ICER issues draft report on atopic dermatitis treatments for moderate-to-severe disease

2021 ◽  
Vol 879 (1) ◽  
pp. 34-34
Keyword(s):  
Atopic Dermatitis ◽  
Severe Disease ◽  
Draft Report

Role of Superantigens in Allergic Inflammation: Their Relationship to Allergic Rhinitis, Chronic Rhinosinusitis, Asthma, and Atopic Dermatitis

2018 ◽  
Vol 32 (6) ◽  
pp. 502-517 ◽  
Author(s):  
Nuray Bayar Muluk ◽  
Fazilet Altın ◽  
Cemal Cingi
Keyword(s):  
T Cells ◽  
Allergic Rhinitis ◽  
Atopic Dermatitis ◽  
Inflammatory Response ◽  
Chronic Rhinosinusitis ◽  
Inflammatory Responses ◽  
Immunoglobulin E ◽  
Severe Disease ◽  
Allergic Inflammation ◽  
Allergic Dermatitis

Objectives Our intention was to review all material published to date regarding superantigens (SAgs) and allergy from an otorhinolaryngological viewpoint to understand this association more clearly. Methods We identified all materials published mentioning both SAg and allergic rhinitis (AR), chronic sinusitis, asthma, and atopic dermatitis (AD) that are indexed on PubMed, Google, or the ProQuest Central databases. Results Staphylococcus aureus is a significant bacterial pathogen in humans and has the ability to produce enterotoxins with superantigenic features. The inflammatory response in allergy seen in both B cell and T cell may be attributed to SAgs. Sufferers of both allergic asthma with rhinitis and AR alone produce serological evidence of immunoglobulin E formation to SAgs produced by S. aureus. Perennial AR sufferers carry S. aureus more frequently and the presence of the organism within the nasal cavity may exacerbate perennial AR. SAg produced by S. aureus potentially worsens the asthmatic inflammatory response within the airway and may lead to the airways becoming hyperresponsive, as well as possibly activating T cells if asthmatic control is poor. Staphylococcal SAgs potentially increase the risk of developing chronic rhinosinusitis with nasal polyposis, additionally being a marker for more severe disease. If SAgs bring about chronic inflammatory responses in the nose and sinuses, then T cells excreting interferon-gamma may be a crucial mediator. In allergic dermatitis, S. aureus could be a key player in exacerbation of the condition. Even in younger pediatric patients with allergic dermatitis, allergic hypersensitivity to SAgs is frequent and may be a factor explaining how severe the condition becomes. Conclusion Just as SAgs are known to feature in many allergic conditions, they play their part in AR, chronic rhinosinusitis, asthma, and AD. Further research is required before the relationship between SAgs and allergy can be adequately explained.

scholarly journals Prevalence of atopic dermatitis, asthma and rhinitis from infancy through adulthood in rural Bangladesh: a population-based, cross-sectional survey

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e042380
Author(s):  
Courtney J Pedersen ◽  
Mohammad J Uddin ◽  
Samir K Saha ◽  
Gary L Darmstadt
Keyword(s):  
Atopic Dermatitis ◽  
Medical Diagnosis ◽  
Severe Disease ◽  
Age Groups ◽  
Working Party ◽  
Atopic Disease ◽  
Secondary Outcome ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
History Of

ObjectiveDescribe the pattern of atopic disease prevalence from infancy to adulthood.DesignCross-sectional household survey.SettingCommunity-based demographic surveillance site, Mirzapur, Bangladesh.Participants7275 individuals in randomly selected clusters within 156 villages.Primary and secondary outcome measuresThe 12-month prevalence of atopic dermatitis (by UK Working Party Criteria (UK criteria) and International Study of Asthma and Allergies in Childhood (ISAAC)), asthma and rhinitis (by ISAAC); disease severity (by ISAAC); history of ever receiving a medical diagnosis.ResultsChildren aged 2 years had the highest prevalence of atopic dermatitis—18.8% (95% CI 15.2% to 22.4%) by UK criteria and 14.9% (95% CI 11.6% to 18.1%) by ISAAC— and asthma (20.1%, 95% CI 16.4% to 23.8%). Prevalence of rhinitis was highest among 25–29 year olds (6.0%, (95% CI% 4.5 to 7.4%). History of a medical diagnosis was lowest for atopic dermatitis (4.0%) and highest for rhinitis (27.3%) and was significantly associated with severe disease compared with those without severe disease for all three conditions (atopic dermatitis: 30.0% vs 11.7%, p=0.015; asthma; 85.0% vs 60.4%, p<0.001; rhinitis: 34.2% vs 7.3%, p<0.001) and having a higher asset-based wealth score for asthma (29.7% (highest quintile) vs 7.5% (lowest quintile), p<0.001) and rhinitis (39.8% vs 12.5%, p=0.003). Prevalence of having >1 condition was highest (36.2%) at 2 years and decreased with age. Having atopic dermatitis (ISAAC) was associated with significantly increased odds ratios (OR) for comorbid asthma (OR 5.56 (95% CI 4.26 to 7.26)] and rhinitis (3.68 (95% CI 2.73 to 4.96)). Asthma and rhinitis were also strongly associated with each other (OR 8.39 (95% CI 6.48 to 10.86)).ConclusionsAtopic disease burden was high in this rural Bangladeshi population. Having one atopic condition was significantly associated with the presence of another. Low incidence of ever obtaining a medical diagnosis highlights an important opportunity to increase availability of affordable diagnosis and treatment options for all age groups.

Immunoinflammatory Biomarkers in Serum Are Associated with Disease Severity in Atopic Dermatitis

Dermatology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Jesper Grønlund Holm ◽  
Guillem Hurault ◽  
Tove Agner ◽  
Maja Lisa Clausen ◽  
Sanja Kezic ◽  
...  
Keyword(s):  
Atopic Dermatitis ◽  
Disease Severity ◽  
Predictive Models ◽  
Severe Disease ◽  
Serum Levels ◽  
Disease Characteristics ◽  
Immunological Markers ◽  
Chemokine Ligand ◽  
Serum Total Ige ◽  
The Relationship

Background: A growing body of evidence links various biomarkers to atopic dermatitis (AD). Still, little is known about the association of specific biomarkers to disease characteristics and severity in AD. Objective: To explore the relationship between various immunological markers in the serum and disease severity in a hospital cohort of AD patients. Methods: Outpatients with AD referred to the Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark, were divided into groups based on disease severity (SCORAD). Serum levels of a preselected panel of immunoinflammatory biomarkers were tested for association with disease characteristics. Two machine learning models were developed to predict SCORAD from the measured biomarkers. Results: A total of 160 patients with AD were included; 53 (33.1%) with mild, 73 (45.6%) with moderate, and 34 (21.3%) with severe disease. Mean age was 29.2 years (range 6–70 years) and 84 (52.5%) were females. Numerous biomarkers showed a statistically significant correlation with SCORAD, with the strongest correlations seen for CCL17/thymus and activation-regulated chemokine (chemokine ligand-17/TARC) and CCL27/cutaneous T cell-attracting-chemokine (CTACK; Spearman R of 0.50 and 0.43, respectively, p < 0.001). Extrinsic AD patients were more likely to have higher mean SCORAD (p < 0.001), CCL17 (p < 0.001), CCL26/eotaxin-3 (p < 0.001), and eosinophil count (p < 0.001) than intrinsic AD patients. Predictive models for SCORAD identified CCL17, CCL27, serum total IgE, IL-33, and IL-5 as the most important predictors for SCORAD, but with weaker associations than single cytokines. Conclusions: Specific immunoinflammatory biomarkers in the serum, mainly of the Th2 pathway, are correlated with disease severity in patients with AD. Predictive models identified biomarkers associated with disease severity but this finding warrants further investigation.

The combined intravenous laser light of blood in complex treatment of patients with atopic dermatitis

2015 ◽  
Vol 9 (4) ◽  
pp. 0-0 ◽  
Author(s):  
Шнайдер ◽  
D. Shnayder ◽  
Утц ◽  
S. Utts ◽  
Москвин ◽  
...  
Keyword(s):  
Atopic Dermatitis ◽  
Laser Therapy ◽  
Laser Light ◽  
Severe Disease ◽  
Wave Length ◽  
Combined Treatment ◽  
Research Centre ◽  
Complete Regression ◽  
Treatment Technique ◽  
Therapeutic Measures

One of the known methods of treatment of patients with atopic dermatitis is laser therapy, however, the task of improving the efficiency of this method is still relevant. The objective of this study was the evaluation of the effectiveness of treatment technique of patients with atopic dermatitis, including alternation in a day the intravenous laser light of blood by low-intensity laser radiation with a wave length of 365 nm and 525 nm (green spectrum). 37 patients with atopic dermatitis (10 women and 27 men) aged 18 to 56 years (the average age 36,2), having a disease duration of 17 to 54 years, were observed. In the complex of therapeutic measures of the main group the laser therapy was included. It is the original technique by means of laser therapeutic apparatus &#34;Lasmik- VLOK&#34; (Registration certificate № RZN 2014/1410 from 06.02.2014) with the laser emitting heads KLVLOK- 365-2 (for LUFOK®) and KL-VLOK-525-2 for intravenous laser light of blood. For this technique the disposable sterile lights KIVL -01 on TU 9444-005-72085060-2008 made in Research centre &#34;Matrix&#34; (Russia, Moscow) were used. It is shown that the combined intravenous laser light of blood with a wavelength of 365 nm (VLOK-365 or LUFOK®) and radiation with a wavelength of 525 nm (green spectrum, VLOK-525) in a day, 10 sessions in combined treatment of patients with atopic dermatitis – allows to achieve complete regression of all acute inflammatory symptoms of disease - erythema, papules, desquamation, excoriations in 87,5% of patients with moderate-severe disease (the average SCORAD index – 57,5±4,0) and to lower at 3,4 times the average SCORAD index (to 21,3±4,0) in patients with severe disease (initial value – 72,8±3,0) with an overall positive dynamics.

scholarly journals Patient Reported Outcome Measure in Atopic Dermatitis Patients Treated with Dupilumab: 52-Weeks Results

2021 ◽  
Author(s):  
Servando E. Marron ◽  
Lucia Tomas-Aragones ◽  
Carlos A. Moncin-Torres ◽  
Manuel Gomez-Barrera ◽  
Francisco Javier Garcia-Latasa de Aranibar
Keyword(s):  
Quality Of Life ◽  
Atopic Dermatitis ◽  
Clinical Practice ◽  
Stressful Life Events ◽  
Severe Disease ◽  
Patient Reported Outcome ◽  
Routine Clinical Practice ◽  
Severe Atopic Dermatitis ◽  
Patient Reported

Dupilumab is used to treat atopic dermatitis patients who have proven to be refractory to previous treatments. The aim of this study was to assess evolution and patient reported outcome measures in adult patients with moderate-to-severe atopic dermatitis treated with Dupilumab in routine clinical practice. The outcomes were evaluated and registered at baseline and weeks-16, 40 and 52. The variables evaluated were: diseases severity, pruritus, stressful life events, difficulty to sleep, anxiety and depression, quality of life, satisfaction, adherence to the treatment, efficacy and safety. Eleven patients were recruited between Nov 14th 2017 and Jan 16th 2018. Demographic variables: 90% Caucasian, 82% women. Clinical variables: Mean duration of AD =17.7 (&plusmn;12.8), 91% had severe disease severity. At baseline, SCORAD mean score = 61.7 (&plusmn;15.5); itch was reported by 100% of patients; itch Visual Analogue Scale mean range of 8 (6-10); HADS mean total score =13.9 (&plusmn;5.5); DLQI mean score =13.3 (&plusmn;8.3): EQ-5D-3L mean range = 57 (30-99). At week-52 there is a significant reduction of SCORAD scores, HADS total score and improved quality of life. &iexcl;This study confirms that Dupilumab, used for 52-weeks under routine clinical practice, maintains the improved atopic dermatitis signs and symptoms obtained at week-16, with a good safety profile.

scholarly journals Atopic dermatitis: clinical phenotypes, persistence and comorbidity

2021 ◽  
Vol 16 (4) ◽  
pp. 265-269
Author(s):  
O.P. Volosovets ◽  
S.P. Kryvopustov ◽  
O.V. Mozyrskaya
Keyword(s):  
Atopic Dermatitis ◽  
Family History ◽  
High Risk ◽  
Age Of Onset ◽  
Severe Disease ◽  
Respiratory Allergy ◽  
Severe Atopic Dermatitis ◽  
Respiratory Allergies ◽  
Duration Of Breastfeeding ◽  
The Impact

Background. Atopic dermatitis is the most common skin disease among children. Its natural history is heterogeneous with a difference in age of manifestation, localization of lesions, severity, sensitization profiles, presence of comorbid atopic conditions, and longitudinal trajectories of disease progression. The study aimed to assess the impact of factors such as the onset of the disease, atopic family history, presence of concomitant allergic pathology, duration of breastfeeding on the course of the disease and the development of respiratory allergies, and the impact of environmental factors that aggravate the disease. Materials and methods. Children with atopic dermatitis (n = 88) were included in the study from September 2020 to April 2021 in Kyiv, Ukraine. Symptoms of respiratory allergy in the history of patients have been documented as comorbidity. Results. Total of 88 patients at the time of examination presented with manifestations of atopic dermatitis in the form of a rash, dry skin, scaling, itching, lichenization. The disease severity was significantly related to the age of onset: children with early phenotype had more severe disease (OR = 16.261; 2.056–127.911). There was no statistically significant association of early phenotype of atopic dermatitis with the development of concomitant allergic diseases (OR = 1.813; 0.415–7.916). A severe course was observed in the group of children with atopic family history (OR = 2.750; 1.123–6.735). Children with severe atopic dermatitis had a high risk of concomitant respiratory allergy (OR = 5.604; 1.863–16.863). The duration of breastfeeding did not impact the severity of atopic dermatitis (OR = 0.778; 0.119–5.100) and the risk of concomitant atopic diseases (OR = 1.417; 0.444–4.521). The course of atopic dermatitis was influenced by seasonality in 76 children (86.4 %): the condition of the skin deteriorated in the winter. Contact with the animal was associated with exacerbation of atopic dermatitis in 4 (4.5 %) children, food ingestion — in 20 children (25 %), pollen trees and grasses caused exacerbation in 5 children (5.7 %). Conclusions. Children with a severe phenotype of atopic dermatitis are at risk of developing respiratory allergies. Patients with atopic dermatitis who develop symptoms at the age of under 2 years, as well as those with an atopic family history, are at high risk of developing a severe disease phenotype.

Safety and Efficacy of Tacrolimus Ointment 0.1% (Protopic™) in Atopic Dermatitis: A Canadian Open-Label Multicenter Study

2004 ◽  
Vol 8 (4) ◽  
pp. 213-219 ◽  
Author(s):  
Jerry Tan ◽  
Richard Langley
Keyword(s):  
Atopic Dermatitis ◽  
Severe Disease ◽  
Multicenter Trial ◽  
Application Site ◽  
Skin Infections ◽  
Open Label ◽  
Safety And Efficacy ◽  
Topical Tacrolimus ◽  
Efficacy Parameters ◽  
Study Sites

Background: Most previously published trials of topical tacrolimus in atopic dermatitis were of relatively short duration and comprised a limited population with moderate-to-severe disease. Objective: The goal of the study was to evaluate the safety and efficacy over a 6-month period of tacrolimus 0.1% ointment in children and adults with a broader severity spectrum of atopic dermatitis. Methods: An open-label multicenter trial in patients 2 years and older was used. Primary safety and tolerability assessments included skin infection and application site adverse events. Efficacy parameters were body surface area involvement, pruritus score, and overall reponse. Results: There were 240 patients recruited at 23 study sites. Significant improvement from baseline was noted for all efficacy endpoints in both pediatric and adult patients. Skin infections occurred in 26% of patients. Burning sensation with product application, reported by 38% of patients, was transient and of mild-to-moderate severity in the majority. Conclusion: Tacrolimus 0.1% ointment was safe, well tolerated, and efficacious in treatment of atopic dermatitis in children and adults over six months.

scholarly journals Temporal Variation in Staphylococcus aureus Protein A Genotypes from Nose and Skin in Atopic Dermatitis Patients

Dermatology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Minke M.F. van Mierlo ◽  
Suzanne G.M.A. Pasmans ◽  
Joan E.E. Totté ◽  
Jill de Wit ◽  
Bjorn L. Herpers ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Atopic Dermatitis ◽  
Temporal Variation ◽  
Disease Severity ◽  
Severe Disease ◽  
Protein A ◽  
Lesional Skin ◽  
Over Time ◽  
Skin Samples

<b><i>Background:</i></b> <i>Staphylococcus aureus</i> colonization is associated with disease severity in patients with atopic dermatitis (AD). <b><i>Objective:</i></b> To investigate temporal variation in <i>S. aureus</i> protein A gene (<i>spa)</i>-types isolated from the nose and lesional skin and the correlation of <i>spa</i>-types with disease severity. <b><i>Results:</i></b> This study included 96 adult AD patients who were assessed at baseline (T0) and after a strict 2-week follow-up period (T1) in which treatment was standardized with a topical corticosteroid. Fifty-five different <i>spa</i>-types were detected in the nose and skin cultures. Seventy-three patients were colonized with <i>S. aureus</i> in the nasal cavity at both time points (persistent carriership), 59 of whom (81%) had identical <i>spa</i>-types over time. For skin samples, 42 (75%) of the 56 persistent skin carriers had identical <i>spa</i>-types over time. The same <i>spa</i>-type was carried in the nose and skin in 79 and 77% of the patients at T0 and T1, respectively. More severe disease was not associated with specific <i>spa</i>-types or with temporal variation in <i>spa</i>-type. <b><i>Conclusion:</i></b> <i>S. aureus</i> strains in AD are highly heterogeneous between patients. The majority of patients carry the same <i>spa</i>-type in the nose and skin without temporal variation, suggesting clonal colonization within individual patients. No predominant <i>spa</i>-type or temporal variation is associated with increased disease severity.

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