Allergen specific immunotherapy (AIT) has been the only pathogenetically relevant treatment of IgE-mediated allergic diseases (ADs) for many years. The use of AIT for atopic dermatitis (AD) treatment is dubious and has both followers and opponents. The improvement of subcutaneous AIT (SCIT) and introduction of Sublingual immunotherapy (SLIT) gives prospects of their application both for adults and children suffering from AD. This review presents results of scientific research, system and meta-analyses that confirm the clinical efficacy of AIT for children with AD who has the sensitization to allergens of house dust mite, grass and plant pollen suffering from co-occurring respiratory ADs and with moderate and severe course of allergic AD. There have been analyzed the most advanced achievements in AIT studies as well as there have been specified the unmet needs in AD. The preliminary diagnostics of IgE-mediated AD and pathophysiological disorders, including immune ones, will allow a doctor to develop appropriate comprehensive treatment algorithm for children’s AD aimed at its correction. The including of AIT to the children’s comprehensive therapy program is reasonable only if AD has the allergic form. It is necessary better to design the randomized research studies and to acquire extended clinical practice in children with AD. Use of the successes of molecular-based allergy diagnostics will help to optimize and personalize the process of selecting the necessary allergens to determine the most appropriate vaccines for children considering the results of the allergen component diagnostics. The strategy of treatment of children with AD in future will be based on individual target therapy.
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RATIONALE: Atopic dermatitis (AD) is the first manifestation of atopic march. The natural history of AD and predictive factors for atopic march were not widely studied in Asia. METHODS: Medical records of AD patients attending Pediatric Allergy clinic at Siriraj hospital prior to 15 years of age were reviewed. Patients were further interviewed to obtain the current symptoms and treatment. RESULTS: Fifty AD patients (68% female) were followed for 9.9 years. Median age at AD diagnosis was 1.2 years with the AD severity being mild (76%), moderate (16%) and severe (8%). Fifty percent of patients had complete remission at the median age of 8 years. The most common allergen sensitization was Dermatophagoides pteronyssinus and Dermatophagoides farinae (65.9%). Patients with early AD (onset < _2 years) was found to have concomitant food allergy in 58% with egg white and cow's milk as the leading causes (91%). Sixty-four percent of early AD had complete remission at the median age of 6.1 years. Food allergy was more prevalent in early AD compared with later onset AD (OR512.19, 95% CI; 1.43-100, p50.008). Allergic rhinitis (AR) and asthma was diagnosed in 60% and 34% of the patients with the median age of 4 and 3 years, respectively. Family history of atopy was associated with the development of asthma (OR55.53, 95% CI; 1.08-28.18, p50.028). CONCLUSIONS: Half of AD children had a complete remission at school age with a better prognosis in early AD. Two-third and one-third developed AR and asthma, respectively. Family history of atopy is a predictor of asthma.
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