Use of probiotics in atopic dermatitis

SUMMARY Atopic dermatitis is a common skin disease. Its increased incidence has changed the focus of research on atopic dermatitis toward epidemiology, prevention, and treatment. Evidence suggests that intestinal microbiota plays an important role in the pathogenesis of atopic dermatitis inducing immunosuppression, but its exact mechanism is still unclear. Probiotics have been widely reported to act on the immune system. They are living microorganisms with immunomodulatory effects that stimulate Th1 cytokines and suppress the Th2 response, which are being researched for the treatment of several diseases. Probiotics most commonly used are part of the intestinal microflora like lactobacilli, bifidobacteria, and enterococci. We describe here a case of evident response to the use of probiotics in a girl with severe atopic dermatitis, with a significant change in severity scores of atopic dermatitis (BSA/SCORAD/FDLQI). Modulation of the intestinal microbiota with probiotics may offer a way to prevent or treat allergic diseases, including atopic dermatitis.

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Influence of intestinal microbiota on the immunopathogenesis of atopic dermatitis in children

Allergology and Immunology in Pediatrics ◽

10.53529/2500-1175-2021-4-4-11 ◽

2021 ◽

pp. 4-11

Author(s):

Alexander Viktorovich Zhestkov ◽

Olga Olegovna Pobezhimova

Keyword(s):

Atopic Dermatitis ◽

Immune System ◽

Intestinal Microbiota ◽

Intestinal Microflora ◽

Dynamic Equilibrium ◽

Clinical Manifestations ◽

Factors Affecting ◽

Intestinal Dysbiosis ◽

Human Intestinal Microbiota ◽

Th1 Cytokines

Particular attention is paid to atopic dermatitis (AD) as one of the earliest and most frequent clinical manifestations of allergy in children. AD is a multifactorial disease, the development of which is closely related to genetic defects in the immune response and adverse environmental influences. It was found that the action of these factors determines the rate of development of AD, especially in young children. One of these factors is a violation of the intestinal microbiota, which plays an essential role in the development of the child's immune system and has a protective effect in the formation of atopy. It has been shown that 80-95% of patients with AD have intestinal dysbiosis, while, along with a deficiency of lactobacilli and bifidobacteria, there is an excessive growth of Staphilococcus. The use of modern molecular genetics technologies made it possible to obtain a fairly complete understanding of the number, genetic heterogeneity and complexity of the bacterial components of the intestinal microbiota, while clinical studies have shown the importance of its interactions with the host organism in the formation of various forms of pathology. It has been established that the human intestinal microbiota is an evolutionary set of microorganisms that exists as a balanced microecological system in which the symbiotic microflora is in dynamic equilibrium, forms microbial associations that occupy a certain ecological niche in it, and is one of the most important factors affecting human health. The gut microbiota plays an important role in the pathogenesis of atopic dermatitis, which causes immunosuppression, but the exact mechanism of its action is still unclear. It is widely known that probiotics act on the immune system. These are living microorganisms with immunomodulatory effects that stimulate Th1 cytokines and suppress Th2 responses, which are being investigated for the treatment of several diseases. The most commonly used probiotics are part of the intestinal microflora such as lactobacilli, bifidobacteria and enterococci. The purpose of this article: to systematize the information available today on the influence of the composition of the intestinal microflora on the immunopathogenesis of atopic dermatitis.

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Remission of Alopecia Universalis after 1 Year of Treatment with Dupilumab in a Patient with Severe Atopic Dermatitis

Skin Appendage Disorders ◽

10.1159/000517832 ◽

2021 ◽

pp. 1-4

Author(s):

Maurizio Romagnuolo ◽

Mauro Barbareschi ◽

Simona Tavecchio ◽

Luisa Angileri ◽

Silvia Mariel Ferrucci

Keyword(s):

Atopic Dermatitis ◽

Skin Disorder ◽

Human Monoclonal Antibody ◽

Severe Atopic Dermatitis ◽

T Helper ◽

T Helper 1 ◽

Th2 Response ◽

Alopecia Universalis ◽

T Helper 2 ◽

Relapsing Remitting

Alopecia areata (AA), an autoimmune disease with a relapsing-remitting course, represents the second cause of nonscarring alopecia worldwide and is associated with several comorbidities, notably atopic dermatitis (AD). In particular, AD is related to its more severe forms alopecia totalis (AT) and alopecia universalis (AU) [Nat Rev Dis Primers. 2017;3:17011]. Considering that AA has been classified as T helper 1-driven disease, whereas AD is the prototypical T helper 2 (Th2)-driven skin disorder, recent studies suggest that these forms may underlie a different chemokine expression resulting in a Th2 skewing as a key pathomechanism that could explain this association [JAMA Dermatol. 2015 May;151(5):522–8]. Several reports showed that dupilumab, a fully human monoclonal antibody targeting the interleukin 4α receptor and thus downregulating Th2 response, led to an improvement of AA associated with AD; most of these patients were females with AT or AU, early-onset AD, and atopic comorbidities [Exp Dermatol. 2020 Aug;29(8):726–32]. We report here a case to further support this hypothesis.

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Approach to the Assessment and Management of Pediatric Patients with Atopic Dermatitis: A Consensus Document. Section II: Comorbid Disease in Pediatric Atopic Dermatitis

Journal of Cutaneous Medicine and Surgery ◽

10.1177/1203475419882655 ◽

2019 ◽

Vol 23 (5_suppl) ◽

pp. 12S-18S ◽

Cited By ~ 2

Author(s):

Chih-ho Hong ◽

Marissa Joseph ◽

Vy HD Kim ◽

Perla Lansang ◽

Irene Lara-Corrales

Keyword(s):

Atopic Dermatitis ◽

Health Care Providers ◽

Pediatric Patients ◽

Allergic Diseases ◽

Care Providers ◽

Barrier Dysfunction ◽

Consensus Document ◽

Common Skin ◽

Genetic And Environmental Factors ◽

Skin Conditions

Pediatric atopic dermatitis (AD) is one of the most common skin conditions encountered by health-care providers caring for infants, children, and adolescents. Pediatric patients with AD may present with other allergic and nonallergic comorbidities that require appropriate treatment and referral. They may also experience a trajectory of allergic diseases known as the atopic march, which depends on a complex interaction between genetic and environmental factors and likely involves early epidermal barrier dysfunction. Here we provide a review and clinical recommendations on the assessment and referral of comorbidities in pediatric AD.

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Increasing Severity of Early-Onset Atopic Dermatitis, But Not Late-Onset, Associates with Development of Aeroallergen Sensitization and Allergic Rhinitis in Childhood

10.22541/au.162577238.82748980/v1 ◽

2021 ◽

Author(s):

Ann-Marie Malby Schoos ◽

Bo Chawes ◽

Klaus Bønnelykke ◽

Jakob Stokholm ◽

Morten Rasmussen ◽

...

Keyword(s):

Allergic Rhinitis ◽

Atopic Dermatitis ◽

Prospective Studies ◽

Early Onset ◽

Late Onset ◽

Skin Barrier ◽

Allergic Diseases ◽

Severe Atopic Dermatitis ◽

Early Exposure ◽

Time Points

Background: Early exposure to allergens through a defect skin barrier has been proposed as a mechanism for inducing sensitization and development of allergic diseases. We hypothesized that early-onset, severe atopic dermatitis (AD) is associated with development of aeroallergen sensitization and allergic rhinitis. Methods: We included 368 children from the Copenhagen Prospective Studies on Asthma in Childhood (COPSAC ) at-risk mother-child cohort. AD was diagnosed prospectively based on Hanifin&Rajka’s criteria and severity assessed using the Scoring Atopic Dermatitis (SCORAD) index. Early-onset AD was defined as debut ≤1 year, late-onset as debut from 1-6 years. Aeroallergen sensitization and allergic rhinitis were diagnosed at ages 6-7 and 12 years. Associations between early-onset and late-onset AD and allergy endpoints were calculated using general estimating equations (GEE) models to compute the overall odds ratios (OR) for both time points. Results: Early-onset AD (yes/no) and severity (SCORAD) were associated with development of aeroallergen sensitization during childhood; GEE OR=1.68 [1.08; 2.62], p=0.02 and 1.08 [1.03; 1.12], p<0.001, whereas late-onset was not; GEE OR=1.65 [0.92; 2.94], p=0.08 and 1.01 [0.97; 1.06], p=0.55. The same trend was seen for allergic rhinitis with significant association between early-onset AD and allergic rhinitis; GEE OR=1.56 [1.01; 2.41], p=0.04 and severity; GEE OR=1.09 [1.05; 1.13], p<0.001, whereas late-onset AD showed no association. The effects on sensitization and rhinitis of early-onset vs. late-onset AD severity were significantly different: p-interaction =0.03 and p-interaction <0.01. Conclusion: Increasing severity of early-onset AD, but not late-onset AD, associates with aeroallergen sensitization and allergic rhinitis later in childhood.

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Glycomacropeptide Attenuates Inflammation, Pruritus, and Th2 Response Associated with Atopic Dermatitis Induced by 2,4-Dinitrochlorobenzene in Rat

Journal of Immunology Research ◽

10.1155/2017/6935402 ◽

2017 ◽

Vol 2017 ◽

pp. 1-11 ◽

Cited By ~ 11

Author(s):

Fabiola Carolina Muñoz ◽

Maritza Montserrat Cervantes ◽

Daniel Cervantes-García ◽

Mariela Jiménez ◽

Javier Ventura-Juárez ◽

...

Keyword(s):

Atopic Dermatitis ◽

Inflammatory Process ◽

Skin Diseases ◽

Immunoglobulin E ◽

Alternative Therapy ◽

Serum Levels ◽

Inhibitory Effect ◽

Industrialized Countries ◽

Th2 Response ◽

Common Skin

Atopic dermatitis (AD) is one of the most common skin diseases, whose incidence is increasing in industrialized countries. The epicutaneous application of a hapten, such as 2,4-dinitrochlorobenzene (DNCB), evokes an experimental murine AD-like reaction. Glycomacropeptide (GMP) is a dairy bioactive peptide derived from hydrolysis ofκ-casein by chymosin action. It has anti-inflammatory, prebiotic, and immunomodulatory effects. The present study was aimed to investigate the effect of GMP administration on DNCB-induced AD in rats. The severity of inflammatory process, pruritus, production of cytokines, and total immunoglobulin E (IgE) content were measured, and the histopathological features were analyzed. GMP reduced the intensity of inflammatory process and edema of DNCB-induced dermatitis, with a significant decrease in eosinophils recruitment and mast cells hyperplasia. In addition GMP suppressed the serum levels of total IgE and IL-4, IL-5, and IL-13 expression in AD-lesions. Besides, the levels of IL-10 were significantly increased. Remarkably, GMP administration before AD-induction abolished pruritus in dermatitis-like reactions in the rats. Taken together, these results indicate that GMP has an inhibitory effect on AD by downregulating Th2 dominant immune response, suggesting GMP as a potential effective alternative therapy for the prevention and management of AD.

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Vascular inflammation in moderate‐to‐severe atopic dermatitis is associated with enhanced Th2 response

Allergy ◽

10.1111/all.14859 ◽

2021 ◽

Author(s):

Axel P. Villani ◽

Ana B. Pavel ◽

Jianni Wu ◽

Marie Fernandes ◽

Catherine Maari ◽

...

Keyword(s):

Atopic Dermatitis ◽

Vascular Inflammation ◽

Severe Atopic Dermatitis ◽

Th2 Response

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Muramylpeptides and other innate immunity receptor agonists in the complex treatment of allergic deseases

Rossiiskii Allergologicheskii ZHurnal ◽

10.36691/rja445 ◽

2015 ◽

Vol 12 (5) ◽

pp. 59-67

Author(s):

I G Kozlov ◽

S V Guryanova ◽

N V Kolesnikova ◽

T M Andronova

Keyword(s):

Immune Response ◽

Innate Immunity ◽

Atopic Dermatitis ◽

Clinical Efficacy ◽

Allergic Diseases ◽

Atopic Asthma ◽

Preclinical Studies ◽

Complex Treatment ◽

Th2 Response ◽

Response Activation

Spread of allergic diseases testifies the inadequacy of the existing concept of pharmacotherapy. The review discusses the immunotherapy of allergic diseases based on the polarization of the immune response - activation of Th1 and suppressing of Th2-response. Clinical efficacy of glucosaminylmuramyldipeptide in atopic asthma and atopic dermatitis is presented in this review of clinical and experimental preclinical studies data.

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Painless thyroiditis in a dupilumab-treated patient

Endocrinology Diabetes and Metabolism Case Reports ◽

10.1530/edm-20-0030 ◽

2020 ◽

Vol 2020 ◽

Author(s):

Daramjav Narantsatsral ◽

Takagi Junko ◽

Iwayama Hideyuki ◽

Inukai Daisuke ◽

Takama Hiroyuki ◽

...

Keyword(s):

Atopic Dermatitis ◽

Treated Patient ◽

Human Monoclonal Antibody ◽

Allergic Diseases ◽

Lymphocytic Infiltration ◽

Interleukin 4 ◽

Severe Atopic Dermatitis ◽

List Type ◽

First Report ◽

Painless Thyroiditis

Summary Dupilumab an inhibitor of the interleukin (IL)-4R-alpha subunit is used for the treatment of allergic diseases. The patient was a 49-year-old man who received dupilumab for the treatment of severe atopic dermatitis. He presented hyperthyroidism with elevated thyroglobulin and anti-thyroid antibody negativity at 4 months after the initiation of therapy. On scintigraphy, the thyroid radioiodine uptake was low. Ultrasonography showed a diffuse hypoechoic area in the thyroid gland. A pathological study revealed lymphocytic infiltration. The administration of dupilumab was continued because of his atopic dermatitis that showed an excellent response. The patient`s hyperthyroidism changed to hypothyroidism 3 weeks later. Six months later his thyroid function normalized without any treatment. We herein describe the case of a patient with atopic dermatitis who developed painless thyroiditis under treatment with dupilumab. To the best of our knowledge, this is the first report of this event in the literature. Learning points: Dupilumab, a fully human monoclonal antibody that blocks interleukin-4 and interleukin-13, has been shown to be effective in the treatment atopic dermatitis and asthma with eosinophilia. Painless thyroiditis is characterized by transient hyperthyroidism and hypothyroidism and recovery without anti-thyroid treatment. This is the first report of painless thyroiditis as an adverse effect of dupilumab, although conjunctivitis and nasopharyngitis are the main adverse effects of dupilumab.

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A CASE OF THE EARLY DEVELOPMENT OF ATOPIC DERMATITIS IN A NURSING INFANT

Вопросы современной педиатрии ◽

10.15690/vsp.v17i3.1894 ◽

2018 ◽

Vol 17 (3) ◽

pp. 244-249

Author(s):

Tatiana V. Turti ◽

Ekaterinа G. Bokuchava ◽

Alexey S. Illarionov ◽

Anastasiya G. Selivanova

Keyword(s):

Atopic Dermatitis ◽

Secondary Prevention ◽

Allergic Diseases ◽

Perinatal Period ◽

Cow’S Milk ◽

Severe Atopic Dermatitis ◽

Breastfeeding Initiation ◽

Cow's Milk ◽

Atopic Status ◽

Antibody Titres

Background. The early (in the first months of life) formation of atopic status and the development of allergies are not uncommon pathological conditions in a pediatrician's practice, requiring sufficiently studied and theoretically grounded measures for the organization of primary/secondary prevention.Case Report. The parents visited a doctor with complaints of widespread skin rashes and troubled night sleep in a child from the age of two months. A burdened history of allergies of the child was traced through the female lineage (food allergy in the mother, maternal sister and grandmother). The perinatal period is complicated by acute respiratory infection in the third trimester and by maternal nutritional preferences (consumption of goat's and whole cow's milk). The delayed (on the 5th day of life) breastfeeding initiation, feeding with cow's milk-based formula, living next to an industrial enterprise, maternal choices of products with a high sensitizing potential not only during pregnancy but also during breastfeeding probably caused the early formation of atopic status — dry skin, widespread papular rash, microvesicles on the cheeks, hips, shins, scratching traces, serous-bloody crusts objectively defined at admission. The SCORAD scores corresponded to severe atopic dermatitis. The ImmunoCAP technology revealed high antibody titres to a number of products, including cow's milk and chicken egg proteins. Based on the findings, a therapeutic diet aimed at secondary prevention of allergic diseases, including respiratory allergies, was developed for the child.Conclusion. A case of the early (from 2 months) formation of atopic status with the development of atopic dermatitis caused by polyvalent food sensitization is described. A therapeutic diet containing products with a low sensitizing potential was prescribed for the child. The suggested therapy including the diet should prevent the progression of an allergic disease.

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Vitamin D and Atopic Dermatitis in Childhood

Journal of Immunology Research ◽

10.1155/2015/257879 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 14

Author(s):

Michelangelo Vestita ◽

Angela Filoni ◽

Maurizio Congedo ◽

Caterina Foti ◽

Domenico Bonamonte

Keyword(s):

Vitamin D ◽

Atopic Dermatitis ◽

Allergic Diseases ◽

Vitamin D Supplementation ◽

Immunomodulatory Effects ◽

Adaptive Immune ◽

Increased Risk ◽

Vitamin D Levels ◽

Adaptive Immune Systems

Vitamin D features immunomodulatory effects on both the innate and adaptive immune systems, which may explain the growing evidence connecting vitamin D to allergic diseases. A wealth of studies describing a beneficial effect of vitamin D on atopic dermatitis (AD) prevalence and severity are known. However, observations linking high vitamin D levels to an increased risk of developing AD have also been published, effectively creating a controversy. In this paper, we review the existing literature on the association between AD and vitamin D levels, focusing on childhood. As of today, the role of vitamin D in AD is far from clear; additional studies are particularly needed in order to confirm the promising therapeutic role of vitamin D supplementation in childhood AD.

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