La medición total de Ige fue un factor predictivo.

La medición total de Ige (altas cincentraciones) fue un factor predictivo de mala respuesta al tratamiento en un estudio finlandes

A smaller percentage of atopic dermatitis (AD) patients with high baseline serum total IgE achieved a good response to treatment, compared with AD patients with lower serum total IgE at baseline, in a retrospective study of Finnish patients.

After adjustment of the data from the multivariate analyses, "the presence of contact allergies and high baseline IgE values [greater than or equal to] 10,0000 IU/mL remained risk factors for poor long-term outcome and were statistically significantly negatively associated with a good treatment response (OR [odds ratio], 0.162 and 0.062, respectively), and with complete remission (OR 0.287 and 0.158, respectively)," wrote Ville Kiiski of Skin and Allergy Hospital, Helsinki, and his colleagues.

The study comprised 169 individuals aged 14-78 with atopic dermatitis. Patients were reevaluated a mean of 4.15 years following the first visit to the specialized AD clinic at Skin and Allergy Hospital of Helsinki University Central Hospital. They received topical treatments as either maintenance therapy with tacrolimus or maintenance treatment with either a combination of topical tacrolimus and topical corticosteroids, or topical corticosteroids alone. A dermatologist provided the patients with a long-term treatment plan, and a nurse provided "hands-on training for adequate topical therapy regimens," when necessary.

"In patients with baseline IgE [greater than or equal to] 10,000 IU/mL, proportions achieving complete remission or a good treatment response were only 8.7% and 14.3%, compared with 51.6% and 79.7% in patients with IgE [less than] 1,000 IU/mL, and 36.9% and 58.1% in patients with IgE 1,000-10.000 IU/mL, respectively," the researchers wrote.

While this study's results suggest that serum total IgE is a predictor of long-term treatment outcome in AD patients, a larger, prospective study is needed to confirm this, they added.

The authors declared no conflicts of interest.

Read the study in Acta Dermato-Venereologica (doi: 10.2340/00015555-2126). 

klennon@frontlinemedcom.com

Benjamin Hidalgo-Matlock

Skin Care Physicians of Costa Rica

4000-1054

2208-8206

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La Historia Clinica sigue siendo más valiosa que los laboratorios...

La medición de Ige especifico para alimentos no fue util en predecir verdadeta alergia alimentaria en el manejo de pacientes con Dermatitis Atopica.

Food-antigen–specific immunoglobulin E is not a predictor of food allergies in atopic dermatitis

Food-antigen–specific immunoglobulin E (sIgE) levels were not clinically useful for predicting food allergy development in a study of infants with atopic dermatitis (AD).

The dual-phase study included 1,087 patients aged 3-18 months who had been diagnosed with AD for no more than 3 months prior to enrollment in the study and had at least mild disease activity. During the first phase of the study, which was a 36-month, randomized, double-blind, vehicle-controlled phase, half of patients were treated with placebo cream and the other half were treated with 1% pimecrolimus cream. In the second phase of the study, which was open-label, all patients received 1% pimecrolimus cream for up to 33 months or the patient's 6th birthday, whichever occurred sooner. Patients were excluded if they received treatment with topical or systemic agents within 7 days before the first application of cream in the study. 

The researchers followed food allergy development during both phases of the study. Other data collected by the researchers included sIgE levels for various foods at baseline and at the end of both phases of the study, with sIgE decision points having been assigned to each food.

By the end of the second phase of the trial, 15.9% of patients had developed a food allergy, with 292 days having been the median period of time that passed before the initial diagnosis of a food allergy was made. The most common food allergies were to peanuts, cow's milk, and egg whites, occurring in 7%, 4%, and 4% of patients respectively. The percentage of patients with any allergy to food other than fish decreased over time. Higher levels of AD severity were predictive for the development of food allergy, with the percentage of patients who developed one or more food allergies by the end of the study having increased with increasing AD severity at baseline. 

Total serum immunoglobulin E (IgE) and sIgE for milk, eggs, and peanuts measured at the end of the second phase also were increased in patients with increasing AD severity. Despite these findings, the positive predictive values for sIgE decision points for the foods tested were low (less than 0.6 for all values tested).

"SIgE decision points, both published values and the novel decision points used in this study, had high [negative predictive values], in particular for peanut[s], egg white[s], and cow's milk. Thus, patients with mild AD with sIgE levels below these cutoffs would be unlikely to have or develop these specific allergies and would not benefit from food challenges or elimination diets. Similarly, elevated sIgE, as defined by the decision points tested, had very low [positive predictive values] for food allergy, both for sIgE values at baseline and at the end of the [first phase of the study] ... Thus, despite an increased likelihood of allergy development with increasing sIgE shown for cow's milk, egg[s], and peanut[s], our data do not support the use of sIgE testing for the diagnosis of food allergy in subjects without a history of reaction to that food," said Dr. Jonathan M. Spergelof the Children's Hospital of Philadelphia and his colleagues. 

Read the full study in Pediatrics (doi: 10.1542/peds.2015-1444).

klennon@frontlinemedcom.com

 

Benjamin Hidalgo-Matlock

Skin Care Physicians of Costa Rica

4000-1054

2208-8206

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Interesante, todo lo que hagamos para evitar acaros, en teoria no es util para prevención de la dermatitis atopica.

Dust mite avoidance for the primary prevention of atopic dermatitis: A systematic review and meta-analysis.

Pediatric Allergy and Immunology 2015;Vol 26(7):646 54

BACKGROUND: Dust mite sensitization plays a controversial role in the development of atopic dermatitis. Despite a lack of evidence for its efficacy, dust mite avoidance is commonly recommended for the prevention and treatment of atopic dermatitis. We aimed to evaluate whether dust mite avoidance strategies reduce the risk of developing atopic dermatitis in high-risk infants compared to randomized controls. METHODS: Studies were obtained by searching MEDLINE, PubMed, Scopus, The Cochrane Library, and The Global Resource of Eczema Trials databases. We included randomized, controlled trials of high-risk infants treated with a dust mite avoidance intervention and assessed for atopic dermatitis. Data were extracted independently by two reviewers using predefined criteria. RESULTS: Seven randomized controlled trials met our inclusion criteria (total n = 3040). Studies were largely unblinded but otherwise of reasonable quality. Three trials utilizing a dust mite avoidance approach but not additional interventions were combined in a meta-analysis. Dust mite avoidance provided no benefit in the prevention of atopic dermatitis (relative risk (RR) = 1.08, 95% confidence interval (CI) = 0.78-1.49, I(2) = 73%). CONCLUSIONS: Dust mite avoidance strategies alone or in combination with additional allergen avoidance modalities do not decrease the risk of developing atopic dermatitis and, given the current state of the evidence, should not be recommended for this purpose. The utility of dust mite avoidance for the treatment of atopic dermatitis or for the prevention and treatment of asthma or seasonal rhinoconjunctivitis are outside the scope of this review.

Benjamin Hidalgo-Matlock

Skin Care Physicians of Costa Rica

4000-1054

2208-8206

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OMS no dice cortar en seco ingesta de carne procesada o roja... Reducir!

WHO Says Public Not Asked to Stop Eating Processed Meat

By Kelly Young

Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH

The World Health Organization clarified that its recent report "does not ask people to stop eating processed meats but indicates that reducing consumption of these products can reduce the risk of colorectal cancer." 

The WHO's International Agency for Research on Cancer classified processed meats as a Group 1 carcinogen last week, meaning that there is "sufficient evidence of carcinogenicity in humans," particularly regarding colorectal cancer. An estimated 34,000 worldwide deaths annually are attributed to high processed meat consumption. They report that every 50 g (1.8 oz.) of processed meat eaten daily is associated with an 18% increased relative risk for developing colorectal cancer.

Red meat received a lower classification, Group 2a, which means it is "probably carcinogenic to humans."

In early 2016, a group within the WHO will examine how and whether processed and red meat fit into a healthy diet. 

WHO statement (Free)

Background: Physician's First Watch coverage of WHO's announcement (Free)

Benjamin Hidalgo-Matlock

Skin Care Physicians of Costa Rica

4000-1054

2208-8206

Please excuse the shortness of this message, as it has been sent from a mobile device.