Narrative review on the management of moderate-severe atopic dermatitis in pediatric age of the Italian Society of Pediatric Allergology and Immunology (SIAIP), of the Italian Society of Pediatric Dermatology (SIDerP) and of the Italian Society of Pediatrics (SIP)

Abstract

Currently, there are a few detailed guidelines on the overall management of children and adolescents with moderate-severe atopic dermatitis. AD ​​is a complex disease presenting with different clinical phenotypes, which require an individualized and multidisciplinary approach. Therefore, appropriate interaction between primary care pediatricians, pediatric allergists, and pediatric dermatologists is crucial to finding the best management strategy. In this manuscript, members of the Italian Society of Pediatric Allergology and Immunology (SIAIP), the Italian Society of Pediatric Dermatology (SIDerP), and the Italian Society of Pediatrics (SIP) with expertise in the management of moderate-severe atopic dermatitis have reviewed the latest scientific evidence in the field. This narrative review aims to define a pathway to appropriately managing children and adolescents with moderate-severe atopic dermatitis.

An updated reappraisal of dupilumab in children and adolescents with moderate–severe atopic dermatitis

“…Finally, the Italian guidelines emphasized a critical issue, such as the need for close interaction between primary care pediatricians, pediatric allergists, and pediatric dermatologists 32 . This partnership is crucial to optimally manage children with AD.…”

Advances for pediatricians in 2022: allergy, anesthesiology, cardiology, dermatology, endocrinology, gastroenterology, genetics, global health, infectious diseases, metabolism, neonatology, neurology, oncology, pulmonology

“…Atopic eczema has several clinical phenotypes that needs a multidisciplinary approach [6]. The review by Galli et al [7] reports current knowledge on treatment for moderate to severe cases. It has been highlighted the use of traditional treatments including trigger avoidance, emollients, bath, topical steroids, calcineurin inhibitors, immunosuppressive agents, anti-H1 antihistamines, phototherapy, education.…”

Tolerogenic Nano-/Microparticle Vaccines for Immunotherapy

“…15 Therefore, they could cause harmful effects to normal cell function. 12,15,16 The cell-based strategies, which include adoptive immunotherapy and stem cell transplantation to inhibit autoreactive T cells and restore immune tolerance, face manufacturing, purification, and scale-up challenges to realize their full potential. 17, 18 Moreover, current therapies often require lifelong, repeated, and even daily administration and are not curative.…”

“…More targeted remedies include the use of recombinant cytokines and monoclonal antibodies (mAbs), for instance, adalimumab (cytokine depletion antibody) and rituximab (B cell depletion antibody). − These treatments are more specific compared to the conventional ones, but they do not have selectivity since they bind their target receptors displayed on all healthy and abnormal cells . Therefore, they could cause harmful effects to normal cell function. ,, The cell-based strategies, which include adoptive immunotherapy and stem cell transplantation to inhibit autoreactive T cells and restore immune tolerance, face manufacturing, purification, and scale-up challenges to realize their full potential. , Moreover, current therapies often require lifelong, repeated, and even daily administration and are not curative. , Besides, the induced tolerance usually has insufficient coverage and requires the periphery regulation provided by specific antigen-presenting cells (APCs) on T cells. , Altogether, these drawbacks of existing treatments highlight the importance of engineering safer, more effective, and long-term approaches inducing more selective immune tolerance.…”