Food allergy, dermatologic diseases, and anaphylaxisDiagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report
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Genetic and other risk factors for AD
Parental atopy, in particular AD, is significantly associated with the manifestation and severity of early AD in children. The circumstance by which the genetics of AD might play a role in the level of natural history and development has been reflected in 2 forms of genetic studies:
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genome-wide screens that identify broad regions of the genome linked with AD and
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candidate gene studies that examine a presumed contribution of genetic variants of disease-process genes in case-control association
Immunopathology
The pathophysiology of AD is the product of a complex interaction between various susceptibility genes, host environments, infectious agents, defects in skin barrier function, and immunologic responses.24 Activation of T lymphocytes, dendritic cells (DCs), macrophages, keratinocytes, mast cells, and eosinophils are characteristic of AD skin inflammatory responses.
Symptoms and signs and diagnostic criteria
The use of well-defined diagnostic criteria is important in the diagnosis of AD, especially for those patients who lack the typical phenotype of the disease, and the diagnostic criteria developed by Hanifin and Rajka are widely accepted (Fig 3).100 Other criteria have been developed101 that correlate well with those of Hanifin and Rajka, although use of only visible eczema as a criterion might lead to overdiagnosis of the disease. Skin biopsies are not essential for the diagnosis but might be
Systemic and topical treatment
The management of AD presents a clinical challenge.
Antimicrobial treatment
Systemic antibiotic treatment is indicated for widespread bacterial secondary infection, (primarily S aureus). First- or second-generation cephalosporins or semisynthetic penicillins for 7 to 10 days are usually effective. Erythromycin-resistant organisms are fairly common, making macrolides less useful alternatives.159 In cases of penicillin or cephalosporin allergy, clindamycin or oral fusidic acid are possible alternatives. Unfortunately, recolonization after a course of antistaphylococcal
Education
The goal of the patients' education should be living with atopic dermatitis by means of an empowered patient or, in the case of infants and young children, a caregiver who can work as a partner with the doctor in self-managing their own or their children's disease.
Education to enhance disease knowledge, psychologic improvement in disease perception, and scratch control behavior modification, together with regular daily treatment, will lead to better skin care. This improvement in disease
Potential approaches for primary and secondary prevention of AD
Based on the idea of diet as modulatory, a number of controlled interventions have tested this hypothesis of primary prevention through the nutritional route. Hydrolyzed cow's milk formula consists of predigested peptides of whey and casein. The formulas have equivalent nutritional values but a reduced capacity to induce IgE-mediated reactions.194, 195, 196, 197 A large controlled study in high-risk infants using different partially and extensively hydrolyzed formulas for the first 6 months of
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This article is being copublished by The Journal of Allergy and Clinical Immunology and Allergy.
Disclosure of potential conflict of interest: T. Bieber has consultant arrangements with Novartis and Schering. C. Bindslev-Jensen serves on the advisory board for Schering-Plough. A. Kapp has received grants/research support from Novartis, Astellas, UCB, ALK, and DPO and served on the speakers' bureau for Novartis, Astellas, UCB, and ALK. K. Turjanmaa a grant and research support from Ansell. U. Wahn has received grants and lecture honoraria from Novartis, MSD, GSK, UCB-Pharma, ALK, and Stallergenes. T. Zuberbier has served on the speakers' bureau for Novartis, Schering-Plough, UCB, Schering, MSD, Stallergenes, and Leti. M. Boguniewicz has received grants/research support from Novartis, Astellas, and Sinclair and has received lecture honoraria from Novartis and Astellas. D. Y. M. Leung has received grants/research support from Novartis and has served on the speakers' bureau for Novartis and Astellas. L. Rosenwasser has consultant arrangements with Novartis and Genentech. J. Spergel has received grants/research support from Novartis and the NIH and served on the speakers' bureau for GSK and Astellas. The rest of the authors have declared that they have no conflict of interest.
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The EAACI/AAAAI/PRACTALL Consensus Group was chaired by Professor Ulrich Wahn.
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The PRACTALL program is a common initiative of both academies, focusing on practical issues of allergology. It is supported by an unrestricted educational grant from Novartis.