Dietary Elimination for the Treatment of Atopic Dermatitis: A Systematic Review and Meta-Analysis

Oykhman, Paul; Dookie, Jared E; Al-Rammahy, Husam; Benedetto, Anna De; Asiniwasis, Rachel Netahe; LeBovidge, Jennifer; Wang, Julie; Ong, Peck Y.; Lio, Peter; Gutierrez, Alvin; Capozza, Korey; Martin, Stephen A.; Frazier, Winfred; Wheeler, Kathryn E.; Boguniewicz, Mark; Spergel, Jonathan M.; Greehawt, Matthew; Silverberg, Jonathan I.; Schneider, Lynda C.; Chu, Derek K.

doi:10.1016/j.jaip.2022.06.044

Cited by 40 publications

(30 citation statements)

References 78 publications

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“… 237 It is not uncommon that patients or providers incorrectly suspect diet as the cause of AD and inaccurately assign food allergies; this not only results in inappropriate testing and dietary changes but may also result in neglect of established AD treatments and possibly even development of IgE-mediated food allergy. 237 , 238 However, it is important for clinicians to be aware that the prevalence of food allergy is significantly higher in children with AD, as compared to healthy children. Therefore, timely prevention and proper diagnosis of food allergy in this population is warranted.…”

Section: Environmental Contributionsmentioning

confidence: 99%

Genetic/Environmental Contributions and Immune Dysregulation in Children with Atopic Dermatitis

Chong¹,

Visitsunthorn²,

Ong³

2022

JAA

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Atopic dermatitis (AD) is one of the most common skin conditions in humans. AD affects up to 20% of children worldwide and results in morbidity for both patients and their caregivers. The basis of AD is an interplay between genetics and the environment characterized by immune dysregulation. A myriad of mutations that compromise the skin barrier and/or immune function have been linked to AD. Of these, filaggrin gene ( FLG ) mutations are the most evidenced. Many other mutations have been implicated in isolated studies that are often unreplicated, creating an archive of genes with potential but unconfirmed relevance to AD. Harnessing big data, polygenic risk scores (PRSs) and genome-wide association studies (GWAS) may provide a more practical strategy for identifying the genetic signatures of AD. Epigenetics may also play a role. Staphylococcus aureus is the most evidenced microbial contributor to AD. Cutaneous dysbiosis may result in over-colonization by pathogenic strains and aberrant skin immunity and inflammation. Aeroallergens, air pollution, and climate are other key environmental contributors to AD. The right climate and/or commensals may improve AD for some patients.

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Section: Environmental Contributionsmentioning

confidence: 99%

Genetic/Environmental Contributions and Immune Dysregulation in Children with Atopic Dermatitis

Chong¹,

Visitsunthorn²,

Ong³

2022

JAA

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“…8,9 Our review identifies gaps in the literature with respect to treatment modalities beyond topical therapies. An understanding of patient values and preferences toward bleach baths, 2 allergen immunotherapy, dietary elimination, 3 and systemic therapies are necessary to inform optimal clinical decision-making. 4,6 With recent data showing the pervasive and influential nature of industry sponsorship bias in cost-effectiveness analyses, 75 our finding of 18 studies being sponsored by industry (and often conducted and written by them), shows the critical need for robust and independent analyses of patient values and preferences regarding new AD treatments.…”

Section: Discussionmentioning

confidence: 99%

“…A topic dermatitis (AD), commonly referred to as eczema or atopic eczema, is characterized by recurrent or chronic skin inflammation that often starts early in life and affects up to 20% of children internationally and 10% of adults in the US. 1 Treatment options for AD range from nonpharmacological, such as bleach baths 2 or dietary exclusions, 3 to topical, oral, and injectable pharmacotherapies. Clinicians hoping to optimally navigate their patients through treatment options often use clinical practice guidelines to support decision-making.…”

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confidence: 99%

Values and Preferences of Patients and Caregivers Regarding Treatment of Atopic Dermatitis (Eczema)

et al. 2023

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ImportancePatient values and preferences can inform atopic dermatitis (AD) care. Systematic summaries of evidence addressing patient values and preferences have not previously been available.ObjectiveTo inform American Academy of Allergy, Asthma &amp; Immunology (AAAAI)/American College of Allergy, Asthma and Immunology (ACAAI) Joint Task Force on Practice Parameters AD guideline development, patient and caregiver values and preferences in the management of AD were systematically synthesized.Evidence ReviewPaired reviewers independently screened MEDLINE, Embase, PsycINFO, and CINAHL databases from inception until March 20, 2022, for studies of patients with AD or their caregivers, eliciting values and preferences about treatment, rated risk of bias, and extracted data. Thematic and inductive content analysis to qualitatively synthesize the findings was used. Patients, caregivers, and clinical experts provided triangulation. The GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation–Confidence in the Evidence from Reviews of Qualitative Research) informed rating of the quality of evidence.FindingsA total of 7780 studies were identified, of which 62 proved eligible (n = 19 442; median age across studies [range], 15 years [3-44]; 59% female participants). High certainty evidence showed that patients and caregivers preferred to start with nonmedical treatments and to step up therapy with increasing AD severity. Moderate certainty evidence showed that adverse effects from treatment were a substantial concern. Low certainty evidence showed that patients and caregivers preferred odorless treatments that are not visible and have a minimal effect on daily life. Patients valued treatments capable of relieving itching and burning skin and preferred to apply topical corticosteroids sparingly. Patients valued a strong patient-clinician relationship. Some studies presented varied perspectives and 18 were at high risk for industry sponsorship bias.Conclusions and RelevanceIn the first systematic review to address patient values and preferences in management of AD to our knowledge, 6 key themes that may inform optimal clinical care, practice guidelines, and future research have been identified.

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“…GUIDAMEX recalca que solo al demostrar así una alergia alimentaria está indicado el manejo con dieta específica y nos recuerda que eliminar innecesariamente alimentos de la dieta en un lactante puede causar desnutrición 34,35 . Un metaanálisis de 2022 solo mostró un beneficio marginal con dietas de eliminación en la mejoría de DA; el manejo principal sigue siendo el dirigido a la piel 36 .…”

Section: S2(20)unclassified

Guía de dermatitis atópica para México (GUIDAMEX): lineamientos usando metodología ADAPTE

Larenas‐Linnemann¹,

Rincón-Pérez²,

Luna-Pech³

et al. 2023

GMM

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Dietary Elimination for the Treatment of Atopic Dermatitis: A Systematic Review and Meta-Analysis

Cited by 40 publications

References 78 publications

Genetic/Environmental Contributions and Immune Dysregulation in Children with Atopic Dermatitis

Genetic/Environmental Contributions and Immune Dysregulation in Children with Atopic Dermatitis

Values and Preferences of Patients and Caregivers Regarding Treatment of Atopic Dermatitis (Eczema)

Guía de dermatitis atópica para México (GUIDAMEX): lineamientos usando metodología ADAPTE

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