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1.
Br J Dermatol ; 186(4): e135-e185, 2022 04.
Article in English | MEDLINE | ID: covidwho-1868581
3.
Dermatol Ther ; 35(7): e15573, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1832028

ABSTRACT

During the SARS-COV-2 pandemic, using face masks became mandatory in many countries. Although evidence suggests that masks can exacerbate several inflammatory skin diseases, few studies focus on their real impact on eczema localized to the face in atopic dermatitis (AD) patients. The aim of this study is to evaluate facial eczema prevalence during pandemic and its psychological impact in AD patients pre-assessed for systemic treatment and/or in therapy with dupilumab. This study includes 71 patients affected by moderate-severe AD, treated with dupilumab at SCDU of Dermatology in Novara, Italy. We calculated the number of subjects with facial involvement in pre- and post-pandemic periods and the related localization trend. We evaluated, in the two groups, clinical and psychological indicators recorded at each visit and the score modifications during the observational period. No statistically significant differences were observed in facial eczema prevalence, between pre- and post-pandemic periods (p = 0.7618) and in facial eczema remission among the two groups (p = 0.1903). In post-pandemic period, psychological scores were significantly lower (DLQI and HADS respectively with p < 0.0001 and p = 0.0025) and the reduction in EASI score during observational period was significantly greater (p = 0.0001). Our analysis revealed a potential protective effect of masks on face eczema, suggesting that they could enhance dupilumab efficacy. Face masks, covering sensitive areas, can positively contribute to mental distress in patients with facial eczema, and being associated with a lower allergic diseases incidence may sustain dupilumab in reducing AD severity.


Subject(s)
COVID-19 , Dermatitis, Atopic , Eczema , Facial Dermatoses , Antibodies, Monoclonal, Humanized , Dermatitis, Atopic/complications , Dermatitis, Atopic/drug therapy , Dermatitis, Atopic/epidemiology , Eczema/complications , Facial Dermatoses/complications , Humans , Pandemics/prevention & control , SARS-CoV-2 , Severity of Illness Index , Treatment Outcome
4.
J Eur Acad Dermatol Venereol ; 36(5): 632, 2022 05.
Article in English | MEDLINE | ID: covidwho-1816588
5.
J Eur Acad Dermatol Venereol ; 36(8): 1292-1299, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1807159

ABSTRACT

BACKGROUND: Moderate-to-severe atopic dermatitis (AD) in the adolescence is a high burden disease, and its treatment can be very challenging due to paucity of approved systemic drugs for this age and their side-effects. Dupilumab was recently approved for treatment of adolescent AD. OBJECTIVES: A multicentre, prospective, real-world study on the effectiveness and safety of dupilumab in adolescents (aged from ≥12 to <18 years) with moderate-to-severe AD was conducted. The main AD clinical phenotypes were also examined. METHODS: Data of adolescents with moderate-to-severe AD treated with dupilumab at label dosage for 16 weeks were collected. Treatment outcome was assessed by EASI, NRS itch, NRS sleep loss and CDLQI scores at baseline and after 16 weeks of treatment. The clinical scores were also evaluated according to clinical phenotypes. RESULTS: One hundred and thirty-nine adolescents were enrolled in the study. Flexural eczema and head and neck eczema were the most frequent clinical phenotypes, followed by hand eczema and portrait-like dermatitis. Coexistence of more than 1 phenotype was documented in 126/139 (88.5%) adolescents. Three patients (2.1%) contracted asymptomatic SARS-CoV-2 infection and 1 of the discontinued dupilumab treatment before the target treatment period. A significant improvement in EASI, NRS itch, NRS sleep loss and CDLQI was observed after 16 weeks of treatment with dupilumab. This outcome was better than that observed in clinical trials. Dupilumab resulted effective in all AD phenotypes, especially in diffuse eczema. Twenty-eight (20.1%) patients reported adverse events, conjunctivitis and flushing being the most frequent. None of patients discontinued dupilumab due to adverse event. CONCLUSIONS: Dupilumab in adolescent AD showed excellent effectiveness at week 16 with consistent improvement of all clinical scores. Moreover, dupilumab showed a good safety profile also in this COVID-19 pandemic era.


Subject(s)
COVID-19 , Dermatitis, Atopic , Eczema , Antibodies, Monoclonal, Humanized , COVID-19/drug therapy , Dermatitis, Atopic/drug therapy , Double-Blind Method , Humans , Pandemics , Prospective Studies , Pruritus , SARS-CoV-2 , Severity of Illness Index , Treatment Outcome
6.
Clin Dermatol ; 39(6): 966-984, 2021.
Article in English | MEDLINE | ID: covidwho-1797056

ABSTRACT

A total of 22 patients who had developed an adverse cutaneous reaction to the Moderna or Pfizer vaccine underwent biopsies. Each patient was assessed light microscopically, and, in select biopsies, spike glycoprotein and cytokine assessment were also conducted. The patients developed self-limited cutaneous reactions often described clinically as urticarial or eczematous within 1 day to 4 weeks after receiving the first or second dose of the Pfizer or Moderna vaccine. Classic clinical and morphologic depictions of type IV cutaneous hypersensitivity with features of eczematous dermatitis, interface dermatitis, granulomatous inflammation, and/or lymphocytic vasculitic component were observed. Clinical and/or histologic features of perniosis, pityriasis rosea, pityriasis rubra pilaris, and guttate psoriasis were seen in select cases. In 2 cases the dominant picture was urticarial vasculitis, possibly reflective of an Arthus type III immune complex action. The biopsy specimens of normal skin post vaccine and of skin affected by the post-vaccine eruption showed rare deep microvessels positive for spike glycoprotein with no complement deposition contrasting with greater vascular deposition of spike protein and complement in skin biopsies from patients experiencing severe coronavirus disease 2019 (COVID-19). It is concluded that self-limited hypersensitivity reactions to the vaccine occur possibly owing to a substance found in the vaccine vehicle (eg, polyethylene glycol). An immune response that is directed against human-manufactured spike has to be considered because some of the reactions clinically and or histologically closely resemble mild COVID-19. Finally, vaccine-associated immune enhancement largely attributable to the adjuvant properties of the vaccine may unmask certain inflammatory milieus operational in psoriasis, atopic dermatitis, and subclinical hypersensitivity.


Subject(s)
COVID-19 , Eczema , Urticaria , COVID-19 Vaccines , Humans , SARS-CoV-2
7.
Occup Environ Med ; 79(8): 521-526, 2022 08.
Article in English | MEDLINE | ID: covidwho-1765135

ABSTRACT

BACKGROUND: Disinfectants are widely used in the medical field, particularly recently because of the coronavirus pandemic, which has led to an increase in their use by both medical professionals and the general population. The objective of this study was to examine whether occupational disinfectant use during pregnancy was associated with the development of allergic disease in offspring at 3 years. METHODS: We used data from 78 915 mother/child pairs who participated in the Japan Environment and Children's Study, which is a prospective birth cohort recruited between January 2011 and March 2014. We examined the associations between maternal disinfectant use during pregnancy and allergic diseases (asthma, eczema and food allergies) in children after adjustment for covariates including maternal postnatal return to work when the child was 1 year old by multivariate logistic regression. RESULTS: Compared with those who never used disinfectants, participants who used disinfectant every day had a significantly higher risk of asthma in their offspring (adjusted OR 1.18, 95% CI 1.05 to 1.33 for 1-6 times a week; adjusted OR 1.26, 95% CI 1.05 to 1.52 for every day). The associations between disinfectant exposure and eczema were similar to those of asthma (adjusted OR 1.16, 95% CI 1.02 to 1.31 for 1-6 times a week; adjusted OR 1.29, 95% CI 1.06 to 1.57 for every day). We found a significant exposure-dependent relationship (p for trend <0.01). There were no significant associations between disinfectant use and food allergies. CONCLUSION: Disinfectant use by pregnant women may be a risk factor for asthma and eczema in offspring. As disinfectants are an effective tool in the prevention of infectious diseases, replication of this study and further research into the mechanisms are warranted.


Subject(s)
Asthma , Disinfectants , Eczema , Food Hypersensitivity , Prenatal Exposure Delayed Effects , Asthma/chemically induced , Asthma/epidemiology , Child , Disinfectants/adverse effects , Eczema/epidemiology , Eczema/etiology , Female , Humans , Infant , Japan/epidemiology , Pregnancy , Prenatal Exposure Delayed Effects/epidemiology , Prospective Studies
9.
An Bras Dermatol ; 97(2): 173-178, 2022.
Article in English | MEDLINE | ID: covidwho-1578973

ABSTRACT

BACKGROUND: The prevalence of atopic eczema is unknown in many countries. The International Study of Asthma and Allergies in Childhood (ISAAC) is an epidemiological landmark in the study of allergic diseases. OBJECTIVE: To validate and assess the reproducibility of the ISAAC Written Atopic Eczema Questionnaire (WAEQ) for children aged between 6 and 7 years by telephone contact. METHODS: Observational study through interviews with guardians of children aged 6 to 7 years using the ISAAC atopic eczema module questionnaire in three different phases separated by 2 weeks: telephone interviews in the first and third contacts and in-person interviews under supervision in the second contact. Reproducibility was estimated using the Kappa index and validation using the sensitivity and specificity coefficients. RESULTS: Data from 88 children (32 from the atopic eczema group) were analyzed. Reproducibility showed almost perfect agreement for the questions "Recurrent pruritic lesions" and "Lesions in typical locations" (Kappa between 0.81-0.82), while a substantial agreement was observed for all other indicators (Kappa variation between 0.66 and 0.78). The validation showed high specificity (≥ 80.4%) and sensitivity (≥ 87.5%) for all questions, except those related to chronicity and medical diagnosis (34.4% and 40.6%, respectively). STUDY LIMITATIONS: Non-random selection, no sample size calculation, participants from a tertiary hospital and study period coincident with the Coronavirus pandemic. CONCLUSIONS: Our results showed that the ISAAC atopic eczema module questionnaire by telephone interviews has good reproducibility and high agreement with the clinical diagnosis of atopic eczema. It may be an appropriate alternative tool in epidemiological studies of childhood atopic eczema, especially in periods of social isolation.


Subject(s)
Asthma , Dermatitis, Atopic , Eczema , Hypersensitivity , Asthma/diagnosis , Asthma/epidemiology , Child , Dermatitis, Atopic/diagnosis , Dermatitis, Atopic/epidemiology , Eczema/diagnosis , Eczema/epidemiology , Humans , Prevalence , Reproducibility of Results , Surveys and Questionnaires , Telephone
10.
Clin Dermatol ; 39(6): 1083-1087, 2021.
Article in English | MEDLINE | ID: covidwho-1588082

ABSTRACT

Data on the tolerability and response to biologic therapies for type 2 immune disorders in the context of coronavirus disease 2019 (COVID-19) are currently lacking. Our survey aimed at assessing the adherence of patients to dupilumab therapy and the risk of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. A total of 80 patients with atopic dermatitis treated with dupilumab completed a web-based survey. Of the 80 patients, 7 discontinued dupilumab owing to concerns and difficulties related to COVID-19. Our sample was highly susceptible to viral infection owing to the frequency of risk factors including living in high SARS-CoV-2 burden areas, such as in Northern Italy; having comorbidities, such as asthma, diabetes, and cardiovascular disease; and being of advanced age. Older patients in our sample are particularly exposed to the risk of COVID-19-related cytokine storm, triggered by excessive interleukin-4 production and type 2 immune response. One patient contracted SARS-CoV-2 infection without the progression of COVID-19 despite continuing scheduled dupilumab treatment. Because evidence on the appropriate management of biologic therapy in the setting of COVID-19 is lacking, the collection of clinical data from patients in treatment with dupilumab is a valuable addition to current clinical practice. Our survey provides a contribution to the understanding of the tolerability and response to dupilumab during COVID-19 and suggests a feasible and effective approach to patients being treated with biologics even when social distancing is required.


Subject(s)
COVID-19 , Dermatitis, Atopic , Eczema , Cytokine Release Syndrome , Dermatitis, Atopic/drug therapy , Humans , SARS-CoV-2
11.
Contact Dermatitis ; 86(2): 98-106, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1511298

ABSTRACT

BACKGROUND: Apprentice nurses are considered at high risk to developing occupational skin diseases. OBJECTIVES: This study assessed the frequency and origin of hand eczema, and work-related risk factors in apprentice nurses. METHODS: The study involved 240 final-year apprentice nurses (females 75%, median age 19 years) from vocational schools in Zagreb, Croatia. The study was performed in 2020/2021 and included a questionnaire and clinical examination by means of the Osnabrück Hand Eczema Severity Index (OHSI). Skin prick test (SPT) with natural rubber latex (NRL) allergen, and patch test with the basic series of allergens, and disinfectants, were performed in 42 apprentice nurses with hand eczema that lasted more than 3 months. RESULTS: Clinically observed and self-reported hand eczema were found in 49% and 46% of apprentice nurses, respectively. Those with observed changes were older and reported more days per month spent on practical work than those with healthy skin (P = .001). Median OHSI was 4 (interquartile range 2-6). There were no positive SPTs to latex, and 11 (26%) apprentice nurses had positive patch test reactions to one or more tested allergens, mostly nickel. CONCLUSIONS: Hand eczema was common in final-year apprentice nurses during the COVID-19 pandemic. It was mostly of irritative origin, associated with the duration of practical training, confirming cumulative effect of hazards on skin barrier.


Subject(s)
COVID-19/nursing , Dermatitis, Occupational/etiology , Eczema/etiology , Hand Dermatoses/etiology , Students, Nursing , Croatia , Female , Humans , Male , Pandemics , Patch Tests , Risk Factors , SARS-CoV-2 , Severity of Illness Index , Young Adult
12.
Acta Derm Venereol ; 101(221)2021 Apr 19.
Article in English | MEDLINE | ID: covidwho-1488422
13.
Acta Derm Venereol ; 101(9): adv00543, 2021 Sep 08.
Article in English | MEDLINE | ID: covidwho-1370975

ABSTRACT

The COVID-19 pandemic has led to enhanced hygiene procedures and use of personal protective equipment, but also to increased attention to occupational skin disease in healthcare workers. The occurrence of hand and facial skin disease in > 5,000 Swedish healthcare workers was investigated in a questionnaire survey. Levels of skin exposure related to hygiene procedures and personal protective equipment were recorded. Caring for patients with COVID-19 entailed higher levels of wet work and face mask exposures, and was associated with higher 1-year prevalence of both hand eczema (36%) and facial skin disease (32%) compared with not being directly engaged in COVID-19 care (28% and 22%, respectively). Acne and eczema were the most common facial skin diseases; for both, a dose-dependent association with face mask use was found. Dose-dependent associations could be shown between hand eczema and exposure to soap and gloves, but not to alcohol-based hand disinfectants.


Subject(s)
COVID-19 , Dermatitis, Occupational , Eczema , Hand Dermatoses , Cross-Sectional Studies , Dermatitis, Occupational/diagnosis , Dermatitis, Occupational/epidemiology , Eczema/diagnosis , Eczema/epidemiology , Hand Dermatoses/diagnosis , Hand Dermatoses/epidemiology , Health Personnel , Humans , Pandemics , SARS-CoV-2
16.
J Prim Care Community Health ; 12: 21501327211018013, 2021.
Article in English | MEDLINE | ID: covidwho-1234502

ABSTRACT

PURPOSE: This study aimed to explore the prevalence of and possible risk factors for hand eczema with respect to the dissemination of information about new hand hygiene habits to protect against ongoing COVID-19 cross-transmission. The authors conducted a survey among health care workers (HCWs) and non-HCW populations in Khon Kaen, Thailand. RESULTS: A total of 805 participants participated. The prevalence of hand eczema in the study population was 20.87%. There were several risk factors, including working as a HCW, having a history of previous hand eczema, having underlying atopic dermatitis, wearing gloves in everyday life, and washing hands frequently (more than 10 times/day). Hand hygiene with alcohol-based products was shown to be a risk factor for hand eczema, (OR (95% CI) 1.86 (1.03-3.35), P = .04). CONCLUSION: In terms of hand eczema prevention, we suggest that the use of alcohol-based products should be discontinued if other handwashing methods are available. The following factors increase the risk of hand eczema: being a HCW, having previous hand eczema, and having underlying atopic dermatitis. Proper strategies in terms of hand eczema prevention should be addressed, especially in this group, since we need to continue performing hand hygiene during the ongoing COVID-19 pandemic.


Subject(s)
COVID-19 , Eczema , Hand Dermatoses , Hand Hygiene , Eczema/epidemiology , Eczema/etiology , Eczema/prevention & control , Habits , Hand Dermatoses/epidemiology , Hand Dermatoses/etiology , Hand Dermatoses/prevention & control , Humans , Pandemics , Prevalence , SARS-CoV-2 , Thailand/epidemiology
17.
Ann Allergy Asthma Immunol ; 127(4): 446-450.e1, 2021 10.
Article in English | MEDLINE | ID: covidwho-1230347

ABSTRACT

BACKGROUND: The coronavirus disease 2019 pandemic has highlighted the importance of accurate capture of vaccine, and vaccine component, allergy. There remains a gap in the prevalence literature from the perspective of direct primary care provider (PCP) reporting at a population level. OBJECTIVE: To determine the prevalence of PCP-documented vaccine and polyethylene glycol (PEG) allergy using electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network. METHODS: Retrospective cohort study using the Canadian Primary Care Sentinel Surveillance Network repository. Machine learning algorithms were applied to evaluate for vaccine allergy documentation, and Anatomic Therapeutic Chemical codes were used for PEG allergy or allergy to common injectable medications containing PEG (CIMCP). RESULTS: The prevalence of PCP-documented vaccine allergy in Canada was 0.037% (395/1,055,677) and of PEG allergy was 0.0009% (10/1,055,677). In total, 0.01% of patients had a documented allergy to either PEG or CIMCP (135/1,055,677). None of the patients with PEG allergy had a documented allergy to a CIMCP. Patients with vaccine allergy and PEG allergy were significantly more likely to have other atopic comorbidities, including asthma (P < .001 for both), eczema (P < .001 and P = .001, respectively), rhinitis (P = .002 and P < .001, respectively), and food allergy (P < .001 for both). Significantly higher rates of depression (P < .001 and P < .001, respectively) and anxiety (P = .003 and P < .001, respectively) were found in those with vaccine allergy, or PEG allergy, than those without vaccine allergy or PEG allergy. CONCLUSION: This is the first study to estimate the prevalence of vaccine and PEG allergy in a national cohort that uses PCP documentation, revealing a low reported rate of vaccine allergy and PEG allergy.


Subject(s)
Hypersensitivity, Immediate/epidemiology , Hypersensitivity, Immediate/immunology , Hypersensitivity/immunology , Polyethylene Glycols/adverse effects , Vaccines/adverse effects , Adult , Algorithms , Anxiety/immunology , Asthma/epidemiology , Asthma/immunology , COVID-19/immunology , Canada/epidemiology , Documentation/methods , Eczema/epidemiology , Eczema/immunology , Electronic Health Records , Female , Health Personnel , Humans , Male , Middle Aged , Pandemics/prevention & control , Prevalence , Primary Health Care/methods , Retrospective Studies , SARS-CoV-2/immunology , Vaccines/immunology
18.
Ann Allergy Asthma Immunol ; 127(3): 312-317, 2021 09.
Article in English | MEDLINE | ID: covidwho-1220652

ABSTRACT

OBJECTIVE: To present an update of birth cohort study designs and their contributions to allergic risk. DATA SOURCES: The PubMed database was used to search for relevant articles. STUDY SELECTIONS: Peer-reviewed prospective and retrospective studies involving the assessment of allergy using human birth cohorts between 2014 and 2021 were evaluated. RESULTS: Parental history of allergic diseases, especially in cases involving both parents, is associated with increased risk of allergy. Exposure to prenatal and postnatal smoking and limited diet diversity were associated with increased allergic burden. The impact of early-life infections and antibiotics on disease development may be associated with the onset of asthma, though this remains debated. Cohort studies also revealed that the mode of delivery and breastfeeding duration affect the odds ratio of asthma and eczema development. Household exposures, including pets, house dust mites, and scented aeroallergens may confer protective effects, whereas high air pollution exposure and low socioeconomic status may be risk enhancing. Exposure to antibiotics during early life may be associated with increased asthma risk, whereas viral infections may lead to disease protection, though the impact of the coronavirus disease 2019 pandemic on allergic risk is yet to be understood. CONCLUSION: Although evaluating the risk of allergic disease development is complex, clinicians can apply these insights on the multifactorial nature of atopy to better understand and potentially mitigate disease development.


Subject(s)
Asthma/immunology , Breast Feeding/methods , Diet/methods , Eczema/immunology , Hypersensitivity/immunology , Inheritance Patterns/immunology , Allergens/administration & dosage , Animals , Anti-Bacterial Agents/adverse effects , Asthma/etiology , Asthma/genetics , Asthma/prevention & control , Cohort Studies , Eczema/etiology , Eczema/genetics , Eczema/prevention & control , Environmental Exposure/adverse effects , Environmental Pollutants/adverse effects , Female , Humans , Hypersensitivity/etiology , Hypersensitivity/genetics , Hypersensitivity/prevention & control , Pets/immunology , Pregnancy , Pyroglyphidae/chemistry , Pyroglyphidae/immunology , Risk Factors , Virus Diseases/immunology , Virus Diseases/virology
20.
J Allergy Clin Immunol Pract ; 9(4): 1508-1509, 2021 04.
Article in English | MEDLINE | ID: covidwho-1171527
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