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In this retrospective study spanning from 2002 to 2019, we analyzed data from 355,277 Korean patients diagnosed with atopic dermatitis (AD) through the National Health Insurance System. Our objective was to comprehensively analyze the trends in prevalence, severity profiles, and treatment approaches for AD in Korea over this 18-year period. Initially, AD prevalence stood at 3.88% in 2002 but notably rose to 5.03% by 2019. During the same period, while AD prevalence decreased in the 0–1-year-old group (from 34.52% to 24.83%), it remained relatively stable in the 1–11-year-old group. Conversely, the 12–19-year-old and 20 years or older age groups witnessed substantial increases in AD prevalence, climbing from 2.55 to 6.02% and 1.44% to 3.53%, respectively. Moreover, the proportion of patients classified as having moderate to severe AD grew from 30.96 to 39.78%. Surprisingly, the prescription pattern, predominantly based on corticosteroid administration, exhibited minimal change despite the rising prevalence of moderate and severe AD cases. These findings underline a persistent reliance on corticosteroid-based treatments for AD, even as the condition's severity escalates among Korean adolescents and adults. Consequently, there is a pressing need to develop novel treatment guidelines emphasizing biologics that offer enhanced safety and efficacy. [ABSTRACT FROM AUTHOR]

Introduction: Previous studies have variably reported inconclusive trends in the prevalence of atopic dermatitis (AD) among adults, and there are limited data on the impact of the COVID-19 pandemic. We aimed to investigate the national trends and age-stratified prevalence of AD among adults from 2007 to 2021 in South Korea, focusing mainly on the impact of the COVID-19 pandemic-related factors. Methods: A nationwide cross-sectional study was conducted using the Korea National Health and Nutrition Examination Survey data from 2007 to 2021. Overall and age-stratified prevalence for AD were assessed using weighted beta coefficients or odds ratios. Results: A total of 83,566 adults over 20 years (male, 49.40%) were included. During the observation period, the prevalence of AD was stable in the overall population from 2.61% (95% CI, 2.29–2.93) in 2007–2009 to 2.15% (1.68–2.63) in 2020 and 2.38% (1.81–2.95) in 2021. However, the weighted prevalence of AD in adults aged 40–59 years old decreased during the pre-pandemic era, and the prevalence of AD in adults aged above 60 years significantly decreased during the pandemic, with a significant decline observed after the initial outbreak. From age-stratification analysis, the adults aged 40–59 years showed a significant increase after the pandemic outbreak which was evident in specific variables: individuals with rural residence, lower education, and lower household income quartiles. Adults aged above 60 years showed a significant decrease in the slope after the outbreak, evident in specific variables: individuals of female, rural residence, lower education, and lower household income quartiles. Conclusion: We observed a stable overall prevalence of AD throughout the 15-year observation period. However, the age-stratified analysis suggested significantly different trends according to age-stratified groups and the impact of the COVID-19 pandemic on the prevalence of AD. [ABSTRACT FROM AUTHOR]

Background: Individuals with atopic dermatitis often develop other conditions. Objective: This study aimed to determine how atopic dermatitis comorbidities develop in children over time. Methods: This population‐based administrative cohort study used national health insurance data. We traced individuals born in Korea between 2002 and 2003 to 2018. The date of initial atopic dermatitis diagnosis was set as the index date. Fifty‐three childhood comorbidities of atopic dermatitis were identified as outcomes of interest by performing a comprehensive literature search and comparing the prevalence of diagnostic codes in children with and without atopic dermatitis. Four control children per individual in the atopic dermatitis group were randomly matched based on sex and index date. The association between atopic dermatitis and the development of each specified disease was assessed using proportional hazard assumption, followed by mapping of the temporal sequences of interconnected comorbidities. Results: The atopic dermatitis and control groups contained 67,632 and 270,528 individuals, respectively. The median age at the index date was 10 months, whereas the median follow‐up period was 15 years. Twenty diseases that were associated with a higher risk of atopic dermatitis were identified and a chain of interconnected conditions created. The progression began in childhood with febrile seizures, constipation, and asthma, and was later associated with the emergence of food allergy, allergic rhinitis, psychiatric disorders, and autoimmune diseases. Conclusion: Our study highlights the temporal nature of atopic dermatitis comorbidities in children, and indicates that an understanding of the comorbidities may inform its clinical management and treatment. [ABSTRACT FROM AUTHOR]

Introduction: Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases. Several studies have investigated the relationship between obesity and AD prevalence, but the results have been conflicting. This study investigated the association between obesity and AD in Korean adolescents. Methods: We used nationally representative data regarding 1,617 Korean adolescents aged 12–18 years, which were obtained from the cross-sectional Korea National Health and Nutrition Examination Survey 2017–2019. Multiple logistic regression analysis (including age, sex, region of residence, number of household members, economic status, lipid profile, and stress level) was used to evaluate the relationships of obesity and abdominal obesity with doctor-diagnosed AD. Results: Although the results were not statistically significant, obese adolescents were diagnosed with AD (20.8%) more often than non-obese adolescents (20.8% vs. 14.5%, p = 0.055). This tendency was more prominent in male adolescents than in female adolescents, but the finding was not statistically significant. Body mass index and the prevalence of abdominal obesity did not differ between the AD and non-AD groups. Adolescents with AD had significantly higher total cholesterol and low-density lipoprotein cholesterol (LDL-C) levels, compared with adolescents who did not have AD. In the adjusted model, an LDL-C level ≥130 mg/dL was a risk factor for AD (adjusted odds ratio, 1.03; 95% confidence interval, 1.01–1.05). Conclusions: A high LDL-C level may be a risk factor for AD. Proper management of dyslipidemia through lifestyle modification may aid in AD prevention and control. Further large-scale prospective studies are needed to assess the associations of AD with obesity and dyslipidemia. [ABSTRACT FROM AUTHOR]

Simple Summary: Research suggests that a skin condition called atopic dermatitis (AD) and cancer, specifically kidney cancer, might be connected. However, we do not have enough evidence to confirm this link. This study aimed to determine whether the risk is real and whether the severity of AD influences this association. We used a big database of health information from Korea for the investigation and found that people with moderate to severe AD have a higher-than-average chance of getting kidney cancer. This discovery could help doctors better understand these conditions and might lead to more frequent check-ups for kidney cancer in people with AD, especially those with severe disease. Background: Evidence for an association between atopic dermatitis (AD) and cancer is still insufficient. In particular, the association between the risk of renal malignancy and the severity of AD has not been thoroughly investigated. Objective: To investigate the risk of renal malignancy and determine the association between AD severity and cancer risk using data from the Korean National Health Insurance Service (KNHIS) database. Methods: We performed a population-based cohort study using the National Health Claims database from the NHIS in Korea. Results: We found a statistically significant association between AD and overall malignancy (for mild AD, hazard ratio (HR): 1.061, 95% confidence interval (CI): 1.006–1.118; for moderate to severe AD, HR: 1.061, 95% CI: 1.014–1.11) compared with the no AD group. The moderate to severe AD group showed a significantly increased risk for renal malignancy (adjusted HR: 1.533, 95% CI: 1.209–1.944) compared with the no AD group. Limitations: Patient inclusion is solely based on diagnostic codes. We had no data about drug use, genetic factors, or other medical history that could affect the cancer risk. Conclusion: In our large population-based cohort study, moderate to severe AD was associated with increased risk of renal malignancy. Regular check-ups for renal malignancy are recommended in this population. [ABSTRACT FROM AUTHOR]

Background: Although atopic dermatitis (AD) in children affects diverse stages of life, no studies have reported on the association between school readiness and AD. Methods: This study used Korean National Health Insurance data and the Health Screening Program for Infants and Children. Among all children born between 2008 and 2012 in Korea, those who were assessed for school readiness through questionnaires in a health screening program performed at 54 and 60 months old were enrolled. AD was defined based on the International Classification of Diseases codes, with two or more prescriptions of topical corticosteroids during the first 54–60 months of life. The primary outcome was the association between school readiness and AD. The questionnaire relating to school readiness comprised six items – cognitive skills, social development, activeness, concentration, emotional development, and language skills. Logistic regression analysis was used to identify the associations between school readiness and AD. Results: This study included 239,673 children without AD and 38,229 children with AD. The average age at which school readiness was assessed was 4.8 years. AD was associated with vulnerability in activeness (adjusted odds ratio: 1.127; 95% confidence interval: 1.071–1.186) and concentrations (1.170; 1.093–1.254). The impact of AD on concentrations showed consistent results regardless of sex, exposure to systemic corticosteroids and antihistamines, and age at the diagnosis of AD. Conclusions: Children with AD have vulnerability in school readiness in the aspects of activeness and concentration. [ABSTRACT FROM AUTHOR]

This cross-sectional, retrospective, observational study aimed to analyze the distribution and healthcare usage patterns of patients with atopic dermatitis using the 2010–2018 Health Insurance Review and Assessment Service data. Patients diagnosed with atopic dermatitis in Korea between January 2010 and December 2018 and registered in the Health Insurance Review and Assessment national database were identified, and 270,008 patients who used healthcare services at least once during this period were evaluated to ascertain the healthcare usage patterns and treatment methods for atopic dermatitis. The number of patients with atopic dermatitis plateaued during the study period, while the number of claims and total expenses increased by a small margin. Atopic dermatitis prevalence was the highest among patients aged <5 years (31.4%), followed by those aged 5–14 years (23.53%) and 15–24 years (15.33%). However, the prevalence in these age groups showed a decreasing trend over time. The most used Western medicine treatments were injections and oral medications involving topical corticosteroids, antihistamine agents, and oral steroids, while it was acupuncture therapy in Korean medicine. The frequency of the most frequently prescribed medication, topical corticosteroid, showed a decreasing trend over time. The findings in this study will inform healthcare policy makers and clinicians across different countries on the usage trends of Western medicine and Korean medicine treatment. [ABSTRACT FROM AUTHOR]

Simple Summary: It is thought that allergic diseases could hamper or trigger carcinogenesis by enhancing host immune defenses or persisting inflammation, respectively. The gastrointestinal (GI) tract plays a crucial role in building the immune system via the gut barrier and through communicating with the microbiome. We hypothesized that allergic diseases may be linked with the occurrence of GI tract cancers. Analyzing national health check-up data, we found that, overall, allergic diseases which consist of allergic rhinitis, asthma, and atopic dermatitis reduced the risk of malignancy in the esophagus, stomach, colorectum, and liver. Given that gastric and liver cancers are typical infection-related malignancies, the inverse associations between allergic diseases and the subsequent development of GI cancers in the present study supports the cancer immunosurveillance hypothesis. This result could provide a clue for the novel approach to the prevention and treatment of GI cancers. The aim of this study was to investigate the effect of allergic diseases, including allergic rhinitis, asthma, and atopic dermatitis, on the development of gastrointestinal (GI) cancers. We analyzed 9,892,633 Korean adults who underwent a medical check-up in the year 2009, and they were followed up until the year 2017. Allergic diseases and cancers were defined using the International Classification of Disease Codes. A Cox proportional hazards model was adapted to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs). During a 7.3-year follow-up period, 48,045 patients were diagnosed with cancer. For all-combined allergic diseases, significant inverse associations were observed for cancers of the esophagus, stomach, colorectum, and liver (adjusted hazard ratios (aHRs [95% confidence interval, CI] 0.86 [0.82–0.91], 0.93 [0.91–0.94], 0.95 [0.93–0.96], and 0.90 [0.88–0.92], respectively). The sex-stratified analysis showed that the preventive effect of allergic diseases was persistent in gastric, colorectal, and liver cancers regardless of sex, while the inverse associations with esophageal and pancreatic cancers were observed only in men (aHR [95% CI] 0.84 [0.80–0.89] and 0.96 [0.93–0.99]). Allergic diseases, particularly allergic rhinitis, in adults were significantly associated with a decreased risk of most GI cancers, except for gallbladder and biliary tract cancers. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) is a chronic inflammatory skin condition associated with a significant disease burden in Korea. AD is highly prevalent among Korean children, adolescents, and adults, and can cause physical discomfort, psychological distress, and social isolation for those affected. Despite advances in our understanding of AD, there are still many unmet needs in diagnosing and managing the disease in Korea. One of the challenges in diagnosing AD is the lack of a definitive biomarker for AD in Korea, and there is a need for more effective, safe, and cost-effective treatments for AD. Therefore, finding out the current epidemiology, burden of AD, and how AD is currently being diagnosed in Korea and reviewing management options available in Korea will help resolve the unmet needs of AD patients in Korea. Addressing these and other unmet needs in AD management and diagnosis in Korea may improve outcomes for those affected by this challenging condition. [ABSTRACT FROM AUTHOR]

To overcome interruption of skin barrier in transdermal drug delivery, the microneedle (MN) patch penetrates the barrier by punching with its MNs. Setting a needleless patch (NL patch) as the control intervention, this study assessed the efficacy of a biodegradable hyaluronic acid MN patch (BHMN patch) for atopic dermatitis (AD) patients with dry skin. Similar two AD lesions were selected from the extremities of a participant. For one lesion, a BHMN patch was attached for 6–8 h on where an aroma cream was applied (BHMN patch group). Simultaneously, an NL patch was attached on the other lesion as in the BHMN patch group (NL patch group). For 2 weeks, the interventions were conducted 3 times a week. The local scoring AD (L-SCORAD) index, the visual analog scale for pruritus and skin dryness, skin hydration, the transepidermal water loss (TEWL), and safety were assessed. Fifteen participants finished this trial with no dropouts. Both groups improved the L-SCORAD index after 2 weeks (p < 0.05), but the score of the BHMN patch group decreased more than that of the NL patch group (p < 0.05). The other outcomes, except for the TEWL, also showed statistical significance in intragroup comparisons. Nevertheless, none of the other outcomes showed statistical significance in intergroup comparisons. The TEWL showed no statistical significance even in intragroup comparison. Recoverable minor adverse events were reported in three cases. Considering the result of L-SCORAD index, the BHMN patch may be effective for ameliorating AD. However, a large-scale confirmatory trial is necessary to reassess other outcomes. Trial Registration: This study was registered with the Clinical Research Information Service, Republic of Korea (Submitted date: 04/01/2022, Registered date: 23/02/2022, The first participant enrollment: 01/12/2021, Registration No. KCT0007037). [ABSTRACT FROM AUTHOR]

A nationwide birth cohort study in South Korea investigated the risk of atopic dermatitis (AD) in infants born to women who were infected with SARS-CoV-2 during pregnancy. The study found that offspring exposed to prenatal SARS-CoV-2 had a higher risk of developing AD, particularly if the infection occurred during the first trimester. The first trimester is a critical phase for developing and maintaining the immune system in the offspring. However, the study did not consider other allergic conditions such as allergic asthma, and further research is needed to comprehensively address this issue. [Extracted from the article]

Background: As atopic dermatitis (AD) has been found to be related to various comorbidities as well as substantial patient burden, questions of a possible relationship between AD and nonallergic diseases beyond allergic diseases have also been raised. Objective: The aim of this nationwide matched cohort study was to evaluate whether AD would increase the development of gastroesophageal reflux disease (GERD). Methods: Patients diagnosed with AD were identified from the National Health Insurance Service-National Sample Cohort (NHIS-NSC) 2.0 database in South Korea from 2002 to 2015. Finally, 9,164 adults with AD (≥20 years old) and age, sex, household income, region of residence, disability, and baseline year-matched 9,164 controls were included in the analysis. Hazard ratio (HR) with 95% confidence interval (CI) for the development of GERD was estimated using a Cox proportional hazard regression model. Results: Overall, 12.3% of the patients in the AD group developed GERD, whereas 10.4% of the individuals in the control group developed GERD. The results of the adjusted model revealed that patients with AD had a significantly increased risk of developing GERD (adjusted HR, 1.15; 95% CI, 1.06–1.26) compared with the matched controls. Increased risk of developing GERD was consistent in subgroup analyses by sex or age groups under 60 years old as well as all the sensitivity analyses performed. Conclusions: This study suggested that appropriate management should be considered in adults with AD to prevent GERD, because AD was found to be associated with an increased risk of subsequent GERD. [ABSTRACT FROM AUTHOR]

Atopic dermatitis is a chronically relapsing inflammatory skin condition that has profound impacts on quality of life of patients and their family. The aim of this study is to investigate the psychological stress in parents of children with atopic dermatitis in Korea, using data from the Korean National Health and Nutrition Examination Survey (KNHANES). This cross-sectional study included parents of participants under 19 years of age (970 with atopic dermatitis and 5,733 without atopic dermatitis after excluding those who meet the exclusion criteria) from the 2009 to 2012 KNHANES. The psychological stress state was evaluated with the following four questionnaire items: self-perception of stress, depressed mood, suicidal ideation, and diagnosis of depression by a physician. After adjusting for age, gender, education level, occupation, and marital status, logistic regression analyses indicated that mothers of children with atopic dermatitis had a higher frequency of stress perception (adjusted odds ratio (aOR) 1.46 (95% confidence interval (95% CI) 1.22– 1.74), p<0.01) and suicidal ideation (aOR 1.40 (95% CI 1.1–1.79), p<0.01) than those without atopic dermatitis. In contrast, fathers of children with atopic dermatitis did not show a significant difference in all items compared with those of children without atopic dermatitis. Understanding the psychological stress in parents of children with atopic dermatitis is important for clinicians, since evaluation, management and support for parents, especially mothers, of children with atopic dermatitis are required. [ABSTRACT FROM AUTHOR]

Few studies have reported an association between atopic dermatitis and cognitive impairment in children. Therefore, we evaluated the association between atopic dermatitis (AD) and neurodevelopmental dysfunction in children. We analyzed 2,395,966 children born between 2008 and 2012 in Korea. All data were acquired from the databases of the Korean National Health Insurance System. AD was defined as five or more diagnoses before age 24 months. The outcome was suspected neurodevelopmental dysfunction in the gross motor skill, fine motor skill, cognition, language, sociality, and self-care domains of the Korean Developmental Screening Test for Infants and Children at age 6 years. The positive control outcome was defined as attention deficit hyperactive disorder (ADHD). The associations were assessed using ordinal logistic regression, adjusting for asthma and allergic rhinitis. Among the eligible children, 89,452 and 30,557 were allocated to the control and AD groups, respectively. In the weighted data, the AD group showed a higher risk of suspected neurodevelopmental dysfunction in the total score (weighted adjusted odds ratio [95% CI] 1.10 [1.05–1.16]), gross motor skills (1.14 [1.04–1.25]), and fine motor skills (1.15 [1.06–1.25]) than the control group. The AD with steroids or hospitalization groups showed an increased risk of suspected neurodevelopmental dysfunction. In addition, the AD group showed a significant association with mental retardation, psychological development disorder, and behavioral and emotional disorders as well as ADHD. AD before age 2 years may be associated with an increased risk of neurodevelopmental dysfunction including gross and fine motor skills in the young childhood period. [ABSTRACT FROM AUTHOR]

Background: The development of dermatitis on face and neck, which was not described in phase 3 clinical trials, has been reported in the literature in patients treated with dupilumab. Little is known regarding the causes or defining features of the facial dermatitis. Objectives: We conducted surveys of consecutive patients with AD on dupilumab to describe its clinical features, morphology and aetiology. Methods: A multi‐centre prospective cohort study was conducted from 1 January 2020, to 31 December 31 2020. A total of 162 patients under dupilumab treatment were asked to complete a questionnaire and patients were evaluated by dermatologists. Results: Of all 162 patients, 137 (84.6%) patients reported pre‐existing facial dermatitis prior to dupilumab therapy. One hundred and twenty‐one (88.3%) patients with pre‐existing facial dermatitis reported improvement of their facial dermatitis with dupilumab therapy, nine (6.6%) patients reported no change after the treatment and seven (4.3%) patients of them got worse after the treatment (exacerbation group). Of 25 patients who reported no pre‐existing active facial dermatitis, six (24%) patients reported new‐onset facial erythema after the starting dupilumab therapy (new‐onset group). A large proportion of the patients in both the exacerbation (86%) and new‐onset groups (67%) had a history of facial TCS use. Both groups showed similar clinical manifestations and distribution with few differences. Conclusions: The vast majority of patients treated with dupilumab in academic institutions from Korea and the United States experienced improvement in their facial dermatitis with dupilumab therapy. A small proportion of patients had new onset and exacerbation. Although the mechanisms of this adverse event remain unclear, steroid withdrawal should be considered as a diagnosis of the erythema in some patients. [ABSTRACT FROM AUTHOR]

Aim: We evaluated the efficacy of sublingual immunotherapy for children aged 5–17 years with atopic dermatitis who were allergic to house dust mites. Methods: This open-label, controlled, randomised trial from June 2015 to February 2018 comprised 60 subjects from a specialist allergy centre in South Korea. Half received sublingual immunotherapy for 12 months and the other half formed the control group. The subjects were evaluated using specialist scores and specific immunoglobulin and skin prick tests. Results: Sublingual immunotherapy significantly decreased the mean Scoring Atopic Dermatitis measurements in the sublingual group from baseline (30.2 ± 10.7) to 3 months (20.7 ± 8.5) and the effects persisted at 12 months (21.5 ± 12.4). However, the control group only showed a significant difference between baseline (30.4 ± 11.9) and 12 months (24.3 ± 10.2). The levels of Dermatophagoides farina-specific immunoglobulin G4 significantly increased in the treatment group from baseline (0.6 ± 0.5) to 12 months (1.0 ± 0.7), with no significant changes in the control group. New sensitisations to two or more allergens between baseline and 12 months were significantly lower in the sublingual group (21.4%) than controls (54.2%). Conclusion: Sublingual immunotherapy improved disease severity and prevented new sensitisations in children with atopic dermatitis who were allergic to dust mites. [ABSTRACT FROM AUTHOR]

The phenotypes of atopic dermatitis (AD) are diverse, and ethnic differences have been suggested. To date, few studies have explored large-scale national data on the treatment patterns of AD in Asians. Therefore, we aimed to examine real-world treatment patterns for AD, including the probability of discontinuation of AD treatment and restart after discontinuation. A retrospective observational study was conducted using the nationwide healthcare database in South Korea between January 1, 2016 to July 31, 2020. We identified 944,559 pediatric patients and 1,066,453 adults with AD. Topical corticosteroids and antihistamines were the most commonly prescribed medications in all age groups. The frequency of topical corticosteroid prescription decreased as the age increased. Although immunosuppressive drugs were not widely used in both children and adults, cyclosporine was the most frequently prescribed immunosuppressant, particularly among those aged 12 years or more (1–2%). Pediatric patients were more likely to discontinue treatment than adult patients. Treatment restart for moderate-to-severe AD was earlier than that for overall AD. In conclusion, significant differences were observed in the treatment patterns of AD between pediatric and adult patients. These findings will improve our understanding of the latest treatment patterns for AD, which may contribute to decision-making in clinical practice. [ABSTRACT FROM AUTHOR]

The implementation of precautionary measures, such as wearing a mask and social distancing, may have affected allergic diseases during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to compare the numbers of medical visits for allergic diseases before and during the COVID-19 pandemic. Data were obtained from the Korean National Health Insurance claims database. Monthly numbers of patients for four allergic diseases, i.e., allergic rhinitis (AR), asthma, atopic dermatitis (AD), and allergic conjunctivitis (AC), were evaluated using ICD-10 codes and compared between the 'before COVID-19' period from January 2018 to February 2020, and the 'during COVID-19' period from March 2020 to June 2021, since the first COVID-19 patient was detected on 20 January 2020, in Korea. Subgroup analyses were performed according to age and sex. The mean numbers of medical visits for AR and asthma were significantly greater before COVID-19 than those during COVID-19 (both p < 0.001). The variance in the number of medical visits for asthma decreased during the COVID-19 pandemic. However, the mean number of medical visits for AD increased slightly during COVID-19 and that for AC did not change before and during the COVID-19 pandemic. In subgroup analyses, the results showed a similar pattern to that of the total number of participants, regardless of age and sex. In conclusion, medical visits for AR and asthma significantly decreased during the COVID-19 pandemic, regardless of age and sex. [ABSTRACT FROM AUTHOR]

Background and Aim: Canine atopic dermatitis (CAD) is a hereditary susceptibility to the development of allergic symptoms in response to repeated exposure to generally innocuous substances known as "allergens." Allergens can be plants, animals, mold, mites, or milk. At present, serological enzyme-linked immunoassay (ELISA) kits are used for immunoglobulin E (IgE)-specific allergen detection due to their simplicity and accuracy. This study aimed to detect allergens in dogs with CAD and determine how they differ according to season, breed, age, and sex using a serological test in six provinces in South Korea for 12 months. This will allow practitioners to easily understand the risk factors related to CAD. Materials and Methods: In this study, IgE allergen-specific ELISA kits were used. The allergens were detected in serum samples collected from different regions considering season, sex, breed, and age. Allergens were divided into the following Ten categories: 1. Dairy, yeast, and egg, 2. grains, 3. vegetables, 4. meat, 5. seafood, 6. animals, 7. mold, 8. insects, 9. mites, and 10. trees. Results: The percentage of allergens detected in males (54.8%) was higher than that of females (45.2%); 54.2% of allergens occurred in 3-year-old dogs or older. Moreover, regarding frequency, 65.6% of overall allergens occur during autumn; Chungcheongnam-do and Jeollabuk-do showed 20.7% and 20.9%, respectively. Additionally, among allergens categories, notable allergen occurrence was as follows: 38.3% corn; 28.7% potatoes; 22.7% duck; 24.4%, codfish; 31.2% animal wool; 95.6% Aspergillus fumigatus; 31.9% flea; 41.8% oak; and 25.0% sheep's sorrel grass. Conclusion: This study showcases the frequency of 60 allergens in six provinces detected in dogs with CAD; most likely from food or the environment using serological ELISA kits. Environmental sensitizer results can be considered for humans suffering from allergies to avoid a similar environment. A large-scale study can be performed to evaluate the allergens in the state. However, neither a skin test nor feed analysis was conducted, which is a limitation of this study. [ABSTRACT FROM AUTHOR]

Bamboo salt and egg white-chalcanthite mixture has been prescribed for relieving the inflammation of atopic dermatitis in Hamyang, Gyeongsangnam-do, Korea. This study was conducted to demonstrate the effect of atopic dermatitis on cell and atopic animal models using a combination of bamboo salt with egg white-chalcanthite, which have been used as folk remedies for inflammatory conditions. Based on the in vitro experiment, the 1:20 mixture of egg white-chalcanthite and bamboo salt was shown to inhibit the release of beta-hexosaminidase and histamine in rat basophilic leukemia cell line RBL-2H3 by sensitizing immunoglobulin E and inducing allergic responses by dinitrophenyl as well as the expression of inflammatory cytokines and inflammatory mediators in a dose-dependent manner in lipopolysaccharide-treated mouse macrophage cell line RAW 264.7 cells. Furthermore, egg white-chalcanthite with bamboo salt and its combination at different mixing ratios showed a decrease in inflammatory mediators. Dinitrochlorbenzene was applied to NC/Nga mice for 6 w to induce the atopic in vivo model. After 4 w administration of the test substance, the dermatitis decreased visually and dermal hyperplasia/inflammation, mast cell/eosinophils counts and degree of nerve fiber infiltration were decreased according to histopathological examination. In addition, the secretion rate of interferon gamma in high-dose treated group was lower than that in atopic dermatitis control group. These results show that bamboo salt with egg white-chalcanthite effectively relieves skin inflammation in atopic dermatitis and it might be a promising mineral agent for relieving the symptoms of atopic dermatitis. [ABSTRACT FROM AUTHOR]

Polyopes affinis is a red algal species commonly found on the South coast and near Jeju Island, Korea. This study aimed to determine whether P. affinis extracts can inhibit the pathogenesis of T-helper-2 (Th2)-mediated inflammation in a human keratinocyte cell line of atopic dermatitis (AD). Cells were incubated with 10 ng/mL of interferon gamma (IFN-γ) and 10 ng/mL of tumor necrosis factor-alpha (TNF-α) at various concentrations of PAB (10, 30, and 60 µg/mL) and PAA (100, 500, and 1000 µg/mL) extracts. A gene-ontology (GO)-enrichment analysis revealed that PAB significantly enriched the genes associated with biological processes such as cell adhesion, immune response, inflammation, and chemokine-mediated pathways. PAB suppressed the expression of the secretory proteins and mRNAs that are associated with the thymus and the production of activation-regulated chemokines (TARC/CCL17) and macrophage-derived chemokines (MDC/CCL22). The effect of the extract on mitogen-activated protein kinases (MAPKs) was related to its inhibition of TARC/CCL17 and MDC/CCL22 production by blocking NF-κB and STAT1 activation. These results suggest that seaweed extract may improve AD by regulating pro-inflammatory chemokines. In conclusion, we first confirmed the existence of phloroglucinol, a polyphenol formed from a precursor called phlorotannin, which is present in PAB, and this result proved the possibility of PAB being used as a treatment for AD. [ABSTRACT FROM AUTHOR]

Summary: Background: Particulate matter (PM) is a mixture of solid and liquid particles suspended in air, which originates from industrial plants or vehicle emissions. Although the skin is the primary body area of contact with air pollutants, the associations between PM and chronic inflammatory skin diseases has not been well established. Aim: To investigate associations between PM and atopic dermatitis (AD) and between PM and other chronic inflammatory dermatoses, using data from the Korean Health Insurance Review and Assessment Service. Methods: Monthly disease statistics from the seven largest cities in South Korea (Seoul, Busan, Daegu, Incheon, Gwangju, Daejeon, Ulsan) and from Jeju Island (in total, a population of 23 288 000 for all eight areas) were included. Based on daily air pollution level and weather forecast from 2015 to 2019, multivariate negative binomial regression analysis was conducted to estimate monthly visits of AD with respect to outdoor air pollutants: coarse PM with a diameter of ≤ 10 μm (PM10) and fine PM with a diameter of ≤ 2.5 μm (PM2.5) ozone (O3), nitrogen dioxide (NO2), sulphur dioxide (SO2) and carbon monoxide (CO). Results: Increases in the levels of PM2.5, PM10, SO2 and CO were associated with significant increases in monthly patient visits for AD. Every 10 μg/m3 increase in PM2.5 and PM10 resulted in patient visit increases of 2.71% (95% CI 0.76–4.71; P < 0.01) and 2.01% (95% CI 0.92–3.11, P < 0.001), respectively, while every 1 part per billion (ppb) increase in SO2 and every 100 ppb increase in CO resulted in visit increases of 2.26% (95% CI 1.35–3.17; P < 0.001) and 2.86% (95% CI 1.35–4.40; P < 0.001), respectively. O3 and NO2 were not associated with increased patient visits for AD. Increases in PM2.5 and PM10 concentrations were also significantly associated with increases in patient visits for psoriasis, seborrhoeic dermatitis and rosacea. Conclusion: Our data suggest that PM is associated with AD and other chronic inflammatory skin diseases. [ABSTRACT FROM AUTHOR]

Background: Children with atopic dermatitis (AD) have multiple risk factors for accidental fractures, injuries that can lead to significant morbidity and mortality. However, little is known about the factors that mediate the relationship between AD and fracture in children. Objective: Our purpose was to examine the association of AD with fracture and to identify potential mediating factors. Methods: This retrospective cohort study examined children with and without AD from a longitudinal matched cohort database of 353,040 children registered in the national health insurance service and participated in the national health- screening program of Korea. We defined AD using medical claims and medication prescription records. We investigated accidental fracture events between the index date and the end of follow- up in a propensity score-- matched cohort. Pre- specified subgroup analyses considered fractures in four different regions of the body. The mediating effects of 10 possible clinical factors (including the use of antihistamines and systemic corticosteroids) and social factors (including nutritional status and parental safety awareness) were determined. Results: There were 145,704 participating children, 20% with AD and 49% girls. Fractures occurred in 6,652 of the children with AD (23%, mean age: 64.6 ± 29.2 months) and in 24,698 of the control group (21%, mean age 65.0 ± 28.9 months). Children with AD had an 8% greater risk of fracture events overall (adjusted relative risk [aRR]: 1.08, 95% CI: 1.05-1.10). In subgroup analysis, AD was related to increased rates of skull and facial bone fracture (aRR: 1.09, 95% CI: 1.04-1.14), for trunk including vertebrae (aRR: 1.58, 95% CI: 1.22-2.05), and for distal limbs (aRR: 1.11, 95% CI: 1.07-1.15). However, the relationship with proximal limb fracture was insignificant. Duration of systemic corticosteroid prescription was the largest mediating factor, followed by duration of antihistamine prescription, and infant feeding practices. In particular, the duration of systemic corticosteroid prescription was significantly associated with fracture events (incidence: 20.1% at the 25th percentile and 23.6% at the 75th percentile; difference: 3.4% [95% CI: 2.8-4.0%]). Conclusions: Children with AD were related to increased fracture events. The key factors with mediating effects were systemic use of corticosteroid and antihistamine. Infant feeding practices had weaker mediating effects. [ABSTRACT FROM AUTHOR]

In traditional Chinese medicine (TCM) and traditional Korean medicine (TKM), Gwakhyangjeonggi-san (GJS) is an herbal decoction used to treat gastrointestinal disorders and allergic diseases. However, no randomized controlled trials have reported the efficacy and safety of GJS against atopic dermatitis (AD) or its comorbidities. This clinical trial investigated the clinical efficacy and safety of GJS for treating patients with AD who have gastrointestinal symptoms, using a multi-omics approach that included 16S rRNA sequencing and metabolomics. This study was a randomized, double-blind, placebo-controlled, parallel-group clinical trial. Fifty-two patients with AD (age: 19–60) were randomly assigned to receive either the GJS (N = 27) or placebo (N = 25) granules thrice daily for 8 weeks. The primary outcome was measured as the change in the SCORing of Atopic Dermatitis index from baseline to 8 weeks. The secondary outcomes included the eczema area and severity index, dermatology life quality index, EuroQoL 5 dimensions 5 levels (EQ-5D-5L), immunological factors, gastrointestinal status, and safety evaluation. In addition, 16S rRNA sequencing on gut-microbiomes and non-targeted metabolomics approach using mass spectrometry on sera samples were applied to investigate the GJS therapeutic mechanism. After 8 weeks, AD symptoms were reduced in both the GJS and placebo groups without any serious adverse events, but the reduction was not significantly different between the two groups. However, t he EQ-5D-5L scores and gastrointestinal symptom scores , such as bitter-tasting fluid presenting in the mouth, upper abdomen bloating, and nausea, only improved in the GJS group. To further elucidate the effect of GJS on patients with AD who have gastrointestinal symptoms, 16S rRNA sequencing and metabolomics were executed. The GJS group had lower gut microbiome diversity including observed OUT, Ace, Chao1 and Shannon index than the placebo group at enrollment time, while the difference in gut microbiome diversity between GJS and placebo group was eliminated by 8 weeks of treatment. Consistently, the metabolomics results showed that the gut microbiome-derived uremic toxins, including indoxyl sulfate and phenylacetylglutamine, significantly increased in the placebo group, while these in GJS group were maintained without any significant change. These results showed that the GJS had no significant effect on AD compared to the placebo but exerted a beneficial effect on improving the quality of life and gastrointestinal symptoms in patients with AD, and it acted by modulating gut microbiome diversity and gut microbiome-derived uremic toxins. Our findings support the use of GJS for AD comorbidities and also provide evidence that multi-omics approaches can be useful for understanding herbal decoctions in TCM and TKM comprehensively. [Display omitted] • GJS benefits the quality of life and gastrointestinal symptoms in AD patients. • GJS changed the microbiome diversity of AD patients with gastrointestinal symptoms. • GJS regulated the gut microbiome-derived uremic toxins. [ABSTRACT FROM AUTHOR]

Previously, we have reported short term effectiveness and safety of dupilumab in Korea. In this study, we are trying to report the long-term effectiveness and safety of dupilumab in Korea. Ninety-nine patients with moderate to severe AD were analyzed. They were evaluated using Eczema Area and Severity Index (EASI), Numerical Rating Scale (NRS), Patient Oriented Eczema Measure (POEM), and Dermatology Quality of Life Index (DLQI) at baseline, week 16, 32 and 52. Efficacy outcomes showed higher improvement at 52 weeks compared with 16 weeks; high percentual reductions in EASI (88.1%), peak pruritus NRS (65.6%), POEM (67.2%), and DLQI (69.0%) compared to baseline. Proportion of patients achieving EASI 75 and 90 were 90.2% and 53.7%. POEM and DLQI had high correlation with clinical measured outcomes. In the analysis for the factors affecting achievement of EASI 90, female gender (OR 2.5), eosinophilia (OR 0.2) and elevated LDH (OR 0.07) were significantly associated. Most frequent adverse events included facial erythema (19.2%) and conjunctivitis (17.2%), which were mild/moderate and resolved during treatment. In conclusion, dupilumab treatment for 52 weeks in Korean patients with moderate-to-severe AD confirmed long term effectiveness and safety. [ABSTRACT FROM AUTHOR]

Background: It is well known that atopic dermatitis (AD) is associated with other allergic diseases. Recentely, links to diseases other than allergic disease have also been actively studied. Among them, the results of studies regarding AD comorbidities, especially cardiovascular disease (CVD), have varied from country to country. Objective: To analyze whether the risk of CVD is different between AD patients and healthy controls using Korean National Health Insurance Data. Methods: We obtained data from 2005 to 2016 from the Korean National Health Insurance Research Database. Patients with one AD code and two AD-related tests codes were selected as AD patients, and age-and sex-matched controls to the AD patients were selected from among those without AD (1:5). Each group was investigated for accompanying metabolic syndrome (which contains hypertension, type 2 diabetes, and hyperlipidemia) and CVD (angina, myocardial infarction, peripheral vascular disease, and stroke) using ICD 10 codes. Results: The incidence of metabolic diseases and CVD were significantly different between the AD and control groups. Using multivariable Cox regression, differences were adjusted for sex, age, and other CVD and metabolic diseases. As a result, not only metabolic disease, but also the CVD risk of AD patients was significantly higher than that of the control group. Patients with AD had as significantly higher risk of hyperlipidemia (hazard ratio [HR] = 33.02, p < 0.001), hypertension (HR = 4.86, p < 0.001), and type 2 diabetes (HR = 2.96, p < 0.001). AD patients also had a higher risk of stroke (HR = 10.61, p < 0.001), myocardial infarction (HR = 9.43, p < 0.001), angina (HR = 5.99, p < 0.001), and peripheral vascular disease (HR = 2.46, p < 0.001). Besides hyperlipidemia, there was no difference in risk according to AD severity. Conclusion: Patients with AD have a greater risk of CVD than those without AD. [ABSTRACT FROM AUTHOR]

Researchers have been interested in probing how the environmental factors associated with allergic diseases affect the use of medical services. Considering this demand, we have constructed a database, named the Allergic Disease Database, based on the National Health Insurance Database (NHID). The NHID contains information on demographic and medical service utilization for approximately 99% of the Korean population. This study targeted 3 major allergic diseases, including allergic rhinitis, atopic dermatitis, and asthma. For the target diseases, our database provides daily medical service information, including the number of daily visits from 2013 and 2017, categorized by patients' characteristics such as address, sex, age, and duration of residence. We provide additional information, including yearly population, a number of patients, and averaged geocoding coordinates by eup, myeon, and dong district code (the smallest-scale administrative units in Korea). This information enables researchers to analyze how daily changes in the environmental factors of allergic diseases (e.g., particulate matter, sulfur dioxide, and ozone) in certain regions would influence patients' behavioral patterns of medical service utilization. Moreover, researchers can analyze long-term trends in allergic diseases and the health effects caused by environmental factors such as daily climate and pollution data. The advantages of this database are easy access to data, additional levels of geographic detail, time-efficient data-refining and processing, and a de-identification process that minimizes the exposure of identifiable personal information. All datasets included in the Allergic Disease Database can be downloaded by accessing the National Health Insurance Service data sharing webpage (https://nhiss.nhis.or.kr). [ABSTRACT FROM AUTHOR]

There is an error in the Funding statement. The correct Funding statement is as follows: This work was supported by the National Research Foundation of Korea funded by the Korean government (NRF-2020R1A4A1018598, NRF-2021R1A2C2006818). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors received no specific funding for this work.By In-Seon Lee; Mijung Yeom; Kyuseok Kim; Dae-Hyun Hahm; SeHyun Kang and Hi-Joon ParkReported by Author; Author; Author; Author; Author; Author [Extracted from the article]

• Risk of type 2 diabetes mellitus (T2D) was increased in adults with atopic dermatitis (AD). • T2D can be related to AD's chronic systemic low-grade inflammation. • A shared genetic background and an unhealthy lifestyle may also contribute to T2D. • The findings emphasize the importance of diabetes screening in adults with AD. This study aimed to investigate the subsequent risk of type 2 diabetes mellitus (T2D) in adults newly diagnosed with atopic dermatitis (AD). This propensity score-matching cohort study used data from the National Health Insurance Service–National Sample Cohort (NHIS–NSC) 2.0 database in South Korea from 2002 to 2015. The adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using a Cox proportional hazards model, for the new onset of T2D (ICD-10 code, E11) in AD patients compared to the matched controls. Subgroup and sensitivity analyses were also conducted. Each of the 36,692 individuals in the AD group and matched control group was included in the analysis. The risk of T2D in the AD group was significantly higher than that of the matched controls in the adjusted model (adjusted HR 1.44; 95% CI 1.27–1.63, P <.001). The results of subgroup analysis by sex, age, and body mass index were consistent with the results of the primary analysis. Sensitivity analyses using different T2D and/or AD definitions also showed consistent results. The significant risk of subsequent T2D in adult AD patients suggested the necessity for efforts to prevent T2D in AD patients. [ABSTRACT FROM AUTHOR]

Recently, it was suggested that CD4+CD25+FoxP3+ Tregs (Regulatory T-cells) exist in canine skin, although their numbers were not significantly different between healthy and atopic dogs. In this study, we investigated whether Treg frequencies correlate with the clinical features of canine atopic dermatitis (cAD). The goal of this study was to compare and analyse the numbers of the circulating Tregs in atopic and healthy dogs. In the peripheral blood mononuclear cells (PBMC) of healthy dogs, Tregs defined as CD4+CD25+FoxP3+ Tregs in the peripheral blood ranged from 0.3% to 1.5%. By contrast, in atopic dogs, the same population ranged from 0.7% to 8.8%. The percentage of CD4+CD25+FoxP3+ Tregs in gated CD4+ T-cells was significantly higher in the peripheral blood of dogs with atopic dermatitis (n = 9) than in the healthy controls (n = 8). The difference in the Treg levels (CD4+CD25+FoxP3+) (P = 0.012) between the atopic and the healthy groups was statistically significant. The circulating T-cells (phenotype CD4+CD25+FoxP3+ and CD4+FoxP3+) were increased significantly in the atopic dogs. The proportion of CD4+CD25+FoxP3+ Tregs of the atopic dogs decreased with advancing age. These findings suggest that changes in the Tregs may mediate the pathogenesis of CAD. [ABSTRACT FROM AUTHOR]

Purpose: Specific food consumption, besides food allergy, may aggravate atopic dermatitis (AD). However, previous reports on the association between AD and food intake in adolescents are scarce. The aim of this study was to determine the relationship between AD and specific food consumption frequency in adolescents. Methods: A cross-sectional analysis using data from the Korea Youth Risk Behavior Web-based Survey 2017 was performed. The frequency of food consumption in the recent-diagnosed AD group (AD diagnosed within 12 months) compared to those in the previous-diagnosed AD (AD diagnosed more than 12 months ago) or control group were investigated. Results: A total of 53,373 participants were eligible for this study. The weighted prevalence of the recent-diagnosed AD and the previous-diagnosed AD was 7.39% and 18.00%, respectively. When compared with subjects with the previous-diagnosed AD, those with the recent-diagnosed AD were significantly more likely to frequently consume fast foods (odds ratio OR 1.405; 95% CI 1.150–1.717), energy drinks (OR 1.457; 95% CI 1.175–1.807), or convenience food (OR 1.304; 95% CI 1.138–1.495). Patients of the recent-diagnosed AD were significantly more likely to frequently consume fast foods (OR 1.374; 95% CI 1.155–1.634) than the control group. The differences in the frequency of specific food consumption among groups were more pronounced in high school students than in middle school students. Conclusions: Frequent intake of fast foods, energy drinks, and convenience food was related to the recent-diagnosed AD in adolescents. Prospective cohort and interventional studies are needed to identify causal relationships. [ABSTRACT FROM AUTHOR]

Recently, it was suggested that CD4+CD25+FoxP3+ Tregs (Regulatory T-cells) exist in canine skin, although their numbers were not significantly different between healthy and atopic dogs. In this study, we investigated whether Treg frequencies correlate with the clinical features of canine atopic dermatitis (cAD). The goal of this study was to compare and analyse the numbers of the circulating Tregs in atopic and healthy dogs. In the peripheral blood mononuclear cells (PBMC) of healthy dogs, Tregs defined as CD4+CD25+FoxP3+ Tregs in the peripheral blood ranged from 0.3% to 1.5%. By contrast, in atopic dogs, the same population ranged from 0.7% to 8.8%. The percentage of CD4+CD25+FoxP3+ Tregs in gated CD4+ T-cells was significantly higher in the peripheral blood of dogs with atopic dermatitis (n = 9) than in the healthy controls (n = 8). The difference in the Treg levels (CD4+CD25+FoxP3+) (P = 0.012) between the atopic and the healthy groups was statistically significant. The circulating T-cells (phenotype CD4+CD25+FoxP3+ and CD4+FoxP3+) were increased significantly in the atopic dogs. The proportion of CD4+CD25+FoxP3+ Tregs of the atopic dogs decreased with advancing age. These findings suggest that changes in the Tregs may mediate the pathogenesis of CAD. [ABSTRACT FROM AUTHOR]

Background: Major questions remain regarding the agestratified trends of allergic diseases and asthma in Korea. Purpose: To identify the estimated recent prevalence and 10- year trends in asthma, allergic rhinitis, and atopic dermatitis among the Korean population from 2008 to 2017. Methods: This nationwide cross-sectional survey (Korean National Health and Nutrition Examination Survey) over 10 years (2008-2017) examined representative samples of the Korean population (n=85,006) including 2,131 infants, 4,352 preschool children, 12,919 school-age children, 44,200 adults, and 21,404 elderly adults. Results: In the 2016 to 2017 population, the estimated prevalence of asthma was 0.9% in infants, 2.3% in preschool children, 4.1% in school-age children, 2.3% in adults, and 4.1% in the elderly. The estimated prevalence of allergic rhinitis was 9.0%, 20.2%, 27.6%, 17.1%, and 6.9%, respectively. The estimated prevalence of atopic dermatitis was 5.9%, 11.3%, 14.6%, 3.9%, and 1.6%, respectively. Ten-year trends revealed a significant decrease in asthma prevalence in infants, preschool children, and the elderly. and in atopic dermatitis prevalence in infants and preschool children (P<0.05 for all trends). Furthermore, 10-year trends demonstrated a significant increase in allergic rhinitis prevalence in school-age children, adults, and the elderly, and in atopic dermatitis prevalence in school-age children and the elderly (P<0.05 for all trends). Conclusion: These results improve our understanding of the age-stratified epidemiology of allergic diseases in Korea and suggest the need for the development of tailored and precise strategies to prevent allergic diseases in different age groups. [ABSTRACT FROM AUTHOR]

Purpose. To determine the incidence of keratoconus and to determine its possible association with common systemic diseases using a nationwide cohort. Methods. This retrospective nationwide cohort study included 1,025,340 subjects from the Korean National Health Insurance Service-National Sample Cohort database from 2004 to 2013. Estimates for incidence rates of keratoconus were identified. After 1 : 5 matching using propensity scores, associations between keratoconus and certain systemic comorbidities were determined using multivariate logistic regression analysis. Results. The incidence during the same period was 15.1 cases per 100,000 person-years. Adjusted logistic regression analysis after propensity score matching revealed significant associations between keratoconus and allergic rhinitis (odds ratio (OR): 1.86; 95% confidence interval (CI): 1.63–2.13; p < 0.001), asthma (OR: 1.20; 95% CI: 1.06–1.36; p < 0.001), atopic dermatitis (OR: 1.33; 95% CI: 1.13–1.56; p < 0.001), and diabetes mellitus (DM) (OR: 1.35; 95% CI: 1.15–1.58; p < 0.001). Conclusion. Estimates of the incidence of keratoconus may help in the planning of eye-care policies, and the results of this study determined the associations between allergic diseases and keratoconus. Conflicting results regarding the association between keratoconus and DM should be further evaluated. [ABSTRACT FROM AUTHOR]

Background: Recent data suggest depression has been linked to chronic skin diseases, including atopic dermatitis (AD), urticaria, and psoriasis. This study compared mental illnesses in patients with AD with those of patients with nonatopic eczema, urticaria, and psoriasis in Korea. Methods: A cross-sectional study design was used, analyzing data from the 2015 Korean National Health Insurance Research Database, a survey of 42,641 AD and 139,486 non-AD (nonatopic eczema, urticaria, and psoriasis) patients (103,938 males, 78,189 females) classified by age: infant, aged 0–3 years; early childhood, aged 4–8 years; late childhood, aged 9–12 years; adolescent, aged 13–18 years; adult, aged 19–64 years; elderly, aged above 65 years. Multiple logistic regression analysis was performed, and the odds ratio (OR) of various mental illnesses – attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), conduct disorder, depression, anxiety, suicidal ideation, schizophrenia, and sleep disorder – were calculated for patients with and without AD. Results: The incidence of depression was not significantly different between AD and non-AD patients. Severe AD showed a high OR of depression (moderate AD OR=1.75; severe AD OR=3.15, P<0.0001). Patients with AD had significantly higher incidence of ADHD (OR=1.48; 95% CI=1.27–1.72), ASD (OR=1.54; 95% CI=1.19–1.99), and conduct disorder (OR=2.88; 95% CI=1.52–5.45). Conclusion: Patients with AD were not found to have higher incidence of depression than non-AD patients. However, severe AD patients were determined to have a significantly higher incidence of depression. Therefore, the severity of dermatitis is thought to contribute to depression. Mental illnesses found to be significantly higher in AD patients were ADHD, ASD, and conduct disorder. [ABSTRACT FROM AUTHOR]

Background: Asthma and allergic diseases account for school absenteeism and may limit academic and social opportunities for a substantial number of students, because they are common chronic disorders affecting school-aged children. We evaluated the prevalence of asthma and allergic diseases in Korean children, as well as associated school absenteeism. Methods: We administered a questionnaire-based survey to 148 asthma-friendly schools from 14 counties or cities in Gyeonggi province in South Korea. The questionnaire was modified from the ISAAC questionnaire, which consists of 13 questions regarding prevalence of asthma, allergic rhinitis, and atopic dermatitis, and the impact of these conditions on school attendance. Results: A total of 41,062 subjects (aged 7–12 years) were enrolled in this study. The overall lifetime prevalence of asthma, allergic rhinitis, and atopic dermatitis was 5.3%, 38.4%, and 25.0%, respectively. Among subjects who had ever been diagnosed with asthma, 9.1% missed school due to asthmatic complaints. Many subjects with allergic rhinitis (3.2%) or atopic dermatitis (1.8%) also responded that they had missed school because of their diseases. Subjects with current symptoms or having undergone a recent treatment for allergic rhinitis or atopic dermatitis had a significantly increased risk of missing school due to asthma. Conclusion: Asthma and allergic diseases present a substantial health and socioeconomic burden, as demonstrated by the prevalence and related school absenteeism among school-aged children in Korea. Coexisting symptomatic allergic rhinitis and atopic dermatitis are associated with increased risk of school absenteeism due to asthma. [ABSTRACT FROM AUTHOR]

Introduction: Seasonal variations of allergic diseases have been of great interest in clinical practice, but large‐scale epidemiological data in the real world is lacking. Methods: We conducted a nationwide, population‐based, cross‐sectional study using the Korean National Health Insurance claims database to examine the seasonalities of allergic rhinitis (AR), asthma, allergic conjunctivitis (AC), and atopic dermatitis (AD). In addition, we investigated the correlations between the monthly patient numbers of each disease and climate factors such as daytime length, temperature, daily temperature range, humidity, solar radiation, rainfall, UVA dose, UVB dose, and PM10. Results: The highest seasonal variation was identified in AC, followed by AR, asthma, and AD. AR was most prevalent in September and least prevalent in July and was positively correlated with a daily temperature range. Asthma had peaked in the winter and spring and was negatively correlated with both temperature and humidity. AC had dual peaks in May and September and the valley in winter. AD was prevalent between May and August with the lowest visits in winter and positively correlated with temperature. Conclusions: We demonstrated a clear seasonality of four allergic diseases. Korea is located in a temperate region with four distinct seasons, with 50 million people all having a single health insurance system. Therefore, our data reflects all hospital visits in Korea with the least chance for selection bias. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To identify the variables that affect family management of childhood atopic dermatitis and establish a prediction model based on Bandura's self‐efficacy theory. Background: Atopic dermatitis is a chronic recurrent skin disease and common health problem in childhood. It is necessary to use an approach that includes parental factors when considering the effective management of childhood atopic dermatitis. Design: A cross‐sectional study design. Methods: A convenience sample, comprising 168 Korean mothers caring for a child with atopic dermatitis under the age of 13, was recruited from the paediatric outpatient departments of two general hospitals in Seoul, South Korea. Data were collected using structured self‐reported questionnaires including severity, antecedents, effort, self‐efficacy and family management of childhood atopic dermatitis from 1 November 2015–28 February 2016. Descriptive statistics about the participants and variables were examined and data were analysed using structural equation modelling. Results: The hypothetical model had an adequate fit to the data, indicating that severity, antecedents, effort and self‐efficacy influenced family management of childhood atopic dermatitis. Conclusion: These results suggest that strategies to support children with atopic dermatitis and their family should consider the influence of such variables. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) is a chronic inflammatory skin disorder. Patients with AD often experience psychological distress and poor health-related quality of life (HRQoL). The aim of this study was to investigate the association of several psychological health statuses and poor HRQoL in an adult population with AD in South Korea. A total of 37,578 adults who participated in the Korean National Health and Nutrition Examination Survey, a nationwide, population-based, cross-sectional health survey between 2008 and 2013 were included. HRQoL was assessed by EuroQoL (EQ) 5-dimension questionnaire and EQ-visual analogue scale scores. Multiple logistic regression analysis was performed to identify the association of stress, sleep duration, depressive mood, depression, suicidal ideation, and HRQoL with AD relative to matched controls. After adjusting in patients with AD confounding factors, stress, depressive mood, depression, suicidal ideation and poor HRQoL were significantly associated with AD. Dermatologists should be concerned with improving HRQoL and managing the psychological health status of adult patients with AD. [ABSTRACT FROM AUTHOR]

Introduction Increased exposure to particulate matter (PM) appears to increase the development of atopic diseases and allergic sensitization. This study evaluated the association between daily levels of PM with diameters less than 10 µm (PM10) and PM2.5 and symptoms of atopic dermatitis (AD) in children living in an industrial urban area. Methods Indoor PM10 and PM2.5 concentrations were measured with an optical particle counter in two preschools near large industrial complexes in Ulsan, South Korea during two 6-month periods (May–October of 2012 and 2013). Twenty-one children with AD from these preschools were enrolled and observed daily for AD symptoms during the same periods. Indoor and outdoor PM concentrations were used to estimate PM exposure based on time activity patterns. Results Analysis of PM10 and PM2.5 concentrations showed that indoor and outdoor PM10 levels varied similarly throughout each 6-month period. In addition, indoor concentration of PM2.5 had high correlation with ambient outdoor concentration of PM10. Correlation analysis also indicated a significant positive correlation between the exacerbation of AD symptoms and daily mean exposure to PM10 and PM2.5. Based on a generalized linear mixed model (GLMM), PM exposure was significantly associated with the exacerbation of AD symptoms, with a maximum adjusted odds ratio (aOR) of 1.399 for a 10 µg/m 3 increase of PM2.5 (95% CI: 1.216–1.610). Discussion Our findings suggest that short-term exposure to PM can exacerbate AD in young children living in an industrial urban area. PM2.5 had a stronger effect than PM10 on exacerbation of AD symptoms. [ABSTRACT FROM AUTHOR]

Background and Objectives: Many studies have reported that fermented foods have favorable effects in preventing and managing atopic dermatitis (AD). Although kimchi, a major fermented food, is an important part of the traditional diet in Korea, only a few studies have investigated the relationship between AD and kimchi. This study aimed to examine the association between the risk of AD and kimchi intake among Korean adults aged 19 to 49 years.Methods and Study Design: We conducted a population-based, cross-sectional study among a total of 7,222 adults who participated in the 2010-2012 Korea National Health and Nutrition Examination Surveys. We defined AD based on responses to a health interview and assessed kimchi intake using a 24-hour recall method administered by well-trained interviewers.Results: In the multivariable logistic regression analysis, we observed a significantly decreased odds ratio (OR) of having AD according to kimchi consumption after adjustment for confounding factors. In particular, subjects in the third quartile of kimchi consumption (85.0-158 g) had a 32% lower presence of AD than those in the first quartile of kimchi consumption (0-36.0 g) (Odds ratio: 0.68, 95% confidence interval: 0.50-0.92).Conclusions: We found that consuming 85.0-158 g/day of kimchi was significantly associated with a lower presence of AD. Considering that one serving size of kimchi is 40 g, this corresponds to about 2-4 servings per day. This finding suggests that adequate amount of kimchi intake might have a protective effect against AD. [ABSTRACT FROM AUTHOR]

Background. Atopic dermatitis (AD) is a common chronic inflammatory skin disease, but only few studies involved samples of children and adolescents that are representative of the entire Korean population. This study aimed to estimate the prevalence and risk factors of AD among children and adolescents in Korea by using nationally representative data. Methods. We used data from the fifth Korean National Health and Nutrition Examination Survey in 2010 and retrospectively evaluated 2,116 children and adolescents. Logistic regression analysis was performed to determine the relationship between AD and other variables, including IgE levels. Results. The prevalence rate of AD in children and adolescents was 15.0%. In the multivariate analysis of ages from 1 to 18 years, age (adjusted odds ratio [aOR], 0.96; p<0.01) was related to AD. From age of 12 to 18 years, smoking (aOR, 8.99; p<0.01) and elevated total IgE serum level (aOR, 5.31; p<0.01) were related to AD. Conclusion. Age, smoking, and elevated total IgE level were related to AD in the children and adolescents. Thus, an antismoking policy and public education are necessary for reducing the prevalence of allergic diseases. In addition, measurement of total IgE level and age may be helpful in the diagnosis of AD. [ABSTRACT FROM AUTHOR]

Aim To examine the prevalence of adult atopic dermatitis according to occupational status. Background While atopic dermatitis is more prevalent among children, some adults also suffer from it. The disease causes considerable difficulty in these adults' social lives at school or work, suggesting that they require high-quality health care. Given the chronic nature and environmental determinants of atopic dermatitis, its associations with occupational characteristics must be clarified. Design An exploratory cross-sectional analysis using secondary data. Method Participants were 662 people diagnosed with atopic dermatitis, all 19 years old or older; raw data were taken from the Korea National Health and Nutrition Examination Survey V (2010-2012) and VI (2013-2014). Results Manual workers (adjusted odds ratio 2.50, 95% confidence interval, 1.30-4.83), paid workers (1.70, 1.15-2.51), regular workers (1.83, 1.18-2.85), and full-time workers (1.88, 1.23-2.89) all showed increased odds of currently suffering from atopic dermatitis. Conclusion Prevalence rates of atopic dermatitis differed by occupational characteristics, which suggests the need for interventions seeking to prevent symptom recurrence that are tailored to occupational characteristics. We expect this study to provide helpful baseline data for better policy-making. [ABSTRACT FROM AUTHOR]

Background: Atopic dermatitis (AD) is a common pruritic inflammatory skin disease with increasing prevalence. It can manifest with many different clinical phenotypes; however, in its chronic stage, hyperpigmentation, excoriation, lichenification, and dryness are the main symptoms. Jaungo comprises two herbs, Lithospermi radix and Angelica gigantis radix, and three carrier oils, and is an approved herbal ointment for xerosis cutis in Korea. In past studies, we demonstrated that Jaungo had anti-inflammatory and antiallergic activity in in vitro and in vivo AD models; however, there are few relevant randomized controlled clinical trials on Jaungo in AD.Methods/design: A randomized, double-blind, placebo-controlled, single-center, phase IIa clinical trial was designed to investigate the safety, preliminary efficacy, and dose response of Jaungo in AD. The study protocol was approved by the Institutional Review Boards of the Kyung Hee University Korean Medicine Hospital (No. KOMCIRB-160617-HR-027) and the Korea Food and Drug Administration (No. 30907). The study aims to enroll 34 AD patients to be randomly distributed among three parallel groups: treatment 1, treatment 2, and the placebo group. Treatment group 1 applies Jaungo twice a day, while treatment group 2 applies Jaungo and the placebo ointment once a day, separately, and the placebo group applies the placebo ointment twice a day, for a total of 3 weeks each. Participants will be evaluated for eczema before and after the application of the ointments based on several parameters including the Eczema Area and Severity Index, the SCORing of Atopic Dermatitis Index, the Dermatology Life Quality Index, transepidermal water loss, total IgE level, eosinophil count, and IL-17, IL-22, and IFN-γ levels.Discussion: The trial is currently ongoing and the enrollment of subjects has been initiated. There is an urgent need to develop a drug for the treatment of dry, hyperpigmented, scaly, and thickened skin in chronic-stage AD. This study will determine the efficacy and safety of Jaungo in AD, providing evidence for specific AD symptoms treated by Jaungo.Trial Registration: Clinical Trials.gov, identifier: NCT02900131 . Registered on 2 September 2016. Korea Clinical Research Information Service, identifier: KCT0002060 . Registered on 22 July 2016. [ABSTRACT FROM AUTHOR]

Background: Despite increasing evidence on the relationship between exposure to phthalates and bisphenol A with allergies and asthma, reports on atopic dermatitis (AD) with these chemicals are few. We assessed the association between AD symptoms and the exposure to phthalates and bisphenol A and in children.Methods: We surveyed 18 boys with AD (age 3-7 years) in a day care center in Seoul between May 2009 and April 2010. AD symptoms were recorded by using a daily symptom diary. We collected 460 series of pooled urine twice a day, in the morning and afternoon, over 230 working days and measured the concentrations of mono-2-ethyl-5-oxohexyl phthalate (5-oxo-MEHP), mono-2-ethyl-5-hydroxyhexyl phthalate (5-OH-MEHP), mono-isobutyl phthalate (MnBP) and bisphenol A glucuronide (BPAG) in the pooled urine. Logistic regression was used for statistical analysis.Results: Most phthalate metabolite levels were higher in the morning than in the afternoon (p < 0.0001). There was seasonal variation in the levels of phthalates and bisphenol A metabolites. Levels of 5-OH-MEHP, MnBP, and BPAG were highest in summer (p < 0.0001). Manifestation of AD symptoms was associated with an increase in urinary levels of MnBP (adjusted odds ratio, aOR = 2.85, 95% CI: 1.12-7.26 per 1 μg/L of MnBP) and BPAG (aOR = 1.79, 95% CI: 0.91-3.52 per 1 μg/L BPAG) on the same day. The levels of MnBP and BPAG in the previous day increased AD symptoms (aOR = 2.74, 95% CI: 1.21-6.20, for 1 μg/L of MnBP and aOR = 2.01, 95% CI: 1.08-3.74 for 1 μg/L BPAG).Conclusion: Our results suggest that exposure to phthalates and bisphenol A is associated with aggravation of AD symptoms in children. [ABSTRACT FROM AUTHOR]

Background and Objectives: Atopic dermatitis is one of the most common pediatric chronic inflammatory skin diseases, and certain food allergens and nutrients are closely related to the development and severity of atopic dermatitis. While avoidance of the causative foods is considered the mainstay of treatment, unverified excessive restriction might induce unnecessary limitations in the food intake, consequently leading to nutritional deficiencies and poor growth. This study aimed to identify the characteristics and nutrient intake status in children with atopic dermatitis and to investigate the effects of individualized nutrition intervention.Methods and Study Design: We retrospectively reviewed electronic medical records of 77 pediatric patients with atopic dermatitis who received 4 months of individualized nutrition intervention combined with an elimination diet. The patient characteristics, nutrient intake status, and clinical status were examined before and after the intervention.Results: Before the intervention, 5 children had a weight for height z-score below -2.0, and 48.1% had experienced food restriction; these children showed a significantly higher SCORing of Atopic Dermatitis index than those without experiences, with the number of restricted foods before the intervention positively correlating with the disease severity. The intakes of n-6 and n-3 fatty acids, calcium, folate, and vitamin D were lower than the recommended nutrient intakes for Koreans. After the intervention, the weight for height z-score of 35 children was significantly increased and their SCORing of Atopic Dermatitis index was significantly reduced (p<0.05).Conclusions: Individualized nutrition intervention appears useful for alleviating the severity of atopic dermatitis and improving the growth status by improving the nutrient intake. [ABSTRACT FROM AUTHOR]

Atopic dermatitis is a common skin disease in adolescents, which may have a negative effect on the mental and emotional health. We investigated the relationship between atopic dermatitis and suicidal behaviors in Korean adolescents. Participants included 74,186 adolescents (38,221 boys and 35,965 girls) in middle and high school who completed the Eighth Korea Youth Risk Behavior Web-Based Survey. There were significant associations between atopic dermatitis and suicidal behaviors for girls. The overestimation of weight perception might have an additive impact on suicidal risk among girls. However, there were no significant associations between atopic dermatitis and suicidal behaviors in boys. [ABSTRACT FROM AUTHOR]

Background and Objectives: The incidence of atopic dermatitis (AD) is continuously increasing in industrialized countries, possibly due to dietary and lifestyle changes. However, the association between processed food intake and AD has not been studied in a large adult population.Methods and Study Design: We investigated the association between dietary habits and AD in 17,497 adults in the 2009-2011 Korean National Health and Nutrition Examination Survey (KNHANES).Results: We identified 4 dietary patterns using principal components analysis of a 63-item food frequency questionnaire: the "traditional dietary pattern", rich in rice and kimchi; the "processed food pattern", with more meat, instant noodles, soda, and processed foods; the "healthy dietary pattern", high in grains, vegetables, fruits, and seaweeds; and the "drinking dietary pattern", mainly drinking coffee and alcohol. Adjusted odds ratios (ORs) for AD were calculated according to dietary patterns after adjusting for potential confounders with incorporation of sample weights for the complex sample design. The "meat and processed food" pattern was associated with a significant 1.57 fold higher OR for atopic dermatitis than the low consumption group. Further analysis revealed that the increased atopic dermatitis was most closely associated with instant noodles. In contrast, the groups with high intake of rice and kimchi exhibited lower ORs, 0.38 and 0.43 folds, compared to the low intake group.Conclusion: Consuming instant noodles, meat and processed foods was associated with increased prevalence of atopic dermatitis, whereas consuming rice and kimchi, and coffee was associated with decreased prevalence of atopic dermatitis. [ABSTRACT FROM AUTHOR]

The prevalence of atopic dermatitis (AD) and obesity have been increasing considerably in Korean school-children. AD is a chronic pruritic recurrent inflammatory skin disorder. Leptin is secreted by adipocytes which has been suggested to be immunologically active; however, their role in AD has not yet been well understood. A total of 227 subjects out of 2,109 elementary school children were defined as having AD based on the ISAAC questionnaire survey. Ninety subjects with AD, aged between 6 and 12 years, completed scoring of severity of AD (SCORAD), skin prick testing, blood tests for total IgE, eosinophil counts, eosinophil cationic protein (ECP) and lipid profiles. Serum leptin levels were also measured. A subject with atopic AD was defined as an AD patient showing at least 1 positive reaction to allergens in skin prick testing. There were no significant differences in age, body mass index, percentage of breast milk feeding, mode of delivery, prevalence of atopy, and lipid profiles between atopic AD and non-atopic AD subjects. The serum leptin levels (log mean±SD) were significantly higher in non-atopic AD group than in the atopic AD group (0.86±0.57 ng/mL vs 0.53±0.72 ng/mL, p=0.045). Subjects with mild-to-moderate AD showed significantly higher serum leptin levels than those with severe AD (0.77±0.67 ng/mL vs 0.33±0.69 ng/mL, p=0.028). There was a marginal inverse correlation between the SCORAD index and the serum leptin concentration in total AD subjects (r=-0.216, p=0.053). The serum leptin levels were significantly higher in non-atopic AD subjects or mild-to-moderate AD subjects. Leptin did not seem to be associated with IgE-mediated inflammation in AD. Obesity-associated high leptin differed between non-atopic AD and atopic AD subjects. [ABSTRACT FROM AUTHOR]