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Abstracts

Abstracts

Atopic dermatitis

A skin application food test (SAFT) was applied to patients under the age of five years, suffering from atopic dermatitis.

In patients who were positive to the SAFT tests, 72% had a food immediate-contact hypersensitivity (FICH) to egg, 47% to cow's milk, 34% to peanut and one patient reacted to soy.

Upon introducing dietary restrictions, atopic dermatitis improved in 9 of 23 patients who could be followed-up.

FICH is an important symptom in children with atopic dermatitis and food allergy. SAFT positive children not only suffer from oral allergy syndrome, but also from food hypersensitivity, with the skin as a primary target organ.

FICH is an important phenomenon that occurs in young children with atopic dermatitis.

The diagnosis of food immediate contact hypersensitivity can be established by using the skin application food test.

"Food Immediate-Contact Hypersensitivity (FICH) and Elimination Diet in Young Children With Atopic Dermatitis: Preliminary Results in 107 Children", Oranje, Arnold P., ACTA Derm Venereol, 1992;Suppl.176:41-44.

Celiac disease

Coeliac disease

Evaluated the prevalence of malnutrition in patients with untreated coeliac disease (CD) according to their pattern of presentation, and the effect of gluten-free diet (GFD) upon nutritional status.

The nutritional status was evaluated by anthropometric measurements (percentage of ideal body weight for height and sex, percentage of standard triceps skinfold thickness and percentage of ideal arm-muscle circumference).

The overall prevalence of malnutrition in our series of CD patients was 53%. Prevalence of malnutrition (actual body weight less than 90% of the ideal) was significantly higher in classical coeliacs (67%) than in subclinical ones (31%), in patients with DH (13%) and in healthy volunteers (13%).

Prevalence of malnutrition in CD is lower than was previously thought. CD patients with classical presentation may require a longer period of GFD to achieve a significant improvement of their nutritional status, with respect to those with subclinical presentation, probably because of a greater extent of intestinal damage.

Finally, a careful evaluation of dietary habits is usually sufficient to identify incomplete adherence to GFD as the reason for nonimprovement of the nutritional status in patients with CD.

Corazza GR et al., Subclinical coeliac disease: an anthropometric assessment. J Intern Med, 236:183-7, 1994 Aug.

Elimination diets

The aim of this study is to clarify the nutritional value of elimination/diets (four types of Japanese style diets) which atopic dermatitis children had been on for 7 days before the examination.

The intake of energy was less than the recommended dietary allowances. This result suggests that the intake of energy is associated with the removing of vegetable oils. As 55% of the children had not had any vegetable oils, the intake of fat was half the recommended dietary allowance.

Half of the children had not had eggs and milk at all, but the intake of protein of the boys was 31% more than the recommended dietary allowance and that of the girls was 42% more than the recommended dietary allowance.

The intake of calcium by the boys was 365 +/- 199 mg and that by the girls was 452 +/- 67 mg.

The intake of iron and vitamins was more than the recommended dietary allowance.

In the case of the boys on elimination diets, the ratio of PFC was P = 17%, F = 12%, C = 71%, and in the case of the girls it was P = 17%, F = 14%, C = 69%.

It has been clarified that the F ratio of the intake of the boys and the girls was smaller than the ratio of the recommended dietary allowances, and that P ratio and C ratio were larger.

Nakashima K: [Nutritional study of elimination diets in the case of two-year-old children recovered from atopic dermatitis] . Sangyo Ika Daigaku Zasshi, 19:13-22, 1997 Mar 1.

Few foods diet

The nutritional content of a few foods diet, supplemented with a casein hydrolysate formula (n = 24) or a whey hydrolysate formula (n = 21), was studied in 45 children with atopic dermatitis.

The six day weighed food inventory record method was used to estimate the mean daily intake of energy, protein, calcium, iron, zinc, folate, and vitamin C on normal diet and on the few foods diet.

The diet was associated with a significant reduction in protein and calcium intake in both groups, and in energy intake in the casein hydrolysate group. The median daily volume of hydrolysate milk taken was 10.5 ml/day (range 0-840 ml/day) for the casein hydrolysate group and 267 ml/day (range 0-1300 ml/day) for the whey hydrolysate group.

Whey hydrolysate appears to be more palatable than casein hydrolysate, which is a potential advantage in the maintenance of an adequate intake in children on a few foods diet.

Mabin DC et al., Nutritional content of few foods diet in atopic dermatitis. Arch Dis Child, 73:208-10, 1995 Sep.

Food factors

Food allergy

Food allergies are causal factors for atopic dermatitis (AD) in 50% in infancy, in 20 to 30% in childhood, and only in 10 to 15% after puberty and in adulthood.

Cow's milk, egg, fish, wheat, soy, nuts and citrus-fruits are the most proven allergens. Pseudoallergens, especially food-additiva, have to be regarded too.

In severe cases of AD semi-elementary respectively few foods diets may be necessary. However in most cases of AD the "diet of choice" is an age related normal nutrition.

To avoid the manifestation of atopy special recommendations for the nutrition of high risk newborns and infants (especially long breast feeding, late solid feeding) should be considered.

Stoumlmann W & Kurz H: [Atopic dermatitis and food allergy in infancy and childhood]. Wien Med Wochenschr, 146:411-4, 1996.

Food-sensitivity

Atopic dermatitis is associated with skin and blood eosinophilia, but the role of eosinophils in the pathogenesis of the skin lesions is poorly understood.

Studied the relationship between the severity of the disease and both the number and the extent of activation of eosinophils in 15 patients with food-sensitive atopic dermatitis to determine whether eosinophils play a role in the pathogenesis of the skin lesions in atopic dermatitis.

A clear relationship was found between the number of light-density eosinophils and the severity of the disease both during the active disease and after clinical improvement. Also, an adhesion-stimulating activity for eosinophils in patients' plasma, which does not change after recovery.

Eosinophils play a pivotal role in the pathogenesis of the skin lesions in atopic dermatitis. In particular, the light-density phenotype seems to be an essential feature of eosinophils involved in this process. The adhesion-promoting activity that we observed in the patients' plasma could be important in the recruitment of eosinophils from the blood into the skin.

Magnarin M et al., A role for eosinophils in the pathogenesis of skin lesions in patients with food-sensitive atopic dermatitis. J Allergy Clin Immunol, 96:200-8, 1995 Aug.

Internal diseases

Skin lesions can be associated with many internal diseases. Most organ systems seem to have conditions in which skin lesions can develop. Treatment of the skin lesions in such a situation is palliative. The underlying internal disease must be addressed for resolution of the skin lesions to occur. It is important to view the skin as an integral communicating part of the body and not just as the skin.

Woods PR: Internal diseases that have skin lesions. Vet Clin North Am Equine Pract, 11:111-26, 1995 Apr.

Immune factors

Contents:

Immunocompetence
Immunologic tests

Immunocompetence

Immune function, particularly cell-mediated immunity (CMI), declines with age and it has been suggested that this may be secondary to the impaired nutritional status often found in the elderly.

A balanced nutritional supplement consisting of several macro- and micro-nutrients was administered daily to 27 housebound elderly (aged 70-85 years) for 12 weeks.

Before supplementation 19% of the entire group of subjects were anergic and another 19% hypoergic, values greater than expected for healthy elderly subjects. A weak association was shown between plasma zinc concentration and the number of positive skin test responses. Supplementation had minimal effect on DCH, resulting in a significant increase only in the sum of positive indurations.

Supplementation did not result in a significant change in any of the lymphocyte populations.

Bunker VW et al., Dietary supplementation and immunocompetence in housebound elderly subjects. Br J Biomed Sci, 51:128-35, 1994 Jun.

Immunologic tests

Study comprised 100 examinees with atopic dermatitis and 50 examinees with chronic urticaria (adult patients and children), as well as 50 examinees in a control group.

Monitoring included laboratory findings; values of eosinophiles, total lymphocytes, T and B lymphocytes, serum immunoglobulin (IgG, IgA, IgM) total IgE and specific IgE; results of cutaneous tests: prick and intradermal test to inhalative and nutritive allergens, scratch test to preservatives and additives, and epicutaneous (patch) test to contact allergens.

Values of total number of lymphocytes and T and B lymphocytes were mainly within the normal limits, therefore these were not good diagnostic parameters.

Eosinophiles were mainly higher and were useful in determination of AD.

Of the applied skin tests, the most important was intradermal test which gave most of the positive results in the patients with atopic dermatitis (98%), then followed scratch test (83%), patch test (64%), and finally epicutaneous test (57%).

Lugovic L & Lipozencic J: [Routine immunologic tests in atopic dermatitis]. Lijec Vjesn, 119:5-10, 1997 Jan.

Nutrition in infancy

Nutrition in infancy (Japanese)

Incidence and relative risk of atopic disease (atopic dermatitis; AD, bronchial asthma; BA, allergic rhinitis; AR) in Japanese infants and children in relation to their nutrition in infancy was analyzed from epidemiological data for 10,000 mothers of infants and children in 1993. A total of 4,610 replies were received:

Subjects were allocated to following 3 groups based on their nutrition during first 3 months after birth;
the breast-fed group (BF),
the formula-fed group (EF),
the mixed-fed group (MF).

Incidence of atopic disease in BF, FF and MF was 24%, 22% and 22%, respectively and no statistical difference could be found among these 3 groups. AD was developed 17.0%, 14% and 14%; BA was 4%, 9% and 5%; AR was 5%, 7% and 6% in BF, FF and MF, respectively.

Results suggest that the breast-fed have certain suppression effects on incidence of bronchial asthma in infants and children.

Arita M et al., [Epidemiological research on incidence of atopic disease in infants and children in relation to their nutrition in infancy]. Arerugi, 46:354-69, 1997 Apr.

n-3 fatty acids

Investigated whether fish oil and/or corn oil had a beneficial effect on the clinical state of atopic dermatitis, and to evaluate the dietary intake of nutrients in this group of patients.

Patients with moderate to severe atopic dermatitis were randomly assigned to receive either 6 g/day of concentrated n-3 fatty acids, or an isoenergetic amount of corn oil.

There were no significant differences in the clinical scores between the two groups at baseline, and at the end of the study.

In the fish oil group, the amount of n-3 fatty acids in serum phospholipids was significantly increased at the end of the trial, compared with pretreatment values, whereas the level of n-6 fatty acids was decreased.

Syland E et al., Dietary supplementation with very long-chain n-3 fatty acids in patients with atopic dermatitis. A double-blind, multicentre study. Br J Dermatol, 130:757-64, 1994 Jun.

Poison oak

Poison Oak and Vitamin C

Patients (#126) with poison oak received injections of 300-600 mg/d of ascorbic acid in two to three divided doses for a median duration of five days. Oral ascorbic acid 600 to 1200 mg was given in certain cases as well.
This treatment had frequent improvement but best results came when there were symptoms of edema on the eyelids or genitals. Injections were better than oral treatment. Intramuscular injections were better than IV injections. Those receiving injections of 150 to 300 mg/d of ascorbic acid before and after exposure resulted in only one with dermatitis, where those who did not utilize the vitamin C therapy developed poison oak dermatitis in 21 of 24 individuals.

"Ascorbic Acid in The Treatment and Prevention of Poison Oak Dermatitis", Klasson, D.H., Archives of Dermatol. Syph., 1947;56:864-867

"Vitamin C for Poison Oak Dermatitis", Gaby, Alan, MD, Townsend Letter for Doctors, August/September 1990;522

Oats

Oats

According to this study, the consumption of oats does not aggravate or cause dermatitis herpetiformis. Seven men and 3 women with biopsy- confirmed dermatitis herpetiformis and a mean age of 58 years were evaluated for gluten-free oat tolerance. Serologic tests for antigliadin, antireticulin, and antiendomysial antibodies were negative before oats were introduced into the diet and after they were discontinued. The architecture and height of the villi were similar before and after the diet, as was the mean enterocyte height. Duodenal intraepithelial lymphocyte counts remained within normal limits. There was no change in dermal IgA.

Hardman, Catherine M., M.R.C.P., et al: Absence of Toxicity of Oats in Patients With Dermatitis Herpetiformis, New England Journal of Medicine, December 25, 1997;337:1884-1887.

Vitamin E & Dermatitis

Vitamin E

Vitamin E's widespread use in cosmetics can cause dermatitis. Usually this is subclinical, but occasionally there is an outbreak of serious papular and follicular dermatitis. The study states that for most people, the use of vitamin E to improve the results of wound healing would be considered supplemental and not essential from a nutritional perspective. There are several studies which suggest that vitamin E may help minimize the damage and increase the potential of healing wounds from radiation sources. In surgical wound healing, the impact of vitamin E is less clear. It is noted that systemic vitamin E will inhibit the inflammatory response, inhibit collagen synthesis, and thereby decrease wound tensile strength. This action is similar to that of glucocorticoids. These effects are mitigated by vitamin A because it works as a lysosomal destabilizing compound that reverses some of the adverse effects of glucocorticoids. In animal models, vitamin E has been found to decrease the development of intraperitoneal adhesions and to be minimally beneficial in breast implant capsular contracture.

Havlik, Robert J., M.D.: Vitamin E and Wound Healing, Plastic and Reconstructive Surgery, December, 1997;1901-1902.