Predictors of severe course of atopic dermatitis
AbstractAtopic dermatitis (AD) is a common inflammatory skin disease that occurs most frequently in children. The disease is characterized as chronic, but only 20% of children suffer from severe AD, while the other 80% reach a long-term remission by the age of 8. The aim of the research was the analysis of modern sources of domestic and foreign literature, highlighting the features of the course of severe forms of AD.
Results. The multifactorial nature of AD pathogenesis, based on the complex interaction of genetic factors, the immune system, the skin microbiome and environmental factors, causes certain difficulties for the physician, both in the diagnosis and therapy selection, and in predicting the course of the disease. Each patient has his own individual combination of clinical symptoms, medical history and aggravating factors that should be considered as predictors of the severity of the disease.
Conclusion. Particular attention should be paid to patients with an early onset of AD, increased transepidermal water loss, with extensive skin lesions at the onset of the disease and under dynamic observation, with concomitant food allergies and/or bronchial asthma.
Keywords:atopic dermatitis; predictors; filaggrin; food allergy; bronchial asthma
Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Glukhova E.A., Mukhortykh V.A., Tamrazova O.B., Taganov A.V., Revyakina V.A. Predictors of severe course of atopic dermatitis. Voprosy pitaniia [Problems of Nutrition]. 2022; 91 (1): 76-85. DOI: https://doi.org/10.33029/0042-8833-2022-91-1-76-85 (in Russian)
References
1. Silverwood R.J., Forbes H.J., Abuabara K., Ascott A., Schmidt M., Schmidt S.A.J., et al. Severe and predominantly active atopic eczema in adulthood and long term risk of cardiovascular disease: population based cohort study. BMJ. 2018; 23 (361): 1786. DOI: https://doi.org/10.1136/bmj.k1786.
2. Mancini A.J., Kaulback K., Chamlin S.L. The socioeconomic impact of atopic dermatitis in the United States: a systematic review. Pediatr Dermatol. 2008; 25 (1): 1–6. DOI: https://doi.org/10.1111/j.1525-1470.2007.00572.x
3. Spergel J.M. From atopic dermatitis to asthma: the atopic march. Ann Allergy Asthma Immunol. 2010; 105 (2): 99–106. DOI: https://doi.org/10.1016/j.anai.2009.10.002
4. Sun D., Ong P.Y. Infectious complications in atopic dermatitis. Immunol Allergy Clin North Am. 2017; 37 (1): 75–93. DOI: https://doi.org/10.1016/j.iac.2016.08.015
5. Klinnert M.D., Booster G., Copeland M., Darr J.M., Meltzer L.J., Miller M., et al. Role of behavioral health in management of pediatric atopic dermatitis. Ann Allergy Asthma Immunol. 2018; 120 (1): 42–48. DOI: https://doi.org/10.1016/j.anai.2017.10.023
6. Consensus based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children. Part I. EDF-Guidelines. 2018. Available from: http://www.turkderm.org.tr/turkdermData/Uploads/files/EDF-guideline-Atopic-Eczema-update%202018.pdf
7. Kim J.P., Chao L.X., Simpson E.L., Silverberg J.I. Persistence of atopic dermatitis (AD): A systematic review and meta-analysis. J Am Acad Dermatol. 2016; 75 (4): 681–7. DOI: https://doi.org/10.1016/j.jaad.2016.05.028
8. Hanifin J.M., Rajka G. Diagnositic features of atopic dermatitis. Acta Derm Venereol (Stockh). 1980; 92: 44–7. DOI: https://doi.org/10.2340/00015555924447
9. Brenninkmeijer E.E., Schram M.E., Leeflang M.M., Bos J.D., Spuls P.I. Diagnostic criteria for atopic dermatitis: a systematic review. Br J Dermatol. 2008; 158 (4): 754–65. DOI: https://doi.org/10.1111/j.1365-2133.2007.08412.x
10. Liu P., Zhao Y., Mu Z.L., Lu Q.J., Zhang L., Yao X., et al. Clinical features of adult/adolescent atopic dermatitis and Chinese criteria for atopic dermatitis. Chin Med J (Engl). 2016; 129 (7): 757–62. DOI: https://doi.org/10.4103/0366-6999
11. Kim J., Kim B.E., Leung D.Y.M. Pathophysiology of atopic dermatitis: clinical implications. Allergy Asthma Proc. 2019; 40 (2): 84–92. DOI: https://doi.org/10.2500/aap.2019.40.4202
12. Kim Y., Blomberg M., Rifas-Shiman S.L., Camargo C.A. Jr., Gold D.R., Thyssen J.P., et al. Racial/ethnic differences in incidence and persistence of childhood atopic dermatitis. J Invest Dermatol. 2019; 139 (4): 827–34. DOI: https://doi.org/10.1016/j.jid.2018.10.029
13. Levin M.E., Botha M., Basera W., Facey-Thomas H.E., Gaunt B., Gray C.L., et al. Environmental factors associated with allergy in urban and rural children from the South African Food Allergy (SAFFA) cohort. J Allergy Clin Immunol. 2020; 145 (1): 415–26. DOI: https://doi.org/10.1016/j.jaci.2019.07.048
14. Lauffer F., Baghin V., Standl M., Stark S.P., Jargosch M., Wehrle J., et al. Predicting persistence of atopic dermatitis in children using clinical attributes and serum proteins. Allergy. 2021; 76 (4): 1158–72. DOI: https://doi.org/10.1111/all.14557
15. Gerner T., Haugaard J.H., Vestergaard C., Deleuran M., Jemec G.B., Mortz C.G., et al. Disease severity and trigger factors in Danish children with atopic dermatitis: a nationwide study. J Eur Acad Dermatol Venereol. 2021; 35 (4): 948–57. DOI: https://doi.org/10.1111/jdv.17007
16. Thorsteinsdottir S., Stokholm J., Thyssen J.P., Nørgaard S., Thorsen J., Chawes B.L. et al. Genetic, clinical, and environmental factors associated with persistent atopic dermatitis in childhood. JAMA Dermatol. 2019; 155 (1): 50–7. DOI: https://doi.org/10.1001/jamadermatol.2018.4061
17. Kim B.E., Leung D.Y.M. Significance of skin barrier dysfunction in atopic dermatitis. Allergy Asthma Immunol Res. 2018; 10 (3): 207–15. DOI: https://doi.org/10.4168/aair.2018.10.3.207
18. Czarnowicki T., He H., Krueger J.G., Guttman-Yassky E. Atopic dermatitis endotypes and implications for targeted therapeutics. J Allergy Clin Immunol. 2019; 143 (1): 1–11. DOI: https://doi.org/10.1016/j.jaci.2018.10.032
19. Riethmuller C., McAleer M.A., Koppes S.A., Abdayem R., Franz J., Haftek M., et al. Filaggrin breakdown products determine corneocyte conformation in patients with atopic dermatitis. J Allergy Clin Immunol. 2015; 136 (6): 1573–80. DOI: https://doi.org/10.1016/j.jaci.2015.04.042
20. Berdyshev E., Goleva E., Bronova I., Dyjack N., Rios C., Jung J., et al. Lipid abnormalities in atopic skin are driven by type 2 cytokines. JCI Insight. 2018; 3 (4): e98006. DOI: https://doi.org/10.1172/jci.insight.98006
21. Alexander H., Brown S., Danby S., Flohr C. Research techniques made simple: transepidermal water loss measurement as a research tool. J Invest Dermatol. 2018; 138 (11): 2295–300. DOI: https://doi.org/10.1016/j.jid.2018.09.001
22. Horimukai K., Morita K., Narita M., Kondo M., Kabashima S., Inoue E., et al. Transepidermal water loss measurement during infancy can predict the subsequent development of atopic dermatitis regardless of filaggrin mutations. Allergol Int. 2016; 65 (1): 103–8. DOI: https://doi.org/10.1016/j.alit.2015.09
23. Federal Clinical Guidelines for the Management of Patients with Ichthyosis; 2015. (in Russian)
24. Thijs J.L., Knipping K., Bruijnzeel-Koomen C.A., Garssen J., de Bruin-Weller M.S., Hijnen D.J. Immunoglobulin free light chains in adult atopic dermatitis patients do not correlate with disease severity. Clin Transl Allergy. 2016; 6 (44). DOI: https://doi.org/10.1186/s13601-016-0132-9
25. Hamilton J.D., Ungar B., Guttman-Yassky E. Drug evaluation review: dupilumab in atopic dermatitis. Immunotherapy. 2015; 7 (10): 1043–58. DOI: https://doi.org/10.2217/imt.15.69
26. Renert-Yuval Y., Thyssen J.P., Bissonnette R., Bieber T., Kabashima K., Hijnen D., et al. Biomarkers in atopic dermatitis-a review on behalf of the International Eczema Council. J Allergy Clin Immunol. 2021; 147 (4): 1174–90. DOI: https://doi.org/10.1016/j.jaci.2021.01.013
27. Miyahara H., Okazaki N., Nagakura T., Korematsu S., Izumi T. Elevated umbilical cord serum TARC/CCL17 levels predict the development of atopic dermatitis in infancy. Clin Exp Allergy. 2011; 41 (2): 186–91. DOI: https://doi.org/10.1111/j.1365-2222.2010.03634.x
28. Wen H.J., Wang Y.J., Lin Y.C., Chang C.C., Shieh C.C., Lung F.W., et al. Prediction of atopic dermatitis in 2-yr-old children by cord blood IgE, genetic polymorphisms in cytokine genes, and maternal mentality during pregnancy. Pediatr Allergy Immunol. 2011; 22 (7): 695–703. DOI: https://doi.org/10.1111/j.1399-3038.2011.01177.x
29. Ahrens B., Schulz G., Bellach J., Niggemann B., Beyer K. Chemokine levels in serum of children with atopic dermatitis with regard to severity and sensitization status. Pediatr Allergy Immunol. 2015; 26 (7): 634–40. DOI: https://doi.org/10.1111/pai.12431
30. Murayama T., Nakamura K., Tsuchida T. Eosinophilic pustular folliculitis with extensive distribution: correlation of serum TARC levels and peripheral blood eosinophil numbers. Int J Dermatol. 2015; 54 (9): 1071–4. DOI: https://doi.org/10.1111/ijd.12281
31. Motegi S., Hattori M., Shimizu A., Abe M., Ishikawa O. Elevated serum levels of TARC/CCL17, Eotaxin-3/CCL26 and VEGF in a patient with Kimura's disease and prurigo-like eruption. Acta Derm Venereol. 2014; 94 (1): 112–3. DOI: https://doi.org/10.2340/00015555-1623
32. Cuccaro A., Annunziata S., Cupelli E., Martini M., Calcagni M.L., Rufini V., et al. CD68+ cell count, early evaluation with PET and plasma TARC levels predict response in Hodgkin lymphoma. Cancer Med. 2016; 5 (3): 398–406. DOI: https://doi.org/10.1002/cam4.585
33. Zheng T., Yu J., Oh M.H., Zhu Z. The atopic march: progression from atopic dermatitis to allergic rhinitis and asthma. Allergy Asthma Immunol Res. 2011; 3 (2): 67–73. DOI: https://doi.org/10.4168/aair.2011.3.2.67
34. Davidson W.F., Leung D.Y.M., Beck L.A., Berin C.M., Boguniewicz M., Busse W.W., et al. Report from the National Institute of Allergy and Infectious Diseases Workshop on “Atopic Dermatitis and the Atopic March: Mechanisms and Interventions”. J Allergy Clin Immunol. 2019; 143 (3): 894–913. DOI: https://doi.org/10.1016/j.jaci.2019.01.003
35. Wisniewski J.A., Agrawal R., Minnicozzi S., Xin W., Patrie J., Heymann P.W., et al. Sensitization to food and inhalant allergens in relation to age and wheeze among children with atopic dermatitis. Clin Exp Allergy. 2013; 43 (10): 1160–70. DOI: https://doi.org/10.1111/cea.12169
36. Kulig M., Bergmann R., Tacke U.,Wahn U., Guggenmoos-Holzmann I. Long-lasting sensitization to food during the first two years precedes allergic airway disease. The MAS Study Group, Germany. Pediatr Allergy Immunol. 1998; 9 (2): 61–7. DOI: https://doi.org/10.1111/j.1399-3038.1998.tb00305.x
37. Du Toit G., Roberts G., Sayre P.H., Plaut M., Bahnson H.T., Mitchell H., et al. Identifying infants at high risk of peanut allergy: the Learning Early About Peanut Allergy (LEAP) screening study. J Allergy Clin Immunol. 2013; 131 (1): 135–43. DOI: https://doi.org/10.1016/j.jaci.2012.09.015
38. Revyakina V.A., Larkova I.A., Kuvshinova E.D., Shavkina M.I., Mukhortykh V.A. Phenotypes of food allergy in children. Voprosy pitaniia [Problems of Nutrition]. 2016; 85 (1): 75–80. (in Russian)
39. Han H., Roan F., Ziegler S.F. The atopic march: current insights into skin barrier dysfunction and epithelial cell-derived cytokines. Immunol Rev. 2017; 278 (1): 116–30. DOI: https://doi.org/10.1111/imr.12546
40. Garrett J.P., Apter A.J., Hoffstad O., Spergel J.M., Margolis D.J. Asthma and frequency of wheeze: risk factors for the persistence of atopic dermatitis in children. Ann Allergy Asthma Immunol. 2013; 110 (3): 146–9. DOI: https://doi.org/10.1016/j.anai.2012.12.013
41. Peters A.S., Kellberger J., Vogelberg C., Dressel H., Windstetter D., Weinmayr G., et al. Prediction of the incidence, recurrence, and persistence of atopic dermatitis in adolescence: a prospective cohort study. J Allergy Clin Immunol. 2010; 126 (3): 590–5. DOI: https://doi.org/10.1016/j.jaci.2010.06.020
42. Paternoster L., Savenije O.E.M., Heron J., Evans D.M., Vonk J.M., Brunekreef B., et al. Identification of atopic dermatitis subgroups in children from 2 longitudinal birth cohorts. J Allergy Clin Immunol. 2018; 141 (3): 964–71. DOI: https://doi.org/10.1016/j.jaci.2017.09.044