Worsening Of Atopic Dermatitis Research Articles

Hollow manganese dioxide-chitosan hydrogel for the treatment of atopic dermatitis through inflammation-suppression and ROS scavenging

Atopic dermatitis (AD) is a chronic inflammatory disease associated with immune dysfunction. High levels of reactive oxygen species (ROS) can lead to oxidative stress, release of pro-inflammatory cytokines, and T-cell differentiation, thereby promoting the onset and worsening of AD. In this study, we innovatively used quaternary ammonium chitosan (QCS) and tannic acid (TA) as raw materials to design and prepare a therapeutic hydrogel(H-MnO2-Gel) loaded with hollow manganese dioxide nanoparticles (H-MnO2 NPs). In this system, the hydrogel is mainly cross-linked by dynamic ion and hydrogen bonding between QCS and TA, resulting in excellent moisture retention properties. Moreover, due to the inherent antioxidant properties of QCS/TA, as well as the outstanding H2O2 scavenging ability of H-MnO2 NPs, the hydrogel exhibits significant ROS scavenging capability. In vitro experiments have shown that H-MnO2-Gel exhibits good cellular biocompatibility. Importantly, in an AD-induced mouse model, H-MnO2-Gel significantly enhanced therapeutic effects by reducing epidermal thickness, mast cell number, and IgE antibodies. These findings suggest that H-MnO2-Gel, by effectively clearing ROS and regulating the inflammatory microenvironment, provides a promising approach for the treatment of AD.

Bojungikgi-tang improves skin barrier function and immune response in atopic dermatitis mice fed a low aryl hydrocarbon receptor ligand diet

BackgroundThe aryl hydrocarbon receptor (AhR) is a transcription factor that plays a crucial role in regulating the immune system and maintaining skin barrier function. AhR signaling is pivotal in the pathogenesis of inflammatory diseases such as atopic dermatitis (AD), and the absence of AhR ligands further contributes to the progression or worsening of AD symptoms.MethodsAD was induced with 2,4-dinitrochlorobenzene (DNCB), and Bojungikgi-tang (BJIKT) was administered orally daily for 10 weeks. Serum IgE, splenocyte IL-4, and IFN-γ levels, skin barrier genes, and AhR target gene expressions were analyzed using RNA-sequencing analysis. Spleen tissues were extracted for fluorescence-activated cell sorting (FACS) analysis to analyze the effect of BJIKT on immune responses. A correlation analysis was conducted to analyze the correlation between immune markers and skin barrier genes and AhR target genes.ResultsBJIKT effectively improved AD symptoms in AD mice fed a low AhR ligand diet by reducing neutrophil and eosinophil counts, lowering IgE levels in the blood, and decreasing IL-4 and IFN-γ levels in the splenocytes. Additionally, BJIKT significantly reduced epithelial skin thickness and transepidermal water loss (TEWL) values and reversed the decreased expression of skin barrier genes. BJIKT also considerably altered the expression of AhR target genes, including Ahr, Ahrr, cytochrome P450 1A1 (CYP1A1), and CYP1B1. Furthermore, AhR target pathway genes were negatively correlated with immune cell subtypes, including CD4 + and CD8 + T cells and macrophages (CD11b + F4/80 +) at the systemic level.ConclusionsBJIKT can regulate AhR activation and may help reduce inflammation in AD by regulating the expression of skin barrier genes and immune responses.

Underlying Immune Mechanisms Involved in Cow's Milk-Induced Hypersensitivity Reactions Manifesting as Atopic Dermatitis.

Of the many symptoms associated with cow’s milk allergy (CMA), many populations face the burden of the appearance or worsening of atopic dermatitis (AD) when consuming milk products. Due to the prevalence and possible severity of symptoms, it is important to understand the underlying immune mechanisms involved in such reactions. Hypersensitivity reactions are exaggerated immune responses to often benign antigens, many times resulting in a cascade of pro-inflammatory processes. Of the four major types, type I and IV are of most relevance when considering atopic dermatitis worsened by cow’s milk. Considered a “true allergy,” type I (immediate) hypersensitivity reactions occur within hours after secondary exposure to an allergen and are primarily driven by antibodies and humoral immune responses. On the contrary, type IV (delayed) hypersensitivity reactions are driven by cell-mediated responses involving T-cell activation. Due to the array of symptoms induced by these complex reactions, it is imperative to diagnose early and treat appropriately. In this literature review, we aim to highlight the primary underlying immune contributors to hypersensitivity reactions, discuss AD as a manifestation of hypersensitivity reactions to cow’s milk, and consider current and future treatment options for combatting hypersensitivities manifesting as AD.

Overview of use, efficacy, and safety of dupilumab in complex patients: a retrospective, case-series study from a large, urban academic center.

Dupilumab has emerged as an effective treatment option for those suffering from moderate-to-severe atopic dermatitis (AD). Since its approval in 2017 by the United States Food and Drug Administration, dupilumab demonstrated efficacy in a wide range of "off-label" dermatologic conditions. With its increasing use, dermatologists must navigate prescribing dupilumab in complex patient populations. To that end, we performed a single-institution, retrospective, case-series study to assess efficacy, tolerability, and safety of dupilumab in elderly, patients on concomitant immunosuppressive/immunomodulating therapies, and those with pre-existing co-morbidities (e.g., malignancies, chronic renal and/or liver diseases, organ transplantation, hematologic malignancies, and infection). We conducted chart reviews of 248 patients who were prescribed dupilumab between January 1, 2017 and August 31, 2021, and identified 64 patients who met the criteria of being in the complex patient group as described above. Our results showed that 87.5% (56/64) of complex patients demonstrated improvement and/or disease clearance on dupilumab. 20.3% (13/64) of them experienced one or more side effects reported as conjunctivitis, seborrheic dermatitis, psoriasiform eruption, xerosis, facial burning sensation, anaphylactic reaction/angioedema, and worsening of AD. 9.4% (6/64) of them discontinued dupilumab due to the side effects. These findings demonstrated that dupilumab can be safely considered in certain complex patient populations such as elderly and those with significant pre-existing co-morbidities and can be safely combined with immunosuppressive medications and/or other biologic therapies. In the future, more studies with long-term follow-up are needed to validate the efficacy and safety of dupilumab in these challenging patients with complex medical histories.

Delayed surgical site infection after posterior cervical instrumented surgery in a patient with atopic dermatitis: a case report.

Objective: Atopic dermatitis (AD) is one of the known risk factors for Staphylococcus aureus infection. The authors report the case of a patient with cervical spondylosis and AD who developed delayed surgical site infection after posterior cervical instrumented surgery.Patient: A 39-year-old male presented to our hospital with paralysis of the left upper extremity without any cause or prior injury. He had a history of severe AD. We performed C3–C7 posterior decompression and instrumented fusion based on the diagnosis of cervical spondylotic amyotrophy. One year after surgery, his deltoid and bicep muscle strength were fully recovered. Nevertheless, his neck pain worsened 2 years after surgery following worsening of AD. One month after that, he developed severe myelopathy and was admitted to our hospital. Radiographic findings showed that all the screws had loosened and the retropharyngeal space had expanded. Magnetic resonance imaging and computed tomography showed severe abscess formation and destruction of the C7/T1 vertebrae.Result: We diagnosed him with delayed surgical site infection. Methicillin-resistant Staphylococcus aureus was identified on abscess culture. The patient responded adequately to treatment with antibiotic therapy and two debridements and the infection subsided.Conclusion: We should consider the possibility of delayed surgical site infection when conducting instrumented spinal surgery in patients with severe AD.

No association between etanercept and new or worsening atopic dermatitis in children with JIA: an analysis from the BSPAR Etanercept Cohort Study

No association between etanercept and new or worsening atopic dermatitis in children with JIA: an analysis from the BSPAR Etanercept Cohort Study

AB0915 No Association between Etanercept and New or Worsening Atopic Dermatitis in Children with Jia: an Analysis from the BSPAR Etanercept Cohort Study

BackgroundEtanercept (ETN) has significantly improved outcomes for children with severe juvenile idiopathic arthritis (JIA), but there are concerns regarding its long-term safety. Recently, 2 case reports have suggested ETN may...

Evaluation of allergy to soy in patients with atopic dermatitis older than 14 years of age

Atopic dermatitis is associated with food allergies. The aim of this study is to evaluate soy allergy in patients suffering from atopic dermatitis. Altogether 228 persons were included; specific IgE, skin prick tests, atopy patch tests, challenge tests with soy and history of soy allergy were evaluated. Soy allergy was confirmed in eight patients (3.5%, in four patients with worsening of atopic dermatitis, in four patients with oral allergy syndrome), sensitisation to soy was found in another 47 patients (20%) with no clinical manifestation after soy ingestion. Dependence was confirmed statistically between soy allergy and pollen allergy and soy sensitivity and pollen allergy. About 20% of patients suffering from atopic dermatitis are sensitised to soy. Clinical symptoms of soy allergy occur only in 3.5% of patients suffering from atopic dermatitis.

Evaluation of Cow’s Milk Allergy in a Large Group of Adolescent and Adult Patients with Atopic Dermatitis

Few studies concerning the occurrence of cow's milk allergy with the use of double-blind, placebo controlled food challenge test in adolescents and adult patients suffering from atopic dermatitis exist. To evaluate the occurrence of cow's milk allergy in adolescents and adults suffering from atopic dermatitis. Altogether 179 persons suffering from atopic dermatitis were included in the study: 51 men and 128 women entered the study with the average age of 26.2 (s.d. 9.5 years). Complete dermatological and allergological examinations were performed. The positive results in specific IgE and in skin prick tests were recorded in 12% of patients. According to the open exposure tests and double-blind, placebo controlled food challenge tests these patients are only sensitized to cow's milk without clinical symptoms of allergy. Double-blind, placebo controlled food challenge test confirmed food allergy to cow milk only in one patient (worsening of atopic dermatitis), the oral allergy syndrome was observed in another one patient, occurrence of this allergy was altogether 1.1%. Cow's milk allergy rarely plays a role in the worsening of atopic dermatitis in adolescent and adult patients.

Milk and wheat allergy, and celiac disease

Cow's milk, egg, wheat, soy, peanut, and fish account for about 90% of the food allergies but there are considerable differences from one country to another. Milk allergy is among the best characterized food allergies, particularly in infants and small children. Only part of the children with early allergy to cow's milk grow into shool-age with milk allergy but those that do often have severe symptoms and high specific IgE level to milk. In accordance, attaining tolerance to cow's milk is associated with decreased epitope binding by IgE and a concurrent increase in corresponding epitope binding by IgG4. Recent data point that analysis of IgE response to milk components may help in determining those with higher risk for persistent or more severe milk allergy. Among wheat allergic patients, co-sensitization to cow's milk and hen's egg is common. Wheat ingestion may trigger immunoglobulin E (IgE)-mediated immediate symptoms, including urticaria, angioedema, bronchial obstruction, nausea and abdominal pain, or in severe cases, even systemic anaphylaxis. Delayed reactions include gastrointestinal symptoms and worsen-ing of atopic dermatitis. In addition to food allergy, wheat ingestion may cause exercise-induced anaphylaxis, or celiac disease (CD), and inhalation and handling of wheat flour aller-gens may lead to respiratory allergy, or contact urticaria on the skin. Wheat IgE is commonly found in all ages of atopic children when whole grains are used as an antigen either in skin prick tests or serum IgE measurements. The specificity of this IgE re-sponse in identifying clinical disease, however, is poor. It is of importance to recognize dis-ease-determining components in the IgE response. Several studies have shown that sensiti-zation particularly to omega-5 gliadin is associated with challenge-proven wheat-allergy. Moreover, recent data imply that gliadin-positive patients have more likely severe reactions after wheat ingestion. A well-characterized severe clinical entity is also wheat-dependent, ex-ercise-induced anaphylaxis in which sensitization to omega-5 gliadin is a prerequisite. We have analyzed especially the gliadin-sepcific responses in wheat allergy. Sensitization to gliadin with a SPT wheal of ≥5 mm at the time of the diagnostic challenge was associated with a slower course of recovery from wheat hypersensitivity (p = 0.019), and a SPT wheal of ≥ 3 mm to gliadin at any time was associated with the development of asthma. Recently, we examined IgE response to 22 wheat components in children with challenge positive wheat allergy and their controls. The results show that wheat-allergy diagnosis can be improved considerably by component-based ap-proach. In the future, wheat IgE diagnosis should include at least measurement of IgE to gli-adins. Gluten and its major component, gliadin, is essential also in the pathogenesis of celiac dis-ease. Gliadin can be a target of both cellular and humoral immune responses. Approximately 90 percent of patients with celiac disease have the HLA-DQ2 haplotype, explaining the family-association of the disease but still leaving open the wide variability in prevalence between dif-ferent Caucasian populations. Both IgA and IgG antibodies can be seen in CD patients but the most sensitive diagnostic work-up is to define tissue transglutaminase (tTG) transglutami-nase IgA antibodies.

Fish allergy in childhood

Fish and its derived products play an important role in human nutrition, but they may also be a potent food allergen. Fish can be an ingested, contact, and inhalant allergen. Gad c I, a Parvalbumin, the major allergen in codfish, is considered as fish and amphibian pan-allergen. Prevalence of fish allergy appears to depend on the amount of fish eaten in the local diet. In Europe, the highest consumption occurs in Scandinavian countries, Spain and Portugal. In Spain, fish is the third most frequent allergen in children under 2 yr of age after egg and cow's milk. An adverse reaction to fish may be of non-allergic origin, due to food contamination or newly formed toxic products, but the most frequent type of adverse reactions to fish are immunologic-mediated reactions (allergic reactions). Such allergic reactions may be both IgE-mediated and non-IgE-mediated. Most cases are IgE-mediated, due to ingestion or contact with fish or as a result of inhalation of cooking vapors. Some children develop non-IgE-mediated type allergies such as food protein induced enterocolitis syndrome. The clinical symptoms related to IgE-mediated fish allergy are most frequently acute urticaria and angioedema as well as mild oral symptoms, worsening of atopic dermatitis, respiratory symptoms such as rhinitis or asthma, and gastrointestinal symptoms such as nausea and vomiting. Anaphylaxis may also occur. Among all the species studied, those from the Tunidae and Xiphiidae families appear to be the least allergenic.

Food hypersensitivity among Finnish university students: association with atopic diseases.

Food hypersensitivity (FH) is commonly suspected, especially among adults with atopic diseases. Symptoms of FH vary from oral allergy syndrome (OAS) to gastrointestinal, respiratory and systemic reactions. More data are needed regarding patient groups at risk for FH, and symptoms and foods responsible for the reactions. FH was studied in 286 Finnish university students. Four study groups were selected: subjects (i) with current atopic dermatitis (AD) with or without allergic rhinoconjunctivits (ARC) or asthma (n = 41); (ii) with past AD with or without ARC or asthma (n = 89); (iii) with ARC or asthma (n = 69); (iv) without clinically confirmed atopic disease (n = 87). A thorough clinical examination was performed with a questionnaire specifying adverse events to foods. In addition, IgE specific to five foods, and skin prick tests to four foods were determined. FH was reported by 172 subjects (60.1%), more often by females (66.3%) than by males (47.9%) (P = 0.003). FH was most frequent among subjects with AD, among those with current AD in 73.2%, with past AD in 66.3%, and with ARC or asthma in 63.8%; 44.8% of subjects without any atopic disease reported FH. Kiwi fruit caused symptoms most frequently (38.4%), followed by milk (32.6%), apple (29.1%), tomato (27.9%), citrus fruits (25.0%), tree nuts (23.3%), and peanut (17.4%). A total of 720 separate symptoms to 25 food items were reported. OAS was most common (51.2%), followed by gastrointestinal symptoms (23.5%), worsening of AD (11.4%), urticaria (4.2%), rhinitis or conjunctivitis (5.7%) and asthma (4.0%). Severe reactions occurred in 3.5% (25/720). Negative IgE and skin prick test to foods predicted well negative history, but the value of positive test results was limited. FH was reported most often by students with current AD and multiple atopic diseases. Severe reactions occurred especially in patients with ARC and asthma. After excluding lactose intolerance, milk hypersensitivity was frequently reported.

Role of foods in irregular aggravation of atopic dermatitis.

Although it is well known that patients with atopic dermatitis often show unpredictable, irregular aggravation of skin lesions, there are no previously published studies examining trigger factors for such unpredictable aggravation. We investigated whether foods play a role in the unpredictable, irregular worsening of atopic dermatitis. The patient group included 195 Japanese adult patients with atopic dermatitis who showed unpredictable, irregular aggravation of skin lesions. They were hospitalized and openly challenged with suspected foods. Photographs of representative skin lesion sites were taken at baseline and before and after the challenge. Challenge-positive foods were determined by evaluating the comparable before-after challenge photographs. One to three (average: 1.7) challenge-positive foods were confirmed in 86 (44%) of the 195 patient examined. Predominant offending foods were chocolate, cheese, coffee, yogurt and some Japanese foods such as glutinous rice cake, soy sauce and fermented soybeans. Specific IgE values to the offending foods were mostly negative. Patients were asked to exclude challenge-positive foods from their diets. They were then discharged and followed up for 3 months at our outpatient clinic. Exclusion of the offending foods for 3 months brought about a progressive improvement of the disease. These results suggest that foods play an important role in unpredictable, irregular aggravation of skin lesions in patients with atopic dermatitis.

Premenstrual Deterioration of Skin Symptoms in Female Patients with Atopic Dermatitis

Background: Although it has been recognized that women with atopic dermatitis often show menstrual-cycle-associated skin deterioration, information about this subject is meager. Objective: To clarify the clinical features of the monthly worsening of atopic dermatitis. Methods: A total of 286 Japanese women with atopic dermatitis were interviewed to see whether the menstrual cycle had any influence upon their skin lesions, and whether they had symptoms of premenstrual syndrome. Patients suffering from monthly skin deterioration were then observed during and after the monthly worsening. Results: Of the 286 patients interviewed, 134 (47%) had monthly skin deterioration, most of which occurred in the premenstrual week. There was individual difference in severity of the monthly skin worsening. All patients with the premenstrual skin aggravation had symptoms of premenstrual syndrome. Conclusions: Premenstrual worsening of skin lesions occurs in approximately half of women with atopic dermatitis. The premenstrual skin deterioration is related to the premenstrual syndrome.

SAFETY OF MEASLES IMMUNIZATION (MI) IN CHILDREN WITH IgE-MEDIATED EGG ALLERGY

It is known that there is a controversy in the literature about the safety of measles vaccine in children with IgE-mediated egg allergy, since the virus vaccine is grown in chicken fibroblast cell cultures, even though egg proteins could not be found.Allergic reactions have, however, been observed in children without egg allergy. To ascertain whether MI does induce allergic reactions in egg allergic children, we have investigated 80 children (52 males and 28 females), median age 2 years 5 months, with a positive challenge test to egg and a positive skin test and/or RAST to egg. Prick tests to ovalbumin, checked after 20 minutes, were positive in 65 children (81%). Specific IgE (Phadebas, RAST, Pharmacia, Uppsala) to egg, judged positive if higher than 0.35 Ul/ml, was present in 67 children (83 %). To confirm egg allergy, an open challenge test was done under observation and with emergency equipment at hand. Reactions were defined as immediate if the first symptoms occurred within 4 hr of egg ingestion and delayed if these occurred after 4 hr. After the challenge test, 52 children (65%) showed immediate allergic reactions; asthma and/or oculorhinitis and/or rash in 25 (31 %), angioedema and urticaria in 27 (34%); 28 (35%) worsening of atopic dermatitis. These 80 children received subcutaneously 0.5 ml of Morbilvax vaccine (Sclavo, grown in chicken fibroblast cell cultures) and were checked within 4 hr for any immediate allergic reactions. In addition, the parents recorded possible reactions such as fever or rash at home. No allergic reactions were noted after MI. The usual reactions to vaccine, including fever and attenuated rash, were recorded in 14 (17%); fever in 10; attenuated rash in 3; attenuated rash and fever in 1. We conclude that MI seems to be safe even in children with documented egg allergy.