Atopic Dermatitis In Infants Research Articles

Lipidomics and Metabolomics in Infant Atopic Dermatitis: What's the Correlation with Early Nutrition?

To date, the complex picture of atopic dermatitis (AD) has not yet been fully clarified, despite the important prevalence of this disease in the pediatric population (20%) and the possibility of persistence into adulthood, with important implications for the quality of life of those affected, as well as significant social and financial costs. The most recent scientific evidence suggests a new interpretation of AD, highlighting the important role of the environment, particularly that of nutrition in the early stages of development. In fact, the new indications seem to point out the harmful effect of elimination diets, except in rare cases, the uselessness of chrono-insertions during complementary feeding and some benefits, albeit weak, of breastfeeding in those at greater risk. In this context, metabolomics and lipidomics can be necessary for a more in-depth knowledge of the complex metabolic network underlying this pathology. In fact, an alteration of the metabolic contents in children with AD has been highlighted, especially in correlation to the intestinal microbiota. While preliminary lipidomic studies showed the usefulness of a more in-depth knowledge of the alterations of the skin barrier to improve the development of baby skin care products. Therefore, investigating the response of different allergic phenotypes could be useful for better patient management and understanding, thus providing an early intervention on dysbiosis necessary to regulate the immune response from the earliest stages of development.

A Multi-centre Analysis of Serum IgE Levels in Atopic Dermatitis

Abstract Objective: To assess the characteristics of total immunoglobulin E (IgE) and allergen-specific IgE (sIgE) to 20 common allergens in 154 patients with atopic dermatitis (AD). To assess the correlation of clinical food allergy with positive food allergens’ sIgE results. We further discuss the significance of IgE as a potential biomarker for AD disease severity. Methods: A total of 154 AD patients were collected from 15 hospitals nationwide in China from 2019 to 2021. Serum IgE was measured using reverse-enzyme immuno capture test (REAST). Patients were required to have at least one positive sIgE (N ≥ 0.35 IU/mL). Patients were divided into groups according to gender, age, disease severity, and region. SPSS 26.0 software was used for statistical analysis. Results: Compared with adolescent and adult, AD in infancy and childhood showed significantly higher frequencies of positive sIgE to food allergens, including egg, cow milk, and wheat (P < 0.01). However, adolescent and adult AD showed significantly higher frequencies of positive sIgE to inhaled allergens, dermatophagoides farinae, and house dust mite. In addition, sIgE in different sexes were different. Compared with women, men showed higher frequencies of positive allergen-specific IgE level to wheat, dermatophagoides farinae, and house dust mite. The most common food allergens with elevated sIgE levels were egg (71%), cow milk (39%) and wheat (32%). However, AD patients reported seafood, including crab, shrimp, and fish, as the most frequent food allergens which aggravate their disease in their daily life. Only 18 (12%) patients reported definite correlation of clinical practice with positive food allergens’ IgE results. Among 154 sIgE-positive patients, 99 patients had an increase of total IgE (≥60 IU/ml). TotalIgE (tIgE) levels were significantly different between mild (193 ± 239 IU/mL), moderate (170 ± 202 IU/mL), and severe (375 ± 343 IU/mL) forms of AD patients (P < 0.01). AD patients with accompanied allergic diseases showed significantly higher tIgE levels than those without accompanied allergic symptoms (280 ± 286 IU/mL vs 194 ± 248 IU/mL). Conclusion: Neither sIgE nor tIgE levels can be used to evaluate the condition or severity of AD. AD patients with accompanied allergic diseases showed significantly higher tIgE levels than those without accompanied allergic symptoms. Infantile AD patients are more allergic to food, while adolescents and adults are more allergic to environmental antigens. IgE tests must be interpreted by combining with clinical history to avoid unnecessary food avoidance. Early food allergen introduction for infants may be promising for the prevention of food allergies.

Correlation of Maternal Vitamin D Status in Early Pregnancy and Vitamin D Supplementation during Pregnancy with Atopic Dermatitis in Infants: A Prospective Birth Cohort Study.

This study aimed to investigate the association of maternal first-trimester vitamin D levels and vitamin D supplementation during pregnancy with infant atopic dermatitis (AD) and to determine the effect of variables such as mode of conception on the association. This study was based on the Shanghai sub-cohort of the International Birth Cohort of China. A total of 4051 woman-infant pairs with singleton pregnancies were recruited. Vitamin D deficiency and insufficiency were defined as serum 25-hydroxyvitamin D concentrations of 25 and 50 nmol/L, respectively. AD in infants was assessed during the first six months using a standardized questionnaire based on the British Working Party criteria. Modified Poisson regression estimated the association between maternal vitamin D status and infant AD. The risk of AD in infants was higher in women with deficient 25-hydroxyvitamin D levels in the first trimester (RR: 1.77, 95% CI: 1.41-2.23). This increased risk was seen in naturally conceived pregnancies, but not in those conceived using assisted reproductive technology (ART). The incidence of AD decreased in infants of mothers who took multi-vitamin (RR: 0.79, 95% CI: 0.67-1.98) and vitamin D supplements (RR: 0.51, 95% CI: 0.37-0.71) compared to those whose mothers did not take any supplements. Maternal vitamin D deficiency had varying effects on AD risk based on passive smoking exposure and breastfeeding patterns. Our findings highlight the importance of monitoring and supplementing vitamin D during pregnancy, especially in specific maternal populations, to reduce the risk of AD in offspring.

Midwives as influencers in skin care for newborns at risk of atopic diseases : Survey of midwives' current recommendations

The prevalence of atopic diseases remains high. Initial studies suggest that primary prevention with regular basic care may influence the incidence of atopic dermatitis in infants; however, data are unclear. Midwives play an important role in the care of women in the peripartum period and therefore also in providing advice on topics such as skin care, breastfeeding and nutrition of the newborn and young infant. The aim of this study was to determine the care recommendations for newborns by midwives. We conducted across-sectional survey among German midwives using questionnaires on the topic of newborn skin care. A total of 128 questionnaires were analyzed. The most common recommendations were oil-based herbal topicals (34.9%) and plain water (34.0%). Approximately 70% of midwives reported recommending various options when there was aknown family history of atopic diathesis. It was remarkable that most of the midwives' recommendations were identical regardless of the presence of an atopic diathesis. Essential care products are only used "when necessary". Training programs for midwives on the topic of "care and strengthening of the skin barrier", taking into account the current guidelines for allergy prevention, should be implemented.

Association of maternal ultra-processed food consumption during pregnancy with atopic dermatitis in infancy: Korean Mothers and Children’s Environmental Health (MOCEH) study

BackgroundMaternal diet during pregnancy might influence the development of childhood allergic disorders. There are few studies on the association between processed food intake and infant atopic dermatitis (AD) during pregnancy. The aim of the present study was to investigate the association of ultra-processed food (UPF) intake during pregnancy with infantile AD.MethodsThis study involved 861 pairs of pregnant women and their offspring from the Mothers’ and Children’s Environmental Health (MOCEH) study, a multi-center birth cohort project conducted in Korea. Dietary intake was estimated using a 24-h recall method at 12−28 weeks gestation. The NOVA classification was used to identify UPF, and UPF intake was calculated as the percentage of total energy consumption and categorized into quartiles. Infantile AD was assessed based on medical history and the criteria of the International Study of Asthma and Allergies in Childhood (ISAAC). Associations were assessed by logistic regression with adjustment for confounding factors.ResultsChildren born to mothers in the highest quartile of UPF consumption (15.5% or more of the total energy) compared to the lowest quartile (6.8% or less) showed a higher risk of AD within 12 months [odds ratio (OR) = 1.69; 95% confidence interval (CI): 1.07−2.66, P for trend 0.0436]. After adjustment for the confounding factors under study, the association was strengthened; the adjusted OR between extreme quartiles was 2.19 (95% CI: 1.11–4.32, P for trend = 0.0418). This association was maintained even after an additional adjustment based on the Korean Healthy Eating Index (KHEI), an indicator of diet quality.ConclusionsHigher maternal consumption of UPF during pregnancy was associated with a greater risk of infantile AD within the first year of life.

The prevalence of atopic dermatitis and the effect of breastfeeding on atopic dermatitis among Saudi infants aged up to six months in the Al Madinah region

Background: Atopic dermatitis (AD) is a common skin condition in infants, and breastfeeding has been proposed as a potential protective factor. The study aims to investigate the prevalence of AD in infants based on guardians' reports and the impact of exclusive breastfeeding (EBF) and formula feeding on the incidence of AD among Saudi infants in the Al Madinah region. Methods: A cross-sectional survey of 200 mothers with infants was conducted using a structured questionnaire. Data collected included demographics, breastfeeding practices, infant characteristics, allergies, and AD diagnosis. Statistical analysis employed chi-square. Results: There were a total of 200 infants, out of which 145 (72.5%) had AD, as confirmed by pediatricians. Gender was significantly associated with the prevalence of AD. Based on their nutritional source, 62 (42.8%) were on EBF, and 83 (57.2%) were non-EBF. Infant nutrition was found to be significantly associated with the hospitalization time of infants because of AD. Other AD risk factors, such as parental allergies, feeding frequencies, and frequency of AD episodes, were not significantly associated with the type of feeding. Conclusions: This study found that AD is quite prevalent in the Al Madinah region of Saudi Arabia. AD was more prevalent in male infants than in females. It suggests that EBF may be a protective factor against hospitalization of Saudi infants because of AD.

Neonatal Filaggrin Genetic Screening and Counseling to Prevent Atopic Dermatitis in High-Risk Infants.

Background: Mutations in filaggrin (FLG), the gene that codes for the skin barrier protein, have been shown to be associated with atopic dermatitis (AD). Objective: The objectives of this study were to determine the effects of genetic counseling and parental education on infants at a high risk of AD. Methods: We enrolled 7521 newborns in Taiwan from January 1, 2016, to March 30, 2020, and all of them received genetic testing encompassing 20 known FLG mutations. The genetic counseling and AD prevention and care team consisted of pediatricians, dermatologists, social workers, and genetic counselors. The counseling was arranged for at least 30 minutes within 45 days after delivery. Results: A total of 2963 high-risk infants (39.4%) were identified. Homozygous c.1432C>T was the most commonly identified mutation. A total of 418 neonates' parents were stratified into counseling and noncounseling groups, where the effect of parental education was evaluated. The genetically stratified parental education program was effective in preventing AD development by 63.3% in high-risk infants before 12 months of life (P < 0.0001). Conclusion: Genetic stratification and parental education are effective in preventing the development of AD in high-risk infants before 12 months of life.

Naturopathic approach towards pediatric atopic dermatitis: A case report

A 75-day-old male infant presented to the Naturopathy and Yoga Hospital by his mother with complaints of a dry, scaly, and itchy scalp, dry skin, and crying while passing stools for a month. He was diagnosed with atopic dermatitis (AD) using the Hanifin–Rajka criteria. The infant has been administered two topical applications on the entire body for ten days using Epsom salt (5 g) (magnesium sulfate) mixed with Aloe vera (15 g), turmeric powder (about 0.6 g) in warm coconut oil. Modifications in the mother’s diet were also advised. The case report shows remarkable changes in the symptoms with a reduction in the scaly patches on the scalp and rashes over the body. Following ten days of intervention, the baby stopped crying while passing stools. On follow-up, 30 days after the discharge, no relapses were reported, and the child was healthy. This case report shows the simple topical application of Epsom salt, coconut oil, Aloe vera, and turmeric combinations in the management of pediatric AD, inferring that, naturopathy interventions can be safe, and cost-effective in managing the AD in infants. However, further large-scale studies are warranted in this area for establishing safety, and efficacy and for large-scale applications in pediatric cases.

Infantile atopic dermatitis – increasing severity predicts negative impacts on maternal and infant sleep: a mixed methods study

BackgroundWhile the impacts of atopic dermatitis (AD) on maternal and child sleep outcomes have been previously explored, less is known about the associations between infantile AD and sleep quality and quantity.ObjectiveTo describe the perceived causes of AD-associated maternal sleep disturbances and the association between AD severity and infant sleep outcomes.MethodsMothers with infants aged < 19 months old with a diagnosis of AD were recruited from social media and medical clinics in Winnipeg, Canada between October 2021 and May 2022. Infant AD severity was classified using maternal-reported data on the Patient-Oriented Scoring Atopic Dermatitis tool (PO-SCORAD). Quantitative data were collected via a series of questionnaires with a subset of mothers subsequently completing semi-structured interviews. Quantitative and qualitative data were integrated in the discussion.ResultsMothers of infants with moderate/severe AD (6/12) were more likely to report their infant suffering from a higher degree of sleeplessness (i.e., ≥ 5 on a scale of 0–10) over the past 48 h compared to mothers of infants with mild AD (0/18). This was supported by qualitative findings where mothers described how their infant’s sleep quality and quantity worsened with AD severity. Additionally, 7/32 mothers reported that their child’s AD, regardless of severity, disturbed their sleep. Maternal sleep loss was most commonly attributed to infant itching (6/7), followed by worry (4/7).ConclusionInfantile AD severity was associated with worse sleep outcomes for both mothers and infants. We propose that maternal and infantile sleep quality and quantity can be improved by reducing AD severity through adherence to topical treatments.

Early skin inflammatory biomarker is predictive of development and persistence of atopic dermatitis in infants

BackgroundThe STOP AD study, a randomized, open-label trial evaluating the effect of short-term (first four postnatal days to 8 weeks) skin barrier protection using AVEENO® Dermexa Fast & Long-Lasting Balm in infants with a parent with allergic disease, demonstrated decreased cumulative incidence and decreased prevalence of AD at 12 months of age. ObjectiveWe aimed to identify skin biomarkers in the STOP AD study that are associated with risk of development of AD. MethodsSkin swabs were collected from the cheek and antecubital fossa (AF) at baseline, 8 weeks, and 12 months from subsets of study participants from each of the intervention arm (43 of 119) and control arm (43 of 138) and were analyzed for specific cytokines (CCL27, CXCL2, hBD1, IL18, IL8, IL1α, IL1RA, IL1β, S100A8/9, IL36γ) by ELISA. ResultsHigher titers of S100A8/9 at the AF at 8 weeks in infants with filaggrin wild type genotype (FLGwt), but not in those with filaggrin loss-of-function mutations (FLGmut), predicted: 1) Development of AD in the first year of life (p=0.033); 2) Presence of AD at 6 months or 12 months of age (p=0.009 and 0.035, respectively); 3) Persistence of AD between 6 and 12 months of age (p<0.001); 4) Development of AD with the emollient intervention. ConclusionIncreased titers of S100A8/9 from skin swabs of the AF in high-risk infants at 8 weeks with FLGwt was predictive of AD developing in the first year of life and of other AD features. These findings suggest that there are different molecular pathways leading to AD in FLGmut individuals and in FLGwt individuals. Early identification of infants who are likely to develop AD will allow more targeted interventions.

Skin biomarkers predict the development of food allergy in early life

BackgroundFood allergy (FA) often occurs in early childhood with and without atopic dermatitis (AD). FA can be severe and even fatal. For primary prevention, it is important to find early biomarkers to predict the future onset of FA before any clinical manifestations. ObjectiveTo find early predictors of future onset of FA in the stratum corneum (SC). MethodsSkin tape strips (STS) were collected from the forearm of newborns (n=129) at the age of 2 months before any signs of clinical FA or AD. Children were clinically monitored until they reached 2 years of age to confirm the presence or absence of FA and AD. STS were subjected to lipidomic analyses by the LC-MS/MS and cytokine determination by Meso Scale Discovery U-Plex assay. ResultsOverall, 9/129 (7.0%) infants developed FA alone, and 9/129 (7.0%) infants developed FA concomitantly with AD (ADFA). In the SC of future FA and ADFA children, absolute amounts of unsaturated (N24:1)(C18S)Ceramide and (N26:1)(C18S)Ceramide and their relative percentages within the molecular group were increased in comparison to healthy children with p-values between <0.01 and p<0.05, ANOVA. Future AD children had normal levels of these molecules. Interleukin (IL)-33 was upregulated in future FA but not AD infants, whereas thymic stromal lymphopoietin (TSLP) was upregulated in AD but not FA. Logistic regression analysis revealed strong FA predicting power for the combination of dysregulated lipids and cytokines, with an odds ratio reaching 101.4 (95% CI 5.4 – 1910.6). ConclusionNon-invasive STS analysis at 2 months of age can identify infants at risk of future FA.

Alterations in gut microbiome associated with severity of atopic dermatitis in infants.

Atopic dermatitis (AD) often arises in infancy, and gut microbial dysbiosis is associated with the development of AD. However, less is known about specific changes in early-life gut microbiome associated with AD and AD severity. This study aims to reveal the gut microbial composition and function profiles associated with the severity of AD in infants. Sixty-two infants (mean [SD] age, 4.7[1.9] months) with different severities of AD were enrolled and divided into three groups (mild, moderate and severe) according to the Scoring Atopic Dermatitis (SCORAD) index. The profiles of gut microbial composition and function were analysed by sequencing 16S ribosomal RNA amplicons. Quality of life on children and the family was evaluated using published questionnaires. Decreased levels of Clostridium sensu stricto, Collinsella and increased level of Parabacteroides presented in the severe AD group compared with the mild AD group after adjusting potential confounders (p < 0.05). There were strong positive correlations between the Scoring Atopic Dermatitis (SCORAD) index and the relative abundance (RA) of Bacteroides and functional pathways for metabolism of sphingolipids and glycosphingolipids (p < 0.05). The SCORAD index was negatively correlated with the RA of Clostridium sensu stricto (p < 0.05), and was also positively correlated with the index of quality of life on children and the family (p < 0.05). Discrepancies in gut microbial composition and functional pathways were observed in infants with mild-to-severe AD. Alterations in butyrate-producing bacteria (Clostridium sensu stricto), sphingolipid-producing bacteria (Parabacteroides, Bacteroides), and related functional pathways were associated with the severity of AD infants.

Gastrointestinal Disorders and Atopic Dermatitis in Infants in the First Year of Life According to ROME IV Criteria-A Possible Association with the Mode of Delivery and Early Life Nutrition.

Background: Functional gastrointestinal disorders are very common condition. The aim of this study is to evaluate the implications of the mode of pregnancy termination and early infant feeding on the incidence of gastrointestinal disorders and atopic dermatitis at birth and 3, 6, and 12 months of age. Methods: This study included 82 pregnant women and their newborns born at term. All newborns were examined at birth and 3, 6, and 12 months of age according to the ROME IV criteria. Results: In children born after cesarean section, the incidence of regurgitation was significantly higher. In children fed mostly or exclusively with formula, dry skin with allergic features was observed more often compared to breastfed children, but this relation was statistically significant only at the age of 12 months. The use of antibiotic therapy increased the risk of allergic skin lesions by almost seven times at 3 months of life. Gastrointestinal disorders in the form of regurgitation, colic, and constipation occur within the period of up to 12 months of the child's life and may be related to the mode of the termination of pregnancy via cesarean section and the use of artificial feeding or antibiotic therapy. The occurrence of atopic dermatitis in infants at 12 months of life is correlated with the mode of the termination of pregnancy after cesarean section. Conclusions: One of the risk factors for the occurrence of atopic dermatitis and gastrointestinal disorders in the period up to 12 months of the child's life may be a cesarean section and the use of formula feeding or antibiotic therapy.

Real-World Evidence Demonstrating Tralokinumab Onset of Action and Efficacy in Two Skin of Color Patients with Moderate-to-Severe Atopic Dermatitis

Introduction: Atopic dermatitis (AD) is a chronic, inflammatory skin disease that has higher prevalence, persistence, and severity, as well as different response to treatment, in skin of color (SOC) patients. This underscores the importance of clinical trial diversity and real-world case reports to help reduce health inequity, improve clinical understanding, and enhance treatment access for all patient populations. Tralokinumab specifically targets interleukin-13, and the onset, efficacy, and safety outcomes from the initial clinical trials revealed striking therapeutic potential. &#x0D; Objective: To provide examples of rapid tralokinumab onset of action in SOC patients, including improvement of the difficult-to-treat head and neck subtype and of hyperpigmentation on the hands.&#x0D; Methods: The authors describe the clinical outcomes of two SOC patients: an 18-year-old Asian male [patient 1] and a 37-year-old African-American male [patient 2]. Data related to tralokinumab treatment were collected during routine clinical practice.&#x0D; Results: Both patients were diagnosed with AD in infancy and continued to suffer from AD. At baseline, each had clearly perceptible erythema, induration, and lichenification and were assigned IGA scores of 3. Patient 1 had a BSA of 22%, managed with clobetasol 0.05% ointment for the body and ruxolitonib 1.5% cream for the face. He had never received systemic treatment. Patient 2 had previous medical history of mild asthma and BSA of 29%. His AD was managed with clobetasol 0.05% ointment. Over the prior two decades, he had been managed with myriad topical corticosteroids, prednisone tapers, as well as methotrexate. Due to insurance barriers, there were challenges obtaining tralokinumab immediately for both patients. The lapse in time was less than 6 weeks in each case. Not surprisingly, IGA 3 was assigned at both time of initial presentation and at time of tralokinumab initiation. Both patients were prescribed an initial dose of 600 mg (four 150 mg subcutaneous injections) followed by 300 mg (two 150 mg subcutaneous injections) administered every other week. After 10 weeks, patient 1 experienced a decrease in IGA from 3 to 1; his BSA decreased from 22% to 7%. After only 6 weeks, patient 2 also exhibited a decrease in IGA from 3 to 1; his BSA decreased from 29% to 6%. The improvement was sustained throughout a 6-month follow-up period in both patients. The authors observed significant improvement in the quality of life for both patients, subjectively and objectively. To date, no patient-reported or investigator-recognized adverse outcomes have occurred.&#x0D; Conclusions: Treatment with tralokinumab 300 mg, every other week, showed a rapid onset of action, with superior efficacy to the original clinical trials in two SOC patients with moderate-to-severe AD, one of which had involvement of the difficult-to-treat area of the head and neck. With no patient- or physician- adverse events reported to date, this observational study underscores the importance of future real-world reports to potentially corroborate our findings.

Risk Factors of Onset Time and Persistence of Atopic Dermatitis in Children Under Age 5 Years: A Cross-Sectional Study.

Background: The prevalence of atopic dermatitis (AD) is high among children, with development of AD occurring during early childhood in most affected children and some having a chronic disease course. Risk factors for AD in this group remain undefined. Objectives: We analyzed the medical records of children with AD under 5 years of age. We summarized characteristics of the natural course of AD in these children and explored relevant risk factors of AD in infancy and early childhood. Methods: Using a self-developed questionnaire, we investigated 716 children under 5 years of age who were treated for AD at the Dermatology Department of the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China. We conducted the study from October 2021 to September 2022 using telephone and on-site interviews with the children's parents. In parental interviews, data were gathered on neonatal diseases, comorbidities, parental allergy history, maternal history of tobacco and alcohol use, and basic infant information at birth. Some children were tested for serum total immunoglobulin E (IgE) before this study. Results: Neonatal hyperbilirubinemia, neonatal respiratory distress syndrome (NRDS), neonatal infection, and infection during childhood had a significant impact on persistent symptoms and the onset of first symptoms in children with AD (P < 0.05). Allergic diseases as common comorbidities with AD, which had earlier onset of AD related to more obvious disease activity (P < 0.05). Parental history of allergy was also significant in AD (P < 0.05). Serum total iIgE levels in children with AD showed an impact on the clinical course of AD; neonatal hyperbilirubinemia and NRDS may affect IgE levels (P < 0.05). Persistent AD had a significant effect on the physical growth of children with height/length for age Z score ≤3 and weight for height/length Z score ≤3 (P < 0.05). Conclusions: Early adverse events in infants, infection before onset, and susceptibility to infection may affect the onset and clinical course of childhood AD. Serum total IgE levels affect the progression of AD. Persistent AD in childhood may have a slight impact on children's physical growth.

Research progress on the intrinsic relationship and mechanism between respiratory allergies and skin allergies

Allergic disease is a systemic disease that affects multiple systems. Respiratory tract and skin are the most frequently involved organs of allergies, which include allergic rhinitis, asthma, acute and chronic urticaria, atopic dermatitis, etc.. They are closely correlated clinically. Respiratory allergies and skin allergies often occur in one patient in the form of synchronous occurrence, synchronous aggravation or mutual transfer of symptoms, and early atopic dermatitis in infants is an independent risk factor of respiratory allergy. Type Ⅰ hypersensitivity is the most common immunologic mechanism of respiratory and skin allergies, which are mediated by allergens induction, multiple immune cells and inflammatory cells involvement, and IgE medicated mast cell degranulation. This present article provides a brief review on the epidemiology, tissue origin, and pathogenesis of respiratory airway allergy and skin allergy, in order to provide new ideas and reference basis for clinical diagnosis and treatment and the development of allergic disease prevention strategies.

EE239 How to Consider Caregiver Health-Related Quality of Life in a Cost-Effectiveness Analysis? An Illustration with Dupilumab for the Treatment of Severe Atopic Dermatitis in Infants in France

EE239 How to Consider Caregiver Health-Related Quality of Life in a Cost-Effectiveness Analysis? An Illustration with Dupilumab for the Treatment of Severe Atopic Dermatitis in Infants in France

Trajectory of stratum corneum lipid subclasses in the first year of life and associations with atopic dermatitis: A prospective cohort study

AbstractBackgroundTrajectories of stratum corneum (SC) lipid subclasses and their associations with infant atopic dermatitis (AD) are unclear. This study aimed to quantify the trajectories of 15 SC subclasses and carbon chain lengths and their associations with AD within 12 months.MethodsIn total, 213 newborns were enrolled at birth with nonlesional skin samples collected from the inner forearm at birth, 42 days, 3, 6, and 12 months, respectively. Lesional skin samples were collected from 120 AD patients at clinic with the disease onset within the first year of life. Mass spectrometry was applied to assess relative contents of 12 ceramide (CER), three free fatty acid (FFA) subclasses, and average carbon chain length (CCL). AD incident within 1 year old was diagnosed by dermatologists according to UK criteria.ResultsSixty‐four (30.0%) cases of ADs occurred in the cohort. All SC lipid subclasses and CCLs, but EOP varied significantly during the first year. AD infants showed lower NP but higher NS, NH, AP, hydroxy FFA, and CCL of FFAs compared with nonaffected infants. After normalization by age, the differences remained and were more pronounced in lesional skin of clinical AD infants compared with non‐ADs. NS, NH, and CCL of FFAs in lesional skin of AD infants showed positive and significant correlations with the levels of transepidermal water loss at 3 month; some evidence supports a negative correlation for NP.ConclusionsWe provide an overview of developmental trajectories of 15 CER and FFA subclasses across the first year of healthy infants and a link between the imbalance of some subclasses with the development of AD.

Prenatal antibiotic exposure increases the risk of infant atopic dermatitis: data from a Greek cohort.

Background. The human microbiome is important due to the impact it has on host immunologic development and allergy-associated diseases. This study aimed to investigate the impact of prenatal exposure to antibiotics on the incidence of atopic dermatitis (AD) in children at 18 months of age. Methods. Mothers were interviewed at baseline, in the maternity ward and by phone questionnaire after 18 months. Demographic data, mode of delivery, yoghurt consumption, antibiotic and other drug use during pregnancy, atopic history, diagnosis of AD and history of infections in the offspring were noted. Results. 385 mothers were interviewed at baseline. 231 (60%) mothers with 236 children responded at follow up. Cesarean section was reported in 116 (50.2%) deliveries while antibiotic use during pregnancy in 55/231 (23.8%) women. 43/236 (18.22%) infants were diagnosed with AD. Intravenous antibiotic use was associated with a 7.7 increased risk of AD diagnosis in the offspring (95%CI 1.23-48.27, p = 0.029). An increased odd for AD was recorded for mothers 30-40 years of age (OR 4.50, 95%CI 1.08-18.7, p = 0.039). No significant association between cesarean section and AD (p = 0.70) was recorded. In multivariate analysis, reported food allergy (OR 8.03, 95%CI 2.30-27.97, p = 0.001) and otitis media episodes in children (OR 3.76, 95%CI 1.60-8.83, p = 0.002) were significantly associated with AD diagnosis. Conclusions. An increased risk of AD was recorded only when antibiotics were given prenatally by intravenous route and in women between 30-40 years of age. Children with food allergy had an increased risk for AD. The relatively high percentage of cesarean sections was not a risk factor for AD.

Maternal supplementation with Limosilactobacillus reuteri FN041 for preventing infants with atopic dermatitis: study protocol for a randomized controlled trial.

Atopic dermatitis (AD) has increased rapidly with rapid urbanization; however, the treatment options for AD are lacking because the commonly used therapies can only alleviate symptoms. Limosilactobacillus reuteri (L. reuteri), FN041 is a specific strain isolated from human breast milk, and its protective potential against AD has been confirmed. This study aims to assess the efficacy of maternal consumption of L. reuteri FN041 during late pregnancy and lactation in preventing infantile AD. First, a randomized, double-blind, placebo-controlled intervention study will be conducted on 340 pregnant females with babies at high risk for AD. These subjects will be randomly divided into four groups of different doses of L. reuteri FN041 (1 × 109, 5 × 109, and 1 × 1010 CFU/d) along with a placebo. The safety and efficacy of maternal use of L. reuteri FN041 for preventing infantile AD will be analyzed, and the most efficient dosage of L. reuteri FN041 will be determined. Subsequently, a multicenter cohort study of 500 pregnant females with babies at high risk for AD will be conducted to promote the maternal application of L. reuteri FN041. These subjects will be administered L. reuteri FN041 at the optimal dose determined during the first stage of late pregnancy and lactation, and their babies will be analyzed for AD development. Recruitment was initiated in October 2022. The primary outcome is the cumulative incidence of AD at 24 months after maternal consumption of L. reuteri FN041 during late pregnancy and lactation, whereas the secondary outcome is the efficiency of L. reuteri FN041 transfer from the mother's gut to breast milk and then the infant's gut after oral supplementation. This study will demonstrate the efficacy of edible probiotics isolated from breast milk in preventing or treating AD in infants. Accordingly, we provide population-based advice for administering specific probiotics for the primary prevention of AD in pregnant females. Understanding the underlying mechanisms of probiotic strains derived from breast milk can promote their application in preventing infant diseases associated with intestinal microbiota imbalance and immune disorders. https://www.chictr.org.cn/, identifier [ChiCTR2300075611].