Guidelines on the Management of Atopic Dermatitis ... - Dermatology
Guidelines on the Management of Atopic Dermatitis ... - Dermatology Guidelines on the Management of Atopic Dermatitis ... - Dermatology
*Day-care attendance (hygiene hypothesis) Animal exposure in early life (hygiene hypothesis) *Endotoxin exposure in early infancy (hygiene hypothesis) *Basic hygiene (hygiene hypothesis) *Early life infections (hygiene hypothesis) *Parasite exposure in early life (hygiene hypothesis) Decreased risk with day-care attendance in 25 infancy May be protective with specific pet exposure in 25, 36, 37, early life 41, 46 Decreased risk of dermatitis development with 25 early life exposure Increased risk with improved personal hygiene 25 No clear evidence for protection from specific organism exposure Protection may be related to microbial burden in early life Little evidence for a protective effect on atopic dermatitis development Exposure reduces IgE sensitisation Protective effect suggested but association with vaccination type unclear. Increased risk with increasing antibiotic 25 25, 41, 45, 47, 48 Vaccination (hygiene hypothesis) Early life antibiotic use (hygiene hypothesis) prescribing in infants *Mode of delivery Increased risk with caesarean section 37, 51 *Maternal age Increased risk with increased age 30, 33 Maternal diet: - Probiotics - Food avoidance - Specific foods Environmental tobacco smoke Maternal risk (parent-oforigin effect) Diet: - Formulae - Solid food introduction - Inclusion – specific food - Exclusion – specific food - Diet restriction - Elemental diet - Organic food Diet supplementation: - Anti-oxidants - Essential fatty acids - Early fish as solid food - Probiotics Possible decreased risk with probiotic use Little evidence for decreased risk with food avoidance if applied in pregnancy or while breast feeding Evidence for decreased risk if fish consumed during pregnancy and breast feeding Major risk factor for development of atopic dermatitis 25, 30, 49, 50 25, 36 30, 34, 35, 36 30, 34, 35, 36, 40 38, 40, 52 70, 71 Increased risk if mother had atopic dermatitis 12, 30, 38 Fully hydrolysed formula – decreased risk Partially hydrolysed formula – no clear evidence for role in control or prevention No clear evidence for role in control or prevention Evidence for delayed onset with fish in early life Decreased risk with maternal probiotic use Disease control in children
Breastfeeding Allergen exposure: - House dust mite - Super-antigen - Type IV allergens Irritant exposure: - Climate - Hard water - Clothing - Occlusive wraps - Clothes softeners Bath additives: - Emollients - Antiseptics - Salt Pollution: - Urbanisation - Smoking - Solvents Co-morbidities: - HIV - BMI - Smoking - Psychosocial stress - Malaria Some evidence for decreased risk in breastfed infants with a family history of atopic dermatitis Decreased exposure/load – no effect prevention but may have an effect on control in severe cases Staphylococcal control – no effect control Contact dermatitis – increased association Increased risk in cooler climates Unclear risk in climate extremes Hard water – no effect if calcium carbonate removed Disease aggravation by fibre roughness Disease aggravation by heavy textiles Silk clothing – no clear evidence for role in control Wet or dry – no clear evidence for role in control No clear evidence for role in control No clear evidence for role in control No clear evidence for role in control No clear evidence for role in control Increased risk with urbanisation Increased risk in adults linked to lifetime exposure Increased risk in established dermatitis No increased risk Increased risk in prevention and dermatitis control Increased risk in adults linked to lifetime exposure Increased risk in prevention (episodes in early life) and dermatitis control Increased risk in Africa * Possible surrogate markers of urbanisation and increased socio-economic status. 30, 39, 40, 58, 59 32, 35, 36, 38 35, 36, 38, 60 61, 62 21 21, 36 28, 63 35 35 38, 64 38, 65 35 38, 66 35, 36, 38, 60 35 21, 31 67 31 68 24 67 36, 37, 69 17 References 1. Cork MJ, Robinson DA, Vasilopoulos Y et al. New perspectives on epidermal barrier dysfunction in atopic dermatitis: Gene-environment interactions. J Allergy Clin Immunol 2006;118:3-21 2. Wolf R, Wolf D. Abnormal epidermal barrier in the pathogenesis of atopic dermatitis. Clinics in Dermatol 2012;30:329-34 3. Irvine AD, Irwin McLean WH, Leung DYM. Filaggrin mutations associated with skin and allergic disease. N Engl J Med 2011;365:1315-27 4. Cork MJ, Danby SG, Vasilopoulos Y et al. Epidermal barrier dysfunction in atopic dermatitis. J Invest Dermatol 2009;129:1892-908 5. Rodriquez E, Baurecht H, Herberich E et al. Meta-analysis of filaggrin polymorphisms in dermatitis and asthma: robust risk factors in atopic disease. J Allergy Clin Immunol 2009;123:1361-70 6. Van den Oord RA, Sheikh A. Filaggrin gene defects and risk of developing allergic sensitisation and allergic disorders: a systematic review and meta-analysis. Br Med J 2009;339:b2433 7. Baurecht H, Irvine AD, Novak N et al. Towards a major risk factor for atopic dermatitis: metaanalyses of filiggrin polymorphism data. J allergy Clin Immunol 2007;120:1406-12 8. Hudson. Skin barrier function and allergic risk. Nature Genetics 2006;38:399-400
- Page 1 and 2: Guidelines on the
- Page 3 and 4: A systematic review of RCTs or a bo
- Page 5 and 6: also by phenotyping characterisatio
- Page 7: dermatitis of 0.75 for monozygotic
- Page 11 and 12: 32. Kolmer H, Platts-Mills TAE. The
- Page 13 and 14: documented an increased one-year pr
- Page 15 and 16: Food allergy in atopic dermatitis:
- Page 17 and 18: Immediate (IgE mediated) hypersensi
- Page 19 and 20: approximately 25% of patients will
- Page 21 and 22: These criteria are set out as follo
- Page 23 and 24: 7. Chalmers DA, Todd G, Saxe N, et
- Page 25 and 26: conclusively linked to atopic aetio
- Page 27 and 28: 17. Iskedjian M, Szajewska H, Spiel
- Page 29 and 30: A more recent review on the use of
- Page 31 and 32: Laundry practices Patients are ofte
- Page 33 and 34: Psychosocial factors [1+; B] Althou
- Page 35 and 36: Emollients are universally recommen
- Page 37 and 38: Advise parents or carers of childre
- Page 39 and 40: Table 6: The available TCS formulat
- Page 41 and 42: In South Africa, tacrolimus is regi
- Page 43 and 44: 27. Kyllonen H , Remitz A, Mandelin
- Page 45 and 46: In the absence of defined protocols
- Page 47 and 48: Adolesc Med. Basel, Karger, 2011;15
- Page 49 and 50: A. Phytotherapy Chinese herbal medi
- Page 51 and 52: 1. Hughes R, Ward D, Tobin AM, Keeg
*Day-care attendance<br />
(hygiene hypo<strong>the</strong>sis)<br />
Animal exposure in early life<br />
(hygiene hypo<strong>the</strong>sis)<br />
*Endotoxin exposure in early<br />
infancy (hygiene hypo<strong>the</strong>sis)<br />
*Basic hygiene (hygiene<br />
hypo<strong>the</strong>sis)<br />
*Early life infecti<strong>on</strong>s (hygiene<br />
hypo<strong>the</strong>sis)<br />
*Parasite exposure in early<br />
life (hygiene hypo<strong>the</strong>sis)<br />
Decreased risk with day-care attendance in 25<br />
infancy<br />
May be protective with specific pet exposure in 25, 36, 37,<br />
early life<br />
41, 46<br />
Decreased risk <strong>of</strong> dermatitis development with 25<br />
early life exposure<br />
Increased risk with improved pers<strong>on</strong>al hygiene 25<br />
No clear evidence for protecti<strong>on</strong> from specific<br />
organism exposure<br />
Protecti<strong>on</strong> may be related to microbial burden in<br />
early life<br />
Little evidence for a protective effect <strong>on</strong> atopic<br />
dermatitis development<br />
Exposure reduces IgE sensitisati<strong>on</strong><br />
Protective effect suggested but associati<strong>on</strong> with<br />
vaccinati<strong>on</strong> type unclear.<br />
Increased risk with increasing antibiotic<br />
25<br />
25, 41, 45,<br />
47, 48<br />
Vaccinati<strong>on</strong> (hygiene<br />
hypo<strong>the</strong>sis)<br />
Early life antibiotic use<br />
(hygiene hypo<strong>the</strong>sis) prescribing in infants<br />
*Mode <strong>of</strong> delivery Increased risk with caesarean secti<strong>on</strong> 37, 51<br />
*Maternal age Increased risk with increased age 30, 33<br />
Maternal diet:<br />
- Probiotics<br />
- Food avoidance<br />
- Specific foods<br />
Envir<strong>on</strong>mental tobacco<br />
smoke<br />
Maternal risk (parent-<strong>of</strong>origin<br />
effect)<br />
Diet:<br />
- Formulae<br />
- Solid food introducti<strong>on</strong><br />
- Inclusi<strong>on</strong> – specific food<br />
- Exclusi<strong>on</strong> – specific food<br />
- Diet restricti<strong>on</strong><br />
- Elemental diet<br />
- Organic food<br />
Diet supplementati<strong>on</strong>:<br />
- Anti-oxidants<br />
- Essential fatty acids<br />
- Early fish as solid food<br />
- Probiotics<br />
Possible decreased risk with probiotic use<br />
Little evidence for decreased risk with food<br />
avoidance if applied in pregnancy or while breast<br />
feeding<br />
Evidence for decreased risk if fish c<strong>on</strong>sumed<br />
during pregnancy and breast feeding<br />
Major risk factor for development <strong>of</strong> atopic<br />
dermatitis<br />
25, 30, 49,<br />
50<br />
25, 36<br />
30, 34, 35,<br />
36<br />
30, 34, 35,<br />
36, 40<br />
38, 40, 52<br />
70, 71<br />
Increased risk if mo<strong>the</strong>r had atopic dermatitis 12, 30, 38<br />
Fully hydrolysed formula – decreased risk<br />
Partially hydrolysed formula – no clear evidence<br />
for role in c<strong>on</strong>trol or preventi<strong>on</strong><br />
No clear evidence for role in c<strong>on</strong>trol or preventi<strong>on</strong><br />
Evidence for delayed <strong>on</strong>set with fish in early life<br />
Decreased risk with maternal probiotic use<br />
Disease c<strong>on</strong>trol in children
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