Atopic Dermatitis

Atopic
Dermatitis

  

• Williams
  H, Robertson C, Stewart A, et
  al [Univ Hosp, Nottingham,
  England; 
  
  Royal Children’s
  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 child’s
  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.
  
       

• Lymphocytes
  
  
  Dworzak
  MN, Froschl G, Printz D, et al
  [ Children’s 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.
  
    

• Mite
  Sensitivity
  
  
  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
  Children’s Hosp, Tokyo; Natl
  Children’s 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.
  
      

• Contact
  Allergy
  
  
  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 bath–PUVA.
  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.