Guidelines on the Management of Atopic Dermatitis ... - Dermatology

interventions can be attempted. Only the evidence for a role of allergen avoidance in
established atopic dermatitis will be addressed here.
A. Inhalant allergy
House dust mite [1+; B]
Circumstantial evidence suggests an important precipitating role for house dust mite
allergens in patients with atopic dermatitis. Reducing exposure to the allergen should
theoretically be beneficial for cases of established dermatitis.
A review of the evidence for house dust mite reduction revealed that there is little evidence
to support a clinical benefit from house dust mite allergen reduction in preventing atopic
dermatitis or controlling established disease, although it may help to reduce severity in
severe atopic dermatitis. 5,10
Pollens [1-; C]
Seasonal variations in atopic dermatitis could be related to exposure to pollens. 9
Animals [1+; B]
There is currently conflicting evidence for the role of pet allergens in atopic dermatitis. 9,24,25,26
In a systematic review of cohort, case-controlled and cross-sectional studies, Langan et al
found no good evidence for a protective effect of furry pet avoidance. 33 In African studies of
atopic dermatitis there is no association with animals in the home and atopic dermatitis. 27-30
B. Ingestant allergy [1+; B]
Diet manipulation other than food avoidance:
Diet supplementation with a variety of products has been suggested both for prevention of
atopic dermatitis (maternal manipulation) and control of existing disease. These aspects are
dealt with fully under the section concerning food allergies and the section on prevention of
atopic dermatitis.
C. Contact allergy [1-; C]
Increasing evidence is being found for the role of contact allergens in atopic patients. It is
well known that atopic dermatitis is a risk factor for developing contact allergies, but the
precise role of contact reactions (irritant and allergic) in atopic dermatitis pathogenesis is not
clear. 9
In a prospective subgroup analysis of 143 Polish children and adolescents classified as
having atopic dermatitis by the ISAAC criteria, the authors found considerable overlap
between atopic and allergic contact dermatitis (55.4% and 30% in children and 38.6% and
51.7% in adolescents respectively). Of those diagnosed with atopic dermatitis based on a
history of an itchy flexural rash, 19.5% (9/46) children and 52% (13/25) adolescent were
found to be due to allergic contact dermatitis and lacked sufficient features for a diagnosis of
atopic dermatitis by Hanifin and Rajka‟s criteria. 31
A systematic review and meta-analysis of allergens responsible for allergic contact
dermatitis found that the top five allergens in children and adolescents included nickel,
ammonium persulfate, gold sodium thiosulfate, thimerosal and p-toluenediamine. 32 Most
studies were from Europe and the United States and the proportion of positive reactions
increased from 1995.