Family History Of Atopic Disease Research Articles

Genetic variations and clinical features associated with burning sensation due to topical tacrolimus in patients with atopic dermatitis

AbstractBackgroundTopical tacrolimus has been used as one of the treatment options for atopic dermatitis (AD). A burning sensation is the most common side effect of topical tacrolimus.ObjectivesThis study was designed to identify genetic variations and clinical features to predict burning sensation by topical tacrolimus in patients with AD.MethodsPatients with AD who had applied topical tacrolimus were classified according to the presence of a burning sensation. We compared the patients' demographics and blood test results, including serum eosinophil, serum immunoglobulin E and multiple allergen simultaneous test. Furthermore, the frequency of variations in barrier‐ (KLK7, FLG 3321delA, FLG K4022X, SPINK5 1156, SPINK5 1188, SPINK5 2475) and immune response‐ (DEFB1, KDR, CDKAL1, IL‐5RA, IL‐9, IL‐12RB1, IL‐12RB2, IL‐17RA) related genes was compared between two groups by reverse blot hybridization assay of the buccal mucosa.ResultsAmong 206 patients with AD using topical tacrolimus, 34 (16.5%) complained of a burning sensation. The burning sensation was associated with severe AD and a family history of atopic disease. Furthermore, with statistical significance, a heterozygous mutation in the filaggrin gene (FLG K4022X) was more frequent in AD patients with a burning sensation due to topical tacrolimus. However, no other significant genetic differences were observed between them.ConclusionsA burning sensation caused by topical tacrolimus can be expected in AD patients with severe symptoms, a family history of atopy and a genetic variation such as FLG K4022X.

Association between polymorphisms of IL33 and IL37 and atopic dermatitis

Atopic dermatitis (AD) is a chronic recurrent inflammatory disease accompanied by severe itching. One of the leading mechanisms underlying the development of AD is an imbalance of the Th1/Th2 cells immune response, which leads to an increased production of inflammatory mediators, including IL-1 family. The IL-1 family includes the recently discovered IL-33 and IL-37, and their role in the pathogenesis of AD has been actively studied. IL-33 functions as an alarmin that can induce IL-31 production, thereby leading to skin barrier impairment, pruritus and scratching. Having both immunomodulatory and immunosuppressive properties, IL-37 suppresses leukocyte infiltration of the affected skin and reduces the activity of proinflammatory cytokines. The aim of our study was to search for associations between gene polymorphisms of IL33, IL37 genes, and risk of AD. A total of 98 patients with moderate and severe AD were included in the study. The control group included 72 healthy volunteers. Polymorphic markers were determined in peripheral blood. After extraction of total RNA, polymorphic markers rs7019575 in the IL33 gene, rs3811046 and rs3811047 in the IL37 gene were analyzed using RT-PCR. There was no statistically significant difference in allele frequency and genotype distribution of rs7019575 (IL33) and rs3811047 (IL37). Studying the rs3811046 polymorphic marker in the IL37 gene showed that the risk of AD was almost 2 times lower for the G allele carriers and more than 2-fold higher for TT homozygous carriers. The haplotype analysis revealed that the GTAA and TTGG haplotypes of IL37 were associated with AD, thus increasing the risk of AD development by 2 and 10 times, respectively. In conclusion, SNP markers identified in this study can be used to predict the risk of AD development in the subjects with a positive family history of atopic diseases.

Correlation of Blomia tropicalis-specific immunoglobulin epsilon profiles with family history of atopy in a Filipino population.

House dust mites are the major source of indoor allergens in the tropical and subtropical regions with Blomia tropicalis (Bt) allergens as one of the leading causative agents of sensitization among patients from the tropics. Despite the clinical importance of Bt in various populations, its allergenicity remains unclear among Filipino allergic patients. This study determined the sensitization profiles of allergic Filipinos against Bt allergens and its correlation with atopy. Total immunoglobulin epsilon (IgE) (n = 960), Bt-specific IgE (n = 247), and Blomia tropicalis 5 (Blo t 5)-specific IgE (n = 87) profiles of allergic and nonallergic subjects were measured through enzyme-linked immunosorbent assay (ELISA). Point-biserial correlation coefficient was used to determine the association between Bt-specific IgE levels and selected demographics. Inhibition ELISA was performed to measure the inhibition capacity of recombinant Blo t 5 (rBlo t 5) against Bt allergen extracts. Mean total IgE levels of allergic cases (n = 171) were significantly higher (P < 0.001) compared to the mean IgE levels of nonallergic controls (n = 76). Among allergic subjects, 58% were sensitized to Blo t extract and 80% of which were sensitized to rBlo t 5 allergen. A positive correlation was observed between Bt-specific IgE and family history of atopic disease (P = 0.031). Inhibition assay revealed that 54% mean reactivity of 7 plasma samples was caused by rBlo t 5, validating that rBlo t 5 is a major allergen in Bt. This study has shown the importance of Bt as an allergen source that sensitizes atopic Filipino subjects. Hence, inclusion of Bt allergen extract and rBlo t 5 in the panel for allergy diagnosis and immunotherapy in Filipino populations is strongly recommended.

Early-Life Risk Factors and Clinical Features of Food Allergy Among Thai Children.

Background: Food allergy affects 1%-10% of children under five worldwide, with genetic and early-life factors playing a primary role. Reported factors include a family history of allergic diseases, personal atopic dermatitis, cesarean section, dietary restrictions during pregnancy and lactation, and the timing of introducing solid foods. This study was aimed at identifying various factors associated with food allergy and evaluate each food allergy's clinical features. Methods: We conducted a case-control study with a participant ratio of 1:2 between cases and controls. Data were gathered from both groups of participants, and questionnaires included living area, sex, and natal history (birth details, maternal diet during pregnancy and breastfeeding, feeding history during infancy, family history of atopic diseases, and household smoking). Results: All 72 cases with food allergy and 145 controls were included in the study. Term birth comprised a protective factor for developing food allergy (adjusted odds ratio [aOR] 0.213, p value 0.022). In contrast, personal atopic dermatitis (aOR 20.097, p value 0.001) and a family history of allergic disease constituted risks (aOR 3.183, p value 0.002). Food allergy was unrelated to cesarean section, low birth weight, dietary restrictions during lactation and pregnancy, exclusive breastfeeding, or the early introduction of complementary foods. The three most common food allergens were egg white (40.2%), wheat (34.7%), and cow's milk (30.5%), respectively. Conclusions: In this study, risk factors associated with food allergy comprised a personal history of atopic dermatitis and a family allergic disease, which may be used as predictive factors for developing food allergy among Thai children.

Predictive factors of atopic-like dermatitis induced by IL-17A inhibitors in patients with psoriasis: A 2-year follow-up study.

Atopic-like dermatitis (ALD) is a common side effect of interleukin-17A (IL-17A) inhibitors. To determine the prevalence, risk factors, outcomes and treatment of ALD in a cohort of psoriasis patients treated with IL-17A inhibitors. This retrospective study included 226 psoriasis patients treated with an IL-17A inhibitor in our dermatology department between July 2020 and July 2022. The patients were reviewed over 2 years. A logistic regression model in rare events data (relogit) was used to predict the risk factors for ALD. Of the 226 patients, 14 had ALD. Data including age, body mass index, IL-17A inhibitor use, personal and family history of atopic disease, pet ownership history, and immunoglobulin E (IgE) levels were analysed using the relogit regression model. It indicated a personal history of atopic disease (odd ratio [OR] 27.830, 95% confidence interval [CI] 3.801-203.770; p = 0.001) and elevated IgE levels (OR 5.867, 95% CI 1.131-30.434; p = 0.035) as independent predictors of incident ALD. In one patient, anti-IL-17A therapy was discontinued, and treatment was switched to tofacitinib. Thirteen patients who continued with IL-17A inhibitor were treated with topical therapy and/or antihistamines, and their ALD was partially or completely resolved. In this study, the incidence rate of ALD was 6.19%. Elevated IgE levels and a personal history of atopic disease were found to be the risk factors for ALD. Our study findings suggest that treatment should be provided based on the severity of psoriasis and incident ALD. Prior to treatment, psoriasis patients who have the risk factors for ALD should be informed of the possible development of ALD, and alternative psoriatic therapeutic options should be considered if severe ALD develops.

Changes in risk factors for food sensitization in early life: Analysis over a period of 10 years.

Although epidemiological trends of childhood food sensitization (FS) in IgE-mediated food allergy were reported in China, few studies have examined at changes in its risk factors. To investigate the change in early-life risk factors associated with childhood food sensitization during 2009-2019 in China. Data from two cross-sectional surveys conducted in 2009 and 2019 (401 and 513 children, respectively) were analyzed. The results of skin prick tests and information on food sensitization-related risk factors in children were summarized, including family history of atopic disease (FHA), demographic characteristics, method of delivery, feeding patterns, sibship size, pet ownership, and vitamin D supplementation. Binary logistic regression was used to calculate the odds ratio and the regression coefficient β-value of risk factors in the 2009 and 2019 surveys separately. Then, coefficient β-value differences between the two surveys were analyzed by the bdiff command in STATA to describe the change in risk factors over 10 years. The 2009 survey revealed that FHA, age, only child, and feeding patterns were associated with food sensitization. The 2019 survey showed that food sensitization was affected by age, sex, and feeding patterns. However, from 2009 to 2019, the probability of food sensitization in the only-child group significantly increased by 226.0% (β-value difference = 0.81, P = 0.024) and decreased by 65.0% in female children (β-value difference = -1.06, P = 0.008). The effect of age on food sensitization decreased by 50.0% (β-value difference = -0.69, P < 0.001) over 10 years. The effect of FHA and common lifestyle factors on food sensitization did not significantly change during 2009-2019. However, the influence of demographic characteristics on food sensitization has changed since 2009; that is, older age, male gender, and only child are more likely to develop food sensitization, which needs to be considered in future epidemiological surveys. http://www.chictr.org.cn/, identifier ChiCTR1900024338.

Stratum corneum lipid and cytokine biomarkers at age 2 months predict the future onset of atopic dermatitis

Atopic dermatitis (AD) commonly occurs in children and can progress into severe phenotypes or atopic march, causing significant impairment in quality of life. It is important to find early biomarkers of future onset of AD before any clinical manifestations. We sought to find early predictors of future onset of AD in skin stratum corneum (SC). Skin tape strips were collected from the forearm of newborns (n= 111) with and without family history of atopic diseases at the age of 2 months before any signs of clinical AD. Children were clinically monitored until they reached age 2 years to ensure the presence or absence of AD. Skin tape strips were subjected to lipidomic analyses by the liquid chromatography electrospray ionization tandem mass spectrometry and cytokine determination by Meso Scale Discovery U-Plex assay. Overall, 22 of 74 (29.7%) and 5 of 37 (13.5%) infants developed AD in the risk group and the control group, respectively. In the SC of future AD children, protein-bound ceramides were decreased (P< .001), whereas unsaturated sphingomyelin species (P< .0001) and "short-chain" nonhydroxy fatty acid sphingosine and alpha-hydroxy fatty acid sphingosine ceramides were elevated (P< .01 and .05, respectively) as compared with healthy children. Thymic stromal lymphopoietin and IL-13 levels were increased in the SC of future AD subjects (by 74.5% and 78.3%, P= .0022 and P< .0001, respectively). Multivariable logistic regression analysis revealed strong AD predicting power of the combination of family history, type 2 cytokines, and dysregulated lipids, with an odds ratio reaching 54.0 (95% CI, 9.2-317.5). Noninvasive skin tape strip analysis at age 2 months can identify asymptomatic children at risk of future AD development with a high probability.

Drug allergy evaluation in children with suspected mild antibiotic allergy.

Adverse antibiotic reactions caused by an immunological mechanism are known as allergic reactions. The percentage of reported antibiotic allergies is likely to differ from the one validated after a drug provocation test (DPT) with the culprit antibiotic. This study aimed to compare the percentage of children who were thought to be allergic to a certain antibiotic with those who have a true allergy, as confirmed by DPTs. We also validated Skin Prick Tests (SPTs) and Intradermal Tests (IDTs) by assessing their sensitivity and specificity, in diagnosing antibiotic allergies using DPT as the gold standard. Furthermore, we investigated epidemiological risk factors such as personal and family history of atopic disease and eosinophilia. Children with a history of possible allergic reaction to an antibiotic underwent a diagnostic procedure that included: (1) Eosinophil blood count, (2) SPTs, (3) IDTs and (4) DPTs. The parameters were compared with Pearson's Chi-Square and Fisher's Exact Test. Several risk factors that were found significant in univariate analysis, such as personal and family history of atopic disease, and positive SPTs and IDTs were examined with multiple logistic regression analysis to see if they were related to a higher risk for a positive DPT. Semi-synthetic penicillin was the most common group of antibiotics thought to cause allergic reactions in this study. Overall, 123 children with a personal history of an adverse reaction to a certain antibiotic, were evaluated. In 87.8% of the cases, the symptoms had occurred several hours after administration of the culprit antibiotic. Both SPTs and IDTs had low sensitivity but high specificity. Moreover, they had a high positive predictive value (PPV). In contrast, eosinophilia was not recognized as a risk factor. Seventeen patients (13.8%) had a true antibiotic allergy, as confirmed by a positive DPT. A positive IDT was a strong predictor of a positive DPT, along with a positive personal and family history of atopy. SPTs and IDTs are very reliable in confirming antibiotic allergy when found positive. A negative result of a SPT highly predicts a negative DPT. A positive IDT and a positive personal and family history of atopy were recognized as significant risk factors for antibiotic allergy.

An update on the prevalence, chronicity, and severity of atopic dermatitis and the associated epidemiological risk factors in the Singapore/Malaysia Chinese young adult population: A detailed description of the Singapore/Malaysia Cross-Sectional Genetics Epidemiology Study (SMCGES) cohort

BackgroundAtopic Dermatitis (AD) is a highly pruritic, chronic-recurrent inflammatory skin condition associated with erythematous lesions that affect a significant proportion of the population. Although AD is a non-communicable disease, it can cause pain, unbearable itchiness, sleep disturbance, loss of work productivity, and reduced quality of life. As a heterogeneous disease, AD is influenced by multiple genes and environmental triggers. As such, it is imperative to gain a deeper insight into the intricate gene-environment relationship that results in the manifestation of AD. MethodsThere are 3 objectives in our study. We first aim to update the epidemiological status of AD amongst young adults in Singapore and Malaysia, in particular amongst the Chinese ethnic background. Next, we re-evaluated the possible associated risk factors, identified in our previous meta-analysis and review studies, on the current cohort. Finally, we described here a detailed disease presentation and symptoms profile of our Singapore and Malaysia Cross-Sectional Genetics Epidemiology Study (SMCGES) cohort, which forms the base population for the discovery of associated genetic factors in relation to asthma, allergic diseases and skin conditions. Based on a skin prick test (SPT) and investigator-administered medical history responses, we assessed the AD profiles of 11 494 participants and the significant modifiable and non-modifiable factors associated with disease presentation. ResultsThe prevalence of AD in the combined population was 13.5%. Chronic and moderate/severe AD were observed in 35.5% and 40.5% of the individuals with AD, respectively. Family history of atopic diseases, prior history of drug allergies, a history of acne, increased household family monthly income, higher number of individuals in the shared household, parental education, sedentary lifestyle, physical activities, alcoholic consumption, and even quality of diet was significantly associated with AD presentation, chronicity, and severity. Among all the factors evaluated, family and personal history of atopic diseases imposed the strongest associated risk. ConclusionsThese findings supported our previous review studies and affirmed that familial history or genetic factors critically influence the development of AD in our population and environment. Environmental and other modifiable factors can also trigger AD throughout the lifetime of individuals who have especially inherited the atopic disease disposition. A better understanding of how these risk factors affect AD individuals in our population can facilitate disease surveillance, monitor disease control, and serve as a description for our future genetic epidemiology studies.

SPECIFIC FOOD ALLERGENS ASSOCIATED WITH CLINICAL SENSITIZATION AMONG PATIENTS PRESENTING TO HOSPITALS IN HYDERABAD, INDIA

<h3>Introduction</h3> Various international initiatives have aimed to estimate the prevalence, burden, and etiology of food-triggered disorders, including food allergy (FA). However, comparatively few efforts have been undertaken in India. A multicenter study was conducted in and around Hyderabad (South India) to identify predominant food allergens impacting the regional population presenting for food-related illness. <h3>Methods</h3> ICMR-National Institute of Nutrition, Hyderabad investigated the relative prevalence of specific food triggers among patients consulting to 5 government and private hospitals in Hyderabad. A pilot study identified 78 food items as perceived illness triggers by 100 patients presenting to hospital network-affiliated physicians. A total of 1966 participants reported illness triggered by ≥1 of the 78 foods and provided detailed demographic information and specific allergy history. Participants underwent SPT, total IgE and sIgE testing to each reported food trigger. <h3>Results</h3> Patients reporting food-related illness were mostly adults (Mean age=44.9; SD=23.4) with a family history of atopic disease (69.4%) and 55.2% were male. Roughly half (48.8%) reported experiencing food-induced reaction symptoms for ≤10 years. Asthma, allergic rhinitis and urticaria were common, with 73.4%, 55.2%, and 32.8% reporting a history of each. The top 12 food-related illness triggers for which SPT suggested allergic sensitization (≥3mm) were chickpea (6.3%), cumin (5.9%), walnut (5.8%), cabbage (2.1%), coconut(1.5%), eggplant(1.5%), split red lentil(1.5%), betel leaf(1.3%), garlic(0.8%), beans(1.1%), prawn(0.7%), mango(0.7%). Relative to SPT, elevated sIgE was less frequently observed for each above food. <h3>Conclusion</h3> The relative distribution of foods associated with allergic sensitization among a large, Hospital-based South Indian sample, differs substantially from those observed in other regions.

Atopic dermatitis in Senegalese children with skin phototype VI: Prevalence, clinical features, and risk factors of severity

Background: Atopic dermatitis (AD) is the most common inflammatory skin disease of childhood. Yet, in sub-Saharan Africa, data on AD in children is scarce. Herein, we aimed to determine the prevalence, clinical features, and risk factors of severity of AD in Senegalese children with skin phototype VI. Materials and Methods: This was a cross-sectional study including children with AD and skin phototype VI younger than fifteen years old seen in two dermatology centers in Senegal over a period of six months. The diagnosis of AD was based on the United Kingdom Working Party (UKWP) criteria. The severity of AD was evaluated with SCORing of Atopic Dermatitis (SCORAD). Results: Among the 630 children consulted during the study period, 104 had AD, yielding a hospital prevalence of 16.5%. The mean age of children with AD was 36 months with a sex ratio of 1. A personal and family history of atopic disease was reported in 86.5% and 84.6% of the patients, respectively. Xerosis was the most common clinical feature, observed in 80.8% of. Post-inflammatory hyperpigmentation and keratosis pilaris were observed in 44.2% and 37.5%, respectively. Severe AD was noted in 12.5%. Risk factors associated with the severity of AD were exposure to incense smoke, an age of onset before 24 months, food allergies, and impetiginisatio. Daily use of shea butter was a protective factor. Conclusion: Our study showed a high hospital prevalence of AD in Senegalese children with skin phototype VI. The result observed with shea butter as a protective factor against severe AD is highly important, although it needs to be confirmed by randomized studies.

FREQUENCY OF SELF-REPORTED ALLERGIC REACTIONS TO THE DRUGS AMONG MEDICAL STUDENTS OF PESHAWAR

ABSTRACTObjective: Worldwide studies indicate that allergic reactions to drug(s) are responsible for significant morbidity and mortality. However, the epidemiological data regarding drug allergies is limited in our community. The aim of this study was to determine the frequency of self-reported drug allergic reactions among medical students of Peshawar.Materials and Methods: A cross-sectional study was conducted on 300 students from various public and private sector medical colleges of Peshawar from Sept 2020 to June 2021. After brief introduction and explaining the purpose of this study, a close ended self-reported questionnaire was distributed among them. Questionnaire was comprised of demographic data, family history of atopic disease, source of drug allergy, signs and symptoms of allergy and route of drug administration.Results: Among 300 students, 23 participants indicated drug allergy with self-reported frequency of 7.67%. The most frequently implicated drugs were antibiotics (52.17%), of which levofloxacin was the most common antibiotic followed by NSAIDs (17.39%). The most commonly reported allergic manifestations were cutaneous (34.8%), followed by gastrointestinal (17.4%) and respiratory (13.4%) symptoms. 78% allergic patients had the drug in oral dosage form.Conclusion: Self-reported allergic reactions to the drugs are highly prevalent and poorly explored. Being the most frequent source of drug allergies, patient awareness and education is needed while prescribing Antibiotics and NSAIDs.

Rectal Bleeding and Cow’s Milk Protein-induced Allergic Proctocolitis: A Prospective Study

To assess time to resolution of food protein–induced allergic proctocolitis (FPIAP).In this study, researchers evaluated 76 infants aged <4 months with rectal bleeding (RB) referred to the pediatric gastrointestinal department at Trousseau Hospital in Paris, France, between May 2014 and December 2017. Only infants whose RB responded to a cow’s milk elimination diet were included in the study.This was a prospective cohort of infants with concern for cow’s milk protein (CMP) allergy who had resolution of RB with CMP elimination. Exclusion criteria included RB because of another etiology and exclusively breastfed infants. A total of 2 to 8 weeks after resolution of RB, CMP oral food challenge (OFC) was completed. If FPIAP was confirmed, OFC was repeated every 2 months after the age of 4 months to assess the time to tolerance of CMP. Ongoing FPIAP CMP was defined as RB, behavioral change, diarrhea, and vomiting. Tolerance was defined as CMP daily without symptoms.Only 31% of the cohort failed OFC at initial diagnostic challenge, meaning that over two-thirds of infants who initially responded to CMP exclusion did not have return of symptoms on rechallenge just weeks later. Of the patients confirmed to have FPIAP CMP, the median age of tolerance was determined to be 6.8 months, with >75% of the cohort tolerant by 10 months. Infants with a first-degree family history of atopic disease developed tolerance later (8.9 months versus 5.1 months).In this work, it was confirmed that the majority of RB in infants is likely not related to FPIAP CMP. This study also revealed that the time to resolution might be earlier than previously thought.Although there are no solid guidelines on introduction of CMP in presumed FPIAP CMP, the majority of patients exclude CMP until approximately 1 year. In this study, it was found that only one-third of RB before 4 months was due to FPIAP. Of those with FPIAP, CMP could be challenged earlier and at more frequent intervals depending on family wishes. A major limitation of this study is that exclusively breastfed infants were excluded and the lack of information on maternal diet in those who were nursing.

ASSOCIATION OF STAT6 GENE SINGLE NUCLEOTIDE POLYMORPHISM WITH FOOD ALLERGY

Abstract Background Food allergy (FA) may be IgE-mediated, non-IgE-mediated or mixed. Genetic predispositions result in dysregulation of the immune system and lead to FA when exposed to environmental triggers. The transcription factor STAT6 is activated by IL-4 and IL-13 and activates cytokine signaling in immune and target tissue cells; contributing in the pathogenesis of allergic disorders including FA. The rs324015 single nucleotide polymorphism (SNP) in the STAT6 gene was previously associated with nut and cow’s milk allergy. Objective to investigate the association of the rs324015 STAT6 gene SNP with food allergy. Patients and Methods After ethical committee approval and informed consent from the patients, this retrospective case control study was conducted on 100 Egyptian children divided into two groups. Group I consisted of 50 children with positive history of FA supported by positive skin prick test +/- oral food challenge and group II consisted of 50 healthy age-matched controls. Blood samples were collected and genotyped using Taqman® Realtime PCR assays. Results We found that the homozygous G genotype and G allele of rs324015 were significantly higher among food allergic subjects than controls. We report no effect of any specific genotype on the phenotype of allergic disease or reacting to a specific food more than others. Genotypes were also not related to disease severity, eosinophil counts, total IgE levels or a family history of atopic disease. Conclusion rs324015 STAT6 gene SNP may be involved in the pathophysiology of food allergy.

Relationship Between Concomitant Atopic Diseases With Atopic Dermatitis Severity And Persistence.

Introduction: The atopic march consists of atopic dermatitis (AD), allergic rhinitis or sinusitis (AR), allergic conjunctivitis (AC) and bronchial asthma (BA). The influence of concomitant atopic diseases on AD is under-explored. We determined the relationship between personal and family history of atopic diseases with AD severity and persistence. Methods: A cross sectional study involving AD patients was performed at dermatology clinics of two tertiary hospitals. Inclusion criterion was all patients diagnosed with AD. Demographic data, personal and family history of atopy (BA, AR and AC) were obtained by face-to-face interview. AD severity was evaluated using Investigator’s Global Assessment (IGA). AD was considered persistent if continued beyond age 12 years. Results: Sixty patients aged 21.6±17.2 participated. There were 25(41.7%) with concomitant AR, 16(26.7%) BA and 12(20%) AC. Forty seven (78.3%) patients had family history of atopy, 25(41.7%) had eczema, 24(40%) AR, 19(31.7%) BA and 2(3.3%) AC. Patients with BA [OR=3.8, 95%CI 1.04 to 14.4)], BA and AR [OR=9.74, 95%CI 1.13 to 83.67) and family history of BA [OR= 4.00, 95%CI 1.20 to 13.27) were more likely to exhibit moderate-severe AD. Personal AR, AC and family history of AD and BA were significantly more prevalent in patients with persistent AD. Conclusions: AR was the most common atopic disease associated with AD. Family history of eczema and AR were common. Personal BA, BA with AR and family history of BA were predictors of severe AD. Personal AR, AC and family history of AD and BA were associated with AD persistence.

Clinical Features and Disease Management in Adult Patients With Atopic Dermatitis Receiving Care at Reference Hospitals in Brazil: the ADAPT Study

Atopic dermatitis is a chronic inflammatory skin disease with a prevalence of 0.02% to 8.1% in adults. Adult patients with moderate-to-severe atopic dermatitis are affected by frequent relapses and a significant disease burden. Objective: To determine the clinical, immunological, and therapeutic profile of Brazilian adults with atopic dermatitis. A multicenter, observational, retrospective, descriptive registry-based study was conducted at reference hospitals between December 2016 and October 2017. The data collected were demographics, personal and family history of atopic diseases, clinical manifestations, laboratory tests, disease severity and management. Of the 187 patients included in the analysis, 56.1% were female and 71.7% were White, with a mean age of 24.7 years. Mean follow-up was 9 years. Asthma or other allergic diseases were reported by 80.2% of patients. The main comorbidity was hypertension (10.2%), and common disease manifestations included pruritus and erythema. Lesions generally affected flexural and nonflexural areas, with typical morphology. Around 83% of patients had moderate-to-severe disease, and 8.6% reported at least 1 hospitalization. Most patients received topical and/or systemic pharmacological therapies, including omalizumab (5.9%); 4.3% received phototherapy. Moreover, 66.8% of patients received adjuvant therapy, and 79.1% changed or discontinued treatment for atopic dermatitis due to remission (46.5%), poor effectiveness (33.7%), or lack of adherence (12.9%). Most patients presented characteristics of type 2 inflammation, with immunoglobulin E levels above 100 IU/mL (94.4%) and peripheral blood eosinophils above 5% (55.9%). Brazilian adult patients with severe atopic dermatitis need treatment to efficiently control the disease and improve quality of life.

Self-assessment

•Time of onset, pattern and severity•Response to previous and current treatments•Possible trigger factors (irritant and allergic)•The impact of the condition on children and their parents or carers•Dietary history including any dietary manipulation•Growth and development•Personal and family history of atopic diseases

Impact of atopic dermatitis on the quality of life of children and their families.

Background Atopic dermatitis (AD) is the most common chronic inflammatory skin disease, with a significant effect on the quality of life (QoL). This study aims to evaluate the impact of AD on the QoL of children and their parents and to identify predictors affecting their QoL. Methods The cross-sectional study was conducted in Montenegro. It included 200 children with AD aged 5-16 years and their parents. The severity of disease was measured by the Three Item Severity (TIS) score, while QoL was assessed with the Children's Dermatology Life Quality Index (CDLQI) and the Dermatitis Family Impact (DFI) questionnaire. Results The mean CDLQI score of the children affected by AD was 17.11 and the mean DFI score of their parents 19.86. There was a significant correlation between AD severity score assessed by a doctor (TIS) and both CDLQI and DFI scores (r=0.53 and r=0.27, respectively). A moderate positive correlation was observed between the QoL of children with AD and QoL of their parents (r=0.53). According to multiple linear regression, more impaired QoL of affected children was associated with more severe AD, younger parent's age and their lower educational level. Poorer QoL of parents was associated with female sex, younger age of children, more severe AD, lower educational level of parents and absence of a family history of atopic disease. Conclusions The present study confirmed that AD has a large negative impact on QoL of both patients with AD and their families. More impaired QoL was associated with more severe AD.

Evaluation of levels of absolute eosinophil count in blood and serum IgE in patients with Atopic dermatitis

Background: Atopic dermatitis is a chronic relapsing disease of the skin, common in infants and children. Defects in the function of skin barrier, reoccurring skin infections and allergen sensitization are associated. Features: itch, rash on extensors and face, lichenification in flexures, family or personal history of atopic diseases. In this study, the relation between severity of AD, serum IgE levels & AEC in blood is found out. Materials and Methods: Our case control study was done in the Department of Dermatology, Venereology and Leprosy, Shadan Institute of Medical Sciences, Hyderabad from October 2019-October 2020. A total of 50 patients, of all age groups, with atopic dermatitis visiting the hospital were enrolled. 50 age matched healthy controls were also included. Inclusion criteria: Age range: 6 months to 40 years. Exclusion criteria: Patients receiving any systemic drug (homeopathic, ayurvedic, unani and allopathic),oral contraceptives, hormonal therapies. Patients who are immunocompromised, pregnant, lactating, with cancer, systemic and autoimmune diseases Method: A thorough clinical history inclusive of age of onset, personal and family history of atopic diseases, duration of illness is taken. Physical examination was done to find the severity (SCORAD index) and the body surface area involved (Wallace’s Rule of Nine). Blood tests were done to find the AEC values and IgE levels in each patient. Result: The onset of disease was seen in patients from 4 months of age to 20 years with an average of 4.8 years. Out of the 50 patients in the study, males and females were 19 and 31 respectively. In patients with AD, the mean AEC was 673 and the mean IgE levels were 301.9 whereas in controls, it was 125 and 31 respectively. Thus, the laboratory workup showed raised values in majority patients with AD. Conclusion: The study showed that AEC and serum IgE levels had a correlation with the severity of atopic dermatitis. History of allergic

An Insight on atopic dermatitis therapy: from conventional to Lipid based nanocarriers

Atopic dermatitis (AD) is a common itching disorder that begins in infancy and may occur in persons with a family history of atopic disease. The disease is characterized by several changes in the epidermal layer with elevated serum immunoglobulin E (IgE) antibodies and histamine. Until now, there is no evident treatment for AD disease; however, topical therapy including topical corticosteroids has been used in both children and adults. Although the preferable route is the topical route, the low penetration across the stratum corneum (SC) layer is the great challenge for researchers and scientists. Nowadays the available drugs have severe side effects and low skin availability. Nanocarriers including liposomes, nanoparticles, nano-mixtures, nanogels, nano-emulsions and others, offer a good solution to these problems. Nanocarriers enable treatment of different forms of dermatitis, enhance drug bioavailability at the site of inflammation, reduce the side effects and increase the safety profiles. Nanoparticulate systems can possibly enhance topical medication delivery because of their ability to upgrade the drug loading, dissolution, and protect the unstable drug from degradation. This review offers an overview of AD types, different management modalities, systemic versus topical treatment, in addition to different types of lipid based nanocarriers that have been investigated for the management of AD.