Atopic comorbidities are common in chronic spontaneous urticaria (CSU), yet their impact on clinical presentation and omalizumab response remains poorly defined. To compare clinical profiles and omalizumab treatment outcomes in CSU patients with atopic dermatitis (AD) and other atopic comorbidities (OACs). This single-center retrospective study included 381 CSU patients treated with ≥3 doses of omalizumab (300 mg/4 weeks) and followed ≥6 months (January 2023-March 2025). Based on the presence or history of atopic comorbidities, patients were stratified into 3 groups: CSU with AD (CSU-AD, n = 76), CSU with OACs (CSU-OACs, n = 93), and CSU with no atopic comorbidities (CSU-NA, n = 212). Clinical features, treatment response (efficacy, speed, and adverse events), and-among 12-month completers-dose reduction/discontinuation and drug survival rates were analyzed. Of all enrolled patients, 44.4% had comorbid allergic diseases. CSU-OACs patients had earlier onset (P = 0.033) and higher angioedema prevalence (P = 0.042); CSU-AD showed higher baseline UAS7 (P = 0.031). Overall omalizumab response rates did not differ significantly among the 3 groups (P = 0.115), but a significantly higher portion of faster-response speed was observed in CSU-OAC (P = 0.019). Adverse events were significantly higher in CSU-OACs (P = 0.004), especially injection-site reactions (P = 0.033) and systemic effects (eg, headache and fatigue; P = 0.025). Drug survival was significantly higher in the CSU-OAC vs. CSU-NA group (P = 0.007). CSU-AD differs only in higher baseline activity, otherwise resembling CSU-NA in treatment response and drug survival. CSU-OACs exhibit not only distinct features such as earlier onset, higher angioedema risk, faster response, and higher drug survival but also more adverse events, indicating that CSU-OAC requires individualized management. Larger multicenter studies are needed to further define the impact of AD and OACs in CSU.
Allergic contact dermatitis is a common cause of eyelid dermatitis. To identify the most common clinically relevant allergens and characterize personal product exposures in patients with eyelid dermatitis presenting for patch testing. Retrospective study of 245 patients with eyelid dermatitis patch tested over a 5-year period. Reported data include demographics, history of atopy, and patch test reaction prevalence and relevance, including reactions to personal care products. 8.83% of patch-tested patients in our clinic presented with primary eyelid dermatitis (+/- head/neck involvement). Carmine, cetrimonium chloride, cocamidopropyl betaine-related surfactants (dimethylaminopropylamine, oleamidopropyl dimethylamine, and amidoamine), preservatives (methylisothiazolinone and formaldehyde), fragrances (Balsam of Peru and linalool), and nickel were the top 10 clinically relevant allergens. Shampoos and make-up were the most common personal products demonstrating reactions. Topical and ocular medicaments, acrylates, hairdressing chemicals, salicylates, and ultraviolet light filters were rare but relevant allergens. Patch testing continues to play an essential role in the diagnosis and management of eyelid dermatitis. Testing supplemental series as well as direct testing of patients' products is critical for the detection of clinically relevant allergens.
Despite known dermatologic risks from sustained mouthpiece contact, the prevalence, clinical presentation, care-seeking patterns, and hygiene practices related to mouthpiece-associated dermatitis and cheilitis in brass musicians remain poorly understood. To characterize mouthpiece-related dermatitis/cheilitis symptoms, performance impact, care-seeking behavior, and hygiene practices among brass musicians. Brass musicians aged ≥15 completed an anonymous 18-item survey. Quantitative data were analyzed with descriptive statistics and logistic regression. Open-ended responses underwent thematic analysis. Of 228 respondents, 48.2% (95% confidence interval [CI]: 41.8-54.7) reported any mouthpiece-related symptoms and 28.1% (95% CI 22.6-34.3) reported definite symptoms. The most common symptoms were redness (67.6%), lip swelling (53.7%), and dryness (52.8%), with impacts on performance quality (47.2%) and the need for playing breaks (46.2%). 80.0% of respondents indicated hygiene familiarity, but only 38.1% cleaned their mouthpiece at least weekly. Symptom reporting varied by age (P = 0.010) and professional level (P = 0.002), though multivariable estimates were imprecise. Qualitative themes highlighted physical and mental symptoms, mouthpiece materials, and self-management. Mouthpiece-related dermatitis and cheilitis are prevalent among brass musicians, frequently impacting performance, yet care-seeking remains limited and symptoms are often self-managed outside formal health care settings.
The present guideline updates the initial ESCD patch testing guideline, summarizing all aspects of patch testing for the diagnosis of contact allergy in patients suspected of suffering, or having been suffering, from allergic contact dermatitis or other delayed-type hypersensitivity skin and mucosal conditions. Sections with brief descriptions and discussions of different pertinent topics are followed by highlighted short practical recommendations, which have been consensualized in a Delphi process. Topics comprise, after an introduction with important definitions, materials, technique, modifications of epicutaneous testing, individual factors influencing the patch test outcome or necessitating special considerations, children, patients with occupational contact dermatitis and drug eruptions as special groups, patch testing of materials brought in by the patient, adverse effects of patch testing and the final evaluation and patient counselling based on this judgement. Finally, short reference is made to aspects of (continuing) medical education and to electronic collection of data for epidemiological surveillance.
Food sensitization is frequently reported in atopic dermatitis (AD), whereas its role in chronic urticaria (CU) remains uncertain. Comparative adult data from India are limited. To compare food sensitization profiles between adults with AD and CU and assess short-term outcomes following targeted allergen avoidance. A total of 126 adults with AD (n = 24) or CU (n = 102) underwent skin prick testing using a standardized 56-allergen panel. All received structured allergen avoidance counselling with fortnightly reassessment over 6 weeks. Severity was assessed using SCORing Atopic Dermatitis (SCORAD) for AD and the urticaria activity score over 7 days (UAS7) for CU. Sensitization burden was significantly greater in AD than in CU. The median food sensitivity score was 44.5 versus 17.0, and the median number of positive allergens was 27.0 versus 12.5 (both P < 0.001), with higher sensitization across all allergen categories. The mean SCORAD decreased from 48.5 ± 9.5 to 25.2 ± 5.1, and mean UAS7 from 24.4 ± 7.6 to 11.5 ± 6.5 at 6 weeks (both P < 0.001). Adults with AD demonstrated substantially greater food sensitization burden than those with CU, with clinically meaningful reductions in disease severity scores observed following targeted allergen avoidance in both conditions.
Individuals with atopic dermatitis (AD) may be referred for patch testing to rule out allergic contact dermatitis (ACD). While past expert consensus outlines when and how to patch test these patients, clinical management and measurement of meaningful clinical improvement is particularly challenging in this population. To develop practical clinical recommendations in the assessment and management of patients with AD undergoing patch testing. An international modified electronic (e)Delphi consensus exercise was conducted among 18 AD and ACD experts. Following 4 rounds, a total of 21/24 (87.5%) clinical management statements and 15/18 (83.3%) clinical assessment statements reached consensus. Avoidance of cutaneous sources of allergens with positive (+, ++, and +++) and doubtful (+/-) reactions, use of hyporeactive products, and strict adherence to a "safe products list" of allergen-free products were recommended. Follow-up at approximately 3 months with assessment via both (1) patient-reported outcomes (PRO) and (2) clinician-reported outcomes (ClinRO) validated measurement tools were recommended to guide therapeutic decision-making. This eDelphi exercise establishes clear recommendations to manage, evaluate, and further treat patients with AD following patch testing.
The understanding of atopic dermatitis (AD) pathogenesis is evolving beyond the barrier-immune dichotomy, with neuropsychological factors gaining prominence as a central component. This review systematically decodes the multi-level crosslink within the "brain-skin axis" in AD, encompassing recent advances in peripheral sensory neuron sensitization, central neural remodeling, and neuro-immune interactions. We elaborate on the roles of neuropeptides, cytokines, the autonomic nervous system, and the hypothalamic-pituitary-adrenal axis in the itch-scratch cycle, inflammation amplification, and mood disorders. Furthermore, we examine the influence of novel therapeutic strategies, including biologics, Janus kinase inhibitors, psychological approaches, and microbiome modulation, on these neuropsychological components. Finally, we outline future research directions, such as elucidating the molecular mechanisms of neuro-immune crosstalk, identifying relevant biomarkers, and establishing interdisciplinary diagnostic and treatment models. A deeper understanding of the role of neuropsychological factors in AD not only drives innovation in treatment strategies but also offers new perspectives for breaking the vicious cycle of "pruritus-inflammation-psychological distress."
Background: Atopic dermatitis (AD) is a pressing pediatric challenge with a profound disease burden. Accurate burden estimation is crucial for developing effective public health and clinical responses.Objective: To assess the temporal trends and future burden of AD in children and adolescents aged 19 years or younger across 5 East Asian countries.Methods: Using Global Burden of Disease 2023 data, this study analyzed the burden of AD-measured by age-standardized incidence, prevalence, and disability-adjusted life year rates-in Japan, South Korea, North Korea, Mongolia, and China. Decomposition analysis was performed to quantify the contributions of population growth, population aging, and epidemiological changes. Projections to 2040 were generated using Bayesian age-period-cohort models.Results: In 2023, East Asian children and adolescents exhibited substantial rates of AD, particularly among females. China experienced the most severe and rapidly worsening burden within the region. Although the disease burden in East Asia has declined, population aging acted as the dominant protective factor, counterbalancing increases associated with population growth and epidemiological changes. By 2040, this burden is expected to decline across all nations except Mongolia, which is forecasted to see a continued increase.Conclusions:The significant disparities in pediatric and adolescent AD burden within East Asia necessitate early, stratified, and multidisciplinary population health action.
There is no consensus on the impact of meteorological factors and air pollutants on childhood atopic dermatitis (AD). Literature was searched in 3 databases (PubMed, Web of Science, and Embase) up to May 1, 2025, and evaluated by 2 independent reviewers. Cross-sectional studies, cohort studies, or time-series analyses were included, reporting outcomes of meteorological factors, air pollutants, and childhood AD. The Newcastle-Ottawa Scale and Agency for Healthcare Research and Quality scale were used to assess study quality. A random-effects model was applied to estimate pooled risk ratios. From 132 identified literature, 49 studies involving nearly 7,091,746 participants were included. Air pollutants were positively correlated with the risk of childhood AD (odds ratio [OR] [95% confidence interval or CI] = 1.030 [1.005, 1.056] for carbon monoxide [CO]; 1.116 [1.075, 1.264] for nitrogen dioxide [NO2]; 1.059 [1.013, 1.108] for ozone; 1.114 [1.039, 1.260] for particulate matter [PM] with diameter of 10 µm [PM10]; 1.041 [1.009, 1.074] for PM with diameter of 2.5 µm [PM2.5]). No clear associations were observed between sulfur dioxide, temperature, humidity, and ultraviolet radiation (UVR) and the risk of childhood AD. Subgroup analysis showed that higher temperature and UVR might reduce the risk of AD, increased concentrations of CO, NO2 in developed countries, and PM10, PM2.5, and NO2 might increase the incidence risk in developing countries. Air pollutants represented significant risk factors for childhood AD, underscoring the imperative to prioritize environmental quality improvement for AD prevention.
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