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Background: Atopic dermatitis (AD) is rising globally, with genetics and environmental factors both playing crucial roles. Dietary habits during pregnancy are linked to children's allergic disease risk. However, limited studies have explored the association between maternal vegetarian diets during pregnancy and child AD. Therefore, this study aimed to examine the relationship between maternal vegetarian diets during pregnancy and the occurrence of AD in children. Methods: In this study, the Taiwan Birth Cohort Study (TBCS) database was used, comprising a representative national birth cohort of infants born in Taiwan in 2005. Of 24,200 mother–child pairs in the database, 20,172 completed face‐to‐face interviews at 6 and 18 months. Employing a 1:10 matching strategy based on maternal age, education level, and child sex, 408 mothers who followed a vegetarian diet during pregnancy were matched with 4080 nonvegetarian mothers. This resulted in a final dataset of 4488 subjects. Logistic regression was used to explore the association between maternal vegetarian diets during pregnancy and the occurrence of AD in children. Results: Among the TBCS participants, there were 292 (1.8%) mothers who adhered to lacto‐ovo vegetarianism and 116 (0.7%) mothers who adhered to veganism, totaling 408 (2.4%) vegetarians during pregnancy. Compared to children of nonvegetarian mothers, children of mothers who followed a vegetarian diet during pregnancy showed a lower risk of developing AD before 18 months of age (OR = 0.65, 95% CI = 0.45–0.93, p = 0.018). Conclusion: This study suggests that a vegetarian diet during pregnancy may lower the risk of AD in children. It is essential to carry out long‐term follow‐up to fully understand the impact of a mother's diet on allergic conditions. [ABSTRACT FROM AUTHOR]

Importance: The cancer risks associated with treatment with topical calcineurin inhibitors (TCIs) in patients with atopic dermatitis (AD) remain controversial, and limited evidence exists regarding the cancer risks among patients with AD treated with TCIs in Asian populations. Objectives: This study identified the association between TCI use and the risks of developing all cancers, lymphoma, skin cancers, and other cancers. Design: This study was a nationwide, population-based, retrospective cohort study. Setting: Taiwan's National Health Insurance Research Database. Participants: Patients diagnosed at least twice with ICD-9 code 691 or at least one time with ICD-9 codes 691 or 692.9 within 1 year between 1 January 2003 and 31 December 2010 were included and followed until 31 December 2018. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using the Cox proportional hazard ratio model. Exposures: Patients using tacrolimus or pimecrolimus were identified in the National Health Insurance Research Database and compared with patients using topical corticosteroids (TCSs). Main Outcomes and Measures: The main outcomes were hazard ratios (HRs) of cancer diagnoses and associated outcomes obtained from the Taiwan Cancer Registry database. Results: After propensity score (PS) matching, the final cohort included 195,925 patients with AD, including 39,185 who were initial TCI users and 156,740 who were TCS users. Propensity score matching was performed according to age, sex, index year, and Charlson Comorbidity Index using a ratio of 1:4. Except for leukemia, HR and 95% CI showed no significant associations between TCI use and the risk of developing all cancer, lymphoma, skin cancers, and other cancers. Sensitivity analysis showed that the lag time HRs for every cancer subtype continued to show no significant association between TCI use and cancer risk, except for leukemia. Conclusions and Relevance: Our study found no evidence to support an association between TCI use and the risks of almost all cancers compared with TCS use in patients with AD, but physicians should be aware of potentially higher risks of leukemia with TCI use. This study represents the first population-based study focused on the cancer risk of TCI use among patients with AD in an Asian population. [ABSTRACT FROM AUTHOR]

This article, published in the journal Allergy, explores the role of miR-223 in atopic dermatitis (AD). The study found that AD patients had higher levels of neutrophil extracellular trap (NET) formation, which decreased after treatment. The expression of miR-223 was elevated in peripheral blood mononuclear cells (PBMCs) and plasma of AD patients, but decreased in neutrophils and skin lesions. The authors hypothesize that the down-regulation of miR-223 in neutrophils leads to increased NET formation and promotes skin inflammation in AD. The study was supported by grants from Taichung Veterans General Hospital in Taiwan. [Extracted from the article]

Although bullous pemphigoid (BP) and atopic dermatitis (AD) share pathogenic mechanisms, their relationship remains controversial. Therefore, we conducted a population-based case–control study to investigate the association between BP and AD in Taiwan. Based on the Taiwan National Health Insurance Research Database, 9344 patients with BP and 18,688 age- and sex-matched controls were enrolled between 2000 and 2013. Furthermore, the study included 7,196 BP patients and 14,392 controls, matched for age, sex, and propensity score of comorbidities, with a case to controls ratio of 1:2. Logistic regression analysis was performed to examine the association between AD and BP. In the age- and sex-matched cohorts, AD (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.50–1.95) was independently associated with BP. In the age, sex, and comorbidities-matched cohorts, AD (OR 1.76, 95% CI 1.55–2.00) remained a significant risk factor for BP. Other significant risk factors included psoriasis, hypertension, diabetes mellitus, chronic kidney disease, chronic obstructive pulmonary disease, neuropsychiatric diseases, and autoimmune connective tissue disease. Limitations of this study include the lack of information on disease severity and phenotypes of BP and misclassification of diseases as potential sources of bias. In conclusion, AD increased the risk of developing BP by 76%, and this association was independent of many BP comorbidities. Further studies are warranted to investigate the clinical and pathophysiological relevance of factors contributing to BP and AD. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID‐19) pandemic has caused changes in the medical practice. However, it is unclear whether the patients receiving phototherapy for their dermatoses have been affected. Objectives: This study aimed to identify the impact of the COVID‐19 pandemic on phototherapy, focusing on the patient profile, adherence, and attitude before and after the surge. Methods: The study encompassed the time 5 months prior to and after the surge of the COVID‐19 pandemic (from May to July, 2021), resulting in the temporary closure of our phototherapeutic unit. Results: Nine hundred eighty‐one patients received phototherapy during this period. Vitiligo, psoriasis (Ps), and atopic dermatitis (AD) represented the groups with the highest patient numbers. For vitiligo, Ps and AD, 39.6%, 41.9%, and 28.4% of the patients resumed phototherapy after the pandemic‐related shutdown (PRS). No significant difference was noted in age, gender, and number of weekly sessions between those who resumed or stopped phototherapy after PRS among three groups. Patients who resumed phototherapy after PRS tended to receive more weekly sessions of phototherapy than those who initiated after PRS. Additionally, patients who resumed phototherapy showed no significant difference in the number of weekly sessions before and after PRS. Conclusions: This study reveals a significant impact of the COVID‐19 pandemic on patients undergoing phototherapy. Although the patient number remained similar before and after PRS, a significant portion of patients discontinued phototherapy after PRS. New strategies and continued education are needed to improve patient management in times of pandemic. [ABSTRACT FROM AUTHOR]

Atopic dermatitis is a prevalent inflammatory skin disease that manifests clinically as pruritus and eczema. Severe forms of atopic dermatitis can be chronic and relapsing or associated with other dermatological complications and comorbidities, resulting in lifelong impacts across multiple aspects for patients. This study was conducted to calculate the atopic dermatitis-related economic burden in Taiwan. First, the out-ofpocket costs incurred by 200 patients with atopic dermatitis were estimated using a specifically designed questionnaire. Secondly, work impairment was converted into quantifiable costs. The costs reimbursed by the Taiwan National Health Insurance (NHI), which were estimated in our previous work, were included in the final calculation. The atopic dermatitis-related economic burden for patients in Taiwan in 2018 was estimated as (2018 New Taiwan dollars; NT$) 37.90 billion, which is 0.207% of Taiwan’s gross domestic product. This substantial economic burden suggests an existing need for more effective and equitable treatment for atopic dermatitis. [ABSTRACT FROM AUTHOR]

Background: Nickel, the fifth most common element on Earth, is the leading inducer of contact allergies in humans, with potent immunological effects. Nickel‐induced contact allergies predominantly affect females. Maternal exposure to nickel has been associated with several developmental abnormalities. However, how a maternal nickel exposure affects the development of atopic diathesis and immune abnormalities in children has never been addressed. Objectives: We aimed to determine whether maternal nickel exposure affects the development of atopic dermatitis and immune abnormalities in their children. Methods: Using a birth cohort study, we analysed 140 mother–child pairs recruited in 2012–2015 from central Taiwan. Maternal exposure to nickel was estimated using urinary nickel levels measured by inductively coupled plasma mass spectrometry (ICP‐MS). The serum levels of 65 analytes and IgE in 3‐year‐old children were profiled with a multiplex ELISA. The correlation between the maternal urinary nickel concentration and serum analyte levels was assessed using Spearmen's correlation. Multivariant regression analysis was performed to evaluate the association between maternal urinary nickel levels and serum analyte concentrations in their children. Results: The geometric means of the maternal urinary nickel and the children's serum IgE levels were 2.27 μg/L and 69.71 IU/mL, respectively. The maternal nickel exposure was associated with increased serum levels of IL‐1β, IL‐2, TNF‐α, and leukaemia inhibitory factor (LIF) but with decreased serum levels of matrix metalloproteinase‐1 (MMP‐1), IL‐2R, and eotaxin‐1 in the children. In addition, the development of childhood atopic dermatitis at 3 years old was significantly associated with the child's serum levels of IgE and IL‐2R, but it was negatively associated with the maternal nickel exposure. Conclusions: This is the first study showing the potential immunological effects of maternal nickel exposure in their children at an early developmental stage. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this study was to conduct a retrospective analysis to understand the patient profile, treatment patterns, healthcare resource utilization, and cost of atopic dermatitis (AD) of patients eligible for targeted therapy in Taiwan. Methods: A retrospective, claims-based analysis was undertaken using Taiwan's National Health Insurance Research Database from 01 January 2014 to 31 December 2017. Patients aged ≥ 2 years and with at least one diagnosis code for AD during 2015 were identified. Patients with comorbid autoimmune diseases were excluded. Enrolled AD patients were categorized using claims-based treatment algorithms by disease severity and their eligibility for targeted therapy treatment. A cohort of targeted therapy-eligible patients was formed, and a matched cohort using patients not eligible for targeted therapy was derived using propensity score matching based on age, gender, and the Charlson Comorbidity Index (CCI). Treatment patterns, resource utilization, and costs were measured during a 1-year follow-up period. Results: A total of 377,423 patients with AD were identified for this study. Most patients had mild AD (84.5%; n = 318,830) with 11.9% (n = 45,035) having moderate AD, and 3.6% (n = 13,558) having severe AD. Within the 58,593 moderate-to-severe AD patients, 1.5% (n = 897) were included in the targeted therapy-eligible cohort. The matched cohort consisted of 3558 patients. During the 1-year follow-up period, targeted therapy-eligible patients utilized antihistamines (85.5%), topical treatments (80.8%), and systemic anti-inflammatories (91.6%) including systemic corticosteroids (51.4%) and azathioprine (59.1%). During the first year of follow-up, targeted therapy-eligible patients (70.5%; 7.01 [SD = 8.84] visits) had higher resource utilization rates and frequency of AD-related outpatient visits compared with the matched cohort (40.80%; 1.85 [SD = 4.71] visits). Average all-cause direct costs during 1-year follow-up were $2850 (SD = 3629) and $1841 (SD = 6434) for the eligible targeted therapy and matched cohorts, respectively. AD-related costs were 17.7% ($506) of total costs for the targeted therapy eligible cohort and 2.2% ($41) for the matched cohort. Conclusions: AD patients eligible for targeted therapy in Taiwan experienced high resource and economic burden compared with their non-targeted-therapy-eligible counterparts. [ABSTRACT FROM AUTHOR]

To determine phenotype-related dupilumab response in adult patients with atopic dermatitis (AD), this multicenter, retrospective study included 111 adults with moderate-to-severe AD in Taiwan, with median age of 31.5 years (18–87) and 71 (64.0%) males. Patients received dupilumab 300 mg per two to three weeks up to 12 months. We found a significant improvement after 4 and 16 weeks of treatment in all patients for all the assessed scores, including eczema area and severity index (EASI) improvement ≥50% (EASI-50) and 75% (EASI-75), EASI reaching minimal clinically important difference (MCID), and Investigator's Global Assessment (IGA) improvement ≥2. Importantly, prior to asthma, early AD onset and 3-week drug intervals were significantly associated with a high proportion of EASI-75 at month 12, while prurigo and lichenoid phenotypes were associated with a lower proportion of EASI-75 at month 12. However, the majority of adverse events were mild in severity. In conclusion, our study results identify phenotype-related dupilumab response at month 12 in adults with moderate-to-severe AD, and we suggest that treatment should not be discontinued until reaching a satisfactory clinical response. [ABSTRACT FROM AUTHOR]

Background: Microbial dysbiosis has been implicated in the development of atopic dermatitis (AD). The risk of development of AD following early‐life infections remains unclear. Objective: To investigate the impact of early‐life infections on AD development. Methods: This population‐based nested case–control study was conducted using the Taiwan's National Health Insurance Research Database. A total of 5454 AD patients and 16 362 control subjects without AD were identified, for the period 1997 to 2013. Demographic characteristics, comorbidities and maternal factors were compared. Adjusted odds ratio (aOR) was calculated to examine the associations between early‐life infections and subsequent AD by conditional stepwise logistic regression analysis. Results: Mean age was 2.6 ± 2.9 years in both groups. Overall infections (41.8% vs. 28.9%) before the diagnosis of AD were more common in AD patients than in control subjects (P < 0.001). Infectious diseases [aOR, 1.40; 95% confidence interval (CI), 1.29–1.51], skin infections (aOR, 1.55; 95% CI, 1.40–1.71) and systemic antibiotic exposure (aOR 1.67, 95% CI 1.55–1.79) before AD diagnosis were independently associated with AD development on multivariate analyses. These results were consistent across observation periods (0–1, 1–2 and >2 years after birth) and sensitivity analyses after redefining the index date as 3 or 6 months before the date of AD diagnosis. Other independent risk factors included asthma, allergic rhinitis, intussusception and neonatal hyperbilirubinemia. No association with subsequent AD was found for maternal age at delivery, Caesarean delivery or prenatal antibiotic exposure. Conclusion: Infections in early life are associated with AD development in infancy and early childhood. [ABSTRACT FROM AUTHOR]

The optimal frequency of water bathing/showering in atopic dermatitis (AD) is unknown. We sought to determine the efficacy of different bathing/showering frequencies at improving AD severity. A systematic review and meta-analysis was performed of studies evaluating the clinical efficacy of bathing/showering regimen in AD. MEDLINE, EMBASE, SCOPUS, LILACS, Cochrane, China National Knowledge Infrastructure, Taiwan electronic periodical services and CiNii were searched. Two authors independently performed title/abstract and full-text review and data extraction. All 13 included studies were prospective and demonstrated numerically reduced AD severity in patients treated with a water bathing/showering regimen in ≥ 1 time-point compared with baseline. In random-effects regression models, baths/showers ≥ 7 vs. < 7 times per week were not associated with significant differences of Cohen's D scores for eczema area and severity index (n = 5 studies; least-square means: 1.34 vs. 0.90; P = 0.45; I2 = 91.8), Scoring AD (n = 5 studies; 0.73 vs. 0.41; P = 0.13; I2 = 97.4) or body surface area (n = 4 studies; 0.45 vs. 0.28; P = 0.17; I2 = 93.4). Similar results were observed in sensitivity analyses by study design, quality, use of emollients, and use of topical corticosteroids. No publication bias was detected by Egger regression (P ≥ 0.26) or Begg rank (P ≥ 0.19) tests. Three studies were included in the qualitative analysis, which found that bathing/showering ≥ 7 resulted in significant improvement of Investigator Global Assessments, extent of skin lesions and itch caused by AD. In conclusion, the optimal frequency of water bathing/showering in AD remains unclear. Daily showers/baths were not associated with worse severity, and should be permitted in AD. Larger scale, well-designed RCT are still needed to determine the optimal bathing parameters. [ABSTRACT FROM AUTHOR]

Atopic dermatitis has a substantial impact on work and activity impairment according to studies from Western communities. Prospective studies of work productivity and activity impairment in Asian patients with atopic dermatitis are lacking. The aims of this study were to investigate the impacts of atopic dermatitis on work productivity and activity impairment among Taiwanese patients, and to stratify the analyses by disease severity. One-third of employed participants reported missing work (absenteeism) in the preceding week due to atopic dermatitis, while 88.5% of the remaining two-thirds reported impaired work effectiveness (presenteeism). In addition, 92.5% of all participants reported impaired daily activities. Overall work impairment (aggregate productivity loss from absenteeism and presenteeism) was 1.8- and 2.6-fold greater in subjects with moderate and severe atopic dermatitis, respectively, compared with those with mild atopic dermatitis. Presenteeism, but not absenteeism, contributes to the majority of total work impairment in this cohort. Daily activity impairment was 1.5-fold greater in moderate atopic dermatitis, and 2.0-fold greater in severe atopic dermatitis, compared with mild atopic dermatitis. Both work and activity impairment showed significant positive correlations with atopic dermatitis severity scores (SCORing Atopic Dermatitis; SCORAD). In conclusion, work productivity and activity impairment is significantly correlated with disease severity in this Taiwanese atopic dermatitis cohort. In order to obtain a full picture of disease burden to patients and caregivers, patients with atopic dermatitis should be monitored for disease activity as well as corresponding impacts on quality of life. [ABSTRACT FROM AUTHOR]

Background: Acetaminophen (APAP) has been associated with the development of atopic diseases. However, little is known about the relationship between prenatal APAP exposure and atopic dermatitis (AD) in offspring. Objective: To investigate the association between prenatal APAP exposure and AD risk in offspring. Methods: In this study, 2029 study pairs (AD‐affected children and their mothers) and 5,058 control pairs were identified between 1998 and 2008 from the Taiwan Longitudinal Health Insurance Database. Maternal APAP exposure during pregnancy was assessed. Results: After adjustment for potential confounders, there was a significant association between risk of offspring AD and exposure to acetaminophen in the first trimester (OR 1.16; 95% CI 1.05‐1.28), the second trimester (OR 1.14; 95% CI 1.03‐1.27), both first and second trimesters (OR 1.30; 95% CI 1.13‐1.51), both first and third trimester (OR 1.20; 95% CI 1.04‐1.39), any trimester (OR 1.12; 95% CI 1.00‐1.26), and all three trimesters (OR 1.32; 95% CI 1.08‐1.62) in a dose‐response manner. Conclusions: Prenatal exposure to acetaminophen was associated with an increased incidence of offspring AD. [ABSTRACT FROM AUTHOR]

What is known and objective: Proton‐pump inhibitors (PPIs) and histamine‐2‐receptor antagonists (H2RAs) are two of the most widely used acid‐suppressive drugs (ASDs). Some studies have reported that prenatal ASD exposure may increase the risk of asthma and other allergic diseases. This study investigated the effects of ASDs on the risk of atopic dermatitis in patients with upper gastrointestinal diseases. Methods: This population‐based retrospective cohort study used data of 289,850 patients with at least two diagnoses of upper gastrointestinal diseases (UGIDs) between 1 January 2001 and 31 December 2005, from Taiwan's National Health Insurance Research Database. The AD risks among ASD users and nonusers were compared. Differences in sociodemographic characteristics and potential covariates were examined. AD hazard ratios were estimated, and groups were compared using Cox proportional hazards regression analysis after adjustment for age, sex and other covariates. Results and discussion: In total, 109,980 patients were included. The adjusted hazard ratio (HR) of AD risk in ASD users relative to that in nonusers was 1.52 (95% confidence interval [CI]: 1.40–1.64, p < 0.001). For a dose‐effect sub‐analysis, patients were divided into four groups based on their defined daily dose. ASDs dose‐dependently affected the AD risk (p for trend <0.01). Furthermore, the adjusted HR of the AD risk among ASD nonusers was 2.30 (95% CI: 2.06–2.57) relative to that in the comparison group (ASD nonusers without UGIDs). Among patients with UGIDs, ASD users had a higher AD risk than ASD nonusers. A subgroup analysis revealed only H2RA use was associated with an increased AD risk (adjusted HR 1.70, 95% CI: 1.53–1.89, p < 0.001). What is new and conclusions: These results indicate that the use of H2RAs was associated with an increased risk of AD among patients with UGIDs, and the increase in risk appeared to be dose‐dependent. ASDs should be used only in situations where clear clinical benefits can be obtained. [ABSTRACT FROM AUTHOR]

Background: Much attention has been focused on environmental risk factors and their roles in eczema development. In this regard, the specific eczema risk factors in Taiwan were relatively unknown. As such, this study investigated the common indoor risk factors present in Taiwanese households. Aims: To discuss the effects of several indoor risk factors on the prevalence of atopic eczema in Taiwan. Materials and Methods: A cross-sectional, population-based study was performed in Kaohsiung, Taiwan, using both survey investigation and fungal culturing. A total of 998 participants were enrolled in the survey, with 513 participants selected for fungal culture. Risks of atopic eczema were calculated as odds ratios for various risk factors using logistic regression. The correlation between potential risk factors and the fungal level was analyzed with linear regression. Results: Pet and house plants have an adjusted odds ratio of 1.434 (95% CL: 1.011–2.033) and 1.820 (95% CL: 1.229-2.696), respectively. Additionally, smoking was shown to possess an odds ratio of 1.461 (95% CL: 1.064-2.006). Wood wall has an adjusted odds ratio of 2.143 (95% CL: 1.235-3.658). Frequent bedroom shower use (β = 0.254) and hours of opened windows (β = 0.106) have shown significant positive associations with indoor fungal level. Conclusion: Pets, house plants, and smoking were concluded to be major risk factors for atopic eczema. Wood wall remained controversial due to its limited sample size and possible confounders. Bedroom shower and window-opening have been shown to increase mold growth, but the lack of association with eczema suggested other allergens besides mold to be the primary eczema trigger. [ABSTRACT FROM AUTHOR]

Background: An association between alopecia areata (AA) and atopic dermatitis (AD) has been reported in previous studies. However, the temporality of this relationship remains unclear based on prior cross‐sectional and case‐control studies. Objective: This study aimed to investigate the bidirectional association between AA and AD. Methods: Participants were recruited from the National Health Insurance Research Database of Taiwan. In analysis 1, we included 12 022 AA patients and 48 088 matched controls to assess the association between AA and AD risks. In analysis 2, 40 307 AD patients and 161 228 matched controls were included to assess the association between AD and AA risks. A Cox regression model was used to calculate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). Results: Compared with controls, AA patients had a significantly increased risk of developing AD (aHR: 5.47; 95% CI: 4.76‐6.28) after adjustment for potential confounders. Likewise, AD patients had a significantly increased risk of developing AA (aHR: 6.00; 95% CI: 5.04‐7.14). Conclusions: Our study demonstrated a bidirectional association between AA and AD, suggesting that these two diseases may share common pathogenic mechanisms. This finding has implications for follow‐up and screening of AA patients for AD and vice versa. [ABSTRACT FROM AUTHOR]

• This is the first population-based study investigating the familial aggregation of atopic dermatitis and co-aggregation of other allergic diseases in individuals with affected relative diagnosed with atopic dermatitis. • The study provides objective quantitative data to find higher relative risks of allergic diseases including asthma and allergic rhinitis in individuals with affected first-degree relatives than in the general population, which are valuable for patient counselling. • Information from large population may help future genetic studies to estimate candidate gene. Atopic dermatitis (AD) is contributed from a result of genetic and environmental interaction. The evidence for familial aggregation in AD has been reported but population-based studies and co-aggregation with other allergic diseases are rarely reported. This study examined familial aggregation and heritability of atopic dermatitis (AD) and to estimate the relative risks (RRs) of other allergic diseases in individuals with relatives diagnosed with AD. We used Taiwan National Health Insurance Research Database to identify all registered beneficiaries (n = 26,525,074) in 2015; among them, 1,248,594 individuals had AD. We estimated familial risks of AD and other allergic diseases by using marginal Cox proportional models. Prevalence of AD in individuals with relatives affected with atopic dermatitis was 3.1-fold higher than the general population (12.4 % vs. 4.0 %, respectively). The adjusted relative risks (RR) for individuals with an affected first-degree relative (FDR) was 2.25 (95 % CI, 2.25–2.26). The adjusted RRs for subjects with an affected parent, an affected offspring or an affected sibling was 2.39 (95 % CI, 2.37–2.41), 2.26 (95 % CI, 2.24–2.28) and 2.30 (95 % CI, 2.29–2.31) respectively. The RRs in individuals with an FDR with AD was 1.34 (95 %CI, 1.34 – 1.34) for asthma and 1.23 (95 %CI, 1.23–1.24) for allergic rhinitis. This nationwide study ascertains that a family history of atopic dermatitis is a risk factor for atopic dermatitis. Individuals with relatives affected by atopic dermatitis have slightly higher risks of developing asthma and allergic rhinitis. [ABSTRACT FROM AUTHOR]

First reported from Taiwan mistakenly as acral acanthosis nigricans in 1991, pigmented carpotarsal hyperkeratosis or hyperkeratosis nigricans carpi et tarsi displays a peculiar distribution of velvety brown‐grey hyperpigmented plaques symmetrically on the flexural side of the wrists and ankles and on the dorsal sides of the hands and feet. A marked epidermal hyperkeratosis with typically mild acanthosis and papillomatosis is observed in histology. Whitish maceration upon perspiration or water exposure, with exacerbation in summer but remission in winter, is common. The association with obesity, endocrine disorders, atopic dermatitis, ichthyosis or malignancy is unknown. Familial occurrence and hereditary patterns are ill‐defined. There is preliminary evidence indicating a pathogenic role of missense mutation in the transcription factor 4 gene. Treatment is empirical, with good outcome with topical retinoids and keratolytic agents. Recurrence is common, and long‐term prognosis is unclear. To be distinguished are acral acanthosis nigricans, palmoplantar keratoderma of the Nagashima type, palmoplantar keratoderma of the Bothnian type and aquagenic palmoplantar keratoderma. Most reported cases are from Southern China and are predominantly observed in men between the ages of 20 and 40 years. The currently used term 'symmetrical acral keratoderma' is non‐specific and misleading and may lead to global unawareness, underreporting or misdiagnosis of this phenomenon. Further genetic and molecular studies are required to clarify its pathogenesis and relation to palmoplantar keratoderma. [ABSTRACT FROM AUTHOR]

Background: Little is known about the associations between allergic disease, sleep-disordered breathing (SDB), and childhood nocturnal enuresis (NE). We examined whether allergic disease and SDB were associated with childhood NE. Methods: Data were assessed from the 2007-2012 Taiwan National Health Insurance Research Database. We enrolled 4308 children aged 5-18 years having NE diagnosis and age- and sex-matched 4308 children as the control group. The odds ratios of NE were calculated to determine an association with preexisting allergic disease and SDB. Results: A total of 8616 children were included in the analysis. Prevalence of allergic diseases and SDB was significantly higher for the NE group than the control group (all p < 0.001). After adjusting odds ratios for potential confounding factors, except asthma, children with allergic rhinitis, atopic dermatitis, allergic conjunctivitis, and obstructive sleep apnea (OSA) had significantly higher odds of NE compared with children never diagnosed. With stratification for sex, girls with allergic rhinitis, atopic dermatitis, allergic conjunctivitis, OSA, and snoring had significantly higher odds of NE, compared with girls never diagnosed. Only boys with allergic rhinitis and OSA were associated with increased odds of NE. With stratification for age, children aged 5-12 years with allergic rhinitis, atopic dermatitis, allergic conjunctivitis, and OSA had significantly higher odds of NE compared with those never diagnosed. Odds of NE increased with the number of comorbid allergic diseases. Conclusions: Allergic diseases and SDB are associated with increased odds of childhood NE. The odds of NE increased with the number of comorbid allergic diseases present. [ABSTRACT FROM AUTHOR]

Background An individual's birth month has been associated with allergic diseases, but little is known about the association between birth month and atopic dermatitis ( AD). Objective The aim of this study was to investigate the risk of AD in children born in various months. Methods Using Taiwan's National Health Insurance Research Database, we conducted a case-control study that included 31 237 AD cases and 124 948 age- and gender-matched controls without AD. Data regarding sociodemographic factors and coexisting medical conditions were collected and controlled in the multivariate logistic regression to determine the adjusted odds ratios and 95% confidence intervals for AD associated with the participant's birth month. Results Compared with people born in May, people born in December had the highest risk of AD ( OR 1.17, 95% CI 1.10-1.25), followed by people born in October ( OR 1.15, 95% CI 1.08-1.22) and November ( OR 1.13, 95% CI 1.06-1.20). Low income ( OR 1.28), asthma ( OR 1.88), allergic rhinitis ( OR 1.70), psoriasis ( OR 2.36), vitiligo ( OR 1.99), urticaria ( OR 2.14), and systemic lupus erythematosus ( OR 1.91) were significant coexisting medical conditions associated with AD. Conclusion Being born in December, October, or November may be associated with an increased risk of AD. Future investigations are needed to evaluate the possible mechanism behind the association between birth month and AD. [ABSTRACT FROM AUTHOR]

Backgrounds: Previous studies have found an increased prevalence of atopic diseases among patients with major depression and bipolar disorder. But the temporal association between atopic diseases in adolescence and the subsequent risk of developing mood disorders has been rarely investigated.Methods: Using the Taiwan National Health Insurance Research Databases, 5075 adolescents with atopic diseases (atopic cohort) and 44,729 without (non-atopic cohort) aged between 10 and 17 in 2000 were enrolled into our study and followed to the end of 2010. Subjects who developed major depression or bipolar disorder during the follow-up were identified.Results: The atopic cohort had an increased risk of developing major depression (HR: 2.45, 95% CI: 1.93~3.11) and bipolar disorder (HR: 2.51, 95% CI: 1.71~3.67) compared to the non-atopic cohort, with a dose-dependent relationship between having a greater number of atopic comorbidities and a greater likelihood of major depression (1 atopic disease: HR: 1.80, 95% CI: 1.29~2.50; 2 atopic comorbidities: HR: 2.42, 95% CI: 1.93~3.04;≥3 atopic comorbidities: HR: 3.79, 95% CI: 3.05~4.72) and bipolar disorder (HR: 1.40, 95% CI: 0.57~3.44; HR: 2.81, 95% CI: 1.68~4.68; HR: 3.02, 95% CI: 1.69~5.38).Discussion: Having atopic diseases in adolescence increased the risk of developing major depression and bipolar disorder in later life. Further studies may be required to clarify the underlying mechanism between atopy and mood disorders, and to investigate whether prompt intervention may decrease the risk of subsequent mood disorders. [ABSTRACT FROM AUTHOR]

Background: There is a demonstrated association between asthma and irritable bowel syndrome (IBS). In this study, we examined the bidirectional association between asthma and IBS using a nationwide database. Methods: We conducted two retrospective cohort studies using data obtained from the National Health Insurance of Taiwan. Study 1 included 29,648 asthma patients newly diagnosed between 2000 and 2010. Study 2 included 29,875 IBS patient newly diagnosed between 2000 and 2010. For each study, four subjects without asthma and IBS were selected, respectively, frequency-matched by sex, age, and the diagnosis date. All four cohorts were followed up until the end of 2011 to estimate incident IBS for Study 1 and incident asthma for study 2. Adjusted hazard ratios (aHRs) were estimated using the Cox proportional hazards model after controlling for sex, age and comorbidities. Results: The incidence of IBS was 1.89 times higher in the asthma cohort than in the comparison cohort (8.26 vs. 4.36 per 1,000 person-years), with an aHR of 1.57 [95% confidence interval (CI) = 1.47–1.68]. The aHRs remained significant in all subgroups measured by sex, age and the presence of comorbidities. In contrast, the incidence of asthma was 1.76 times higher in the IBS cohort than the comparison cohort (7.09 vs. 4.03 per 1,000 person-years), with an aHR of 1.54 (95% CI = 1.44−1.64). Similarly, aHRs remained significant in all subgroups measured by sex, age and the presence of comorbidities. Conclusion: The present study suggests a bidirectional association between asthma and IBS. Atopy could be a shared pathophysiology underlying this association, deserving a further investigation. [ABSTRACT FROM AUTHOR]

Background/Objective: Atopic dermatitis comprises a group of chronic, relapsing inflammatory conditions. Topical steroids (TS) can ameliorate atopic dermatitis but induce skin atrophy and secondary infection. Tzu-Yun ointment (TYO) was used widely for skin ulcers and pus discharges. This study sought to determine whether TYO can replace TS therapy for atopic dermatitis. Methods: This preliminary, randomized, controlled, open-label design compared the therapeutic effects of TS and TYO in patients with atopic dermatitis; 33 patients were randomly assigned to the TS group (17 patients) and the TYO group (16 patients). All patients received an 8-week TS or TYO treatment. Primary outcome measures were assessed by using the Eczema Area and Severity Index (EASI) and Three Item Severity (TIS) before the treatment (baseline, week 0) and 1 week (week 1), 2 weeks (week 2), 4 weeks (week 4), and 8 weeks (week 8) after initiation of the treatment. Results: Of the 33 enrolled patients, 31 (16 in the TS group and 15 in the TYO group) completed the study. Patients in both groups showed decreased EASI and TIS scores, with no significant difference at weeks 0, 1, 2, 4, and 8. Conclusion: TYO may be as effective as TS therapy for atopic dermatitis and has potential as an alternative treatment for this condition. [ABSTRACT FROM AUTHOR]

Background Epidemiological investigations have examined the association between type 1 diabetes mellitus (T1DM) and atopic disease, but have obtained conflicting results. Objectives To analyse the association between T1DM and atopic dermatitis ( AD) in a population-based, retrospective cohort study that investigated the hypothesis that childhood T1DM is a risk factor for subsequent AD. Methods From claims data of the National Health Insurance programme of Taiwan, we identified 3386 patients with T1DM newly diagnosed from 1998 to 2011 and 12 725 randomly selected controls without T1DM. These were frequency matched by age, sex and year of diagnosis. Both cohorts were followed up until the end of 2011 to evaluate the AD risk. We used Cox proportional hazards regression models to analyse the risk of AD. Results The overall incidence rate of AD was 1·40-fold (significantly) higher in the T1DM cohort than in the non-T1DM cohort (3·31 vs. 2·35 per 1000 person years). After adjustment for potential risk factors, the overall risk of AD remained higher in the T1DM cohort [adjusted hazard ratio ( HR) 1·76, 95% confidence interval ( CI) 1·29-2·39] than in those without T1DM. Compared with the non-T1DM cohort, the patients with T1DM with more emergency room visits (adjusted HR 30·1, 95% CI 18·7-48·5) or hospitalizations (adjusted HR 70·3, 95% CI 45·6-114·5) had a higher risk of subsequent AD. Conclusions This nationwide, retrospective cohort study demonstrates that childhood T1DM may increase the risk of AD. [ABSTRACT FROM AUTHOR]

Background Atopic dermatitis affects 15-30% of children worldwide. Onset of disease usually occurs within the first year of life, over half of which regress by 6 years of age. The aim of this study was to investigate the risk factors related to the persistence of infantile atopic dermatitis. Methods In this birth cohort study, patients were enrolled prenatally and followed until 6 years of age; 246 patients had infantile atopic dermatitis at 6 months of age. Family history, maternal and paternal total and specific Immunoglobulin E (IgE) levels, and cord blood IgE were recorded. Clinical examination, questionnaire survey, and blood samples for total and specific IgE of the children were collected at each follow-up visit. Results Of the 246 patients with infantile atopic dermatitis at 6 months of age, 48 patients had persisted atopic dermatitis at 6 years of age (19.5%). Risk factors associated with persistent infantile atopic dermatitis included egg white sensitization (odds ratio: 3.801, P = 0.020), and atopic dermatitis involving two or more areas at 6 months old (odds ratio: 2.921, P = 0.018) after multivariate analysis with logistic regression. Patients with persistent infantile atopic dermatitis had a higher risk of asthma before 6 years old (39.6% vs 24.2%, P = 0.032). Conclusion Egg white sensitization and the initial involvement of two or more areas at 6 months of age were associated with the persistent infantile atopic dermatitis. Patients with persistent infantile atopic dermatitis are more likely to develop asthma by 6 years of age. [ABSTRACT FROM AUTHOR]

Background: Clinical and immunological studies have consistently shown a relationship between atopic diathesis and idiopathic nephrotic syndrome (INS). However, no large population cohort study has yet to demonstrate the nature of the relationship between these disorders. Methods: Claims data from a random selection of children representing half of the insured population in Taiwan were examined. During the period from 1998 to 2007, we identified 192,295 children aged <18 years with newly diagnosed atopic dermatitis (AD) and 769,169 frequency-matched controls. Incidence of INS and hazard ratios (HRs) were calculated. Results: The AD cohort had a 2-fold higher overall incidence of INS than the non-AD cohort [7.20 vs. 3.60 per 100,000 person-years, respectively; 95 % confidence interval (CI) 1.50-2.66]. The HR for INS increased with age and was higher among females. The HR for INS was also higher in AD children with more medical visits per year, ranging from 0.94 for those having ≤3 visits to 38.6 for those having >6 visits (trend test P < 0.0001). In particular, the risk of INS clearly increased during the initial 5 years after AD onset. Conclusions: Children with AD have a greater incidence and risk of developing INS and this risk increases with AD severity. [ABSTRACT FROM AUTHOR]

Objective Both atopic dermatitis and epilepsy have been regarded as chronic inflammatory diseases. However, their association has yet to be investigated. Methods Using the Taiwan National Health Insurance Research Database, 35,312 patients with atopic dermatitis but without a history of epilepsy, and 35,312 age-/gender-matched controls were enrolled between 1998 and 2008, and followed to the end of 2011 to identify the development of epilepsy. Results Subjects with atopic dermatitis had a higher incidence of developing epilepsy (0.94 vs. 0.27/1,000 person-years, p < 0.001) than the control group. The Cox regression model showed that atopic dermatitis increased the risk of developing epilepsy (hazard ratio [ HR] 2.91, 95% confidence interval [ CI] 2.23-3.82) after adjusting for demographic data and medical comorbidities. Sensitivity tests showed consistent findings ( HR 2.32, 95% CI 1.68-2.96) after excluding the first year of observation. In addition, asthma ( HR 1.34, 95% CI 1.04-1.72) and allergic rhinitis ( HR 1.34, 95% CI 1.04-1.73) were related to the risk of epilepsy. Significance Subjects with atopic dermatitis were associated with an increased risk of developing epilepsy in later life. Further studies would be needed to investigate the underlying mechanisms. A PowerPoint slide summarizing this article is available for download in the Supporting Information section . [ABSTRACT FROM AUTHOR]

Background Atopic dermatitis ( AD) often manifests in early childhood and has variable disease course among individual patients. Previous studies regarding the natural course of AD have usually been of small sample size and were not based on nationwide populations. Objectives We aimed to find out the disease duration and remission rate of children with early-onset AD (onset in the first 2 years of life) in Taiwan, and to determine whether the presence of allergic rhinitis ( AR) or asthma affects the disease course. Methods The patients with early-onset AD in a nationally representative cohort were selected using the National Health Insurance Research Database of Taiwan and were followed from birth to 10 years of age. Kaplan-Meier survival analysis was carried out to analyse the disease duration and remission of AD. Between-group analysis using the log-rank test was carried out to analyse the influence of risk factors on the disease course. Results Of the 1404 children with early-onset AD, 19·4% had disease duration < 1 year and 48·7% had disease duration < 4 years. During the follow-up, 69·8% of the patients went into remission. Sex, onset age, presence of AR, presence of asthma and presence of respiratory atopy (either AR or asthma) did not show statistically significant influence on disease course. Conclusions Children in Taiwan with early-onset AD had disease of variable natural course, and the median disease duration was 4·2 years. About 70% of the patients went into remission eventually. The presence of AR or asthma did not affect the disease course of AD. [ABSTRACT FROM AUTHOR]

Allergic rhinitis (AR) is common in children. Characteristic symptoms of AR may result in daytime inattention, irritability, and hyperactivity, which are also components of ADHD. Conflicting data in previous studies exist regarding the relationship between ADHD and AR. The aim of this study was to examine the prevalence and risk of AR in ADHD patients in Taiwan. We conducted a cross-sectional study using the National Health Insurance Research Database in Taiwan. The study subjects included 469 patients who received psychiatric care for ADHD in 2005 and the general population ( n = 220,599). Distributions of age, gender, and living areas as well as allergic diseases in the general population and in the ADHD group were examined by χ tests. Multivariate logistic regression models were used to analyze the risk factors of AR. The prevalence of AR in ADHD group and the general population was 28.4 and 15.2 %, respectively. The prevalence of asthma was 9.6 % in ADHD group and 6.4 % in the general population. Both the prevalence of AR ( p < 0.001) and asthma ( p = 0.008) was significantly higher in ADHD group than the general population. The multivariate logistic regression analysis showed that ADHD patients had an increased rate of AR than general population (OR = 1.83; 95 % CI = 1.48-2.27; p < 0.0001), and asthma was strongly associated with AR (OR = 9.28; 95 % CI = 8.95-9.63; p < 0.0001). Our data showed that ADHD patients had an increased rate of AR. Therefore, psychiatrists should be more aware of the comorbidity of AR when treating ADHD patients. [ABSTRACT FROM AUTHOR]

Background The biological mechanisms of how prenatal smoke exposure leading to atopic disorders remain to be addressed. Whether prenatal smoke exposure affects DNA methylation leading to atopic disorders is not clear. Objective As most children suffering from atopic dermatitis ( AD) continue to develop asthma later in life, we explored whether prenatal smoke exposure induces cord blood DNA methylation. Methods Methylation differences associated with smoke exposure were screened by Illumina Infinium 27K methylation arrays for 14 children from the Taiwan birth panel study cohort initially. Information about development of atopic dermatitis ( AD) and risk factors was collected. Cord blood cotinine levels were measured to represent prenatal smoke exposure. CpG loci that demonstrated a statistically significant difference in methylation were validated by methylation-dependent fragment separation ( MDFS). Differential methylation in three genes ( TSLP, GSTT1, and CYB5R3) was identified through the screen. Results Among these, only thymic stromal lymphopoietin ( TSLP) gene displayed significant difference in promoter methylation percentage after being validated by MDFS ( p = 0.018). TSLP gene was further investigated in a larger sample of 150 children from the cohort who completed the follow-up study. Methylation status of the TSLP 5′-CpG island ( CGI) was found to be significantly associated with prenatal smoke exposure ( OR=3.17, 95% CI=1.63-6.19) and with AD ( OR=2.32, 95% CI=1.06-5.11). The degree of TSLP 5′ CGI methylation inversely correlated with TSLP protein expression levels ( r = −0.45, P = 0.001). Conclusions & Clinical Relevance The effect of prenatal tobacco smoke exposure on the risk for AD may be mediated through DNA methylation. [ABSTRACT FROM AUTHOR]

Kawasaki disease (KD) is an acute febrile systemic vasculitis and has been reported to be associated with allergic disease. The risk of atopic dermatitis (AD) in preschool children with KD has not been investigated. The study was to determine the longitudinal risk of the development of AD in preschool children with KD A nationwide 5-year population-based study was performed using data from the National Health Insurance Database in Taiwan between 1999 and 2003. The risk factors for AD were compared between the 2 study groups during the follow-up period using the Cox proportional hazards model. In addition, plasma interleukin (IL)-5 levels were analyzed in normal subjects and KD patients. Among the 1440 subjects included, 21.6% developed AD during the 5-year follow-up period, of which 30.3% and 18.7% belonged to the study cohort and the comparison group, respectively. Children with KD were 1.25 times more likely to have AD than those in controls (P = 0.04). Levels of IL-5 and IgE were significantly higher in KD patients. Children with KD had a higher risk of developing AD during the 5-year follow-up period than the control group. Increased IL-5 and IgE levels may be key factors contributing to the risk of AD. [ABSTRACT FROM AUTHOR]

Atopic dermatitis is a chronic inflammatory skin disease. Multiple genetic and environmental factors are thought to be responsible for susceptibility to AD. In this study, we collected 2,478 DNA samples including 209 AD patients and 729 control subjects from Taiwanese population and 513 AD patients and 1027 control subject from Japanese population for sequencing and genotyping ORAI1. A total of 14 genetic variants including 3 novel single-nucleotide polymorphisms (SNPs) in the ORAI1 gene were identified. Our results indicated that a non-synonymous SNP (rs3741596, Ser218Gly) associated with the susceptibility of AD in the Japanese population but not in the Taiwanese population. However, there is another SNP of ORAI1 (rs3741595) associated with the risk of AD in the Taiwanese population but not in the Japanese population. Taken together, our results indicated that genetic polymorphisms of ORAI1 are very likely to be involved in the susceptibility of AD. [ABSTRACT FROM AUTHOR]

The term 'hand dermatitis' describes inflammatory skin condition localized to the hands. Nurses working at hospital settings are prone to develop hand dermatitis. The current study aimed to evaluate whether certain genetic polymorphisms were associated with the development of atopic eczema or non-atopic hand dermatitis in Taiwanese population. Nurses of Kaohsiung Medical University Hospital were recruited. Atopic eczema, non-atopic hand dermatitis and normal control groups were identified. The serine protease inhibitor Kazal type 5 ( SPINK5), filaggrin and interleukin-31 ( IL-31) gene variants were compared between the diseased and control groups. Our results showed that rs2303070 T allele of SPINK5 (assuming recessive model; OR = 3.58, 95% CI 1.63-7.84; P = 0.0014) and rs7977932 G allele of IL-31 (assuming recessive model; OR = 18.25, 95% CI = 3.27-101.94; P = 0.0009) were associated with increased risks of developing atopic eczema, while rs6892205 G allele of SPINK5 (assuming dominant model; OR = 3.79, 95% CI 1.55-9.28; P = 0.0036) was associated with the development of non-atopic hand dermatitis. In summary, our results showed that distinct SPINK5 and IL-31 gene variants were associated with the development of atopic eczema and non-atopic hand dermatitis. The barrier function, particularly those regulated by SPINK5, may play an important role in the development of both atopic eczema and non-atopic hand dermatitis. [ABSTRACT FROM AUTHOR]

Background: Skin infection and/or nasal carriage of Staphylococcus aureus in children with atopic dermatitis (AD) is a risk factor for exacerbating disease or subsequent recurrent S. aureus infection. The purpose of the study is to evaluate the antibiotic susceptibilities of S. aureus strains from AD children and determine the most appropriate choice of antibiotics. Methods: Nasal swabs from 168 healthy children with AD and 20 AD children with concurrent skin and soft-tissue infections (SSTI) were collected in 2005-2008. S. aureus strains were further analyzed for and compared with antibiotic susceptibilities. Results: There were 78 (46.4%) healthy children with AD colonized with S. aureus, and 24 (30.8%) were methicillinresistant S. aureus (MRSA). Among the 20 SSTI-infecting strains, 12 (60%) were MRSA. Antimicrobial susceptibility testing showed that, after penicillin, colonizing and SSTI-infecting strains had the highest rates of resistance to erythromycin (50% and 70%, respectively). All isolated strains were susceptible to vancomycin, rifampin, and mupirocin. Multi-drug resistance was found in 70% of the colonizing and 50% of the SSTI-infecting strains. D-test assay revealed inducible clindamycin resistance in 75% of the colonizing strains. The most prevalent resistance gene was ermB which was present in 94.9% and 92.9% of colonizing and SSTI-infecting strains, respectively. Conclusions: This study found that colonizing and SSTI-infecting strains of S. aureus from AD children had a high prevalence of MRSA and multi-drug resistance. Trimethoprim-sulfamethoxazole, rifampin, fusidic acid and mupirocin appear to be more suitable for treatment and decolonization of S. aureus in AD children. [ABSTRACT FROM AUTHOR]

Objectives: Atopic dermatitis (AD) is a common allergy that causes the skin to be dry and itchy. It appears at an early age, and is closely associated with asthma and allergic rhinitis. Thus, AD is an indicator that other allergies may occur later. Literatures indicate that the molecular basis of patients with AD is different from that of healthy individuals. According to the classics of Traditional Chinese Medicine, the body constitution of patients with AD is also different. The purpose of this study is to determine the differences in pulse spectrum analysis between patients with AD and nonatopic healthy individuals. Methods: A total of 60 children (30 AD and 30 non-AD) were recruited for this study. A pulse spectrum analyzer (SKYLARK PDS-2000 Pulse Analysis System) was used to measure radial arterial pulse waves of subjects. Original data were then transformed to frequency spectrum by Fourier transformation. The relative strength of each harmonic wave was calculated. Moreover, the differences of harmonic values between patients with AD and non-atopic healthy individuals were compared and contrasted. Results: This study showed that harmonic values and harmonic percentage of C3 (Spleen Meridian, according to Wang's hypothesis) were significantly different. Conclusions: These results demonstrate that C3 (Spleen Meridian) is a good index for the determination of atopic dermatitis. Furthermore, this study demonstrates that the pulse spectrum analyzer is a valuable auxiliary tool to distinguish a patient who has probable tendency to have AD and/or other allergic diseases. [ABSTRACT FROM AUTHOR]

It is common to recommend breastfeeding and a delayed introduction of solids to prevent atopic dermatitis (AD). However, the scientific evidence for this is inconclusive. The aim of this study was to explore the effect of breastfeeding and solids on AD, when taking account of reverse causality. This on-going birth cohort study was designed to sample 24,200 representative post-partum women and their babies from the Taiwan National Birth Registration database. Using two home interviews at 6 and 18 months after birth, with structured questionnaires about diet and physician's diagnosis of AD by parental reports, a total of 20,172 pairs (83.4%) were reviewed completely. Considering reverse causality, we excluded 2399 children with AD in the first 6 months of life and 18,733 were finally recruited. All study participants provided informed consent as approved by the Ethics Review Board of the National Taiwan College of Public Health. After adjustment for potential confounders, the overall results showed that the increased duration of breastfeeding seemed to increase the risk of AD at 18 months in children. However, no significant effect was found for the delayed introduction of solids on the risk of AD. There is no evidence of a protective effect of prolonged breastfeeding and a delayed introduction of solids against AD among children at age 18 months, and may even be a risk factor of AD. [ABSTRACT FROM AUTHOR]

Background: Atopic patients are exceptionally sensitive to airborne allergens. Sensitization to fungal allergens may be associated with respiratory allergic disease (RAD) and atopic dermatitis (AD). This study investigates the relationship between sensitization to different fungal allergens and the clinical manifestations of atopic disease. Methods: We retrospectively reviewed the medical records of atopic patients from the National Taiwan University Hospital from 2004 to 2009. A total of 133 atopic patients were found who were sensitive to at least 1 of the 3 most common fungi (Candida albicans, Aspergillus fumigatus, Penicillium chrysogenum) in Taiwan and were enrolled in the study. These patients were further divided into subgroups of isolated AD, isolated RAD and AD + RAD. The association between sensitization to fungi and allergic disease was analyzed by logistic regression analysis. Results: The sensitization rate to Candida-specific IgE was 81.2%, followed closely by Aspergillus at 69.2% and Penicillium at 63.2%. Isolated AD was the most common diagnosis. The levels of specific IgE antibodies against Aspergillus, Candida and Penicillium were highest in patients with isolated AD. Logistic regression revealed that isolated AD was highly associated with sensitization to Candida [odds ratio (OR) 10.45, 95% confidence interval (CI) 2.37-45.9]. In contrast, sensitization to Penicillium (OR 0.34, 95% CI 0.13-0.87)and Candida (OR 0.30, 95% CI 0.10-0.92) showed a negative association with isolated RAD. Conclusions: Fungal sensitization is more closely associated with AD than RAD. Our results suggest that specific sensitization to fungal allergensplays a critical role in the pathogenesis of atopic disease. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

To study the prevalence of atopic dermatitis, allergic rhinitis, and asthma in Taiwan, we analysed the claims data of a nationally representative cohort of 997,729 enrolees from the National Health Insurance register from 2000 to 2007. Overall, 66,446 patients were diagnosed with atopic dermatitis, and 49.8% of them had concomitant allergic rhinitis and/or asthma. The overall 8-year prevalences of atopic dermatitis, allergic rhinitis, and asthma were 6.7%, 26.3% and 11.9%, respectively. Children and adolescents had significantly higher prevalences of these atopic diseases. The prevalence of atopic dermatitis in females was lower than that in males before the age of 8 years, but became higher after that. Patients with atopic dermatitis were more likely to have allergic rhinitis and asthma. Those having both atopic dermatitis and allergic rhinitis possessed an even higher risk for asthma (odds ratio 9.04). The numbers of visits for atopic dermatitis were highest in late spring to mid-summer. These data suggest that atopic diseases are common in Taiwan. [ABSTRACT FROM AUTHOR]

Background Children with atopic dermatitis (AD) are more frequently colonized by Staphylococcus aureus than healthy children. Objectives To assess whether any relationship exists between nasal meticillin-resistant S. aureus (MRSA) colonization and subsequent skin and soft-tissue infections (SSTI). Patients and methods From 2005 through 2006, comparative molecular analyses of 23 MRSA-colonizing isolates from 133 children with AD, 44 MRSA-colonizing isolates from 490 healthy controls, and 12 MRSA-infecting isolates from 20 children with AD and concurrent SSTI were conducted. Results Nasal MRSA colonization in children with AD was significantly higher compared with normal individuals (17·3% vs. 9·0%; P = 0·01). The molecular characteristics differed significantly between the MRSA isolates from children with AD and the MRSA-colonizing isolates from healthy controls. The clone characterized as sequence type (ST)59 (338)/pulsotype B/staphylococcal cassette chromosome mec (SCC mec) VT/Panton–Valentine leucocidin (PVL)-positive/staphylococcal enterotoxin B (SEB)-positive accounted for half of the MRSA isolates from children with AD, and another clone, characterized as ST59/pulsotype A/SCC mec IV/PVL-negative/SEB-positive accounted for 61% of the MRSA-colonizing isolates from healthy controls. Conclusions We found MRSA colonizing the anterior nares of a large number of Taiwanese children, especially among those with AD. Analysis of our data provides evidence that links MRSA-colonizing isolates to MRSA-infecting isolates from concurrent SSTI in children with AD. [ABSTRACT FROM AUTHOR]

Background Attempts to identify predictors of atopic dermatitis (AD) have focused on genetic and immunologic factors. However, the role of neuro-mediators remains to be elucidated. Objective To evaluate nerve growth factor (NGF) and vaso-active intestinal peptide (VIP) in predicting paediatric AD and assess their correlation with intrinsic and extrinsic types of AD. Methods We performed a nested case–control study in the prospective Taiwan birth panel cohort study. Cord and maternal plasma and questionnaires were gathered at birth. During follow-up, we identified 40 available AD cases, which were matched to 80 unaffected controls chosen from this cohort. The concentrations of IgE, NGF, and VIP in cord and maternal plasma of these subjects were performed by ELISA. Receiver-operating characteristic (ROC) curves were generated to see how well each biomarker could predict AD. Results The NGF levels were significantly higher in AD patients than controls (mean±SD: 65.47±44.45 vs. 49.21±12.18 pg/mL for cord plasma and 89.68±41.04 vs. 66.96±23.05 pg/mL for maternal plasma) ( P<0.05). VIP levels were also higher but not statistically significant. Plasma NGF may be a better biomarker than IgE in detecting paediatric AD (area under the ROC curve=0.65 vs. 0.61 for cord plasma and 0.69 vs. 0.61 for maternal plasma). Maternal NGF levels were significantly higher in patients with both intrinsic (96.18±48.15 pg/mL) and extrinsic (86.18±37.23 pg/mL) types of AD compared with controls (66.96±23.05 pg/mL) ( P<0.05). We assessed a significant correlation between self-reported stress during pregnancy and maternal NGF levels ( r=0.22, P=0.02). Conclusion Our results suggest that NGF is a good alternative biomarker in predicting children with a risk of AD. [ABSTRACT FROM AUTHOR]

Previous studies of predictors of atopic dermatitis (AD) in Asia have had limited sample size and small numbers of variables focused primarily on family history or dietary exposures. The purpose of this study was to evaluate the influence of various environmental risk factors for early infantile AD. We used multistage, stratified systematic sampling to recruit 2048 mother–child pairs from the Taiwan national birth registration in 2003. Information on environmental risk factors for infant AD gathered by questionnaire were available from 1760 infants at 6 months of age. Multiple logistic regression was used to estimate adjusted odds ratios (aORs) and their 95% confidence intervals (CIs) for risk factors for AD after adjusting for potential confounders. AD was noted in 118 of 1760 (6.7%) of the infants. After adjusting for maternal age and education, family history of atopy, infant gender, and gestational age, fungi on walls of the house [aOR 2.14 (95% CI 1.41–3.22)] and frequent use of microwave oven at home [aOR 1.71 (95% CI 1.13–2.58)] increased the risk of early infantile AD. This study suggests that environmental factors do play a role in early infantile AD. Fungi, a kind of aeroallergen, are especially important in humid climate as in Taiwan and their impacts might be felt at the early infant stage. The hazards of microwave use should be paid more attention. [ABSTRACT FROM AUTHOR]

Background Epidemiological study on childhood dermatoses performed by direct inspection of dermatologists is limited. Objective To investigate the prevalence of selective childhood dermatoses in Taiwan. Methods In a cross-sectional study carried out in June 2004, 4067 of 7851 children aged between 6 and 11 years living in the Kaohsiung County in south Taiwan were clinically surveyed and examined by two board-certified dermatologists (response rate 52%), regarding the point prevalence of acne, ephelides, warts, atopic dermatitis (AD), psoriasis, alopecia areata (AA) and keloid. Results Acne vulgaris was found in girls and boys from the age of 6 and 7, respectively, with comedones being the earliest presentation. Ephelides were not infrequently observed in our children (prevalence rate 8.4%, 95% confidence interval, CI 7.9–9.3%). The prevalence of warts on hands was 2.4% (95% CI 1.9–2.9%). The prevalence of AD was 1.7% (95% CI 1.3–2.1%), without gender difference. There were only four cases of AA but no psoriasis was found. Keloid was identified in 13 boys and 10 girls, accounting for 0.6% (95% CI 0.598–0.602%) of the children. Conclusion Acne vulgaris is as common in Taiwan as in Western countries. Ephelides are not uncommon in our population with the main skin types III–IV. A clustered distribution of the wart infection was noted. The low prevalence of AD in Taiwan seems unaltered over the past decade. AA and psoriasis are rare in our series. Most keloids in our children are caused by BCG vaccination. [ABSTRACT FROM AUTHOR]

Background The prevalence of atopic eczema in adolescents has recently been reported as increasing in many countries, a phenomenon yet to be fully explained. This study compared the prevalence of atopic eczema among Taiwanese adolescents with individual-level risk factors and community-level data of temperature, relative humidity, and air pollutants to determine whether changes in these factors could explain the observed change in prevalence. Methods We conducted two nationwide, cross-sectional surveys of atopic illness and symptoms among Taiwanese 12–15-year-old schoolchildren in 1995–1996 and 2001. The effects of personal and environmental factors were assessed and temporal changes of outdoor monitoring data were also compared with the prevalence difference of atopic eczema. Results A total of 42 919 adolescents from the 1995 to 1996 survey and 10 215 adolescents from the 2001 survey attended schools located within 1 km of 22 monitoring stations. The 12-month prevalence of atopic eczema increased significantly during this period [adjusted prevalence ratio (PR)=1.43, 95% confidence interval (CI) 1.21–1.70 in boys; PR=1.77, 95% CI 1.49–2.10 in girls]. After adjustment for potential risk factors, the prevalence differences were statistically unchanged. Although parental education level contributed the most, changes in personal and environmental factors might not explain the observed prevalence increases of atopic eczema. Temporal change in the relative humidity was significantly associated with prevalence increase among boys but its contribution was also small. Conclusion Correlates of the investigated risk factors that have changed over time still underlie the prevalence increases of atopic eczema in Taiwanese adolescents. The exact reasons for the rising trends remain to be elucidated. [ABSTRACT FROM AUTHOR]

Examines mite allergen exposure as a risk factor in atopic dermatitis development during early infancy in Taipei, Taiwan. Influence of allergen exposure during infancy on allergic diseases in later life; Prevention of allergic diseases by avoiding allergen sensitization; Role of heredity in allergic diseases.

The objective of this study was to examine the relationship between indoor environmental factors and atopic eczema in a subtropical area. A case-control study was performed using participants from a survey that included 144 school children with atopic eczema and 144 age- and gender-matched controls. The study was confined to 4164 primary school children aged 6–12 yr attending 8 primary schools in Kaohsiung rural municipalities who participated in the study. Cases of atopic eczema were ascertained by asking whether a physician had ever diagnosed this condition in the child. Information regarding the home environment was obtained using a structured written questionnaire, completed by the parents of the children. Of the many indoor environmental factors included in this study, such as dampness and smoking, none was found to be associated with atopic eczema. [ABSTRACT FROM AUTHOR]

Chronic hand eczema is an important occupational skin disease with atopic dermatitis ( AD) and wet work being the most important risk factors. This study was launched to analyse the potential association between AD-related inflammation genes and development of non-atopic hand eczema among nurses in University Hospital. Atopic eczema, non-atopic hand dermatitis and control groups were identified. The association between occurrence of non-atopic hand eczema and interleukin ( IL) -13, IL-4 and IL-5 gene variants was analysed. IL13 rs20541 A allele [assuming recessive model; odds ratio ( OR) = 3.38, 95% CI: (1.63-7.00)] showed association with development of non-atopic hand eczema. Additive score analyses showed combination of this gene variant with previously identified risk factors including certain SPINK5 polymorphism and more than 10 years of work experience conferred highest risk for development of non-atopic hand eczema. As non-atopic hand eczema made up significant portion of occupational skin diseases, further studies should be focused on this commonly encountered skin condition. [ABSTRACT FROM AUTHOR]

Background Considering the early onset of atopic dermatitis (AD), which most often arises in the first year of life, risk factors occurring very early in life must be considered. Little is known about the effects of maternal occupational exposure on the development of atopic disorders in children. Objectives The aim of this study was to evaluate associations between maternal employment and childhood AD. Methods We used multistage stratified systematic sampling to recruit 24 200 mother-newborn pairs from the Taiwan national birth register. Information on maternal occupation categories, work stress, working time, shift work and potential confounders during pregnancy was gathered by questionnaires after birth. At 3 years of age, information on the development of AD was assessed by home interviews. Multiple logistic regression analysis was performed to estimate the association of maternal employment and AD. Results Overall, 11 962 out of 19 381 mothers (61·7%) worked during pregnancy. The children of mothers who worked during pregnancy had an increased risk of AD compared with those whose mothers did not work [odds ratio (OR) 1·38, 95% confidence interval (CI) 1·25-1·53]. The children of mothers with a professional or technical occupation had a higher risk of AD (OR 1·64, 95% CI 1·44-1·87). The risk of AD was found to increase with maternal work stress during pregnancy in a dose-response manner ( Ptrend < 0·01). The mothers of children with AD had a longer working time than those without AD ( P < 0·0001). However, no significant association between AD and maternal shift work was found. Conclusions Working in professional or technical occupations increased the risk of childhood AD in addition to work stress during pregnancy. [ABSTRACT FROM AUTHOR]