Prospective study on the effect of an aminoacid-basedformula in infants with cow’s milk allergy/intolerance

and atopic dermatitis Niggemann Ped All Imm 2001; 12:78

SCORAD

INDEX

25 -

20 -

15 -

10 -

5 -

AT ENTRY AFTER 6 MONTHS

Feedings with aminoacide basedformula (NEOCATE) was also associated with a better growththan that abserved with extensivelyhydrolized formula

24.6

10.7

5/5/2001

p<0.001

Efficacy of low metal diets and dental metal elimination in the management of atopic dermatitis in patients who showed positive patch tests and/or clinical exacerbation by oral provocation tests with metal salts Adachi J Dermatol 1997; 24: 12

%PATIENTS

50 -

40 -

30 -

20 -

10 -

26%

41%

33%

In these patients there wasa significant (p<0.05) decreasein peripheral eosinophils

5/5/2001

MARKED MODERATE MINIMAL

IMPROVEMENT

Clinical reactivity to beef in children allergic to cow’s milk Werfel JACI 1997; 99: 293

In 335 patientswith atopic dermatitis

11 (+) DBPCFCs to beefof these

8 were allergic also to milk3 tolerated well cooked beef

1. several protein in beef appeared to denature with heating2. protein fractions persisted even after heating the beef extract for 2 hours at 85 degrees C3. specific IgE antibodies only to heat-labile beef proteins might explain why some patients can tolerate well-cooked beef but not medium-rare and rare beef

5/5/2001

Value of egg specific IgE > 2kU/L at the age of 1 yrs as a predictor of indoor allergens sensitization at 3 yrs of age

Nickel JACI 1997; 99: 613

5/5/2001

100 - 90 - 80 - 70 - 60 - 50 - 40 - 30 - 20 - 10 -

SPECIFICITY POSITIVE PREDICTIVE VALUE

99%

78%

“Hen’s egg-specific IgE at the age of 12 months is a valuable marker for subsequent allergic sensitization to allergens that cause asthma”

Atopic dermatitis and food hypersensitivity reactionsBurks J Pediatr 1998; 132: 132

%

CHILDREN

100 - 90 - 80 - 70 - 60 - 50 - 40 - 30 - 20 - 10 -

AT LEAST POSITIVEONE (+) SPT CHALLENGE

5/5/2001

60%

38.7%

165 pts mean age 49 months with atopic dermatitis

• few foods (milk, egg, peanut, soy, wheat, cod/catfish) accounted for 89% of the positive challenges• by use of screening prick skin tests for these seven foods we could identify 99% of the allergic patients correctly

Prevalence of IgE-mediated food allergy among childrenwith atopic dermatitis Eigenmann Pediatrics 1998; 101: E8

%CHILDREN

40 -

30 -

20 -

10 -

37%

Approximately one third of children with refractory,moderate-severe AD have IgE-mediated clinical reactivityto food proteins

5/5/2001

Wheat allergy: diagnostic accuracy of skin prick andpatch tests and specific IgE in infants with challenge-proven wheat allergy Majamaa Allergy 1999; 54: 851

100 - 90 - 80 - 70 - 60 - 50 - 40 - 30 - 20 - 10 -

(+) PATCH (+) CAP RAST (+) SPT

86%

23%20%

Patch testing with cereals will significantlyincrease the probabilityof early detection of cereal allergy in infants with atopic eczema

5/5/2001

Latex type I sensitization and allergy in children with atopicdermatitis. Evaluation of cross-reactivity to some foods

Tucke Pediatr Allergy Immunol 1999; 10: 160

%CHILDREN

5/5/2001

20 -

10 -

16.2%

• these children also presented specific IgE to potato, tomato, sweet pepper and avocado• an isolated latex-specific IgE response without food-specific IgE was never observed

Children with atopic dermatitis are a high-risk group for latex sensitization

Natural latex (+) IgE

Probiotics in prevention of atopic disease: a randomizedplacebo-controlled trial Kalloimaki Lancet 2001; 357: 1076

% childrenwith atopicdermatitisby the ageof 2 years

50 -

40 -

30 -

20 - 10 -

Placebo Lactobacillus GG

Lactobacillus GG was given prenatallyto mothers who had at least one first-degree relative (or partner)with atopic eczema, allergic rhinitis, or asthma, and postnatally for 6 months to their infants

Lactobacillus GG waseffective in preventionof early atopic diseasein children at high risk

46%

23%

5/5/2001

Long-term safety and efficacy of tacrolimus ointment for the treatment of atopic dermatitis in children

Kang J Am Acad Dermatol 2001; 44 (1 Suppl): S58

255 children, 2 to 15 years of age, applied 0.1% tacrolimus ointmenttwice daily for up to 12 months

1. substantial improvements of atopic dermatitis was observed during the first week of treatment and was maintained throughout the study2. transient skin burning and itching were the most common adverse events3. there was no increased incidence of infections or other significant adverse events

5/5/2001

Probiotics in the management of atopic eczemaIsolauri Clin Exp Allergy 2000; 30: 1604

SCORAD

INDEX

15 -

10 -

5 -

During Formula Formula + Formula + breast alone Bifidobacterium Lactobacillus GG feeding lactis Bb-12 AFTER 2 MONTHS

5/5/2001

16

13.4

0 1

27 infants mean age 4.6 months,with atopic eczema during exclusively breast feeding were weaned to extensively hydrolysed formula alone or to the same formula plus probiotics

A trial of oolong tea in the management of recalcitrant atopic dermatitis

Uehara Arch Dermat 2001; 137: 42

1 month 6 months % pts with moderate-marked improvement

70 -60 -50 -40 -30 -20 -10 -

%PATIENTS

63%54%

5/5/2001

in animal models administration of tea (green, black, or oolong) has suppressed type I and type IV allergic reactions 118 patients were asked to drink oolong tea made from a 10-g teabag placed in 1000 ml of boiling water and steeped for 5 minutes, divided into 3 equal servings after regular meals

Increased leukotriene production by food additives in patients with atopic dermatitis and proven food intolerance Worm Clin Exp Allergy 2001; 31: 265

To determine sulfidoleucotriene production in isolated leucocytes from the peripheral blood after stimulation with different food additives

in the non-atopic group no increased sulfidoleukotriene release was observed increased sLT production, in the presence of single food additives, was observed in the majority of patients with a proven food intolerance towards food additives 5/5/2001

What is the cost of atopic dermatitis in preschool children? Emerson Br J Dermatol 2001; 144: 514

• The 12-month period prevalence of AD in 1761 children was 16.5%• total mean disease costs were estimated to be pound 79.59 per child over the 12-month period• most prescribing costs (76%) were due to emollients and bath preparations• the annual U.K. cost of AD in children aged 1-5 years in 1995-96 was pound 47 million

5/5/2001

First experience of topical SDZ ASM 981 in childrenwith atopic dermatitis

Harper Br J Dermatol 2001; 144: 781

SDZ ASM 981 is a selective inhibitor of the production of pro-inflammatory cytokines from T cells and mast cells in vitro.It is the first ascomycin macrolactam derivative under developmentfor the treatment of inflammatory skin diseases.

• the Eczema Area Severity Index (EASI) improved by 8-89% at 3 weeks of treatment

• in children 1-4 years of age, blood concentrations of SDZ ASM 981 during topical treatment with the 1% cream were consistently low even in the children with the most extensive areas treated

5/5/2001

Intradermal administration of a killed Mycobacterium vaccaesuspension (SRL 172) is associated with improvement in

atopic dermatitis in children with moderate-to-severe diseaseArkwright J Allergy Clin Immunol 2001; 107: 531

AFTER 3 MONTHSAFFECTED AREA SEVERITY

%REDUCTION

- 10 -- 20 -- 30 -- 40 -- 50 -- 60 -- 70 -- 80 -- 90 --100-

- 48%

- 4%

- 68%

- 18%

ACTIVE (0.3 ml)

PLACEBO

41 children5-18 years

There were no untowardeffects of the treatment,apart from a local reactionin 13 of the 21 children,which occurred 1 monthafter SRL 172 administrationand settled spontaneously5/5/2001

p<0.001 p<0.01

IgE food sensitization to cow’s milk, egg or peanut is a major risk factor for the presence of atopic dermatitis in infancy Hill J Pediatr 2000; 137: 475

%

CHILDREN

WITH

(+)

SPT

80 -

70 -

60 -

50 -

40 -

30 -

20 -

10 -

AGE 6 months 12 months

83%

22%

65%

5%

36%

19%

severe atopic dermatitis

atopic dermatitis in general

controls

5/5/2001

Increased urinary leukotriene E4 excretion in patients with atopic dermatitis Hishinuma Br J Dermatol 2001; 144: 19

150 -

100 -

50 -

ATOPIC CONTROLSDERMATITIS

125

60

URINARYLTE4

pg/mgcreatinine

Cysteinyl LTs may beinvolved in the pathophysiologyof AD

5/5/2001

p < 0.01

The frequency of common skin conditions in preschool-agechildren in Australia: atopic dermatitis

Foley Arch Dermatol 2001; 137: 293

ATOPICDERMATITIS

%CHILDREN

40 -

30 -

20 -

10 -

30.8%

participants (n 1116) were examined by a dermatologist

most children (63.7%) were classified as having minimal or mild disease

only 5.8% of children with atopic dermatitis did not have face or flexural involvement

5/5/2001

Cyclosporin (5mg/Kg/day) for severe childhood atopic dermatitis: short course (12 weeks) versus continuous (1 year) therapy

Harper Br J Dermatol 2000; 142: 52

More consistent control is achived with continuous treatment; however, short course therapy was adequate for some patients.

5/5/2001

10

8

6

4

2

0

0 1 2 3 4 5 6 7 8 9 10 11 12

Months MonthsProfile fo severity (‘SASSAD Score’) Profile of pruritus

Short courseContinuous

60

50

40

30

20

10

00 1 2 3 4 5 6 7 8 9 10 11 12

Short courseContinuous

Vis

ual

an

alo

gu

e sc

ale