Ziel der hier vorgelegten Untersuchung war es, die Bedeutung von S. aureus-Exotoxinen/Superantigenen als Pathogenitätsfaktor bei der AD zu analysieren, da kausalpathogenetisch ausgerichtete Experimentalansätze sowie systematische klinische Untersuchungen zu dieser Thematik bei Patienten mit AD ausstanden. In einer Querschnittsstudie war eine Assoziation zwischen dem Grad der S. aureus-Besiedlung und dem Schweregrad der AD nachzuweisen. Von 74 Kindern mit AD waren 60 (81%) mit S. aureus kolonisiert. S. aureus Exotoxin-sezernie-rende Stämme wurden bei 40 Patienten (53%) von der Haut isoliert. Am häufigsten wurden SEA- und SEC-sezernierende Stämme nachgewiesen, gefolgt von SEB, TSST-1 und SED. Der ausgeprägteste Schweregrad der AD wurde in der mit Exotoxin-sezernierenden S. aureus-kolonisierten Gruppe beobachtet. Für die Schwere der Erkrankung, gemessen am SCORAD-Score wurde eine Varianzaufklärung von 30% für die Exotoxine und 50% für die S. aureus-Infektion errechnet. In einer Subgruppe von Patienten wurde der Einfluß von S. aureus-Exotoxinen auf intradermale T-Zell-Rezeptor-Vß-Repertoir-Veränderungen untersucht. Bei den Patienten mit chronischer AD, die mit SEB-sezernierendem S. aureus besiedelt waren, war mittels immunhistologischer Untersuchung in der Haut nachzuweisen, dass zwischen 25% und 65% der intradermalen T-Zellen das zugehörige Superantigen-reaktive Vß-T-Zell-Repertoire gegenüber 5% bis 17% der T-Zellen im Blut exprimieren. Weder in der Haut noch im Blut war eine Akkumulation nicht-superantigenreaktiver T-Zell-Subpopulationen nachzuweisen. Auch fand sich keine selektive Akkumulation von Vß-T-Zell-Subpopulationen bei Kindern mit S. aureus-Kolonisierung ohne Exotoxinnachweis. Die Ergebnisse belegen, dass bei Kindern mit AD und positivem S. aureus-Exotoxinnachweis auf ekzematöser Haut ein Grossteil der dermal akkumulierten T-Zellen auf diese S. aureus-Exotoxine/Superantigene reagieren können und wesentlich an der Pathogenese der AD beteiligt sind. In einer Teilpopulation bei 58 Kindern mit AD wurden Prävalenz und Rolle von Serum-IgE-Antikörpern gegen die S. aureus-Exotoxine SEA und SEB untersucht. Bei 34% der Kinder mit AD (20/58) konnten wir spezifische IgE-Antikörper gegen SEA und/oder SEB nachweisen (45% zu SEB, 10% zu SEA und 45% zu SEA und SEB). Alle gegen SEA und SEB sensibilisierten Kindern waren mit S. aureus kolonisiert gegenüber 71% (27/38) der nicht-sensibilisierten Kinder. Der Grad der S. aureus-Besiedlung, die Prävalenz von SEB-sezernierendem S. aureus auf der Haut, sowie die Prävalenz von S. aureus-Hautinfektionen war in der sensibilisierten Gruppe höher. Die höchste Varianzaufklärung von 37% wurde zwischen dem Vorliegen von S. aureus-Hautinfektionen und dem Nachweis spezifischer SEA/SEB-IgE-Antikörper ermittelt; diese stellen somit einen Risikofaktor für eine Sensibilisierung gegen S. aureus-Exotoxine dar. Die SEA/SEB-sensibilisierte Gruppe zeigte einen höheren Schweregrad der AD, höhere Serum-Gesamt-Spiegel und eine polyvalente Sensibilisierung gegen Inhalations- und Nahrungsmittelallergene. Insgesamt belegen unsere klinischen, immunologischen und statistischen Ergebnisse, dass die S. aureus-Exotoxine einen wesentlichen Einfluss auf die Immunpathogenese der AD haben. Eine orale Therapie mit CyA kann bei S. aureus-kolonisierten Kindern die S. aureus-Besiedlungsdichte reduzieren. In der S. aureus-infizierten Gruppe war die Prävalenz von Exotoxin-produzierendem S. aureus und die Krankheitsaktivität höher, wobei eine Verminderung der Besiedlung nicht beobachtet wurde. Die Ergebnisse dieser Arbeit erlauben den Schluss, dass S. aureus-Exotoxine als Triggerfaktor die Exazerbation der AD im Kindesalter wesentlich unterstützen. Deswegen sollte in ein therapeutisches Konzept eine konsequente Prävention bzw. eine Behandlung von S. aureus-Infektionen einbezogen werden. Kinder mit bereits schwerer AD profitieren von einer immunmodulatorischen Therapie. / Background: The skin of patients suffering from atopic dermatitis (AD) exhibits a striking susceptibility to colonization with S. aureus. Some strains of S. aureus secrete exotoxins with T cell superantigen activity (toxigenic strains) and abnormal T cell functions are known to play a critical role in AD. Objective: The aim of this study was to determine the impact of exotoxin production by skin-colonizing S. aureus on disease severity and the presence of T-cell subsets in lesional skin. Furthermore, we investigated the effect of oral cyclosporin A in severe pediatric atopic dermatitis on disease severity and S. aureus colonization density. Methods: In a cross sectional study of 74 children with atopic dermatitis, the presence and density of toxigenic and non-toxigenic strains of S. aureus was correlated with disease severity. In a subgroup of patients the T cell receptor (TCR) Vß repertoire of peripheral blood and lesional T cells was investigated and correlated with individual superantigen activity of skin colonizing S. aureus. Furthermore, in a subgroup of patients, the presence of IgE antibodies to SEA and SEB was correlated with severity of the disease and the total and other unrelated allergen-specific IgE titers and density of colonization with S. aureus strains on atopic skin and episodes of superficial S. aureus skin infections. Eleven children with severe AD (SCORAD score > 50) were treated for eight weeks with 2.5 to 5 mg/kg CyA. In five children the skin was only colonized with S. aureus whereas the remaining six patients had clinically relevant skin infections with requirement for systemic antibiotic therapy. The isolates from the latter patients were sensitive for the selected antibiotics. Clinical and microbiological investigations were performed before and after CyA therapy. Results: 53% of children with AD were colonized with toxigenic strains of S. aureus producing SEC, SEA, TSST-1, SEB and SED in decreasing frequency. Children colonized with toxigenic S. aureus strains presented with higher disease severity as compared to the non-toxigenic and S. aureus negative groups. The influence of exotoxin production on the SCORAD score was determined as R2 = 0.3 (ie, 30% of the SCORAD score is explained by exotoxin production), whereas infection with S. aureus revealed R2 = 0.5. Patients colonized with toxigenic S. aureus exhibited shifts in the intradermal TCR Vß repertoire which correspond to the respective superantigen-responsive T cell subsets. In a subgroup of patients, twenty of 58 children (34%) were sensitized to superantigens (45% to SEB, 10% to SEA, 45% to SEA and SEB). In this group, severity of AD and levels of specific IgE to food and air allergens were higher. The degree of disease severity correlated to a higher extent with the presence of SEA/SEB-specific antibodies than with total serum IgE levels. Density of colonization with superantigen-secreting S. aureus strains was higher in the superantigen IgE-positive group. Sixty-three of these children experienced repeated episodes of superficial S aureus skin infections. The influence of S. aureus skin infection on the presence of SEA/SEB-specific antibodies was determined as R2 = 0.37 (ie, 37% of the the presence of SEA/SEB-specific antibodies is explained by S. aureus superficial skin infection). In the group of patients, who were treated with CyA, clinical signs and symptoms of AD improved in all patients (mean SCORAD score reduction from 74 to 29). However, disease severity was more supressed by CyA in the "colonized" patients compared with the patients with clinical S. aureus infections. Furthermore, there was a significant decrease in S. aureus density on atopic skin after CyA treatment in "colonized" patients but not in "infected" patients. The prevalence of exotoxin producing strains was higher in the "infected" group. Conclusion: The data demonstrate that S. aureus released exotoxins can modulate disease severity and dermal T cell infiltration. Patients, suffering from AD may take profit from both consequent prevention or treatment of S. aureus skin infection as well as immunmodulating approaches.

A dermatite atópica (DA) é uma dermatose inflamatória crônica que persiste no adulto em 40% dos casos. Foram avaliados 75 adultos com DA, utilizando um questionário geral (SF-36) e um específico (DLQI). O escore de gravidade empregado foi o EASI, e o prurido e a insônia foram avaliados por medidas subjetivas. Os aspectos emocionais da QV na DA foram os mais comprometidos, e quatro grupos, segundo o EASI e o SF-36 foram estabelecidos: I (16/75)-doença leve e menor comprometimento da QV; II (19/75)-doença leve e maior comprometimento da QV, com predomínio do sexo feminino; III (7/75)-doença grave e menor comprometimento da QV; IV (33/75)-doença grave e maior comprometimento da QV. Sugerimos que a QV deve ser cuidadosamente considerada quando utilizada como instrumento exclusivo de avaliação na DA no adulto / INTRODUCTION: Atopic dermatitis AD) is a chronic, inflammatory and pruritic dermatosis with an increasing prevalence in the last 30 years. It affects 2-7% of the adults, and may persist in adult life in 40% of the cases. Adults with AD suffer an impact generated with this disease in the physical and especially in the emotional aspects in their daily activities, social and familial dynamics, leading to financial and self-esteem losses. The aim of this study was to analyze the quality of life (QV) of these patients. METHODS: Seventy-five adult patients with AD were evaluated, utilizing a generic (SF-36) and a specific (DLQI)questionnaire. EASI was the severity score chosen, and pruritus and insomnia were evaluated by subjective measures. Patients were divided into four distinct groups, according to EASI and SF-36. RESULTS: The most compromised domains were related to the emotional aspects in SF-36, and symptoms and feelings in DLQI. Four groups, according to EASI and SF-36 were established: I (16/75)-mild disease and less QV compromise; II (19/75)-mild disease and more QV compromise, with predominance of women; III (7/75)-severe disease and less QV compromise; IV (33/75)-severe disease and more QV compromise. These groups did not show any correlation with age, educational level, income and time length of the disease. CONCLUSIONS: We suggest that QV must be carefully evaluated, when utilized as exclusive evaluation instrument in adult AD, once individual emotional aspects may masquerade its analysis.

Background: Financial constraints challenge evidence of the effectiveness of dermatological inpatient management. Objective: To evaluate the effectiveness of hospitalization in atopic dermatitis and psoriasis regarding initial and sustained benefits. Methods: Prospective study on adults with psoriasis vulgaris (n = 22) and atopic dermatitis (n = 14). At admission, discharge, and 3 months after discharge, validated outcomes of objective and subjective disease severity were assessed by trained investigators. Results: Hospitalization resulted in substantial benefit in quality of life and clinical disease severity. Looking at mean scores, the observed benefit appeared stable until 3-month follow-up. The analysis of individual patient data revealed significant changes in disease severity between discharge and 3-month follow-up with some patients relapsing, others further improving. Reasons for hospitalization and treatment performed were not related to sustained benefit. Conclusions: In psoriasis vulgaris and atopic dermatitis, hospitalization effectively improved quality of life and clinical disease severity. Further research should focus on prognostic factors for sustained improvement. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Background: Pimecrolimus cream (Elidel®, SDZ ASM 981), a non-steroid inhibitor of inflammatory cytokines, is effective in the treatment of atopic dermatitis (AD). We assessed whether early treatment of AD signs/symptoms reduces the need for topical corticosteroids. Objective: To investigate the efficacy and safety of pimecrolimus cream 1% in the long-term management of adult AD. Methods: 192 adults with moderate to severe AD were randomised (1:1) for twice daily (b.i.d.) treatment of early signs or symptoms of AD with either pimecrolimus cream 1% or vehicle cream (control group) to prevent progression to flares. Treatment was given as needed for 24 weeks. In the event of flares, a moderately potent corticosteroid (prednicarbate 0.25% cream) was permitted as rescue medication in both groups. The percentage of days on which a topical corticosteroid was used to treat disease flares was the main outcome measure. Results: Corticosteroid medication was used on 14.2% (95% confidence interval, CI: 8.3–21.1) of the days of the 24-week treatment period in the pimecrolimus group and on 37.2% (95% CI: 30.4–44.0) of the days in the control group (p < 0.001). In total, 44.8% (43/96) of patients in the pimecrolimus group did not experience a flare compared with 18.8% (18/96) of patients in the control group. The median time to first flare was 144 days in the pimecrolimus group and 26 days in the control group (p < 0.001). Pimecrolimus treatment was also associated with improvement in signs and symptoms of AD, pruritus, patients’ self-assessment and quality of life. Conclusions: Pimecrolimus cream 1% b.i.d. is an effective, well-tolerated, long-term treatment for AD in adults, substantially reducing the number of flares compared to a conventional therapy and consequently reducing or eliminating the need for corticosteroid treatment. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2005. / Härtill 6 uppsatser.

Les eczémas [eczéma allergique de contact (EAC) et l'eczéma atopique (EA)] sont des dermatoses inflammatoires fréquentes des pays industrialisés. Elles sont induites suite au recrutement et à l'activation dans la peau de lymphocytes T spécifiques d'allergènes, qui sont présents dans notre environnement, et qui sont habituellement très bien tolérés par la majoritédes individus exposés. Ce travail de thèse porte sur un aspect novateur de la physiopathologie des eczémas, à savoir : la contribution des lymphocytes T mémoires résidants (LTrm) dans la peau à la chronicité et à la sévérité de ces maladies.Capitalisant sur des modèles précliniques pertinents ainsi que sur des échantillons cliniques prélevés chez les patients, ce travail a permis d'acquérir de nouvelles connaissances : (i) de nombreux LTrm CD8+ spécifiques colonisent les lésions d'eczéma (ii) ils s'accumulent avecla persistance de l'allergène dans la peau, (iii) ils jouent un rôle majeur dans les récidives de la maladie, mais (iv) ils expriment à leur surface divers récepteurs inhibiteurs, tels que PD-1 ou TIM-3, qui empêchent la survenue de réponses allergiques excessives.Ces travaux apportent donc des informations majeures sur la nature unique des LTrm CD8+ spécifiques d'allergènes et des mécanismes qui contrôlent leur réactivation, afin de préserver l'intégrité de la peau et la survenue de réactions chroniques sévères. Le développement des nouvelles stratégies thérapeutiques ciblant la réactivation des LTrm via leurs récepteursinhibiteurs pourrait permettre de restaurer la tolérance chez les individus allergiques / Allergic contact dermatitis (ACD) and atopic dermatitis (AD), also referred to contact or atopic eczema, are frequent skin inflammatory diseases with increasing prevalence and high socioeconomic impact in Western countries. Eczemas are the prototype of skin delayed-type hypersensitivity reactions. Skin lesions are induced by the recruitment and activation in the skin of effector/memory T cells specific for environmental antigens that are innocuous to healthy non-allergic individuals.The aim of this work was to better understand the pathophysiology of eczemas by a comprehensive analysis of the contribution of skin resident memory T cells (Trm) to the chronicity and severity of these diseases.Capitalizing on relevant preclinical eczema models and on clinical samples collected from allergic patients, this work showed that: (i) numerous allergen-specific CD8+Trm colonize the eczema lesion, (ii) they accumulate in the epidermis in response to the long-term persistence of the allergen in the skin, (iii) they are instrumental for the recurrence of eczema, but (iv) theyexpress several inhibitory check point receptors (ICRs, such as PD-1, TIM-3) at their surface, which keep them in check to prevent the development of severe immunopathology.Thus, our work provides important information for considering the unique nature of hapteninduced CD8+ Trm and the mechanisms that prevent their unwanted reactivation and subsequent development of chronic or severe skin allergy. The development of therapeutic strategies targeting the reactivation of skin Trm in situ via their ICRs should open new avenues to restore tolerance in allergic individuals

A dermatite atópica (DA) é uma dermatose inflamatória crônica que persiste no adulto em 40% dos casos. Foram avaliados 75 adultos com DA, utilizando um questionário geral (SF-36) e um específico (DLQI). O escore de gravidade empregado foi o EASI, e o prurido e a insônia foram avaliados por medidas subjetivas. Os aspectos emocionais da QV na DA foram os mais comprometidos, e quatro grupos, segundo o EASI e o SF-36 foram estabelecidos: I (16/75)-doença leve e menor comprometimento da QV; II (19/75)-doença leve e maior comprometimento da QV, com predomínio do sexo feminino; III (7/75)-doença grave e menor comprometimento da QV; IV (33/75)-doença grave e maior comprometimento da QV. Sugerimos que a QV deve ser cuidadosamente considerada quando utilizada como instrumento exclusivo de avaliação na DA no adulto / INTRODUCTION: Atopic dermatitis AD) is a chronic, inflammatory and pruritic dermatosis with an increasing prevalence in the last 30 years. It affects 2-7% of the adults, and may persist in adult life in 40% of the cases. Adults with AD suffer an impact generated with this disease in the physical and especially in the emotional aspects in their daily activities, social and familial dynamics, leading to financial and self-esteem losses. The aim of this study was to analyze the quality of life (QV) of these patients. METHODS: Seventy-five adult patients with AD were evaluated, utilizing a generic (SF-36) and a specific (DLQI)questionnaire. EASI was the severity score chosen, and pruritus and insomnia were evaluated by subjective measures. Patients were divided into four distinct groups, according to EASI and SF-36. RESULTS: The most compromised domains were related to the emotional aspects in SF-36, and symptoms and feelings in DLQI. Four groups, according to EASI and SF-36 were established: I (16/75)-mild disease and less QV compromise; II (19/75)-mild disease and more QV compromise, with predominance of women; III (7/75)-severe disease and less QV compromise; IV (33/75)-severe disease and more QV compromise. These groups did not show any correlation with age, educational level, income and time length of the disease. CONCLUSIONS: We suggest that QV must be carefully evaluated, when utilized as exclusive evaluation instrument in adult AD, once individual emotional aspects may masquerade its analysis.

Submitted by Geandra Rodrigues (geandrar@gmail.com) on 2018-10-10T13:46:10Z No. of bitstreams: 1 ingridpimentelcunhamagalhaesdesouzalima.pdf: 1571962 bytes, checksum: 521511b66ed89adf27b01a59f98c7cfc (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2018-10-16T13:34:14Z (GMT) No. of bitstreams: 1 ingridpimentelcunhamagalhaesdesouzalima.pdf: 1571962 bytes, checksum: 521511b66ed89adf27b01a59f98c7cfc (MD5) / Made available in DSpace on 2018-10-16T13:34:14Z (GMT). No. of bitstreams: 1 ingridpimentelcunhamagalhaesdesouzalima.pdf: 1571962 bytes, checksum: 521511b66ed89adf27b01a59f98c7cfc (MD5) Previous issue date: 2018-08-24 / O objetivo do presente estudo é avaliar a positividade do teste cutâneo de contato alérgico de leitura tardia para Dermatophagoides pteronyssinus, Dermatophagoides farinae e Blomia tropicalis em pacientes com doenças respiratórias como rinite alérgica e/ou asma com ou sem dermatite atópica. A maioria dos trabalhos existentes nessa área de pesquisa se refere ao emprego desse método diagnóstico na dermatite atópica, mas, neste estudo, a amostra é composta, principalmente, de pacientes com doenças respiratórias. Blomia tropicalis é um ácaro muito incidente no Brasil e só há dois trabalhos que envolvem o emprego deste ácaro da poeira domiciliar típico de países de clima tropical. Os pacientes foram selecionados pela história clínica e foram divididos em dois grupos: I- pacientes com doenças respiratórias, como asma e/ou rinite alérgica, com dermatite atópica e II- pacientes somente com doenças respiratórias. Foi realizado teste cutâneo de leitura imediata e teste de cutâneo de contato alérgico de leitura tardia para os três ácaros no mesmo dia. O teste de contato alérgico foi retirado em 48 horas. A análise estatísitica foi realizada em porcentagens e a tabela 1 apresenta as variáveis por sexo e por grupo estudado. Setenta e quatro pacientes, com idades de 2 a 60 anos, foram incluídos neste estudo; 16 no grupo I e 58 no grupo II. Considerando o teste cutâneo de leitura imediata, o ácaro mais prevalente foi o Dermatophagoides pteronyssinus, seguido pelo Dermatophagoides farinae e Blomia tropicalis. Em relação ao teste cutâneo de contato alérgico de leitura tardia, o ácaro que induziu maior positividade foi o Dermatophagoides farinae (78,4%), seguido pelo Dermatophagoides pteronyssinus (77%) e Blomia tropicalis (52,7%). Comparando o teste cutâneo de leitura imediata com o teste cutâneo de contato alérgico de leitura tardia, 53 pacientes (71,6%) foram positivos para ambos os testes, e 30 (56,6%) foram positivos ao mesmo ácaro. Foram identificados seis pacientes (8%) que tinham história clinica positiva para alergia e só apresentavam positividade no teste cutâneo de contato alérgico de leitura tardia. Estes resultados sugerem que o teste cutâneo de contato alérgico de leitura tardia é relevante e deve ser considerado como um teste diagnóstico adicional, em pacientes com história clínica positiva para doenças respiratórias, com teste cutâneo de leitura imediata negativa. / The aim of this study is to evaluate the positivity rates of atopy patch tests for Dermatophagoides pteronyssinus, Dermatophagoides farinae and Blomia tropicalis in patients with respiratory diseases such as asthma and allergic rhinitis with or without atopic dermatitis. Most studies have been performed with atopic dermatitis patients, but in our study, most of the patients had respiratory conditions. Blomia tropicalis is a mite that is prevalent in tropical areas, such as Brazil, and only two publications include these three mites, which are present in Brazil. The patients’ clinical histories were collected, and the patients were subjected to skin prick and patch tests with the three different house dust mites on the same day. The patch tests were examined 48 hours later, and then, the patients were divided into two groups: I- patients with respiratory diseases, such as asthma and/or rhinitis, and atopic dermatitis and II-patients with only respiratory diseases. The statistical analysis results are presented as percentages, and Table 1 presents the variables by gender and groups studied. A total of 74 patients ranging in age from 2 to 60 years old were included in this study; 16 patients were included in group I and 58 were included in group II. In the skin prick tests, the most prevalent mite that evoked a reaction was Dermatophagoides pterronyssinus, followed by Dermatophagoides farinae and Blomia tropicalis. Regarding the atopy patch tests, the mite that most frequently induced a positive reaction was Dermatophagoides farinae (78.4%), followed by Dermatophagoides pteronyssinus (77%) and Blomia tropicalis (52.7%). A comparison between the skin prick and atopy patch tests revealed that 53 patients (71.6%) were positive on both tests, and 30 (56.6%) patients were positivite for the same mite. We found six patients (8%) who had a positive clinical history of allergy and only exhibited positivity on the atopy patch test. These results suggest that the mite atopy patch test is relevant and should be considered as an additional test for patients with clinical histories of allergic respiratory disease who have negative prick test results.

Contexte : La prévalence de l'asthme et des allergies a augmenté au cours de ces dernières décennies,en particulier chez les enfants et dans le monde occidental. Cette augmentation de la prévalence estdevenue un problème très grave de santé publique et pourrait être liée à une combinaison deprédisposition génétique, de facteurs environnementaux et des changements dans le mode de vie, ycompris les habitudes alimentaires. Cependant, les études épidémiologiques concernant les maladiesallergiques chez l’enfant en relation avec l'alimentation sont rares.Objectifs : Ce travail analyse la littérature récente traitant l'alimentation, les habitudes alimentaires et lanutrition en relation avec les maladies allergiques chez les enfants en tenant compte de la méthodologieutilisée pour évaluer les habitudes alimentaires. En outre, il évalue en premier lieu l'association entre leshabitudes alimentaires et l'asthme et les maladies allergiques et en deuxième lieu la relation entrel'asthme et le surpoids/l’obésité dans l’étude des six villes françaises.Méthodes : MEDLINE/PubMed et Cochrane Database of Systematic Reviews ont été utilisés pour larevue de la littérature concernant l'alimentation et les maladies allergiques. Des études transversales ontété menées à Bordeaux, Clermont-Ferrand, Créteil, Marseille, Reims, Strasbourg sur 7 432 enfantsscolaires, choisis au hasard et âgés de 9-11 ans. Des questionnaires adressés aux parents, basés surl'Enquête internationale sur l'asthme et les allergies dans l'enfance (ISAAC), ont été utilisés pourrecueillir des informations sur les maladies allergiques et les facteurs de risque potentiels, y compris unquestionnaire de fréquence alimentaire pour évaluer les habitudes alimentaires des enfants. Des testscutanés aux allergènes communs ont été effectués afin d'identifier l'existence d'une hypersensibilitéallergique et des tests d’effort ont été effectués pour évaluer l'asthme à l’effort.Résultats : Les apports moyens de 12 principaux produits alimentaires consommés par les élèves ontété calculées et trois profils alimentaires ont été extraits par analyse en composantes principales:l’alimentation proche du régime méditerranéen, l’alimentation à base d’oméga-3 et de poissons gras etl’alimentation non équilibrée. Les risques relatifs des maladies allergiques ont été estimés par des odds7ratios (OR) et le contrôle des facteurs de confusion a été réalisé par des régressions logistiques. Lessifflements, l’asthme et la rhinite sont plus fréquents chez les garçons que chez les filles. En analysemultivariée, l’alimentation à base d’oméga-3 avait un effet protecteur contre l'asthme vie et l’asthmesévère chez les enfants (OR ajusté: 0,77 ; IC 95%: [0,62 -0,96] et OR ajusté: 0,55 ; IC 95%: [0,32 -0,94]respectivement). L’adhérence à une alimentation proche du régime méditerranéen et riche enantioxydants semble avoir un effet protecteur contre les maladies allergiques. Le surpoids et l’obésitéont été positivement associés avec l’asthme vie chez les enfants ne présentant pas de sifflements (ORajusté: 1,98 ; IC 95%: [1,06 -3,70]) et ont été de même associé positivement avec la rhinite vie et larhinite 12 mois chez les enfants présentant des sifflements (OR ajusté: 1,63 ; IC 95%: [1,09 -2,45] etOR ajusté: 2,20 ; IC 95%: [1,13 -4,27] respectivement), mais pas avec l’asthme à l’effort.Conclusion: Dans l'ensemble, l'adhésion à un régime alimentaire sain, y compris les antioxydants et lesoméga-3 semble avoir un effet protecteur sur l'asthme et les allergies chez les enfants. Le surpoids etl’obésité a été associé significativement avec l’asthme chez les enfants non atopiques et la rhiniteallergique chez les enfants atopiques. Des études prospectives longitudinales sont donc nécessaires pourpouvoir évaluer les relations de causalité. / Background: The prevalence of asthma and allergy has risen in recent decades, especially amongchildren and in the Western world. This increase in prevalence has become a serious public healthproblem and might be related to a combination of genetic predisposition, environmental factors, andlifestyle changes, including dietary habits. However, epidemiological studies concerning childhood dietrelatedallergic diseases are scarce.Objectives: This work reviews published literature dealing with diet, dietary patterns and nutrition inrelation with allergic diseases among children taking into account the methodology used to evaluatedietary patterns. Moreover, it assesses primary the association between food patterns and asthma andallergic diseases and secondary the relation between asthma and overweight/obesity in the French SixCities Study.Methods: MEDLINE/PubMed and Cochrane Database of Systematic Reviews were used for theliterature review concerning diet and allergic diseases. Cross-sectional studies were conducted inBordeaux, Clermont-Ferrand, Créteil, Marseille, Reims, and Strasbourg among 7432 randomly selectedschoolchildren aged 9-11 years. Parental questionnaires, based on the International Study on Asthmaand Allergies in Childhood (ISAAC), were used to collect information on allergic diseases and potentialrisk factors including a food frequency questionnaire to evaluate dietary habits. Skin prick testing tocommon allergens was performed to identify the existence of an allergic hypersensitivity and exercisetest was performed to assess Exercise-Induced Asthma (EIA).Results: The mean intakes of 12 main food items were calculated and three food patterns wereextracted by principal component analysis labeled: the Mediterranean-like diet, the diet rich in omega-3fatty acids and the unhealthy diet. Relative risks of allergic diseases were estimated as odds ratios (OR)and confounders control was performed with multiple logistic regressions. Wheezing, asthma andrhinitis were more prevalent in boys than in girls. In the multivariate analysis, diet rich in omega-3 wasprotective for lifetime and severe asthma in children (adjusted OR: 0.77; 95% CI: [0.62 -0.96] and9adjusted OR: 0.55; 95% CI: [0.32 -0.94] respectively). Adherence to the Mediterranean-like diet rich inantioxidants tended to be protective against allergic diseases. Overweight and obesity were positivelyassociated with lifetime asthma in non-wheezing children (adjusted OR: 1,98 ; 95% CI: [1,06 -3,70])and were also positively associated with lifetime and past year allergic rhinitis in wheezing children(adjusted OR: 1.63; 95% CI: [1.09 -2.45] and adjusted OR: 2.20; 95% CI: [1.13 -4.27] respectively), butwere not associated with EIA.Conclusion: Overall, adherence to a healthy diet including antioxidants and omega-3 fatty acids seemsto have a protective effect on asthma and allergy in childhood. Overweight and obesity weresignificantly associated with asthma in non-atopic children and with allergic rhinitis in atopic children.Prospective longitudinal studies should be necessary for evaluation of causal relations.

Background: Financial constraints challenge evidence of the effectiveness of dermatological inpatient management. Objective: To evaluate the effectiveness of hospitalization in atopic dermatitis and psoriasis regarding initial and sustained benefits. Methods: Prospective study on adults with psoriasis vulgaris (n = 22) and atopic dermatitis (n = 14). At admission, discharge, and 3 months after discharge, validated outcomes of objective and subjective disease severity were assessed by trained investigators. Results: Hospitalization resulted in substantial benefit in quality of life and clinical disease severity. Looking at mean scores, the observed benefit appeared stable until 3-month follow-up. The analysis of individual patient data revealed significant changes in disease severity between discharge and 3-month follow-up with some patients relapsing, others further improving. Reasons for hospitalization and treatment performed were not related to sustained benefit. Conclusions: In psoriasis vulgaris and atopic dermatitis, hospitalization effectively improved quality of life and clinical disease severity. Further research should focus on prognostic factors for sustained improvement. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.