ABSTRACT
This review provides a summary of key findings from nine systematic reviews on atopic eczema (AE) published over the 2-year period from January 2012 to 31 December 2013, focusing on epidemiology, mechanisms of disease and methodological issues. There is now reasonable evidence to suggest that antibiotic exposure in early life is associated with increased incidence of AE, but delivery by caesarean section is not. The prevalence of AE is increasing in Africa, eastern Asia, western Europe and parts of northern Europe. Autoimmunity may play a part in the development and subsequent severity of AE. For researchers conducting clinical trials and other prospective studies involving patients with AE, the two best-validated scales for capturing objective clinical signs of AE are the Eczema Assessment Severity scale (EASI) and the objective SCORing Atopic Dermatitis scale (objSCORAD). For the assessment of quality of life in children aged 0-3 years, the Infant Dermatitis Quality of Life scale (IDQoL) is reasonably well validated. A standardized definition of an incident case of AE for use in prevention studies is still required.
Subject(s)
Dermatitis, Atopic , Anti-Bacterial Agents/adverse effects , Dermatitis, Atopic/diagnosis , Dermatitis, Atopic/epidemiology , Dermatitis, Atopic/etiology , Humans , Interleukin-10/genetics , Polymorphism, Genetic , Quality of Life , Review Literature as Topic , Risk Factors , Severity of Illness IndexABSTRACT
This review provides a summary of key findings from 22 systematic reviews on atopic eczema (AE) published over the 2-year period from January 2012 to 31 December 2013, focusing on prevention and treatment of AE. For an update of systematic reviews on the epidemiology, mechanisms of disease and methodological issues, see Part 1 of this update. Based on current systematic review evidence, the most promising intervention for the prevention of AE is the use of probiotics (and possibly prebiotics) during the late stages of pregnancy and early life. Exposure to household pets, especially dogs, may also be protective, but exclusive breastfeeding for up to 7 months does not confer benefit. The role of vitamin D in preventing AE is currently unclear. Very few of the systematic reviews provided additional evidence for the use of specific treatments for AE. Further research is required to establish the role of desensitization, Chinese herbal medicines, homeopathy and specialist clothing. Nevertheless, there is now clear evidence that evening primrose oil and borage oil are not effective for the treatment of AE. There have been no randomized controlled trials on the use of H1 anti-histamines as monotherapy for the treatment of AE.
Subject(s)
Dermatitis, Atopic/therapy , Animals , Breast Feeding , Complementary Therapies/methods , Dermatitis, Atopic/prevention & control , Desensitization, Immunologic/methods , Dogs , Histamine H1 Antagonists/therapeutic use , Humans , Immunosuppressive Agents/therapeutic use , Pets , Prebiotics/administration & dosage , Probiotics/administration & dosage , Vitamin D/therapeutic useSubject(s)
Anti-Inflammatory Agents/administration & dosage , Bell Palsy/drug therapy , Prednisolone/administration & dosage , Acyclovir/administration & dosage , Acyclovir/adverse effects , Anti-Inflammatory Agents/adverse effects , Antiviral Agents/administration & dosage , Antiviral Agents/adverse effects , Bell Palsy/diagnosis , Drug Administration Schedule , Drug Therapy, Combination , Follow-Up Studies , Humans , Prednisolone/adverse effects , Prognosis , Randomized Controlled Trials as TopicABSTRACT
BACKGROUND: To assess the accuracy of findings from the clinical history, symptoms, signs and diagnostic tests (ECG, CXR and natriuretic peptides) in relation to the diagnosis of left ventricular systolic dysfunction (LVSD) in a primary care setting. METHODS: Diagnostic accuracy systematic review, we searched Medline (1966 to March 2008), EMBASE (1988 to March 2008), Central, Cochrane and ZETOC using a diagnostic accuracy search filter. We included cross-sectional or cohort studies that assess the diagnostic utility of clinical history, symptoms, signs and diagnostic tests, against a reference standard of echocardiography. We calculated pooled positive and negative likelihood ratios and assessed heterogeneity using the I2 index. RESULTS: 24 studies incorporating 10,710 patients were included. The median prevalence of LVSD was 29.9% (inter-quartile range 14% to 37%). No item from the clinical history or symptoms provided sufficient diagnostic information to "rule in" or "rule out" LVSD. Displaced apex beat shows a convincing diagnostic effect with a pooled positive likelihood ratio of 16.0 (8.2-30.9) but this finding occurs infrequently in patients. ECG was the most widely studied diagnostic test, the negative likelihood ratio ranging from 0.06 to 0.6. Natriuretic peptide results were strongly heterogeneous, with negative likelihood ratios ranging from 0.02 to 0.80. CONCLUSION: Findings from the clinical history and examination are insufficient to "rule in" or "rule out" a diagnosis of LVSD in primary care settings. BNP and ECG measurement appear to have similar diagnostic utility and are most useful in "ruling out" LVSD with a normal test result when the probability of LVSD is in the intermediate range.
