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PubMed | University of Tübingen, UniversitatsSpital Zurich, Charité - Medical University of Berlin, Deutscher Neurodermitisbund DNB e. V. and 16 more.
Type: Journal Article | Journal: Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG | Year: 2015

Atopic dermatitis (AD) represents a pruritic, non-contagious, chronic or chronically relapsing, inflammatory skin disease. The course of the disease may be complicated by bacterial or viral superinfections. The first manifestation of the disease and further flare-ups are due to genetic predisposition and also to a variety of further trigger factors. The therapy regimen should be adapted to disease symptoms that are actually present and consider individual features of the disease as reported by the patients or their parents. This short version of the German guideline on AD provides an overview of evidence-based diagnostic and treatment options. All recommendations made here are the result of a consensus of the scientific medical societies, working groups and support groups based on scientific data published to date. Abstracts and details of the studies cited are provided in the long version of this guideline (see: www.awmf.org).


Hradetzky S.,Abteilung fur Immundermatologie und Experimentelle Allergologie | Heratizadeh A.,Abteilung fur Immundermatologie und Experimentelle Allergologie
Allergologie | Year: 2015

The saprophytic yeast Malassezia sympodialis is a member of the skin microflora of healthy as well as of diseased skin. Skin colonization with Malassezia species can be found particularly in a subgroup of adult patients with AD, but may already be detected in diseased infants and children. However, specific characteristics of colonisation significantly differing from healthy individuals could not be identified so far. Regarding therapeutic intervention topical application of ciclopiroxolamine 1% cream over a period of 4 weeks or oral administration of itraconazole over 1 - 2 months is possible. Patients who may benefit from this treatment should suffer from a more severe, recalcitrant course of the disease with involvement of the headneck-shoulder region and sensitization to Malassezia species. Whereas the role of irritating metabolites and enzymes for AD is not clear yet, the sensitization to allergens from Malassezia sympodialis is specific for AD and might contribute to perpetuation and exacerbation of the disease, especially when those allergens share homology to other Malassezia species as well as to human proteins. © 2015 Dustri-Verlag Dr. Karl Feistle.


Heratizadeh A.,Abteilung fur Immundermatologie und experimentelle Allergologie | Werfel T.,Abteilung fur Immundermatologie und experimentelle Allergologie
Monatsschrift fur Kinderheilkunde | Year: 2015

This article presents an overview of recent study data on the prevention of atopic dermatitis (AD) and sensitization during childhood. Recommendations from the current German guidelines on prevention of allergic diseases are presented from the dermatologist’s perspective while focusing on environmental conditions, such as keeping pets and exposure to house dust mites, topical therapy and life style conditions as well as aspects of topical therapy in children with AD predisposed to AD. © 2015, Springer-Verlag Berlin Heidelberg.


Heratizadeh A.,Abteilung fur Immundermatologie und experimentelle Allergologie | Werfel T.,Abteilung fur Immundermatologie und experimentelle Allergologie
Allergologie | Year: 2015

During the last decade numerous studies focusing on strategies in primary prevention of allergic diseases have been published which are characterized by a broad variety of study concepts and hypotheses. However, for life-style risk factors such as consumption of tobacco or overweight specific effects on inflammation have now been observed also for atopic dermatitis (AD). Recently published studies on the relevance of a dysfunction of the epidermal barrier in AD revealed further promising results. In infants with filaggrinloss- of-function mutations exposure to cats significantly increased the risk of eczema. Indeed, there is now sufficient evidence for the benefit of cat's avoidance in predisposed families. Since IgE-sensitization to distinct food allergens has been demonstrated to correlate with the severity of the disease, sensitization via the skin in children predisposed for AD is discussed. Systematic analyses of the type-IV sensitization profile of individuals with AD versus non-atopic controls also revealed a higher risk of selected contact sensitizations. With regard to prevention strategies focusing on stabilizing the skin barrier function, a consequent use of emollients in predisposed infants during their first weeks of life has been demonstrated to significantly reduce the incidence of eczema. Table 1 represents an overview on studies cited in this article. © 2015 Dustri-Verlag Dr. Karl Feistle.


Wichmann K.,Abteilung fur Immundermatologie und Experimentelle Allergologie | Heratizadeh A.,Abteilung fur Immundermatologie und Experimentelle Allergologie | Werfel T.,Abteilung fur Immundermatologie und Experimentelle Allergologie
Hautarzt | Year: 2012

Food allergy predominantly affects children rather than adult patients with atopic dermatitis (AD). Early sensitization to foods has been found to be significantly associated with AD. Three different patterns of clinical reactions to food allergens in AD patients exist: i. immediate-type reaction, ii. isolated late-type reaction, iii. combined reaction (i. + ii.). While in children allergens from cow's milk, hen's egg, soy, wheat, fish, peanut or tree nuts are mostly responsible for allergic reactions, birch-pollen related food allergens seem to play a major role in adolescent and adults with AD in Central and Northern Europe. Defects of the epidermal barrier function seem to facilitate the development of sensitization to allergens following epicutaneous exposure. The relevance of defects of the gut barrier as well as genetic characteristics associated with an increased risk for food allergy remain to be further investigated. Numerous studies focus on prevention strategies which include breast-feeding or feeding with hydrolyzed milk substitute formula during the first 4 months of life. © Springer-Verlag 2012.


Heratizadeh A.,Abteilung fur Immundermatologie und Experimentelle Allergologie | Wichmann K.,Abteilung fur Immundermatologie und Experimentelle Allergologie | Werfel T.,Abteilung fur Immundermatologie und Experimentelle Allergologie
Allergologie | Year: 2010

Atopic dermatitis (AD) represents a chronic inflammatory skin disease which is mostly associated with severe pruritus. For the treatment of AD the stage of the disease and complications such as bacterial superinfection of AD have to be considered. There are a number of external and internal treatment options for AD available. Over a long period a change of the individual treatment strategy might be indicated. For external treatment of AD symptoms not only emollients, but also anti-inflammatory and antipruritic substances might be necessary. The efficacy of topical steroids for the treatment of AD has sufficiently been demonstrated in a series of clinical trials. To reduce the risk for side effects the potency, the frequency and duration of usage as well as the localization of application and the patients age should be considered. Topical calcineurin inhibitors represent a further anti-inflammatory treatment option. Regarding the recommendation of the EMEA (European Medicines Agency) topical calcineurin inhibitors should be prescribed as "second-line" therapy in case of a risk for irreversible side effects or in case use of topical steroids is not possible. Since "ultra-long" experiences remain to be assessed, topical calcineurin inhibitors should be prescribed up from the age of 3, and tacrolimus 0.1% from the age of 17, respectively. Atopi-cal antiseptic treatment is indicated in cases of clinical manifestation of superinfection of AD. In order to reduce the risk for the development of bacterial resistance and epicutaneous sensitization topical antibiotics should temporarily be applied. UV-irradiation represents a further therapeutic option which can also be combined with topical steroids. © 2010 Dustri-Verlag Dr. Karl Feistle.


Heratizadeh A.,Abteilung fur Immundermatologie und experimentelle Allergologie | Werfel T.,Abteilung fur Immundermatologie und experimentelle Allergologie | Rosner L.M.,Abteilung fur Immundermatologie und experimentelle Allergologie
Hautarzt | Year: 2014

Due to a broad variety of extrinsic trigger factors, patients with atopic dermatitis (AD) are characterized by complex response mechanisms of the adaptive immune system. Notably, skin colonization with Staphylococcus aureus seems to be of particular interest since not only exotoxins, but also other proteins of S. aureus can induce specific humoral and cellular immune responses which partially also correlate with the severity of AD. In a subgroup of AD patients Malassezia species induce specific IgE- and T cell-responses which has been demonstrated by atopy patch tests. Moreover, Mala s 13 is characterized by high cross-reactivity to the human corresponding protein (thioredoxin). Induction of a potential autoallergy due to molecular mimicry seems therefore to be relevant for Malassezia-sensitized AD patients. In addition, sensitization mechanisms to autoallergens aside from cross-reactivity are under current investigation. Regarding inhalant allergens, research projects are in progress with the aim to elucidate allergen-specific immune response mechanisms in more depth. For grass-pollen allergens a flare-up of AD following controlled exposure has been observed while for house dust mite-allergens a polarization towards Th2 and Th2/Th17 T cell phenotypes can be observed. These and further findings might finally contribute to the development of specific and effective treatments for aeroallergen-sensitized AD patients. © 2014, Springer-Verlag Berlin Heidelberg.


Wichmann K.,Abteilung Fur Immundermatologie und Experimentelle Allergologie | Heratizadeh A.,Abteilung Fur Immundermatologie und Experimentelle Allergologie | Werfel T.,Abteilung Fur Immundermatologie und Experimentelle Allergologie
Allergologie | Year: 2013

Atopic dermatitis is a chronic inflammatory skin disease with a complex pathogenesis and different exogenous and endogenous trigger factors. One important factor is the sensitisation to inhalant and/or food allergens. The detection of total IgE and specific IgE antibodies to inhalant and/or food allergens is one central aspect in diagnosing atopic dermatitis, especially if skin prick tests are not feasible. Many patients are polysensitised, but not all sensitisations are of clinical relevance. The challenge is to identify the sensitisations with clinical relevance and to initiate suitable therapeutic options. In this article we go into detail for the allergens house dust mite, pollen, food, and malassezia sympodialis. Furthermore the authors comment on the impact of the detection of specific IgG/IgG4 antibodies in the diagnosis of food allergy in atopic dermatitis. Moreover new options in the in-vitro diagnostic will be explained briefly and their actual diagnostic significance in patients with atopic dermatitis will be highlighted. These options are the detection of specific IgE antibodies to rekombinant allergens and the allergen chip. © 2013 Dustri-Verlag Dr. Karl Feistle.


Heratizadeh A.,Abteilung fur Immundermatologie und experimentelle Allergologie | Wassmann A.,Abteilung fur Immundermatologie und experimentelle Allergologie | Werfel T.,Abteilung fur Immundermatologie und experimentelle Allergologie
Monatsschrift fur Kinderheilkunde | Year: 2014

Food allergy can be observed in a subgroup of atopic patients, such as patients suffering from atopic dermatitis (AD). Approximately 30 % of children with moderate or more severe forms of AD and sensitization to food allergens show associated clinical symptoms of hypersensitivity. Many patients with AD or parents of affected children suspect food as being relevant trigger factors for AD. Patients who actually benefit from elimination diets must be identified by means of validated diagnostic procedures. In turn malnutrition and associated limitations of quality of life should be avoided in those patients for whom food allergy could be excluded. As determination of specific IgE, results of skin prick tests and the patient history often do not correlate with eczematous reactions to food allergens, oral food challenges supervised by allergologists still represent the diagnostic gold standard for elucidating the clinical relevance of sensitization. As eczematous lesions often deteriorate after a period of 6–48 h after food challenge, examination of the skin should also be performed on the following day. Moreover, in patients with AD, the challenge with a food allergen should be performed in a repeated test over 2 days. © 2014, Springer-Verlag Berlin Heidelberg.


PubMed | Abteilung fur Immundermatologie und experimentelle Allergologie
Type: Journal Article | Journal: Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete | Year: 2012

Food allergy predominantly affects children rather than adult patients with atopic dermatitis (AD). Early sensitization to foods has been found to be significantly associated with AD. Three different patterns of clinical reactions to food allergens in AD patients exist: i. immediate-type reaction, ii. isolated late-type reaction, iii. combined reaction (i.+ii.). While in children allergens from cows milk, hens egg, soy, wheat, fish, peanut or tree nuts are mostly responsible for allergic reactions, birch-pollen related food allergens seem to play a major role in adolescent and adults with AD in Central and Northern Europe. Defects of the epidermal barrier function seem to facilitate the development of sensitization to allergens following epicutaneous exposure. The relevance of defects of the gut barrier as well as genetic characteristics associated with an increased risk for food allergy remain to be further investigated. Numerous studies focus on prevention strategies which include breast-feeding or feeding with hydrolyzed milk substitute formula during the first 4 months of life.

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