Atopic Dermatitis

RALEIGH, N.C. – The infra-auricular fissure present in the overwhelming majority of atopic dermatitis patients provides a simple and convenient guide to disease severity, according to the results of a prospective study.

Infra-auricular fissures are highly prevalent in atopic dermatitis patients of all ages and racial/ethnic groups and in both genders. And the form the lesion takes shows a good correlation with disease severity as measured with the Eczema Area and Severity Index (EASI) and other metrics, Dr. Gil Yosipovitch said at the annual meeting of the Society for Investigative Dermatology.

"I’m not saying this is an ideal test, but I think that it’s a very easy bedside marker that we could use in our clinics. We can’t use the EASI all the time in busy fast-track clinics," observed Dr. Yosipovitch, professor of dermatology at Wake Forest University in Winston-Salem, N.C.

He and his coinvestigators assigned an infra-auricular fissure score of 1 to atopic dermatitis patients with an infra-auricular line and a score of 2 in those with an infra-auricular line accompanied by erythema and a small fissure. Those patients with a deeper infra-auricular fissure with significant erosion got a 3.

An infra-auricular fissure was present in every one of 81 consecutive children and adults with clinician-diagnosed atopic dermatitis. Fifty-eight percent had an infra-auricular fissure score of 1, 27% had a 2, and 15% scored 3. The infra-auricular fissure score showed a strong correlation with results on the validated EASI, with a correlation coefficient of 0.6.

Moreover, among the 29 patients seen at follow-up 1-2 months later, reductions in visual analog scale itch intensity, EASI score, and Investigator Global Assessment scores in response to treatment showed a significant correlation with improvement in the infra-auricular fissure score.

Dr. Yosipovitch reported having no financial conflicts.

RALEIGH, N.C. – The infra-auricular fissure present in the overwhelming majority of atopic dermatitis patients provides a simple and convenient guide to disease severity, according to the results of a prospective study.

Infra-auricular fissures are highly prevalent in atopic dermatitis patients of all ages and racial/ethnic groups and in both genders. And the form the lesion takes shows a good correlation with disease severity as measured with the Eczema Area and Severity Index (EASI) and other metrics, Dr. Gil Yosipovitch said at the annual meeting of the Society for Investigative Dermatology.

"I’m not saying this is an ideal test, but I think that it’s a very easy bedside marker that we could use in our clinics. We can’t use the EASI all the time in busy fast-track clinics," observed Dr. Yosipovitch, professor of dermatology at Wake Forest University in Winston-Salem, N.C.

He and his coinvestigators assigned an infra-auricular fissure score of 1 to atopic dermatitis patients with an infra-auricular line and a score of 2 in those with an infra-auricular line accompanied by erythema and a small fissure. Those patients with a deeper infra-auricular fissure with significant erosion got a 3.

An infra-auricular fissure was present in every one of 81 consecutive children and adults with clinician-diagnosed atopic dermatitis. Fifty-eight percent had an infra-auricular fissure score of 1, 27% had a 2, and 15% scored 3. The infra-auricular fissure score showed a strong correlation with results on the validated EASI, with a correlation coefficient of 0.6.

Moreover, among the 29 patients seen at follow-up 1-2 months later, reductions in visual analog scale itch intensity, EASI score, and Investigator Global Assessment scores in response to treatment showed a significant correlation with improvement in the infra-auricular fissure score.

Dr. Yosipovitch reported having no financial conflicts.

RALEIGH, N.C. – The infra-auricular fissure present in the overwhelming majority of atopic dermatitis patients provides a simple and convenient guide to disease severity, according to the results of a prospective study.

Infra-auricular fissures are highly prevalent in atopic dermatitis patients of all ages and racial/ethnic groups and in both genders. And the form the lesion takes shows a good correlation with disease severity as measured with the Eczema Area and Severity Index (EASI) and other metrics, Dr. Gil Yosipovitch said at the annual meeting of the Society for Investigative Dermatology.

"I’m not saying this is an ideal test, but I think that it’s a very easy bedside marker that we could use in our clinics. We can’t use the EASI all the time in busy fast-track clinics," observed Dr. Yosipovitch, professor of dermatology at Wake Forest University in Winston-Salem, N.C.

He and his coinvestigators assigned an infra-auricular fissure score of 1 to atopic dermatitis patients with an infra-auricular line and a score of 2 in those with an infra-auricular line accompanied by erythema and a small fissure. Those patients with a deeper infra-auricular fissure with significant erosion got a 3.

An infra-auricular fissure was present in every one of 81 consecutive children and adults with clinician-diagnosed atopic dermatitis. Fifty-eight percent had an infra-auricular fissure score of 1, 27% had a 2, and 15% scored 3. The infra-auricular fissure score showed a strong correlation with results on the validated EASI, with a correlation coefficient of 0.6.

Moreover, among the 29 patients seen at follow-up 1-2 months later, reductions in visual analog scale itch intensity, EASI score, and Investigator Global Assessment scores in response to treatment showed a significant correlation with improvement in the infra-auricular fissure score.

Dr. Yosipovitch reported having no financial conflicts.

RALEIGH, N.C. – Climate and weather can be added to the short list of factors known to influence the prevalence of atopic dermatitis, according to Dr. Jonathan I. Silverberg.

He presented a first-of-its-kind analysis in which he merged data from the Department of Health and Human Services’ 2007 National Survey of Children’s Health with state-by-state data from the National Oceanic and Atmospheric Administration’s National Climatic Data Center and the National Weather Service.

The National Survey of Children’s Health involved in-depth telephone interviews with parents in 91,642 households having one or more children under age 18 years.

Among the key findings: The prevalence of eczema was significantly lower in areas of the country with high relative humidity during the previous 2 years, especially during the months of November through April. The prevalence of eczema was also lower in areas with a high-to-extreme UV index, and with a higher-than-average outdoor air temperature, noted Dr. Silverberg of St. Luke’s–Roosevelt Hospital Center, New York.

In contrast, eczema prevalence was increased in regions with a high heating degree day index, which is a statewide, population-based measure of the energy demand needed to heat indoor structures by 1° F for 1 day using a baseline temperature of 65° F.

Children living in areas in the top tertile nationally in terms of mean relative humidity had a 20% lower risk of having eczema than did those residing in the lowest tertile. Children living in the top tertile for mean annual outdoor air temperature had a 23% lower prevalence of eczema than did those in the lowest tertile. Similarly, children living in areas with a high-to-extreme UV index, a measure which incorporates clear-sky days, had a 24% lower eczema prevalence than did children living under the condition of a low-to-moderate UV index.

Children residing in regions in the top tertile in terms of heating degree days had a 30% higher prevalence of eczema than did those living in the lowest tertile.

The most likely explanation for the effects climactic factors exert upon eczema prevalence involves the environmental impact upon skin barrier function. However, this study can’t pinpoint causality. Other possible mechanisms that might account for the observed association include vitamin D status, immune responses, or allergen exposures, according to Dr. Silverberg.

Previously established risk factors for eczema include family history, race/ethnicity, urban living, and socioeconomic status.

This study was funded in part by a grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Silverberg reported having no financial conflicts.

RALEIGH, N.C. – Climate and weather can be added to the short list of factors known to influence the prevalence of atopic dermatitis, according to Dr. Jonathan I. Silverberg.

He presented a first-of-its-kind analysis in which he merged data from the Department of Health and Human Services’ 2007 National Survey of Children’s Health with state-by-state data from the National Oceanic and Atmospheric Administration’s National Climatic Data Center and the National Weather Service.

The National Survey of Children’s Health involved in-depth telephone interviews with parents in 91,642 households having one or more children under age 18 years.

Among the key findings: The prevalence of eczema was significantly lower in areas of the country with high relative humidity during the previous 2 years, especially during the months of November through April. The prevalence of eczema was also lower in areas with a high-to-extreme UV index, and with a higher-than-average outdoor air temperature, noted Dr. Silverberg of St. Luke’s–Roosevelt Hospital Center, New York.

In contrast, eczema prevalence was increased in regions with a high heating degree day index, which is a statewide, population-based measure of the energy demand needed to heat indoor structures by 1° F for 1 day using a baseline temperature of 65° F.

Children living in areas in the top tertile nationally in terms of mean relative humidity had a 20% lower risk of having eczema than did those residing in the lowest tertile. Children living in the top tertile for mean annual outdoor air temperature had a 23% lower prevalence of eczema than did those in the lowest tertile. Similarly, children living in areas with a high-to-extreme UV index, a measure which incorporates clear-sky days, had a 24% lower eczema prevalence than did children living under the condition of a low-to-moderate UV index.

Children residing in regions in the top tertile in terms of heating degree days had a 30% higher prevalence of eczema than did those living in the lowest tertile.

The most likely explanation for the effects climactic factors exert upon eczema prevalence involves the environmental impact upon skin barrier function. However, this study can’t pinpoint causality. Other possible mechanisms that might account for the observed association include vitamin D status, immune responses, or allergen exposures, according to Dr. Silverberg.

Previously established risk factors for eczema include family history, race/ethnicity, urban living, and socioeconomic status.

This study was funded in part by a grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Silverberg reported having no financial conflicts.

RALEIGH, N.C. – Climate and weather can be added to the short list of factors known to influence the prevalence of atopic dermatitis, according to Dr. Jonathan I. Silverberg.

He presented a first-of-its-kind analysis in which he merged data from the Department of Health and Human Services’ 2007 National Survey of Children’s Health with state-by-state data from the National Oceanic and Atmospheric Administration’s National Climatic Data Center and the National Weather Service.

The National Survey of Children’s Health involved in-depth telephone interviews with parents in 91,642 households having one or more children under age 18 years.

Among the key findings: The prevalence of eczema was significantly lower in areas of the country with high relative humidity during the previous 2 years, especially during the months of November through April. The prevalence of eczema was also lower in areas with a high-to-extreme UV index, and with a higher-than-average outdoor air temperature, noted Dr. Silverberg of St. Luke’s–Roosevelt Hospital Center, New York.

In contrast, eczema prevalence was increased in regions with a high heating degree day index, which is a statewide, population-based measure of the energy demand needed to heat indoor structures by 1° F for 1 day using a baseline temperature of 65° F.

Children living in areas in the top tertile nationally in terms of mean relative humidity had a 20% lower risk of having eczema than did those residing in the lowest tertile. Children living in the top tertile for mean annual outdoor air temperature had a 23% lower prevalence of eczema than did those in the lowest tertile. Similarly, children living in areas with a high-to-extreme UV index, a measure which incorporates clear-sky days, had a 24% lower eczema prevalence than did children living under the condition of a low-to-moderate UV index.

Children residing in regions in the top tertile in terms of heating degree days had a 30% higher prevalence of eczema than did those living in the lowest tertile.

The most likely explanation for the effects climactic factors exert upon eczema prevalence involves the environmental impact upon skin barrier function. However, this study can’t pinpoint causality. Other possible mechanisms that might account for the observed association include vitamin D status, immune responses, or allergen exposures, according to Dr. Silverberg.

Previously established risk factors for eczema include family history, race/ethnicity, urban living, and socioeconomic status.

This study was funded in part by a grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Silverberg reported having no financial conflicts.

RALEIGH, N.C. – Atopic dermatitis patients who possess a filaggrin loss-of-function mutation are not likely to be clear of the skin disease for longer than 5 months at a time, according to study results.

The prospective cohort PEER (Pediatric Eczema Elective Registry) study also found that the four most prevalent filaggrin mutations in white patients do not respond similarly to atopic dermatitis medications.

For example, patients with at least one null allele for R501X – the most prevalent filaggrin mutation in the PEER cohort – were 55% less likely than the group as a whole to report being symptom free for 6 months while off all medications for atopic dermatitis. In contrast, those with an S3247X mutation were 3.7-fold more likely to be both symptom and medication free for a 6-month period, according to Dr. David J. Margolis, professor of dermatology at the University of Pennsylvania, Philadelphia.

He presented a study involving 857 PEER participants who underwent DNA analysis screening for the four most common filaggrin mutations in white patients (R501X, 2282del4, R2247X, and S3247X). A total of 28% of white patients had at least one of the mutations, as did 5% of black patients. An R501X mutation was present in 12.2% of white patients and 3.3% of black patients. The second most common mutation (2282del4) was noted in 11.8% of white patients and 0.6% of black patients.

The ongoing Valeant Pharmaceutical–funded PEER study involves children with atopic dermatitis who used topical pimecrolimus (Elidel) for at least 6 weeks during the 6 months immediately prior to enrollment. Their average age at diagnosis was 2.1 years. Participants have been prospectively followed in the registry for a mean of roughly 5 years. They can use any form of treatment they choose. Data on the status of their skin disease are collected at 6-month intervals, allowing for the characteristic waxing and waning of atopic dermatitis.

In all, 81% of PEER participants have been symptom free for at least 6 months on at least one occasion during the 5 years of follow-up. However, only 25.6% were both symptom free and not using an eczema medication.

In a cross-sectional snapshot obtained at 3 years of follow-up, 62% of patients were still using a topical calcineurin inhibitor, 58% were on topical steroids, and 35% were on both forms of therapy.

Patients with any of the four filaggrin mutations were 50% as likely as those without a mutation to be symptom free for a 6-month period, after adjustment for age, sex, and ancestry.

Participants with an R501X mutation were an adjusted 55% less likely than the overall PEER cohort to be symptom free for 6 months while off medications; hence, they could be said to have significantly more persistent or severe disease, Dr. Margolis noted.

In contrast, patients with a 2282del4 mutation were 1.7-fold more likely than the overall group to be symptom free while off therapy for 6 months, whereas those with an R2247X mutation were about equally likely as the patients with none of the filaggrin mutations to enjoy such a period.

The filaggrin gene, which is located on chromosome 1, codes for filament-aggregating protein. It is thought that filaggrin loss-of-function mutations promote breakdown of the skin barrier, allowing a more aggressive immunologic response to antigens and irritants. In 2006, it was demonstrated that filaggrin loss-of-function mutations increase an individual’s risk of developing atopic dermatitis threefold.

That being said, the PEER analysis demonstrates that different filaggrin mutations vary considerably in the degree to which their associated skin disease is treatment-refractory. One reasonable hypothesis is that these differences in treatment responsiveness are related to mutation penetrance.

A limitation of this PEER analysis is that it screened only for the four most prevalent filaggrin mutations, he noted. Roughly 30-40 mutations have been reported thus far.

This study was funded by the National Institutes of Health. Dr. Margolis reported having no financial conflicts.

RALEIGH, N.C. – Atopic dermatitis patients who possess a filaggrin loss-of-function mutation are not likely to be clear of the skin disease for longer than 5 months at a time, according to study results.

The prospective cohort PEER (Pediatric Eczema Elective Registry) study also found that the four most prevalent filaggrin mutations in white patients do not respond similarly to atopic dermatitis medications.

For example, patients with at least one null allele for R501X – the most prevalent filaggrin mutation in the PEER cohort – were 55% less likely than the group as a whole to report being symptom free for 6 months while off all medications for atopic dermatitis. In contrast, those with an S3247X mutation were 3.7-fold more likely to be both symptom and medication free for a 6-month period, according to Dr. David J. Margolis, professor of dermatology at the University of Pennsylvania, Philadelphia.

He presented a study involving 857 PEER participants who underwent DNA analysis screening for the four most common filaggrin mutations in white patients (R501X, 2282del4, R2247X, and S3247X). A total of 28% of white patients had at least one of the mutations, as did 5% of black patients. An R501X mutation was present in 12.2% of white patients and 3.3% of black patients. The second most common mutation (2282del4) was noted in 11.8% of white patients and 0.6% of black patients.

The ongoing Valeant Pharmaceutical–funded PEER study involves children with atopic dermatitis who used topical pimecrolimus (Elidel) for at least 6 weeks during the 6 months immediately prior to enrollment. Their average age at diagnosis was 2.1 years. Participants have been prospectively followed in the registry for a mean of roughly 5 years. They can use any form of treatment they choose. Data on the status of their skin disease are collected at 6-month intervals, allowing for the characteristic waxing and waning of atopic dermatitis.

In all, 81% of PEER participants have been symptom free for at least 6 months on at least one occasion during the 5 years of follow-up. However, only 25.6% were both symptom free and not using an eczema medication.

In a cross-sectional snapshot obtained at 3 years of follow-up, 62% of patients were still using a topical calcineurin inhibitor, 58% were on topical steroids, and 35% were on both forms of therapy.

Patients with any of the four filaggrin mutations were 50% as likely as those without a mutation to be symptom free for a 6-month period, after adjustment for age, sex, and ancestry.

Participants with an R501X mutation were an adjusted 55% less likely than the overall PEER cohort to be symptom free for 6 months while off medications; hence, they could be said to have significantly more persistent or severe disease, Dr. Margolis noted.

In contrast, patients with a 2282del4 mutation were 1.7-fold more likely than the overall group to be symptom free while off therapy for 6 months, whereas those with an R2247X mutation were about equally likely as the patients with none of the filaggrin mutations to enjoy such a period.

The filaggrin gene, which is located on chromosome 1, codes for filament-aggregating protein. It is thought that filaggrin loss-of-function mutations promote breakdown of the skin barrier, allowing a more aggressive immunologic response to antigens and irritants. In 2006, it was demonstrated that filaggrin loss-of-function mutations increase an individual’s risk of developing atopic dermatitis threefold.

That being said, the PEER analysis demonstrates that different filaggrin mutations vary considerably in the degree to which their associated skin disease is treatment-refractory. One reasonable hypothesis is that these differences in treatment responsiveness are related to mutation penetrance.

A limitation of this PEER analysis is that it screened only for the four most prevalent filaggrin mutations, he noted. Roughly 30-40 mutations have been reported thus far.

This study was funded by the National Institutes of Health. Dr. Margolis reported having no financial conflicts.

RALEIGH, N.C. – Atopic dermatitis patients who possess a filaggrin loss-of-function mutation are not likely to be clear of the skin disease for longer than 5 months at a time, according to study results.

The prospective cohort PEER (Pediatric Eczema Elective Registry) study also found that the four most prevalent filaggrin mutations in white patients do not respond similarly to atopic dermatitis medications.

For example, patients with at least one null allele for R501X – the most prevalent filaggrin mutation in the PEER cohort – were 55% less likely than the group as a whole to report being symptom free for 6 months while off all medications for atopic dermatitis. In contrast, those with an S3247X mutation were 3.7-fold more likely to be both symptom and medication free for a 6-month period, according to Dr. David J. Margolis, professor of dermatology at the University of Pennsylvania, Philadelphia.

He presented a study involving 857 PEER participants who underwent DNA analysis screening for the four most common filaggrin mutations in white patients (R501X, 2282del4, R2247X, and S3247X). A total of 28% of white patients had at least one of the mutations, as did 5% of black patients. An R501X mutation was present in 12.2% of white patients and 3.3% of black patients. The second most common mutation (2282del4) was noted in 11.8% of white patients and 0.6% of black patients.

The ongoing Valeant Pharmaceutical–funded PEER study involves children with atopic dermatitis who used topical pimecrolimus (Elidel) for at least 6 weeks during the 6 months immediately prior to enrollment. Their average age at diagnosis was 2.1 years. Participants have been prospectively followed in the registry for a mean of roughly 5 years. They can use any form of treatment they choose. Data on the status of their skin disease are collected at 6-month intervals, allowing for the characteristic waxing and waning of atopic dermatitis.

In all, 81% of PEER participants have been symptom free for at least 6 months on at least one occasion during the 5 years of follow-up. However, only 25.6% were both symptom free and not using an eczema medication.

In a cross-sectional snapshot obtained at 3 years of follow-up, 62% of patients were still using a topical calcineurin inhibitor, 58% were on topical steroids, and 35% were on both forms of therapy.

Patients with any of the four filaggrin mutations were 50% as likely as those without a mutation to be symptom free for a 6-month period, after adjustment for age, sex, and ancestry.

Participants with an R501X mutation were an adjusted 55% less likely than the overall PEER cohort to be symptom free for 6 months while off medications; hence, they could be said to have significantly more persistent or severe disease, Dr. Margolis noted.

In contrast, patients with a 2282del4 mutation were 1.7-fold more likely than the overall group to be symptom free while off therapy for 6 months, whereas those with an R2247X mutation were about equally likely as the patients with none of the filaggrin mutations to enjoy such a period.

The filaggrin gene, which is located on chromosome 1, codes for filament-aggregating protein. It is thought that filaggrin loss-of-function mutations promote breakdown of the skin barrier, allowing a more aggressive immunologic response to antigens and irritants. In 2006, it was demonstrated that filaggrin loss-of-function mutations increase an individual’s risk of developing atopic dermatitis threefold.

That being said, the PEER analysis demonstrates that different filaggrin mutations vary considerably in the degree to which their associated skin disease is treatment-refractory. One reasonable hypothesis is that these differences in treatment responsiveness are related to mutation penetrance.

A limitation of this PEER analysis is that it screened only for the four most prevalent filaggrin mutations, he noted. Roughly 30-40 mutations have been reported thus far.

This study was funded by the National Institutes of Health. Dr. Margolis reported having no financial conflicts.

Move over Lyme disease, there is a new tick borne illness in town - an allergic reaction to beef.

According to a new report from ABC News, a single bite from a lone star tick may trigger the allergy.

Photo ©James Gathany/CDC

Researchers at the University of Virginia began to look into the ticks after the allergy began to spread along the East Coast, where lone star ticks are prevalent. The researchers noted that they have seen 400 cases of the meat allergy, mostly in Virginia, with 90% of the patients reporting a history of tick bites.

Alpha-gal antibodies, found in red meat, increase after a bite from a long star tick. Several hours after eating beef, patients with the allergy will have a reaction and develop hives, and could even go into anaphylactic shock.

The news report noted that author John Grisham, who has a plantation in Virginia, is believed to have developed the allergy.

Watch the full ABC News report here.

Move over Lyme disease, there is a new tick borne illness in town - an allergic reaction to beef.

According to a new report from ABC News, a single bite from a lone star tick may trigger the allergy.

Photo ©James Gathany/CDC

Researchers at the University of Virginia began to look into the ticks after the allergy began to spread along the East Coast, where lone star ticks are prevalent. The researchers noted that they have seen 400 cases of the meat allergy, mostly in Virginia, with 90% of the patients reporting a history of tick bites.

Alpha-gal antibodies, found in red meat, increase after a bite from a long star tick. Several hours after eating beef, patients with the allergy will have a reaction and develop hives, and could even go into anaphylactic shock.

The news report noted that author John Grisham, who has a plantation in Virginia, is believed to have developed the allergy.

Watch the full ABC News report here.

Move over Lyme disease, there is a new tick borne illness in town - an allergic reaction to beef.

According to a new report from ABC News, a single bite from a lone star tick may trigger the allergy.

Photo ©James Gathany/CDC

Researchers at the University of Virginia began to look into the ticks after the allergy began to spread along the East Coast, where lone star ticks are prevalent. The researchers noted that they have seen 400 cases of the meat allergy, mostly in Virginia, with 90% of the patients reporting a history of tick bites.

Alpha-gal antibodies, found in red meat, increase after a bite from a long star tick. Several hours after eating beef, patients with the allergy will have a reaction and develop hives, and could even go into anaphylactic shock.

The news report noted that author John Grisham, who has a plantation in Virginia, is believed to have developed the allergy.

Watch the full ABC News report here.

RALEIGH, N.C. – Pediatric atopic dermatitis has been linked to several previously unreported comorbidities – including increased rates of recurrent ear infections, bleeding gums and other dental problems, and visual difficulties – in a large, national population-based study.

While the dental findings need confirmation, the study provided supportive evidence on behalf of previously reported associations between atopic dermatitis and comorbid asthma and respiratory and food allergies. The study also broke new ground by demonstrating that the more severe the eczema, the greater the severity of the comorbid conditions, according to Dr. Jonathan I. Silverberg of St Luke’s–Roosevelt Hospital and Beth Israel Medical Center, New York.

"In general, food allergy, respiratory allergy, and asthma are more severe in children with concomitant eczema. In addition, the severity of these comorbidities correlates with the severity of the skin disease. Thus, aggressive treatment or prevention of atopic dermatitis might modify the risk of developing these comorbidities," he said.

He presented an analysis of the 2007 National Survey of Children’s Health, a Department of Health and Human Services–funded survey involving in-depth telephone interviews with parents in 91,642 households having one or more children under age 18 years.

The prevalence of pediatric eczema in this national study was 13%. The mean age of affected children was 7.5 years. Parents of kids with eczema characterized the skin disease as mild in 67% of cases, moderate in 26%, and severe in 7%.

Among the notable study findings:

– Among all children without eczema, 13.5% were black. However, black children accounted for 22.2% of all children with eczema.

– Children diagnosed with atopic dermatitis in the previous 12 months were significantly more likely than were children without eczema to have had food allergies in the past 12 months, by a margin of 15.1% to 3.6%. They also were more likely to have had asthma in the past 12 months (19.8% versus 7.9%), as well as respiratory allergies during the same time period (34.4%, compared with a 14.3% rate in children without eczema).

– Among children with asthma and mild or moderate atopic dermatitis, 5.5% had severe asthma in the past 12 months. But among those with comorbid severe atopic dermatitis, 36.1% had severe asthma. The same trend pertained to children with atopic dermatitis and comorbid hay fever or food allergies.

– Only 7.6% of children without eczema had impaired sleep for an average of 4 or more nights per week, compared with 10% of those with mild or moderate eczema and 22.2% of those with severe eczema.

– Recurrent ear infections within the past 12 months were reported for 6% of children with no eczema and 10.4% of those with eczema. Visual problems occurred in 1% of kids without eczema and 2.2% with eczema. These differences were significant; however, the rates of recurrent ear infections and visual problems didn’t rise with increasing eczema severity.

– In contrast, bleeding gums within the past 12 months occurred in 2.9% of children without atopic dermatitis, 4.3% with mild or moderate atopic dermatitis, and 12.6% of those with severe atopic dermatitis. Similarly, broken teeth within the last year were reported in 3.8% of subjects with no eczema, 5.1% with mild eczema, and 10.3% with severe eczema.

– Children with eczema were found to have poorer overall health and used a greater number of health-related services. Thirty-seven percent of them had seen a specialist within the past 12 months, compared with 21% of children without eczema.

Dr. Silverberg reported having no relevant financial disclosures.

RALEIGH, N.C. – Pediatric atopic dermatitis has been linked to several previously unreported comorbidities – including increased rates of recurrent ear infections, bleeding gums and other dental problems, and visual difficulties – in a large, national population-based study.

While the dental findings need confirmation, the study provided supportive evidence on behalf of previously reported associations between atopic dermatitis and comorbid asthma and respiratory and food allergies. The study also broke new ground by demonstrating that the more severe the eczema, the greater the severity of the comorbid conditions, according to Dr. Jonathan I. Silverberg of St Luke’s–Roosevelt Hospital and Beth Israel Medical Center, New York.

"In general, food allergy, respiratory allergy, and asthma are more severe in children with concomitant eczema. In addition, the severity of these comorbidities correlates with the severity of the skin disease. Thus, aggressive treatment or prevention of atopic dermatitis might modify the risk of developing these comorbidities," he said.

He presented an analysis of the 2007 National Survey of Children’s Health, a Department of Health and Human Services–funded survey involving in-depth telephone interviews with parents in 91,642 households having one or more children under age 18 years.

The prevalence of pediatric eczema in this national study was 13%. The mean age of affected children was 7.5 years. Parents of kids with eczema characterized the skin disease as mild in 67% of cases, moderate in 26%, and severe in 7%.

Among the notable study findings:

– Among all children without eczema, 13.5% were black. However, black children accounted for 22.2% of all children with eczema.

– Children diagnosed with atopic dermatitis in the previous 12 months were significantly more likely than were children without eczema to have had food allergies in the past 12 months, by a margin of 15.1% to 3.6%. They also were more likely to have had asthma in the past 12 months (19.8% versus 7.9%), as well as respiratory allergies during the same time period (34.4%, compared with a 14.3% rate in children without eczema).

– Among children with asthma and mild or moderate atopic dermatitis, 5.5% had severe asthma in the past 12 months. But among those with comorbid severe atopic dermatitis, 36.1% had severe asthma. The same trend pertained to children with atopic dermatitis and comorbid hay fever or food allergies.

– Only 7.6% of children without eczema had impaired sleep for an average of 4 or more nights per week, compared with 10% of those with mild or moderate eczema and 22.2% of those with severe eczema.

– Recurrent ear infections within the past 12 months were reported for 6% of children with no eczema and 10.4% of those with eczema. Visual problems occurred in 1% of kids without eczema and 2.2% with eczema. These differences were significant; however, the rates of recurrent ear infections and visual problems didn’t rise with increasing eczema severity.

– In contrast, bleeding gums within the past 12 months occurred in 2.9% of children without atopic dermatitis, 4.3% with mild or moderate atopic dermatitis, and 12.6% of those with severe atopic dermatitis. Similarly, broken teeth within the last year were reported in 3.8% of subjects with no eczema, 5.1% with mild eczema, and 10.3% with severe eczema.

– Children with eczema were found to have poorer overall health and used a greater number of health-related services. Thirty-seven percent of them had seen a specialist within the past 12 months, compared with 21% of children without eczema.

Dr. Silverberg reported having no relevant financial disclosures.

RALEIGH, N.C. – Pediatric atopic dermatitis has been linked to several previously unreported comorbidities – including increased rates of recurrent ear infections, bleeding gums and other dental problems, and visual difficulties – in a large, national population-based study.

While the dental findings need confirmation, the study provided supportive evidence on behalf of previously reported associations between atopic dermatitis and comorbid asthma and respiratory and food allergies. The study also broke new ground by demonstrating that the more severe the eczema, the greater the severity of the comorbid conditions, according to Dr. Jonathan I. Silverberg of St Luke’s–Roosevelt Hospital and Beth Israel Medical Center, New York.

"In general, food allergy, respiratory allergy, and asthma are more severe in children with concomitant eczema. In addition, the severity of these comorbidities correlates with the severity of the skin disease. Thus, aggressive treatment or prevention of atopic dermatitis might modify the risk of developing these comorbidities," he said.

He presented an analysis of the 2007 National Survey of Children’s Health, a Department of Health and Human Services–funded survey involving in-depth telephone interviews with parents in 91,642 households having one or more children under age 18 years.

The prevalence of pediatric eczema in this national study was 13%. The mean age of affected children was 7.5 years. Parents of kids with eczema characterized the skin disease as mild in 67% of cases, moderate in 26%, and severe in 7%.

Among the notable study findings:

– Among all children without eczema, 13.5% were black. However, black children accounted for 22.2% of all children with eczema.

– Children diagnosed with atopic dermatitis in the previous 12 months were significantly more likely than were children without eczema to have had food allergies in the past 12 months, by a margin of 15.1% to 3.6%. They also were more likely to have had asthma in the past 12 months (19.8% versus 7.9%), as well as respiratory allergies during the same time period (34.4%, compared with a 14.3% rate in children without eczema).

– Among children with asthma and mild or moderate atopic dermatitis, 5.5% had severe asthma in the past 12 months. But among those with comorbid severe atopic dermatitis, 36.1% had severe asthma. The same trend pertained to children with atopic dermatitis and comorbid hay fever or food allergies.

– Only 7.6% of children without eczema had impaired sleep for an average of 4 or more nights per week, compared with 10% of those with mild or moderate eczema and 22.2% of those with severe eczema.

– Recurrent ear infections within the past 12 months were reported for 6% of children with no eczema and 10.4% of those with eczema. Visual problems occurred in 1% of kids without eczema and 2.2% with eczema. These differences were significant; however, the rates of recurrent ear infections and visual problems didn’t rise with increasing eczema severity.

– In contrast, bleeding gums within the past 12 months occurred in 2.9% of children without atopic dermatitis, 4.3% with mild or moderate atopic dermatitis, and 12.6% of those with severe atopic dermatitis. Similarly, broken teeth within the last year were reported in 3.8% of subjects with no eczema, 5.1% with mild eczema, and 10.3% with severe eczema.

– Children with eczema were found to have poorer overall health and used a greater number of health-related services. Thirty-seven percent of them had seen a specialist within the past 12 months, compared with 21% of children without eczema.

Dr. Silverberg reported having no relevant financial disclosures.

RALEIGH, N.C. – Once-daily application of an emollient from birth through age 6 months has shown considerable promise as a means of preventing atopic dermatitis, according to the Barrier Enhancement for Eczema Prevention study.

BEEP was a multicenter, international, randomized controlled pilot study assessing the feasibility, safety, and effectiveness of a novel approach to the prevention of atopic dermatitis. The study hypothesis was that protecting the skin barrier early in life can prevent this common skin disease, explained Dr. Eric L. Simpson of Oregon Health and Science University, Portland.

The rationale for this approach lies in previous work demonstrating that skin barrier dysfunction precedes eczema development. And emollients can be effective in treating mild disease and preventing flares, he said at the annual meeting of the Society for Investigative Dermatology.

BEEP involved 124 infants in Portland and at four medical centers in the United Kingdom. All were deemed high risk for atopic dermatitis because they had one or more first-degree relatives with a history of asthma, hay fever, or atopic dermatitis. Participating families were randomized to either once-daily application of an emollient to the baby’s entire body except the scalp and diaper area starting before age 3 weeks and continuing for 6 months, or to a control group that agreed to refrain from regular use of emollients. All families received advice on best-practice skin care, namely to minimize the use of harsh cleansers and hot water bathing.

The 6-month cumulative incidence of investigator-diagnosed eczema was 21.8% in the daily emollient group, compared with 43.3% in controls, for a 67% reduction in risk. It was a considerably more dramatic effect than what the investigators had anticipated.

"This was kind of a surprising finding to us," Dr. Simpson admitted. Patients will be followed up at 1 and 2 years to learn whether the early-life treatment actually prevented or simply delayed onset of atopic dermatitis.

In a subanalysis, skin barrier function studies were carried out in 15 patients divided between a control and intervention arm. Children in the control arm showed favorable albeit nonsignificant trends for less transepidermal water loss and a lower skin pH.

Parents in the intervention arm were given a choice of three emollients of various viscosities: sunflower seed oil; Cetaphil cream in the United States or Doublebase gel in the United Kingdom; or Aquaphor in the United States or 50-50 ointment, a white soft paraffin/liquid paraffin product marketed in the United Kingdom. More than two-thirds of families opted for Cetaphil cream or Doublebase gel.

Ninety-six percent of families in the intervention arm found their emollient acceptable, and 80% indicated they used it at least 5 days per week.

No cases of irritant or contact dermatitis occurred in the emollient group. Three mild skin infections occurred in each study arm.

Dr. Simpson’s BEEP coinvestigators included atopic dermatitis experts such as Dr. Hywel C. Williams, professor of dermatology at the University of Nottingham (England) and Dr. Jon M. Hanifin, professor emeritus of dermatology at Oregon Health and Science University.

The researchers are now planning a larger, definitive, randomized controlled trial of emollient therapy early in life as a means of preventing the development of atopic dermatitis. This study will be powered to look at the relative efficacy of different emollients. Also, it will include objective measures of adherence, such as volume of emollient used, rather than simply relying upon parental report.

Audience members expressed enthusiasm over the BEEP findings. The prevalence of atopic dermatitis has been rising for decades; the disease exacts a steep toll in terms of quality of life; and to date, there has been no established eczema prevention strategy. Moreover, there is the prospect that by preventing eczema via a simple topical therapy it will be possible to halt the "atopic march" to asthma and other comorbidities.

Dr. Simpson noted that BEEP was a small-scale feasibility study carried out because investigators were initially unsure if families would be willing to participate in a clinical trial where they could be randomized to avoiding emollients. But 28%-59% of the families approached at the participating centers agreed to enroll.

BEEP was funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the Oregon Clinical and Translational Research Institute, and the U.K. National Institute for Health Research.

Dr. Simpson reported having no financial conflicts of interest.

RALEIGH, N.C. – Once-daily application of an emollient from birth through age 6 months has shown considerable promise as a means of preventing atopic dermatitis, according to the Barrier Enhancement for Eczema Prevention study.

BEEP was a multicenter, international, randomized controlled pilot study assessing the feasibility, safety, and effectiveness of a novel approach to the prevention of atopic dermatitis. The study hypothesis was that protecting the skin barrier early in life can prevent this common skin disease, explained Dr. Eric L. Simpson of Oregon Health and Science University, Portland.

The rationale for this approach lies in previous work demonstrating that skin barrier dysfunction precedes eczema development. And emollients can be effective in treating mild disease and preventing flares, he said at the annual meeting of the Society for Investigative Dermatology.

BEEP involved 124 infants in Portland and at four medical centers in the United Kingdom. All were deemed high risk for atopic dermatitis because they had one or more first-degree relatives with a history of asthma, hay fever, or atopic dermatitis. Participating families were randomized to either once-daily application of an emollient to the baby’s entire body except the scalp and diaper area starting before age 3 weeks and continuing for 6 months, or to a control group that agreed to refrain from regular use of emollients. All families received advice on best-practice skin care, namely to minimize the use of harsh cleansers and hot water bathing.

The 6-month cumulative incidence of investigator-diagnosed eczema was 21.8% in the daily emollient group, compared with 43.3% in controls, for a 67% reduction in risk. It was a considerably more dramatic effect than what the investigators had anticipated.

"This was kind of a surprising finding to us," Dr. Simpson admitted. Patients will be followed up at 1 and 2 years to learn whether the early-life treatment actually prevented or simply delayed onset of atopic dermatitis.

In a subanalysis, skin barrier function studies were carried out in 15 patients divided between a control and intervention arm. Children in the control arm showed favorable albeit nonsignificant trends for less transepidermal water loss and a lower skin pH.

Parents in the intervention arm were given a choice of three emollients of various viscosities: sunflower seed oil; Cetaphil cream in the United States or Doublebase gel in the United Kingdom; or Aquaphor in the United States or 50-50 ointment, a white soft paraffin/liquid paraffin product marketed in the United Kingdom. More than two-thirds of families opted for Cetaphil cream or Doublebase gel.

Ninety-six percent of families in the intervention arm found their emollient acceptable, and 80% indicated they used it at least 5 days per week.

No cases of irritant or contact dermatitis occurred in the emollient group. Three mild skin infections occurred in each study arm.

Dr. Simpson’s BEEP coinvestigators included atopic dermatitis experts such as Dr. Hywel C. Williams, professor of dermatology at the University of Nottingham (England) and Dr. Jon M. Hanifin, professor emeritus of dermatology at Oregon Health and Science University.

The researchers are now planning a larger, definitive, randomized controlled trial of emollient therapy early in life as a means of preventing the development of atopic dermatitis. This study will be powered to look at the relative efficacy of different emollients. Also, it will include objective measures of adherence, such as volume of emollient used, rather than simply relying upon parental report.

Audience members expressed enthusiasm over the BEEP findings. The prevalence of atopic dermatitis has been rising for decades; the disease exacts a steep toll in terms of quality of life; and to date, there has been no established eczema prevention strategy. Moreover, there is the prospect that by preventing eczema via a simple topical therapy it will be possible to halt the "atopic march" to asthma and other comorbidities.

Dr. Simpson noted that BEEP was a small-scale feasibility study carried out because investigators were initially unsure if families would be willing to participate in a clinical trial where they could be randomized to avoiding emollients. But 28%-59% of the families approached at the participating centers agreed to enroll.

BEEP was funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the Oregon Clinical and Translational Research Institute, and the U.K. National Institute for Health Research.

Dr. Simpson reported having no financial conflicts of interest.

RALEIGH, N.C. – Once-daily application of an emollient from birth through age 6 months has shown considerable promise as a means of preventing atopic dermatitis, according to the Barrier Enhancement for Eczema Prevention study.

BEEP was a multicenter, international, randomized controlled pilot study assessing the feasibility, safety, and effectiveness of a novel approach to the prevention of atopic dermatitis. The study hypothesis was that protecting the skin barrier early in life can prevent this common skin disease, explained Dr. Eric L. Simpson of Oregon Health and Science University, Portland.

The rationale for this approach lies in previous work demonstrating that skin barrier dysfunction precedes eczema development. And emollients can be effective in treating mild disease and preventing flares, he said at the annual meeting of the Society for Investigative Dermatology.

BEEP involved 124 infants in Portland and at four medical centers in the United Kingdom. All were deemed high risk for atopic dermatitis because they had one or more first-degree relatives with a history of asthma, hay fever, or atopic dermatitis. Participating families were randomized to either once-daily application of an emollient to the baby’s entire body except the scalp and diaper area starting before age 3 weeks and continuing for 6 months, or to a control group that agreed to refrain from regular use of emollients. All families received advice on best-practice skin care, namely to minimize the use of harsh cleansers and hot water bathing.

The 6-month cumulative incidence of investigator-diagnosed eczema was 21.8% in the daily emollient group, compared with 43.3% in controls, for a 67% reduction in risk. It was a considerably more dramatic effect than what the investigators had anticipated.

"This was kind of a surprising finding to us," Dr. Simpson admitted. Patients will be followed up at 1 and 2 years to learn whether the early-life treatment actually prevented or simply delayed onset of atopic dermatitis.

In a subanalysis, skin barrier function studies were carried out in 15 patients divided between a control and intervention arm. Children in the control arm showed favorable albeit nonsignificant trends for less transepidermal water loss and a lower skin pH.

Parents in the intervention arm were given a choice of three emollients of various viscosities: sunflower seed oil; Cetaphil cream in the United States or Doublebase gel in the United Kingdom; or Aquaphor in the United States or 50-50 ointment, a white soft paraffin/liquid paraffin product marketed in the United Kingdom. More than two-thirds of families opted for Cetaphil cream or Doublebase gel.

Ninety-six percent of families in the intervention arm found their emollient acceptable, and 80% indicated they used it at least 5 days per week.

No cases of irritant or contact dermatitis occurred in the emollient group. Three mild skin infections occurred in each study arm.

Dr. Simpson’s BEEP coinvestigators included atopic dermatitis experts such as Dr. Hywel C. Williams, professor of dermatology at the University of Nottingham (England) and Dr. Jon M. Hanifin, professor emeritus of dermatology at Oregon Health and Science University.

The researchers are now planning a larger, definitive, randomized controlled trial of emollient therapy early in life as a means of preventing the development of atopic dermatitis. This study will be powered to look at the relative efficacy of different emollients. Also, it will include objective measures of adherence, such as volume of emollient used, rather than simply relying upon parental report.

Audience members expressed enthusiasm over the BEEP findings. The prevalence of atopic dermatitis has been rising for decades; the disease exacts a steep toll in terms of quality of life; and to date, there has been no established eczema prevention strategy. Moreover, there is the prospect that by preventing eczema via a simple topical therapy it will be possible to halt the "atopic march" to asthma and other comorbidities.

Dr. Simpson noted that BEEP was a small-scale feasibility study carried out because investigators were initially unsure if families would be willing to participate in a clinical trial where they could be randomized to avoiding emollients. But 28%-59% of the families approached at the participating centers agreed to enroll.

BEEP was funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the Oregon Clinical and Translational Research Institute, and the U.K. National Institute for Health Research.

Dr. Simpson reported having no financial conflicts of interest.

WAIKOLOA, HAWAII – The calcineurin inhibitors are effective for long-term maintenance therapy in chronic hand dermatitis, despite their black box warning, and can help reduce the use of topical steroids, according to dermatologist Joseph F. Fowler Jr.

Pimecrolimus 1% cream is nongreasy and thus preferred by many patients over tacrolimus 0.1% ointment, he said at the seminar sponsored by the Skin Disease Education Foundation (SDEF).

Bruce Jancin/IMNG Medical Media

"Please understand that I love topical steroids. We all need to use them. But I don’t want to use them continuously because of the variety of adverse effects, especially local atrophy. And if we’re worried about skin barrier function, we don’t want to thin the skin out and reduce the barrier even more with overuse of topical steroids," he said.

"So after we’ve got somebody under control with aggressive use of higher-potency topical steroids, I like to think about the calcineurin inhibitors. I also like to think about what I call the therapeutic moisturizers – those device and [over-the-counter] products that contain ceramides and natural moisturizing factors – and I’ll maybe use a low- to midpotency topical steroid two or three times a week as needed," added Dr. Fowler of the University of Louisville (Ky.).

There are several skin barrier protection products approved as prescription devices rather than medications, such as Atopiclair, Eletone, EpiCeram, Hylatopic, Neosalus, and Tetrix. Many aren’t promoted much anymore by their manufacturers, yet all have supporting evidence that they enhance the skin barrier, he said.

The two skin barrier products Dr. Fowler is most familiar with because of his involvement in clinical trials are Tetrix and Neosalus.

The investigator-blinded, nonrandomized Tetrix cream study involved patients with known allergies to three common, structurally dissimilar test antigens: nickel, neomycin, and fragrance mix. Following exposure to the test antigens, delayed-type hypersensitivity reactions on patch testing were significantly less at sites pretreated with Tetrix cream than at untreated test sites (Cutis 2008;82[suppl. 4]:21-8).

In the multicenter prospective Neosalus foam study, 31 patients with chronic allergic or irritant hand dermatitis of at least 12 months’ duration were randomized to treatment with Neosalus foam plus triamcinolone cream 0.1% or to an over-the-counter (OTC) moisturizer plus the topical steroid. During 8 weeks, patients in the Neosalus group averaged 51.4 doses of the topical steroid, compared with 72.5 doses in controls. Eczema severity scores were also significantly better in the Neosalus group (Am. J. Contact Dermat. 2000;11:165-9).

OTC moisturizers containing ceramide, a lipid that boosts stratum corneum function, include Aveeno eczema therapy moisturizing cream, CeraVe lotion and cleanser, Cetaphil Restoraderm moisturizer, and Curel Sensitive Skin Remedy, Dr. Fowler continued.

He said that he likes to choose from a short list of topical steroids for maintenance therapy. Fluticasone cream or lotion has fewer local adverse effects than many other steroids and has demonstrated long-term efficacy and safety in the setting of atopic dermatitis. Hydrocortisone butyrate lipid cream or lotion has excellent tolerability and a good moisturizing effect.

When there is concern that a patient’s dermatitis may be compounded by topical steroid allergy, clocortolone cream or desonide ointment are excellent choices; there is virtually no allergenicity to either product, according to Dr. Fowler.

"If I’m worried about topical steroid allergy, the sprays, I think, are very nice. Clobetasol spray has almost nothing in it that’s likely to be an allergen, although it’s a little oily and that can be an issue. But if you’re worried about allergy either to the steroid or to other factors in the product, that’s a good one. Also, triamcinolone ... has virtually nothing in it that’s allergenic other than occasionally the triamcinolone itself, and it’s not oily," he said.

The topical corticosteroid foams are a well-received option for maintenance therapy on hairy areas or for large surfaces.

When a higher-potency topical steroid is desired during a breakthrough episode, halcinonide cream has low allergenicity, a desirable biphasic quick and then delayed release, and good moisturizing and emollient properties, Dr. Fowler said.

He reported that he serves as a consultant to Allerderm, Coria, Galderma, Graceway, Hyland, Johnson & Johnson, Quinnova, Ranbaxy, Shire, Stiefel, Triax, and UCB.

SDEF and this news organization are owned by Elsevier.

WAIKOLOA, HAWAII – The calcineurin inhibitors are effective for long-term maintenance therapy in chronic hand dermatitis, despite their black box warning, and can help reduce the use of topical steroids, according to dermatologist Joseph F. Fowler Jr.

Pimecrolimus 1% cream is nongreasy and thus preferred by many patients over tacrolimus 0.1% ointment, he said at the seminar sponsored by the Skin Disease Education Foundation (SDEF).

Bruce Jancin/IMNG Medical Media

"Please understand that I love topical steroids. We all need to use them. But I don’t want to use them continuously because of the variety of adverse effects, especially local atrophy. And if we’re worried about skin barrier function, we don’t want to thin the skin out and reduce the barrier even more with overuse of topical steroids," he said.

"So after we’ve got somebody under control with aggressive use of higher-potency topical steroids, I like to think about the calcineurin inhibitors. I also like to think about what I call the therapeutic moisturizers – those device and [over-the-counter] products that contain ceramides and natural moisturizing factors – and I’ll maybe use a low- to midpotency topical steroid two or three times a week as needed," added Dr. Fowler of the University of Louisville (Ky.).

There are several skin barrier protection products approved as prescription devices rather than medications, such as Atopiclair, Eletone, EpiCeram, Hylatopic, Neosalus, and Tetrix. Many aren’t promoted much anymore by their manufacturers, yet all have supporting evidence that they enhance the skin barrier, he said.

The two skin barrier products Dr. Fowler is most familiar with because of his involvement in clinical trials are Tetrix and Neosalus.

The investigator-blinded, nonrandomized Tetrix cream study involved patients with known allergies to three common, structurally dissimilar test antigens: nickel, neomycin, and fragrance mix. Following exposure to the test antigens, delayed-type hypersensitivity reactions on patch testing were significantly less at sites pretreated with Tetrix cream than at untreated test sites (Cutis 2008;82[suppl. 4]:21-8).

In the multicenter prospective Neosalus foam study, 31 patients with chronic allergic or irritant hand dermatitis of at least 12 months’ duration were randomized to treatment with Neosalus foam plus triamcinolone cream 0.1% or to an over-the-counter (OTC) moisturizer plus the topical steroid. During 8 weeks, patients in the Neosalus group averaged 51.4 doses of the topical steroid, compared with 72.5 doses in controls. Eczema severity scores were also significantly better in the Neosalus group (Am. J. Contact Dermat. 2000;11:165-9).

OTC moisturizers containing ceramide, a lipid that boosts stratum corneum function, include Aveeno eczema therapy moisturizing cream, CeraVe lotion and cleanser, Cetaphil Restoraderm moisturizer, and Curel Sensitive Skin Remedy, Dr. Fowler continued.

He said that he likes to choose from a short list of topical steroids for maintenance therapy. Fluticasone cream or lotion has fewer local adverse effects than many other steroids and has demonstrated long-term efficacy and safety in the setting of atopic dermatitis. Hydrocortisone butyrate lipid cream or lotion has excellent tolerability and a good moisturizing effect.

When there is concern that a patient’s dermatitis may be compounded by topical steroid allergy, clocortolone cream or desonide ointment are excellent choices; there is virtually no allergenicity to either product, according to Dr. Fowler.

"If I’m worried about topical steroid allergy, the sprays, I think, are very nice. Clobetasol spray has almost nothing in it that’s likely to be an allergen, although it’s a little oily and that can be an issue. But if you’re worried about allergy either to the steroid or to other factors in the product, that’s a good one. Also, triamcinolone ... has virtually nothing in it that’s allergenic other than occasionally the triamcinolone itself, and it’s not oily," he said.

The topical corticosteroid foams are a well-received option for maintenance therapy on hairy areas or for large surfaces.

When a higher-potency topical steroid is desired during a breakthrough episode, halcinonide cream has low allergenicity, a desirable biphasic quick and then delayed release, and good moisturizing and emollient properties, Dr. Fowler said.

He reported that he serves as a consultant to Allerderm, Coria, Galderma, Graceway, Hyland, Johnson & Johnson, Quinnova, Ranbaxy, Shire, Stiefel, Triax, and UCB.

SDEF and this news organization are owned by Elsevier.

WAIKOLOA, HAWAII – The calcineurin inhibitors are effective for long-term maintenance therapy in chronic hand dermatitis, despite their black box warning, and can help reduce the use of topical steroids, according to dermatologist Joseph F. Fowler Jr.

Pimecrolimus 1% cream is nongreasy and thus preferred by many patients over tacrolimus 0.1% ointment, he said at the seminar sponsored by the Skin Disease Education Foundation (SDEF).

Bruce Jancin/IMNG Medical Media

"Please understand that I love topical steroids. We all need to use them. But I don’t want to use them continuously because of the variety of adverse effects, especially local atrophy. And if we’re worried about skin barrier function, we don’t want to thin the skin out and reduce the barrier even more with overuse of topical steroids," he said.

"So after we’ve got somebody under control with aggressive use of higher-potency topical steroids, I like to think about the calcineurin inhibitors. I also like to think about what I call the therapeutic moisturizers – those device and [over-the-counter] products that contain ceramides and natural moisturizing factors – and I’ll maybe use a low- to midpotency topical steroid two or three times a week as needed," added Dr. Fowler of the University of Louisville (Ky.).

There are several skin barrier protection products approved as prescription devices rather than medications, such as Atopiclair, Eletone, EpiCeram, Hylatopic, Neosalus, and Tetrix. Many aren’t promoted much anymore by their manufacturers, yet all have supporting evidence that they enhance the skin barrier, he said.

The two skin barrier products Dr. Fowler is most familiar with because of his involvement in clinical trials are Tetrix and Neosalus.

The investigator-blinded, nonrandomized Tetrix cream study involved patients with known allergies to three common, structurally dissimilar test antigens: nickel, neomycin, and fragrance mix. Following exposure to the test antigens, delayed-type hypersensitivity reactions on patch testing were significantly less at sites pretreated with Tetrix cream than at untreated test sites (Cutis 2008;82[suppl. 4]:21-8).

In the multicenter prospective Neosalus foam study, 31 patients with chronic allergic or irritant hand dermatitis of at least 12 months’ duration were randomized to treatment with Neosalus foam plus triamcinolone cream 0.1% or to an over-the-counter (OTC) moisturizer plus the topical steroid. During 8 weeks, patients in the Neosalus group averaged 51.4 doses of the topical steroid, compared with 72.5 doses in controls. Eczema severity scores were also significantly better in the Neosalus group (Am. J. Contact Dermat. 2000;11:165-9).

OTC moisturizers containing ceramide, a lipid that boosts stratum corneum function, include Aveeno eczema therapy moisturizing cream, CeraVe lotion and cleanser, Cetaphil Restoraderm moisturizer, and Curel Sensitive Skin Remedy, Dr. Fowler continued.

He said that he likes to choose from a short list of topical steroids for maintenance therapy. Fluticasone cream or lotion has fewer local adverse effects than many other steroids and has demonstrated long-term efficacy and safety in the setting of atopic dermatitis. Hydrocortisone butyrate lipid cream or lotion has excellent tolerability and a good moisturizing effect.

When there is concern that a patient’s dermatitis may be compounded by topical steroid allergy, clocortolone cream or desonide ointment are excellent choices; there is virtually no allergenicity to either product, according to Dr. Fowler.

"If I’m worried about topical steroid allergy, the sprays, I think, are very nice. Clobetasol spray has almost nothing in it that’s likely to be an allergen, although it’s a little oily and that can be an issue. But if you’re worried about allergy either to the steroid or to other factors in the product, that’s a good one. Also, triamcinolone ... has virtually nothing in it that’s allergenic other than occasionally the triamcinolone itself, and it’s not oily," he said.

The topical corticosteroid foams are a well-received option for maintenance therapy on hairy areas or for large surfaces.

When a higher-potency topical steroid is desired during a breakthrough episode, halcinonide cream has low allergenicity, a desirable biphasic quick and then delayed release, and good moisturizing and emollient properties, Dr. Fowler said.

He reported that he serves as a consultant to Allerderm, Coria, Galderma, Graceway, Hyland, Johnson & Johnson, Quinnova, Ranbaxy, Shire, Stiefel, Triax, and UCB.

SDEF and this news organization are owned by Elsevier.

ORLANDO – Reports of U.S. children with a food allergy jumped by a third between 2003-2004 and 2007-2008.

The finding is based on survey responses collected by the Centers for Disease Control and Prevention from more than 90,000 patients during each of the two time periods. An analysis of other data collected by the surveys implicated younger age, lack of health insurance, and eczema as three factors associated with the increased prevalence of food allergies in children, Dr. Karen A. DeMuth said during a poster presentation at the meeting (J. Allergy Clin. Immunol. 2012 [doi:10.1016/j.jaci.2011.12.147]).

Other possible factors not accounted for in the survey results might also have played a role in the sharp rise, such as an increased level of awareness about food allergies among parents, and an increased rate of testing children for food allergies, she acknowledged in an interview. The telephone surveys conducted by the CDC relied exclusively on parents’ reports of allergies in their children, and so the rates do not reflect allergy rates documented by physician examinations or food-challenge tests. But the fact that these limitations applied in both survey periods – 2003-2004 and 2007-2008 – makes it less likely that they played a major role in explaining the increased food allergy prevalence.

"These data show us how many parents think their kids have a food allergy," Dr. DeMuth said.

She and her associate used data collected in the first two National Surveys of Children’s Health. During 2003-2004, the CDC completed telephone surveys with 102,353 U.S. households, and during 2007-2008, the agency obtained responses from 91,642 families. During each survey, the CDC collected data for a single child aged 0-17 years from each responding family.

During the first survey, parents reported a food allergy in their child at a rate of 3,566 cases/100,000 children, a prevalence rate of 3.6%. By the second survey, the prevalence rose to 4,848 cases/100,000 children, a rate of 4.8%, a 33% relative increase that was statistically significant, reported Dr. DeMuth, an allergist and immunologist at Emory University in Atlanta.

The prevalence rates increased by an absolute rate of more than 2% in eight states: Arkansas, Delaware, Georgia, Hawaii, Maryland, Ohio, Oklahoma, and New Hampshire. The greatest absolute rise in percent terms was in Oklahoma, where the prevalence rate jumped by 3.2 percentage points. During 2007-2008, the highest overall reported prevalence rate for pediatric food allergies was in New Hampshire, where 6.7% of families reported having a child with a food allergy. The lowest prevalence rate during 2007-2008 was in Wisconsin, with a 3.3% rate. Between 2003-2004 and 2007-2008, a statistically significant increase in the prevalence of pediatric food allergies occurred in 17 states.

Three factors were linked on a statistically significant level with the increased rate of food allergies: Age of 0-5 years boosted the food allergies rate by 33%, compared with older children; having no health insurance was linked with a 48% higher rate of food allergy increase; and having eczema or atopic dermatitis was linked with a 4.7-fold higher rate of food-allergy increase, compared with children without skin atopy.

Results from two other studies reported in posters at the meeting further documented recent prevalence rates of pediatric food allergies in U.S. populations.

A survey of randomly-selected U.S. families was conducted during June 2009-February 2010 and collected information on 38,480 children aged 0-17. The results found that 3,218 parents (8%) said they had a child with a food allergy, reported Dr. Ruchi S. Gupta and her associates from Northwestern University in Chicago (J. Allergy Clin. Immunol. 2012 [doi:10.1016/j.jaci.2011.12.145]).

The parents said that 70% of these children had been identified as having a food allergy by a physician, and that 20% of the children had their food allergy documented by an oral food-challenge test. The allergens that the responding parents reported were peanut, milk, tree nut, shellfish, egg, fin fish, wheat, soy, and sesame. The most common presenting symptom was urticaria, reported for roughly half of the children with a food allergy.

The second report included data from a retrospective chart review done at a single, hospital-based Medicaid clinic in the East Harlem section of New York City. During July 1, 2008-July 1, 2010, the clinic saw 9,314 children, of whom 331 (3.6%) had a physician-diagnosed food allergy, reported Dr. Sarah A. Taylor-Black and her associate from Mount Sinai Medical Center in New York (J. Allergy Clin. Immunol. 2012 [doi:10.1016/j.jaci.2011.12.148]). The patients’ average age at diagnosis was 1.7 years, with a range of 4 months to 10 years old. The most common allergy was to peanut, followed by shellfish, egg, tree nut, milk, fruit, fish, soy, vegetable, seed, and wheat. Allergy prevalence was 5.6% among black children, compared with 3.0% among Hispanic children, a statistically significant difference. Skin symptoms were the most common presentation in children with allergies to peanut, shellfish, egg, milk, and fish.

Dr. DeMuth, Dr. Gupta, and Dr. Taylor-Black all said that they had no disclosures.

Mitchel L. Zoler/IMNG Medical Media

ORLANDO – Reports of U.S. children with a food allergy jumped by a third between 2003-2004 and 2007-2008.

The finding is based on survey responses collected by the Centers for Disease Control and Prevention from more than 90,000 patients during each of the two time periods. An analysis of other data collected by the surveys implicated younger age, lack of health insurance, and eczema as three factors associated with the increased prevalence of food allergies in children, Dr. Karen A. DeMuth said during a poster presentation at the meeting (J. Allergy Clin. Immunol. 2012 [doi:10.1016/j.jaci.2011.12.147]).

Other possible factors not accounted for in the survey results might also have played a role in the sharp rise, such as an increased level of awareness about food allergies among parents, and an increased rate of testing children for food allergies, she acknowledged in an interview. The telephone surveys conducted by the CDC relied exclusively on parents’ reports of allergies in their children, and so the rates do not reflect allergy rates documented by physician examinations or food-challenge tests. But the fact that these limitations applied in both survey periods – 2003-2004 and 2007-2008 – makes it less likely that they played a major role in explaining the increased food allergy prevalence.

"These data show us how many parents think their kids have a food allergy," Dr. DeMuth said.

She and her associate used data collected in the first two National Surveys of Children’s Health. During 2003-2004, the CDC completed telephone surveys with 102,353 U.S. households, and during 2007-2008, the agency obtained responses from 91,642 families. During each survey, the CDC collected data for a single child aged 0-17 years from each responding family.

During the first survey, parents reported a food allergy in their child at a rate of 3,566 cases/100,000 children, a prevalence rate of 3.6%. By the second survey, the prevalence rose to 4,848 cases/100,000 children, a rate of 4.8%, a 33% relative increase that was statistically significant, reported Dr. DeMuth, an allergist and immunologist at Emory University in Atlanta.

The prevalence rates increased by an absolute rate of more than 2% in eight states: Arkansas, Delaware, Georgia, Hawaii, Maryland, Ohio, Oklahoma, and New Hampshire. The greatest absolute rise in percent terms was in Oklahoma, where the prevalence rate jumped by 3.2 percentage points. During 2007-2008, the highest overall reported prevalence rate for pediatric food allergies was in New Hampshire, where 6.7% of families reported having a child with a food allergy. The lowest prevalence rate during 2007-2008 was in Wisconsin, with a 3.3% rate. Between 2003-2004 and 2007-2008, a statistically significant increase in the prevalence of pediatric food allergies occurred in 17 states.

Three factors were linked on a statistically significant level with the increased rate of food allergies: Age of 0-5 years boosted the food allergies rate by 33%, compared with older children; having no health insurance was linked with a 48% higher rate of food allergy increase; and having eczema or atopic dermatitis was linked with a 4.7-fold higher rate of food-allergy increase, compared with children without skin atopy.

Results from two other studies reported in posters at the meeting further documented recent prevalence rates of pediatric food allergies in U.S. populations.

A survey of randomly-selected U.S. families was conducted during June 2009-February 2010 and collected information on 38,480 children aged 0-17. The results found that 3,218 parents (8%) said they had a child with a food allergy, reported Dr. Ruchi S. Gupta and her associates from Northwestern University in Chicago (J. Allergy Clin. Immunol. 2012 [doi:10.1016/j.jaci.2011.12.145]).

The parents said that 70% of these children had been identified as having a food allergy by a physician, and that 20% of the children had their food allergy documented by an oral food-challenge test. The allergens that the responding parents reported were peanut, milk, tree nut, shellfish, egg, fin fish, wheat, soy, and sesame. The most common presenting symptom was urticaria, reported for roughly half of the children with a food allergy.

The second report included data from a retrospective chart review done at a single, hospital-based Medicaid clinic in the East Harlem section of New York City. During July 1, 2008-July 1, 2010, the clinic saw 9,314 children, of whom 331 (3.6%) had a physician-diagnosed food allergy, reported Dr. Sarah A. Taylor-Black and her associate from Mount Sinai Medical Center in New York (J. Allergy Clin. Immunol. 2012 [doi:10.1016/j.jaci.2011.12.148]). The patients’ average age at diagnosis was 1.7 years, with a range of 4 months to 10 years old. The most common allergy was to peanut, followed by shellfish, egg, tree nut, milk, fruit, fish, soy, vegetable, seed, and wheat. Allergy prevalence was 5.6% among black children, compared with 3.0% among Hispanic children, a statistically significant difference. Skin symptoms were the most common presentation in children with allergies to peanut, shellfish, egg, milk, and fish.

Dr. DeMuth, Dr. Gupta, and Dr. Taylor-Black all said that they had no disclosures.

Mitchel L. Zoler/IMNG Medical Media

ORLANDO – Reports of U.S. children with a food allergy jumped by a third between 2003-2004 and 2007-2008.

The finding is based on survey responses collected by the Centers for Disease Control and Prevention from more than 90,000 patients during each of the two time periods. An analysis of other data collected by the surveys implicated younger age, lack of health insurance, and eczema as three factors associated with the increased prevalence of food allergies in children, Dr. Karen A. DeMuth said during a poster presentation at the meeting (J. Allergy Clin. Immunol. 2012 [doi:10.1016/j.jaci.2011.12.147]).

Other possible factors not accounted for in the survey results might also have played a role in the sharp rise, such as an increased level of awareness about food allergies among parents, and an increased rate of testing children for food allergies, she acknowledged in an interview. The telephone surveys conducted by the CDC relied exclusively on parents’ reports of allergies in their children, and so the rates do not reflect allergy rates documented by physician examinations or food-challenge tests. But the fact that these limitations applied in both survey periods – 2003-2004 and 2007-2008 – makes it less likely that they played a major role in explaining the increased food allergy prevalence.

"These data show us how many parents think their kids have a food allergy," Dr. DeMuth said.

She and her associate used data collected in the first two National Surveys of Children’s Health. During 2003-2004, the CDC completed telephone surveys with 102,353 U.S. households, and during 2007-2008, the agency obtained responses from 91,642 families. During each survey, the CDC collected data for a single child aged 0-17 years from each responding family.

During the first survey, parents reported a food allergy in their child at a rate of 3,566 cases/100,000 children, a prevalence rate of 3.6%. By the second survey, the prevalence rose to 4,848 cases/100,000 children, a rate of 4.8%, a 33% relative increase that was statistically significant, reported Dr. DeMuth, an allergist and immunologist at Emory University in Atlanta.

The prevalence rates increased by an absolute rate of more than 2% in eight states: Arkansas, Delaware, Georgia, Hawaii, Maryland, Ohio, Oklahoma, and New Hampshire. The greatest absolute rise in percent terms was in Oklahoma, where the prevalence rate jumped by 3.2 percentage points. During 2007-2008, the highest overall reported prevalence rate for pediatric food allergies was in New Hampshire, where 6.7% of families reported having a child with a food allergy. The lowest prevalence rate during 2007-2008 was in Wisconsin, with a 3.3% rate. Between 2003-2004 and 2007-2008, a statistically significant increase in the prevalence of pediatric food allergies occurred in 17 states.

Three factors were linked on a statistically significant level with the increased rate of food allergies: Age of 0-5 years boosted the food allergies rate by 33%, compared with older children; having no health insurance was linked with a 48% higher rate of food allergy increase; and having eczema or atopic dermatitis was linked with a 4.7-fold higher rate of food-allergy increase, compared with children without skin atopy.

Results from two other studies reported in posters at the meeting further documented recent prevalence rates of pediatric food allergies in U.S. populations.

A survey of randomly-selected U.S. families was conducted during June 2009-February 2010 and collected information on 38,480 children aged 0-17. The results found that 3,218 parents (8%) said they had a child with a food allergy, reported Dr. Ruchi S. Gupta and her associates from Northwestern University in Chicago (J. Allergy Clin. Immunol. 2012 [doi:10.1016/j.jaci.2011.12.145]).

The parents said that 70% of these children had been identified as having a food allergy by a physician, and that 20% of the children had their food allergy documented by an oral food-challenge test. The allergens that the responding parents reported were peanut, milk, tree nut, shellfish, egg, fin fish, wheat, soy, and sesame. The most common presenting symptom was urticaria, reported for roughly half of the children with a food allergy.

The second report included data from a retrospective chart review done at a single, hospital-based Medicaid clinic in the East Harlem section of New York City. During July 1, 2008-July 1, 2010, the clinic saw 9,314 children, of whom 331 (3.6%) had a physician-diagnosed food allergy, reported Dr. Sarah A. Taylor-Black and her associate from Mount Sinai Medical Center in New York (J. Allergy Clin. Immunol. 2012 [doi:10.1016/j.jaci.2011.12.148]). The patients’ average age at diagnosis was 1.7 years, with a range of 4 months to 10 years old. The most common allergy was to peanut, followed by shellfish, egg, tree nut, milk, fruit, fish, soy, vegetable, seed, and wheat. Allergy prevalence was 5.6% among black children, compared with 3.0% among Hispanic children, a statistically significant difference. Skin symptoms were the most common presentation in children with allergies to peanut, shellfish, egg, milk, and fish.

Dr. DeMuth, Dr. Gupta, and Dr. Taylor-Black all said that they had no disclosures.

Mitchel L. Zoler/IMNG Medical Media

SAN DIEGO – Nearly half of elderly patients admitted to a geriatric ward reported having symptoms of pruritus, results from a single-center study found.

"Pruritus is a common complaint among the elderly," Dr. Yee Leng Teoh and colleagues wrote in an abstract presented during a poster session at the annual meeting of the American Academy of Dermatology. "It may have a significant impact on quality of life, but may be underestimated and poorly addressed."

In a study of 194 patients admitted to the geriatric ward of Changi General Hospital, Singapore, between March and May of 2010, Dr. Teoh and associates used a structured questionnaire including the Dermatology Life Quality Index (DLQI) to assess the prevalence and severity of itch and its impact on quality of life. They reviewed the patients’ hospital records regarding comorbid conditions, prior skin disease, medication use, and social background.

The mean age of the patients was 85 years, and their mean DLQI score was 6.7. Nearly half (49%) reported having a problem with itch for a mean of 15.3 months. Negative impacts on quality of life included disruption of sleep (reported by 35% of respondents) and disruption of mental concentration (reported by 31% of respondents).

More than half of patients (61%) said they had informed a physician about the problem, yet 26% believed that it was not sufficiently addressed. Twenty patients (10%) were diagnosed with a specific dermatologic condition, most commonly eczema and dermatophyte infection.

Of the participants who had informed their physician about the problem, 58% were treated with topical agents, 4% with oral antihistamines, and 33% with topical agents and oral antihistamines; 5% did not receive any treatment.

Study participants with a history of cerebrovascular accidents or transient ischemic attacks were 3.5 times more likely to have itch, compared with those who did not have this history. And patients with diabetes were 2.2 times more likely to have itch, compared with those who did not have the condition.

This may be because "sympathetic dysfunction caused hypohidrosis and resulted in xerosis," they hypothesized. "Another possible explanation is that patients with diabetic polyneuropathy, usually as a result of poor diabetic control, have damaged sensory C fibers, which can cause pruritus."

The study also found that elderly patients being treated with laxatives were 2.1 times less likely to have itch, compared with patients not taking laxatives. "We postulate that laxatives may facilitate the clearing of bile acids, resulting in a reduced incidence of itch," Dr. Teoh and associates wrote. "Lactulose can inhibit formation of deoxycholic acid from primary bile acids. This effect is thought to be mediated through the acidification of the proximal bowel, leading to reduction in 7 alpha-dehydroxylase, which converts primary to secondary bile acids."

The researchers reported having no relevant financial disclosures.

SAN DIEGO – Nearly half of elderly patients admitted to a geriatric ward reported having symptoms of pruritus, results from a single-center study found.

"Pruritus is a common complaint among the elderly," Dr. Yee Leng Teoh and colleagues wrote in an abstract presented during a poster session at the annual meeting of the American Academy of Dermatology. "It may have a significant impact on quality of life, but may be underestimated and poorly addressed."

In a study of 194 patients admitted to the geriatric ward of Changi General Hospital, Singapore, between March and May of 2010, Dr. Teoh and associates used a structured questionnaire including the Dermatology Life Quality Index (DLQI) to assess the prevalence and severity of itch and its impact on quality of life. They reviewed the patients’ hospital records regarding comorbid conditions, prior skin disease, medication use, and social background.

The mean age of the patients was 85 years, and their mean DLQI score was 6.7. Nearly half (49%) reported having a problem with itch for a mean of 15.3 months. Negative impacts on quality of life included disruption of sleep (reported by 35% of respondents) and disruption of mental concentration (reported by 31% of respondents).

More than half of patients (61%) said they had informed a physician about the problem, yet 26% believed that it was not sufficiently addressed. Twenty patients (10%) were diagnosed with a specific dermatologic condition, most commonly eczema and dermatophyte infection.

Of the participants who had informed their physician about the problem, 58% were treated with topical agents, 4% with oral antihistamines, and 33% with topical agents and oral antihistamines; 5% did not receive any treatment.

Study participants with a history of cerebrovascular accidents or transient ischemic attacks were 3.5 times more likely to have itch, compared with those who did not have this history. And patients with diabetes were 2.2 times more likely to have itch, compared with those who did not have the condition.

This may be because "sympathetic dysfunction caused hypohidrosis and resulted in xerosis," they hypothesized. "Another possible explanation is that patients with diabetic polyneuropathy, usually as a result of poor diabetic control, have damaged sensory C fibers, which can cause pruritus."

The study also found that elderly patients being treated with laxatives were 2.1 times less likely to have itch, compared with patients not taking laxatives. "We postulate that laxatives may facilitate the clearing of bile acids, resulting in a reduced incidence of itch," Dr. Teoh and associates wrote. "Lactulose can inhibit formation of deoxycholic acid from primary bile acids. This effect is thought to be mediated through the acidification of the proximal bowel, leading to reduction in 7 alpha-dehydroxylase, which converts primary to secondary bile acids."

The researchers reported having no relevant financial disclosures.

SAN DIEGO – Nearly half of elderly patients admitted to a geriatric ward reported having symptoms of pruritus, results from a single-center study found.

"Pruritus is a common complaint among the elderly," Dr. Yee Leng Teoh and colleagues wrote in an abstract presented during a poster session at the annual meeting of the American Academy of Dermatology. "It may have a significant impact on quality of life, but may be underestimated and poorly addressed."

In a study of 194 patients admitted to the geriatric ward of Changi General Hospital, Singapore, between March and May of 2010, Dr. Teoh and associates used a structured questionnaire including the Dermatology Life Quality Index (DLQI) to assess the prevalence and severity of itch and its impact on quality of life. They reviewed the patients’ hospital records regarding comorbid conditions, prior skin disease, medication use, and social background.

The mean age of the patients was 85 years, and their mean DLQI score was 6.7. Nearly half (49%) reported having a problem with itch for a mean of 15.3 months. Negative impacts on quality of life included disruption of sleep (reported by 35% of respondents) and disruption of mental concentration (reported by 31% of respondents).

More than half of patients (61%) said they had informed a physician about the problem, yet 26% believed that it was not sufficiently addressed. Twenty patients (10%) were diagnosed with a specific dermatologic condition, most commonly eczema and dermatophyte infection.

Of the participants who had informed their physician about the problem, 58% were treated with topical agents, 4% with oral antihistamines, and 33% with topical agents and oral antihistamines; 5% did not receive any treatment.

Study participants with a history of cerebrovascular accidents or transient ischemic attacks were 3.5 times more likely to have itch, compared with those who did not have this history. And patients with diabetes were 2.2 times more likely to have itch, compared with those who did not have the condition.

This may be because "sympathetic dysfunction caused hypohidrosis and resulted in xerosis," they hypothesized. "Another possible explanation is that patients with diabetic polyneuropathy, usually as a result of poor diabetic control, have damaged sensory C fibers, which can cause pruritus."

The study also found that elderly patients being treated with laxatives were 2.1 times less likely to have itch, compared with patients not taking laxatives. "We postulate that laxatives may facilitate the clearing of bile acids, resulting in a reduced incidence of itch," Dr. Teoh and associates wrote. "Lactulose can inhibit formation of deoxycholic acid from primary bile acids. This effect is thought to be mediated through the acidification of the proximal bowel, leading to reduction in 7 alpha-dehydroxylase, which converts primary to secondary bile acids."

The researchers reported having no relevant financial disclosures.

ORLANDO – Children who have at least two diagnoses of the "allergic triad" – asthma, allergic rhinitis, and atopic dermatitis – often receive prescriptions from multiple physicians and may be at risk for substantial exposure to exogenous corticosteroids.

This finding, from a chart review of 197 pediatric patients seen between 2000 and 2010 at a single U.S. allergy/immunology clinic, "reinforces the need for improved communication and coordination of care," said Dr. Min Jung Lee of Cohen Children’s Medical Center of New York.

Of the 197 patients who had been diagnosed with at least two of the three ICD-9 codes for asthma, allergic rhinitis, and/or atopic dermatitis, 48% had all three conditions. Of the patients diagnosed with two of the three conditions, 67% had both asthma and allergic rhinitis, 16.5% had asthma and atopic dermatitis, and 16.5% had allergic rhinitis and atopic dermatitis, Dr. Lee said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Of the patients with asthma, 74% were treated with inhaled steroids. Of those, 36% received steroid prescriptions from multiple physicians, 29% from allergists alone, 21% from primary care physicians alone, and 9% from pulmonologists alone. Of the patients with allergic rhinitis, 62% were treated with intranasal steroids, of which 20% were given prescriptions by multiple physicians, 67% by allergists alone, 5% by primary care physicians alone, and 3% by otolaryngologists alone. Of those with atopic dermatitis, 75% were treated with topical steroids; of those, 41% received steroid prescriptions from multiple physicians, 23% from dermatologists alone, 21% from allergists alone, and 7% from primary care physicians alone. (There were small numbers from each group for which the specialty of the prescriber was unknown.)

Among the children with both asthma and allergic rhinitis, 55% were treated with corticosteroids for both conditions and 38% for one of the two conditions, while just 7% were not treated with corticosteroids. For those with asthma and atopic dermatitis, 59% were prescribed corticosteroids for both conditions and 23% for just one of the two, while 18% received no corticosteroids. For the allergic rhinitis plus atopic dermatitis group, 6% were treated with corticosteroids for both conditions and 82% for just one, while 12% received none.

For the 95 patients who had all three conditions, 41% were treated with corticosteroids for all three, 36% for two of the three, and 19% for one of the three. Just 4% of that group was not treated with corticosteroids, Dr. Lee reported.

In response to an audience member’s question about whether the prescriptions were coordinated, she replied, "No, usually we didn’t see any communication between physicians."

In an interview, the study’s principal investigator, Dr. James C. Fagin, noted, "Our concern is the cumulative effect, because there are so many physicians involved and the communication is so poor that the primary care physician may not know what the [specialist] is prescribing, or if the [specialist] changes that prescription to a more potent drug. Without the electronic medical record to cement all of this, it becomes difficult to manage. We are certainly guilty in our speciality because we’re not always notifying the primary care physician every time we change a prescription."

However, "in terms of asthma care, we want the primary care physician to be actively involved, but they aren’t always good at communicating with specialists about changes they make. ... Communication has to go both ways," added Dr. Fagin, director of pediatric allergy and clinical immunology and director of the Center for Childhood Asthma at the Cohen children’s center.

In response to another audience member’s question regarding the role of electronic medical records, Dr. Lee responded that "access to electronic pharmacy records would also be very beneficial for each of us to know what our patients are getting."

Both Dr. Lee and Dr. Fagin stated that they had no disclosures.

ORLANDO – Children who have at least two diagnoses of the "allergic triad" – asthma, allergic rhinitis, and atopic dermatitis – often receive prescriptions from multiple physicians and may be at risk for substantial exposure to exogenous corticosteroids.

This finding, from a chart review of 197 pediatric patients seen between 2000 and 2010 at a single U.S. allergy/immunology clinic, "reinforces the need for improved communication and coordination of care," said Dr. Min Jung Lee of Cohen Children’s Medical Center of New York.

Of the 197 patients who had been diagnosed with at least two of the three ICD-9 codes for asthma, allergic rhinitis, and/or atopic dermatitis, 48% had all three conditions. Of the patients diagnosed with two of the three conditions, 67% had both asthma and allergic rhinitis, 16.5% had asthma and atopic dermatitis, and 16.5% had allergic rhinitis and atopic dermatitis, Dr. Lee said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Of the patients with asthma, 74% were treated with inhaled steroids. Of those, 36% received steroid prescriptions from multiple physicians, 29% from allergists alone, 21% from primary care physicians alone, and 9% from pulmonologists alone. Of the patients with allergic rhinitis, 62% were treated with intranasal steroids, of which 20% were given prescriptions by multiple physicians, 67% by allergists alone, 5% by primary care physicians alone, and 3% by otolaryngologists alone. Of those with atopic dermatitis, 75% were treated with topical steroids; of those, 41% received steroid prescriptions from multiple physicians, 23% from dermatologists alone, 21% from allergists alone, and 7% from primary care physicians alone. (There were small numbers from each group for which the specialty of the prescriber was unknown.)

Among the children with both asthma and allergic rhinitis, 55% were treated with corticosteroids for both conditions and 38% for one of the two conditions, while just 7% were not treated with corticosteroids. For those with asthma and atopic dermatitis, 59% were prescribed corticosteroids for both conditions and 23% for just one of the two, while 18% received no corticosteroids. For the allergic rhinitis plus atopic dermatitis group, 6% were treated with corticosteroids for both conditions and 82% for just one, while 12% received none.

For the 95 patients who had all three conditions, 41% were treated with corticosteroids for all three, 36% for two of the three, and 19% for one of the three. Just 4% of that group was not treated with corticosteroids, Dr. Lee reported.

In response to an audience member’s question about whether the prescriptions were coordinated, she replied, "No, usually we didn’t see any communication between physicians."

In an interview, the study’s principal investigator, Dr. James C. Fagin, noted, "Our concern is the cumulative effect, because there are so many physicians involved and the communication is so poor that the primary care physician may not know what the [specialist] is prescribing, or if the [specialist] changes that prescription to a more potent drug. Without the electronic medical record to cement all of this, it becomes difficult to manage. We are certainly guilty in our speciality because we’re not always notifying the primary care physician every time we change a prescription."

However, "in terms of asthma care, we want the primary care physician to be actively involved, but they aren’t always good at communicating with specialists about changes they make. ... Communication has to go both ways," added Dr. Fagin, director of pediatric allergy and clinical immunology and director of the Center for Childhood Asthma at the Cohen children’s center.

In response to another audience member’s question regarding the role of electronic medical records, Dr. Lee responded that "access to electronic pharmacy records would also be very beneficial for each of us to know what our patients are getting."

Both Dr. Lee and Dr. Fagin stated that they had no disclosures.

ORLANDO – Children who have at least two diagnoses of the "allergic triad" – asthma, allergic rhinitis, and atopic dermatitis – often receive prescriptions from multiple physicians and may be at risk for substantial exposure to exogenous corticosteroids.

This finding, from a chart review of 197 pediatric patients seen between 2000 and 2010 at a single U.S. allergy/immunology clinic, "reinforces the need for improved communication and coordination of care," said Dr. Min Jung Lee of Cohen Children’s Medical Center of New York.

Of the 197 patients who had been diagnosed with at least two of the three ICD-9 codes for asthma, allergic rhinitis, and/or atopic dermatitis, 48% had all three conditions. Of the patients diagnosed with two of the three conditions, 67% had both asthma and allergic rhinitis, 16.5% had asthma and atopic dermatitis, and 16.5% had allergic rhinitis and atopic dermatitis, Dr. Lee said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Of the patients with asthma, 74% were treated with inhaled steroids. Of those, 36% received steroid prescriptions from multiple physicians, 29% from allergists alone, 21% from primary care physicians alone, and 9% from pulmonologists alone. Of the patients with allergic rhinitis, 62% were treated with intranasal steroids, of which 20% were given prescriptions by multiple physicians, 67% by allergists alone, 5% by primary care physicians alone, and 3% by otolaryngologists alone. Of those with atopic dermatitis, 75% were treated with topical steroids; of those, 41% received steroid prescriptions from multiple physicians, 23% from dermatologists alone, 21% from allergists alone, and 7% from primary care physicians alone. (There were small numbers from each group for which the specialty of the prescriber was unknown.)

Among the children with both asthma and allergic rhinitis, 55% were treated with corticosteroids for both conditions and 38% for one of the two conditions, while just 7% were not treated with corticosteroids. For those with asthma and atopic dermatitis, 59% were prescribed corticosteroids for both conditions and 23% for just one of the two, while 18% received no corticosteroids. For the allergic rhinitis plus atopic dermatitis group, 6% were treated with corticosteroids for both conditions and 82% for just one, while 12% received none.

For the 95 patients who had all three conditions, 41% were treated with corticosteroids for all three, 36% for two of the three, and 19% for one of the three. Just 4% of that group was not treated with corticosteroids, Dr. Lee reported.

In response to an audience member’s question about whether the prescriptions were coordinated, she replied, "No, usually we didn’t see any communication between physicians."

In an interview, the study’s principal investigator, Dr. James C. Fagin, noted, "Our concern is the cumulative effect, because there are so many physicians involved and the communication is so poor that the primary care physician may not know what the [specialist] is prescribing, or if the [specialist] changes that prescription to a more potent drug. Without the electronic medical record to cement all of this, it becomes difficult to manage. We are certainly guilty in our speciality because we’re not always notifying the primary care physician every time we change a prescription."

However, "in terms of asthma care, we want the primary care physician to be actively involved, but they aren’t always good at communicating with specialists about changes they make. ... Communication has to go both ways," added Dr. Fagin, director of pediatric allergy and clinical immunology and director of the Center for Childhood Asthma at the Cohen children’s center.

In response to another audience member’s question regarding the role of electronic medical records, Dr. Lee responded that "access to electronic pharmacy records would also be very beneficial for each of us to know what our patients are getting."

Both Dr. Lee and Dr. Fagin stated that they had no disclosures.