: 6.23, 95%CI [1.12, 34.62]). Immunoglobulin E (IgE) levels were significantly decreased, after treatment with TA (p = 0.04). Subgroup analysis indicated no statistically significant difference in eczema-related cytokines (p = 0.44). Recurrence rates of using TA and other drugs were similar (p = 0.40). CONCLUSION TA appear to be effective in some therapies when treating patients with atopic eczema, but with apparent side effects. It cannot be concluded that TA can be generally used for eczema in the clinic, because of the small sample size. Further multi-center studies with large samples, and high-quality RCTs should be conducted to clarify the efficacy and safety of TA for treating eczema.
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[Air pollution and atopic eczema : Systematic review of findings from environmental epidemiological studies].
Krämer, U, Behrendt, H
Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete. 2019;(3):169-184
Abstract
BACKGROUND Among the many risk factors for the development of atopic eczema (AE), the influence of air pollution has recently been discussed more often. A systematic review about this topic however is lacking. AIMS Which effects of outdoor air pollution (particles, nitric oxides, sulfur dioxide, ozone or general traffic exhaust emissions) on AE can be demonstrated in a systematic analysis of available environmental epidemiologic studies? METHODS All environmental epidemiologic studies on AE and air pollution found in the literature database PubMed were identified. The most important key figures of these studies were tabulated, the quality of evidence was graded and the studies described. RESULTS A total of 57 studies were identified. Only one of the 15 cross-sectional studies with a large-scale exposure assessment found a significant association between AE and air pollution. In contrast 23 of 30 studies with small-scale exposure assessment found a significant association between AE and traffic related emissions-especially from trucks. Of the 30 studies, 14 were cohort studies (1 adult, 13 birth cohorts). The sole adult cohort found an association with intrinsic AE. In the East Asian cohorts (all published since 2015), an association between maternal exposure to traffic-related pollution and incidence of AE in the offspring was found. This was less clear in cohorts from Europe/US or simply not investigated. In 5/5 panel studies (all from South Korea), symptom severity of AE was found to be significantly and positively related to outdoor air pollution. CONCLUSIONS In a systematic analysis of environmental epidemiologic studies about air pollution and AE rather good evidence was found that, based on small-scale exposure measurements, especially truck traffic emissions increased AE prevalence, while large-scale exposure to larger particles (PM10) or SO2 was without effect. Considering pathophysiologic aspects traffic exhaust emissions seem to affect both skin barrier function and activation of immune responses.
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Probiotics supplement for the prevention of eczema in children: Study protocol for a meta-analysis and systematic review.
Yang, W, Tu, R, Hu, Y, He, T, Zhang, W, Gu, L, Liu, H
Medicine. 2019;(34):e16957
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Abstract
BACKGROUND Atopic dermatitis (AD), also called eczema, is one of the most familiar chronic diseases in childhood. A possible pathological mechanism is immune dysfunction resulting in IgE sensitization to allergens. The recent studies demonstrated that the immune system can be affected by probiotics or prebiotics. However, the effectiveness and safety of probiotics or prebiotics on prevention of eczema are still unclear. To investigate this question, we conduct a systematic review and meta-analysis. METHODS The protocol followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Four main databases (PubMed, Embase, the Cochrane Library, and the web of science) will be searched dating until 15 July 2019 for randomized controlled trials investigating the effects and safety of probiotics or prebiotics on prevention of eczema in children with no language restrictions. In addition, a manual search of the references of relevant published studies will also be considered.Studies selection, data extraction, and risk of bias assessment will be conducted by two independent reviewers. The primary outcome is the incidence of eczema. The second outcome is adverse events. The duration of intervention, the timing of intervention and intervention organism will be taken into consideration. RESULTS The results will provide useful information about the effect and safety of probiotics or prebiotics on reducing the incidence of eczema in children. CONCLUSION The findings of this study will be published in a peer-reviewed journal.PROSPERO registration number: CRD42019136528.
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Endoplasmic reticulum aminopeptidase 1 polymorphism Ile276Met is associated with atopic dermatitis and affects the generation of an HLA-C associated antigenic epitope in vitro.
Niepiekło-Miniewska, W, Mpakali, A, Stratikos, E, Matusiak, Ł, Narbutt, J, Lesiak, A, Kuna, P, Wilczyńska, K, Nowak, I, Wiśniewski, A, et al
Journal of the European Academy of Dermatology and Venereology : JEADV. 2019;(5):906-911
Abstract
BACKGROUND Atopic dermatitis (AD) is a common inflammatory skin disease of complex aetiology, with interactions between susceptibility genes and environmental factors. We have previously described a protective effect of the KIR2DS1 gene encoding the natural killer cell receptor, whose ligands are HLA-C molecules. Here, we found an association of HLA-C*05:01 allele with AD. KIR-HLA-C interactions are affected by peptides presented by HLA-C. The generation of these peptides is strongly influenced by endoplasmic reticulum aminopeptidases 1 and 2 (ERAP1 and ERAP2). Expression and activity of ERAP molecules depend on the polymorphisms of their genes. OBJECTIVE Possible associations of several single nucleotide polymorphisms (SNPs) in the ERAP1 and ERAP2 genes with susceptibility to AD. METHODS Peripheral blood DNA isolation from 318 patients and 549 controls. PCR-SSO or PCR-SSP for HLA-C typing; TaqMan Genotyping Assay for ERAP typing. RESULTS Only one SNP in the ERAP1 gene, rs26618T>C, causing the amino acid change Ile276Met, had an association with AD. To gain insight on the functional role of this SNP, we produced recombinant variants differing only at position 276 (Ile or Met) and tested their aminopeptidase activity against a N-terminally extended precursor LIVDRPVTLV of the HLA-C*05:01 epitope IVDRPVTLV. Both ERAP1 variants were able to efficiently generate the epitope, although the 276Ile allotype was able to do this about 50% faster. Furthermore, both variants were quite inefficient in further degradation of the mature epitope. Finally, we found that the effect of 276Met on susceptibility to AD was seen only in KIR2DS1-negative individuals, not protected by this KIR. CONCLUSION Associations of HLA-C*05:01 allele and rs26618T>C (Ile276Met) ERAP1 polymorphism with AD, and a significant difference between these two ERAP1 variants in their ability to generate an epitope for the HLA-C*05:01 molecule was found.