ATOPIC DERMATITIS

PREVENTION

Sumadiono
Pediatric Department Sardjito Hospital/Faculty of
Medicine gadjah Mada University Yogyakarta
ATOPIC DERMATITIS

- A chronic skin disorder

- Scally & itching rashes
- >> a family history of allergic

In half will be gone by the

teenage years
in others, it is lifelong
ATOPIC DERMATITIS

- A chronic skin disorder

- Scally & itching rashes
- >> a family history of allergic

In half will be gone by the

teenage years
in others, it is lifelong
INCIDENCE:
>> during infancy & childhood
(10% to 20%)
< 1 year: 80%
< 5 year: 95%
General population 1% - 5%
Worldwide incidence increase
Many conditions make worse:
- emotional stress
- changes in temperature or humidity
- bacterial skin infections
- contact with irritating clothing/wool

Progressive cases  serious systemic disease &

life-threatening

In some infants:
food allergies  provoke atopic dermatitis
Effective treatments are
available  cures ??

>> research of allergy prevention

There is some conflicting evidence
that preventive dietary measures
& hypoallergenic formulas

may postpone the emergence of these

symptoms
Are prevention measures during pregnancy
and after birth

have significant value

in preventing the occurrence of atopic

dermatitis?
 Development of Allergy

Cytokine profile of fetus skewed towards

TH 2 profile (allergic phenotype)

Progression in development of allergies,

first to foods, then inhalants, initially to
perennial aeroallergens
Allergy Preventions

1. Primary Prevention

2. Secondary Prevention

3. Tertiary Prevention
Allergy Preventions

1. Primary Prevention

2. Secondary Prevention
Before any IgE-mediated
3. disease
Tertiary has occurred
Prevention
 Cow’s Milk Protein
VACCINATION
GENERATION OF
MEMORY
B CELL
ACTIVATION
ANTIGEN
DIFFERENTIATION
SPECIFIC B ANTIGEN
CELL PROCESSING & & AFFINITY
PRESENTATION MATURATION

Cow’s Milk epitope ACTIVATED

ANTIBODY SECRETING
PLASMA CELLS
CD4+ Th-2 CELL IL-4
IL-5,IL-13

MHC Class II B CELL IMMUNOGLOBULINE

T CELL RECEPTOR ANTIGEN

 Allergy Preventions

1. Primary Prevention

2. Secondary Prevention

Futher 3. Tertiary Prevention

sensitivities once IgE-mediated
disease has developed
 Allergy Preventions

3. Tertiary
Prevention
manifestation of
allergic disease
Which children should be targets of any
intervention?

Prediction of Allergy:
Allergy gene: Polymorphic genetic markers
Region 11q13 IgE receptor
5q31-33  cytokine gene
12q  IFN-gamma

Candidate for prevention ?

 Which children should be targets of any
intervention?

Prediction of Allergy:
Family history/atopy: most useful
Risk: 38-58% (1 parent)
60-80% (2 parent)
sens/specificity: 45%/74%
Cord blood IgE:
sens/specificity: 26%/74%
Combination: sensitivity: 56%
 During pregnancy

Genetic factors:
out of control because of his or her
genetic programming

Reducing times
a pregnant women suffers allergic reactions

reduce the chances of the baby becoming

allergic
Prevention starts in early pregnancy
reducing exposure to allergens

Pets
House dust-mites
Irritants (cigarette smoke)
 Dietary Manipulation
during Pregnancy

Should not be recommended as a

way to prevent allergy

Risk of maternal malnutrition

 While Breastfeeding

Significant amounts of allergens pass

through the breastmilk causing allergic
symptoms in babies

High risk infants should be breastfed

exclusively, if possible, for a minimum of
six months
 While Breastfeeding

Significant amounts of allergens pass

through the breastmilk causing allergic
symptoms in babies

High risk infants should be breastfed

exclusively, if possible, for a minimum of
six months

If breastfeeding is not possible ??

 If breastfeeding is not possible ??

Hypoallergenic formula ?

Soy-based formula or goat's milk

formula are not recommended for
allergic or potentially allergic
infants
 When introducing solids

The earlier a child is exposed to allergens

the more likely they are to cause an allergic reaction

Where there is a family history of allergy

solids should not be introduced
before six months if possible
 When introducing solids

Start with the least allergenic foods first

Introducing one new food per week

Begin with small amounts and increase gradually

All foods, even fruits, should be cooked

 When introducing solids

Wheat and soy until nine months

Cow's milk until 12 months

Eggs until 18-24 months

Peanuts, nuts, fish and shellfish until

36 months
 Secondary prevention
Much current research is ongoing to
prevent the progression of the
atopic march

ETAC ??
 Tertiary prevention

Allergen avoidance,
emergency action plans, and
medications remain the
mainstay