DERMATITE

ATOPICA

Specificity of allergen skin testing in predicting positive open foodchallenges (n°555) to milk, egg and peanut in children

Sporik Clin Exp Allergy 2000; 30: 1495

but no negative challenge if skin weal diameterswere at or above:- 8 mm for cow’s milk and peanut- 7 mm for egg white

POSITIVE NEGATIVE INCONCLUSIVE

70 -

60 -

50 -

40 -

30 -

20 -

10 -

55%

positive reactions could occur also with a skin weal diameter of 0 mm

37%

8%

5/5/2001

%FOOD

CHALLENGES

Specific IgE levels in the diagnostic of immediate hypersensitivity to cow’s milk protein in the infant

Garcia-Ara JACI 2001; 107: 185

170 patients under 1 year with a reaction suggesting immediatehypersensitivity to cow’s milk formula

• SPT with milk

NEGATIVEEXCLUDES ALLERGYIN 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 IgElevels for cow’s milk may be helpful

5/5/2001

Wheat allergy: diagnostic accuracy of skin prick andpatch tests and specific IgE in infants with challenge-proven wheat allergy Majamaa Allergy 1999; 54: 851

100 - 90 - 80 - 70 - 60 - 50 - 40 - 30 - 20 - 10 -

(+) PATCH (+) CAP RAST (+) SPT

86%

23%20%

Patch testing with cereals will significantlyincrease the probabilityof early detection of cereal allergy in infants with atopic eczema

5/5/2001

Atopy patch tests, together with determination of specific IgE levels,reduce the need for oral food challenges in children with atopicdermatitis Roehr JACI 2001; 107: 548

(+)PREDICTIVE

VALUE

100 - 90 - 80 - 70 - 60 - 50 - 40 - 30 - 20 - 10 -

MILK EGG WHEAT SOY

95%100%

94% 94% 94% 92%

50%

100%

POSITIVE APT ONLY

PLUS POSITIVE SPT 5/5/2001

Atopy patch test for food allergensRoehr JACI 2001; 107: 548Technique:

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 childback 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 infiltration5/5/2001

Prospective study on the effect of an aminoacid-basedformula in infants with cow’s milk allergy/intolerance

and atopic dermatitis Niggemann Ped All Imm 2001; 12:78

SCORAD

INDEX

25 -

20 -

15 -

10 -

5 -

AT ENTRY AFTER 6 MONTHS

Feedings with aminoacide basedformula (NEOCATE) was also associated with a better growththan that abserved with extensivelyhydrolized formula

24.6

10.7

5/5/2001

p<0.001

Probiotics in the management of atopic eczemaIsolauri Clin Exp Allergy 2000; 30: 1604

SCORAD

INDEX

15 -

10 -

5 -

During Formula Formula + Formula + breast alone Bifidobacterium Lactobacillus GG feeding lactis Bb-12 AFTER 2 MONTHS

5/5/2001

16

13.4

0 1

27 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

Exposure to Dermatophagoides pteronyssinus andthe occurrence of atopic dermatitis at 3 years of age

Huang Ped. All. Imm. 2001; 12:11

25 -

20 -

15 -

10 -

5 -

0

%

CHILDREN

5.3 %

21.6 %

> 1 < 1Der p 1 µg/g dust

1/4/2001

p < 0.015

26/10/2000

Effect of house dust mite avoidance measures in children with atopic dermatitis

Ricci Br. J. Dermatol. 2000; 143: 379

41 children with atopic dermatitis and high specific IgEMite allergens in children’s beds

Before After Before After

Avoidance measuresAvoidance measures

2 -

1 -

0

g/g

DUST

SCORAD

40 -

30 -

20 -

10 -

0

0.73

1.84 33

26

p = .022

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

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

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

Per

mea

bil

ity

(cm

/s)

0 100 200 300 400

Effects of Der p 1 on permeability of epithelial monolayers to 14C mannitol Wan Clin. Exp. Allergy 2000; 30: 685

3/3/2001

16 HBE 14o- cells

MDCK cells

10-4

10-5

10-6

• •

•

• ••

•

30/3/2001Robinson Clin. Exp. Allergy 1997; 27: 10

Dendritic antigenpresenting cell

Sensitization

At site of disruption allergenis able to gain access toantigen presenting cells

Basament membrane

Tight junction

Desmosome

Intermediatejunction

Increased urinary leukotriene E4 excretion in patients with atopic dermatitis Hishinuma Br J Dermatol 2001; 144: 19

150 -

100 -

50 -

ATOPIC CONTROLSDERMATITIS

125

60

URINARYLTE4

pg/mgcreatinine

Cysteinyl LTs may beinvolved in the pathophysiologyof AD

5/5/2001

p < 0.01

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

11 -

10 -

9 -

8 -

7 -

6 -

5 -

4 -

3 -

2 -

1 -

0

SYMTOMS

SCORE

6.8

8.7

-

-

2.0

2.1

p = .014