What's in a name? Atopic dermatitis or atopic eczema, but not eczema alone

Silverberg, Jonathan I.; Thyssen, Jacob P.; Paller, Amy S.; Drucker, Aaron M.; Wollenberg, Andreas; Lee, K. H.; Kabashima, Kenji; Todd, Gail; Schmid‐Grendelmeier, Peter; Bieber, Thomas

doi:10.1111/all.13225

Cited by 40 publications

(39 citation statements)

References 17 publications

(24 reference statements)

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“…We have also elected to use the term AD, rather than eczema, as it is a more specific clinical term,45 despite eczema being commonly used term in the community. We will use the UK Working Party Criteria for AD as a primary outcome in this study 23.…”

Section: Discussionmentioning

confidence: 99%

PEBBLES study protocol: a randomised controlled trial to prevent atopic dermatitis, food allergy and sensitisation in infants with a family history of allergic disease using a skin barrier improvement strategy

Lowe

Tang

et al. 2019

BMJ Open

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IntroductionThe skin is an important barrier against environmental allergens, but infants have relatively impaired skin barrier function. There is evidence that impaired skin barrier function increases the risk of allergic sensitisation, atopic dermatitis (AD) and food allergy. We hypothesise that regular prophylactic use of emollients, particularly those that are designed to improve skin barrier structure and function, will help prevent these conditions. With the aim of determining if application of a ceramide-dominant emollient two times per day reduces the risk of AD and food allergy, we have commenced a multicentre phase III, outcome assessor blinded, randomised controlled trial of this emollient applied from birth to 6 months.Methods and analysisInfants (n=760) with a family history of allergic disease will be recruited from maternity hospitals in Melbourne. The primary outcomes are as follows: the presence of AD, assessed using the UK Working Party criteria, and food allergy using food challenge, in the first 12 months of life as assessed by a blinded study outcome assessor. Secondary outcomes are as follows: food sensitisation (skin prick test), skin barrier function, AD severity, the presence of new onset AD after treatment cessation (between 6 and 12 months) and the presence of parent reported AD/eczema. Recruitment commenced in March 2018.Ethics and disseminationThe PEBBLES Study is approved by the Human Research Ethics Committees of the Royal Children’s Hospital (RCH) (#37090A) and the Mercy Hospital for Women (2018–008). Parents or guardians will provide written informed consent. Outcomes will be disseminated through peer-reviewed publications and presented at scientific conferences.Trial registration numbersACTRN12617001380381 andNCT03667651.

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Section: Discussionmentioning

confidence: 99%

PEBBLES study protocol: a randomised controlled trial to prevent atopic dermatitis, food allergy and sensitisation in infants with a family history of allergic disease using a skin barrier improvement strategy

Lowe

Tang

et al. 2019

BMJ Open

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“…All responses were anonymous. No a priori definition of consensus was determined but, post hoc, and it was decided to use rules similar to the Harmonizing Outcome Measures for Eczema (HOME) initiative, which have been used in previous IEC consensus articles . Consensus required that less than 30% of the voters disagreed (i.e.…”

Section: Methodsmentioning

confidence: 99%

Conjunctivitis in atopic dermatitis patients with and without dupilumab therapy – international eczema council survey and opinion

Thyssen

Bruin‐Weller

Paller

et al. 2019

Acad Dermatol Venereol

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Background Conjunctivitis is common in patients with atopic dermatitis ( AD ) in general and a commonly reported adverse event in AD clinical trials with dupilumab. Objective To survey opinions and experience about conjunctivitis occurring in AD , including those during dupilumab treatment in a group of AD experts from the International Eczema Council ( IEC ). Methods Electronic survey and in‐person discussion of management strategies. Results Forty‐six (53.5%) IEC members from 19 countries responded to the survey. Consensus was reached for several statements regarding diagnostic workup, referral and treatment. IEC members suggest that patients with AD should (i) routinely be asked about ocular complaints or symptoms, (ii) obtain information about the potential for conjunctivitis before starting dupilumab therapy and (iii) if indicated, be treated with dupilumab despite previous or current conjunctivitis. In cases of new‐onset conjunctivitis, there was consensus that dupilumab treatment should be continued when possible, with appropriate referral to an ophthalmologist. Limitations The study relies on expert opinion from dermatologists. Responses from few dermatologists without dupilumab access were not excluded from the survey. Conclusion The IEC recommends that dermatologists address conjunctivitis in patients with AD , especially during treatment with dupilumab.

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“…Currently, reliable criteria for distinguishing between transitory rashes and AD in infancy are not well established. Young children cannot describe or report itchiness, leading to problems in diagnoses and nomenclature of AD . Furthermore, some two‐thirds of children diagnosed with AD are not truly atopic, ie not sensitised to any allergens …”

Section: Introductionmentioning

confidence: 99%

“…Young children cannot describe or report itchiness, 3 leading to problems in diagnoses and nomenclature of AD. 4 Furthermore, some two-thirds of children diagnosed with AD are not truly atopic, ie not sensitised to any allergens. 5,6 The literature relating to clinical trials and cohorts reports several methods for ascertaining AD.…”

Section: Introductionmentioning

confidence: 99%

Diagnosing atopic dermatitis in infancy: Questionnaire reports vs criteria‐based assessment

Dharma

Lefebvre

Tran

et al. 2018

Paediatric Perinatal Epid

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Background Persisting atopic dermatitis (AD) is known to be associated with more serious allergic diseases at later ages; however, making an accurate diagnosis during infancy is challenging. We assessed the diagnostic performance of questionnaire‐based AD measures with criteria‐based in‐person clinical assessments at age 1 year and evaluated the ability of these diagnostic methods to predict asthma, allergic rhinitis and food allergies at age 5 years. Methods Data relate to 3014 children participating in the Canadian Healthy Infant Longitudinal Development (CHILD) Study who were directly observed in a clinical assessment by an experienced healthcare professional using the UK Working Party criteria. The majority (2221; 73.7%) of these children also provided multiple other methods of AD ascertainment: a parent reporting a characteristic rash on a questionnaire, a parent reporting the diagnosis provided by an external physician and a combination of these two reports. Results Relative to the direct clinical assessment, the area under the Receiver Operating Characteristic curve for a parental report of a characteristic rash, reported physician diagnosis and a combination of both were, respectively, 0.60, 0.69 and 0.70. The strongest predictor of asthma at 5 years was AD determined by criteria‐based in‐person clinical assessment followed by the combination of parental and physician report. Conclusions These findings suggest that questionnaire data cannot accurately substitute for assessment by experienced healthcare professionals using validated criteria for diagnosis of atopic dermatitis. Combining the parental report with diagnosis by a family physician might sometimes be appropriate (eg to avoid costs of a clinical assessment).

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What's in a name? Atopic dermatitis or atopic eczema, but not eczema alone

Abstract: Background: The ideal nomenclature of atopic dermatitis (AD) / atopic eczema (AE)

Cited by 40 publications

References 17 publications

PEBBLES study protocol: a randomised controlled trial to prevent atopic dermatitis, food allergy and sensitisation in infants with a family history of allergic disease using a skin barrier improvement strategy

PEBBLES study protocol: a randomised controlled trial to prevent atopic dermatitis, food allergy and sensitisation in infants with a family history of allergic disease using a skin barrier improvement strategy

Conjunctivitis in atopic dermatitis patients with and without dupilumab therapy – international eczema council survey and opinion

Diagnosing atopic dermatitis in infancy: Questionnaire reports vs criteria‐based assessment

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