Browsing by Subject "atopic dermatitis"

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  • Antti, Andreas; Salava, Alexander; Perälä, Miia; Remitz, Anita (Helsingin yliopisto, 2020)
    Atooppista ihottumaa sairastavat pikkulapset, jotka eivät saa riittävää vastetta miedoille kortikosteroideille, tarvitsevat usein tehokkaampaa hoitoa. Pitkäaikaisessa hoidossa suositellaan takrolimuusivoiteen käyttöä, jos kortikosteroidihoitokuurin loputtua tauti uusii jatkuvasti. 0,03% takrolimuusivoide ja 1% pimekrolimuusivoide on hyväksytty yli 2-vuotiaiden lasten atooppisen ihottuman hoitoon. 0,1% takrolimuusivoide on kuitenkin ollut off label -käytössä lasten atooppisen ihottuman hoidossa, mutta tutkimustietoa puuttuu edelleen alle 2-vuotiaiden pitkäaikaisesta 0,1% takrolimuusihoidosta. Tavoite oli selvittää vahvempien paikallishoitojen käyttöä atooppisen ihottuman hoitoon lapsipotilaiden kohortissamme. Kohortissamme potilaat olivat 1-3 -vuotiaita lapsia, joilla oli keskivaikea tai vaikea atooppinen ihottuma (Rajka-Langelandin luokitus). Aineistona käytettiin kolmen vuoden seurantatutkimuksen dataa, jossa 152 lapsipotilasta jaettiin satunnaistetusti tavanomaiseen kortikosteroidihoitoryhmään (1% hydrokortisoni tai tarvittaessa vahvempi hydrokortisoni-17-butyraattivoide) ja takrolimuusihoitoryhmään (0.03% tai tarvittaessa vahvempi 0.1% voide). Tutkimuksen keskeyttäneitä potilaita oli yhteensä 15 ensimmäisen vuoden aikana huonon hoitokomplianssin takia. Potilaiden seurantakäynneillä arvioitiin kliinistä hoidon vastetta ja usein tarve vahvempaan hoitoon ilmeni ensimmäisen seurantavuoden aikana. 51 (85,9%) potilaista kortikosteroidiryhmässä (n=60) ja 50 (78,1%) takrolimuusiryhmästä (n=64) tarvitsivat vahvempaa hoitoa, puutteellisen hoitovasteen takia. Ihottuman vaikeusaste ja EASI-pisteet ennustivat tarpeen vahvemmalle hoidolle (p=0,009, MannWhitney U-testi. Kohortisamme keskivaikea ja vaikea atooppinen ihottuma oli alihoidettua, joka saattaa lisätä kroonistumisen ja liitännäissairauksien kehittymisen riskiä. Tutkimuksemme osoittaa, että pienet lapset, joilla on vaikeahoitoinen atooppinen ihottuma, saattavat hyötyä hoidosta 0,1% takrolimuusivoiteella tai keskivahvoilla kortikosteroideilla.
  • Klimek, Ludger; Bachert, Claus; Pfaar, Oliver; Becker, Sven; Bieber, Thomas; Brehler, Randolf; Buhl, Roland; Casper, Ingrid; Chaker, Adam; Czech, Wolfgang; Fischer, Joerg; Fuchs, Thomas; Gerstlauer, Michael; Hoermann, Karl; Jakob, Thilo; Jung, Kirsten; Kopp, Matthias V.; Mahler, Vera; Merk, Hans; Muelleneisen, Norbert; Nemat, Katja; Rabe, Uta; Ring, Johannes; Saloga, Joachim; Schlenter, Wolfgang; Schmidt-Weber, Carsten; Seyfarth, Holger; Sperl, Annette; Spindler, Thomas; Staubach, Petra; Strieth, Sebastian; Treudler, Regina; Vogelberg, Christian; Wallrafen, Andrea; Wehrmann, Wolfgang; Wrede, Holger; Zuberbier, Torsten; Bedbrook, Anna; Canonica, Giorgio W.; Cardona, Victoria; Casale, Thomas B.; Czarlewski, Wienczylawa; Fokkens, Wytske J.; Hamelmann, Eckard; Hellings, Peter W.; Jutel, Marek; Larenas-Linnemann, Desiree; Mullol, Joaquim; Papadopoulos, Nikolaos G.; Toppila-Salmi, Sanna; Werfel, Thomas; Bousquet, Jean (2019)
  • PASTURE EFRAIM Study Grp; Metzler, Stefanie; Frei, Remo; Schmausser-Hechfellner, Elisabeth; Pekkanen, Juha; Karvonen, Anne M.; Kirjavainen, Pirkka V.; Roduit, Caroline (2019)
    Background: Allergies are a serious public health issue, and prevalences are rising worldwide. The role of antibiotics in the development of allergies has repeatedly been discussed, as results remain inconsistent. The aim of this study was to investigate the association between pre-and post-natal antibiotic exposure and subsequent development of allergies (atopic dermatitis, food allergy, asthma, atopic sensitization and allergic rhinitis). Methods: A total of 1080 children who participated in a European birth cohort study (PASTURE) were included in this analysis. Data on antibiotic exposure during pregnancy and/or first year of life and allergic diseases were collected by questionnaires from pregnancy up to 6 years of age and analysed by performing logistic regressions. To take into account reverse causation, we included models, where children with diagnosis or symptoms of the respective disease in the first year of life were excluded. Results: Antibiotic exposure in utero was significantly and positively associated with atopic dermatitis and food allergy. The strongest effect was on diseases with onset within the first year of life (for atopic dermatitis: aOR 1.66, 95% CI 1.11-2.48 and for food allergy: aOR 3.01, 95% CI 1.22-7.47). Antibiotics in the first year of life were positively associated with atopic dermatitis up to 4 years (aOR 2.73, 95% CI 1.66-4.49) and also suggested a dose-response relationship. A tendency was observed with asthma between 3 and 6 years (aOR 1.65, 95% CI 0.95-2.86). Conclusions: Our findings show positive associations between exposure to antibiotics and allergies, mainly atopic dermatitis and food allergy within the first year of life, after prenatal exposure, and atopic dermatitis and asthma after post-natal exposure to antibiotics in children born in rural settings.
  • Pfaller, Birgit; Yepes-Nuñez, Juan José; Agache, Ioana; Akdis, Cezmi A.; Alsalamah, Mohammad; Bavbek, Sevim; Bossios, Apostolos; Boyman, Onur; Chaker, Adam; Chan, Susan; Chatzipetrou, Alexia; du Toit, George; Jutel, Marek; Kauppi, Paula; Kolios, Antonios; Li, Carmen; Matucci, Andrea; Marson, Alanna; Bendien, Sarah; Palomares, Oscar; Rogala, Barbara; Szepfalusi, Zsolt; Untersmayr, Eva; Vultaggio, Alessandra; Eiwegger, Thomas (2021)
    Abstract Biologicals have transformed the management of severe disease phenotypes in asthma, atopic dermatitis, and chronic spontaneous urticaria. As a result, the number of approved biologicals for the treatment of atopic diseases is continuously increasing. Although atopic diseases are among the most common diseases in the reproductive age, investigations, and information on half-life, pharmacokinetics defining the neonatal Fc receptors (FcRn) and most important safety of biologicals in pregnancy are lacking. Given the complex sequence of immunological events that regulate conception, fetal development, and the intrauterine and postnatal maturation of the immune system, this information is of utmost importance. We conducted a systematic review on biologicals in pregnancy for indications of atopic diseases. Evidence in this field is scare and mainly reserved to reports on the usage of omalizumab. This lack of evidence demands the establishment of a multidisciplinary approach for the management of pregnant women who receive biologicals and multicenter registries for long-term follow-up, drug trial designs suitable for women in the reproductive age, and better experimental models that represent the human situation. Due to the very long half-life of biologicals, pre-conception counseling, and health care provider education is crucial to offer the best care for mother and fetus. This position paper integrates available data on safety of biologicals during pregnancy in atopic diseases via a systematic review with a detailed review on immunological considerations how inhibition of different pathways may impact pregnancy.
  • Thyssen, Jacob P.; Berents, Teresa; Bradley, Maria; Deleuran, Mette; Grimstad, Oystein; Korhonen, Laura; Langeland, Tor; Sarnhult, Tore; Thomsen, Simon Francis; Thune, Turid; Wahlgren, Carl-Fredrik; Vestergaard, Christian; Von Kobyletzki, Laura B.; Remitz, Anita (2020)
    Similarities and differences in the everyday clinical management of moderate-to-severe atopic dermatitis in Nordic countries are unknown. Using a modified Delphi approach, 15 dermatologists from Denmark, Finland, Norway and Sweden completed face-to-face and online questionnaires and participated in summary discussions to map expert opinion on the clinical management of moderate-to-severe atopic dermatitis in these Nordic countries. Through discussions, 6 adult patient profiles, reflecting common disease presentations of atopic dermatitis, were identified. Using these case profiles, diagnostic work-up, treatment goals, patient education and treatment approaches were discussed. Patient education was identified as essential for effective management. A treatment sequence of moderate-to-potent topical glucocorticosteroids and emollients, followed by systemic treatment, was recommended, allowing 3 months to ascertain systemic treatment response before switching, if necessary. Consensus was not reached on systemic treatment choice, reflecting differences in clinical practice and reimbursement between countries. Practical, case-based clinical recommendations were developed for optimal patient care.
  • Akerstrom, Ulf; Reitamo, Sakari; Langeland, Tor; Berg, Mats; Rustad, Lisbeth; Korhonen, Laura; Loden, Marie; Wiren, Karin; Grande, Mats; Skare, Petra; Svensson, Ake (2015)
    Atopic dermatitis (AD) affects adults and children and has a negative impact on quality of life. The present multicentre randomized double-blind controlled trial showed a barrier-improving cream (5% urea) to be superior to a reference cream in preventing eczema relapse in patients with AD (hazard ratio 0.634, p = 0.011). The risk of eczema relapse was reduced by 37% (95% confidence interval (95% CI) 10-55%). Median time to relapse in the test cream group and in the reference cream group was 22 days and 15 days, respectively (p = 0.013). At 6 months 26% of the patients in the test cream group were still eczema free, compared with 10% in the reference cream group. Thus, the barrier-improving cream significantly prolonged the eczema-free time compared with the reference cream and decreased the risk of eczema relapse. The test cream was well tolerated in patients with AD.
  • Kiiski, Ville; Karlsson, Oskar; Remitz, Anita; Reitamo, Sakari (2015)
    Most patients with severe atopic dermatitis have elevated serum IgE levels, but there has been little research into IgE as a predictive biomarker in long-term disease outcome. The aim of this study was to evaluate the predictive value of IgE and other factors in patients with atopic dermatitis in a university clinic setting. There were 169 eligible patients (14-78 years) with a mean follow-up of 4.15 years. High baseline IgE (>= 10,000 IU/ml) was the most important patient-related factor for a poor longterm outcome, being negatively associated with good treatment response (odds ratio (OR) 0.062, p=0.002). Only 14.3% of patients with this high baseline IgE achieved a good treatment response in follow-up, compared with 79.7% in patients with lower (
  • Palmgren, Teppo (Helsingin yliopisto, 2019)
    Maapähkinäallergia on eniten anafylaktisia reaktioita aiheuttava ruoka-aine Euroopassa, mutta sen diagnostiikka on vielä viime vuosiin asti ollut hyvin epävarmaa. Perinteisistä ruoka-ainespesifisistä seerumin IgE-määrityksistä ja ihon prick-testeistä on alettu siirtyä allergeenikomponenttispesifisiin IgE-määrityksiin niiden huomattavasti paremman ennustearvon vuoksi. Luotettavin vakavaa maapähkinäallergiaa ennustava mittari on tällä hetkellä Ara h 2 –allergeenille spesifisen IgE:n määritys. Tässä tutkimuksessa selvitettiin näiden menetelmien luotettavuutta maapähkinäallergian diagnostiikassa, ja lisäksi muiden kliinisten tekijöiden yhteyttä maapähkinäallergian puhkeamiseen. Koska atooppinen ekseema ennustaa aiempien tutkimuksien perusteella allergioiden ja astman kehittymistä, on kiinnostuttu mahdollisuudesta ehkäistä allergioita hoitamalla perusteellisesti lapsuusiän atooppista ihottumaa topikaalisella takrolimuusilla tai kortisonilla. Lisäksi ihon läpäisykerroksen toimintaan vaikuttavien filaggriinigeenimutaatioiden tiedetään ennustavan maapähkinäallergian puhkeamista ja atopiataipumusta. Tässä tutkimuksessa analysoitiin 81 potilasta 3-vuotisen interventiotutkimuksen loppukäynnin kohdalla. Tutkimus on satunnaistettu vertaileva seurantatutkimus, jossa vertaillaan takrolimuusi- ja kortikosteroidihoitoa 1-3-vuotiailla lapsilla, joilla on todettu keskivaikea tai vaikea atooppinen ihottuma. Tutkimuksen alussa ryhmät olivat ihottuman vaikeusasteen ja sukupuolten suhteen samankaltaiset. Ihottuman vaikeusasteen arviointiin käytettiin EASI- ja IGA-määrityksiä. Maapähkinäallergiadiagnoosi asetettiin, mikäli anamneesissa oli altistumista seurannut vakava allerginen reaktio. Ihottuman vaikeusaste parani yhtä paljon kummassakin ryhmässä, mutta maapähkinäallergiaa ja astmaa ilmeni enemmän kortisoniryhmässä. Tässä tutkimuksessa ei kuitenkaan havaittu tilastollisesti merkitsevää eroa hoitoryhmien välillä. Tutkimusaineistosta on tarkoitus jatkossa määrittää filaggriinigeenimutaatioiden prevalenssi ja määrittää niiden yhteyttä atooppiseen ihottumaan, maapähkinäallergiaan ja astmaan.
  • Thyssen, Jacob P.; Heegaard, Steffen; Ivert, Lena; Remitz, Anita; Agner, Tove; De Bruin-Weller, Marjolein; Huldt-Nystrom, Theis; Korhonen, Laura; Ivert, Lina U.; Leinonen, Pekka; Mandelin, Johanna; Sarnhult, Tore; Schopf, Thomas; Sundlisaeter, Eirik; Thomsen, Simon F.; Tzellos, Thrasyvoulos; Vestergaard, Christian; von Kobyletzki, Laura; Bradley, Maria (2020)
    There is a need for unified guidance on the management of ocular manifestations of atopic dermatitis and ocular manifestations associated with dupilumab in the Nordic region (Denmark, Finland, Norway and Sweden). This initiative gathered Nordic dermatologists and ophthalmologists to identify consensus in this area using a modified Delphi process. The initiative was led by a Nordic expert panel who developed a questionnaire that was circulated to a wider group. The results informed an agenda consisting of 24 statements to be voted on using a 5-point Likert scale at a meeting in Copenhagen on 24 April 2019. A facilitator moderated discussion and revised statements according to expert feedback for a second vote when required to reach consensus. Consensus was reached for 23 statements regarding the diagnosis, treatment and referral of these patients, which we hope will improve patient management in the Nordic region.
  • Toppila-Salmi, Sanna; Chanoine, Sebastien; Karjalainen, Jussi; Pekkanen, Juha; Bousquet, Jean; Siroux, Valerie (2019)
    Background The aim was to study the association between allergic multimorbidity and adult-onset asthma considering the number of allergic diseases and the age effect. Methods We used population-based data from Finnish national registers including 1205 adults over 30 years of age with recently diagnosed asthma (age range: 30-93), matched for gender, age, and living region with one or two controls (n = 2050). Allergic rhinitis (AR), allergic conjunctivitis (AC), and allergic dermatitis (AD) were defined from self-completed questionnaire. Conditional logistic regression adjusted on potential confounders (smoking, growing in countryside, childhood hospitalized infection/pneumonia, parental asthma/allergy, parental smoking, education level, professional training, number of siblings, and birth order) was applied to estimate the asthma risk associated with allergic multimorbidity. Results A total of 1118 cases with asthma and 1772 matched controls were included [mean (SD, min-max) 53 (11, 31-71) years, 37% men)]. AR, AC, and AD were reported by 50.2%, 39.6%, and 33.8%, respectively, among subjects with asthma and 26.1%, 20.0%, and 23.5%, respectively, among controls. Compared to nonatopics, adult-onset asthma increased with the number of allergic diseases; adjusted OR for asthma [95% CI] associated with 1, 2, and 3 allergic diseases was 1.95 [1.52-2.49], 2.87 [2.19-3.77], and 4.26 [3.07-5.90], respectively. The association between adult-onset asthma and >= 1 allergic multimorbidity decreased with increasing age (3.52 [2.51-4.94], 2.44 [1.74-3.42], and 1.68 [1.04-2.71]) in subjects <50 years, 50-62 years, and > 62 years, respectively (p for age*>= 1 allergic multimorbidity interaction, 0.002). Conclusions Adult-onset asthma was positively associated with the number of allergic diseases, and this association decreases with age.
  • Anturaniemi (o.s. Roine), Johanna; Zaldívar-López, Sara; Savelkoul, Huub F. J.; Elo, Kari; Hielm-Bjorkman, Anna (2020)
    Canine atopic dermatitis (CAD) has a hereditary basis that is modified by interactions with the environment, including diet. Differentially expressed genes in non-lesional skin, determined by RNA sequencing before and after a dietary intervention, were compared between dogs with naturally occurring CAD (n = 4) and healthy dogs (n = 4). The dogs were fed either a common commercial heat-processed high carbohydrate food (kibble diet) (n = 4), or a non-processed high fat food (raw meat-based diet) (n = 4). At the end of the diet intervention, 149 differentially expressed transcripts were found between the atopic and healthy dogs. The main canonical pathways altered by the dysregulation of these genes were angiopoietin signaling, epidermal growth factor signaling, activation of angiogenesis, and alterations in keratinocyte proliferation and lipid metabolism. On the other hand, 33 differently expressed transcripts were found between the two diet groups, of which 8 encode genes that are annotated in the current version of the dog genome: immunoglobulin heavy constant mu (IGHM), immunoglobulin lambda-like polypeptide 5 (IGLL5), B-cell antigen receptor complex-associated protein beta chain (CD79B), polymeric immunoglobulin receptor (PIGR), cystathionine beta-synthase (CBS), argininosuccinate synthase 1 (ASS1), secretory leukocyte peptidase inhibitor (SLPI), and mitochondrial ribosome recycling factor (MRRF). All genes were upregulated in the raw diet group. In conclusion the findings of this study suggest alterations in lipid and keratinocyte metabolism as well as angiogenesis in the skin of atopic dogs. Additionally, a possible enhancement of innate immunity and decrease in oxidative stress was seen in raw food fed dogs, which could have an important role in preventing hypersensitivities and disturbed immunity at young age.
  • Alenius, Harri; Sinkko, Hanna; Moitinho-Silva, Lucas; Rodriguez, Elke; Broderick, Conor; Alexander, Helen; Reiger, Matthias; Hjelmso, Mathis Hjort; Fyhrquist, Nanna; Olah, Peter; Bryce, Paul; Smith, Catherine; Koning, Frits; Eyerich, Kilian; Greco, Dario; van den Bogaard, Ellen H.; Neumann, Avidan U.; Traidl-Hoffmann, Claudia; Homey, Bernhard; Flohr, Carsten; Bonnelykke, Klaus; Stokholm, Jakob; Weidinger, Stephan (2021)
    The two most common chronic inflammatory skin diseases are atopic dermatitis (AD) and psoriasis. The underpinnings of the remarkable degree of clinical heterogeneity of AD and psoriasis are poorly understood and, as a consequence, disease onset and progression are unpredictable and the optimal type and time point for intervention are as yet unknown. The BIOMAP project is the first IMI (Innovative Medicines Initiative) project dedicated to investigating the causes and mechanisms of AD and psoriasis and to identify potential biomarkers responsible for the variation in disease outcome. The consortium includes 7 large pharmaceutical companies and 25 non-industry partners including academia. Since there is mounting evidence supporting an important role for microbial exposures and our microbiota as factors mediating immune polarization and AD and psoriasis pathogenesis, an entire work package is dedicated to the investigation of skin and gut microbiome linked to AD or psoriasis. The large collaborative BIOMAP project will enable the integration of patient cohorts, data and knowledge in unprecedented proportions. The project has a unique opportunity with a potential to bridge and fill the gaps between current problems and solutions. This review highlights the power and potential of the BIOMAP project in the investigation of microbe-host interplay in AD and psoriasis.