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

对特应性皮炎（AD）儿童抗原致敏的前瞻性治疗的有效性还没有足够的前瞻性描述。为了阐明引发特应性进展的机制，我们进行了一项随机、开放标签、平行组研究，以评估中重度AD儿童患者主动管理的疗效和安全性。主动治疗组的受试者接受局部皮质类固醇的间歇性预防性给药1年。主动组的SCORAD指数和TARC水平显著降低。尽管两组使用软膏的情况无统计学显著性，但在12个月研究访视时，反应性治疗组屋尘螨特异性IgE水平的平均增幅显著高于主动治疗组。本研究的结果表明，通过局部皮质类固醇的间歇性预防性应用来维持婴儿AD缓解的可能性可以有效地防止随后对空气过敏原的致敏，也许是所谓的“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.”