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The burden of atopic dermatitis (AD), a chronic, relapsing inflammatory skin disease, increases with disease severity and is associated with multiple flares per year over many years. We characterized the real-world burden of disease, including flares, in patients with AD enrolled in MEASURE-AD from Latin America. Patients (aged ≥12 years) with physician-confirmed AD receiving or eligible for systemic therapy were enrolled in MEASURE-AD between December 2019 and June 2020. Patient characteristics, treatments and outcomes were recorded during a single office visit. Primary outcome measures included worst itch within the past 24 h (Worst Pruritus Numerical Rating Scale [WP-NRS]) and quality of life (QoL; Dermatology Life Quality Index [DLQI] and cDLQI). Among secondary outcomes, the frequency and duration of disease flares within the last 6 months were assessed. Herein result from the Latin American (Brazil, Mexico and Argentina) population (N=180; adults (≥18 years), n=157; adolescents, n=23). Analyses were based on observed data; only descriptive statistics were presented. The mean (SD) age was 33.8 (17.0) years, 52.2% were males and all patients were receiving AD treatment, including 65.6% receiving systemic therapy alone or in combination. Severe pruritus (WP-NRS ≥7) was reported by 54.4% of patients (adults, 57.3%; adolescents, 34.8%). A very or extremely large effect on QoL (DLQI or cDLQI ≥11) was reported among 50.0% of patients ≥16 years and 42.9% of patients 12–15 years. Over the previous 6 months, 0, 1–2, 3–4, 5–6 and >6 flares were reported by 8.3%, 27.2%, 31.1%, 11.7% and 15.6% of patients, respectively. On average, flares lasted 15.2 days (adults, 15.9 days; adolescents, 11.1 days). Although all patients received treatment and two-thirds received systemic therapies, severity scores and impact on QoL and itch were extremely high, suggesting that AD is not adequately controlled in all patients. [ABSTRACT FROM AUTHOR]

Childhood atopic dermatitis (AD) is a chronic and recurrent health problem that involves multiple factors, particularly immunological and environmental. We evaluated the impact of docosahexaenoic acid (DHA) supplementation on prenatal arsenic exposure on the risk of atopic dermatitis in preschool children as part of the POSGRAD (Prenatal Omega-3 fatty acid Supplements, GRowth, And Development) clinical trial study in the city of Morelos, Mexico. Our study population included 300 healthy mother-child pairs. Of these, 146 were in the placebo group and 154 in the supplement group. Information on family history, health, and other variables was obtained through standardized questionnaires used during follow-up. Prenatal exposure to arsenic concentrations, which appear in maternal urine, was measured by inductively coupled plasma optical emission spectrometry. To assess the effect of prenatal arsenic exposure on AD risk, we ran a generalized estimating equation model for longitudinal data, adjusting for potential confounders, and testing for interaction by omega-3 fatty acid supplementation during pregnancy. The mean and SD (standard deviation) of arsenic concentration during pregnancy was 0.06 mg/L, SD (0.04 mg/L). We found a marginally significant association between prenatal arsenic exposure and AD (OR = 1.12, 95% CI: 0.99, 1.26); however, DHA supplementation during pregnancy modified the effect of arsenic on AD risk (p < 0.05). The results of this study strengthen the evidence that arsenic exposure during pregnancy increases the risk of atopic dermatitis early in life. However, supplementation with omega-e fatty acids during pregnancy could modify this association., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Studies suggest that children who start solid foods early are at risk for developing food allergies. Herein, we evaluated the effects of the introduction of peanuts to the diets of children on emerging peanut allergies. Children with allergic rhinitis and asthma were enrolled in the present study and evaluated in four stages. In the first stage, a clinical history was completed for all participants. In the second stage, skin tests were conducted to detect the sensitization to peanuts. In the third stage, the parents were interviewed about the peanut-eating habits of their children. In the fourth stage, children with a convincing history of allergy or a positive peanut skin test result were subjected to an open oral food challenge (OOFC). Three hundred children in four groups were included, 58.2% of the subjects were male, and the mean age was 7.3±3.9 years. The median age of first exposure to peanuts in patients with peanut allergies was greater than that in children without peanut allergies (2 years versus 1 year; p=0.009). The multivariate analysis, including only those children subjected to the OOFC, revealed that the consumption of peanuts after the age of ≥2 years is a risk factor for developing a peanut allergy (odds ratio=8.0, 95% confidence interval 1.3-50.0, p=0.026). The results of the present study showed that the late introduction of peanuts to children increases the risk of developing a peanut allergy. [ABSTRACT FROM AUTHOR]

With the advancement of knowledge in relation to the physiopathogenesis of atopic dermatitis (AD), several new therapeutic forms have been developed. There are also new guidelines for self-care. On the other hand, there is still an underdiagnosis of AD in Mexico. Thus, the need was seen to develop a national guide, with a broad base among the different medical groups that care for patients with AD. The Atopic Dermatitis Guidelines for Mexico (GUIDAMEX) was developed with the ADAPTE methodology, with the endorsement and participation of ten national medical societies, from physicians in Primary Healthcare to allergists and dermatologists. Throughout the manuscript, key clinical questions are answered that lead to recommendations and suggestions for the diagnosis of AD (including differential diagnosis with immunodeficiency syndromes), the recognition of comorbidities and complications, non-pharmacological treatment including therapeutic education, treatment of flares and maintenance therapy. The latter encompasses general measures to avoid triggering factors, first-line treatment focussed on repair of the skin barrier, second-line treatment (topical proactive therapy), and third-line phototherapy or systemic treatment, including dupilumab and JAK inhibitors.

The clinical behavior of asthma varies with age at onset. This study was undertaken to identify associated markers of adult-onset allergic asthma (age ≥20 years).This cross-sectional study compared two groups: 58 patients with asthma onset at ≥20 years and 66 with onset at ≥20 years. They were compared depending on results of clinical history, and body mass index (BMI), aeroallergen sensitization, total serum IgE, eosinophil count, asthma control test, and asthma severity level.Ages at first asthma episode were 10.0 ± 6.6 and 33.4 ± 10.5 (p<0.001) in the <20 and ≥20 group, respectively. BMI was higher in adult asthmatic subjects (29.8 versus 27.1, P=0.017), but BMI ≥30 kg/m(2) was not associated with asthma onset in ≥20 years (odds ratio [OR] = 1.56, 95% confidence interval [CI] 0.759 to 3.211; p= 0.227). After multivariate analysis, allergic rhinitis and IgE ≥150 IU/mL were negatively correlated with asthma onset in ≥20 years old (OR adjusted [ORa] = 0.255, 95% CI 0.078 to 0.837, P= 0.024, and ORa =0.385, 95% CI 0.175 to 0.849, p= 0.018, respectively).Adult-onset allergic asthma was not different from early-onset asthma. [ABSTRACT FROM AUTHOR]

Background: Sensitization to allergens in atopic dermatitis patients is a risk factor for developing asthma and allergic rhinitis in the future, as well as an aggravating factor in the course of the disease. Recent studies have attributed the activity of the proteases of some antigens to cause a grater defect in the epithelial barrier and a more severe disease. Objectives: To know the sensitization to allergens pattern in children with atopic dermatitis attended at Allergology Service of University Hospital of UANL, Mexico, and to know if these children have higher sensitization to antigens with proteolytic activity. Material and method: A retrospective study was done reviewing the skin prick test reports done in our service to children ranging from 5 months to 1 6 years old, diagnosed with atopic dermatitis during a period of 2 years, from January 2012 to January 2014. The frequency of sensitization to aeroallergens and food were analyzed as well as the weal size (≥6mm) on the skin in response to each particular allergen in the case of food skin prick test. Results: Reports of skin tests of 66 children, 30 boys and 36 girls, were included; 37 of children were sensitized to more than one allergen, 18/66 had asthma and/or allergic rhinitis, 40/66 60% skin prick tests were positive to high activity protease aeroallergens (Dermatophagoides pteronyssinus/Dermatophagoides farinae). Regarding food, sensitization was seen in 38 children; fruits and vegetables were the two most common foods. Only seven children had skin prick weal bigger than 6 mm, mainly to egg, fish and cow's milk. Conclusion: Children with atopic dermatitis are often sensitized to high protease activity aeroallergens, polysensitization is very common and the association with airway allergy is seen early in life. Sensitization to food is also common in these patients, but only a small percentage showed a response large enough to be associated with disease severity. [ABSTRACT FROM AUTHOR]

The common manifestations of atopic dermatitis (AD) appear sequentially with involvement of the cheeks in infancy, flexural extremities in childhood, and hands in adulthood. Although less common clinical manifestations are well described, they have not been the subject of epidemiologic studies to describe their prevalence in specific age groups. This observational, cross-sectional, comparative study included 131 children younger than 18 of both sexes with AD who attended the clinics of the Dermatology Department of the National Institute of Pediatrics in Mexico City. Patients were examined to determine the presence of infrequent clinical manifestations of AD during infancy, preschool and school age, and adolescence and stratified according to sex, age, and number of clinical signs. A chi-square test was used to detect differences according to age and sex. Logistic regression analysis was also performed. The main findings according to age were genital dermatitis and papular-lichenoid dermatitis variant in infants; atopic feet, prurigo-like, nummular pattern, and erythroderma in preschool and school-aged children; and eyelid eczema and nipple dermatitis in adolescents. The risk of development of nipple dermatitis and eyelid eczema increased with age, and the development of genital dermatitis decreased with age. The knowledge of the prevalence of less common clinical manifestations of AD according to age in different populations might be helpful in diagnosing incipient cases of AD. [ABSTRACT FROM AUTHOR]

Background: Several international guidelines on immunotherapy exist, but they only apply partially in Mexico. The Mexican guideline of immunotherapy dates from 1998. Objectives: To establish clinical recommendations and suggestions for Allergy residents and specialists for skin testing and allergen immunotherapy based on evidence and Mexican expert opinion, according to the GRADE system. Methods: The guidelines were developed following the methodology of a guideline for clinical practice starting with the formulation of clinical questions, in the context of Mexican environmental conditions and morbidity, with the participation of allergists from all regions of the country. External validation was obtained. Its development followed three steps: 1. formulation of 24 clinical questions. 2. Search for consensus on the answers among members of the Regional chapters of both Mexican Colleges of Allergists (CMICA and COMPEDIA) during regional meetings. 3. Literature search for articles related to the questions and grading of its quality according to GRADE. Results: Based on the regional consensus, 116 articles and the safety, patient acceptance/ comfort and cost clinical recommendations and suggestions were developed on basic aspects of skin testing, subcutaneous and sublingual immunotherapy (patient preparation, vial preparation and application schedules) and the treatment of eventual adverse reactions. Conclusions: A clinical guideline was developed respecting particular methodology, validated by CMICA and COMPEDIA for its implementation among Mexican allergists. Several aspects deserve further study to improve scientific evidence. [ABSTRACT FROM AUTHOR]

Background: Atopic dermatitis is an ever more frequent disease in children; its etiology is unknown, although a genetic predisposition along with environment factors could be the origin. Objective: To determine the prevalence of atopic dermatitis among school-children and the main associated risk factors. Patients and methods: A randomized, stratified and conglomerated sample of 6 to 12 year-old school-children was obtained. Their parents answered the main ISAAC questionnaire, to which some variables were added, such as family and hereditary history, tobaccosmoking exposure and nutritional condition according to the body mass index as associated risk factors. Results: We found a prevalence of 3% for atopic dermatitis, and the presence of dermatitis symptoms during the last twelve months was found in 6.8% of the cases. Multivariate analysis demonstrated an elevated risk for atopic dermatitis in children of mothers with any type of allergic disease (OR 2.75, CI 95% 1.09 to 6.92, p = 0.031). Conclusions: The frequency of atopic dermatitis as well as that of the symptoms was low, similar to previous reports conducted in Mexico. Maternal atopy was the only factor associated with atopic dermatitis. [ABSTRACT FROM AUTHOR]

Background: Atopic dermatitis is a frequent chronic dermatosis in children. Objective: To determine the prevalence of atopic dermatitis in a pediatric population from Morelia, Michoacan. Participants and methods: An observational, descriptive and comparative study was done to estimate the prevalence and underdiagnosis of atopic dermatitis in children and teenagers from Morelia, Michoacan (n = 9578). This study had a sensitivity of 0.87 and a specificity of 0.92. Results: A prevalence of 10.1% and 5.4% was found in children from 6 to 10 years old and teenagers from 11 to 16 years old. The diagnosis was done in only 20% of all cases. The high underdiagnosis suggests taking emergent actions of preventive medicine. Conclusions: The prevalence of atopic dermatitis in pediatric population from Morelia is similar of that reported in the United States and less than of Mexico City. [ABSTRACT FROM AUTHOR]

The International Study of Asthma and Allergy in childhood (ISAAC) has assessed the prevalence of asthma, as well as the factors related to the disease in different countries. The aim of this study was to identify asthma risks factors in Mexico City. Data were obtained from questionnaires of children participating in a phase 3b ISAAC survey. Two thousand ninety-eight boys and 2008 girls were recruited in the 6- to 7-year-old group and 3243 boy and 3333 girls were recruited in the 13- to 14-year-old group. Logistic regression was used to determine the asthma risks factors. In the logistic regression for cumulative and current asthma prevalence, the variables allergic rhinitis and atopic dermatitis were the most important risk factors with the highest odds ratios (OR > 1.5; p < 0.05). The use of antibiotics and paracetamol in the first 12 months of life were related to cumulative asthma in both genders in the 6- to 7-year-old group. Contact of pregnant mother with farm animals was positively related with cumulative asthma in boys in the 6- to 7-year-old group. The main factors associated with the cumulative and current prevalence of asthma in both age groups were atopic dermatitis and allergic rhinitis. Future interventions for the prevention and early diagnosis and treatment could be focused in the natural history of the atopic march. [ABSTRACT FROM AUTHOR]

Summary We undertook an association analysis between the ile50val, glu375ala, cys406arg, and ser761pro polymorphisms of the IL-4Rα gene and atopic asthma, total IgE levels and IL-4 serum levels in a population from western Mexico. We found that the ser761pro polymorphism was monomorphic for ser761, while there was no association between any of the other polymorphisms and the three phenotypes analysed. [ABSTRACT FROM AUTHOR]

Background: In Mexico, the economic burden of medical care for patients with atopic dermatitis is unknown., Objective: To determine the annual direct medical costs of the treatment for patients with moderate to severe atopic dermatitis who receive medical attention at "Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado" (Institute for Social Security and Social Services for State Workers, better known as ISSSTE), as well as the main variables associated with it., Methods: A multicenter, retrospective cohort study. Clinical records of patients with moderate to severe atopic dermatitis were reviewed and a multivariate analysis was designed by using a generalized linear model., Results: 65 patients were included; 41 of them (63.07 %) had moderate atopic dermatitis, and 24 (36.92 %) had severe AD; 39 (60 %) of them were female patients. In groups with severe atopic dermatitis, statistically significant differences were observed in matters of the duration of the evolution of the disease, comorbidities, intense pruritus, and depression. The average annual cost of medical care for patients with moderate atopic dermatitis was 1527 ± 623 USD, and for patients with severe atopic dermatitis the cost was 9487 ± 8990 USD. Significant differences were observed in dermatology consultations, referrals, laboratory and diagnostic studies, and the number of drugs prescribed by physicians. With the multivariate analysis, it was identified that the highest cost was presented by severe patients (p = 0.0001) who were younger and had comorbidities, along with diagnosis of depression., Conclusions: The severity of atopic dermatitis, the age average, the presence of comorbidities, and the diagnosis of depression are the variables with the highest association and impact on the direct cost of medical care.

Background: In Mexico, there are very few studies aimed at establishing the prevalence of allergic rhinitis (AR) and atopic dermatitis (AD) in late adolescents., Objective: To determine the prevalence of allergic rhinitis and atopic dermatitis in late adolescents and compare it according to their gender., Methods: A cross-sectional study that included 1992 15 to 18 year old adolescents who were recruited through a stratified and randomized probabilistic sample by clusters. The prevalence of AR (allergic rhinitis) and AD (atopic dermatitis) was identified with the questionnaire of "The International Study of Asthma and Allergies in Childhood"., Results: 1056 (53%) women and 936 (47%) men were included in the study. The prevalence of AR was 9.0% (95% CI = 7.8% - 10.4%); the frequency was higher in women (6.7% versus 11.1%, p = 0.001). The symptoms of rhinitis plus conjunctivitis predominated in women (16.0% versus 23.1%, p < 0.0001). The prevalence of AD was 5.2% (95% CI = 4.3% - 6.2%) and, once again, it was more frequent in women (7.7% versus 2.4%, p < 0.0001). The main factors associated with AR and AD were the female gender and a history of family atopic allergic diseases (p < 0.001)., Conclusions: There was a significant difference in the prevalence of AR and AD according to gender in late adolescents; women were most affected. In addition, a history of family atopic allergic diseases was another risk factor that was linked to both diseases.

Background: There is limited epidemiological information on the treatment of atopic dermatitis (AD) from specialist physicians in Mexico., Objective: To know the criteria that is used by specialists in Mexico to diagnose and treat AD., Methods: An observational, descriptive and cross-sectional study, which was authorized by the ethics committee, was carried out through an electronic survey., Results: 114 surveys were carried out; 56% of the participants were allergists, 38% were dermatologists and 5% were pediatricians. It was identified that 54% used clinical criteria for the diagnosis of AD and 42% used the criteria of Hanifin-Rajka as a diagnostic complement; 38% requested total and/or specific IgE, blood biometry and blood chemistry tests. They recount that 90% of patients under the age of 18 had mild AD, 8% had moderate AD and 2% had severe AD; and, in patients over the age of 18, 89% had mild AD, 6% had moderate AD and 5% had severe AD. The patients' care was multidisciplinary, since 57% of the survey respondents requested assessments combined with ophthalmology, dermatology and allergology., Conclusion: Knowledge of the disease will lead to a better control of the disease. The challenge is to have a patient registry, update treatment guidelines, consider comorbidities and have therapeutic options for its control.

Background: The prevalence of allergic diseases markedly varies according to the geographical region., Objective: To determine the prevalence of asthma, allergic rhinitis and atopic dermatitis in children of six and seven years of age., Methods: Cross-sectional study that included a sample of almost 15 thousand children in five cities of Mexico. To obtain the prevalence of allergic diseases and their symptoms, the parents of the children answered The International Study of Asthma and Allergies in Childhood questionnaire. 95% confidence intervals (CI) were estimated for proportions., Results: Of the total sample, 7466 (52.5 %) were boys and 7463 (47.5%) girls. In general, the prevalence of asthma, exercise-induced asthma and current asthma was 6.1 % (95% CI = 5.7%-6.5%), 2.1 % (95% CI = 1.9%-2.3%) and 11.6 % (95% CI = 11.1% -12.1%), respectively. On the other hand, the prevalence of allergic rhinitis was 5.4 % (95% CI = 5.1%-5.8%), rhinitis with conjunctivitis, 19.2 % (95% CI = 18.6%-19.8%), and current rhinitis, 52.8% (95% CI = 52.0%-53.6%). The prevalence of atopic dermatitis and current dermatitis was 3.4 % (95% CI = 3.1%-3.7%) and 7.8% (95 % CI = 7.4%-8.2%), respectively., Conclusions: Our results indicate that the prevalence of allergic diseases in school children is similar to that observed in previous studies in Mexico.

Background: The diagnostic approaches and therapeutic strategies of atopic dermatitis (AD) are generally inconsistent among physicians and health institutions., Objective: To develop a consensus statement among experts to reduce the variations in practice regarding the diagnosis and treatment of patients ≥ 12 years with AD to improve their care., Methods: Systematic literature search in PubMed and GREAT. With methodological support and using the Delphi method, a formal consensus was developed among 16 experts in Dermatology and Allergology, based on the current evidence and its applicability in the Mexican context. Apart from intense electronic communication, several issues of disagreement were discussed in two face-to-face meetings., Results: The clinical experts reached consensus on 46 statements related to the definition, classification, diagnostic strategies and treatment of AD. For the diagnosis we suggest the Williams criteria and for severity scoring the SCORAD (by the doctor) and POEM (by the patient). In addition to general care and treatment education (workshops), we suggest four steps for treatment, depending on severity: 1. Topical treatment with anti-inflammatory agents (and systemic: antihistamines/antileukotrienes -low level evidence-) 2. Phototherapy, 3. Cyclosporin A and 4. Dupilumab, with the possibility of managing this biological earlier on if a fast effect is needed. In extrinsic AD we suggest evaluating the addition of allergen immunotherapy or an elimination diet, if there is an IgE-mediated respiratory or food allergy, respectively., Conclusion: The panel of experts reached consensus on relevant aspects of AD with a focus on the transcultural adaptation of recent evidence.

Investigates the influence of birth, siblings and maternal factors in atopic dermatitis (AD) in Mexico City, Mexico. Correlations between early infections and sibship size; Significance of postmaturity on the risk of developing AD; Impact of the disease on first-born children.

This article reports that the IX Annual meeting of dermatology "Dermatology and Internal Medicine," organized by the Department of Dermatology of the Hospital General was held in Mexico City, Mexico in October 9-11, 1986. During the event researcher Jon Hanifin talked about some important aspects in immunopharmacology of atopic dermatitis. He said that erythema and itch have been induced by experimental stress interviews and by blind food challenges. On the other hand, basophils from patients with atopic dermatitis have increased histamine release after exposure to immunologic or non immunologic lectin stimuli.