Yukihiro Ohya

Application of moisturizer to neonates prevents development of atopic dermatitis

BACKGROUND Recent studies have suggested that epidermal barrier dysfunction contributes to the development of atopic dermatitis (AD) and other allergic diseases. OBJECTIVE We performed a prospective, randomized controlled trial to investigate whether protecting the skin barrier with a moisturizer during the neonatal period prevents development of AD and allergic sensitization. METHODS An emulsion-type moisturizer was applied daily during the first 32 weeks of life to 59 of 118 neonates at high risk for AD (based on having a parent or sibling with AD) who were enrolled in this study. The onset of AD (eczematous symptoms lasting >4 weeks) and eczema (lasting >2 weeks) was assessed by a dermatology specialist on the basis of the modified Hanifin and Rajka criteria. The primary outcome was the cumulative incidence of AD plus eczema (AD/eczema) at week 32 of life. A secondary outcome, allergic sensitization, was evaluated based on serum levels of allergen-specific IgE determined by using a high-sensitivity allergen microarray of diamond-like carbon-coated chips. RESULTS Approximately 32% fewer neonates who received the moisturizer had AD/eczema by week 32 than control subjects (P = .012, log-rank test). We did not show a statistically significant effect of emollient on allergic sensitization based on the level of IgE antibody against egg white at 0.34 kUA/L CAP-FEIA equivalents. However, the sensitization rate was significantly higher in infants who had AD/eczema than in those who did not (odds ratio, 2.86; 95% CI, 1.22-6.73). CONCLUSION Daily application of moisturizer during the first 32 weeks of life reduces the risk of AD/eczema in infants. Allergic sensitization during this time period is associated with the presence of eczematous skin but not with moisturizer use.

Evaluation of the staphylococcal exotoxins and their specific IgE in childhood atopic dermatitis

BACKGROUND Superantigenic exotoxins produced by Staphylococcus aureus and their specific IgE antibodies are thought to be important precipitating factors of atopic dermatitis (AD), but there are few reports evaluating these 2 factors at the same time. OBJECTIVE We examined whether the presence of the exotoxins sampled from the skin of patients with AD and the levels of anti-exotoxin IgE antibodies in their sera correlated with their severity of AD. METHODS Patients with mild-to-severe AD, 1 to 22 years of age, were evaluated by using Leicesters scoring system. Specific IgE antibodies against these exotoxins were determined by using ELISA. S aureus was isolated from 3 different areas of the skin. We examined whether the exotoxin (staphylococcal enterotoxin [SE]A, SEB, SEC, SED, and toxic shock syndrome toxin-1) could be detected. RESULTS The levels of SEB-specific IgE were correlated with the severity of AD. Five of 6 patients having very high SEB-specific IgE antibody titers were under 6 years of age, and SEB was most frequently isolated (41%). There was no difference in severity between patients with or without exotoxin-producing S aureus. The severity of 9 patients who had both exotoxin-producing S aureus on the skin and specific IgE antibody against the same exotoxin in sera was significantly higher than that of the other patients. CONCLUSIONS Anti-SEB IgE titers correlate well with the severity of AD. The presence of exotoxin-producing S aureus may precipitate AD through its specific IgE antibody.

Towards global consensus on outcome measures for atopic eczema research: results of the HOME II meeting

The use of nonstandardized and inadequately validated outcome measures in atopic eczema trials is a major obstacle to practising evidence‐based dermatology. The Harmonising Outcome Measures for Eczema (HOME) initiative is an international multiprofessional group dedicated to atopic eczema outcomes research. In June 2011, the HOME initiative conducted a consensus study involving 43 individuals from 10 countries, representing different stakeholders (patients, clinicians, methodologists, pharmaceutical industry) to determine core outcome domains for atopic eczema trials, to define quality criteria for atopic eczema outcome measures and to prioritize topics for atopic eczema outcomes research. Delegates were given evidence‐based information, followed by structured group discussion and anonymous consensus voting. Consensus was achieved to include clinical signs, symptoms, long‐term control of flares and quality of life into the core set of outcome domains for atopic eczema trials. The HOME initiative strongly recommends including and reporting these core outcome domains as primary or secondary endpoints in all future atopic eczema trials. Measures of these core outcome domains need to be valid, sensitive to change and feasible. Prioritized topics of the HOME initiative are the identification/development of the most appropriate instruments for the four core outcome domains. HOME is open to anyone with an interest in atopic eczema outcomes research.

Rationale and study design of the Japan environment and children’s study (JECS)

BackgroundThere is global concern over significant threats from a wide variety of environmental hazards to which children face. Large-scale and long-term birth cohort studies are needed for better environmental management based on sound science. The primary objective of the Japan Environment and Children’s Study (JECS), a nation-wide birth cohort study that started its recruitment in January 2011, is to elucidate environmental factors that affect children’s health and development.Methods/DesignApproximately 100,000 expecting mothers who live in designated study areas will be recruited over a 3-year period from January 2011. Participating children will be followed until they reach 13 years of age. Exposure to environmental factors will be assessed by chemical analyses of bio-specimens (blood, cord blood, urine, breast milk, and hair), household environment measurements, and computational simulations using monitoring data (e.g. ambient air quality monitoring) as well as questionnaires. JECS’ priority outcomes include reproduction/pregnancy complications, congenital anomalies, neuropsychiatric disorders, immune system disorders, and metabolic/endocrine system disorders. Genetic factors, socioeconomic status, and lifestyle factors will also be examined as covariates and potential confounders. To maximize representativeness, we adopted provider-mediated community-based recruitment.DiscussionThrough JECS, chemical substances to which children are exposed during the fetal stage or early childhood will be identified. The JECS results will be translated to better risk assessment and management to provide healthy environment for next generations.

Risk of postpartum depression in relation to dietary fish and fat intake in Japan: The Osaka Maternal and Child Health Study

BACKGROUND An ecological analysis found that the docosahexaenoic acid content in mothers milk and seafood intake were inversely correlated with postpartum depression. This prospective study investigated the relationship of consumption of selected high-fat foods and specific types of fatty acids with the risk of postpartum depression. METHOD The subjects were 865 Japanese women. Dietary data were obtained from a self-administered diet history questionnaire during pregnancy. The Edinburgh Postnatal Depression Scale (EPDS) was used for the evaluation of postpartum depression. Adjustment was made for age, gestation, parity, cigarette smoking, family structure, family income, education, changes in diet in the previous month, season when data at baseline were collected, body mass index, time of delivery before the second survey, medical problems in pregnancy, babys sex and babys birthweight. RESULTS The percentage of women with high depression scores was 14.0%. No evident dose-response associations were observed between intake of fish, meat, eggs, dairy products, total fat, saturated fatty acids, monounsaturated fatty acids, n-3 polyunsaturated fatty acids, n-6 polyunsaturated fatty acids, linoleic acid, alpha-linolenic acid, arachidonic acid, eicosapentaenoic acid or docosahexaenoic acid and the ratio of n-3 to n-6 polyunsaturated fatty acids and the risk of postpartum depression. However, there was an inverted J-shaped relationship between intake of n-3 polyunsaturated fatty acids and docosahexaenoic acid and the risk of postpartum depression. CONCLUSIONS This study failed to substantiate a clear inverse relationship between fish and n-3 polyunsaturated fatty acid intake and postpartum depression. Further investigations are needed to determine whether fish and n-3 polyunsaturated fatty acid consumption is preventive against postpartum depression.

Report from the fourth international consensus meeting to harmonize core outcome measures for atopic eczema/dermatitis clinical trials (HOME initiative)

This article is a report of the fourth meeting of the Harmonising Outcome Measures for Eczema (HOME) initiative held in Malmö, Sweden on 23–24 April 2015 (HOME IV). The aim of the meeting was to achieve consensus over the preferred outcome instruments for measuring patient‐reported symptoms and quality of life for the HOME core outcome set for atopic eczema (AE). Following presentations, which included data from systematic reviews, consensus discussions were held in a mixture of whole group and small group discussions. Small groups were allocated a priori to ensure representation of different stakeholders and countries. Decisions were voted on using electronic keypads. For the patient‐reported symptoms, the group agreed by vote that itch, sleep loss, dryness, redness/inflamed skin and irritated skin were all considered essential aspects of AE symptoms. Many instruments for capturing patient‐reported symptoms were discussed [including the Patient‐Oriented SCOring Atopic Dermatitis index, Patient‐Oriented Eczema Measure (POEM), Self‐Administered Eczema Area and Severity Index, Itch Severity Scale, Atopic Dermatitis Quickscore and the Nottingham Eczema Severity Score] and, by consensus, POEM was selected as the preferred instrument to measure patient‐reported symptoms. Further work is needed to determine the reliability and measurement error of POEM. Further work is also required to establish the importance of pain/soreness and the importance of collecting information regarding the intensity of symptoms in addition to their frequency. Much of the discussion on quality of life concerned the Dermatology Life Quality Index and Quality of Life Index for Atopic Dermatitis; however, consensus on a preferred instrument for measuring this domain could not be reached. In summary, POEM is recommended as the HOME core outcome instrument for measuring AE symptoms.

Report from the third international consensus meeting to harmonise core outcome measures for atopic eczema/dermatitis clinical trials (HOME)

This report provides a summary of the third meeting of the Harmonising Outcome Measures for Eczema (HOME) initiative held in San Diego, CA, U.S.A., 6–7 April 2013 (HOME III). The meeting addressed the four domains that had previously been agreed should be measured in every eczema clinical trial: clinical signs, patient‐reported symptoms, long‐term control and quality of life. Formal presentations and nominal group techniques were used at this working meeting, attended by 56 voting participants (31 of whom were dermatologists). Significant progress was made on the domain of clinical signs. Without reference to any named scales, it was agreed that the intensity and extent of erythema, excoriation, oedema/papulation and lichenification should be included in the core outcome measure for the scale to have content validity. The group then discussed a systematic review of all scales measuring the clinical signs of eczema and their measurement properties, followed by a consensus vote on which scale to recommend for inclusion in the core outcome set. Research into the remaining three domains was presented, followed by discussions. The symptoms group and quality of life groups need to systematically identify all available tools and rate the quality of the tools. A definition of long‐term control is needed before progress can be made towards recommending a core outcome measure.

Factors Associated with Steroid Phobia in Caregivers of Children with Atopic Dermatitis

Abstract:  Topical corticosteroids (TCS) are first‐line therapeutic agents for atopic dermatitis (AD). Some patients express irrational fear and anxiety about using TCS, which leads to poor outcomes for AD. Although it is important to understand the factors underlying steroid phobia so that its effects can be minimized, few studies have addressed this subject. Here, we used a questionnaire to investigate predictive factors for steroid phobia in the caregivers (usually mothers) of children with AD. We studied 436 children with AD (mean age 47.6 mos, range 2–236 mos) who newly visited our AD outpatient unit. The caregivers were asked to complete a medical history questionnaire regarding AD. Steroid phobia was analyzed for correlations with other patient and caregiver variables. Overall, 38.3% of the caregivers were reluctant to use TCS on their children’s skin. Patient characteristics female sex (odds ratio [OR] = 1.85 vs male; p = 0.005), child’s paternal history of AD (OR = 1.94; p = 0.03), and frequent changing of clinics (OR = 1.25; p = 0.03) were predictive factors for steroid phobia. AD severity did not correlate with steroid phobia. Our findings suggest that greater attention to the patient’s sex and clinical background of patients with AD is important to the success of AD therapy, regardless of AD severity.

Home environment and suspected atopic eczema in Japanese infants: The Osaka Maternal and Child Health Study

Atopic eczema is most commonly diagnosed in children under the age of 5 yr. Environmental factors during pregnancy or in early life may confer risk for childhood atopic eczema. The present prospective study examined the relationship of the perinatal home environment and the risk of suspected atopic eczema among Japanese infants under the age of 1. Study subjects were 865 parent–child pairs. The term ‘suspected atopic eczema’ was used to define an outcome based on our questionnaire at 2–9 months postpartum. Adjustment was made for maternal age, gestation, family income, maternal and paternal education, maternal and paternal history of asthma, atopic eczema, and allergic rhinitis, time of delivery before the second survey, babys older siblings, babys sex, and babys birth weight. A high mite allergen level from maternal bedclothes and mold in the kitchen during pregnancy were significantly associated with an increased risk of suspected atopic eczema. Frequent vacuuming practices during pregnancy and giving the infant a bath or shower at least once a day were significantly inversely related to the risk of suspected atopic eczema. Maternal smoking, maternal use of a synthetic duvet and pillow, carpet use in the living room and maternal bedroom, indoor domestic pets, no ducted heating appliance, and gas use for cooking during pregnancy and household smoking in the same room as the infant, infants synthetic duvet, carpet use in the infants room, or vacuuming the infants room were not related to the risk of suspected atopic eczema. High house dust mite allergen levels and mold in the kitchen during pregnancy may increase the risk of infantile atopic eczema, whereas frequent vacuuming practices during pregnancy and giving the infant a bath or shower at least once a day may protect against infantile atopic eczema.

Education, but not occupation or household income, is positively related to favorable dietary intake patterns in pregnant Japanese women: the Osaka Maternal and Child Health Study

Although a large body of epidemiologic data accumulated in Western countries show that individuals with a higher socioeconomic position consume higher quality diets, information on such socioeconomic differences in the diets of non-Western populations, including Japanese, is absolutely lacking. This cross-sectional study examined the association of socioeconomic position with dietary intake in a group of pregnant Japanese women. Subjects were 1002 Japanese women during pregnancy. Socioeconomic position was assessed by education, occupation, and household income. Dietary intake was estimated using a validated, self-administered, comprehensive diet history questionnaire. Education was associated positively with intake of protein; total n-3 and marine-origin n-3 polyunsaturated fatty acids; dietary fiber; cholesterol; potassium; calcium; magnesium; iron; vitamins A, D, E, and C; and folate 9 and inversely with that of carbohydrate. No associations were seen between education and intake of total fat; saturated, monounsaturated, and total and n-6 polyunsaturated fatty acids; alcohol; or sodium. Regarding food, higher education was associated with a higher intake of vegetables, fish and shellfish, and potatoes and lower intake of rice. Education was not associated with intake of bread, noodles, confectioneries and sugars, fats and oils, pulses and nuts, meat, eggs, dairy products, or fruit. For occupation, housewives had a higher intake of dietary fiber, magnesium, iron, vitamin A, folate, and pulses and nuts than working women. Household income was not associated with any nutrient or food examined. In conclusion, education, but not occupation or household income, was positively associated with favorable dietary intake patterns in a group of pregnant Japanese women.