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Prospective study on the effect of an aminoacid-based formula in infants with cow’s milk allergy/intolerance and atopic dermatitis Niggemann Ped All Imm.

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Presentation on theme: "Prospective study on the effect of an aminoacid-based formula in infants with cow’s milk allergy/intolerance and atopic dermatitis Niggemann Ped All Imm."— Presentation transcript:

1 Prospective study on the effect of an aminoacid-based formula in infants with cow’s milk allergy/intolerance and atopic dermatitis Niggemann Ped All Imm 2001; 12:78 SCORADSCORAD INDEXINDEX AT ENTRY AFTER 6 MONTHS Feedings with aminoacide based formula (NEOCATE) was also associated with a better growth than that abserved with extensively hydrolized formula /5/2001 p<0.001

2 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%PATIENTS % 41% 33% In these patients there was a significant (p<0.05) decrease in peripheral eosinophils 5/5/2001 MARKED MODERATE MINIMAL IMPROVEMENT

3 Clinical reactivity to beef in children allergic to cow’s milk Werfel JACI 1997; 99: 293 In 335 patients with atopic dermatitis 11 (+) DBPCFCs to beef of these 8 were allergic also to milk 3 tolerated well cooked beef 1. several protein in beef appeared to denature with heating 2. protein fractions persisted even after heating the beef extract for 2 hours at 85 degrees C 3. 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

4 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/ 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”

5 Atopic dermatitis and food hypersensitivity reactions Burks J Pediatr 1998; 132: 132 %CHILDREN%CHILDREN AT LEAST POSITIVE ONE (+) SPT CHALLENGE 5/5/ % 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

6 Prevalence of IgE-mediated food allergy among children with atopic dermatitis Eigenmann Pediatrics 1998; 101: E8 %CHILDREN%CHILDREN % Approximately one third of children with refractory, moderate-severe AD have IgE-mediated clinical reactivity to food proteins 5/5/2001

7 Wheat allergy: diagnostic accuracy of skin prick and patch tests and specific IgE in infants with challenge- proven wheat allergy Majamaa Allergy 1999; 54: (+) PATCH (+) CAP RAST (+) SPT 86% 23% 20% Patch testing with cereals will significantly increase the probability of early detection of cereal allergy in infants with atopic eczema 5/5/2001

8 Latex type I sensitization and allergy in children with atopic dermatitis. Evaluation of cross-reactivity to some foods Tucke Pediatr Allergy Immunol 1999; 10: 160 %CHILDREN%CHILDREN 5/5/ % 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

9 Probiotics in prevention of atopic disease: a randomized placebo-controlled trial Kalloimaki Lancet 2001; 357: 1076 % children with atopic dermatitis by the age of 2 years Placebo Lactobacillus GG Lactobacillus GG was given prenatally to 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 was effective in prevention of early atopic disease in children at high risk 46% 23% 5/5/2001

10 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): S children, 2 to 15 years of age, applied 0.1% tacrolimus ointment twice 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 study 2. transient skin burning and itching were the most common adverse events 3. there was no increased incidence of infections or other significant adverse events 5/5/2001

11 Probiotics in the management of atopic eczema Isolauri Clin Exp Allergy 2000; 30: 1604 SCORADINDEXSCORADINDEX During Formula Formula + Formula + breast alone Bifidobacterium Lactobacillus GG feeding lactis Bb-12 AFTER 2 MONTHS 5/5/ 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

12 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 %PATIENTS%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

13 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

14 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 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 was pound 47 million 5/5/2001

15 First experience of topical SDZ ASM 981 in children with 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 development for 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

16 Intradermal administration of a killed Mycobacterium vaccae suspension (SRL 172) is associated with improvement in atopic dermatitis in children with moderate-to-severe disease Arkwright J Allergy Clin Immunol 2001; 107: 531 AFTER 3 MONTHS AFFECTED AREA SEVERITY %REDUCTION%REDUCTION % - 4% - 68% - 18% ACTIVE (0.3 ml) PLACEBO 41 children 5-18 years There were no untoward effects of the treatment, apart from a local reaction in 13 of the 21 children, which occurred 1 month after SRL 172 administration and settled spontaneously 5/5/2001 p<0.001 p<0.01

17 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%CHILDREN W I T H (+) S P T AGE 6 months 12 months 83% 22% 65% 5% 36% 19% severe atopic dermatitis atopic dermatitis in general controls 5/5/2001

18 Increased urinary leukotriene E4 excretion in patients with atopic dermatitis Hishinuma Br J Dermatol 2001; 144: ATOPIC CONTROLS DERMATITIS URINARY LTE4 pg/mg creatinine Cysteinyl LTs may be involved in the pathophysiology of AD 5/5/2001 p < 0.01

19 The frequency of common skin conditions in preschool-age children in Australia: atopic dermatitis Foley Arch Dermatol 2001; 137: 293 ATOPIC DERMATITIS %CHILDREN%CHILDREN %  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

20 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/ Months Profile fo severity (‘SASSAD Score’) Profile of pruritus Short course Continuous Short course Continuous Visual analogue scale


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