Аллергология и Иммунология в Педиатрии (Mar 2023)

Consensus document APAIR: atopic dermatitis in children — update 2019 (short version) Part 1.

  • Yu. S. Smolkin,
  • I. I. Balabolkin,
  • I. A. Gorlanov,
  • L. S. Kruglova,
  • A. V. Kudryavtseva,
  • R. Y. Meshkova,
  • H. B. Migacheva,
  • R. F. Khakimova,
  • A. A. Cheburkin,
  • E. A. Kuropatnikova,
  • N. A. Lyan,
  • A. V. Maksimova,
  • S. S. Masalskiy,
  • O. Y. Smolkina

DOI
https://doi.org/10.24411/2500-1175-2020-10001
Journal volume & issue
Vol. 0, no. 1
pp. 4 – 25

Abstract

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Atopic eczema (atopic dermatitis, AD) — chronic recurrent inflammation of the skin, arising as a result of a violation of the epidermal barrier and entailing its further dysfunction. Maximum development atopic dermatitis reaches on the background of predisposition to IgE-mediated hypersensitivity, implemented in sensitization to surrounding allergens.The diagnosis of atopic eczema is clinical. An obligatory clinical symptom is itching in combination with 3 other criteria: typical morphology and distribution; a history of atopy; chronically xerosis; AD debut up to 2 years. The phase of the disease and the severity of skin lesions are of practical importance for clarifying the stage AD. Changes characteristic of different phases can be observed simultaneously. Morphological and age-related classifications of AD are conditional and have little effect on the therapeutic strategy. Clinical variants of AD (allergic and non-allergic) are a single nosological form that requires common approaches to therapy. The prevalence of AD is greatest in children a 1-st year of life (up to 30%) and significantly decreases in adolescence.Point and inherited mutations in genes (for example, filaggrin) are a key point in the pathogenesis of AD. Immune disorders are not limited to IgE-dependent reactions and occur with the participation of many cytokines (IL-4, IL-5, IL-13, IL-25, IL-31, TSLP). Bacteria and fungi act as infectious agents or superantigens for lymphocytes.Food allergies are detected in 30–40% of children with AD causing aggravation of the disease. The children in the first year dominated by sensitization to food allergens: milk, eggs, cereals, fish. An allergological examination using skin prick tests or specific IgE is informative and necessary, but the presence of sensitization should be clarified using an elimination-provocation test with this product.

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