- Email: [email protected]
Targeted Therapy in Children with Atopic Dermatitis
AB148 Abstracts
483
The Natural History of Atopic Dermatitis and Its Association with Atopic March
Sinjira Somanunt, MD, Jittima Veskitkul, MD, Punchama Pacharn, MD, Nualanong Visitsunthorn, MD, Pakit Vichyanond, MD, FAAAAI, Orathai Jirapongsananuruk, MD; Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. RATIONALE: Atopic dermatitis (AD) is the first manifestation of atopic march. The natural history of AD and predictive factors for atopic march were not widely studied in Asia. METHODS: Medical records of AD patients attending Pediatric Allergy clinic at Siriraj hospital prior to 15 years of age were reviewed. Patients were further interviewed to obtain the current symptoms and treatment. RESULTS: Fifty AD patients (68% female) were followed for 9.9 years. Median age at AD diagnosis was 1.2 years with the AD severity being mild (76%), moderate (16%) and severe (8%). Fifty percent of patients had complete remission at the median age of 8 years. The most common allergen sensitization was Dermatophagoides pteronyssinus and _2 Dermatophagoides farinae (65.9%). Patients with early AD (onset < years) was found to have concomitant food allergy in 58% with egg white and cow’s milk as the leading causes (91%). Sixty-four percent of early AD had complete remission at the median age of 6.1 years. Food allergy was more prevalent in early AD compared with later onset AD (OR512.19, 95% CI; 1.43-100, p50.008). Allergic rhinitis (AR) and asthma was diagnosed in 60% and 34% of the patients with the median age of 4 and 3 years, respectively. Family history of atopy was associated with the development of asthma (OR55.53, 95% CI; 1.08-28.18, p50.028). CONCLUSIONS: Half of AD children had a complete remission at school age with a better prognosis in early AD. Two-third and one-third developed AR and asthma, respectively. Family history of atopy is a predictor of asthma.
484
Clinical Impact in the Real Life of Guidelines Recommendations for Atopic Dermatitis in a Tropical Population (TECCEMA cohort)
SUNDAY
Yuliana Toro; University of Antioquia, Medellin, Colombia. RATIONALE: Atopic dermatitis is a prevalent disease. There are several consensus on the management of eczema, but little has been studied of the real life impact of its recommendations. Here we evaluate the level of clinical control in patients with dermatitis in a tropical environment, applying the recommendations of international consensus. METHODS: Prospective cohort study with follow-up for 24 months. From a population of patients diagnosed with dermatitis, the response to pharmacotherapy recommended by consensus and guidelines were evaluated in the real life. Scoring Atopic Dermatitis (SCORAD), Dermatology Life Quality Index (DLQI) and a subjective scale (SS) were used during each clinical assessment. RESULTS: We select 233 patients with dermatitis from the TECCEMA cohort in a tropical region. One hundred and seventy eight finished the follow-up. Most recommendations from guidelines were applied in all patients and after 6 months, a significant reduction in the SCORAD, DLQI and SS was observed especially in the group with moderate dermatitis. Nevertheless, after 2 years, only 33% of patients had a SCORAD <15%, DLQI <5 and SS <80%. CONCLUSIONS: Drug treatment recommended by the guidelines allows achieving a significant reduction in the severity of eczema and improved quality of life. However, most patients in tropical region do not get complete control of the disease. It is necessary to develop treatments taking into account the special conditions of the region.
J ALLERGY CLIN IMMUNOL FEBRUARY 2016
485
Targeted Therapy Dermatitis
in
Children
with
Atopic
Tatiana Slavyanskaya, MD, PhD1,2, Vladislava Derkach2,3; 1Peoples’ Friendship University of Russia, Moscow, Russia, 2Institute of Immunophysiology, Moscow, Russia, 3Pacific State Medical University, Vladivostok, Russia. RATIONALE: The Development of new strategies of atopic dermatitis (AD) treatment is a topical issue. METHODS: There have been used immunological, allergological and clinical methods. RESULTS: The determination of the immunopathogenic phenotype (IPF) in 300 children (Ch) 5-17 years with moderately severe AD during exacerbation has made it possible to discover an allergic form of AD with sensibilization to HDMA in 94 Ch (SCORAD 44.2 6 2.46). It has been noted the prevalence of Th2-cells, phagocytic index/number falls down to 25.5 6 1.02% and 2.14 6 0.4 of microbial bodies respectively. Ch have received 3 different complex therapy program (CTP): 1CTP – basic therapy (BT); 2CTP - BT and subcutaneous immunotherapy (SCIT); 3CTP – multiagent immunotherapy – MIT (BT+SCIT+ immunomodulator, aimed at activation of phagocytes). Application of MIT contributed to IFNy synthesis activation and reduction of level of IL-4 and IL-13 cytokines, stimulating specific IgE. The MIT has made it possible to conduct SCIT according to an accelerated schedule, increasing clinical effectiveness as compared 1CTP and 2CTP. In the 3CTP during 3 years, we have recorded a considerable decrease of the SCORAD, reduction of flareups, BT in the absence of AD manifestations and hospital care, improvement of quality of life, long-term treatment effect (monitoring exceeding 5 years). MIT was pharmacoeconomically effective. CONCLUSIONS: A preliminary diagnostic of IPF of AD and pathophysiologic disorders, including immune ones, enables a doctor to develop a correct algorithm of combination therapy of AD in Ch, aimed at their correction. A future strategy of treating Ch with AD should be based on application the individual targeted therapy.
483
The Natural History of Atopic Dermatitis and Its Association with Atopic March
Sinjira Somanunt, MD, Jittima Veskitkul, MD, Punchama Pacharn, MD, Nualanong Visitsunthorn, MD, Pakit Vichyanond, MD, FAAAAI, Orathai Jirapongsananuruk, MD; Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. RATIONALE: Atopic dermatitis (AD) is the first manifestation of atopic march. The natural history of AD and predictive factors for atopic march were not widely studied in Asia. METHODS: Medical records of AD patients attending Pediatric Allergy clinic at Siriraj hospital prior to 15 years of age were reviewed. Patients were further interviewed to obtain the current symptoms and treatment. RESULTS: Fifty AD patients (68% female) were followed for 9.9 years. Median age at AD diagnosis was 1.2 years with the AD severity being mild (76%), moderate (16%) and severe (8%). Fifty percent of patients had complete remission at the median age of 8 years. The most common allergen sensitization was Dermatophagoides pteronyssinus and _2 Dermatophagoides farinae (65.9%). Patients with early AD (onset < years) was found to have concomitant food allergy in 58% with egg white and cow’s milk as the leading causes (91%). Sixty-four percent of early AD had complete remission at the median age of 6.1 years. Food allergy was more prevalent in early AD compared with later onset AD (OR512.19, 95% CI; 1.43-100, p50.008). Allergic rhinitis (AR) and asthma was diagnosed in 60% and 34% of the patients with the median age of 4 and 3 years, respectively. Family history of atopy was associated with the development of asthma (OR55.53, 95% CI; 1.08-28.18, p50.028). CONCLUSIONS: Half of AD children had a complete remission at school age with a better prognosis in early AD. Two-third and one-third developed AR and asthma, respectively. Family history of atopy is a predictor of asthma.
484
Clinical Impact in the Real Life of Guidelines Recommendations for Atopic Dermatitis in a Tropical Population (TECCEMA cohort)
SUNDAY
Yuliana Toro; University of Antioquia, Medellin, Colombia. RATIONALE: Atopic dermatitis is a prevalent disease. There are several consensus on the management of eczema, but little has been studied of the real life impact of its recommendations. Here we evaluate the level of clinical control in patients with dermatitis in a tropical environment, applying the recommendations of international consensus. METHODS: Prospective cohort study with follow-up for 24 months. From a population of patients diagnosed with dermatitis, the response to pharmacotherapy recommended by consensus and guidelines were evaluated in the real life. Scoring Atopic Dermatitis (SCORAD), Dermatology Life Quality Index (DLQI) and a subjective scale (SS) were used during each clinical assessment. RESULTS: We select 233 patients with dermatitis from the TECCEMA cohort in a tropical region. One hundred and seventy eight finished the follow-up. Most recommendations from guidelines were applied in all patients and after 6 months, a significant reduction in the SCORAD, DLQI and SS was observed especially in the group with moderate dermatitis. Nevertheless, after 2 years, only 33% of patients had a SCORAD <15%, DLQI <5 and SS <80%. CONCLUSIONS: Drug treatment recommended by the guidelines allows achieving a significant reduction in the severity of eczema and improved quality of life. However, most patients in tropical region do not get complete control of the disease. It is necessary to develop treatments taking into account the special conditions of the region.
J ALLERGY CLIN IMMUNOL FEBRUARY 2016
485
Targeted Therapy Dermatitis
in
Children
with
Atopic
Tatiana Slavyanskaya, MD, PhD1,2, Vladislava Derkach2,3; 1Peoples’ Friendship University of Russia, Moscow, Russia, 2Institute of Immunophysiology, Moscow, Russia, 3Pacific State Medical University, Vladivostok, Russia. RATIONALE: The Development of new strategies of atopic dermatitis (AD) treatment is a topical issue. METHODS: There have been used immunological, allergological and clinical methods. RESULTS: The determination of the immunopathogenic phenotype (IPF) in 300 children (Ch) 5-17 years with moderately severe AD during exacerbation has made it possible to discover an allergic form of AD with sensibilization to HDMA in 94 Ch (SCORAD 44.2 6 2.46). It has been noted the prevalence of Th2-cells, phagocytic index/number falls down to 25.5 6 1.02% and 2.14 6 0.4 of microbial bodies respectively. Ch have received 3 different complex therapy program (CTP): 1CTP – basic therapy (BT); 2CTP - BT and subcutaneous immunotherapy (SCIT); 3CTP – multiagent immunotherapy – MIT (BT+SCIT+ immunomodulator, aimed at activation of phagocytes). Application of MIT contributed to IFNy synthesis activation and reduction of level of IL-4 and IL-13 cytokines, stimulating specific IgE. The MIT has made it possible to conduct SCIT according to an accelerated schedule, increasing clinical effectiveness as compared 1CTP and 2CTP. In the 3CTP during 3 years, we have recorded a considerable decrease of the SCORAD, reduction of flareups, BT in the absence of AD manifestations and hospital care, improvement of quality of life, long-term treatment effect (monitoring exceeding 5 years). MIT was pharmacoeconomically effective. CONCLUSIONS: A preliminary diagnostic of IPF of AD and pathophysiologic disorders, including immune ones, enables a doctor to develop a correct algorithm of combination therapy of AD in Ch, aimed at their correction. A future strategy of treating Ch with AD should be based on application the individual targeted therapy.