Atopic Dermatitis: The Epidemiology, Causes and Prevention of Atopic Eczema

Cover......Page 1
Half-title......Page 3
Title......Page 5
Copyright......Page 6
Dedication......Page 7
Contents......Page 9
Contributors......Page 11
Foreword......Page 13
Why a book devoted to the epidemiology of atopic dermatitis?......Page 15
Acknowledgments......Page 16
PART I The nature of the problem......Page 17
A distinct ‘entity’ or a continuum?......Page 19
More than one disease?......Page 22
Is atopic dermatitis atopic?......Page 23
Regressive and progressive nosology of disease......Page 24
What is a good disease definition?......Page 25
The Hanifin, Lobitz and Rajka diagnostic criteria......Page 26
The modern age......Page 28
The UK refinement of Hanifin and Rajka’s criteria......Page 29
Simple prevalence survey to assess the burden of disease......Page 30
As a diagnostic aid in the primary care setting......Page 31
Misclassification......Page 32
Adults and infants......Page 34
Where do other ‘variants’ of atopic dermatitis fit in?......Page 35
Conclusions......Page 36
Summary of key points......Page 37
References......Page 38
Pathophysiological mechanisms......Page 41
Immunopathogenesis......Page 42
Immunoregulatory dysfunction......Page 43
Cell regulatory abnormalities......Page 44
Clinical features of atopic dermatitis......Page 47
Diagnostic criteria......Page 48
Specific clinical features......Page 49
Summary of key points......Page 51
References......Page 52
Introduction......Page 59
Problem areas......Page 60
The studies......Page 61
Clinical trials......Page 62
Problem areas......Page 63
Studies which have examined real and apparent atopic dermatitis clearance......Page 64
Conclusions......Page 65
How many and why?......Page 70
Sensitization......Page 72
Recommendations for future studies which examine the natural history of atopic dermatitis......Page 73
Issues relating to analysis and interpretation......Page 74
References......Page 75
The triangle of occupational skin disease, hand eczema and atopic dermatitis......Page 78
Sick leave and change of work due to atopic dermatitis......Page 80
Risk factors for hand eczema: atopic dermatitis as an effect modifier......Page 81
On the quantification of risk......Page 82
Occupational guidelines for patients with atopic dermatitis......Page 84
References......Page 85
PART II Descriptive studies which indicate the size of the problem......Page 87
The need for a geographical epidemiology approach in atopic dermatitis......Page 89
International variation in the prevalence of atopic dermatitis......Page 90
Atopic dermatitis and westernization......Page 93
Epidemiological transition......Page 95
Regional variation in the prevalence of atopic dermatitis......Page 96
Geographical clues to environmental associations......Page 97
Summary of key points......Page 99
References......Page 100
The prevalence of atopic dermatitis in young schoolchildren......Page 103
Teenagers and adults......Page 104
Severity indices currently available......Page 105
Population studies of severity......Page 106
The financial burden in the UK......Page 107
Morbidity and social costs......Page 108
Specific measures of quality of life used in atopic dermatitis......Page 109
Summary of key points......Page 111
References......Page 112
Summary of available secular trend studies......Page 114
Validation of the outcome variable......Page 117
Genetic susceptibility......Page 119
Geographical differences and migration studies......Page 120
Environmental factors and lifestyle......Page 122
Immunology and infections......Page 123
Future public health implications of increasing atopic dermatitis?......Page 124
References......Page 125
PART III Analytical studies which point to causes of atopic dermatitis......Page 129
Family studies......Page 131
Twin studies......Page 132
Newer genetic approaches......Page 133
Serum IgE level......Page 134
Atopy......Page 136
HLA system......Page 137
Maternal effect and genomic imprinting......Page 138
Summary of key points......Page 139
References......Page 140
The concept of programming during early development......Page 143
Lessons from the programming of nondermatological disease......Page 144
Atopy – effects of fetal growth and of maternal nutrition......Page 145
Pointers to the possibility of programming by other maternal influences......Page 149
Cord blood predictors of later atopic disease......Page 150
Month of birth......Page 151
References......Page 152
Socioeconomic status, health and epidemiology......Page 157
Social class and atopy......Page 158
Atopic dermatitis: a social class gradient?......Page 159
Why a positive social class gradient in dermatitis?......Page 160
Dermatitis and other socioeconomic indicators......Page 161
Implications and future directions......Page 162
Summary of key points......Page 163
References......Page 164
Maternal factors and the increased prevalence of atopic dermatitis......Page 166
Age of first-time mothers in European countries......Page 167
Atopic dermatitis and parity......Page 168
Direct studies of maternal age and atopic dermatitis......Page 169
Conclusion......Page 170
References......Page 171
Arsenic and heavy metals......Page 173
Indoor and outdoor pollution – measurement......Page 175
Tobacco smoke......Page 176
Industrial and traffic pollution in east versus west Germany......Page 179
References......Page 183
Why study migrant groups?......Page 187
Defining migrant groups......Page 188
Migrant studies of other diseases......Page 189
Studies of ethnic groups in one location......Page 190
Studies of migrants in two locations......Page 193
Why do migrants have more atopic dermatitis than those in their country of origin?......Page 194
Retention of customs......Page 196
Conclusions and future recommendations......Page 197
References......Page 198
Serum IgE concentrations......Page 201
Results of patch tests......Page 202
Eosinophilic cationic protein (ECP)......Page 203
Dust mites......Page 204
Animal dander......Page 205
Serum IgE antibodies as epidemiological risk factors for atopic dermatitis......Page 206
Conclusions......Page 207
References......Page 208
Some children with atopic dermatitis react adversely to foods......Page 211
Comment......Page 213
Avoidance of selected foods can cause atopic dermatitis to improve......Page 214
The few food diet......Page 215
Elemental diet......Page 216
Reasons for improvement of dermatitis on an elimination diet......Page 217
References......Page 218
PART IV Intervention studies......Page 221
Genetic factors......Page 223
Immunological factors......Page 224
Local cutaneous factors......Page 225
Environmental engineering......Page 226
Breast feeding......Page 227
House dust mite......Page 228
Intervention studies......Page 229
Recommendations for the prevention of atopic dermatitis and implications for future strategies......Page 232
Summary of key points......Page 233
References......Page 234
PART V Lessons from other fields of research......Page 237
One disease or many?......Page 239
Prognosis and natural history......Page 240
Studies have addressed the wrong questions......Page 242
Risk factors......Page 243
Time trends......Page 246
Summary of key points......Page 247
References......Page 248
Canine atopic dermatitis......Page 251
Association of atopic dermatitis with other allergic diseases......Page 252
The prevalence of skin test reactivity to specific allergens in canine atopic dermatitis......Page 253
Pathomechanism of atopic dermatitis......Page 255
Genetic predisposition......Page 256
Season of the year......Page 257
Regional and international factors......Page 258
References......Page 259
PART VI Conclusions......Page 263
A better understanding of disease burden......Page 265
Migrant studies which point to a strong role of the environment......Page 266
Genetic epidemiology......Page 267
The lamentable volume of research into the epidemiology of atopic dermatitis......Page 268
Lack of measures of atopic dermatitis severity for use in epidemiological studies......Page 269
A poor understanding of the natural history of atopic dermatitis......Page 270
The relationship of atopic dermatitis to other types of dermatitis......Page 271
Where should we direct our future efforts?......Page 272
Where does clinical and public health policy need to be modified?......Page 273
What is limiting progress?......Page 274
Conclusions......Page 275
References......Page 276
Dermato-epidemiology organizations......Page 280
Patient organizations......Page 281
Index......Page 283