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SYSTEMIC TREATMENT
Velling P, Skowasch D, Pabst S, Jansen E, Tuleta I & Grohe C (2011) Improvement of quality of life in patients with concomitant allergic asthma and atopic dermatitis: one year follow-up of omalizumab therapy. European Journal of Medical Research 16(9):407–10
Omalizumab is a treatment used for improving allergic asthma and the authors suggest that it may be a useful treatment for atopic eczema. Twenty-two subjects were recruited to the study. Thirteen of them had asthma but no eczema and nine of them had both.
All were treated with omalizumab for 12 months. Before starting the treatment, baseline measures for asthma-related quality of life and eczema-related quality of life were measured, and asthma-related treatments were also noted. These were all measured during treatment and again at the end of the study. Quality of life showed significant improvement in the asthma and eczema group and modulated the use of oral steroids in the same group. The authors conclude that omalizumab is effective at improving dermatology quality of life and positively modulating oral steroid use, in patients who have both asthma and eczema.
* Access to the full article is not free but the abstract can be seen here.
EPIDEMIOLOGY
Flohr C, Nagel G, Weinmayer G, Kleiner A, Strachan DP & Williams HC (2011) The ISAAC Phase Two Study Group. British Journal of Dermatology 165(6):1280–89
This international study aimed to clarify whether exclusive breastfeeding for 4 months protects against childhood eczema. 51,119 randomly selected 8–12-year-old schoolchildren were chosen and questionnaires were completed by parents. Children were examined for flexural eczema and underwent skin prick tests. The results suggest that there was a protective effect of ever having been breastfed for more severe disease. However, there was no evidence that being breastfed for 4 months or longer protects against eczema.
* Access to the full article is not free but the abstract can be seen here.
These results are consistent with findings from a recent systematic review of prospective studies. The authors recommend that UK breastfeeding guidelines with regard to eczema should be reviewed. Intervention studies are now required to explore how and when solids should be introduced alongside breastfeeding to aid protection against eczema and other allergic diseases.
DISEASE SEVERITY
O’Neill JL, Chan YH, Rapp SR &Yosipovitch G (2011) Differences in itch characteristics between psoriasis and atopic dermatitis patients: results of a web-based questionnaire. Acata Dermato-venereologica 91(5):537–40
This study set out to identify how subjects with psoriasis and eczema viewed the itch that they experienced. This was achieved using a web based survey completed by 524 subjects with eczema and 195 with psoriasis. The responses identified some key differences between the two groups. Those with eczema reported more frequent and intense itching that was more often associated with heat and sweating. Those with psoriasis reported more embarrassment associated with their itching. Both groups considered scratching pleasurable. The authors concluded that future treatments may be developed to target these differences.
* Access to this article is free of charge and can be found here.
SERVICE DELIVERY
Schuttelaar ML, Vermeulen KN & Coenraads PJ (2011) Costs and cost-effectiveness analysis of treatment in children with eczema by nurses practitioner vs dermatologist: results of a randomized, controlled trial and a review of international costs. British Journal of Dermatology 165(3):600–11
A previous study indicated that when nurse practitioners were employed in place of dermatologists, outcomes in terms of eczema severity and quality of life were similar but patient satisfaction was higher. This study aimed to identify the cost-effectiveness of such a substitution. The authors conclude that substituting nurse practitioners for dermatologists was both cost-saving and cost-effective. They also state that the treatment of choice is that provided by the nurse practitioner, as it is equally effective with higher patient satisfaction. This study was carried out in the Netherlands and although the authors tried to make international comparisons they concluded this was too difficult because of differences in costs and unit prices.
* Access to the full article is not free but the abstract can be seen here.
DIAGNOSTICS
Toledo F, Garcia-Bravo B, Fernandez-Redondo V, De la Cuadra J, Gimenez-Arnau AM, Borrego L, Carrascosa JM, Armario-Hita JC, Sanchez-Pedreno P, Hervella M, Gonzalez R & Silvestre JF (2011) Patch testing in children with hand eczema: A 5-year multicentre study in Spain. Contact Dermatitis 65(4):213–9
This Spanish study states that whilst hand eczema is common in children they are rarely patch tested for it. The aim of this study was to identify the prevalence of contact allergy in children with hand eczema and identify the most frequent allergens and their relevance. The researchers looked retrospectively through 5 years of records of people who had had patch tests in 11 Spanish hospitals. A total of 11,729 people had been patch tested. Of these, 480 were children and 111 (23.1%) of them had hand eczema. Of the children with hand eczema, 46.8% had at least one positive reaction to the patch tests. The most common allergens included nickel sulphate and fragrance mix 1. The authors recommend that patch testing should be carried out on all children with chronic hand eczema.
* Access to the full article is not free but the abstract can be seen here.
Czarnobilska E, Obtulowicz K, Dyga W & Spiewak R (2011) A half of schoolchildren with ‘ISAAC eczema’ are ill with allergic contact dermatitis. Journal of the European Academy of Dermatology and Venereology 25(9):1104–7
This study states that the similarity in clinical symptoms between atopic eczema and allergic contact dermatitis may lead to misdiagnosis – particularly as patch testing for contact allergy does not seem popular among paediatric allergists. The resulting bias leads mainly to under-diagnosis of allergic contact dermatitis and over-diagnosis of atopic eczema in children and adolescents.
143 schoolchildren (who had already been identified as having eczema) were recruited to the study and patch tested. Results showed that 55.4% of the children and 30% of the adolescents had atopic eczema and 38.6% and 31%, respectively, were diagnosed with allergic contact dermatitis. There was significant overlap between the two conditions. Based on these results the authors concluded that it was reasonable to estimate that the general prevalence of allergic contact dermatitis was 8.5% of children and 5.8% of adolescents.
* Access to the full article is not free but the abstract can be seen here
NUTRITIONAL ISSUES
Jin YY, Cao RM, Chen J, Kaku Y, Wu J, Cheng Y, Shimizu T, Takase M, Wu SM & Chen TX (2011) Partially hydrolyzed cow’s milk formula has a therapeutic effect on the infants with mild to moderate atopic dermatitis: a randomized, double blind study. Pediatric Allergy and Immunology 22(7):688–94
Partially hydrolysed cow’s milk formula (phCMF) has been shown to prevent allergy in infants at high risk of atopic eczema. This Chinese study aimed to investigate whether it had a beneficial impact on children who already had atopic eczema. Over a 2-year period 113 infants with eczema under 6 months were randomised to receive either phCMF or cow’s milk formula. Assessments were made at baseline, 4, 8 and 12 weeks.
Assessments included disease severity measures, growth status of the child and allergy profile. During the study period and at the end of it, disease severity measures were all significantly better in the phCMF group and there were significantly fewer flares. Growth rates were the same in both groups and were within normal parameters.
*Access to the full article is not free but the abstract can be seen here.
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