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Leung D.Y.M.,National Jewish Health
Allergology International | Year: 2013

Atopic dermatitis (AD) is a chronic inflammatory skin disease that is often associated with the development of food allergy and asthma. New insights into AD reveals an important role for structural abnormalities in the epidermis resulting in a leaky epithelial barrier as well as chronic immune activation that contribute to the pathophysiology of this common skin disease. Patients with AD have a predisposition to colonization or infection by microbial organisms, most notably Staphylococcus aureus and herpes simplex virus (HSV). Measures directed at healing and protecting the skin barrier and controlling the immune activation are needed for effective management of AD. Early intervention may improve outcomes for AD as well as reduce the systemic allergen sensitization that may lead to associated allergic diseases in other organs. © 2013 Japanese Society of Allergology.


Leung D.Y.M.,National Jewish Health | Guttman-Yassky E.,Mount Sinai School of Medicine
Journal of Allergy and Clinical Immunology | Year: 2014

Atopic dermatitis (AD) is the most common chronic inflammatory skin disease. It often precedes the development of food allergy and asthma. Recent insights into AD reveal abnormalities in terminal differentiation of the epidermal epithelium leading to a defective stratum corneum, which allows enhanced allergen penetration and systemic IgE sensitization. Atopic skin is also predisposed to colonization or infection by pathogenic microbes, most notably Staphylococcus aureus and herpes simplex virus. Causes of this abnormal skin barrier are complex and driven by a combination of genetic, environmental, and immunologic factors. These factors likely account for the heterogeneity of AD onset and the severity and natural history of this skin disease. Recent studies suggest prevention of AD can be achieved through early interventions to protect the skin barrier. Onset of lesional AD requires effective control of local and systemic immune activation for optimal management. Early intervention might improve long-term outcomes for AD and reduce the systemic allergen sensitization that leads to associated allergic diseases in the gastrointestinal and respiratory tract. © 2014 American Academy of Allergy, Asthma & Immunology.


Boguniewicz M.,National Jewish Health | Leung D.Y.M.,University of Colorado at Denver
Immunological Reviews | Year: 2011

Atopic dermatitis (AD) is an important chronic or relapsing inflammatory skin disease that often precedes asthma and allergic disorders. New insights into the genetics and pathophysiology of AD point to an important role of structural abnormalities in the epidermis as well as immune dysregulation not only for this skin disease but also for the development of asthma and allergies. Patients with AD have a unique predisposition to colonization or infection by microbial organisms, most notably Staphylococcus aureus and herpes simplex virus. Measures directed at healing and protecting the skin barrier and addressing the immune dysregulation are essential in the treatment of patients with AD, and early intervention may improve outcomes for both the skin disease as well as other target organs. © 2011 John Wiley & Sons A/S.


Lower respiratory tract virus infections are the major cause of asthma exacerbations. Severity of infection and age at initial encounter with virus appear to be major determinants of the risk for allergic asthma later in life. In animal models, reinfection of mice initially infected as neonates leads to markedly enhanced alterations in airway function and inflammation, unlike reinfection of older mice. Both innate and adaptive immune responses contribute to this susceptibility with lung dendritic cells showing marked differences in phenotype and function in young compared to older mice, and these differences are further enhanced following virus infection. These findings have implications for therapeutic targeting, for example, of RSV G and F surface proteins at different stages of the response to infection. © 2012 Elsevier Ltd.


Szefler S.J.,National Jewish Health
Journal of Allergy and Clinical Immunology | Year: 2010

This year's summary will focus on recent advances in pediatric asthma as reported in Journal of Allergy and Clinical Immunology publications in 2009. New National Asthma Education and Prevention Program asthma guidelines were released in 2007, with a particular emphasis on asthma control. Now that we have worked with the principals of the guidelines for 2 years, new insights are reported on how to implement the guidelines into clinical practice. This year's report will focus on gaps in management that need to be addressed, including health disparities, methods to improve asthma management through opportunities available in school-based asthma programs, and more information on the development of asthma in childhood. This information brings us closer to the point of managing children with controllable asthma and understanding reasons why asthma is not controlled in the remaining children. If we can close these gaps through better communication, improvements in the health care system, and new insights into treatment, we will move closer to better methods to intervene early in the course of the disease and induce clinical remission as quickly as possible in most children. © 2010 American Academy of Allergy, Asthma & Immunology.

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