Atopic Dermatitis

Although in many cases, food-allergen tolerance can be achieved with oral immunotherapy, primary prevention of food allergies remains crucial, according to the French Society of Allergology. In new recommendations that were presented at a session of the Congress of French Pediatric Societies, the academic society advocated early introduction of allergens for all children, starting at 4 months of age.

The latest prevention data from two major studies, LEAP and EAT, have prompted European and French experts to rethink their stance on food diversification. The new French proposals were recently published under the coordination of Dominique Sabouraud-Leclerc, MD, pediatrics department, Reims (France) University Hospital, on behalf of the Food Allergy Working Group of the French Society of Allergology.

For all newborns, regardless of whether they have a history of atopic or nonatopic dermatitis, food diversification is now recommended from 4 months of age instead of 6 months, as was previously recommended. If the child does not develop atopic dermatitis or develops only a mild form, peanuts, eggs, and nuts may be introduced at home.

However, if the child experiences severe atopic dermatitis, an allergy testing panel for peanuts, nuts, eggs, and cow’s milk proteins should be performed. An oral food challenge may be conducted at the allergist’s discretion.

Regarding peanuts, the working group proposed introducing a purée in the form of either a mixture of peanuts/hazelnuts/cashew nuts (1 level teaspoon five times a week; 2 g of protein/food per week) or a 100% peanut paste (1 scant teaspoon four times a week; 2 g of peanut protein/week). If the family is worried, the allergist can suggest monitoring the child in the clinic waiting room for 30 minutes after the first dose.

“We shouldn’t delay the introduction of the primary allergens anymore, regardless of whether children are at risk for a food allergy, and particularly a peanut allergy,” explained Stéphanie Lejeune, MD, pediatric pulmonologist and allergist at Lille (France) Regional University Hospital, who presented these new findings at the congress. “In fact, if we only target at-risk children, we overlook children with no family history who will nevertheless develop food allergies. The idea is to introduce everything, especially peanuts, between 4 and 6 months of age and to no longer do so gradually, one food after another, as was being done until now, beginning at 6 months and over. We must give priority to regularity over quantity.”

Although this approach is based on clinical trials, no real-life data are currently available.
 

LEAP and EAT studies support early introduction of peanuts

A study from 2021 summed up the risk factors for peanut allergy. About 61% of infants (4-11 months) had atopic dermatitis, 18% had a food allergy, 62% had a first-degree relative with a peanut allergy, and 11% had a confirmed peanut allergy. The risk of peanut allergy increased with age and severe eczema.

In 2015, the LEAP study, which was conducted in the United Kingdom with 640 infants aged 4-11 months who had risk factors for peanut allergy, revolutionized peanut-allergy primary prevention. Regardless of whether the children were sensitized or not, the number of children who developed a peanut allergy was systematically lower in the group that ingested the allergen in comparison with the “avoidance” group.

Additionally, the LEAP-ON study showed that protection against peanut allergy persisted for 12 months after cessation of consumption between ages 5 and 6 years among children who had consumed peanuts previously.

Early diversification in the general population was investigated in the EAT study, which involved 1303 breastfed infants. Of these infants, 24% had atopic dermatitis (median SCORAD score, 7.5). They were divided into two arms: avoidance and breast feeding until 6 months (standard introduction) or early introduction at 3 months (boiled egg, milk, peanuts, sesame, white fish, wheat, 2 g of protein twice a week). In the per-protocol analysis, there were 13 cases of peanut allergy in the standard introduction group; there were no cases in the early introduction group.

A version of this article first appeared on Medscape.com.

Although in many cases, food-allergen tolerance can be achieved with oral immunotherapy, primary prevention of food allergies remains crucial, according to the French Society of Allergology. In new recommendations that were presented at a session of the Congress of French Pediatric Societies, the academic society advocated early introduction of allergens for all children, starting at 4 months of age.

The latest prevention data from two major studies, LEAP and EAT, have prompted European and French experts to rethink their stance on food diversification. The new French proposals were recently published under the coordination of Dominique Sabouraud-Leclerc, MD, pediatrics department, Reims (France) University Hospital, on behalf of the Food Allergy Working Group of the French Society of Allergology.

For all newborns, regardless of whether they have a history of atopic or nonatopic dermatitis, food diversification is now recommended from 4 months of age instead of 6 months, as was previously recommended. If the child does not develop atopic dermatitis or develops only a mild form, peanuts, eggs, and nuts may be introduced at home.

However, if the child experiences severe atopic dermatitis, an allergy testing panel for peanuts, nuts, eggs, and cow’s milk proteins should be performed. An oral food challenge may be conducted at the allergist’s discretion.

Regarding peanuts, the working group proposed introducing a purée in the form of either a mixture of peanuts/hazelnuts/cashew nuts (1 level teaspoon five times a week; 2 g of protein/food per week) or a 100% peanut paste (1 scant teaspoon four times a week; 2 g of peanut protein/week). If the family is worried, the allergist can suggest monitoring the child in the clinic waiting room for 30 minutes after the first dose.

“We shouldn’t delay the introduction of the primary allergens anymore, regardless of whether children are at risk for a food allergy, and particularly a peanut allergy,” explained Stéphanie Lejeune, MD, pediatric pulmonologist and allergist at Lille (France) Regional University Hospital, who presented these new findings at the congress. “In fact, if we only target at-risk children, we overlook children with no family history who will nevertheless develop food allergies. The idea is to introduce everything, especially peanuts, between 4 and 6 months of age and to no longer do so gradually, one food after another, as was being done until now, beginning at 6 months and over. We must give priority to regularity over quantity.”

Although this approach is based on clinical trials, no real-life data are currently available.
 

LEAP and EAT studies support early introduction of peanuts

A study from 2021 summed up the risk factors for peanut allergy. About 61% of infants (4-11 months) had atopic dermatitis, 18% had a food allergy, 62% had a first-degree relative with a peanut allergy, and 11% had a confirmed peanut allergy. The risk of peanut allergy increased with age and severe eczema.

In 2015, the LEAP study, which was conducted in the United Kingdom with 640 infants aged 4-11 months who had risk factors for peanut allergy, revolutionized peanut-allergy primary prevention. Regardless of whether the children were sensitized or not, the number of children who developed a peanut allergy was systematically lower in the group that ingested the allergen in comparison with the “avoidance” group.

Additionally, the LEAP-ON study showed that protection against peanut allergy persisted for 12 months after cessation of consumption between ages 5 and 6 years among children who had consumed peanuts previously.

Early diversification in the general population was investigated in the EAT study, which involved 1303 breastfed infants. Of these infants, 24% had atopic dermatitis (median SCORAD score, 7.5). They were divided into two arms: avoidance and breast feeding until 6 months (standard introduction) or early introduction at 3 months (boiled egg, milk, peanuts, sesame, white fish, wheat, 2 g of protein twice a week). In the per-protocol analysis, there were 13 cases of peanut allergy in the standard introduction group; there were no cases in the early introduction group.

A version of this article first appeared on Medscape.com.

Although in many cases, food-allergen tolerance can be achieved with oral immunotherapy, primary prevention of food allergies remains crucial, according to the French Society of Allergology. In new recommendations that were presented at a session of the Congress of French Pediatric Societies, the academic society advocated early introduction of allergens for all children, starting at 4 months of age.

The latest prevention data from two major studies, LEAP and EAT, have prompted European and French experts to rethink their stance on food diversification. The new French proposals were recently published under the coordination of Dominique Sabouraud-Leclerc, MD, pediatrics department, Reims (France) University Hospital, on behalf of the Food Allergy Working Group of the French Society of Allergology.

For all newborns, regardless of whether they have a history of atopic or nonatopic dermatitis, food diversification is now recommended from 4 months of age instead of 6 months, as was previously recommended. If the child does not develop atopic dermatitis or develops only a mild form, peanuts, eggs, and nuts may be introduced at home.

However, if the child experiences severe atopic dermatitis, an allergy testing panel for peanuts, nuts, eggs, and cow’s milk proteins should be performed. An oral food challenge may be conducted at the allergist’s discretion.

Regarding peanuts, the working group proposed introducing a purée in the form of either a mixture of peanuts/hazelnuts/cashew nuts (1 level teaspoon five times a week; 2 g of protein/food per week) or a 100% peanut paste (1 scant teaspoon four times a week; 2 g of peanut protein/week). If the family is worried, the allergist can suggest monitoring the child in the clinic waiting room for 30 minutes after the first dose.

“We shouldn’t delay the introduction of the primary allergens anymore, regardless of whether children are at risk for a food allergy, and particularly a peanut allergy,” explained Stéphanie Lejeune, MD, pediatric pulmonologist and allergist at Lille (France) Regional University Hospital, who presented these new findings at the congress. “In fact, if we only target at-risk children, we overlook children with no family history who will nevertheless develop food allergies. The idea is to introduce everything, especially peanuts, between 4 and 6 months of age and to no longer do so gradually, one food after another, as was being done until now, beginning at 6 months and over. We must give priority to regularity over quantity.”

Although this approach is based on clinical trials, no real-life data are currently available.
 

LEAP and EAT studies support early introduction of peanuts

A study from 2021 summed up the risk factors for peanut allergy. About 61% of infants (4-11 months) had atopic dermatitis, 18% had a food allergy, 62% had a first-degree relative with a peanut allergy, and 11% had a confirmed peanut allergy. The risk of peanut allergy increased with age and severe eczema.

In 2015, the LEAP study, which was conducted in the United Kingdom with 640 infants aged 4-11 months who had risk factors for peanut allergy, revolutionized peanut-allergy primary prevention. Regardless of whether the children were sensitized or not, the number of children who developed a peanut allergy was systematically lower in the group that ingested the allergen in comparison with the “avoidance” group.

Additionally, the LEAP-ON study showed that protection against peanut allergy persisted for 12 months after cessation of consumption between ages 5 and 6 years among children who had consumed peanuts previously.

Early diversification in the general population was investigated in the EAT study, which involved 1303 breastfed infants. Of these infants, 24% had atopic dermatitis (median SCORAD score, 7.5). They were divided into two arms: avoidance and breast feeding until 6 months (standard introduction) or early introduction at 3 months (boiled egg, milk, peanuts, sesame, white fish, wheat, 2 g of protein twice a week). In the per-protocol analysis, there were 13 cases of peanut allergy in the standard introduction group; there were no cases in the early introduction group.

A version of this article first appeared on Medscape.com.

Key clinical point: The prevalence of keratosis pilaris (KP) was low in Finnish patients with atopic dermatitis (AD), with no evidence of KP serving as a predictor of AD severity or its early onset.

Major finding: KP was less frequent in patients with AD (28 with vs. 319 without KP), with no association observed between KP and AD severity based on the Eczema Area and Severity Index at the clinical visit (P = .3232; 95% CI 0.276-0.357) or Rajka Langeland severity score (P = .649; 95% CI 0.569-0.654) and early onset of AD (odds ratio 0.616; 95% CI 0.225-1.690).

Study details: Findings are from a cross-sectional, observational study including 502 patients with AD.

Disclosures: This study was funded by University of Helsinki. The authors declared no conflicts of interest.

Source: Salava A et al. Keratosis pilaris and filaggrin loss-of-function mutations in patients with atopic dermatitis – Results of a Finnish cross-sectional study. J Dermatol. 2022 (May 26). Doi: 10.1111/1346-8138.16477

Key clinical point: The prevalence of keratosis pilaris (KP) was low in Finnish patients with atopic dermatitis (AD), with no evidence of KP serving as a predictor of AD severity or its early onset.

Major finding: KP was less frequent in patients with AD (28 with vs. 319 without KP), with no association observed between KP and AD severity based on the Eczema Area and Severity Index at the clinical visit (P = .3232; 95% CI 0.276-0.357) or Rajka Langeland severity score (P = .649; 95% CI 0.569-0.654) and early onset of AD (odds ratio 0.616; 95% CI 0.225-1.690).

Study details: Findings are from a cross-sectional, observational study including 502 patients with AD.

Disclosures: This study was funded by University of Helsinki. The authors declared no conflicts of interest.

Source: Salava A et al. Keratosis pilaris and filaggrin loss-of-function mutations in patients with atopic dermatitis – Results of a Finnish cross-sectional study. J Dermatol. 2022 (May 26). Doi: 10.1111/1346-8138.16477

Key clinical point: The prevalence of keratosis pilaris (KP) was low in Finnish patients with atopic dermatitis (AD), with no evidence of KP serving as a predictor of AD severity or its early onset.

Major finding: KP was less frequent in patients with AD (28 with vs. 319 without KP), with no association observed between KP and AD severity based on the Eczema Area and Severity Index at the clinical visit (P = .3232; 95% CI 0.276-0.357) or Rajka Langeland severity score (P = .649; 95% CI 0.569-0.654) and early onset of AD (odds ratio 0.616; 95% CI 0.225-1.690).

Study details: Findings are from a cross-sectional, observational study including 502 patients with AD.

Disclosures: This study was funded by University of Helsinki. The authors declared no conflicts of interest.

Source: Salava A et al. Keratosis pilaris and filaggrin loss-of-function mutations in patients with atopic dermatitis – Results of a Finnish cross-sectional study. J Dermatol. 2022 (May 26). Doi: 10.1111/1346-8138.16477

Key clinical point: A substantial proportion of adults with atopic dermatitis showed contact hypersensitivity to preservatives (PCHS), thus highlighting the need for patch testing in case of worsening skin symptoms because of topical medications or personal care products.

Major finding: The most common preservatives affecting patients with concomitant AD and PCHS were methylisothiazolinone (MI; 83.8%) and 3:1 ratio of methylchloroisothiazolinone/MI (Kathon CG; 36.8%), followed by methyldibromo-glutaronitrile (16.2%), paraben (11.8%), and formaldehyde (7.4%). The majority of patients (79.41%) had one PCHS, whereas 17.65% of patients had two PCHS, with MI and Kathon CG being the most common combination.

Study details: Findings are from a 15-year retrospective study including 723 adults with PCHS and 639 adults with AD, of which 68 patients had concomitant AD and PCHS.

Disclosures: This study was funded by Semmelweis 250+ PhD Excellency Scholarship, Hungary. The authors declared no conflicts of interest.

Source: Nemeth D et al. Preservative contact hypersensitivity among adult atopic dermatitis patients. Life (Basel). 2022;12(5): 715 (May 11). Doi: 10.3390/life12050715

Key clinical point: A substantial proportion of adults with atopic dermatitis showed contact hypersensitivity to preservatives (PCHS), thus highlighting the need for patch testing in case of worsening skin symptoms because of topical medications or personal care products.

Major finding: The most common preservatives affecting patients with concomitant AD and PCHS were methylisothiazolinone (MI; 83.8%) and 3:1 ratio of methylchloroisothiazolinone/MI (Kathon CG; 36.8%), followed by methyldibromo-glutaronitrile (16.2%), paraben (11.8%), and formaldehyde (7.4%). The majority of patients (79.41%) had one PCHS, whereas 17.65% of patients had two PCHS, with MI and Kathon CG being the most common combination.

Study details: Findings are from a 15-year retrospective study including 723 adults with PCHS and 639 adults with AD, of which 68 patients had concomitant AD and PCHS.

Disclosures: This study was funded by Semmelweis 250+ PhD Excellency Scholarship, Hungary. The authors declared no conflicts of interest.

Source: Nemeth D et al. Preservative contact hypersensitivity among adult atopic dermatitis patients. Life (Basel). 2022;12(5): 715 (May 11). Doi: 10.3390/life12050715

Key clinical point: A substantial proportion of adults with atopic dermatitis showed contact hypersensitivity to preservatives (PCHS), thus highlighting the need for patch testing in case of worsening skin symptoms because of topical medications or personal care products.

Major finding: The most common preservatives affecting patients with concomitant AD and PCHS were methylisothiazolinone (MI; 83.8%) and 3:1 ratio of methylchloroisothiazolinone/MI (Kathon CG; 36.8%), followed by methyldibromo-glutaronitrile (16.2%), paraben (11.8%), and formaldehyde (7.4%). The majority of patients (79.41%) had one PCHS, whereas 17.65% of patients had two PCHS, with MI and Kathon CG being the most common combination.

Study details: Findings are from a 15-year retrospective study including 723 adults with PCHS and 639 adults with AD, of which 68 patients had concomitant AD and PCHS.

Disclosures: This study was funded by Semmelweis 250+ PhD Excellency Scholarship, Hungary. The authors declared no conflicts of interest.

Source: Nemeth D et al. Preservative contact hypersensitivity among adult atopic dermatitis patients. Life (Basel). 2022;12(5): 715 (May 11). Doi: 10.3390/life12050715

Key clinical point: In a real-world setting, patients initiating dupilumab reported longstanding moderate-to-severe atopic dermatitis (AD) with frequent type 2 comorbidities and poor quality of life (QoL).

Major finding: Patients reported experiencing AD for a median duration of 17 years, with 93.3% of patients receiving treatments for AD in the previous year, 49.5% receiving systemic medications, and 65.4% reporting a history of ≥1 type 2 inflammatory comorbidities. Overall, 89.2% of patients had a disease severity score of 3/4 (moderate/severe AD) and a mean dermatology life quality index score of 12.7, indicating a severe effect of AD on QoL.

Study details: Findings are from an interim analysis of the ongoing longitudinal, prospective, observational PROSE study including 315 adults with physician-diagnosed AD who initiated dupilumab.

Disclosures: This study was sponsored by Sanofi and Regeneron Pharmaceuticals, Inc. Seven authors declared being employees and shareholders of Regeneron Pharmaceuticals or Sanofi, and the other authors reported ties with various sources, including Sanofi and Regeneron.

Source: Bagel J et al. Baseline demographics and severity and burden of atopic dermatitis in adult patients initiating dupilumab treatment in a real-world registry (PROSE). Dermatol Ther (Heidelb). 2022 (May 20). Doi: 10.1007/s13555-022-00742-w

Key clinical point: In a real-world setting, patients initiating dupilumab reported longstanding moderate-to-severe atopic dermatitis (AD) with frequent type 2 comorbidities and poor quality of life (QoL).

Major finding: Patients reported experiencing AD for a median duration of 17 years, with 93.3% of patients receiving treatments for AD in the previous year, 49.5% receiving systemic medications, and 65.4% reporting a history of ≥1 type 2 inflammatory comorbidities. Overall, 89.2% of patients had a disease severity score of 3/4 (moderate/severe AD) and a mean dermatology life quality index score of 12.7, indicating a severe effect of AD on QoL.

Study details: Findings are from an interim analysis of the ongoing longitudinal, prospective, observational PROSE study including 315 adults with physician-diagnosed AD who initiated dupilumab.

Disclosures: This study was sponsored by Sanofi and Regeneron Pharmaceuticals, Inc. Seven authors declared being employees and shareholders of Regeneron Pharmaceuticals or Sanofi, and the other authors reported ties with various sources, including Sanofi and Regeneron.

Source: Bagel J et al. Baseline demographics and severity and burden of atopic dermatitis in adult patients initiating dupilumab treatment in a real-world registry (PROSE). Dermatol Ther (Heidelb). 2022 (May 20). Doi: 10.1007/s13555-022-00742-w

Key clinical point: In a real-world setting, patients initiating dupilumab reported longstanding moderate-to-severe atopic dermatitis (AD) with frequent type 2 comorbidities and poor quality of life (QoL).

Major finding: Patients reported experiencing AD for a median duration of 17 years, with 93.3% of patients receiving treatments for AD in the previous year, 49.5% receiving systemic medications, and 65.4% reporting a history of ≥1 type 2 inflammatory comorbidities. Overall, 89.2% of patients had a disease severity score of 3/4 (moderate/severe AD) and a mean dermatology life quality index score of 12.7, indicating a severe effect of AD on QoL.

Study details: Findings are from an interim analysis of the ongoing longitudinal, prospective, observational PROSE study including 315 adults with physician-diagnosed AD who initiated dupilumab.

Disclosures: This study was sponsored by Sanofi and Regeneron Pharmaceuticals, Inc. Seven authors declared being employees and shareholders of Regeneron Pharmaceuticals or Sanofi, and the other authors reported ties with various sources, including Sanofi and Regeneron.

Source: Bagel J et al. Baseline demographics and severity and burden of atopic dermatitis in adult patients initiating dupilumab treatment in a real-world registry (PROSE). Dermatol Ther (Heidelb). 2022 (May 20). Doi: 10.1007/s13555-022-00742-w

Key clinical point: Face masks worn during the COVID-19 pandemic increased the quality of life by covering facial eczemas and increased the efficacy of dupilumab therapy by minimizing exposure to allergens and air pollution in patients with atopic dermatitis (AD).

Major finding: Although the prevalence of facial eczema was similar before and after the COVID-19 pandemic (P = .7618), patients with AD showed improved Dermatology Life Quality Index scores at baseline (13.14 vs. 23.06; P < .0001) along with a higher reduction in Eczema Area and Severity Index scores after 16 weeks of dupilumab treatment (−21.46 vs. −17.83; P = .0001) in the post- vs. pre-pandemic period.

Study details: Findings are from a retrospective study including 64 adults with moderate-to-severe AD who were assessed for facial involvement at baseline and after 16 weeks of dupilumab therapy in both the pre- and post-pandemic periods.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Vanessa M et al. Facial dermatoses and use of protective mask during Covid-19 pandemic: A clinical and psychological evaluation in patients affected by moderate–severe atopic dermatitis under treatment with dupilumab. Dermatol Ther. 2022; e15573 (May 10). Doi: 10.1111/dth.15573

Key clinical point: Face masks worn during the COVID-19 pandemic increased the quality of life by covering facial eczemas and increased the efficacy of dupilumab therapy by minimizing exposure to allergens and air pollution in patients with atopic dermatitis (AD).

Major finding: Although the prevalence of facial eczema was similar before and after the COVID-19 pandemic (P = .7618), patients with AD showed improved Dermatology Life Quality Index scores at baseline (13.14 vs. 23.06; P < .0001) along with a higher reduction in Eczema Area and Severity Index scores after 16 weeks of dupilumab treatment (−21.46 vs. −17.83; P = .0001) in the post- vs. pre-pandemic period.

Study details: Findings are from a retrospective study including 64 adults with moderate-to-severe AD who were assessed for facial involvement at baseline and after 16 weeks of dupilumab therapy in both the pre- and post-pandemic periods.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Vanessa M et al. Facial dermatoses and use of protective mask during Covid-19 pandemic: A clinical and psychological evaluation in patients affected by moderate–severe atopic dermatitis under treatment with dupilumab. Dermatol Ther. 2022; e15573 (May 10). Doi: 10.1111/dth.15573

Key clinical point: Face masks worn during the COVID-19 pandemic increased the quality of life by covering facial eczemas and increased the efficacy of dupilumab therapy by minimizing exposure to allergens and air pollution in patients with atopic dermatitis (AD).

Major finding: Although the prevalence of facial eczema was similar before and after the COVID-19 pandemic (P = .7618), patients with AD showed improved Dermatology Life Quality Index scores at baseline (13.14 vs. 23.06; P < .0001) along with a higher reduction in Eczema Area and Severity Index scores after 16 weeks of dupilumab treatment (−21.46 vs. −17.83; P = .0001) in the post- vs. pre-pandemic period.

Study details: Findings are from a retrospective study including 64 adults with moderate-to-severe AD who were assessed for facial involvement at baseline and after 16 weeks of dupilumab therapy in both the pre- and post-pandemic periods.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Vanessa M et al. Facial dermatoses and use of protective mask during Covid-19 pandemic: A clinical and psychological evaluation in patients affected by moderate–severe atopic dermatitis under treatment with dupilumab. Dermatol Ther. 2022; e15573 (May 10). Doi: 10.1111/dth.15573

Key clinical point: Probiotic supplementation reduced the clinical severity of atopic dermatitis (AD) and improved the quality of life (QoL) in adults with AD compared with control intervention.

Major finding: Probiotic vs. control intervention significantly reduced the clinical severity of AD in both the short-term (standard mean difference [SMD] 0.63; P = .04) and long-term (SMD 1.57; P < .001) and significantly improved the long-term QoL (SMD 0.74; P < .001), with a mixture of Lactobacillus salivarius and Bifidobacterium being the best supplementation for both short- and long-term outcomes (surface under the cumulative ranking 95.2%).

Study details: Finding are from a meta-analysis of nine studies including 402 adults who received probiotic supplementation (patients with AD; n = 208) or placebo or standard treatment only (control individuals; n = 194).

Disclosures: This study was supported by the Medical and Health Research Project of China Aerospace Science and Industry Corporation. The authors declared no conflicts of interest.

Source: Li Y et al. The efficacy of probiotics supplementation for the treatment of atopic dermatitis in adults: A systematic review and meta-analysis. J Dermatolog Treat. 2022 (Jun 7). Doi: 10.1080/09546634.2022.2080170

Key clinical point: Probiotic supplementation reduced the clinical severity of atopic dermatitis (AD) and improved the quality of life (QoL) in adults with AD compared with control intervention.

Major finding: Probiotic vs. control intervention significantly reduced the clinical severity of AD in both the short-term (standard mean difference [SMD] 0.63; P = .04) and long-term (SMD 1.57; P < .001) and significantly improved the long-term QoL (SMD 0.74; P < .001), with a mixture of Lactobacillus salivarius and Bifidobacterium being the best supplementation for both short- and long-term outcomes (surface under the cumulative ranking 95.2%).

Study details: Finding are from a meta-analysis of nine studies including 402 adults who received probiotic supplementation (patients with AD; n = 208) or placebo or standard treatment only (control individuals; n = 194).

Disclosures: This study was supported by the Medical and Health Research Project of China Aerospace Science and Industry Corporation. The authors declared no conflicts of interest.

Source: Li Y et al. The efficacy of probiotics supplementation for the treatment of atopic dermatitis in adults: A systematic review and meta-analysis. J Dermatolog Treat. 2022 (Jun 7). Doi: 10.1080/09546634.2022.2080170

Key clinical point: Probiotic supplementation reduced the clinical severity of atopic dermatitis (AD) and improved the quality of life (QoL) in adults with AD compared with control intervention.

Major finding: Probiotic vs. control intervention significantly reduced the clinical severity of AD in both the short-term (standard mean difference [SMD] 0.63; P = .04) and long-term (SMD 1.57; P < .001) and significantly improved the long-term QoL (SMD 0.74; P < .001), with a mixture of Lactobacillus salivarius and Bifidobacterium being the best supplementation for both short- and long-term outcomes (surface under the cumulative ranking 95.2%).

Study details: Finding are from a meta-analysis of nine studies including 402 adults who received probiotic supplementation (patients with AD; n = 208) or placebo or standard treatment only (control individuals; n = 194).

Disclosures: This study was supported by the Medical and Health Research Project of China Aerospace Science and Industry Corporation. The authors declared no conflicts of interest.

Source: Li Y et al. The efficacy of probiotics supplementation for the treatment of atopic dermatitis in adults: A systematic review and meta-analysis. J Dermatolog Treat. 2022 (Jun 7). Doi: 10.1080/09546634.2022.2080170

Key clinical point: Children born to mothers who received probiotics vs. placebo during gestation or 1 year after childbirth showed a lower risk for infantile atopic dermatitis (AD), but a similar risk for immunoglobulin E (IgE)-associated infantile AD or sensitive constitution.

Major finding: Children born to mothers in the probiotics vs. placebo group showed a lower risk for infantile AD (risk ratio [RR] 0.86; 95% CI 0.78-0.95), although the risk for IgE-associated infantile AD (RR 0.98; 95% CI 0.79-1.22) or sensitive constitution (RR 0.93; 95% CI 0.81-1.08) was similar between both the treatment groups.

Study details: Findings are from a meta-analysis of eight randomized controlled trials including 2575 infants born to mothers who received probiotics or placebo during gestation or 1 year after birth.

Disclosures: This study did not report any source of funding. The authors declared no conflicts of interest.

Source: Pan H, Su J. Association of probiotics with atopic dermatitis among infant: A meta-analysis of randomized controlled trials. Oxid Med Cell Longev. 2022;2022:5080190 (May 23). Doi: 10.1155/2022/5080190

Key clinical point: Children born to mothers who received probiotics vs. placebo during gestation or 1 year after childbirth showed a lower risk for infantile atopic dermatitis (AD), but a similar risk for immunoglobulin E (IgE)-associated infantile AD or sensitive constitution.

Major finding: Children born to mothers in the probiotics vs. placebo group showed a lower risk for infantile AD (risk ratio [RR] 0.86; 95% CI 0.78-0.95), although the risk for IgE-associated infantile AD (RR 0.98; 95% CI 0.79-1.22) or sensitive constitution (RR 0.93; 95% CI 0.81-1.08) was similar between both the treatment groups.

Study details: Findings are from a meta-analysis of eight randomized controlled trials including 2575 infants born to mothers who received probiotics or placebo during gestation or 1 year after birth.

Disclosures: This study did not report any source of funding. The authors declared no conflicts of interest.

Source: Pan H, Su J. Association of probiotics with atopic dermatitis among infant: A meta-analysis of randomized controlled trials. Oxid Med Cell Longev. 2022;2022:5080190 (May 23). Doi: 10.1155/2022/5080190

Key clinical point: Children born to mothers who received probiotics vs. placebo during gestation or 1 year after childbirth showed a lower risk for infantile atopic dermatitis (AD), but a similar risk for immunoglobulin E (IgE)-associated infantile AD or sensitive constitution.

Major finding: Children born to mothers in the probiotics vs. placebo group showed a lower risk for infantile AD (risk ratio [RR] 0.86; 95% CI 0.78-0.95), although the risk for IgE-associated infantile AD (RR 0.98; 95% CI 0.79-1.22) or sensitive constitution (RR 0.93; 95% CI 0.81-1.08) was similar between both the treatment groups.

Study details: Findings are from a meta-analysis of eight randomized controlled trials including 2575 infants born to mothers who received probiotics or placebo during gestation or 1 year after birth.

Disclosures: This study did not report any source of funding. The authors declared no conflicts of interest.

Source: Pan H, Su J. Association of probiotics with atopic dermatitis among infant: A meta-analysis of randomized controlled trials. Oxid Med Cell Longev. 2022;2022:5080190 (May 23). Doi: 10.1155/2022/5080190

Key clinical point: Dupilumab led to clinically meaningful improvements in atopic dermatitis (AD) severity, extent, and itch severity in a real-world population of adults with moderate-to-severe AD.

Major finding: At 4 months, the Investigator’s Global Assessment score reduced by ≥1 point in 81.8% of patients and by ≥2 points in 62.8% of patients. Additionally, at 4 months, the mean itch severity score and affected body surface area reduced from 7.0 to 2.8 and from 39.3% to 16.3% (both P < .0001), respectively, with improvements being significant regardless of age, sex, or treatment history (all P < .0001).

Study details: Findings are from a retrospective, observational study based on electronic medical records of adults with moderate-to-severe AD who were evaluated at 4 months after initiating dupilumab.

Disclosures: This study was funded by Regeneron Pharmaceuticals, Inc., and Sanofi. Four authors declared being current or former employees and stockholders of Sanofi or Regeneron Pharmaceuticals. The other authors declared ties with various sources, including Regeneron and Sanofi.

Source: Eichenfield LF et al. Real-world effectiveness of dupilumab in atopic dermatitis patients: Analysis of an electronic medical records dataset. Dermatol Ther (Heidelb). 2022 (May 11). Doi: 10.1007/s13555-022-00731-z

Key clinical point: Dupilumab led to clinically meaningful improvements in atopic dermatitis (AD) severity, extent, and itch severity in a real-world population of adults with moderate-to-severe AD.

Major finding: At 4 months, the Investigator’s Global Assessment score reduced by ≥1 point in 81.8% of patients and by ≥2 points in 62.8% of patients. Additionally, at 4 months, the mean itch severity score and affected body surface area reduced from 7.0 to 2.8 and from 39.3% to 16.3% (both P < .0001), respectively, with improvements being significant regardless of age, sex, or treatment history (all P < .0001).

Study details: Findings are from a retrospective, observational study based on electronic medical records of adults with moderate-to-severe AD who were evaluated at 4 months after initiating dupilumab.

Disclosures: This study was funded by Regeneron Pharmaceuticals, Inc., and Sanofi. Four authors declared being current or former employees and stockholders of Sanofi or Regeneron Pharmaceuticals. The other authors declared ties with various sources, including Regeneron and Sanofi.

Source: Eichenfield LF et al. Real-world effectiveness of dupilumab in atopic dermatitis patients: Analysis of an electronic medical records dataset. Dermatol Ther (Heidelb). 2022 (May 11). Doi: 10.1007/s13555-022-00731-z

Key clinical point: Dupilumab led to clinically meaningful improvements in atopic dermatitis (AD) severity, extent, and itch severity in a real-world population of adults with moderate-to-severe AD.

Major finding: At 4 months, the Investigator’s Global Assessment score reduced by ≥1 point in 81.8% of patients and by ≥2 points in 62.8% of patients. Additionally, at 4 months, the mean itch severity score and affected body surface area reduced from 7.0 to 2.8 and from 39.3% to 16.3% (both P < .0001), respectively, with improvements being significant regardless of age, sex, or treatment history (all P < .0001).

Study details: Findings are from a retrospective, observational study based on electronic medical records of adults with moderate-to-severe AD who were evaluated at 4 months after initiating dupilumab.

Disclosures: This study was funded by Regeneron Pharmaceuticals, Inc., and Sanofi. Four authors declared being current or former employees and stockholders of Sanofi or Regeneron Pharmaceuticals. The other authors declared ties with various sources, including Regeneron and Sanofi.

Source: Eichenfield LF et al. Real-world effectiveness of dupilumab in atopic dermatitis patients: Analysis of an electronic medical records dataset. Dermatol Ther (Heidelb). 2022 (May 11). Doi: 10.1007/s13555-022-00731-z

Key clinical point: Patients with atopic dermatitis (AD) experience a fluctuation in depression severity over time, with the likelihood of experiencing depressive symptoms being the highest in patients with severe AD.

Major finding: Among patients with ≥2 follow-up visits, most (49.46%) experienced a fluctuation in depression severity, whereas 45.65% experienced a persistent severity of depression. High Eczema Area Severity Index (adjusted odds ratio [aOR] 7.622; 95% CI 3.881-14.968) and itch (aOR 14.745; 95% CI 4.696-46.297) scores were strongly associated with difficulty in concentrating over time.

Study details: Findings are from a longitudinal, dermatology practice-based study including 695 adults with AD who were evaluated at baseline and at every 6-month follow-up visits.

Disclosures: This study was funded by the US Agency for Healthcare Research and Quality, the Dermatology Foundation, and Galderma. R Chavda and S Gabriel declared being employees of Galderma, and JI Silverberg declared serving as a consultant for Galderma.

Source: Chatrath S et al. Longitudinal course and predictors of depressive symptoms in atopic dermatitis.  J Am Acad Dermatol. 2022 (May 9). Doi: 10.1016/j.jaad.2022.04.061

Key clinical point: Patients with atopic dermatitis (AD) experience a fluctuation in depression severity over time, with the likelihood of experiencing depressive symptoms being the highest in patients with severe AD.

Major finding: Among patients with ≥2 follow-up visits, most (49.46%) experienced a fluctuation in depression severity, whereas 45.65% experienced a persistent severity of depression. High Eczema Area Severity Index (adjusted odds ratio [aOR] 7.622; 95% CI 3.881-14.968) and itch (aOR 14.745; 95% CI 4.696-46.297) scores were strongly associated with difficulty in concentrating over time.

Study details: Findings are from a longitudinal, dermatology practice-based study including 695 adults with AD who were evaluated at baseline and at every 6-month follow-up visits.

Disclosures: This study was funded by the US Agency for Healthcare Research and Quality, the Dermatology Foundation, and Galderma. R Chavda and S Gabriel declared being employees of Galderma, and JI Silverberg declared serving as a consultant for Galderma.

Source: Chatrath S et al. Longitudinal course and predictors of depressive symptoms in atopic dermatitis.  J Am Acad Dermatol. 2022 (May 9). Doi: 10.1016/j.jaad.2022.04.061

Key clinical point: Patients with atopic dermatitis (AD) experience a fluctuation in depression severity over time, with the likelihood of experiencing depressive symptoms being the highest in patients with severe AD.

Major finding: Among patients with ≥2 follow-up visits, most (49.46%) experienced a fluctuation in depression severity, whereas 45.65% experienced a persistent severity of depression. High Eczema Area Severity Index (adjusted odds ratio [aOR] 7.622; 95% CI 3.881-14.968) and itch (aOR 14.745; 95% CI 4.696-46.297) scores were strongly associated with difficulty in concentrating over time.

Study details: Findings are from a longitudinal, dermatology practice-based study including 695 adults with AD who were evaluated at baseline and at every 6-month follow-up visits.

Disclosures: This study was funded by the US Agency for Healthcare Research and Quality, the Dermatology Foundation, and Galderma. R Chavda and S Gabriel declared being employees of Galderma, and JI Silverberg declared serving as a consultant for Galderma.

Source: Chatrath S et al. Longitudinal course and predictors of depressive symptoms in atopic dermatitis.  J Am Acad Dermatol. 2022 (May 9). Doi: 10.1016/j.jaad.2022.04.061

Key clinical point: Baricitinib vs. dupilumab demonstrated similar efficacy in reducing atopic dermatitis (AD) severity and improving quality of life (QoL), with more rapid improvement in itch.

Major finding: A dose of 4 mg baricitinib vs. dupilumab as monotherapy or with topical corticosteroids (TCS) was more likely to show ≥4-point improvement in itch scores at 4 weeks among patients with inadequate response or intolerance to topical treatments (dupliumab: relative risk [RR] 2.62; P = .013; TCS: RR 2.16; P = .029). However, both drugs showed similar efficacy across Eczema Area and Severity Index 75, itch, and QoL scores at 16 weeks.

Study details: This data comes from an indirect treatment comparison analysis of nine placebo-controlled trials included 3364 adults with moderate-to-severe AD and inadequate response or intolerance to topical treatments or cyclosporine who received dupilumab ± TCS or baricitinib ± TCS.

Disclosures: This study was supported by Eli Lilly and Company. Five authors declared being employees or shareholders of Eli Lilly. The other authors reported ties with various sources, including Eli Lilly.

Source: de Bruin-Weller MS et al. Indirect treatment comparison of baricitinib versus dupilumab in adults with moderate-to-severe atopic dermatitis. Dermatol Ther (Heidelb). 2022 (May 11). Doi: 10.1007/s13555-022-00734-w

Key clinical point: Baricitinib vs. dupilumab demonstrated similar efficacy in reducing atopic dermatitis (AD) severity and improving quality of life (QoL), with more rapid improvement in itch.

Major finding: A dose of 4 mg baricitinib vs. dupilumab as monotherapy or with topical corticosteroids (TCS) was more likely to show ≥4-point improvement in itch scores at 4 weeks among patients with inadequate response or intolerance to topical treatments (dupliumab: relative risk [RR] 2.62; P = .013; TCS: RR 2.16; P = .029). However, both drugs showed similar efficacy across Eczema Area and Severity Index 75, itch, and QoL scores at 16 weeks.

Study details: This data comes from an indirect treatment comparison analysis of nine placebo-controlled trials included 3364 adults with moderate-to-severe AD and inadequate response or intolerance to topical treatments or cyclosporine who received dupilumab ± TCS or baricitinib ± TCS.

Disclosures: This study was supported by Eli Lilly and Company. Five authors declared being employees or shareholders of Eli Lilly. The other authors reported ties with various sources, including Eli Lilly.

Source: de Bruin-Weller MS et al. Indirect treatment comparison of baricitinib versus dupilumab in adults with moderate-to-severe atopic dermatitis. Dermatol Ther (Heidelb). 2022 (May 11). Doi: 10.1007/s13555-022-00734-w

Key clinical point: Baricitinib vs. dupilumab demonstrated similar efficacy in reducing atopic dermatitis (AD) severity and improving quality of life (QoL), with more rapid improvement in itch.

Major finding: A dose of 4 mg baricitinib vs. dupilumab as monotherapy or with topical corticosteroids (TCS) was more likely to show ≥4-point improvement in itch scores at 4 weeks among patients with inadequate response or intolerance to topical treatments (dupliumab: relative risk [RR] 2.62; P = .013; TCS: RR 2.16; P = .029). However, both drugs showed similar efficacy across Eczema Area and Severity Index 75, itch, and QoL scores at 16 weeks.

Study details: This data comes from an indirect treatment comparison analysis of nine placebo-controlled trials included 3364 adults with moderate-to-severe AD and inadequate response or intolerance to topical treatments or cyclosporine who received dupilumab ± TCS or baricitinib ± TCS.

Disclosures: This study was supported by Eli Lilly and Company. Five authors declared being employees or shareholders of Eli Lilly. The other authors reported ties with various sources, including Eli Lilly.

Source: de Bruin-Weller MS et al. Indirect treatment comparison of baricitinib versus dupilumab in adults with moderate-to-severe atopic dermatitis. Dermatol Ther (Heidelb). 2022 (May 11). Doi: 10.1007/s13555-022-00734-w