New approaches to the prevention of childhood atopic dermatitis

Flohr, Carsten; Mann, Julianne A.

doi:10.1111/all.12343

Cited by 43 publications

(32 citation statements)

References 78 publications

(83 reference statements)

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“…Taking into account the burden on health-care resources, the impact on the quality of life of patients and their caregivers, together with increasing evidence that AD may progress to other allergic phenotypes, there is a clear need to improve disease prevention [46] . The still growing understanding of the pathoetiology and of environmental risk factors for AD contributes to this goal [47] .…”

Section: Prevention Of Admentioning

confidence: 99%

Atopic Dermatitis: Global Epidemiology and Risk Factors

2015

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Fifty percent of all those with atopic dermatitis develop other allergic symptoms within their first year of life and probably as many as 85% of patients experience an onset below 5 years of age Key insights Atopic dermatitis often begins in early childhood and is the first Key WordsAtopic dermatitis · Atopic march · Skin barrier defect · Immune dysregulation · Genetics · Environment Abstract Atopic dermatitis (AD) is a chronic inflammatory skin disease posing a significant burden on health-care resources and patients' quality of life. It is a complex disease with a wide spectrum of clinical presentations and combinations of symptoms. AD affects up to 20% of children and up to 3% of adults; recent data show that its prevalence is still increasing, especially in low-income countries. First manifestations of AD usually appear early in life and often precede other allergic diseases such as asthma or allergic rhinitis. Individuals affected by AD usually have genetically determined risk factors affecting the skin barrier function or the immune system. However, genetic mutations alone might not be enough to cause clinical manifestations of AD, and it is merely the interaction of a dysfunctional epidermal barrier in genetically predisposed individuals with harmful effects of environmental agents which leads to the development of the disease. AD has been described as an allergic skin disease, but today, the contribution of allergic reactions to the initiation of AD is challenged, and it is proposed that allergy is rather a consequence of AD in subjects with a concomitant underlying atopic constitution. Treatment at best achieves symptom control rather than cure; there is thus a strong need to identify alternatives for disease prevention. • AD usually starts in early childhood and can be the initial step of the so-called 'atopic march'.• The prevalence of AD is as high as 20% in children in some countries and continues to increase, affecting now not only developed countries but also lowincome countries.• AD is a complex disease, and the relationship between allergy and AD (allergy being a cause and/or an exacerbating factor of AD) is still debated.• Genetics has recently been shown to be an important risk factor for AD, and the strongest association so far with the gene encoding filaggrin has raised the recent interest in the role of skin barrier impairment in the development of AD.• Environmental factors and specifically exposure to microbes are also recognized to play a role in the development of the disease.• AD is a multifactorial disease presenting with different endophenotypes.• The prevention of AD should start as soon as possible (possibly even in utero), targeting both skin barrier, immune/allergy and environmental aspects.

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Section: Prevention Of Admentioning

confidence: 99%

Atopic Dermatitis: Global Epidemiology and Risk Factors

2015

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“…9,26 Breastfeeding Breastfeeding has traditionally been considered a major barrier against AD and allergy. Research in this field is ongoing.…”

Section: Dietary Modificationsmentioning

confidence: 99%

Can Atopic Dermatitis Be Prevented?

Fuente

2015

Actas Dermo-Sifiliográficas (English Edition)

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Atopic dermatitis has become a health problem in our setting due to its rising prevalence, impact on quality of life, associated costs, and role in the progression to other atopic diseases. Furthermore, atopic dermatitis has no definitive cure and therefore preventive measures are important. In this article, we review the latest advances in both primary prevention (reduction of the incidence of atopic dermatitis) and secondary prevention (reduction of associated morbidity and reduction of the atopic march). We analyze the different preventive strategies available, including modification of the immune system through microbial exposure, induction of immune tolerance through antigen exposure, and restoration of skin barrier function to halt the atopic march. Dermatologists need to be familiar with these strategies in order to apply them where necessary and to accurately inform patients and their relatives to prevent misguided or inappropriate actions. Dermatitis atópica; Prevención; Marcha atópica ¿Se puede prevenir la dermatitis atópica?Resumen La dermatitis atópica (DA) se ha convertido en un problema de salud en nuestro medio debido al aumento de su prevalencia, la alteración de la calidad de vida, los gastos que ocasiona y su implicación en la progresión a otras enfermedades atópicas. Además no tiene una cura definitiva, por lo que sería interesante la aplicación de medidas preventivas. En este artículo se revisan los últimos avances implicados en su prevención, tanto primaria (disminución de incidencia), como secundaria (disminución de morbilidad, evitar la progresión de la marcha atópica). Se abordan las diversas estrategias implicadas, entre las que se encuentran la modificación del sistema inmune mediante exposición microbiana, la inducción de tolerancia inmunológica por exposición antigénica y la restauración de la función barrera para frenar la marcha atópica. Estas medidas deberían ser conocidas por los dermatólogos para aplicarlas ଝ Please cite this article as: Gómez-de la Fuente E. ¿Se puede prevenir la dermatitis atópica?. Actas Dermosifiliogr. 2015. ARTICLE IN PRESS+Model 2 E. Gómez-de la Fuente cuando sea posible, y poder informar adecuadamente a los pacientes y familiares, evitando actuaciones inadecuadas y/o erróneas.

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“…There is an overwhelming experimental evidence that vitamin D acts on the function of immune cells, but the complexity of this system, cannot be applied to the general population, and no specific nutritional guideline can be issued in the setting of allergy. Also, it is not yet possible to recommend an absolute strategy for the use of VD in the therapy of asthma and allergic diseases, or in prevention [62–65]. Clinical trials and population-based prospective studies are needed, in order to better understand the molecular mechanism by which VD may affect immunological disorders and their development.…”

Section: General Backgroundmentioning

confidence: 99%

Vitamin D, allergies and asthma: focus on pediatric patients

Giustina¹,

Landi²,

Bellini

et al. 2014

World Allergy Organization Journal

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In recent years, the interest of the scientific world towards vitamin D gradually increased, and several studies have been conducted to dissect its possible role in modulating the development/course of allergic diseases. Also, Vitamin D supplementation has been assessed as a beneficial approach for treating allergies in some, but not all studies. We reviewed herein the available and relevant literature concerning the possible links between Vitamin D, its supplementation and allergic diseases. A literature search was made independently by the Authors, identifying articles for a narrative review. As per literature, Vitamin D plays a key role in calcium and phosphate metabolism, and it is essential for bone health in infants, children and adolescents. However, there is presently insufficient evidence to support vitamin D supplementation for prevention or treatment of allergic diseases in infants, children and adolescents, concerning allergic rhinitis, asthma, food allergy and atopic dermatitis.

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New approaches to the prevention of childhood atopic dermatitis

Cited by 43 publications

References 78 publications

Atopic Dermatitis: Global Epidemiology and Risk Factors

Atopic Dermatitis: Global Epidemiology and Risk Factors

Can Atopic Dermatitis Be Prevented?

Vitamin D, allergies and asthma: focus on pediatric patients

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