A review on the role of moisturizers for atopic dermatitis

Effective management of atopic dermatitis (AD) involves the treatment of a defective skin barrier. Patients with AD are therefore advised to use moisturizers regularly. To date, there are few comparative studies involving moisturizers in patients with AD, and no classification system exists to objectively determine which types of moisturizers are best suited to specific AD phenotypes. With this in mind, a group of experts from allergy and immunology, adult and pediatric dermatology, and pediatrics centers within Southeast Asia met to review current data and practice, and to develop recommendations regarding the use of moisturizers in patients with AD within the Asia-Pacific region. Chronicity and severity of AD, along with patient age, treatment compliance, and economic background should all be taken into account when selecting an appropriate moisturizer for AD patients. Other considerations include adjuvant properties of the product, cosmetic acceptability, and availability over the counter. Well-defined clinical phenotypes of AD could optimally benefit from specific moisturizers. It is hoped that future studies may identify such differences by means of filaggrin mutation subtypes, confocal microscopic evaluation, pH, transepidermal water loss or presence of allergy specific IgE. Recommendations to improve the regular use of moisturizers among AD patients include measures that focus on treatment compliance, patient and caregiver education, appropriate treatment goals, avoidance of sensitizing agents, and collaboration with other relevant specialists.

A review of oral food challenges in children presenting to a single tertiary centre with perceived or true food allergies

<p><b>INTRODUCTION</b>The prevalence of perceived food allergies exceeds that of true food allergies. Unnecessary food avoidance may increase parental and patient anxiety, reduce quality of life and increase the risk of nutritional deficiency. An oral food challenge (OFC) can provide an objective measure regarding the presence or absence of food allergies in a child. This study reviews the indications for and outcomes of OFCs performed on children.</p><p><b>METHODS</b>A retrospective review was performed on all children who underwent OFCs at the Allergy Unit of the National University Hospital, Singapore, over a three-year period.</p><p><b>RESULTS</b>A total of 197 OFCs were performed among 58 patients (34 male, 24 female). Most of the tests were for allergies to tree nuts (n = 107). Among the OFCs, 43.1% were for foods that were avoided and never eaten due to perceived food allergies, 25.9% were for foods that had previously resulted in positive skin prick tests (SPTs) and/or immunoassay results, 16.2% were for foods thought to worsen eczema and 14.7% were for foods thought to have caused a previous reaction. Of all the OFCs, 5% were positive, although adverse reactions were mostly cutaneous. Challenge-positive patients had either positive SPTs (wheal > 3 mm) or raised serum immunoglobulin E levels to specific foods that they reacted to during the challenges. No episodes of anaphylaxis were reported after the challenge. Most of the patients were able to safely introduce the avoided foods into their diets.</p><p><b>CONCLUSION</b>OFCs provide an objective assessment for suspected food allergies.</p>

The role of antiseptic agents in atopic dermatitis

The skin of individuals with atopic dermatitis has a susceptibility to be colonized with Staphylococcus aureus. This has been associated with increased frequency and severity of exacerbations of atopic dermatitis. Therefore, there is a growing interest in the use of antiseptic agents to target primary bacterial colonization and infection. Antiseptic agents have been found to be better tolerated and less likely to induce bacterial resistance as compared to antibiotics. There is also a wide variety of antiseptic agents available. The efficacy of antiseptic agents has yet to be established as the studies reviewed previously have been small and of suboptimal quality. This review discusses the rationale behind targeting S. aureus with antiseptic agents and presents findings from a review of studies assessing the efficacy of antiseptics in atopic dermatitis in the last five years. Four studies were found, including a bleach bath study which has already been reviewed elsewhere. The remaining 3 studies assessed the efficacy of sodium hypochlorite containing cleansing body wash, sodium hypochlorite baths and 1% triclosan in leave on emollient. These studies suggested some benefit for the inclusion of antiseptic use with the mainstay management of atopic dermatitis, including a potential steroid sparring effect. However, there are many limitations to these studies which therefore warrant further investigation on the impact of antiseptic use in atopic dermatitis.

The Influence of Breastfeeding and Weaning Practices on the Development of Allergic Disease Review of Current Evidence / 소아알레르기및호흡기학회지

Food allergies and atopic diseases are on the rise worldwide. There have been several published practice guidelines on the primary prevention of these diseases. One aspect of these guidelines is the recommendations on infant nutrition, as food allergen exposure and other nutritional factors may influence allergen sensitization. This article aims to review the current international recommendations on infant diet and weaning practices in the primary allergy prevention of infants. The conclusions drawn are as follows: (1) Breastfeeding is considered the gold standard for infant nutrition, especially since exclusive breastfeeding confers some protection against the development of allergic diseases. However, large cohort studies have not been carried out in Asian populations. (2) Maternal avoidance of allergenic food substances during pregnancy and lactation has not been proven to reduce the risk of allergies and is not recommended as a primary prevention strategy. (3) Hydrolyzed formulas have not been shown to have an advantage over breastfeeding, although they have some protective value against atopic eczema in at risk infants when compared to regular cows milk based infant formula. (4) Soy formula is also not recommended for prevention of atopic diseases. (5) Weaning to semisolids should be undertaken between the ages of 4 to 6 months as weaning before the age of 4 months is associated with increased of allergy symptoms. (6) The age for introduction of certain highly allergenic foods have been arrived at empirically and included in some guidelines. These comprise the initiation of dairy products at 12 months, eggs at 24 months, and peanuts, nuts and fish at 36 months.