Novel therapeutic approach for maintenance treatment with proactive management in childhood atopic dermatitis; mechanistic analysis

前瞻地描述了特应性皮炎(AD)儿童对抗原致敏的主动治疗的疗效。为了阐明引发特应性进行期的机制，我们进行了一项随机、开放标签、平行分组研究，以评估儿童中重度AD患者主动治疗的有效性和安全性。积极治疗组的受试者接受了为期一年的间歇性预防性局部皮质类固醇治疗。主动组SCORAD指数和TARC水平显著降低。尽管两组中软膏的使用在统计学上没有显著差异，但在12个月的研究访问中，反应性治疗组的室内尘螨特异性IgE水平的平均增幅显著高于主动性治疗组。本研究的结果表明，通过间歇性预防性应用局部皮质类固醇来维持婴儿AD缓解的可能性，可以有效地防止随后对空气过敏原的敏化，可能还可以防止所谓的“特应性进行曲”。

Efficacy of proactive therapy for sensitization to antigens in children with atopic dermatitis (AD) has not been enough described prospectively. To clarify the mechanisms that set off the atopic march, we conducted a randomized, open-label, parallel group study to evaluate the efficacy and safety of proactive management in pediatric patients with moderate to severe AD. Subjects in the proactive treatment group received an intermittent preventive administration of topical corticosteroid for 1 year. The SCORAD index and TARC level significantly decreased in the proactive group. Although ointment use in both groups were not statistically significant, the mean increase in house dust mite-specific IgE level was significantly higher in the reactive treatment group than in the proactive group at the 12 -month study visit. The results of the present study suggest the possibility that maintenance of infantile AD remission by means of intermittent preventive application of topical corticosteroids can effectively prevent subsequent sensitization to aeroallergens and perhaps to the so-called “atopic march.”