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DERMATITE ATOPICA. Specificity of allergen skin testing in predicting positive open food challenges (n°555) to milk, egg and peanut in children Sporik.

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Presentation on theme: "DERMATITE ATOPICA. Specificity of allergen skin testing in predicting positive open food challenges (n°555) to milk, egg and peanut in children Sporik."— Presentation transcript:

1 DERMATITE ATOPICA

2 Specificity of allergen skin testing in predicting positive open food challenges (n°555) to milk, egg and peanut in children Sporik Clin Exp Allergy 2000; 30: 1495 but no negative challenge if skin weal diameters were at or above: - 8 mm for cow’s milk and peanut - 7 mm for egg white POSITIVE NEGATIVE INCONCLUSIVE % positive reactions could occur also with a skin weal diameter of 0 mm 37% 8% 5/5/2001 %FOODCHALLENGES%FOODCHALLENGES

3 Specific IgE levels in the diagnostic of immediate hypersensitivity to cow’s milk protein in the infant Garcia-Ara JACI 2001; 107: patients under 1 year with a reaction suggesting immediate hypersensitivity to cow’s milk formula SPT with milk NEGATIVE EXCLUDES ALLERGY IN 97% OF PATIENTS > 3 mm PPV of 60% IgE - CAP > 2.5 kU(A)/L PPV of 90% > 5 kU(A)/L PPV of 95% If the prick test response is positive, specific IgE levels for cow’s milk may be helpful 5/5/2001

4 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

5 Atopy patch tests, together with determination of specific IgE levels, reduce the need for oral food challenges in children with atopic dermatitis Roehr JACI 2001; 107: 548 (+) P R E D I C T I V E VALUEVALUE MILK EGG WHEAT SOY 95% 100% 94% 92% 50% 100% POSITIVE APT ONLY PLUS POSITIVE SPT 5/5/2001

6 Atopy patch test for food allergens Roehr JACI 2001; 107: 548 Technique:  1 drop (50  l) of fresh cow milk containing 3.5% fat whisked white and yolk egg soy milk wheat powder 1 gr in 10 ml water on filter paper and applied to uninvolved skin on the child back by Finn chamber  occlusion time 48 hours  results are read 20 min and 25 hrs after removal  positive results: erythema + infiltration  irritant reactions: brownish erythema without infiltration 5/5/2001

7 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

8 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

9 Exposure to Dermatophagoides pteronyssinus and the occurrence of atopic dermatitis at 3 years of age Huang Ped. All. Imm. 2001; 12: %CHILDREN%CHILDREN 5.3 % 21.6 % > 1 < 1 Der p 1 µg/g dust 1/4/2001 p < 0.015

10 26/10/2000 Effect of house dust mite avoidance measures in children with atopic dermatitis Ricci Br. J. Dermatol. 2000; 143: children with atopic dermatitis and high specific IgE Mite allergens in children’s beds Before After Avoidance measures  g/g D U S T SCORADSCORAD p =.022

11  Eczema severity decreased significantly in both HDM sensitive and non sensitive patients (p < 0.001)  sCD30 levels were significantly reduced in both groups (p < 0.001)  Patients not sensitized to HDM allergens benefited from the bedcovers as much as sensitized patients A result which could be due to a reduction in beds of: other important allergens supertantigens irritants and enzymes Effectiveness of occlusive bedding in the treatment of atopic dermatitis a placebo-controlled trial of 12 months’ duration Holm Allergy 2001; 56: 152 “bedcovers should be part of routine treatment for AD” 1/4/2001

12 3/3/2001 Cell monolayers showing the contiguous TJs as disclosed by occludin staining (green) and the punctate appearance of desmoplakin (red). The same cell monolayers after treatment with Der p 1 for 2.5 h. Loss of occludin and desmoplakin (TJ Proteins) immunostaining in cells treated with Der p 1. Wan Clin. Exp. Allergy 2000; 30: 685

13 3/3/2001 Control 30 min 1 hour 2 hour Phase contrast images of epithelial monolayers exposed to Der p 1. After treatment with allergen, the cohesive appearance of the epithelial monolayer is obviously changed. Frank exfoliation leads to the formation of acellular vacancies (at 2 h). Wan Clin. Exp. Allergy 2000; 30: 685

14 Permeability (cm/s) Effects of Der p 1 on permeability of epithelial monolayers to 14C mannitol Wan Clin. Exp. Allergy 2000; 30: 685 3/3/ HBE 14o - cells MDCK cells

15 30/3/2001 Robinson Clin. Exp. Allergy 1997; 27: 10 Dendritic antigen presenting cell Sensitization At site of disruption allergen is able to gain access to antigen presenting cells Basament membrane Tight junction Desmosome Intermediate junction

16 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

17  Randomized, double blind, placebo-controlled, crossover study over 8 weeks of Montelukast as adjunctive treatment in 8 adult patients The leukotriene antagonist montelukast as a therapeutic agent for atopic dermatitis. Stevenson Ann. Allergy Asthma Immunol. 2000; 85: 477 5/2/2001 Placebo Montelukast SYMTOMSSCORESYMTOMSSCORE p =.014


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