Clinical and Immunological Changes of Immunotherapy in Patients with Atopic Dermatitis: Randomized Controlled Trial

Caraballo, Jorge Mario Sánchez; Villa, Ricardo Cardona

doi:10.5402/2012/183983

Cited by 27 publications

(38 citation statements)

References 29 publications

(30 reference statements)

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“…The trial by Sanchez-Caraballo and Cardona-Villa 412 reported a significant improvement in disease severity, measured using the SCORAD index, in the experimental group compared with the control group after 6 months (p = 0.03), but the magnitude of benefit cannot be found in the reported data. An unvalidated patient-reported subjective score was also used to assess disease severity in this study and there was a significant difference in severity between treatments in favour of specific immunotherapy (p = 0.01).…”

Section: Benefitscontrasting

confidence: 48%

“…Eight participants in the immunotherapy group and six participants in the placebo group experienced worsening of skin inflammation that required mild topical corticosteroids. In the trial by Sanchez-Caraballo and Cardona-Villa, 412 16 local immediate reactions were observed in 11 patients in the first 3 months of treatment, whereas no systemic reactions were recorded. It was unclear in which groups these adverse events were observed.…”

Section: Harmsmentioning

confidence: 99%

“…The other trial in children did not find any evidence of benefit. 412 The smallest trial provided evidence of benefit for immunotherapy, but with only 20 participants and a questionable placebo treatment (histamine) this does not add much weight to the evidence. 411 The evidence base for this treatment is far from clear.…”

Section: Overall Implications For Research and Practicementioning

confidence: 99%

“…One small unblinded trial by Sanchez-Caraballo and Cardona-Villa, 412 reported in 2012, compared specific immunotherapy using subcutaneous house dust mite allergens once a month for 1 year plus standard treatment (emollients, topical steroids, tacrolimus and oral steroids if needed) with standard treatment alone in 65 children and adults with eczema and sensitisation to house dust mite allergens (two common species). There were four dropouts in the control group and one in the experimental group.…”

Section: -414mentioning

confidence: 99%

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Scoping systematic review of treatments for eczema

Nankervis

Kim

Delamere

et al. 2016

Programme Grants Appl Res

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BackgroundEczema is a very common chronic inflammatory skin condition.ObjectivesTo update the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) systematic review of treatments for atopic eczema, published in 2000, and to inform health-care professionals, commissioners and patients about key treatment developments and research gaps.Data sourcesElectronic databases including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Skin Group Specialised Register, Latin American and Caribbean Health Sciences Literature (LILACS), Allied and Complementary Medicine Database (AMED) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from the end of 2000 to 31 August 2013. Retrieved articles were used to identify further randomised controlled trials (RCTs).Review methodsStudies were filtered according to inclusion criteria and agreed by consensus in cases of uncertainty. Abstracts were excluded and non-English-language papers were screened by international colleagues and data were extracted. Only RCTs of treatments for eczema were included, as other forms of evidence are associated with higher risks of bias. Inclusion criteria for studies included availability of data relevant to the therapeutic management of eczema; mention of randomisation; comparison of two or more treatments; and prospective data collection. Participants of all ages were included. Eczema diagnosis was determined by a clinician or according to published diagnostic criteria. The risk of bias was assessed using the Cochrane Collaboration risk-of-bias tool. We used a standardised approach to summarising the data and the assessment of risk of bias and we made a clear distinction between what the studies found and our own interpretation of study findings.ResultsOf 7198 references screened, 287 new trials were identified spanning 92 treatments. Trial reporting was generally poor (randomisation method: 2% high, 36% low, 62% unclear risk of bias; allocation concealment: 3% high, 15% low, 82% unclear risk of bias; blinding of the intervention: 15% high, 28% low, 57% unclear risk of bias). Only 22 (8%) trials were considered to be at low risk of bias for all three criteria. There was reasonable evidence of benefit for the topical medications tacrolimus, pimecrolimus and various corticosteroids (with tacrolimus superior to pimecrolimus and corticosteroids) for both treatment and flare prevention; oral ciclosporin; oral azathioprine; narrow band ultraviolet B (UVB) light; Atopiclair™ and education. There was reasonable evidence to suggest no clinically useful benefit for twice-daily compared with once-daily topical corticosteroids; corticosteroids containing antibiotics for non-infected eczema; probiotics; evening primrose and borage oil; ion-exchange water softeners; protease inhibitor SRD441 (Serentis Ltd); furfuryl palmitate in emollient; cipamfylline cream; andMycobacterium vaccaevaccine. Additional research evidence is needed for emollients, bath additives, antibacterials, specialist clothing and complementary and alternative therapies. There was no RCT evidence for topical corticosteroid dilution, impregnated bandages, soap avoidance, bathing frequency or allergy testing.LimitationsThe large scope of the review coupled with the heterogeneity of outcomes precluded formal meta-analyses. Our conclusions are still limited by a profusion of small, poorly reported studies.ConclusionsAlthough the evidence base of RCTs has increased considerably since the last NIHR HTA systematic review, the field is still severely hampered by poor design and reporting problems including failure to register trials and declare primary outcomes, small sample size, short follow-up duration and poor reporting of risk of bias. Key areas for further research identified by the review include the optimum use of emollients, bathing frequency, wash products, allergy testing and antiseptic treatments. Perhaps the greatest benefit identified is the use of twice weekly anti-inflammatory treatment to maintain disease remission. More studies need to be conducted in a primary care setting where most people with eczema are seen in the UK. Future studies need to use the same core set of outcomes that capture patient symptoms, clinical signs, quality of life and the chronic nature of the disease.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Benefitscontrasting

confidence: 48%

Section: Harmsmentioning

confidence: 99%

Section: Overall Implications For Research and Practicementioning

confidence: 99%

Section: -414mentioning

confidence: 99%

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Scoping systematic review of treatments for eczema

Nankervis

Kim

Delamere

et al. 2016

Programme Grants Appl Res

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“…La sensibilidad en orden de frecuencia fue a Alternaria alternata, Aspergillus fumigatus, Candida albicans, Cladosporium herbarum y Tricophyton mentagrophytes. 29 Esta prevalencia baja de sensibilidad a hongos encontrada en Medellín es similar a la encontrada en pacientes con asma o rinitis en el mundo 8,13,14 y se puede presentar aislada o en racimos con sensibilidad a varios hongos. Raras veces se encuentra sensibilización a hongos aislada; es más frecuente la sensibilidad concomitante con otros alérgenos.…”

Section: Antecedentesunclassified

Perfil clínico de sensibilización a hongos en Medellín, Colombia

Bissinger¹,

Bareño

2016

RAM

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123www.nietoeditores.com.mx artículo original R Re ev vi is st ta a M Mé éx xi ic co o Perfil clínico de sensibilización a hongos en Medellín, ColombiaResumen ANTECEDENTES: la sensibilización a hongos se relaciona con enfermedades alérgicas como: asma, rinitis, conjuntivitis y dermatitis. En general, se asocia con sensibilidad a otros alérgenos. El patrón multisistémico se asoció en Medellín con la sensibilización a hongos.OBJETIVO: determinar el perfil clínico de la sensibilización a hongos en la ciudad de Medellín, Colombia. MATERIAL y MÉTODO:estudio observacional, descriptivo y retrospectivo consistente en la revisión de historias clínicas de pacientes menores de 70 años de edad con sensibilidad a hongos en las pruebas de neumoalergenos realizadas entre el 1 enero de 2011 y el 31 de marzo de 2014 en la consulta de alergología de dos clínicas. Se evaluaron 16 hongos y la coexistencia de enfermedades alérgicas y las condiciones ambientales. anTeCeDenTes Se reconoce que los hongos perticipan en los padecimientos alérgicos y no alérgicos. Está demostrado que los hongos pueden producir alergia tipo I en individuos susceptibles; los identificados con mayor frecuencia son ascomicetos, basidiomicetos y deuteromicetos. 1 Los hongos se encuentran en el interior de las viviendas y en espacios exteriores. La concentración de hongos en los interiores se ha asociado con diversos factores, entre los más relevantes están la humedad visible, las plantas y las mascotas. RESULTADOS 2-5La humedad y los hongos visibles en las viviendas se han asociado con sensibilización a éstos y a enfermedades alérgicas como: asma, rinitis y dermatitis, así como con la severidad de éstas. [6][7][8][9][10] Son escasos los estudios que no identifican esta asociación. 11,12La sensibilidad a hongos en pacientes alérgicos se ha reportado en numerosos estudios y así se ha determinado que en pacientes con rinitis y asma varía de 3 a 20% en Europa, 10% en Escandinavia, de 30 a 60% en Estados Unidos 13 y 6.7% en China.14 La expresión clínica presentada por pacientes sensibilizados a hongos es: asma, dermatitis, rinitis. La sensibilidad a hongos se asocia con sensibilidad a otros alérgenos.8 Está demostrada la asociación entre la sensibilidad a hongos y la severidad del asma 15-18 y de los síntomas de rinitis. 19Existe relación entre la sensibilidad a hongos y la edad; es más frecuente en niños y jóvenes que en adultos y en ancianos. 9,20-22 En Monterrey, México, se encontró mayor prevalencia de sensibilidad a hongos en el grupo de 0 a 10 años. 23En Colombia se demostró que la prevalencia de síntomas de asma y rinitis va en aumento (asma de 10.4 a 12% y rinitis 22.6 a 32% MATERIAL AND METHOD:We reviewed the medical records of 897 patients younger than 70 years old with fungi sensitization in the prick test during the period 1 January 2011 to 31 March 2014 in the allergy facility from 2 clinics. We evaluate 16 fungi and the presence of allergic diseases as well as the environmental conditions. RESULTS:Form 897 prick test, 12.8% were positive to fungi, an...

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Specific allergen immunotherapy for the treatment of atopic eczema

Tam

Calderón

Manikam

et al. 2016

Cochrane Database of Systematic Reviews

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Comparison 1 Immunotherapy versus control, Outcome 6 Use of other medications for eczema.. .. Analysis 2.1. Comparison 2 Planned subgroup analyses: immunotherapy versus control, Outcome 1 Participant-or parentreported specific symptoms of eczema-SCORAD part C by route of immunotherapy.. .. .. .. .. Analysis 2.2. Comparison 2 Planned subgroup analyses: immunotherapy versus control, Outcome 2 Participant-or parentreported specific symptoms of eczema-severity of sleep disturbance by route of immunotherapy.. .. .. Analysis 2.3. Comparison 2 Planned subgroup analyses: immunotherapy versus control, Outcome 3 Participant-or parentreported specific symptoms of eczema-SCORAD part C by allergen type.. .. .. .. .. .. .. Analysis 2.4. Comparison 2 Planned subgroup analyses: immunotherapy versus control, Outcome 4 Participant-or parentreported specific symptoms of eczema-severity of sleep disturbance by allergen type.. .. .. .. .. Analysis 2.5. Comparison 2 Planned subgroup analyses: immunotherapy versus control, Outcome 5 Participant-or parentreported specific symptoms of eczema-SCORAD part C by participant age.. .. .. .. .. .. . Analysis 2.6. Comparison 2 Planned subgroup analyses: immunotherapy versus control, Outcome 6 Participant-or parentreported specific symptoms of eczema-itch severity by participant age.. .. .. .. .. .. .. . Analysis 2.7. Comparison 2 Planned subgroup analyses: immunotherapy versus control, Outcome 7 Participant-or parentreported specific symptoms of eczema-severity of sleep disturbance by participant age.. .. .. .. . Analysis 2.8. Comparison 2 Planned subgroup analyses: immunotherapy versus control, Outcome 8 Participant-or parentreported specific symptoms of eczema-itch severity by severity at randomisation.. .. .. .. .. . Analysis 2.9. Comparison 2 Planned subgroup analyses: immunotherapy versus control, Outcome 9 Participant-or parentreported specific symptoms of eczema-severity of sleep disturbance by severity at randomisation.. .. .. Analysis 2.10. Comparison 2 Planned subgroup analyses: immunotherapy versus control, Outcome 10 Adverse events: any local reaction by route of immunotherapy.

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Clinical and Immunological Changes of Immunotherapy in Patients with Atopic Dermatitis: Randomized Controlled Trial

Cited by 27 publications

References 29 publications

Scoping systematic review of treatments for eczema

Scoping systematic review of treatments for eczema

Perfil clínico de sensibilización a hongos en Medellín, Colombia

Specific allergen immunotherapy for the treatment of atopic eczema

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