Background The association between atopic dermatitis (AD) and food allergy (FA) is not fully understood, although a causal relationship has been suggested. This has important implications for ...prevention and treatment. Objective We aimed to review the association between AD and FA, the effect of FA on AD severity, chronicity, and age of onset, and the temporal relationship between the two. Methods Medline and Embase were systematically searched from inception to November 2014 for studies investigating both AD and FA. Results Sixty-six studies were identified. Eighteen were population-based, 8 used high-risk cohorts, and the rest comprised patients with either established AD or FA. In population-based studies, the likelihood of food sensitization was up to 6 times higher in patients with AD versus healthy control subjects at 3 months of age (odds ratio, 6.18; 95% CI, 2.94-12.98; P < .001). Other population-based studies reported that up to 53% of subjects with AD were food sensitized, and up to 15% demonstrated signs of FA on challenge. Meanwhile, studies including only patients with established AD have reported food sensitization prevalences up to 66%, with challenge-proven FA prevalences reaching up to 81%. Sixteen studies suggested that FA is associated with a more severe AD phenotype. Six studies indicated that AD of earlier onset or increased persistence is particularly associated with FA. Finally, one study found that AD preceded the development of FA. Conclusions This systematic review confirms a strong and dose-dependent association between AD, food sensitization, and FA. AD of increased severity and chronicity is particularly associated with FA. There is also evidence that AD precedes the development of food sensitization and allergy, in keeping with a causal relationship.
Prevention of food allergy du Toit, George, MD; Tsakok, Teresa, MRCP; Lack, Simon, BA ...
Journal of allergy and clinical immunology,
04/2016, Letnik:
137, Številka:
4
Journal Article
Recenzirano
Odprti dostop
The past few decades have witnessed an increase in the prevalence of IgE-mediated food allergy (FA). For prevention strategies to be effective, we need to understand the causative factors ...underpinning this rise. Genetic factors are clearly important in the development of FA, but given the dramatic increase in prevalence over a short period of human evolution, it is unlikely that FA arises through germline genetic changes alone. A plausible hypothesis is that 1 or more environmental exposures, or lack thereof, induce epigenetic changes that result in interruption of the default immunologic state of tolerance. Strategies for the prevention of FA might include primary prevention , which seeks to prevent the onset of IgE sensitization; secondary prevention , which seeks to interrupt the development of FA in IgE-sensitized children; and tertiary prevention , which seeks to reduce the expression of end-organ allergic disease in children with established FA. This review emphasizes the prevention of IgE-mediated FA through dietary manipulation, among other strategies; in particular, we focus on recent interventional studies in this field.
Placebos are widely used in clinical practice in spite of ethical restrictions. Whether such use is justified depends in part on the relative benefit of placebos compared to 'active' treatments. A ...direct test for differences between placebo and 'active' treatment effects has not been conducted.
We aimed to test for differences between treatment and placebo effects within similar trial populations.
A Cochrane Review compared placebos with no treatment in three-armed trials (no treatment, placebo, and treatment). We added an analysis of treatment and placebo differences within the same trials. SYNTHESIS METHODS: For continuous outcomes we compared mean differences between placebo and no treatment with mean differences between treatment and placebo. For binary outcomes we compared the risk ratio for treatment benefit (versus placebo) with the risk ratio for placebo benefit (versus no treatment). We conducted several preplanned subgroup analyses: objective versus subjective outcomes, conditions tested in three or more trials, and trials with varying degrees of bias.
In trials with continuous outcomes (n = 115) we found no difference between treatment and placebo effects (MD = -0.29, 95% CI -0.62 to 0.05, P = 0.10). In trials with binary outcomes (n = 37) treatments were significantly more effective than placebos (RRR = 0.72, 95%CI = 0.61 to 0.86, P = 0.0003). Treatment and placebo effects were not different in 22 out of 28 predefined subgroup analyses. Of the six subgroups with differences treatments were more effective than placebos in five. However when all criteria for reducing bias were ruled out (continuous outcomes) placebos were more effective than treatments (MD = 1.59, 95% CI = 0.40 to 2.77, P = 0.009).
Placebos and treatments often have similar effect sizes. Placebos with comparatively powerful effects can benefit patients either alone or as part of a therapeutic regime, and trials involving such placebos must be adequately blinded.
Abstract Background Atopic dermatitis is the commonest chronic inflammatory disorder of the skin, affecting more than 20% of children in industrialised countries and up to 5% of adults. This ...condition is often associated with other atopic diseases, such as IgE-mediated food allergy (FA). Food allergen recognition via antigen-presenting cells in eczematous skin has been suggested to act as an important mediator of food sensitisation and FA. This would have important implications for prevention and treatment. We aimed to review the association between atopic dermatitis and FA; the effect of FA on atopic dermatitis severity, chronicity, and age of onset; and whether there was a temporal association between atopic dermatitis and FA. Methods A systematic search of Medline and Embase, with no language limits imposed, from inception until Nov 30, 2014, was supplemented by a hand search of the literature. Two authors independently screened abstracts for suitability, resulting in 164 articles that were read in full. Article selection for further analysis was based on specific inclusion and exclusion criteria. We extracted data from selected articles using a predefined proforma. Since we did not consider formal meta-analysis to be either feasible or appropriate, we assigned a quality score to each article. Findings 66 studies were identified. 18 were population based, eight used high-risk cohorts, and 40 comprised patients with either established atopic dermatitis or FA. In population-based studies, the likelihood of food sensitisation was up to six times higher in patients with atopic dermatitis than in healthy controls at 3 months of age (odds ratio 6·18, 95% CI 2·94–12·98; p<0·001). Studies that included only patients with established atopic dermatitis reported food sensitisation prevalences of up to 66%, with challenge-proven FA prevalences up to 81%. Results from 16 studies suggested that FA is associated with a more severe atopic dermatitis phenotype. Six studies indicated that atopic dermatitis of earlier onset or increased persistence is particularly associated with FA. Finally, results of one study indicated that atopic dermatitis preceded the development of FA. Interpretation We confirm a strong and dose-dependent association between atopic dermatitis, food sensitisation, and FA. Atopic dermatitis of increased severity and chronicity is particularly associated with FA. Atopic dermatitis appeared to precede the development of FA, in keeping with a causal association. This evidence provides further support for skin barrier repair, early proactive treatment for atopic dermatitis, and reduction of environmental food allergen exposure in the prevention of food sensitisation and allergy. Funding None.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'in coronary artery bypass grafting using radial artery grafts, does proximal ...anastomosis to the aorta or left internal mammary artery achieve better patency'. Altogether >183 papers were found using the reported search, of which 9 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Radial artery grafts typically have a narrower lumen than vein grafts, and as such there is some concern that anastomosing them directly to the aorta during coronary artery bypass grafting (CABG) may impair graft patency. As such, some surgeons prefer to anastomose radial artery grafts to a second-order vessel such as the left internal mammary artery (LIMA). We sought to assess the evidence for this. A handful of papers directly addressing the issue of the effect of the site of proximal anastomosis on graft patency were found, with three showing no significant difference. One such study reported an insignificant difference in angiographic patency at 32 months postoperatively, with 94.1% of off-aorta grafts remaining patent vs 87.2% of off-LIMA grafts (p = 0.123). However, a large-scale well-designed study was able to demonstrate a statistically significant difference at five years postoperatively, with 74.3% of off-aorta grafts patent, compared with 65.2% of off-LIMA (p = 0.004). Nonetheless, a number of papers that report patency for either off-aorta or off-LIMA grafts give comparable figures for each technique. Additionally, different centres and investigators report very different patency results for grafts that have the same site of proximal anastomosis. One centre was able to achieve patency rates for off-LIMA grafts of 88% up to a mean of 7.7 years postoperatively while another centre reported a patency rate of only 78.6% at three years. Given this, and the plethora of other factors influencing graft patency, we conclude that the best evidence suggests that the site of proximal anastomosis has little or no effect on radial artery graft patency following CABG.
Abstract
Skin diseases affect one-third of the global population, posing a major healthcare burden. Deep learning may optimise healthcare workflows through processing skin images via neural networks ...to make predictions. A focus of deep learning research is skin lesion triage to detect cancer, but this may not translate to the wider scope of >2000 other skin diseases. We searched for studies applying deep learning to skin images, excluding benign/malignant lesions (1/1/2000-23/6/2022, PROSPERO CRD42022309935). The primary outcome was accuracy of deep learning algorithms in disease diagnosis or severity assessment. We modified QUADAS-2 for quality assessment. Of 13,857 references identified, 64 were included. The most studied diseases were acne, psoriasis, eczema, rosacea, vitiligo, urticaria. Deep learning algorithms had high specificity and variable sensitivity in diagnosing these conditions. Accuracy of algorithms in diagnosing acne (median 94%, IQR 86–98;
n
= 11), rosacea (94%, 90–97;
n
= 4), eczema (93%, 90–99;
n
= 9) and psoriasis (89%, 78–92;
n
= 8) was high. Accuracy for grading severity was highest for psoriasis (range 93–100%,
n
= 2), eczema (88%,
n
= 1), and acne (67–86%,
n
= 4). However, 59 (92%) studies had high risk-of-bias judgements and 62 (97%) had high-level applicability concerns. Only 12 (19%) reported participant ethnicity/skin type. Twenty-four (37.5%) evaluated the algorithm in an independent dataset, clinical setting or prospectively. These data indicate potential of deep learning image analysis in diagnosing and monitoring common skin diseases. Current research has important methodological/reporting limitations. Real-world, prospectively-acquired image datasets with external validation/testing will advance deep learning beyond the current experimental phase towards clinically-useful tools to mitigate rising health and cost impacts of skin disease.
Pediatric urticaria Tsakok, Teresa; Du Toit, George; Flohr, Carsten
Immunology and allergy clinics of North America,
02/2014, Letnik:
34, Številka:
1
Journal Article
Recenzirano
Although urticaria is not a life-threatening disease, its impact on quality of life in children should not be overlooked. A systematic search of online databases, including Medline, was performed to ...inform a review aiming to equip clinicians with an evidence-based approach to all aspects of pediatric urticaria. This review hinges on an illustrative case and includes a summary table of studies pertaining to disease management in children. The multiple issues faced by patients, their families, and treating clinicians are highlighted, and the current literature on the presentation, natural history, investigation, and management of this poorly understood condition is assessed.
Abstract Background Allergies affect up to 30% of adults and are increasing in prevalence. However, little is known about the genetic aetiology of immediate (type I) and delayed (type IV) immunity ...underpinning allergic reactions. Delayed hypersensitivity to nickel is the commonest form of contact dermatitis, affecting 17% of women and resulting in considerable occupational disability. The importance of environmental factors in nickel allergy is well established, but the question of this trait's heritability remains unknown. Methods 780 women, comprising 120 monozygotic (MZ) and 270 dizygotic (DZ) twin pairs, were assessed for a 48-h response to nickel patch testing. Associations between nickel sensitivity and the abundance of 401 metabolites were assessed to identify a potential biomarker for this allergic response. A genome-wide association study (GWAS) of the abundance of the top-ranking metabolite was done to ascertain correlations with common genetic variants. Findings A positive patch test to nickel was observed in at least one individual of 34 MZ and 102 DZ twin pairs. The case-wise concordance was approximately 50% for MZs and 30% for DZs, giving an estimated heritability of 54%. Metabolomic profiling showed that the strongest association was with isovalerate (p=1·97 × 10−3 ), a constituent of fatty acid metabolism. The GWAS of the abundance of isovalerate showed that the strongest association was with a single nucleotide polymorphism (SNP) of ANO6 (12q12), rs11183014 (p=1·8 × 10−6 ). There were also suggestive associations with four additional SNPs from ANO6 and a variant of CAMK1D (p<9·5 × 10−6 ). Interpretation Nickel allergy seems to be moderately heritable, and preliminary genetic analyses may suggest functional roles for ANO6 and CAMK1D in this delayed hypersensitivity response. Combined use of metabolomic and genome-wide genotyping data offers great promise in the discovery of novel genetic variants for nickel allergy. Funding King's College London Biomedical Research Centre.
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