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Asthma, atopic dermatitis, and allergic rhinitis display a marked circadian variation with the maximum of disease activity during the night. Due to the consecutive disruption of sleep architecture, affected children often suffer from daytime sleepiness and have reduced quality of life. Currently there is a diagnostic gap in detecting nocturnal asthma and allergy symptoms, leading to a significant underestimation of the frequency. Caring for children with asthma, atopic dermatitis, and/or rhinitis should include standardized detection of nocturnal symptoms and a regular assessment of sleep quality and potential daytime sleepiness. Vice versa, in the differential diagnostic of a child with enhanced daytime sleepiness, the very frequent atopic diseases should be routinely considered. As asthma and obstructive sleep apnea syndrome often occur together, the presence of one of these two diseases should prompt the systematic search for the other one. [ABSTRACT FROM AUTHOR]

Difficulties: Evaluating patients with atopic dermatitis or atopic hand eczema is a unique challenge for the occupational dermatologist. It is not only necessary to distinguish atopic dermatitis or atopic hand eczema from other forms of eczema and arrive at a appropriate diagnosis but in many instances it is also difficult to determine causation because the role of exogenous as well as endogenous factors needs to be established by the expert. Only when this process is completed can a recommendation concerning the liability of the insurer be made. Assessment of disease continuing after termination of occupational exposure: It can be difficult to determine the causation if the eczema that was primarily caused by occupational exposure does not fade away after the activity responsible for the initial damage has been terminated. As there is no commonly accepted algorithm to decide if the skin lesion is still caused by the former contact to the responsible agents on the job or if endogenous factors are responsible for the skin disease after the occupational exposure has been terminated, every case must be meticulously judged by taking into consideration the conflicting individual factors. [ABSTRACT FROM AUTHOR]