• Clinical efficacy and immunomodulatory effect of allergen-specific immunotherapy with prolonged course of probiotics at atopic dermatitis in children

Clinical efficacy and immunomodulatory effect of allergen-specific immunotherapy with prolonged course of probiotics at atopic dermatitis in children

SOVREMENNAYA PEDIATRIYA.2018.8(96):99-102; doi 10.15574/SP.2018.96.99

Mochulska O. M., Chornomydz I. B., Horishnyi  I. M.
SHEE «Ternopil State Medical University named after I. Ya. Horbachevsky of Ministry of Healthcare in Ukraine»

Atopic dermatitis is particular in the structure of allergic diseases as it is one of the most prevalent and very first allergic manifestations, often transforming into other allergic forms, decreasing children's life quality independent of the age and requiring long, step-by-step treatment and follow-up care. The modern strategy for the treatment of atopic dermatitis in children is based on the principles of evidence-based medicine, summarized in the conclusions of International Consensus Conference on Atopic Dermatitis II (ICCAD). In order to unify different approaches to the diagnosis and treatment of atopic dermatitis, the European Academy of Allergology and Clinical Immunology (European Academy of Allergy and Clinical Immunology, EAACI) together with the American Academy of Allergy, Asthma and Immunology (American Academy of Allergy, Asthma & Immunology, AAAAI) created a working group PRAСTALL (Practical Allergology Consensus Report). Treatment of atopic dermatitis consists of: control of the environment to eliminate allergenic and non-allergenic factors; medical0cosmetic skin care; systemic and local pharmacotherapy; treatment of concomitant diseases; patient education; rehabilitation and prevention. Systemic pharmacotherapy includes using drugs of the following groups: antihistamines, membrane's stabilizators (kromons), leukotriene receptor antagonists, anti-IgE, glucocorticosteroids, sedative medications, enzymes, sorbents, hepatoprotectors, probiotics, antioxidants, antibacterial and antifungal, immunomodulatory and immunosuppressive drugs.

Key words: atopic dermatitis, glucocorticosteroids, antihistamines, membrane stabilizing (kromons), antagonists of leukotriene receptors, anti-IgE drugs.

REFERENCES

1. Balabolkin II, Bulhakova VA, Yeliseyeva TI. (2017). Atopic dermatitis in children: immunological aspects of pathogenesis and therapy. Pediatrics. 2: 128–131.

2. Besh LV. (2017). Atopic dermatitis in children: what do pediatricians need to know today? Health of Ukraine. 7(404): 20–21.

3. Ministry of Healthcare of Ukraine (2012). Adapted clinical guidelines for the diagnosis, prevention and treatment of atopic dermatitis. Kyiv: 76.

4. Mochulska OM. (2017). Comparative characteristic of clinical efficacy of different treatment schemes at atopic dermatitis in children, features of using specific immunological tolerance induction. Actual questions of pediatrics, obstetrics and gynecology. 1: 5–11.

5. Nevozynskaia ZA, Plieva KT, Korsunskaia IM. (2016). Possibilities of control over the course of atopic dermatitis. Consilium Medicum. Dermatology. 1: 49–53.

6. Okhotnikova O.M., Yakovleva N.Y., Chernysh Y.R. (2016). Modern aspects of external anti'inflammatory therapy of atopic dermatitis in children. Sovremennaya pediatriya. 2: 92—99. https://doi.org/10.15574/SP.2016.74.92

7. Samtsov AV, Sokolovskyi EV, Araviyskaia EA. (2015). Recommendations for the treatment of atopic dermatitis (atopic eczema) of the American Academy of Dermatology, the European Academy of Dermatovenereology and the Russian Society of Dermatovenereology and Cosmetology. Expert opinion. Herald of Dermatology and Venereology. 6: 11–16.

8. Slavianskaya TA, Derkach VV. (2016). The strategy of treatment atopic dermatitis: from the past to the future. Allergology and Immunology. 1(17): 4–11.

9. Tyazhka OV. (2013, March). Atopic dermatitis in children. Health of Ukraine. Thematic issue: 30–31.

10. Chopiak VV, Kaliuzhna LD, Stepanenko VI et al. (2016). Atopic dermatitis: an adapted clinical approach, based on evidence. State Expert Center of the Ministry of Health in Ukraine. Kyiv: 112.

11. Anto JM, Bousquet J, Akdis M et al. (2017). Mechanisms of the Development of Allergy (MeDALL): Introducing novel concepts in allergy phenotypes. Journal of Allergy and Clinical Immunology. 139; 2: 388—399. https://doi.org/10.1016/j.mod.2017.04.104

12. Chan S, Cornelius V, Chen T et al. (2017). Atopic Dermatitis Anti;IgE Paediatric Trial (ADAPT): the role of anti;IgE in severe paediatric eczema: study protocol for a randomised controlled trial. Trails. 18; 1: 136.

13. Czarnowicki T, Krueger JG, Guttman-Yassky E. (2017). Novel concepts of prevention and treatment of atopic dermatitis through barrier and immune manipulations with implications for the atopic march. Journal of Allergy and Clinical Immunology. 139; 6: 1723—1734. https://doi.org/10.1016/j.jaci.2017.04.004; PMid:28583445

14. Danby SG, Chalmers J, Brown K et al. (2016). A functional mechanistic study of the effect of emollients on the structure and function of the skin barrier. British Journal of Dermatology. 175; 5: 1011—1019. https://doi.org/10.1111/bjd.14684; PMid:27097823

15. Drucker AM. (2017). Atopic dermatitis: Burden of illness, quality of life, and associated complications. Allergy & Asthma Proceedings. 38; 1: 3—8. https://doi.org/10.2500/aap.2017.38.4005; PMid:28052794

16. Edwards C. (2016). Measurements of structure and function of skin: emollient effects on atopic dermatitis. British Journal of Dermatology. 175; 5: 868—869. https://doi.org/10.1111/bjd.14942; PMid:27790690

17. Furue M, Chiba T, Tsuji G. et al. (2017). Atopic dermatitis: immune deviation, barrier dysfunction, ige autoreactivity and new therapies. Allergology International. 66; 3: 398—403. https://doi.org/10.1016/j.alit.2016.12.002; PMid:28057434

18. Gittler JK, Wang JF, Orlow SJ. (2017). Bathing and associated treatments in atopic dermatitis. American Journal of Clinical Dermatology. 18; 1:45—57. https://doi.org/10.1007/s40257-016-0240-2; PMid:27913962

19. Heratizadeh A, Werfel T. (2016). Anti;inflammatory therapies in atopic dermatitis. Allergy. 71; 12: 1666—1675. https://doi.org/10.1111/all.13065; PMid:27735066

20. Jonathan I Silverberg, Silverberg N. (2017). Atopic Dermatitis, an Issue of Dermatologic Clinics. Elsevier. Health Science Division. 35: 33.

21. Kamata Y, Tominaga M, Takamori M. (2016). Itch in atopic dermatitis management. Current Problems in Dermatology. 50: 86—93. PMid:27578076

22. Kido;Nakahara M, Furue M, Ulzii D et al. (2017). Itch in atopic dermatitis. Immunology and Allergy Clinics of North America. 37; 1: 113—122.

23. Kim JP, Chao LX, Simpson EL, Silverberg JI. (2016). Persistence of atopic dermatitis (AD): A systematic review and meta;analysis. Journal of the American Academy of Dermatologyol. 75; 4: 681—687. https://doi.org/10.1016/j.jaad.2016.05.028; PMid:27544489 PMCid:PMC5216177

24. Lee GB, Fonacier L. (2017). Difficult to manage atopic dermatitis. Journal of Allergy and Clinical Immunology: in Practice. 5; 1: 207—208. https://doi.org/10.1016/j.jaip.2016.09.007; PMid:28065338

25. Metz M, Staubach P. (2016). Itch management: topical agents. Current Problems in Dermatology. 50: 40—45. PMid:27578070

26. Ohtsu H, Seike M. (2017). Histamine and histamine receptors in allergic dermatitis. Handbook of Experimental Pharmacology. 241: 333—345. https://doi.org/10.1007/164_2016_9; PMid:27787718

27. Silverberg NB, Duran;McKinster C. (2017). Special Considerations for Therapy of Pediatric Atopic Dermatitis. Dermatologic Clinics. 35; 3: 351—363. https://doi.org/10.1016/j.det.2017.02.008; PMid:28577804

28. Wert AF, Posa D, Tsilochristou O, Schwerk N. (2016). Treatment of allergic children — where is the progress (for the practicing allergist)? Pediatric Allergy and Immunology. 27; 7: 671—681. https://doi.org/10.1111/pai.12653; PMid:27614100

Article received: Jun 13, 2018. Accepted for publication: Nov 26, 2018.