Consensus document APAIR: atopic dermatitis in children — update 2019 (short version) Part 2.

Atopic  dermatitis (AD) is a diagnosis  with precise criteria  described  by Hanifin & Rajka. A differential diagnosis  should be considered at  the  discrepancy of  the  symptoms or torpid  eczema.  The  list  of  diseases  is genetic  syndromes with  the impaired epidermal barrier, metabolic diseases,  skin infections, psoriasis and others. Skin infections in the diagnostic search should be considered the first  time.

The basis of therapy allergic eczema is the elimination of allergenic and non-allergenic triggers, topical steroids and inhibitors calcineurin with uses of emollients  in the skincare  process. This therapy is sufficient for most patients.

Systemic therapy of dermatitis consists of short courses of steroids (up to 1 week) with the ineffectiveness of external preparation. If long-term therapy is necessary, it is proposed to consider the possibility of prescribing  dupilumab and cyclosporin A. Antihistamines can be considered as a drug for stopping itching in the early days  of the disease. With  a sufficient effect of external anti-inflammatory drugs, the use of antihistamines is not required.

Exclusion  of  culpable  food  allergens  leads  to rapid  remission  of  the disease.  Non-specific hypoallergenic diets  reduce  the quality of life  of patients and  should  not be used for a long time. The main  formula for feeding children  with  allergies to cow's milk protein  is extensively hydrolysed formula. The amino  acid-based formula is reserved  for severe cases.

During the period of remission, it is important to provide  skincare and regular use of emollients, as well as a complex  to eliminate  causative allergens from  the patient’s environment.

Specific immunotherapy can be recommended for patients with a proven  role of the allergen in the development of exacerbation  AD and with a combination of eczema  with allergic rhinoconjunctivitis and asthma.

1. Lyons J.J., Milner J.D., Stone K.D. Atopic Dermatitis in Children: Clinical Features, Pathophysiology, and Treatment. Immunol. Allergy Clin. North Am. 2015; 35(1): 161–183.

2. Zhang L.Y., Tian W., Shu L. et al. Clinical Features, STAT3 Gene Mutations and Th17 Cell Analysis in Nine Children with Hyper-IgE Syndrome in Mainland China. Scand. J. Immunol. 2013; 78(3): 258–65.

3. Tom W.L. Eichenfield Eczematous disorders. In: Eichenfield L.F., Frieden I.J., Mathes E.F., Zaenglein A.L. Neonatal and Infant Dermatology. Third edition. ELSEVIER 2015: 216–232.

4. Kawasaki Y., Toyoda H., Otsuki S. et al. Anovel Wiskott-Aldrich syndrome protein mutation in an infant with thrombotic thrombocytopenic purpura. Eur.J. Haematol. 2013; 90(2): 164–168.

5. Tavil B., Erdem A.Y., Azik F. et al. Successful allogeneic hemopoietic stemcell transplantation in a case of Wiskott-Aldrich syndrome and non-Hodgkin lymphoma. Pediatr. Transplant. 2013; 17(6):E146–E148.

6. Jesenak M., Plamenova I., Plank L., Banovcin P. Wiskott-Aldrich syndrome caused by a new mutation associated with multifocal dermal juvenile xanthogranulomas. Pediatr. Dermatol. 2013; 30(5):91–94.

7. Thyssen J.P., Godoy-Gijon E., Elias P.M. Ichthyosis vulgaris: the filaggrin mutation disease. Br J Dermatol.2013; 168: 1155–1166.

8. Fortugno P., Bresciani A., Paolini C. Proteolytic activation cascade of the Netherton syndrome — defective protein, LEKTI, in the epidermis: implications for skin homeostasis J Invest Dermatol. 2011; 131: 2223–2232.

9. Gelmetti C.M., Grimalt R. Infantile Seborrhoeic Dermatitis In: Irvin A.D., Hoeger H.P., Yan A.C. Harper’s Textbook of Pediatric Dermatology, third edition, 2011; 35: 1–35.8.

10. Gelmetti C., Frasin A.L. Infantile seborrhoeic dermatitis: a disappearing disease. Eur J Pediatr Dermatol. 2008; 18: 155–156.

11. Karadag A.S., Bilgili S.G., Calka O. Acrodermatitis enteropathica in three siblings Indian J Dermatol, Venereol Leprol. 2013; 79 (2): 268–269.

12. Ashkenazi-Hoffnung L., Bilavsky E., Amir J. Acrodermatнtis enteropathica in a 9-month-old infant. Israel Medical Association J. 2011; 13(4): 258.

13. Jung A.G., Mathony U.A., Behre B., Kьry S., Schmitt S. et al. Acrodermatitis enteropathica: an uncommon differential diagnosis in childhood — first description of a new sequence variant. J Deutsch Dermatol Gesellschaft. 2011; 9(12): 999–1002.

14. Minkov M. Multisystem Langerhans Cell Histiocytosis in Children. Paediatr Drugs. 2011; 13(2): 75–86.

15. Larralde M. Langerhans cell histiocytosis in children under one year. Arch Argent Pediatr. 2008; 106(3): 269–272.

16. Shmidt E., Levitt J. Dermatologic infestations International Journal of Dermatology. 2012; 51: 131–141.

17. Nowicka D., Grywalska E. The Role of Immune Defects and Colonization of Staphylococcus aureus in the Pathogenesis of Atopic Dermatitis. Analytical CellularPathology. 2018; 5: 7 p.

18. Wollenberg A., Barbarot T., Bieber T. et al. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I. J Eur Acad Dermatol Venereol. 2018; 32: 657–682.

19. Eichenfield L.F., Tom W.L., Berger T.G. et al. Guidelines of care for the management of atopic dermatitis, section 2: management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014; 71(1): 116–132.

20. Еkerstrцm U., Reitamo S., Langeland T. et al. Comparison of moisturizing creams for the prevention of atopic dermatitis relapse: A randomized double-blind controlled multicentre clinical trial. Acta Derm. Venereol. 2015; 95(5): 587–592.

21. Pelc J., Czarnecka-Operacz M., Adamski Z. The structure and function of the epidermal barrier in patients with atopic dermatitis – Treatment options. Part two. Postep. Dermatologii i Alergol. 2018; 35(2): 123–127.

22. Adverse events of dupilumab in adults with moderate-to-severe atopic dermatitis: a meta-analysis / Ou Z., Chen C., Chen A., [et al.] International immunopharmacology. — 2018. — Т. 54. — С. 303–310.

23. Werfel T., Wollenberg A., Pumnea T., Heratizadeh A. Neues in der Systemtherapie der atopischen Dermatitis. Hautarzt . 2018; 69(3): 217–224.

24. Berth-Jones J., Graham-Brown R.A.C. Treatment of itching in atopic eczema. Br Med J. 1989; 298: 491–492.

25. Kemp J.P. Tolerance induction to antihistamines: Is it a problem? AnnAllergy. 1995; 50: 7–11.

26. Российский национальный согласительный документ по атопическому дерматиту. Атопический дерматит: применение антигистаминных препаратов. — М.: «Фармарус Принт», 2002. — 24 с.

27. Ferrer M., Morais-Almeida M., Guizova M., Khanferyan R. Evaluation of treatment satisfaction in children with allergic disease treated with an antihistamine: an international, non-interventional, retrospective study. Clin Drug Investig. 2010; 30(1): 15–34.

28. Гущин И.С. Аллергическое воспаление и его фармакологический контроль. М., «Фармарус Принт», 1998.

29. Diepgen T.L. Long-term treatment with cetirizine of infants with atopic dermatitis: a multi-country, double-blind, randomized, placebo-controlled trial (the ETAC trial) over 18 months. Pediatr Allergy Immunol. Aug-2002; 13(4): 278–286.

30. Nassif A., Chan S.C., Storrs F.J. et al. Abnormal skin irritancy in atopic dermatitis and in atopy without dermatitis. Arch Dermatol 1994; 130: 1402–1407.

31. Bremmer S.F., Simpson E.L. Dust mite avoidance for the primary prevention of atopic dermatitis: A systematic review and meta-analysis. Pediatric Allergy andImmunology. Nov 2015; 26(7), 646–654.

32. Nankervis H., Pynn E.V. et al. House dust mite reduction and avoidance measures for treating eczema (Review). The Cochrane Collaboration. 2015.

33. Sanda T., Yasue T., Oohashi M. et al. Effectiveness of house dust-mite allergen avoidance through clean room therapy in patients with atopic dermatitis. J Allergy Clin Immunol 1992; 89: 653–657.

34. Bock S.A., Atkins F.M. Patterns of food hypersensitivity during sixteen years of double-blind, placebo-controlled food challenges. J Pediatr 1990; 117: 561–567.

35. Young M.C. Elimination Diets in Eczema—A Cautionary Tale. The Journal of Allergy and Clinical Immunology: In Practice. 2016, V.4, Issue 2, P. 237–238.

36. Chang A., Robison R., Cai M., Singh A.M. Natural history of food triggered atopic dermatitis and development of immediate reactions in children. J Allergy Clin Immunol Pract. 2016 Mar-Apr; 4(2): 229–236.

37. Kim J.S., Nowak-Wegrzyn A., Sicherer S.H., Noone S., Moshier E.L., Sampson H.A. Dietary baked milk accelerates the resolution of cow’s milk allergy in children. The Journal of Allergy and Clinical Immunology. 2011; 128(1): 125–131.

38. Sampson H.A. The immunopathogenic role of food hypersensitivity in atopic dermatitis. Acta Derm Venereol Suppl (Stockh) 1992; 176: 34–37.

39. Bergmann M.M., Caubet J.C., Boguniewicz M., Eigenmann P.A. Evaluation of food allergy in patients with atopic dermatitis. The Journal of Allergy and Clinical Immunology: In Practice. 2013; 1(1): 22–28.

40. Zeiger R.S. Use of elemental formulas: Hydrolysates in allergy prevention. Ross Conference 107th: Physiologic/Immunologic Responses to Dietary Nutrients: Role of Elemental and Hydrolysate Formulas in Management of the Pediatric Patient. Ross Products Publishers, Columbus, Ohio, 1998: 108–126.

41. Fiocchi A. et al. World Allergy Organization (WAO) diagnosis and rationale for action against CMA (DRACMA) guidelines. Pediatr Allergy immunol 2010; 21(suppl 21): 1–125.

42. Meyer R.et al. Malnutrition in children with food allergies in the UK. J Hum Nutr Diet. 2013; 27, 227–235.

43. Koletzko S. et al. Diagnostic approach and management of CMA in infants and children: ESPGHAN GI Committee practical guidelines. J Pediatr Gastroenterol Nutr, 2012: 221–229.

44. Ludman S. et al. Managing CMA in children. BMJ. 2013; 347: 355.-186.

45. Venter C. et al. Diagnosis and management of non-IgE-mediated CMA in infancy — a UK primary care practical guide. Clin Transl Allergy. 2013; 3(1): 23.

46. Hill D.J. et al. The efficacy of amino AAF in relieving the symptoms of CMA: a systematic review. Clin Exp Allergy. 2007 Jun; 37(6): 808–822.

47. Luyt D et al. Standards of Care Committee (SOCC) of the BSACI. BSACI guideline for the diagnosis and management of CMA. Clin. Exp. Allergy 2014, 44, 642–672.

48. Meyer R. et al. When Should Infants with Cow’s Milk Protein Allergy Use an Amino Acid Formula? A Practical Guide. J Allergy Clin Immunol Pract 2017 Mar-Apr; 6(2): 383–399.

49. Antunes J. et al. Allergy to eHF. Allergol Immunopathol. 2009; 37: 272–274.

50. Liacouras C.A. et al. EoE: a 10-year experience in 381 children. ClinGastroenterol Hepatol. 2001; 3(12): 1198–1206.

51. Gil K.M., Sampson H.A. Psychological and social factors of atopic dermatitis. Allergy 9S: 84–89.

52. White A., Horne D.J., Varigos G.A. Psychological profile of the atopic eczema patient. Australas J Dermatol 1990; 31: 13–16.

53. Noren P., Melin L. The effect of combined topical steroids and habit-reversal treatment in patients with atopic dermatitis. Br J Dermatol 1989; 121: 359–366.

54. Melin L., Frederiksen T., Noren P. et al. Behavioral treatment of scratching in patients with atopic dermatitis. Br J Dermatol 1986; 115: 467–474.

55. Horne D.J., White A.E., Varigos G.A. A preliminary study of psychological therapy in the management of atopic eczema. Br J Med Psychol 1989; 62: 241–248.

56. Haynes S.N., Wilson C.C., Jaffe P.G. et al. Biofeedback treatment of atopic dermatitis: controlled case studies of eight cases. Biofeedback Self Regul 1979; 4: 195–209.

57. Wollenberg A., Barbarot T., Bieber T. et al Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part II. J Eur Acad Dermatol Venereol 2018; 32: 850–878.

58. Sidbury R., Davis D.M., Cohen D.E. et al. Guidelines of care for the management of atopic dermatitis: section 3. Management and treatment with phototherapy and systemic agents. J. Am. Acad. Dermatol. 2014; 71(2): 327–349.

59. Астафьева Н.Г., Кобзев Д.Ю. Между верой и знанием: официальная, альтернативная и комплементарная медицина в лечении астмы и аллергии (часть 1). Лечащий врач. 2012, № 6: 59–62.

60. Астафьева Н.Г., Кобзев Д.Ю. Между верой и знанием: официальная, альтернативная и комплементарная медицина в лечении астмы и аллергии (часть 2). Лечащий врач. 2012, № 8: 74–77.

61. «Атопический дерматит у детей: обновление 2019 (на правах руководства)». Согласительный документ Ассоциации детских аллергологов и иммунологов России. Москва: АДАИР, 2019; Cамара: ООО «Полиграфическое объединение «Стандарт», 2019. — 222 с.

62. Приказ Министерства здравоохранения РФ от 7 июня 2018 г. № 321н «Об утверждении перечней медицинских показаний и противопоказаний для санаторно-курортного лечения» ГАРАНТ.РУ: http://www.garant.ru/products/ipo/prime/doc/71879402/#ixzz5Qak8NB83

63. Погонченкова И.В., Рассулова М.А., Хан М.А., Лян Н.А. и др. Современные технологии медицинской реабилитации детей с атопическим дерматитом//Доктор.Ру. 2016. №12 (129). Часть 2. С. 44–47.

64. Смолкин Ю.С., Балаболкин И.И., Горланов И.А. и др. Атопический дерматит у детей: обновление 2019 (на правах руководства). Согласительный документ Ассоциации детских аллергологов и иммунологов России. Краткая версия. Часть 1. Аллергология и иммунология в педиатрии 2020; 60 (1): 4–25, https://doi.org/10.24411/2500-1175-2020-10001

65. Glover M.T., Atherton D.J. A doubleblind controlled trial of hyposensitization to Dermatophagoides pteronyssinus in children with atopic eczema. Clin Ex Allergy. 1992; 22: 440–446.

66. Максимова А.В., Смолкин Ю.С. Аллергические реакции к компонентам вакцин в обосновании тактики профилактической вакцинации чувствительных пациентов: аналитический обзор. Педиатрия. Приложение к журналу Consilium Medicum 2019; 3: 24–32.