Consensus Conference on Clinical Management of pediatric Atopic Dermatitis

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Abstract

The Italian Consensus Conference on clinical management of atopic dermatitis in children reflects the best and most recent scientific evidence, with the aim to provide specialists with a useful tool for managing this common, but complex clinical condition. Thanks to the contribution of experts in the field and members of the Italian Society of Pediatric Allergology and Immunology (SIAIP) and the Italian Society of Pediatric Dermatology (SIDerP), this Consensus statement integrates the basic principles of the most recent guidelines for the management of atopic dermatitis to facilitate a practical approach to the disease. The therapeutical approach should be adapted to the clinical severity and requires a tailored strategy to ensure good compliance by children and their parents. In this Consensus, levels and models of intervention are also enriched by the Italian experience to facilitate a practical approach to the disease.

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Most cited references 226

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The National Human Activity Pattern Survey (NHAPS): a resource for assessing exposure to environmental pollutants.

N E Klepeis, W C Nelson, W R Ott … (2001)

Because human activities impact the timing, location, and degree of pollutant exposure, they play a key role in explaining exposure variation. This fact has motivated the collection of activity pattern data for their specific use in exposure assessments. The largest of these recent efforts is the National Human Activity Pattern Survey (NHAPS), a 2-year probability-based telephone survey (n=9386) of exposure-related human activities in the United States (U.S.) sponsored by the U.S. Environmental Protection Agency (EPA). The primary purpose of NHAPS was to provide comprehensive and current exposure information over broad geographical and temporal scales, particularly for use in probabilistic population exposure models. NHAPS was conducted on a virtually daily basis from late September 1992 through September 1994 by the University of Maryland's Survey Research Center using a computer-assisted telephone interview instrument (CATI) to collect 24-h retrospective diaries and answers to a number of personal and exposure-related questions from each respondent. The resulting diary records contain beginning and ending times for each distinct combination of location and activity occurring on the diary day (i.e., each microenvironment). Between 340 and 1713 respondents of all ages were interviewed in each of the 10 EPA regions across the 48 contiguous states. Interviews were completed in 63% of the households contacted. NHAPS respondents reported spending an average of 87% of their time in enclosed buildings and about 6% of their time in enclosed vehicles. These proportions are fairly constant across the various regions of the U.S. and Canada and for the California population between the late 1980s, when the California Air Resources Board (CARB) sponsored a state-wide activity pattern study, and the mid-1990s, when NHAPS was conducted. However, the number of people exposed to environmental tobacco smoke (ETS) in California seems to have decreased over the same time period, where exposure is determined by the reported time spent with a smoker. In both California and the entire nation, the most time spent exposed to ETS was reported to take place in residential locations.

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Adverse effects of topical glucocorticosteroids.

Ulrich Hengge, Thomas Ruzicka, Robert A. Schwartz … (2006)

Topical corticosteroids were introduced into medicine about 50 years ago. They represent a significant milestone in dermatologic therapy. Despite encouragement to report observed adverse drug reactions, the clinical practice of reporting is poor and incomplete. Likewise, adverse effects and safety of topical corticosteroids are neglected in the medical literature. The authors provide an updated review of their adverse-effect profile. Children are more prone to the development of systemic reactions to topically applied medication because of their higher ratio of total body surface area to body weight. Cutaneous adverse effects occur regularly with prolonged treatment and are dependent on the chemical nature of the drug, the vehicle, and the location of its application. The most frequent adverse effects include atrophy, striae, rosacea, perioral dermatitis, acne, and purpura. Those that occur with lower frequency include hypertrichosis, pigmentation alterations, delayed wound healing, and exacerbation of skin infections. Of particular interest is the rate of contact sensitization against corticosteroids, which is considerably higher than generally believed. Systemic reactions such as hyperglycemia, glaucoma, and adrenal insufficiency have also been reported to follow topical application. The authors provide an updated review of local and systemic adverse effects upon administration of topical corticosteroids, including the latest FDA report on the safety of such steroids in children. At the completion of this learning activity, participants should be familiar with topical corticosteroids and their proper use.

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Loss-of-function variants in the filaggrin gene are a significant risk factor for peanut allergy

Sara Brown, Yuka Asai, Heather J. Cordell … (2011)

Background IgE-mediated peanut allergy is a complex trait with strong heritability, but its genetic basis is currently unknown. Loss-of-function mutations within the filaggrin gene are associated with atopic dermatitis and other atopic diseases; therefore, filaggrin is a candidate gene in the etiology of peanut allergy. Objective To investigate the association between filaggrin loss-of-function mutations and peanut allergy. Methods Case-control study of 71 English, Dutch, and Irish oral food challenge–positive patients with peanut allergy and 1000 non peanut-sensitized English population controls. Replication was tested in 390 white Canadian patients with peanut allergy (defined by food challenge, or clinical history and skin prick test wheal to peanut ≥8 mm and/or peanut-specific IgE ≥15 kUL−1) and 891 white Canadian population controls. The most prevalent filaggrin loss-of-function mutations were assayed in each population: R501X and 2282del4 in the Europeans, and R501X, 2282del4, R2447X, and S3247X in the Canadians. The Fisher exact test and logistic regression were used to test for association; covariate analysis controlled for coexistent atopic dermatitis. Results Filaggrin loss-of-function mutations showed a strong and significant association with peanut allergy in the food challenge–positive patients (P = 3.0 × 10−6; odds ratio, 5.3; 95% CI, 2.8-10.2), and this association was replicated in the Canadian study (P = 5.4 × 10−5; odds ratio, 1.9; 95% CI, 1.4-2.6). The association of filaggrin mutations with peanut allergy remains significant (P = .0008) after controlling for coexistent atopic dermatitis. Conclusion Filaggrin mutations represent a significant risk factor for IgE-mediated peanut allergy, indicating a role for epithelial barrier dysfunction in the pathogenesis of this disease.

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Author and article information

Contributors

Elena Galli: galli.elena@fbfrm.it

Iria Neri: iria.neri@aosp.bo.it

Giampaolo Ricci: 0039 0512143075 , giampaolo.ricci@unibo.it

Ermanno Baldo: ermanno.baldo@apss.tn.it

Maurizio Barone: dott.maurizio.barone@tiscali.it

Anna Belloni Fortina: anna.bellonifortina@gmail.com

Roberto Bernardini: r.bernardini@usl11.toscana.it

Irene Berti: irene.berti@burlo.trieste.it

Carlo Caffarelli: carlo.caffarelli@unipr.it

Elisabetta Calamelli: elisabetta.calamelli@studio.unibo.it

Lucetta Capra: cpl@unife.it

Rossella Carello: carellorossella@gmail.com

Francesca Cipriani: francesca.cipriani8@unibo.it

Pasquale Comberiati: pasquale.comberiati@gmail.com

Andrea Diociaiuti: andrea.diociaiuti@opbg.net

Maya El Hachem: may.elhachem@opbg.net

Elena Fontana: fontanaelena.7@gmail.com

Michaela Gruber: michaelagrubermd@gmail.com

Ellen Haddock: ehaddock@ucsd.edu

Nunzia Maiello: nunzia.maiello@unina2.it

Paolo Meglio: paolo.meglio@tiscali.it

Annalisa Patrizi: annalisa.patrizi@unibo.it

Diego Peroni: diego.peroni@unife.it

Dorella Scarponi: dorella.scarponi@aosp.bo.it

Ingrid Wielander: Ingrid.wielander@asbz.it

Lawrence F. Eichenfield: leichenfield@rchsd.org

Journal

Journal ID (nlm-ta): Ital J Pediatr

Journal ID (iso-abbrev): Ital J Pediatr

Title: Italian Journal of Pediatrics

Publisher: BioMed Central (London )

ISSN (Electronic): 1824-7288

Publication date (Electronic): 2 March 2016

Publication date PMC-release: 2 March 2016

Publication date Collection: 2016

Volume: 42

Electronic Location Identifier: 26

Affiliations

[ ]Pediatric Allergy Unit, Research Center, San Pietro Hospital - Fatebenefratelli, Rome, Italy

[ ]Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy

[ ]Pediatric Unit - Department of Medical and Surgical Sciences, S. Orsola Malpighi Hospital, University of Bologna, Pad. 16, Via Massarenti, 11 – 40138 Bologna, Italy

[ ]Pediatric Department, “S. Maria del Carmine” Hospital of Rovereto, APSS (Provincial Agency for Health Services), Trento, Italy

[ ]Institute of Relational Psychotherapy – IPR, Rome, Italy

[ ]Pediatric Dermatology Unit, Department of Medicine, University of Padua, Padua, Italy

[ ]Pediatric Unit, San Giuseppe Hospital, Empoli, Italy

[ ]Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy

[ ]Pediatric Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy

[ ]Department of Medical Sciences, Section of Paediatrics, University of Ferrara, Ferrara, Italy

[ ]Pediatric Clinic, University of Verona, Verona, Italy

[ ]Dermatology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy

[ ]Department of Pediatrics, Central Hospital of Bolzano, Bolzano, Italy

[ ]Departments of Pediatrics and Dermatology, School of Medicine, University of California, San Diego, CA USA

[ ]Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy

[ ]Primary Care Pediatrician, Health National Service, Rome, Italy

Article

Publisher ID: 229

DOI: 10.1186/s13052-016-0229-8

PMC ID: 4776387

PubMed ID: 26936273

SO-VID: 2489cd55-78a5-46b8-b727-02a7fe5c52fd

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 18 November 2015

Date accepted : 14 February 2016

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ScienceOpen disciplines: Pediatrics

Keywords: atopic dermatitis,childhood,consensus,management

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ScienceOpen disciplines: Pediatrics

Keywords: atopic dermatitis, childhood, consensus, management

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Consensus Conference on Clinical Management of pediatric Atopic Dermatitis

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Abstract

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Pediatric Pulse: Advancing Neonatal and Child Health

Most cited references 226

The National Human Activity Pattern Survey (NHAPS): a resource for assessing exposure to environmental pollutants.

Adverse effects of topical glucocorticosteroids.

Loss-of-function variants in the filaggrin gene are a significant risk factor for peanut allergy

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Cited by 32

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