Consensus document APAIR: atopic dermatitis in children — update 2019 (short version) Part 2.

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

1 Association Pediatric Allergist and Immunologist Russia, Moscow;
2 Academy 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;
3 National Medical Research Center for Children’s Health Federal state autonomous institution of the Russian Federation Ministry of Health, Moscow;
4 St. Petersburg State Pediatric Medical University, St. Petersburg;
5 Central State Medical Academy of Department of President Affairs, Moscow;
6 Sechenov First Moscow State Medical University, Moscow;
7 Federal State Budgetary Educational Institution of Higher Education «Smolensk State Medical University» of Ministry of Healthcare of the Russian Federation, Smolensk;
8 Federal State Budgetary Educational Institution of Higher Education «V.I. Razumovsky Saratov State Medical University» of Ministry of Healthcare of the Russian Federation, Saratov;
9 Federal State Budgetary Educational Institution of Higher Education «Kazan State Medical University» of Ministry of Healthcare of the Russian Federation, Kasan;
10 Russian 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 61 • Number 2 • June 2020, pp. 4 – 26
DOI: 10.24411/2500-1175-2020-10004

Atopic dermatitis (AD) is a diagnosis with precise criteria described by Hanifin & Rajka. A differential diagnosis should be considered at the discrepancy of the symptoms or torpid eczema. The list of diseases is genetic syndromes with the impaired epidermal barrier, metabolic diseases, skin infections, psoriasis and others. Skin infections in the diagnostic search should be considered the first time.
The basis of therapy allergic eczema is the elimination of allergenic and non-allergenic triggers, topical steroids and inhibitors calcineurin with uses of emollients in the skincare process. This therapy is sufficient for most patients.
Systemic therapy of dermatitis consists of short courses of steroids (up to 1 week) with the ineffectiveness of external preparation. If long-term therapy is necessary, it is proposed to consider the possibility of prescribing dupilumab and cyclosporin A.
Antihistamines can be considered as a drug for stopping itching in the early days of the disease. With a sufficient effect of external anti-inflammatory drugs, the use of antihistamines is not required.
Exclusion of culpable food allergens leads to rapid remission of the disease. Non-specific hypoallergenic diets reduce the quality of life of patients and should not be used for a long time. The main formula for feeding children with allergies to cow’s milk protein is extensively hydrolysed formula. The amino acid-based formula is reserved for severe cases.
During the period of remission, it is important to provide skincare and regular use of emollients, as well as a complex to eliminate causative allergens from the patient’s environment.
Specific immunotherapy can be recommended for patients with a proven role of the allergen in the development of exacerbation AD and with a combination of eczema with allergic rhinoconjunctivitis and asthma.

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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 2. Allergology and Immunology in Pediatrics. 2020;61(2):4-26. (In Russ.)

For correspondense

Yury S. Smolkin, doctor of medical sciences, professor of Department of Clinical Immunology and Allergology Academy of postgraduate educational under FSBU FSCC of FMBA, vicepresident APAIR
ORCID ID: 0000-0001-7876-6258
Address: 6 Ostrovityanova Str., Moscow, 117513, Russia