Williams H, Robertson C, Stewart A, et al [Univ Hosp, Nottingham, England;
Royal Childrens Hosp,Parkville, Australia; Univ of Auckland, New Zealand; et al]
Worldwide Variations in the Prevalence of Symptoms of Atopic Eczema in the International Study of Asthma and Allergies in Childhood
J Allergy Clin Immunol 103: 125-138, 1999
This article is based on the International Study of Asthma and Allergies in Childhood [ISAAC] phase-1 report and is dependent on the replies to questionnaires from one group of 6-7 year [ 250,000] and another of 13-14 years [450,000] school going children. They represent 56 countries of the world.
A relapsing pruritic eruption involving the creases and of 12 months duration constituted the diagnostic criteria. If it came in the way of a childs sleep for a minimum of 1 day a week the disease was categorized severe.
In the first group 16% of Sweden and Japan contrasted with the 2% from Iran. In the second older group 1% of Albania and 17% from Nigeria showed an absence of matching. Disease severity was noted to run parallel to the incidence. In general the prevalence was higher in Northern Europe and Australia than in Asia, Eastern and Central Europe.
Environmental variations may be responsible for this erratic distribution.
Dworzak MN, Froschl G, Printz D, et al [ Childrens Cancer Research Inst, Vienna; Allergieambulatorium Rennweg, Vienna]
Skin-Associated Lymphocytes in the Peripheral Blood of Patients with Atopic Dermatitis : Signs of Subset Expansion and Stimulation
J Allergy Clin Immunol 103: 901-906, 1999
This article relates Atopic Dermatitis [AD] to cutaneous lymphocyte associated antigen [CLA] and described as an adhesion molecule associated with T-cells. Allergen-reactive memory T cells with in vivo activation and secreting type 2 helper cytokines have been studied. Examination for CLA+ T lymphocyte in the peripheral blood have been carried out in patients and controls with 3-color flow cytometry.
After prick and radioallergosorbent testing 59 individuals comprising children and young adults were studied. Four groups were created. Mild AD had 21 patients [ median age 5-8 years]; severe 15 [median age 10.7] constituting groups 1 and 2 respectively. Control group had allergies or atopic disease without asthma and skin involvement. They numbered 3 median age 7.7 years. Group 4 had no allergies and numbered 4 with a median of 7.7 years.
Only severe AD showed more CLA+ CD4 T cells and CD4+ memory cells. This was most marked in children below 10 years of age.
This important work will have to be repeated and confirmed.
Varela P, Selores M, Gomes E, et al [Hospital Geral de S Antonio, Porto, Portugal; Centro Hospitalar de Vila Nova de Gaia, Portugal; Instituto de Ciencias Biomedicas Abel Salazar, Porto, Portugal]
Immediate and Delayed Hypersensitivity to Mite Antigens in Atopic Dermatitis
Pediatr Dermatol 16: 1-5, 1999
In a study of 51 atopic dermatitis subjects below the age of 15 years [mean 5.9 years] made up of 24 boys and 27 girls. Almost 50% showed an immediate weal and erythema response and about 60% a delayed reaction to 2 mite antigens viz Dermatophagoides pteronyssinus [Dp] and D farinae. These findings were based on clinical evaluation, patch and prick tests and radioallergosorbent testing [RAST] for mite specific IgE. Food and airborne allergies were included in the tests.
Multiple positives was the rule. Food allergens were common in the younger age group and aeroallergens in the older one. Generally younger children exhibited a delayed type sensitivity and the older an immediate reaction. Thus the delayed type reaction appears to perpetuate disease progression.
Staphylococcal Exotoxins Sensitivity
Nomura I, Tanaka K, Tomita H, et al [Natl Childrens Hosp, Tokyo; Natl Childrens Med Research Ctr, Tokyo]
Evaluation of the Staphylococcal Exotoxins and Their Specific IgE in Childhood Atopic Dermatitis
J Allergy Clin Immunol 104: 441-446, 1999
94 patients comprised this study; the age group being 1 to 22 years, and the severity of disease had a mean score 35.4 points. IgE levels against Staphylococcal Exotoxins [SE] A, B [SEB] and SEC as well as those related to toxic shock syndrome toxin-1 were studied. Serum analysis also included total IgE levels, those against house dust mites, cedar pollen, and egg albumin.
Severe atopic dermatitis and high levels of SEB-IgE were more often found in children below 6 years [ 5 out of 6 patients].
Despite the findings of this type, it is known that oozing or moist surface of dermatitis is easily colonized by Staphylococcus aureus. Their exotoxins may play a role in the etiology or exacerbation of atopic dermatitis.
Giordano-Labadie F, Rance F, Pellegrin F, et al [CHU-Purpan, Toulouse, France]
Frequency of Contact Allergy in Children with Atopic Dermatitis : Results of a Prospective Study of 137 Cases
Contact Dermatitis 40: 192-195, 1999
All the subjects in this study had atopic dermatitis, and the study included subjects between the ages of 4 months and 16 years. 137 children including 67 girls were patch tested.
Positivity to metals, fragrance, balsam of Peru, lanolin, neomycin, emollients, nickel and other allergies was observed in 43% of children.
Infants and children can develop contact dermatitis irrespective of the presence of atopic dermatitis. Patch testing children is advised.
Kira J, Kawano Y, Horiuchi I, et al [Kyushu Univ, Japan]
Clinical, Immunological and MRI Features of Myelitis with Atopic Dermatitis [Atopic Myelitis]
J Neurol Sci 162: 56-61, 1999
14 patients of acute myelitis developing in a milieu of atopic dermatitis [AD] are compared with 12 without AD. The former occurred in the age group of 20-46 years and the latter 13-60 years. Males were affected more often in the AD group. Sensory rather than motor involvement was more common and the cervical region was preferred in AD patients.
Serum IgE levels were higher in the AD group. Specificity to Dermatophagoides farinae related IgE was observed in AD associated disease, suggesting a mite associated etiology.
Simons FER, for the ETAC Study Group [ Univ of Manitoba, Winnipeg; et al]
Prospective, Long-term Safety Evaluation of the H1-Receptor Antagonist Cetirizine in Very Young Children with Atopic Dermatitis
J Allergy Clin Immunol 104: 433-440, 1999
This study involves children between the ages of 12 and 14 months. 399 received 0.25 mgm /kg cetirizine and 396 a placebo twice a day. An average of 16.8 months constituted the period of observation. 37 children on cetirizine and 54 on placebo developed adverse effects. Children on cetirizine had less of weal and erythema reactions as well as asthmatic episodes. Physical and mental developments showed no abnormalities; blood chemistry and urinalysis were not affected over a period of 18 months. Despite all subjects being those of atopic dermatitis additional antihistamines were not required in those receiving cetirizine. No sleep disturbances were recorded.
This important study from 12 European countries and Canada over a period covering 1994 and 1997 brings out the safety of cetirizine in children.
Der-Petrossian M, Seeber A, Honigsmann H, et al [Univ of Vienna; Sozialmedizinisches Zentrum Ost, Vienna]
Half-Side Comparison Study on the Efficacy of 8-Methoxypsoralen Bath-PUVA Versus Narrow-Band Ultraviolet B Phototherapy in Patients with Severe Chronic Atopic Dermatitis
Br J Dermatol 142: 39-43, 2000
This randomized study of 12 adults with severe atopic dermatitis [AD] has first tested the subjects for minimal erythema dose [MED] for narrow band UV-B and minimal phototoxic dose [MPD] of 8-methoxypsoralen bathPUVA. Subsequently 8-methoxypsoralen was used as a bath on one half of the body from the face downwards. This was treated with UVA-beginning with ½ MPD thrice a week. The other side received UV-B in MED dose also thrice a week. The object was to maintain mild erythema. Dose levels of these had to be adjusted accordingly.
10 patients completed their treatments and were evaluated at 2,4 and 6 weeks of treatment. 2 had complete remission and 7 marked improvement with both modalities. Relief from pruritus was obtained in two weeks and skin lesions cleared later. One patient had partial improvement with both treatments.
Both treatments were equally effective and well tolerated. Oral psoralens often cause systemic disturbances hence may be replaced by the bath therapy or narrow-band UV-B used without psoralens.