Consensus document APAIR: atopic dermatitis in children — update 2019 (short version) Part 1.

Y.S. Smolkin ^1,2,11, I.I. Balabolkin ^1,3, I.A. Gorlanov ⁴, L.S. Kruglova ⁵, A.V. Kudryavtseva ^1,6, R.Y. Meshkova ^1,7, H.B. Migacheva ^1,8, R.F. Khakimova ^1,9, A.A. Cheburkin ^1,10, E.A. Kuropatnikova ^1,11, N.A. Lyan ^1,6, A.V. Maksimova ^1,11, S.S. Masalskiy ^1,11, O.Y. Smolkina ^1,11

¹Association Pediatric Allergist and Immunologist Russia, Moscow;
²Academy postgraduate education «Federal State Budget Founding Federal Research and Clinical Center of specialized types of health care and medical technology of the Federal Medical and Biological Agency», Moscow;
³National Medical Research Center for Children’s Health Federal state autonomous institution of the Russian Federation Ministry of Health, Moscow;
⁴St. Petersburg State Pediatric Medical University, St. Petersburg;
⁵Central State Medical Academy of Department of President Affairs, Moscow;
⁶Sechenov First Moscow State Medical University, Moscow;
⁷Federal State Budgetary Educational Institution of Higher Education «Smolensk State Medical University» of Ministry of Healthcare of the Russian Federation, Smolensk;
⁸Federal State Budgetary Educational Institution of Higher Education «V.I. Razumovsky Saratov State Medical University» of Ministry of Healthcare of the Russian Federation, Saratov;
⁹Federal State Budgetary Educational Institution of Higher Education «Kazan State Medical University» of Ministry of Healthcare of the Russian Federation, Kasan;
¹⁰Russian Medical Academy of Postgraduate Education, Moscow;
¹¹«Scientific-Clinical Consultative Center of Allergology and Immunology», L.t.d, Moscow.

ALLERGOLOGY AND IMMUNOLOGY IN PEDIATRICS, Volume 60 • Number 1 • March 2020, pp. 4 – 25
DOI: 10.24411/2500-1175-2020-10001

Abstract

Atopic eczema (atopic dermatitis, AD) — chronic recurrent inflammation of the skin, arising as a result of a violation of the epidermal barrier and entailing its further dysfunction. Maximum development atopic dermatitis reaches on the background of predisposition to IgE-mediated hypersensitivity, implemented in sensitization to surrounding allergens.
The diagnosis of atopic eczema is clinical. An obligatory clinical symptom is itching in combination with 3 other criteria: typical morphology and distribution; a history of atopy; chronically xerosis; AD debut up to 2 years. The phase of the disease and the severity of skin lesions are of practical importance for clarifying the stage AD. Changes characteristic of different phases can be observed simultaneously. Morphological and age-related classifications of AD are conditional and have little effect on the therapeutic strategy. Clinical variants of AD (allergic and non-allergic) are a single nosological form that requires common approaches to therapy. The prevalence of AD is greatest in children a 1-st year of life (up to 30%) and significantly decreases in adolescence.
Point and inherited mutations in genes (for example, filaggrin) are a key point in the pathogenesis of AD. Immune disorders are not limited to IgE-dependent reactions and occur with the participation of many cytokines (IL-4, IL-5, IL-13, IL- 25, IL-31, TSLP). Bacteria and fungi act as infectious agents or superantigens for lymphocytes.
Food allergies are detected in 30–40% of children with AD causing aggravation of the disease. The children in the first year dominated by sensitization to food allergens: milk, eggs, cereals, fish. An allergological examination using skin prick tests or specific IgE is informative and necessary, but the presence of sensitization should be clarified using an elimination-provocation test with this product.

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Smolkin YS, Balabolkin II, Gorlanov IA, Kruglova LS, Kudryavtseva AV, Meshkova RY, Migacheva HB, Khakimova RF, Cheburkin AA, Kuropatnikova EA, Lyan NA, Maksimova AV, Masalskiy SS, Smolkina OY. Consensus document APAIR: atopic dermatitis in children — update 2019 (short version) part 1. Allergology and Immunology in Pediatrics. 2020;60(1):4-25. (In Russ.) https://doi.org/10.24411/2500-1175-2020-10001

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Yury S. Smolkin, doctor of medical sciences, professor of Department of Clinical Immunology and Allergology, vicepresident APAIR
Address: 6 Ostrovityanova Str., Moscow, 117513, Russia
E-mail: smolking@df.ru