Prevention of Transcutaneous Sensitization to Cow Milk Proteins in Infants with Atopic Dermatitis: Cohort Study

Abstract

Background. Malformations in epidermal barrier in children with atopic dermatitis (AD) can cause transcutaneous sensitization with further development of allergic diseases that can worsen the AD course and significantly reduces patients’ quality of life.Objective. The aim of the study was to determine the effect of topical treatment and maintenance therapy with pimecrolimus 1% cream (PIM) and topical glucocorticosteroids (tGCS) in infants with AD on reducing the risk of developing transcutaneous sensitization (due to the levels of specific IgE to the cow milk protein over time) and on reducing the disease severity (by the EASI scale).Methods. The study included children aged from 1 to 4 months with early manifestations of moderate and severe AD. The severity of AD was estimated via the EASI scale at start of observation, then at 6, 9 and 12 months of life. The class and level of specific IgE to cow milk proteins (CMP) were determined by the ImmunoCAP method at the point of enrolment and at the ages of 6 and 12 months. Statistical analysis of studied indicators dynamics and their comparison in research groups was carried out using multifactorial dispersion analysis.Results. The study included 36 patients. All patients have received standard tGCS therapy in combination with emollients (wet wrap) for 10 days. The maintenance therapy was prescribed in postacute period. It included topical calcineurin inhibitor PIM 2 times/day for 3 months, then double application (morning/evening) 3 times/week up to the age of 1 year old (group 1). Other group had maintenance therapy — tGCS2 times/week for 3 months, and then at AD aggravation (group 2). Group 1 has shown lower level of sensitization to CMP at the age of 6 and 12 months and more significant decrease in AD severity according to EASI scale compared to group 2.Conclusion. The treatment with PIM is effective in therapy of AD and prevention of transcutaneous sensitization in infants.

Role of skin management in the prevention of atopic dermatitis and food allergy

“…The proactive group experienced significant reductions in AD severity, quality of life scores, and serum TARC levels compared with the reactive group. Another observational study found that infants aged 1–4 months who received active eczema treatment with topical glucocorticoids for 10 days followed first by maintenance therapy with pimecrolimus 1% cream twice daily for 3 months, and continued on pimecrolimus twice daily three times a week until age 1 year had a lower risk of food allergen sensitization compared with infants who received only reactive treatment with topical steroids during eczema flares 58 . A retrospective study by Miyaji et al 7 .…”