Early intervention of atopic dermatitis as a preventive strategy for progression of food allergy

Abstract

Background Atopic diseases, such as atopic dermatitis (AD) and food allergy (FA), have increased in prevalence in industrialized countries during the past few decades and pose a significant health burden. They appear to have a common underlying mechanism and a natural disease progression. AD is generally the first atopic disease to manifest followed by other atopic diseases, such as FA, allergic rhinitis, or allergic asthma suggesting that they are likely different manifestations of the same disease. Body Evidence suggests that allergic sensitization occurs through an impaired skin barrier, while consumption of these foods at an early age may actually result in tolerance. This has been termed the Dual-Allergen-Exposure hypothesis. Loss of barrier integrity has been hypothesized to enable penetration of allergens, pollutants, and microbes and initiation of an inflammatory immune cascade of events leading to sensitization. The immune dysfunction is thought to further exacerbate the impaired skin barrier to form a vicious cycle. There is much interest in preventing or protecting the skin barrier from developing a proinflammatory atopic state, which may potentially lead to the development of AD and subsequently, FA. Conclusion Research on preventing or treating skin barrier dysfunction is ongoing. A number of studies have evaluated the efficacy of emollients in preventing AD and FA with mixed results. Studies have differed in the study design, population characteristics, emollients type, and frequency, duration, and area of application. Emollient type has varied widely from oils, creams, petrolatum-based lotions, and trilipid creams. Current research is directed towards the use of trilipid emollients that are similar to the skin’s natural lipid composition with a 3:1:1 ratio of ceramides, cholesterol and free fatty acids and a pH that is similar to that of skin to determine their effectiveness for skin barrier repair and prevention of AD and FA.

Oryza Ceramide®, a rice-derived extract consisting of glucosylceramides and β-sitosterol glucoside, improves facial skin dehydration in Japanese subjects

“…Furthermore, cracks in the epidermis caused by dehydration of the s. corneum increases susceptibility to bacterial and viral infections, as well as sensitization by allergens, which are risk factors for infectious diseases [37] and skin allergies [38]. Assessing the primary outcome, cheek TEWL after 4 weeks and after 12 weeks of the Oryza Ceramide ® intervention was significantly reduced (Table 2).…”

From Skin Barrier Dysfunction to Systemic Impact of Atopic Dermatitis: Implications for a Precision Approach in Dermocosmetics and Medicine

“…New emollient formulations for skin barrier repair and prevention of AD could have the following properties: (i) lipid ratios similar to the skin’s natural lipid composition; (ii) moisturizing agents (humectants, ceramides, emulsifiers); (iii) occlusive agents; (iv) pH similar to that of skin (pH 4–6) [ 123 , 124 ], and (v) probiotic fragments, as well as other ingredients, to reduce Staphylococcus biofilm formation and prevent microbiome dysbiosis [ 125 ]…”

Atopijski dermatitis i faktori rizika za nastanak bolesti

“…36,1% ispitanika navodi da je dijete u ranoj dobi, odnosno do prve godine života liječeno antibioticima (grafikon 10). U literaturi se također upotreba antibiotika prije navršene prve godine života povezuje s rizikom od pojave alergijskih bolesti i AD 18 . Rizik raste sa svakim ponovljenim ciklusom uzimanja antibiotika.…”